At UBC Dental clinic, I had never seen a pregnant woman as a client so it was an unique yet challenging experience form me to provide effective clinical therapies for pregnant mothers at Jim Pattison Maternity Clinic. The pregnant mothers at that site usually had medical conditions, especially gestational diabetes, and other social problems (ie. addiction and income) which add difficulties and seriousness of cases. As well being pregnant mothers, many of them could not handle usual long dental hygiene appoints happened at UBC dental clinic. Also my ergonomics had to be compromised as pregnant mothers had to be upright positions with a wedge under right lower back to have comfortable postures for the mothers. Another challenge came up with language barrier, as most of the mothers spoke Punjabi with no or little English literacy so it was difficult to present diagnosis and treatment plans as well as to build rapports to gain their cooperation. Many mothers presented with generalized plaque-induced gingivitis modified by hormonal fluctuations from pregnancy,

Patient care at Jim Pattison Maternity Clinic (L: Dr. L. Donnelly; R: K. Nguyen)

which was closely related to their chief concern of sensitivity teeth and bleeding gums. There was limited equipment as no powered-instruments and local anesthetics were not available. Also, being a left-handed clinician, there was no space for me to come to the left side of the medical bed to effectively position myself to provide therapy. Yet, I managed to each case effectively by going over all the medical considerations ahead of time to maximize my given time, removed calculus effectively by using various provided tools and built rapport with my patients by discussing about babies and pregnancy. I also interacted many children and babies by providing toothbrushes and talking about oral hygiene habits for children and babies which intrigued mothers to have better oral health status and to gain knowledge about oral hygiene habits. Overall, I improved my clinical therapy skills by overcoming all the listed obstacles and interacting a new cohort of clients.

I had an older patient who was regularly seen by a graduated dental hygiene student. From

Radiolucency found on 37 perapical region in 2011

my initial dental hygiene assessment, I found a perapical radiograph that revealed a periapical radiolucency on tooth 16. I looked for a referral or any intervention that has been done on the area but could not found any. My periodontal exam revealed a deeper pocketing and worsened

Larger radiolucency found at the same area in 2013

clinical measurements on the area compared to the time the graduated dental hygiene student measured.

I took a new perioapical radiograph for the area and identified the remaining periapical radiolucency, which was bigger and spreading to other areas. I immediately refereed the patient for an emergency clinic for a possible periapical abscess. Later, the emergency dentist’s report identified periodontal abscess with root necrosis which resulted in tooth extraction. One of the major concerns for the patient was too keep his remaining teeth; however, the practitioner ignorance on follow-up with identified lesion cost the patient to suffer much more serious infection than he initially had and a tooth. This case reminded me of the importance of ethical and moral duties of dental hygienists who are striving to provide holistic care as primary care providers.