Seeing the Invisible

Over the Christmas holidays I had the opportunity to participate in the first day of the oral cancer-screening project that myself and my partner, friend and fellow dental hygienist Joanne- have been in the process of developing.  The organization that we are working to establish a long-term collaborative relationship with is The Good Neighbours’ Club in Toronto, Ontario.  I am writing this blog to give you some insight and background information as to why we have chosen to work with this organization.  This is blog is part one.  In part two, I will share the learning experiences from the first day.

  The Good Neighbours’ Club is an organization that works with homeless, unemployed, marginalized, and/or lonely older adult men. I encourage you to take an opportunity to view their website to gain an idea of the great role this organization plays in the community http://goodneighboursclub.org.

Some may ask why we have chosen to work with this organization over others.  Although there are many groups of socially isolated and marginalized individuals in society, the reason that we chose this organization is that this population demographic is often a cohort whose needs are minimized. From a societal standpoint, men are viewed as naturally empowered individuals.  Socialization evolves and fosters what is supposed to be a strong male identity. Furthermore, the older adult male is at risk for oral cancer, this risk is further compounded by smoking and drinking habits. 

Not only is this project an opportunity to improve the oral health of these men, it is also an opportunity to improve their personal wellbeing.  The personal wellbeing of these men is improved by providing an opportunity for empowerment.  Personal empowerment is a key component of health promotion and oral health is increasingly viewed as an intrinsic part of overall health.  Empowerment comes from the individual feeling a sense of control over their health and as being viewed as an active participant in the decision making process. 

Though this project, we hope to accomplish development of meaningful relationships with the members of this club. Meaningful relationships are accomplished by active listening, empathy and setting mutually agreed upon goals. Empowerment involves guiding the client and providing direction, but not necessarily telling the client what to do.  A trusting relationship facilitates the empowerment process.  (Falk-Rafael, 2001)  This project will allow us to be more visible within the Good Neighbours’ Club; with frequent visits and follow-ups we hope that this will foster a trusting relationship with the members. 

As with any new endeavor, there are bound to be bumps along the way.  Part of the success of volunteer and community development projects is dependent on the identification of areas for improvement, a determination of what works and what does not, and strategies for improvement next time around.

                        As a clinician, you are only as good as your assessment tools.  During the screenings, I found that I was consciously thinking of ways to improve our assessment form for next time around.  Regardless of setbacks encountered, this project was a success.  Taking the time a see an individual who is otherwise invisible in society could mean a world of happiness to them even if just for a few minutes to look in their mouth; you could make their day. 

I would love to hear your thoughts.

Reference List:

Falk-Rafael, A.R. (2001). Empowerment as a process of evolving consciousness: A model of empowered caring. Advances in Nursing Science.  24(1), 1-16.

Good Neighbours’ Club.  Mission Statement. Retrieved Dec 14, 2010 from http://goodneighboursclub.org/

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