Part of the community health course in the fifth semester here at Niagara College in the Dental Hygiene program required going out into the community and getting involved through observation and promotion of oral health. On Thursday January 23, 2020 from 1 p.m. to 3 p.m. I went to shadow the Niagara Regional Health Unit during a school screening with a peer. This screening took place at St. Augustine School and involved a registered dental hygienist, a dental assistant, and students in grades two and seven. Before the shadowing I knew a bit about the program since we had a representative come into our class and talk about the services they provide for the public. They have clinics where they provide fluoride and sealants, go to elementary schools for their screening program, and they have a mobile dental clinic (Health n’ Smiles, 2020).
During the shadowing I learned that the purpose of their visit is to get children who require urgent dental care the care they need and to refer others in need of non-urgent care. “Urgent” in the eyes of the program includes frank (full blown) cavitated lesions. The documentation consisted of a computerized chart made on excel where they recorded findings such as cavitated lesions, missing teeth, restorations, gingivitis, calculus (present of 2 or more teeth), and referrals for fluoride and sealants. There was no documentation regarding if the child had mixed or permanent dentition. There were not traditional indices being used but there was data collection (Wilkins, Page 370) being used for example the documentation for gingivitis was “Y” for yes or “N” for no. When urgent matters are noted in a student's oral cavity a letter goes home to the parent with several options to proceed in attending to the matter. The then have in total 60 days to get the matter attended to with proof from a dentist that the work has either been looked at (if the tooth is about to exfoliate) or restored. Students with non-urgent referrals which include pit and fissure sealants and fluoride treatments just get a letter sent home, but these matters are not on a timeline or followed up with by the program employees. If the urgent matters are not attended to within the time frame allotted, then it is neglect towards the child. According to a clinical report dental neglect is “Willful failure of parent or guardian, despite adequate access to care, to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection” (American Academy of Pediatric Dentistry).
The health interventions I witnessed were primary interventions which consisted of prevention of dental caries by referring close to all students for fluoride varnish treatments, and pit and fissure sealants for children with no caries (Darby, Page 41). The secondary interventions involve early detection and prompt intervention for example when they found a carious lesion in the child's mouth, they then write the warning to the parent for and referral for fluoride (Darby, Page 41). The screening took place in the library, the set up was a lay down chair and to the right of the clinician was masks, a flashlight, gloves, hand sanitizer, and disposable mouth mirrors which were suitable for single use (Miller, Page 166) and there was a dirty garbage bin to the left. The clinician did not wear gloves, but they did have a no touch policy involving one of her hands holding the mouth mirror and the other using a flashlight. She used the same mask, sanitizer between each student which has been shown to be effective hand antisepsis (Miller, Page 95) and used a new mouth mirror for each student. Gloves were put on and the lay down chair was wiped down with wipes in between the different grades. I feel like with the circumstances that they are in they tried their best to be IPAC friendly. For example, when they separated the clean from the dirty side and when we helped carry out their supplies the assistant said she “wanted to pack the trunk herself because she had to try and pack it as IPAC friendly as she could”.
Communication techniques I witnessed were verbal and non-verbal shown when the dental hygienist was speaking clearly with a vocabulary (Darby, Page 53) that the children would understand. For example, for the younger children who asked what the purpose of the screening was the hygienist replied, “we’re just counting your teeth buddy and looking for cavities”. They clinician asked questions to clarify specific queries (Darby, Page 57) for example a child said she had pain and so she was asked questions like “where does it hurt, does it hurt to hot or cold, does your parents know, does it always hurt?” The ADPIE process was as follows: (A) collection of the data while looking at children's oral cavity, (D) the hygienist determines if the caries are frank or if the child has gingivitis, (P) an urgent notice or non-urgent referral for preventative measures is sent out to the parents (I) hygiene services can be done at a dentist of the family’s choice or at the NRHU dental clinic (E) the program follows up with all the urgent case, and lastly this is all recorded within the system (Darby, Page 2).
In conclusion shadowing with the Niagara Regional Health Unit was a good experience. It allowed me to see how some occupations from the dental team are helping the community and gave me insight on what it may be like to work for Public Health. It allowed me to see how the dental hygiene occupation may look outside the clinic walls.
References
Oral and Dental Aspects of Child Abuse and Neglect (2017). Retrieved from
Health n’Smiles. (2020). Retrieved from
Darby, Michele Leonardi, Walsh, Margaret M. (4 Eds.) (2015). Dental hygiene: Theory and Practice. St. Louis, Missouri: Saunders/Elsevier.
Miller, Chris H. (6 Eds.) (2018). Infection Control: And the Management of Hazardous Materials for the Dental Team. St. Louis, Missouri: Saunders/Elsevier.
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