A Beginning but No End: The Dental Hygiene Process of Care

A new client had an appointment scheduled with me this week, her first appointment within our practice.  Although our administrative department is well-versed in explaining the importance of a comprehensive oral evaluation (COE) to our clients, both new and existing, I did find myself seated with someone that “just wants a cleaning for today.”  So it began, my explanation of the dental hygiene process of care to this new smile we have welcomed into our practice. 

At times, this explanation may take me one minute, or it may take me fifteen, depending on whether or not I need to “look inside” the oral cavity (as if to confirm that yes, we do need to complete a COE), take a few intra-oral photographs, complete a PSR, or perhaps initiate a discussion of the periodontal disease process with my well-used periodontal flip-chart.

I always find myself at ease as I explain the dental hygiene process of care to people as I’m a strong supporter of it.  The dental hygiene process of care works, time and time again.

When we consider debridement, an implementation procedure, it is so much more than the seemingly simple act (for those that take it for granted) of adapting the leading third of a periodontal instrument to the tooth.  How can I even consider picking up a periodontal scaler without thorough knowledge of the periodontal status, tooth anatomy, restoration integrity, referral urgency, and other important client-specific assessment data?  Without said assessment, I have no foundation for a dental hygiene diagnosis, and certainly not even a hint of an individualized dental hygiene care plan. 

The dental hygiene process of care provides the framework, or structure, necessary to provide the highest calibre of dental hygiene care to every client (which is fair and just) yet it manages to do this in an individualized fashion.  The process needs to be followed in order to optimize oral health and the support that oral health lends to total health.  When we deviate from the process, we compromise outcomes which can and do negatively affect oral health. 

It’s important to remember that the process is a cycle, and at times, a cycle within a cycle.  At a single appointment we may complete all five components from assessment through to evaluation on a small scale. For other measures, we may need several months to complete the cycle, but in both cases, the process starts all over again to either maintain or improve the oral health.  The process has a beginning, but no end.

The initial assessment, the comprehensive oral assessment (COE), is lengthy, and may take anywhere for fourty-five to ninety minutes, but this information is vital for a solid foundation upon which the rest of the process will be supported and built.  The length of time required is often directly related to the complexity of the assessment data.

How the assessment data is analyzed and interpreted is our dental hygiene diagnosis, which often, but not always, presents itself as some type of deficit.  Errors can easily be made within the dental hygiene diagnosis, such as developing a dental diagnosis or confusing client-centered goals with dental hygiene interventions.  (For instance, the client tells you they “want a cleaning” but is this really their goal or is it a part of our intervention?  Why does the client “want a cleaning?” Isn’t their goal more accurately described as to achieve oral health, fresh breath, or a pleasing smile?) The dental hygiene diagnosis may seem abstract, at times difficult to grasp and convey, but it serves as the basis for the client-centered goals.  And it is the goals that feed the dental hygiene care plan.

The dental hygiene care plan is a strategy of all of the interventions within our scope of practice, what will be done, when to do it based on priority sequence, and how long it all will take.

And now the moment we’ve all been waiting for: implementation!  Putting the dental hygiene care plan into action isn’t always what we thought it would be; snow falls into blizzards, calculus is much more tenacious than we ever anticipated, children/spouses/pets become ill, and well, people simply change their minds.  So we amend the plan, we do the very best we can, and we move on.

And did it work? Were the interventions successful? Were the client- (not the dental hygienist) centered goals met?  Partially met?  Unmet?  Why or why not?  What is the next step?  Where do we, the client-dental hygienist team, go from here? This is why we evaluate.  And this is where I find the greatest amount of professional satisfaction in clinical practice, is evaluation.  This is where I truly feel I have made a difference.  And this is because of a process that is none short of brilliant.

Social Responsibility of the Registered Dental Hygienist: Examining Our Role in the Context of the Community

by Joanne Peazel McCavery, RDH, BSc


As dental hygienists, we are defined by our education, our written and clinical examinations, and our registration with a regulatory body.  Dental hygiene is a profession, one of a few dozen legislated by the Regulated Health Professions Act, 1991, as set for by the Health Professions Regulatory Advisory Council. We are guided by standards, regulations, bylaws, and codes and we strive to meet the requirements for registration to practice this wonderful profession.  We demonstrate a commitment to continuing education and quality assurance, all the while supported by a compassionate and caring nature; these characteristics are what led many of us to become dental hygienists in the first place.

The majority of dental hygienists apply their knowledge, skills, attitude, and judgement in traditional private practice settings, although we are certainly not confined to this, and many have ventured into non-traditional areas.  As we practice in a multitude of settings, we might ponder how far our obligations as oral health care professionals extend, and this inquiry becomes more relevant the more we diversify.   

We may wonder who our client really is.  Is it the person seated in the dental chair, or should we include their spouse at home or their homebound great grandmother in a long term care facility?  Are the children in the elementary school down the street our clients? Do we consider the people we don’t see as being our clients, simply because of their proximity or association?

From time to time, I have asked myself when my dental hygiene hat should come off.  I feel that I am always a dental hygienist, but where do I draw the line between speaking up for oral health and stepping on a stranger’s toes, (to put it delicately,) because I notice her 9-month old child drinking a bottle of cola? What, if any, is my obligation? And where does that obligation end, or should I consider it to be limitless?

My client and I are partners in their care, but how do I develop a smooth transition between what is my responsibility and what is theirs? 

Questions like these can and will continue for days, weeks, and longer. But why do these questions arise in the first place?  The questions are important, as they initiate dialogue, contemplation, and professional progression. But equally important is where do we find the answers?

What do I, as part of this knowledgeable and compassionate dental hygiene collective, do on account of my professional responsibility to my community?

Well to start, I join the provincial and national dental hygiene associations.  The larger their numbers, the stronger their voices.  What they’re saying, pleading, and shouting is oral health for all. And I want to be a part of that message.

Next, I keep my dental hygiene hat on and instead try to focus on how I am sending the message and how it is supposed to be received: I focus on communication and the human interaction.

Finally, I am a firm supporter of volunteering, and this is probably my favourite way to assuage some of my social responsibilities.  Volunteering my time, skills, knowledge, or resources can vary greatly with what I’m comfortable with and able to give.  I can choose to volunteer a few hours per year, to a few days per week, or anything in between.

For a time, I felt that my volunteering should be geared towards oral health promotion and dental hygiene-related activities.  Although I have a fair amount of oral health knowledge to share with my community, I’ve reconsidered and decided to be more flexible with how I give myself. I do participate in health promotion activities in my community, and that is my primary focus, but I also find myself fundraising, helping people improve their reading, or wrapping presents for underprivileged children at the holidays.  (That doesn’t mean we can’t read about oral health or I won’t sneak a few toothbrushes and floss into the gifts...)

If you’re new to volunteering or haven’t done it for a while, and would like to begin slowly, there are a lot of short-term, no commitment opportunities available. You can also look into positions that require certain skills or activities that you enjoy doing or are passionate about.

Below are some of the links that I use for sourcing volunteer positions:

1.  volunteer Toronto: http://www.volunteertoronto.ca/

2.  Canadian Volunteer Directory: http://www.canadian-universities.net/Volunteer/

3.  Yonge Street Mission: http://www.ysm.ca/

Volunteer positions can also be created wherever you see a gap or a need within your community. A new oral health promotion program targeting a specific population might be easier to start up than you think.

 

If you’d like more information about how you can get more involved in your community or you’d like to share your special story about how you give back, drop me a line.  It would be great to connect, inspire, and motivate each other! 

Be the change you want to see.

Oral Cancer Screening Project Request #1

Hello,

We are two dental hygienists who are starting an oral cancer-screening program at the Good Neighbors’ Club, in Toronto, ON.  The Good Neighbors’ Club is a drop-in centre that works to improve the quality of life of older, unemployed and/or socially isolated men.

As this is a non-profit venture, any donations that you may provide would be greatly appreciated. 

We are especially looking for the following products:

·      Alcohol-free mouth rinse

·      Toothbrushes

·      Sugar free gum

·      Denture care kits

·      Floss

·      Toothpaste

·      Dixie Cups

Please let us know if this is a project that you believe in supporting with your kind donations.  We look forward to hearing from you J

The Dental Hygiene Pen, Part 1 – Effective Time Management With a Commitment to Records Regulations, Standards of Practice, and Ethical Principles –

It may seem as though in our pursuit as dedicated, competent dental hygienists, time may occasionally be lost for documenting the care provided.  Unfortunately, there are instances when the only form of communication that we have with other people is through what we have written down.  Can we accurately say that the quality of our documents is a reliable measure of the quality of the dental hygiene care we provide?  Many people say yes, we can.

On the surface, documentation might seem monotonous, uninteresting, and repetitive in nature.  The significance of what needs to be written down may be unknown for several years.  Perhaps it seems that there might be something more important to do at the moment, such as furthering the client’s oral health knowledge or asepsis management.

Although the topic of dental hygiene documentation is very broad, and a brief blog cannot even begin to convey its significance, I feel a quick look at documentation specifically during the periodontal maintenance appointment is time well spent.

It goes without saying that the client chart needs to reflect the various components of the dental hygiene process of care.  Assessment findings need to be thoroughly documented, both as baseline data and also as periodic updates. The dental hygiene diagnosis and client goal statements drive the dental hygiene care plan, which are also to be recorded.  The implementation procedures must include the time spent (either in minutes or units; fee codes are not an acceptable standard.)  (Remember that dental radiographs are a prescription, much like a medication, are not in the dental hygiene scope of practice; therefore, the prescription must also be written down.)  Oral self care aids and instructions have to be recorded.  Evaluation documentation completes the cycle.

This brings us to the perennial question: how do we record all of this in the client record with limited appointment times?  Perhaps the development of a periodontal maintenance sheet can help.  Preprinted sheets can be utilized that have check boxes or words to circle.  This can speed up the documentation process and also assist with intra- and interprofessional calibration. Preprinted forms require minimal work to develop but can facilitate high quality documentation.

Below is a template example of what might be included in a preprinted periodontal maintenance form, although you can tailor yours to suit your practice needs:

Name:  __________________________________________   Medical Alert: None o or ______________________________
Date:	M.H. Update Changes:  Y oNo ______________		EO:  o WNL or ________________­­­_ IO:  o WNL or _________________ TMJ: o WNL or _________________ OSC Practices: _________________  _________________		Deposits:		L	M	H	OSC: E G F P
Clinician:					Plaque
Time In:	Meds: o none ______________ ______________ ______________ ______________				Supra. Calculus
Time Out:					Sub. Calculus
Consent: o Y oN					Stain
DH DX – Human Needs Deficits: oWholesome Facial Image  oProtection From Health Risks  oFreedom from Anxiety/Stress                                                      o Biologically Sound/Functional Dentition  oResponsibility for Oral Health  oFreedom from Head/Neck Pain  oSkin/Mucous Membrane Integrity of the Head/Neck  oConceptualization/Understanding
Client Goals:	Observations: Client Informed: oY oN			Next Appt. / TX Advised:		OSC Aids Dispensed:                                   otb       ot. paste      ointerdental br.                                  ofloss  ofl. holder   othreader oother: ______________________                      OSC Instructions: _____________________________
Radiographs:                    BWs: oo  oo        FMX/PAs:                           oo  ooo  oo             oo                oo              oo  ooo  oo            PAN: o   CEPH: o    DDS/DMD: __________		Notes:
		Today’s TX Interventions:
Evaluation:							DDS/DMD:

(Some formatting has been lost during posting.)
The above template can be printed twice on each side of an 8 1/2 x 11 inch page.  You might also consider including a periodontal charting record on the reverse.  It’s quick and easy to look back at what transpired during previous periodontal maintenance appointments using a standard and comprehensive format.

A key feature to consider with your documentation is a blank area or section.  A blank area or section can be interpreted as a criterion that was not assessed or completed, so ensure that all areas have some type of notation in them, even if it’s a dash ‘-,’ ‘WNL,’ ‘N/A,’ or ‘none.’ This cannot be overemphasized, especially with regards to identifying features, such as client and clinician names.

Finally, be sure to document throughout the appointment, writing down relevant pieces of information as they arise. For this, I advocate the use of overgloves.

To this end, the purpose here was a bit of a review, sprinkled with perhaps some new information to inspire. In this ever-evolving profession, as we continue to progress in the care we provide, we must upgrade our documentation skills to reflect that progression. 

            I’d love to hear about how you successfully manage your documents.  What works well for you?

Suggested Readings:

1. CDHO Regulations Part III.I - Records  http://www.cdho.org/LegislationAndByLaws/RecordsReg.pdf
2. CDHO Registrant’s Handbook, Chapter 6, Recordkeeping http://www.cdho.org/Practice_RegistrantsHandbook.htm
3. RCDSO Dental Recordkeeping Guideline http://www.rcdso.org/pdf/guidelines/RCDSO_Guidelines_Dental_Recordkeeping_May08.pdf

Overview of Extra and Intraoral Examinations: The Foundation for Oral Cancer Detection

Evidence is ever-increasing pointing to the notion that a dental hygiene appointment, is more than simply looking at the teeth.  A dental hygiene visit may in fact save your client’s life.  The dental hygienist, a key member of the oral healthcare team, is extensively trained in completing assessments of the head and neck region and conducting an overall appraisal of a client’s health status.

            Oral cancer is an example of a life threatening disease that may be detected by a dental hygienist. With early detection and timely treatment, morbidity from oral cancer could be dramatically reduced.  The five-year survival rate for those with localized disease at diagnosis is about 80 percent compared with only 19 percent for those whose cancer has spread to other parts of the body.  Early detection of oral cancers is often possible. Tissue changes in the mouth that might signal the early signs of cancer often can be seen and felt easily. It is a known fact that early detection saves lives.

The extraoral and intra oral examinations are a physical, systematic examination of the head and neck area outside and inside the oral cavity.  The examination involves palpation or physical manipulation and detailed visual inspection of the structures of the head and neck region followed by careful documentation of significant findings.  The examination only takes a few minutes and enables the clinician to detect early changes in structure, which may be indicative of disease. 

Here are some tips to completing efficient, yet thorough extra and intraoral examinations:

·      Follow a consistent sequence

·      Use an effective palpation technique

·      Have a good knowledge and understanding of the location of all lymph nodes and anatomic landmarks

·      Document all findings accurately

            This brings us to documentation of findings.  The manner in which findings are documented is vital as assessment findings are used as baseline findings for which all other future visits are compared.  It is also commonplace, that more than one clinician will treat a client during their care.  A consistent documentation technique ensures a uniform language amongst clinicians.  A clinician should be able to pick up a client record and gain a true picture of the client’s oral health status.

 I would like to propose a uniform method of documentation of oral lesions among all dental hygiene clinicians.  I particularly like the ABCDT format that is outlined in the Patient Assessment Tutorials text by Jill Nield-Gehrig.

ABCDT is an acronym for:

·      Area

·      Border

·      Colour

·      Diameter

·      Type

The dental hygienist is adept at the recognition of conditions that are beyond his/her scope of practice.  Upon recognition of those conditions, a referral to the appropriate health care professional is indicated.  Please note that if a suspect lesion does not resolve after 2 weeks, a referral should be made to an appropriate specialist.  A prudent dental hygienist will follow up to determine the status of the lesion and what the appropriate course of action may be. 

This now brings us to variants of normal such as linea alba, mucoceles, fordyce granules etc… I propose that these findings are documented using the ABCDT format as well, with the appropriate name in parenthesis following the description. 

As a clinician myself, I can share the sentiment that there would not be enough room in the chart, or enough time in an appointment to document in this manner.  It is important to note that client and dental team education is key.  Perhaps the initial examination could be lengthened?  Note that at subsequent appointments the clinician would just complete an update, which is an abbreviated version of the initial exam.  Another thing to consider is whether standardized assessment forms for all dental hygienists could help? What do you think? I would love to hear your thoughts!

Reference List:

Darby, Michelle Leonardi, and Margaret M. Walsh. (2010) Dental Hygiene Theory and Practice Third Edition. St. Louis, MO: Saunders Elsevier.

Nield-Gehrig, J.S. (2007). Patient Assessment Tutorials: A Step by Step Guide for the Dental Hygienist . Baltimore, MA: Lippincott Williams & Wilkins.

Top 10 Tips for Successful Pit and Fissure Sealants

As dental hygienists, we strive to prevent disease and promote health.  Pit and fissure sealants are a commonly recommended preventive strategy and many of our clients benefit from their successful placement.  Sealant retention is synonymous with sealant success.

The pit and fissure sealant material is typically a lightly- or unfilled low viscosity composite resin, and behaves and is treated as such.

Below are some tips that might complement or enhance future sealant placement.

1.  Adhere to the Dental Hygiene Process of Care (DHPC)

The placement of pit and fissure sealants is a valuable component of the implementation phase in the DHPC, but skipping any of the other components may lead to sealant failure. 

Consider the level of caries risk and caries activity of the client.  Tooth characteristics to appraise include anatomical features that are conducive to caries formation, recent eruption, and operculum proximity.  Be sure to assess buccal pits of mandibular molars, lingual pits of maxillary molars, and lingual pits of maxillary anterior teeth, in addition to the occlusal surfaces of posterior teeth. As many sealant clients are children, you may also contemplate behaviour management strategies to be utilized during the procedure.

2.  Follow the Manufacturer’s Instructions

Reading instructions is always time well spent.  Thoroughly reviewing the product characteristics will provide valuable insight as various products behave differently in the oral environment.  For example, some products may be applied in a semi-wet field, whereas others require a moisture-free field.  Variations in curing times and types will also alter the manipulation of the resin material.

3.  Prophy with a Prophy Jet

More debris will be removed with a prophy jet than with a slow speed handpiece and prophy brush.  The less contaminated the tooth is, the better the retention.

4.  Overetch - Apply Etch to Extend Beyond Where the Sealant is Expected

Overetching will help to ensure that the entire area to be sealed is etched.  Unetched areas will not retain the sealant properly and the sealant may fail.

5.  Dispense the Sealant Material Into a Dappen Dish and Apply it to the Tooth with a Microbrush

This can help to improve infection control, by not placing a sealant syringe into a client’s oral cavity.  As well, the clinician may find improved control by applying the material with a microbrush.  If too much sealant material has inadvertently been placed on the tooth, simply wick the excess material with the readily accessible microbrush.  Consider placing the resin in the mesial pit first and then guide it to the distal, as this flow is naturally supported by anatomy and gravity.

6.  Guide the Sealant Material Into the Pits and Fissures with an Explorer

After the correct amount of sealant material has been placed on the tooth, gently guide the resin into the pits and fissures with a clean explorer to help improve contact and retention. 

7.  Evaluate the Integrity of the Sealant Immediately After Placement

Evaluate for air bubbles or voids with the explorer and if found, correct them immediately.  Attempt to dislodge the sealant with the explorer. A properly placed sealant will adhere to the tooth and cannot be displaced with gentle pressure.

8.  Apply Fluoride After the Sealant Procedure

This helps to remineralize the overetched areas of enamel.  Remember that acidulated phosphate fluoride is contraindicated on sealants, as they are type of composite resin; consider neutral sodium fluoride instead.

9.  Educate the Client About the Purpose, Limitations, and Expectations of a Pit and Fissure Sealant Before and After the Procedure

Clients (and parents) will need to be informed that:

• the pit and fissure sealant does not prevent interproximal decay, so flossing daily is still required
• the pit and fissure sealant will deteriorate faster with poor oral hygiene, so excellent oral hygiene is still needed
• the pit and fissure sealant won’t last indefinitely, but excellent oral hygiene and following professional recommendations for continuing care will prolong it
• the pit and fissure sealant is not a replacement for  a noncariogenic diet and fluoride therapy
• the pit and fissure sealant will not improve the condition of the gingiva

10. Practice Four-Handed Pit and Fissure Sealant Placement

Utilization of an assistant to place sealants allows for improved efficiency, better field maintenance, and reduced clinician anxiety.

What do you think?  Do you have any other tips that you find improves the success of your pit and fissure sealants?  Please share them!

Community Health in the Dental Hygiene Diploma Curriculum

The focus of the community health component in the curriculum is multidimensional.

First, the dental hygiene student gains insight into the position that dental hygienists have in community health.  This position encompasses all five of the CDHO roles and responsibilities of clinician, health promoter, educator, administrator, and researcher.  Students participate in all five of these roles through didactic instruction, assignments, in-class written tests, community field placements, and the incorporation of community health partners into the CBC student dental hygiene clinic.  Presently, our roles as registered health care providers are being further defined by the eight domains of dental hygiene, as outlined by the national dental hygiene competencies.  This new era of dental hygiene provides community health with a very exciting future and the possibilities for further enhancement of this valuable profession are bountiful.

Second, the dental hygiene student enhances his/her understanding of the social responsibility associated with the dental hygiene profession.  Dental hygienists have a specialized body of knowledge as related to their extensive understanding of oral health and the link with overall health and wellness, their continuous dedication to disease prevention, and the natural tendency towards client-centered care.  Along with the extensive body of knowledge, dental hygienists have a responsibility to the individuals that comprise the general population; the dental hygiene students are trained to seek out clients in the community, in contrast to the dental hygiene services traditionally provided to clients that seek it out themselves.

Third, the dental hygiene student will expand his/her understanding of evidence-based practice.  Studies of epidemiology, biostatistics, scientific communication, and statistical significance all contribute to competency when faced with implementing evidence supported treatment modalities into client care in a timely fashion.

Lastly, an understanding of community health programs is undertaken.  The dental hygiene students study effective community program design, and how to plan and evaluate successful community programs.  Through numerous field placements, students are then provided with the opportunity to design and implement their own community programs, an experience that consistently reports positive experiences on behalf of the students and community partners alike.

Community health is a unique aspect of the dental hygiene curriculum.  It gathers information learned from all other aspects of the dental hygiene body of knowledge, and challenges dental hygienists and future dental hygienists to rethink our perception of the client and how we apply the dental hygiene process of care.

The significance of the study of community health has greatly increased with the ability for dental hygienists in Ontario to self-initiate.  A thorough understanding of community health is mandatory for future dental hygienists to be able to successfully integrate self-initiation into practice.  Self-initiation is the bridge between dental hygiene and the people; community health provides dental hygienists with tools to succeed once that bridge has been crossed.

A Child’s First Dental Visit: Developing Healthy Lifestyles Through Oral Health Promotion of the Very Young

Provincial and national professional dental hygiene and dental associations recommend that children receive their first dental visit by or shortly after the eruption of the child’s first tooth or by the child’s first birthday, whichever comes first.

As oral health care workers (OHCWs,) are we consistently making this recommendation to our clients, the parents of these infants and toddlers?  How do we address the surprising concerns about this being “too early?”  And of course, how can OHCWs in a general practice setting effectively welcome these new, little clients into our practices in an effective, nonthreatening, and successful manner?

The foundation of this recommendation lies in the concept of primary disease prevention:  preventing disease before it starts.  By seeing a child so young, we are able to examine the oral cavity for any signs of disease, trauma, abuse, or neglect.  Parental education about oral self care, dietary considerations, strategies to reduce early childhood caries, and accident/injury prevention can also be emphasized. 

Parents of small children can be reassured about an early first visit to an OHCW through education about the importance of early examination of the child’s oral cavity and newly erupting primary dentition.  Insight into what will occur at the first visit will help to reassure the parents, by reducing the fear of the unknown.  A discussion with the parent about the importance of the primary teeth with regards to oral development, diet, speech maturation, aesthetics, and self-esteem can further assist to create value for that early, first dental or dental hygiene visit.

‘Conditioning’ of the young child prior to the first dental visit can greatly assist with it’s success.  Conditioning involves suitable preparation to make the visit easier and the client more manageable.  For example, parents may be instructed to only discuss the dental office in a positive light such as “it’s going to be fun” or “the dental hygienist is our friend.” Unfortunately, children struggle to understand the concept of a double-negative and saying to the child “there’s nothing to be scared of” may have the opposite effect and might encourage the child to be scared.  Parents can also practice with the young children what might happen in the dental office, by having the child lie of the sofa, open their mouth, turn their head to the left and right, perhaps with the parent shining a small flashlight into the child’s mouth.

Upon arrival of the child in the dental office, the use of positive terminology only is to be continued by both the parent and the OHCW.  Smiling will help to diffuse fear and promote relaxation for all individuals, including the parent.  Children tend to follow the parent’s lead, so a relaxed parent is likely to result in a relaxed child; an anxious, frightful parent is likely to result in an anxious, frightful child. 

A medical and dental history review of small children is likely to be brief, but is still an important aspect of assessment.  Insight gathered regarding medication use, illness/infection history, previous head and neck injury, and overall parental attitude towards oral health will help to guide the rest of the process of care.

A few options exist for examining the small child’s oral cavity. First, the child may lie on the parent’s abdomen while the parent lies in the dental chair; the parent may then securely and comfortably wrap their arms around the child.  Another option is for the parent and OHCW to sit knee-to-knee while the child lies on their thighs, with the parent’s arms crossed firmly over the child and the child’s head towards the OHCW for examination.

Of course, not all first dental visits, especially of infants and toddlers, are completed smoothly or according to our hope and intention.  Sometimes the first dental visit might simply be a ride in the dental chair and a discussion with the parents regarding their child’s oral health; this could be considered a success over that of no dental visit at all. By scheduling another appointment in six months, there will likely be a gradual increase in both comfort and compliance. An early dental visit can also provide insight into whether a child might require a referral to a qualified specialist.

Oral health care of infants and toddlers may seem daunting and certainly presents with a unique set of challenges. Our greatest success lies with our patience, compassion, and early intervention as we open our practices and hearts to these small but special clients.

References

Darby, Michelle Leonardi, and Margaret M. Walsh. Dental Hygiene Theory and Practice Third Edition. St. Louis, MO: Saunders Elsevier, 2010.

Newborns and Infants. 2010. Ontario Dental Association. 6 Sept. 2010. <http://www.oda.on.ca/newborns-a-infants.html#baby>

Oral Health for Children – A Parent’s Guide.  2009. Ontario Dental Hygienists’ Association. 6 Sept. 2010. <https://www.odha.on.ca/PDFs/5childrenWeb.pdf>

Oral Health Matters for You and Your Baby. Smile City.ca brought to you by CDHA. 6 Sept. 2010. <http://www.smilecity.ca/parents_resources.asp>

Wilkins, Esther M., Clinical Practice of the Dental Hygienist 10^th Edition. Baltimore, MD: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009.

Your Child’s First Visit. 10 Apr. 2005. Canadian Dental Association. 6 Sept. 2010. <http://www.cda-adc.ca/en/oral_health/cfyt/dental_care_children/first_visit.asp>