Dental Hygiene for Special Patients

Transcription

Volume 29
Number 2
Summer 2013
Dental Hygiene for
Special Patients
Caring for Patients with
Neuromuscular Disorders
The Virtual Dental Home
A New Look at Learning
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In this issue of the
Summer 2013
3
From the Editor’s Desk
Caring for Special People
4
CDHA NewsNotes
CDHA Leading the Way
5
President’s Message
100 Years of Dental Hygiene
6
6LifeLongLearning
Neurological and Neuromuscular Disorders
Dental Hygiene Care for Special Patients
12 PracticePointers
Caring for Patients with Neuromuscular Disorders
14PublicHealth
18StayingHealthy
Shape Matters! The Role of Hand Instrument Design
21
StudentConnection
2013 Cora Ueland Scholarship Award Recipients
National Boards – Are You Prepared?
Student Delegates to the ADHA
Celebrating 100 Years of the Profession
California Students Shine in 2013 Table Clinic
and Research Competitions
27
24CareerCorner
Michelle Smith, RDH, BA
27
EducationExchange
30NewsBytes
CDHA News Makers
14
Journal Sponsored by
This Journal is printed on 100% recycled paper
2012–2013 Executive Officers
Contributions of scientific and original articles.
The Journal of the California Dental Hygienists’
Association is formatted by and published under the
supervision of the Editor. The opinions expressed or
implied in this publication are strictly those of the
authors and do not necessarily reflect the opinion,
position or official policies of the CDHA nor are
claims or statements by authors verified.
The only permission granted for photocopying or
storage of items is for personal use, or the use by
libraries; all other uses require the written permission
of the Editor or President. CDHA reserves the right
to illustrate, reduce, revise or reject any manuscript
submitted. Articles are considered for publication on
condition they are contributed solely to the Journal.
Contributors are notified within 90 days if a
manuscript is accepted for publication.
Correspondence should be addressed directly
to the Editor:
Cathy Draper, RDH, MS
E-mail : [email protected]
FAX: 408-252-4350
Mail: 1310 Regency Drive • San Jose, CA 95129
President
President Elect
VP Membership &
Professional Development
VP Membership
& Public Relations
Susan Lopez, RDH, BS
Nadine Lavell, RDH, MS
Terri Vosper, RDHAP, BA
Karine Strickland, RDHAP, BS
Secretary-Treasurer
Lygia Jolley, RDH, BA
Immediate Past President
Lisa Okamoto, RDH, AS
Executive Administrator
Jenifer McDonald
Component Trustees
Central Coast Tracy Woods-Boyan, RDHAP
East Bay Lolly Tribble, RDH
San FernandoValley
Kirsten Thye, RDH
San Francisco Michael Long, RDH
Kern County Harriet A. Luzinas-Smith, RDH
San Gabriel Valley Beverly Legg, RDH, MS
Long Beach Beth Strauss, RDH
San Joaquin Valley Fred Thomas, RDH
Los Angeles Tricia Osuna, RDH, BS, FAADH
Monterey Bay Mary Jo Cardinale, RDH, BS
Mt. Diablo Frannie Driscoll, RDH, BS
Napa-Solano Ivy Zellmer, RDH
Santa Barbara Alexandra Major, RDH
Santa Clara Valley
Theresa Guinasso, RDH
Mary Jacobson, RDH
Shasta
Six Rivers Darla Dale, RDHAP, BS
Orange County Rhonda McMorran, RDH
South Bay Carole Broder, RDH, BS
Tri County Darlene Cheek, RDH, BS, MPH
Peninsula Angela Punaro, RDH
Display and classified advertising. The California
Dental Hygienists’ Association does not assume
liability for contents of advertisements. Inquiries
regarding display advertising should be directed to:
Shanda Wallace, RDH, BS
611 Bristol Ave. • Stockton, CA 95204
[email protected]
[email protected]
Redwood Tamara Wells, RDH
Valley Oaks Linda Wise, RDH
Ventura County Erica Johnson, RDH
Copyright ©2013 by the California Dental
Hygienists’ Association. The Journal is published on a
regular schedule by the California Dental Hygienists’
Association. Subscription rate is as follows:
$15 for CDHA members
$25 for non-CDHA members and ADHA members within U.S.
$50 to ADHA members outside the U.S. and
non-members within the U.S.
Advisory Board
All change of name or address should be sent to:
California Dental Hygienists’ Association
1900 Point West Way, Suite 222
Sacramento, CA 95815-4706
Phone: 916-993-9102
E-mail: [email protected]
Internet: http://www.cdha.org
Sacramento Valley Carol Lee, RDH, MS
San Diego County
Jackie Buchanan, RDH
Journal Staff
Calendar of Events
Editor Cathy Draper, RDH, MS
August 9-10, 2013
Strategic Planning and BOT Meeting
Doubletree Hotel, Sacramento, CA
Toni S. Adams, RDH, MA
Aubreé Chismark, RDH, MS
Carol Lee, RDH, MS
Donna Smith, RDH, MSEd
Ellen Standley, RDH, MA
Graphic Design Dorreen P. Davis
Printer
Moore Bergstrom Co.
November 2, 2013
Fall CE Extravaganza and
National Board Review Course
Hilton San Francisco Airport,
Bayfront Hotel, Burlingame, CA
November 3, 2013
Board of Trustees Meeting
Hilton San Francisco Airport,
Bayfront Hotel, Burlingame, CA
About the Cover: RDHAP Diann Azevedo delivering care to a homebound client.
Photography by: Julius Mork, licensing from ZUMA Press, Incorporated.
From the Editor’s Desk
“Caring for
Special People”
Ever since my mother began to use a walker on a regular basis several years ago, I have become acutely aware of the many challenges
anyone with a physical disability faces as they carry out the activities of daily living. In my mother’s case, just venturing out of the
house is now limited to the most essential trips and always has to be planned with accessibility in mind. As she and I have learned the
hard way, the handicapped parking is not necessarily close to the entrance of the building and not all doors are equipped to stay open
to allow everyone with mobility challenges to enter with ease.
The difficulties my mother and I have faced just getting inside the building, be it the grocery store or church, are not much different
than the obstacles many Californians face in obtaining dental services. Just getting to a dental office for care may not be possible for
individuals with complex medical or physical conditions; and once you do arrive, will they be prepared to care for you? Anxiety about
dental treatment as well as the ability to pay for care can further complicate the situation. Yet, there is
no question that regular oral care is an essential component of overall health, particularly for persons
with disabilities and the medically compromised. The serious consequences of dental neglect lead to
needless pain and suffering as well as increased costs.
Our current oral healthcare delivery system, like the handicapped parking places that are not always
close to the entrance of the building, does not meet the needs of all individuals. However, the ability
to make care more accessible may be a reality in the near future. The Virtual Dental Home (VDH)
demonstration project is an innovative new delivery model for maintaining the oral health of vulnerable
populations here in California. The goal of the project is to demonstrate by using the latest technology
to collaborate with dentists at remote office sites, that registered dental hygienists in alternative
practice, registered dental hygienists employed in public health programs and registered dental
assistants can keep people healthier in their community settings by providing education, preventive
care, interim therapeutic restorations triage, and case management. The VDH project also has the added potential of becoming a
part of the general health reform efforts designed to develop comprehensive health homes for vulnerable populations in addition to
increasing the scope of practice for dental health professionals.
The focus of this issue of the CDHA Journal is “caring for patients with special needs.” No matter what their disability or challenge,
all patients have the right to have competent and compassionate care - all patients should be “special”. It is estimated that over 52
million Americans have some type of disabling condition – ranging from mild physical limitations to severe developmental disabilities.
That individual with a disabling condition could be your mother, father, child or even yourself.
The question is, will our healthcare system be up to the challenge of delivering the care for
the special people in our lives?
CDHA Journal – Summer 2013
Cathy Draper, RDH, MS
Editor
3
CDHA NewsNotes
CDHA Leading the Way
The 27th annual House of Delegates of the California Dental
Hygienists’ Association was held May 31-June 2 at the Long Beach
Hilton Hotel. Over 400 members, delegates and students met
for a weekend that included continuing education, networking
and thoughtful deliberation to set CDHA’s course for the coming
year. This year’s Professional
Issues Forum centered on
three topics; the Virtual Dental
Home Demonstration Project,
alternative criteria for dental
hygiene licensure and the sunset
review of the Dental Hygiene
Committee of California. All
three subjects generated lively
discussion on the future direction
of the profession in California.
Outgoing CDHA President Susan Lisa Okamoto, RDH receives the
2013 President’s Recognition Award
Lopez, RDH, BS presented Lisa
Okamoto, RDH with the 2013 President’s Recognition Award. Lisa
was cited for her outstanding contributions to CDHA, particularly in
the area of her organizational skills, attention to detail and support
during the recent management transition process.
Susan Savage, RDH, BS,
the 2012-2013 President
of the American Dental
Hygienists’ Association,
was also on hand to give
greetings on behalf of
ADHA, participate in
the Student House of
Representatives and to
install incoming President,
Nadine Lavell, RDH,
Incoming President Nadine Lavel, RDH, MS
with ADHA President Susan Savage, RDH, BS MS. Nadine’s theme for
the coming year, “CDHA
Leading the Way”, brings new emphasis to the important role
that CDHA plays for the dental hygiene porfession in California
particularly as new opportunities arise for increasing access to
care for all populations.
4
Actions of the House of Delegates included:
• Adoption of the criteria for CDHA Life membership
• Creation of the Alternative Practice Council
• Development of guidelines for the ethical use of CDHA
social media
• Referral for further review: the definition of “full mouth
debridement” as it relates to the CDT Code 4355
• Adoption of the 2013-2014 CDHA Budget
• Election of the 2013-2014 slate of CDHA officers and
ADHA Delegates
A full report of the 2013 CDHA HOD can be found at www.cdha.org
2013-2014 CDHA President
Nadine Lavell, RDH, MS assumed the leadership of the California
Dental Hygienists’ Association on June 2, 2013. Nadine brings a
wealth of experience to her new role as president of the largest
association representing the interests of all dental hygienists in
California. While she currently practices in Healdsburg in Northern
California, Nadine’s dental hygiene career has also taken her to
Alaska, Arizona, Iowa and Minnesota. Nadine received her Bachelor’s
degree from Idaho State University and her Master’s in Dental
Hygiene from the University of Iowa. Her professional experience
has included a research and instructional design appointment at the
University of Iowa as well as teaching appointments at the University
of Iowa and Santa Rosa Junior College.
2013- 2014 CDHA Officers
President: Nadine Lavell, RDH, MS
President Elect: Karine Strickland, RDHAP, BS
Vice-President of Administration and Public Relations:
Julie Coan, RDH, BS
Vice-President of Membership and Professional Development:
Laurel Bleak, RDH, BS
Secretary- Treasurer: Lygia Jolley, RDH, BA
Immediate Past President: Susan Lopez, RDH, BS
Speaker of the House of Delegates:
Vickie Kimbrough-Walls, RDH, EdD
CDHA Journal Vol. 29 No. 2
Message from the President
Author(s)
One Hundred Years of Dental Hygiene
“Proud Past, Unlimited Future”
One hundred is an extraordinary number. For our profession, it
reflects a century of service and care provided by the thousands of
graduates from dental hygiene institutions across this country.
Our first one hundred years was a time of tremendous growth,
achievements and challenges. We all learned that our profession
evolved from that first class led by Dr. Fones in 1913. Most of those
first graduates were hired by the Bridgeport, Connecticut school
district to provide dental health education and “teeth cleaning” on-site
for the children. The decay rate of the district decreased dramatically.
Providing health care to the public was the vision of the future
for Dr. Fones’ first class of students in 1913. This vision remains
strikingly similar to the over 6,700 students who will graduate from
our dental hygiene programs in 2013, however these graduates
must be prepared for an infinitely more complicated world where
technology will redefine how health care will be delivered.
Over the last 100 years, in order to meet the challenges of access
to care, many states have expanded their practice acts to allow
dental hygienists to provide on-site services. This follows the path
that was forged by those first dental hygienists, as they provided
safe and effective care to children in the Bridgeport schools.
It is important to reflect upon how far our profession has advanced
in this last century. The responsibilities of the clinical dental hygienist
have evolved from “cleaning” the teeth, to care of the oral cavity,
to the awareness of the systemic involvement of oral issues. Dental
hygienists are now recognized as essential members of corporate,
public health and educational institutions.
Here in California, we too are almost
ready to celebrate our 100 year
anniversary. The first dental hygiene
class in the state was accepted to
UCSF in 1918. Dental hygiene in
California has a rich and robust history
of professional, educational and
legislative landmark advances: from
the early expansion of the dental practice act in the mid 1970’s to
allow the use of local anesthetics: to the decades long quest for the
RDHAP licensure category: to the formation of the Dental Hygiene
Committee of California (DHCC), the nation’s first self-regulating
dental hygiene committee: to the establishment of the UCSF and
the USC Masters in Dental Hygiene programs: to the passage of
AB1202 giving the DHCC the regulatory control over any new
dental hygiene programs proposed in our state.
CDHA has navigated our profession through these turbulent,
challenging and exciting times and our organization has emerged
stronger and wiser for the journey. In California, all dental hygienists
as well as the public have benefitted from CDHA’s longstanding
and growing relationships with our legislators, our professional
counterpart, the California Dental Association, and our many health
care partners throughout the state.
As CDHA sets the stage for our next one hundred years of growth,
it will be our task, as members, to create a future that will be
built upon the strengths that have made our association successful
and will move CDHA forward with changes that will inspire our
members, advance our profession and meet the needs of yet
unknown challenges.
Happy Birthday to us all,
Susan Lopez, RDH, BS
2012-2013 CDHA President
Celebrating 100 years of dental hygiene, CDHA President Susan
Lopez and ADHA President Susan Savage
5
LifeLongLearning
Donna Kawahara, BDSc (DH), MHST
Neurological and Neuromuscular Disorders
Dental Hygiene Care for Special Patients
Introduction
Neurological Disorders
Physiologically, the sympathetic and parasympathetic nervous
systems, and their links with the human musculature, are intricate
and complicated. Neurological and neuromuscular conditions and
disorders, such as Multiple Sclerosis and Muscular Dystrophy, pose
oral care challenges for both clients and for the dental hygienists
who provide comprehensive care for this population. Due to the
complex nature of these conditions, and in order to provide optimal
levels of dental hygiene care, it is important for dental hygienists
to understand the various signs and symptoms of neurological and
neuromuscular conditions as well as the associated limitations these
disorders place on the affected clients. An increased understanding
of neurological and neuromuscular disorders can lead to a
collaborative approach between the dental hygienist and the client,
thus optimizing their oral health outcomes.
Neurological disorders stem from pathology of the brain, spinal
cord, and nerves. As a result of neurological dysfunction, the
signaling between the nervous system and muscles is disrupted.
This leads to malfunctions affecting voluntary and involuntary
movement, including walking, speaking, swallowing, breathing, and
cognitive functions such as learning and memory.2 Some examples
of neurological disorders are: Alzheimer’s, Parkinson’s, migraine
headaches, and Multiple Sclerosis.3,4
LEARNING OBJECTIVES
Upon completion of this course, the dental professional will be able to:
1. Discuss the general pathophysiology related to
neuromuscular disorders.
2. Recognize the signs and symptoms of potential
neuromuscular disorders.
3. Make ongoing evaluations of a client’s physical and mental
complications for individualized care planning.
4. Discuss knowledgably the various aspects of the specific
neurological and/or neuromuscular disorder with the client.
NEUROLOGICAL AND NEUROMUSCULAR DISORDERS
The neuromuscular system is a fine balance of electrical impulses
from the brain, moving down the spinal cord, and the action of
chemical transmitters to the muscle fibers working cohesively to
produce movement.1 Disorders affecting these systems fall into two
descriptive categories: neurological and neuromuscular. A plethora
of conditions affecting neuromuscular function exists; however,
for the purpose of this review, the following four conditions will be
discussed: Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis
(ALS), Myasthenia Gravis (MG), and Myotonic Muscular Dystrophy
(DM). Knowledge and understanding of these disorders is critical to
the dental hygiene professional in order to optimize dental hygiene
assessment, treatment planning and the delivery of care.
6
Multiple Sclerosis
Multiple Sclerosis (MS) is a neurological condition of unknown etiology
affecting sensory and motor nerve transmission.5,6 It affects more
females than males at a ratio of 3:2, with an average age of onset
between 20 and 45 years.5,7 The disease causes damage to the myelin
sheaths around the axons within the brain and spinal cord.5 Due to
the loss of myelin sheathing and exposure of axon fibers, inflammation
results, leading to interference with nerve impulse transmission.5 The
range of symptoms for MS is varied but includes: muscle weakness,
dizziness, balance problems, bladder and bowel dysfunction, changes
in personality, depression, and cognitive impairment.5,8 Visual
disturbances, facial pain, and trigeminal neuralgia are common early
symptoms, as well as numbness or paresthesia of the extremities.5, 7 In
addition, people affected by MS complain of muscle spasticity, tremors,
spasms, and fatigue, which may limit daily activities.5 Dysphagia
(difficulty with swallowing), and dysarthria (difficulty with speech) can
also be complications of MS, particularly in the advanced stages.7
Trigeminal neuralgia, a painful condition caused by inflammation of the
trigeminal nerve (fifth cranial nerve), is present in up to 32% of those
individuals afflicted with MS.7 It is important for dental hygienists to
be cognizant of the pain experienced with trigeminal neuralgia, which
can be triggered by even the lightest, most gentle touch. In addition,
some individuals may find tooth brushing to be very painful due to
their trigeminal neuralgia, resulting in poor oral hygiene. Bilateral facial
palsy may occur in up to 25% of MS cases, but should not be confused
with Bell’s palsy, a temporary form of facial paralysis of the sixth
cranial nerve affecting only one side of the face.5,7 Between 20 and
50% of individuals living with MS report experiencing chronic facial
pain, presenting challenges for clinicians in interpreting and diagnosing
their pain.5 The clinician must try to determine whether the pain is
due to a dental infection or disease, or due to MS-related symptoms.5
Chronic pain from MS may present as parasthesia, burning, throbbing
LifeLongLearning
or shooting pain, or may be revealed as a painful reaction to a typically
non-painful touch.
Mobility challenges, including problems with gait, affect the activities
of daily living for the client with MS. Depending on the severity of the
condition, people living with MS may require a cane or other mobility
aids such walkers and wheelchairs. Dental hygienists must consider
mobility as a potentially limiting factor for access to professional
oral health care. As the severity of the disease increases, so do the
physical barriers regarding access to care. When mobility is severely
restricted and the individual loses the ability to bear weight, additional
challenges may arise due to the client’s inability to transfer from the
wheelchair to the treatment chair
without mechanical assistance. In
such cases, individuals must be
treated in the wheelchair, or treated
in special practice settings equipped
with mechanical lifting devices.
Some wheelchairs have a reclining
feature, allowing the clinician easier
access to the oral cavity while the
client remains in his/her wheelchair. Even with a reclining feature,
access and visibility may be limited for the dental hygienist in addition
to the obvious ergonomic challenges.
Manual dexterity is another challenge for individuals living with MS,
making tooth brushing and flossing difficult.9 Of the people living
with MS, approximately 25% are unable to independently execute
personal oral self-care, and almost one third of individuals need to
adapt to using their non-dominant hand in order to perform daily oral
self-care tasks.5 With advanced stages of disease, oral health care
providers must be aware that the client’s ability to verbalize his/her
needs may be impaired due to dysarthria. In addition, if dysphagia
becomes significant, choking and aspiration risks are increased,
thus contraindicating the use of ultrasonic debridement equipment.
Individuals may require a feeding tube for nutrition when dysphagia
is substantial and may have increased levels of dental calculus due to
the lack of mastication, therefore creating an even greater need for
professional dental hygiene care.
Neuromuscular Disorders
Neuromuscular disorders, as compared and contrasted to neurological
disorders, affect nerves controlling voluntary muscles such as the
muscles of the arms and legs, while neurological disorders can
affect both voluntary muscles and involuntary muscles, as well as
brain neurons.2,10 The numerous neuromuscular disorders can be
subcategorized by pathophysiology and for the purpose of this review,
examples of neuromuscular conditions categorized as motor neuron,
peripheral neuropathy, and myopathy will be highlighted.
Motor Neuron Diseases
Motor neuron diseases affect essential muscle activity; including
walking, breathing, and swallowing.11 Messages sent from the brain are
disrupted due to nerve damage, with gradual muscle weakening and
wasting, and muscle twitching resulting from these signal disruptions.11
Motor neuron diseases are more common in males than females, and
typically do not affect individuals until after 40 years of age.11 Sporadic,
or non-inherited motor neuron diseases, have unknown causes but may
have environmental or viral factors associated with them.11 Amyotrophic
lateral sclerosis is one of the most common motor neuron diseases and
will be discussed in the following section.
Amyotrophic Lateral Sclerosis
Amyotrophic Lateral Sclerosis (ALS), also referred to as Lou Gehrig’s
disease, is a neurodegenerative disorder of unknown etiology; however
some genetic factors have been identified with this disease.12 While
there have been no consistent associations between environmental
factors and ALS, tobacco use has been associated with its development
in some cases.12,13 Progressive muscular paralysis due to degeneration
of motor neurons in the primary motor cortex, brain stem, and spinal
cord are all characteristics of ALS.12,14 The distribution of ALS diagnoses
is 5-10% familial, exhibiting a Mendalian genetic inheritance pattern,
while in the vast majority of cases, 90%, it is a sporadic disease
without a familial link.13 The age of onset for sporadic ALS is between
55 and 65 years, accounting for about one third of all ALS cases, with
a male to female ratio of approximately 1.5 to 1.12.15 Approximately
two thirds of all ALS cases are of the classical or spinal form, affecting
the upper and lower motor neurons.12
ALS can have a ‘limb’ onset (i.e., affecting the arms and legs) or a
‘bulbar’ onset (i.e., affecting swallowing ability). With limb onset, the
main symptoms are related to muscle weakness and wasting, with
foci being muscles of the shoulders, forearms and hands, as well as
the proximal thigh and distal foot muscles.12,13 Upper limb weakness
presents difficulties for the individual facing tasks associated with
both gross motor function such as hair washing, and fine motor skills
such as holding and manipulating a pen.15 Abnormal muscle tone in
limb onset ALS may present as fasciculations (involuntary muscle
twitching), and spasticity (increased stiffness and uncontrolled or
sudden jerking movements).12
With bulbar onset, ALS presents with dysarthria and dysphagia.12,13,15
Dysphagia leads to increased risk of aspiration, dehydration and
malnutrition.12,13 The soft palate may be weakened, contributing
to dysarthria and causing a nasal quality of the voice, along with a
weakened tongue causing slow, slurred speech.12 Limb symptoms
may also present concurrently with bulbar symptoms.12 Sialorrhoea
(excessive drooling) is present in most ALS cases due to swallowing
Continued on Page 8
7
LifeLongLearning
difficulties in combination with mild bilateral facial weakness affecting
the lower part of the face.12 In addition to the above ALS symptoms,
there are ‘pseudobulbar’ symptoms of lability (spontaneous emotional
changes) and excessive yawning.12,15 Emotional lability consisting
of pathological laughing or crying is seen in approximately 50% of
all cases.12,15 It is important for dental hygienists to understand that
emotional lability is not a mood disorder, but rather an effect of the
underlying ALS pathology.15 Other signs and symptoms of ALS that
may impact dental hygiene care are the brisk jaw jerks associated with
spasticity.12,13,15 Furthermore, the gag reflex is preserved or heightened
throughout the disease’s progression.12,13,15 Fasciculations, or wasting
of the tongue, as well as slowed tongue movements due to spasticity,
are other features of ALS that the oral health care provider should
be aware of as they create clinical management challenges affecting
intraoral access can increase the risk of inadvertent aspiration.12,13
Other common symptoms of ALS include fatigue and reduced capacity
for exercise, eventually leading to the need for assistance with activities
of daily living.13 Individuals with ALS experience chronic pain in up to
73% of cases and it is not uncommon for dementia to be present as
well.12,13,15 Approximately half of individuals diagnosed with ALS will
die within three years of the disease onset, with respiratory failure and
pulmonary complications being the typical causes of death.12,13,15
Peripheral Neuropathy
Over one hundred types of peripheral neuropathy have been identified,
each with their own set of symptoms. All peripheral neuropathies
consist of damage to the peripheral nervous system.16 The peripheral
nervous system is responsible for transmitting information from the
brain and spinal cord to the rest of the body.16 The types of symptoms
experienced are dependent upon the diagnosis, and vary from
temporary numbness to muscle weakness, burning pain to organ
dysfunction.16 For the purpose of this review, Myasthenia Gravis has
been highlighted as one of the peripheral neuropathies.
Myasthenia Gravis
Myasthenia Gravis (MG) is an uncommon acquired autoimmune
disorder that can occur at any age, but has a peak age of onset for
females between the teen years and
the 30s, and between the age of 50
and 70 for males.17,18,19,20 More females
are diagnosed with MG than males,
and the disorder is characterized by
weakness of the skeletal muscles
and fatigue with exertion.18,19,20
MG is also associated with other
autoimmune conditions such as
Grave’s disease (a thyroid condition),
diabetes, rheumatoid arthritis, and
8
lupus.18 A distinct characteristic of MG is a fluctuating skeletal muscle
weakness that can vary from day-to-day, hour-to-hour, and muscle-tomuscle.17,18,20 MG only affects voluntary muscles; while other involuntary
muscles, such as the heart, remain unaffected.17
With the number of different muscles that can be affected, there is a
wide variation in clinical presentation of MG.17 Ocular symptoms are
common at onset of MG.17,19 Individuals may experience ptosis (eyelid
drooping) due to weakness of the levator palpabrae muscle, and diplopia
(blurred vision) due to weakness of the extraocular muscles.17,18,20 A
characteristic of MG is Cogan’s lid twitch, an upper eyelid twitch that
occurs after looking down for a few seconds and then looking straight
again.20 Moreover, many persons with MG report that bright lights are
bothersome, making the eye muscles weak.17 From a dental hygiene
perspective, problems tolerating bright lights are important to remember
due to the bright overhead treatment lights or light sources attached to
loupes. Taking care to keep the operatory light directed away from the
client’s eyes as much as possible, and providing dark protective eyewear
can help to minimize the negative effects of the bright sources of light
required for the provision of dental hygiene care.
With MG disease progression, facial, including the orbicularis oris,
and masticatory muscle weakness will become more apparent
leading to dysphagia, dysarthria, and eventually to the appearance
of an expressionless face.18,20 When an affected individual laughs,
the appearance of a ‘myasthenic sneer’ is created.17 The sneering
appearance is due to the activation of the levator muscles that raise
the upper lip exposing the canines without the corners of the mouth
being drawn up and out.20 Individuals experiencing these effects
are unable to whistle, effectively use a straw, blow up a balloon, or
expectorate.17 Tongue weakness is another symptom of MG.17 The classic
‘myasthenic’ tongue has a distinctive triple longitudinal furrow and is
flaccid and atrophied, creating ongoing choking risks as the tongue is
unable to move food effectively.17,18 Like ALS, the soft palate muscles
may be weakened producing a nasal quality to the voice, and nasal
regurgitation.18,20 Individuals affected with MG may have difficulty with
chewing due to masseter muscle weakness, and in severe cases the jaw
may need to be manipulated by hand to facilitate chewing as well as
finger support to stay closed.17,18
Dysphagia, resulting from weakness of the tongue and posterior
pharyngeal muscles, and muscle fatigue associated with chewing and
swallowing is common and one of the most serious symptoms of MG.17,
20
Another serious symptom of MG is difficulty breathing due to the
airway becoming obstructed by secretions that the individual cannot
clear away because the muscles that produce a cough are too weak.17
Because of facial muscle weakness and the resulting lack of facial
expression, the affected person may be in crisis, but not appear to be
distressed. Signs and symptoms of airway distress include restlessness
and rapid shallow breathing.17 For clinicians, an awareness of such
LifeLongLearning
signs of distress are key points to remember when treating a client
with MG in order to maintain client safety. In addition, MG muscle
weakness causes difficulties for self-care (such as hair washing and
shaving) and oral self-care (such as tooth brushing).17 Furthermore,
difficulties walking long distances, walking up stairs, and the use
of a wheelchair, may pose obstacles in accessing care for oral
hygiene services. Certain factors have been identified in increasing
muscle weakness for individuals with MG including: exertion, hot
temperatures, infections, stress, and certain drugs including estertype local anesthetics.20 When administering a local anesthetic, a
good first choice for this client population would be mepivicaine, due
its minimal side effects along with its shorter duration.18 Infiltration
techniques are preferable to nerve block anesthesia in order to
minimize any potentially negative effects of the local anesthetic on
the MG client. Bilateral mandibular block injections must be avoided
due to swallowing difficulties present in MG.18 When using local
anesthetics, it is important that the client remain in the dental chair
until they are able to swallow without difficulty and they no longer
need suction assistance to clear secretions.18 For stress or anxiety
reduction, use of nitrous oxide sedation is an acceptable option
for these clients.18 In terms of oral self-care, the use of a powered
toothbrush is helpful. Regardless of the type of toothbrush used, the
handle may require a modification in order for the individual to be
able to manage the device effectively while reducing muscle fatigue.18
Myopathy
Myopathies are primary, inherited neuromuscular disorders
characterized by muscle necrosis and progressive degenerative skeletal
muscle.21,22 Myopathies fall into two broad categories: acquired, as
with muscle cramps, and inherited, as with muscular dystrophy.23
Myotonic Muscular Dystrophy
Myotonic muscular dystrophy (DM) is an autosomal dominant,
multisystemic genetic disease that encompasses a variety of
impairments including the muscular, ocular, respiratory, cardiac,
endocrine, and central nervous systems.24,25,26 Myotonic dystrophy
type 1 (DM1) is the most common type affecting adults, with a
prevalence rate of 2.1 to 14.3 per 100,000 people.21,25 The age of
onset varies greatly, from birth to 60 years of age and beyond.27
The clinical manifestations of DM1 include ptosis (drooping
eyelids), atrophy of the small muscles of the hand and forearm
extensor muscles, and weakness of facial muscles.21 Common signs
and symptoms include: myotonia (muscle rigidity), cardiomyopathy
(abnormal functioning of the cardiac muscle), cataracts, and
endocrinopathy.21 Cataracts are the most common finding in those
individuals with asymptomatic or late onset DM1, and in such late
onset cases, myotonia and muscle weakness are rarely present.20,22
However, for most individuals with DM1, muscle atrophy affecting
the head and neck muscles
are the major clinical
symptoms, and are often
the initial presenting
features.21,22,27 DM1
affects cranial muscles,
and the involvement of
the sternocleidomastoid
muscle creates a forward
curvature of the neck, coined ‘swan neck.21 DM does not always
demonstrate myotonia, or limb or facial muscle weakness. Typical
symptoms may include diabetes, cognitive deficits, excessive
daytime sleepiness, irritable bowel syndrome, respiratory failure,
and cardiac conduction (electrical impulse) abnormalities.22,27
With DM, there is a progressive loss of muscle strength, and
weakness of facial and anterior neck muscles.25 As deterioration
progresses, individuals typically rely on wheelchairs for mobility and
often have difficulty carrying out daily activities.25 Excessive daytime
sleepiness is common and can be debilitating or disabling for DM1.22
Myotonias are common and can affect grip and other muscles such
as the tongue and facial muscles, causing challenges with speaking,
chewing and swallowing.22,24 Along with myotonias, it should also
be noted that muscle pain is a common symptom of DM.22 Sudden
cardiac death, in all age groups, may occur due to affected cardiac
muscles.24,25 Furthermore, involvement of the central nervous system
may occur including cognitive impairment, dementia, and changes in
personality.22,26 Chest infections and diaphragm weakness contribute
greatly to respiratory failure, with many individuals become severely
disabled by the fifth or sixth decade of life.22,24
For clients with DM, dental hygienists should be aware that there is a
high prevalence of malocclusion, including anterior open bite, lateral
cross bite, and excessive inter-occlusal distance, possibly caused
by reduced muscle function.21 Due to their inability to maintain
adequate personal oral hygiene, individuals with DM tend to have
fewer teeth, higher plaque scores and caries experience, and greater
periodontal pocket depths compared to healthy cohorts.21 Further
considerations related to weakness of the muscles of mastication
and facial expression with DM1 include potential difficulties with
mastication, swallowing, respiration, and expectoration.21, 27
Summary
While a comprehensive discussion of all neurological and
neuromuscular disorders is outside the scope of this review, there are
recurring themes that can be extrapolated from one neurological/
neuromuscular disorder to another, in order to optimize the
management of dental hygiene care. In addressing the various physical
Continued on Page 10
9
LifeLongLearning
Oral Manifestations of Neurological and Neuromuscular Disorders
Multiple Sclerosis
Paresthesia
Facial Pain
Trigeminal Neuralgia
Dysphagia
Bilateral Facial Palsy
Amyotrophic Lateral Sclerosis Myasthemia Gravis
Dysarthria
Intolerant of bright lights
Dysphagia
Facial muscle weakness
Sialorrhoea
Masticatory muscle weakness
Facial spasticity
Dysphagia
Elevated gag reflex
Fasciculation of the tongue
limitations during self-care management, strategies for individual client
care could include: modified handles on manual toothbrushes, use of
powered toothbrushes, and when determined necessary, assistance
with daily oral care. In addition, any modified oral care techniques
that have been recommended should be periodically re-evaluated as
disease progression continues. New strategies and modifications should
be suggested in order to meet the evolving challenges and specific
needs of the client.
Ensuring that safe professional oral care is provided requires a
working knowledge of neurological and neuromuscular conditions.
Health and safety issues include risk of falls due to compromised
ability to walk, risk of aspiration, and the need for appropriate use of
local anesthetics. Potential side effects from local anesthesia include
increased impairment of the swallowing reflex with mandibular nerve
block injections.18 In order to facilitate a safe dental hygiene treatment
experience, consultation with general medical practitioners or
specialists is recommended.
Generally, for neurological and neuromuscular disorders with the
common symptoms of fatigue, weakness and the potential for distress,
it is helpful to establish an open and friendly rapport with the client
to reduce or eliminate emotional stress, and to adequately and
respectfully assess and meet their specific needs.18 Allowing the client
to rest before beginning the procedure may also be beneficial, along
with scheduling multiple, short early morning appointments when the
client has greater muscle strength.18 Keeping the client upright or only
slightly reclined during the appointment will also help to avoid closing
the throat, thereby reducing fluid regurgitation.18 Use of a mouth prop
may help to reduce masticatory muscle stress; however it is important
to ensure that the jaw is not being overstretched.18
Removing and adapting to physical barriers, such as ensuring
wheelchair accessibility, and working while the client remains seated in
a wheelchair, should be considered fundamental and reflect the right
of all individual’s to receive the highest standard of professional oral
healthcare possible. Complex and severe cases may require special
care practice settings.
10
Myotonic Muscular Dystrophy
Facial muscle weakness
Anterior neck muscle weakness
Dysphagia
Masticatory muscle weakness
Malocclusion
While the preceding discussion reflects a mere sampling of
neuromuscular and neurological conditions, dental hygienists should be
aware of the general and specific health and care needs of each client.
A thorough review of the client’s medical history is crucial to obtaining
relevant and adequate information in order to provide the best, safest,
and most empathetic oral healthcare possible. Individualized treatment
adaptations and considerations can serve to reduce client anxiety, and
increase confidence in the dental hygiene practitioner’s knowledge and
expertise, culminating in a positive experience and improved outcomes
for both the client and the dental hygienist.
References are available in the online version of this issue at
www.cdha.org
About the Author:
Donna Kawahara received her diploma
in dental hygiene from Confederation
College in Thunder Bay, Ontario, Canada
in 1997. She completed her BDSc
(dental hygiene) through the University
of British Columbia in 2009, and her
Masters of Health Studies (Leadership)
from Athabasca University in 2011.
Donna has worked in private practice for 16 years, and is currently a
part time clinical dental hygiene instructor at the University of Alberta,
Faculty of Medicine and Dentistry. Her focus of interest lies in the oral
health of long-term care residents, especially the geriatric population
and individuals with disabilities requiring assistance with daily living.
Donna can be contacted at [email protected]
Acknowledgements: Special thanks is given to Janet Aquilina-Arnold,
RDH, BDSC(DH) for her assistance with this article.
LifeLongLearning 2 CE Units (Category I)
Home Study Correspondence Course
“Neurological and Neuromuscular Disorders
Dental Hygiene Care for Special Patients”
2 CE Units – ADHA/CDHA Member $25, Non-member $35
Circle the correct answer for questions 1-10
1.
Neurological disorders have symptoms affecting:
a. voluntary and involuntary movement and cognitive functioning
b. involuntary movements
c. voluntary movements
d. cognitive functioning and voluntary movements
2.
Which of the following statements is TRUE of Multiple Sclerosis ?
a. it has unknown etiology and affects more females than males
b. it is caused by a virus and affects more males than females
c. the average age of onset is birth to 16 years
d. it causes damage to the myelin sheaths in the brain and spinal cord
e. both a and d
3. Trigeminal neuralgia, which occurs in 32% of Multiple Sclerosis
clients, can result in:
a. pain with bright lights
b. pain with walking
c. pain with toothbrushing
d. pain with shoulder and arm movements
4. Motor neuron diseases including Amyotrophic Lateral Sclerosis (ALS):
a. affect essential muscle activity; including walking, breathing,
and swallowing
b. affect more males than females
c. usually have an onset at 40 years of age or older
d. all of the above
5. Most of the cases of Amyotrophic Lateral Sclerosis(ALS) have a
strong familial or genetic link.
a. True
b. False
6. Difficulty swallowing, (dysphagia) a common condition in neurological
as well as neuromuscular disorders, can lead to which of the following ?
a. increased risk of aspiration
b. cardiac arrhythmia
c. bilateral facial muscle weakness
d. increased pain
7. Myasthemia Gravis(MG) is an autoimmune disorder and is characterized by weakness of the skeletal muscles and fatigue with exertion.
MG is also associated with other autoimmune conditions such as:
a. Parkinson’s disease and Alzheimer’s disease
b. Grave’s disease and diabetes
c. Sjögren’s syndrome and Parkinson’s disease
d. Nicotine and alcohol addiction
8. Ocular symptoms are common at the onset of which
neuromuscular disorder?
a. Multiple Sclerosis
b. Myasthemia Gravis
c. Amyotrophic Lateral Sclerosis d. Myotonic Muscular Dystrophy
9. Forward curvature of the neck, “swan neck”, caused by atrophy and
weakness of the sternocleidomastoid muscle is a symptom found in:
a. Multiple Sclerosis
b. Myasthemia Gravis
c. Amyotrophic Lateral Sclerosis
d. Myotonic Muscular Dystrophy
10.Special dental hygiene treatment considerations for neurological and
neuromuscular disorder clients include:
a. more upright client positioning
b. careful selection of local anesthesia types and techniques
c. individualized modifications for personal oral hygiene strategies
d. optimal appointment scheduling
e. all of the above
The following information is needed to process your CE certificate. Please allow 4 - 6 weeks to receive your certificate.
Please print clearly:
ADHA Membership ID#: ________________________ Expiration:___________
❑ I am not a member
Name: _____________________________________________________ License #: ___________________
Mailing Address: __________________________________________________________________________
Phone: ______________________ Email: __________________________ Fax: ______________________
Signature: ______________________________________________________________________________
Please mail photocopy of completed Post-test and completed information with your check payable to CDHA:
1900 Point West Way, Suite 222, Sacramento, CA 95815-4706
11
PracticePointers
Caring for Patients with Neuromuscular Disabilities
Patients with neuromuscular disabilities can present challenges to
the oral healthcare provider. Some patients may require extensive
modifications in the dental operatory while others may only need minor
adjustments for the safe delivery of care. It is important to establish
open and friendly patient rapport in order to respectfully assess and
meet the specific needs of this population while reducing any emotional
stress surrounding the delivery of dental hygiene care.
Use of a Mechanical Lifting Device
for a Patient with Multiple Sclerosis
Keeping in mind that every patient will have unique needs and
limitations, the following points should be taken into consideration for
developing a dental hygiene care plan:
Appointment Planning
• Review the medical history prior to the appointment and
consult with any medical practitioners, specialists and caregivers
if necessary.
• Schedule multiple, early morning appointments when muscle
strength is greatest
• Allow for extra time needed to accommodate the special needs
of the patient
Mobility
• Observe the impact of the disability on how the particular patient
moves. Watch for any challenges to delivering safe treatment such
as uncontrolled body movements or issues with posture.
• Maintain a clear pathway from the reception area to the
treatment area.
• Patients using a wheelchair (or their caregivers) may be able to
explain how to make a smooth transfer from their wheelchair.
• Ask the patient or caregiver about special preferences such as
padding, pillows, or other comfort devices.
• Patients who are unable to transfer from a wheelchair may be
treated in their wheelchair with the help of a specially designed
sliding board (transfer board) to provide head support.
• Practice settings can be equipped with a patient transfer device
for patients with severe mobility disabilities.
12
PracticePointers
CDHA Celebrates 2012-2013
Corporate Sponsors
Intraoral - Neuromuscular Issues
• Adapt intraoral care based on the extent of the neuromuscular
complications. Excessive saliva (drooling), gagging and
difficulty swallowing must be taken into consideration.
• Schedule early morning
appointments, prior to eating,
to minimize problems with the
gag reflex.
• Reduce swallowing difficulties by
keeping the patient in an upright
position and tilting the head slightly
to one side.
Diamond Sponsors- $15,000 or more
Philips Oral Healthcare
www.philipsoralhealthcare.com
Silver Sponsor
TePe USA
www.tepeusa.com
$3,000.00–$5,999.99
• Mouth props or a bite block may be beneficial.
• Select an appropriate short-acting local anesthetic to reduce
difficulties with swallowing or biting of the tongue and cheek.
Crest Oral-B
Colgate Oral Pharmaceuticals
www.crestprohealth.com
www.colgate.com
Oral Hygiene Self-Care Strategies
Bronze Sponsors
• Focus on the specific needs of the patient.
• Include the caregiver in the
oral health education and
demonstration of self-care
techniques when appropriate.
• Suggest ways to adapt the
handle of the toothbrush to
meet the needs of the patient.
• Recommend an appropriate
power toothbrush.
• Develop strategies for
interproximal cleaning.
Reference:
1. National Institute of Dental and Craniofacial Research. Practical oral care
series. [Internet].Bethesda (MD): National Institute of Health; 2012 Feb [cited
2013 Jul 4]. Available from http://www.nidcr.nih.gov/OralHealth/Topics/
DevelopmentalDisabilities/.
$1,500.00–$2,999.99
Cetylite
www.cetylite.com
Dentsply Professional
www.dentsply.com
Educational Designs
www.educationaldesigns.com
Susan Lopez, RDH, BS set out to encourage each one of us to
“Step Up and Reach Out” during her presidential year, 20122013. Our association benefitted greatly from the generosity of
a number of companies in spite of
fierce competition in our current
economy. CDHA’s leaders and
members would like to express
our appreciation to our corporate
sponsors for their ongoing
support of our education sessions,
workshops, student programs and
member events.
13
PublicHealth
Carol Lee, RDH, MS
Visualizing the Future of Expanding Access to Care:
Take a moment to imagine what your community would look like
if everyone was able to receive basic, comprehensive healthcare
services in settings that were easily accessible for their specific
needs. Now, consider today’s reality. Anywhere from one third to
half of the population in California goes without regular oral care.
The Virtual Dental Home, (Health Workforce Pilot Project #172),
provides critical oral health services to the most vulnerable and
underserved populations among us, while opening up new avenues
for dental hygienists to deliver care to a growing patient base.1
Based on the healthcare reform principles of the “Triple Aim”, the
Virtual Dental Home (VDH) creates a perfect opportunity to improve
the health of thousands while maximizing the oral health workforce.2
Early intervention and
disease prevention, key
components of dental
hygiene care, are widely
accepted as fundamental
to improving oral health.
The VDH demonstration
project seeks to improve the
• Improving the patient
oral health of underserved
experience of care
Californians through a
• Improving the health
combination of workforce
of populations
and policy initiatives. Defined
• Reducing the per capita cost
as a community based oral
of health care
health delivery system, the
VDH allows people to receive preventive and early intervention
therapeutic services in the community settings where they live or
receive educational, social, or general health services.
The “Triple
Aim” optimizes
health system
performance by
accomplishing
three goals
simultaneously.
Spearheadding the pilot project is it’s creator Dr. Paul Glassman,
Professor of Dental Practice and Director of the Pacific Center for
Special Care at the University of Pacific, Arthur A. Dugoni School
of Dentistry. As Dr. Glassman explains, “the Virtual Dental Home
provides a mechanism for expanding oral health services into
community sites while demonstrating innovative ways to deliver oral
health care. The goal is to reach populations of children and adults
who face significant barriers in accessing dental services in traditional
offices and clinic settings.” Funding for the project comes from a
14
number of sources including grants from the California Department
of Public Health through the Health Resources and Services
Administration, American Dental Hygienists’ Association Institute for
Oral Health, California Health Care Foundation, Verizon Foundation,
California Dental Association Foundation, First Five Commissions of
Los Angeles and San Mateo Counties, and the San Diego Foundation
in addition to a number of others. These grants have enabled the
expansion of oral health services into community sites at a time when
so many services have been reduced or eliminated.
Telehealth—An Innovative Technology Application
Telemedicine is
defined as the use of
electronic information
and communication
The ideal healthcare delivery system
would be designed to:3,4
technologies to provide
and support health care
• Eliminate barriers that contribute
to oral health disparities
delivery when distance
separates the participants.
• Prioritize disease prevention and
health promotion
The use of these
innovative technologies
• Provide oral health services in
a variety of settings outside of
are key components of
the traditional brick and mortar
the VDH. The broader
practice
term, telehealth, includes
• Utilize an expanded array
telemedicine as well as a
of competent providers who
variety of other services.
are authorized to provide
Optimal use of telehealth
evidence-based care while being
technology within such
compensated for their services
projects as the VDH has
• Include collaborative and
the potential for increasing
multidisciplinary teams working
access to health care for
across the health care system
all of California residents
• Foster continuous improvement
while improving clinical
and innovation
efficiency, increasing
access to health information, and reducing the cost of providing
necessary health care.5 California led the nation by developing
the guidelines for this innovative technology with the Telemedicine
Development Act of 1996. The Telehealth Advancement Act of
PublicHealth
2011 further updated California law and removed some of the
policy barriers for the use of telehealth technologies. Teledentistry is
now emerging as a viable option addressing the barriers of location
and access by linking oral health practitioners and patients in the
community with dentists at remote office sites. Sharing information
and knowledge from a distance has dramatically changed the
practice of healthcare and holds special promise for the delivery of
oral healthcare services to our most vulnerable populations.6
Health Workforce Pilot Project #172
California Health Workforce Pilot Projects
•First established in 1972
•Test, demonstrate, and evaluate new or expanded
roles for healthcare professionals
• Provide data to support the need for changing the scope of
practice or regulatory changes in health care delivery
• 171 HWPP pilot programs have been carried out between
1973 and 2005
• The Registered Dental Hygienist in Alternative Practice model
was first tested as a pilot project
The purpose of Health Workforce Pilot Project #172
(The VDH demonstration project) is to evaluate the
efficacy and safety of two duties performed by allied
dental professionals who are part of an ongoing
community-based system of care. While most
of the duties carried out by providers in this
community-based system are already
allowed under existing law, the new
duties will require expanding the
scope of practice for these dental
professionals. The new duties being
evaluated under this HWPP are:
• Determining, based on protocols, which radiographs to take,
if needed, to facilitate an initial oral evaluation by a dentist.
• Placement of “Interim Therapeutic Restorations” (ITR) when
directed to do so by a collaborating dentist.
While the short-term goal of HWPP #172 is to evaluate the safety
and the efficacy of these new duties, the long-term objectives
are to allow allied health personnel the opportunity to work
with underserved populations in community settings outside the
walls of the traditional dental office. With collaborating dentists
working from a distant setting to facilitate the appropriate care for
patients, the development of new models of care has the potential
to improve the oral health of underserved populations in addition
to employing oral health
What’s an “ITR”?
professionals in innovative
and exciting ways.
An Interim Therapeutic Restoration
(ITR) is a fluoride-releasing glass
The project has been
ionomer that can be placed in a
divided into three phases:
cavitated lesion that does not involve
planning, implementation
the pulp. ITRs can be placed without
and evaluation of the
the need for local anesthesia or a dental
data. Eleven allied dental
drill. ITRs stabilize the progression
professional participants
of dental caries making them ideal
(1 RDAES, 2 RDHs and 8
for infants, children, adolescents and
RDHAPs) were enlisted and
individuals with special health care
trained during the initial
needs when conventional restorative
planning phase. These
care is not available or care does not
participants were instructed
need to be deferred.
in the standard protocol for
determination of necessary photographs and radiographs, the use
of the intraoral camera, data collection, the use of electronic health
record systems, and the criteria and technique for placement of
ITRs. All participants were calibrated in all phases of the project.
Statewide demonstration sites and the collaborative dentists were
identified during the planning phase.
The second phase of the
project, implementation
of care, is currently in
progress. VDH demonstration
sites include Head Start
Preschools, elementary
schools, community clinics,
residential facilities for
people with disabilities, and
long-term care facilities for
dependent and elderly individuals. Initial patient assessments are
carried out by the allied dental professional in the same manner as in
a traditional dental office or clinic setting. The main difference is that
the data is transmitted electronically via telehealth technology to a
dentist in a remote location for evaluation and treatment planning.
This telecommunication technique is defined as “store and forward”.
15
PublicHealth
The comprehensive data collection includes the following procedures:
• Oral soft tissue examination
• Intra and extra oral digital photos including occlusal images
• Appropriate x-rays using the NOMAD™ portable x-ray unit
and a digital sensor
• Dental charting
• Periodontal assessment
• Saliva assessment
• CAMBRA caries assessment
The patient’s electronic records
are uploaded from a laptop onto
the secure, cloud-based, electronic
health records system called
Denticon. Once all the information
has been uploaded, the collaborating
dentist is notified by email that the patient records are ready
for review. After reviewing the records, the dentist develops a
treatment plan outlining what areas of the mouth will require
treatment and how the treatment should be performed. Patient
care including prophylaxis, fluoride varnish application, and the
placement of any necessary ITRs, is performed by the allied
dental professional in the patient’s community – be it the school
setting, group home or long term care facility. Patients may also be
referred to a dental practice in their area for appropriate care if the
collaborating dentist identifies more extensive treatment needs. The
VDH project not only promotes oral health and disease prevention,
but also creates a mechanism to track and support the individual’s
need for additional and follow-up dental care.
What the Future Holds
Data is still being collected for the VDH demonstration project.
However, two years into the project, early analysis indicates that
the project holds great promise as a cost effective
mechanism to impact the access, care, and health
of California’s diverse communities. Legislation
was introduced in April of 2013 by Assemblymen
Bocanegra and Logue (AB1174) to expand the scope
of practice for RDHAPs, RDHs and RDAESs. AB1174
has the potential to support the practice of teledentistry
as well as enable the reimbursement by Medi-Cal
for VDH treatment. The bill has been referred to the
Assembly Committee on Health for further discussion and has
been put on a two year cycle. This is definitely legislation to watch,
considering the impact it will have on expanding the ways care
can be delivered and increasing the avenues for compensating
providers. Telehealth and teledentistry hold great promise for
meeting the “Triple Aim” of healthcare reform.7 Bringing care to
the vulnerable in their communities holds the promise of improving
the overall experience of care, improving oral health and reducing
What People Are Saying About the VDH Demonstration Project
“The virtual dental home demonstration project has been an incredible
opportunity to utilize all my skills as a preventive oral health specialist.” ~ RDHAP Participant
“Because the dentist is not physically present, the extensive initial intake
assessment and case management aspects are extremely important to
improved health outcomes for the patient.”
~ RDHAP Participant
“The use of telehealth and the eyes, ears and communicative skills of the
allied dental professional are designed to provide a facility, such as the
skilled nursing home, with comprehensive care for the individual.” ~ RDHAP Participant
“Just being able to be seen is a positive asset. As a school nurse who has
been working in the district boundaries for over 20 years, I have seen the
struggles families must overcome to get their children in for dental care.” ~ VDH Site Administrator
16
“Having the services on the school site has allowed students to receive care
in a timely manner without missing school. The hygienists have helped
the students to view dental care as a positive, rather than frightening,
experience.” ~ VDH Trainee
“We are so grateful and appreciative of your work. School dental care
really helps kids and parents to detect any problems as early as possible.
Thank you so much!” ~ Parent
“The VDH is located in the exact community that it services. Access to
health services is always improved when the services provided are in
~ VDH Site Administrator
your own neighborhood.” “My wish is that the program will receive more notice in the dental
community and that it will become available to more groups within our
underserved communities.” ~ VDH Collaborating Dentist
PublicHealth
the cost of care while expanding the opportunities for better
utilization of the oral health care workforce.
For more information on the Virtual Dental Home and other
community programs of the Pacific Center for Special Care visit:
http://dental.pacific.edu/Community_Involvement.html
References are available in the online version of this issue at
www.cdha.org
About the Author
Carol Lee, RDH, MS, has been in practice
since 1977 with a career that includes
dental hygiene education, clinical practice,
and public health. A member of the
adjunct faculty at Carrington College, she
is a contributor to several journals and a
requested speaker for continuing education in
ergonomics and clinical practice. Passionate
about community dental health, Carol received the first ADHA
Community Outreach Award and has organized countless outreach
programs and activities, particularly for children, seniors and the
homebound. She is an American Academy of Dental Hygiene
Fellow, past CDHA president and serves on the CDHA Journal
Editorial Advisory Board and the ADHA Diversity Committee.
CalHyPAC
Supporting the legislative voice of Dental Hygiene
Healthcare reform is here!
NOW is a time of opportunity for the dental hygiene profession.
CalHyPAC keeps our political voice strong by:
• Educating policymakers on the needs of the dental hygiene profession
• Advocating with those who care about the oral health of all Californians,
especially children and seniors
Your financial support is essential to the future of our profession!
Contribute to CalHyPAC today!
For more information, visit us at
www.cdha.org/practice/ca_hypac.htm or email: [email protected]
17
StayingHealthy
Laura J Webb, CDA, RDH, MS
Shape Matters! The Role of Hand Instrument
Design in Work Related Musculoskeletal Disorders
I consider myself very fortunate that during the first 18 years of my
career in full-time clinical practice, I never developed a workforce
related musculoskeletal disorder (WMSDs). I believe that this
was, in part, due to my formal dental hygiene education which
emphasized the use of proper positioning, lighting, sharp and larger
diameter instrument handle, and the value of powerscaling. I was
also fortunate to work in dental practice settings where I was able
to order my own instruments, as needed, as well as have reasonable
patient scheduling. Over the last 15 years I have worked as an
educator and part-time clinical dental hygienist, which has probably
put me at lower risk for WMSDs than my colleagues practicing full
time. It also has afforded me the opportunity to experiment with
some of the new instruments so I can select the design that works
best for me. With that in mind, I would like to share some important
points to consider when selecting instruments designed to support a
long and healthy dental hygiene career.
WMSDs have long been associated with work related injuries for
dental hygienists and have been cited as one of the reasons why
many hygienists need to leave the workforce prematurely.1,2,3,4
Factors contributing to WMSDs include workforce practices
related to positioning, lighting, magnification, glove fit, instrument
sharpness, and technique.1,2,4,5,6
Periodontal debridement procedures carried out with hand
instruments may put dental hygienists at higher risk for carpal
tunnel syndrome (CTS), a WMSD and nerve compression disorder.
Hand instrumentation procedures can comprise 50% or more of
the workday activity requiring a high level of precision and pinch
force from the dominant hand during instrumentation and static
force from the non-dominant hand during retraction procedures
with the dental mirror.4,7
Instrument handle design is an important factor to consider when
developing strategies for lowering our risk for CTS.5
Critical features include the following:
• Round handles remove the stresses experienced with the
flat surfaces and corners found with older style hexagon or
octagon handles.5
• Research supports the theory that larger diameter handles
decrease the pinch force and muscle activity required for
instrumentation.5,7 Some studies suggest that a 10mm
diameter is the optimum and preferred diameter and report
18
that the use of a larger diameter does not statistically improve
outcomes.6,7,8 Other experts believe that a 9mm diameter
should not be exceeded or functionality may be lost.5
• The use of lightweight (less than 15g) handles can be
beneficial as they require less pinch force.5,7,8 Lightweight
tube handles can be more expensive and handles with thin
walls may make them more prone to failure.9
• Non-serrated instruments may be easier to clean and sterilize,
but knurls/serrations in handles assist in increased friction
and control. Manufacturers strive to create the perfect “pattern”
that is functional but does not tear gloves or abrade fingers.5,6
In one study, it was concluded that use of nitrile gloves and
knurled resin surfaces provided the greatest friction.9
• Resin/plastic/silicone handles may flex contributing to
reduced tactile sense, certainly a problematic feature for dental
hygienists. Some instrument companies have addressed this
problem by placing a stainless steel rod through the handle.
This adds stability but also adds a little weight.1,5 Resin/plastic/
silicone handles also tend to lose color over time and may be
prone to cracking. Titanium and aluminum handles discolor,
fade, and pit with repeated cleaning/sterilization procedures.5
It is worth noting that neurosurgeons and orthopedic surgeons have
recommended that clinicians alternate the diameter and weight
of instruments used during periods of practice so the stress to
muscles is not identical with each use and to allow the muscles to
recover from stresses.1,4,5
Some instrument manufacturers have developed innovative handle
designs that take into consideration repetitive stress activities:
• G Hartzell & Son manufactures light-weight stainless steel
handles in a variety of designs in addition to a silicone resin
handle design with an internal stainless steel rod. They report
that their 9mm diameter “A” handle is the lightest weight
stainless steel handle available. It is made with an ultralightweight stainless steel with a special slip-resistant knurl
pattern. (Figure 1).
Figure 1: CSHA, ultra-lightweight 9mm stainless steel “A” handle,
Courtesy of G. Hartzell and Sons
StayingHealthy
The “Spectra-Touch” (resin) 9.5mm (at widest point)
diameter handle comes in eleven colors, and has slight
cushioning on the grips. (Figure 2).
Figure 2: Spectra-Touch, lightweight 9.5mm silicone resin handle
courtesy of G. Hartzell and Sons
• Hu-Friedy manufactures a lightweight, “slightly over 3/8
inch” (9.5-10mm) diameter resin handle with a steel inner
core design that is available in a variety of colors. (Figures 3
& 4). It is uniquely textured with wavey grooves and knurling.
Figure 3: Resin 8 handle courtesy of Hu-Friedy
Figure 4: Steel inner-core courtesy of Hu-Friedy
• American Eagle Instruments has designed a lightweight,
aggressively knurled, 9mm diameter, solid medical grade resin
handle available in a variety of colors. (Figure 5). The resin
handle along with the tips weighs approximately 12gms. 5-13
• Paradise Dental Technologies (PDT) makes a 10mm
diameter, lightweight, knurled, solid resin handle which is
available in a variety of colors. (Figure 6). PDT reports that this
solid design reduces weight and increases tactile sensitivity.
Figure 6: 10mm, lightweight resin handle courtesy of PDT
A instrument design does not fit all and shape does matter! Dental
hygienists have varying opinions about which design features
contribute best to their personal comfort and tactile sense. Some
clinicians prefer solid handles as opposed to hollow handles,
especially for mirrors, explorers and probes. Hygienists with small
hands/fingers may prefer the smaller 8mm handles.5 It is fair to say
though, that many of us practice with instruments based upon what
we learned in school and we may not have taken the opportunity to
experiment with newer designs.
WMSDs pose a real threat to a dental hygienists’ health, quality
of practice, and career longevity. Making careful evaluation and
experimenting with a variety of instrument designs should be a
professional priority for all clinicians!
Instrument Manufacturer Contact Information
American Eagle Instruments – www.am-eagle.com
G. Hartzell and Son – www.ghartzellandson.com
Hu-Friedy – www.hu-friedy.com
Paradise Dental Technologies – www.pdtdental.com
Figure 5: Lightweight, 9mm, medical grade resin handle
courtesy of American Eagle Instruments
Table 1 – Critical Instrument Design Features
Shape
Round
• Removes stresses
associated with flat
surfaces and corners
Size
Weight
Larger
Lighter
• Requires less
• Requires less
pinch force
pinch force
• 9-10mm
• May be prone to
optimum/preferred
fail due to thin
walls
Friction
More
• Requires less pinch
force
Knurled handle
• Improves friction
• Excessive knurls may
tear gloves
Non-knurled handle
• May be easier to
clean and sterilize
Materials
Plastic, Resin or Silicone
• Possible tactile challenges; solid design
may enhance tactile feedback
• May pose a flex factor
• May pose durability challenges
• Risk of contamination in seams/grooves
Aluminum
• Discolors, fades, pits during sterilization
Titanium
• Expensive, fades, pits during sterilization
19
StayingHealthy
About the Author
References:
Laura J. Webb, CDA, RDH, MS, an
experienced clinician, educator, and speaker,
is the owner of LJW Education Services.
Laura provides educational methodology
courses and accreditation consulting services
for DH/DA education programs as well
as CE courses for professionals including
instrumentation and provision of local
anesthesia. She completed her undergraduate
work at Foothill College and San Jose State University, and holds a MS
in Health Service Administration from University of St Francis. With
over 40 years of experience in dentistry including general and specialty
private practice settings, Laura has written and reviewed articles and
textbook chapters for a variety of professional publications, and is
the 2012 recipient of the ADHA Alfred C Fones Award. Laura can be
reached at www.ljweduserv.com.
1. Ahern S. (2010). Applying ergonomics to dental scalers, (Master Thesis)
Kansas State University
2. Hayes MJ; Cockrell D; Smith Dr. A systematic review of musculoskeletal
disorders among dental professionals. Int J Dent Hygiene 7, 2009; 159-165
3. Morse T; Michalak-Turcotte C; Atwood-Sanders M; Warren N; Peterson D;
Bruneau H; Chernaiack M. A pilot study of hand and arm musculoskeltal
disorders in dental hygiene students. Journal of Dental Hygiene Vol 77, Issue
III, 2003; 173-179
4. Simmer-Beck M; Bray K; Branson B; Glaros A; Weeks J. Comparision of
Muscle Activity Associated with Structural Differences in Dental Hygiene
Mirrors. Journal of Dental Hygiene, Vol 80, No.1, 2006; 1-16
5. Hartzell, A. (n.d.) “Ergonomics for Instruments”, (presentor’s notes)
G. Hartzell & Son
6. Stanfield J. A better way to scale. [Internet]. Missoula; Paradise Dental
Technologies; c 2013. [cited 2013 Jun 20] Available from:
http://www.pdtdental.com/documents/2011Gen/A_Better_Way_to_Scale.pdf
7. Dong D; Barr A; Loomer, P; LaRoche C; Young E; Rempel D. The effects of
periodontal instrument handle design on hand muscle load and pinch force.
JADA, Vol 137, 2006; 1123-1130
8. Piercy, DA. Can choice of scaling instruments affect wrist and hand pain?
Dental Health (UK) 47:4; July 2008; 5-6
9. Laroche C, Barr A, Dong H, Rempel D. Effect of dental tool surface texture
and material on static friction with a wet gloved fingertip. J Biomech 2007;
40 (3); 697-701
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20
Tonya Lanthier, RDH
StudentConnection
2013 Cora Ueland Scholarship Award Recipients
Cora Ueland, founder and first director of the dental hygiene program at the University of Southern California, expected the highest standards
of scholarship and professionalism of her students. The Cora Ueland Scholarship was originally established in the 1950’s as a student loan fund.
In 1998, the California Dental Hygienists’ Association converted the loan program to an annual scholarship award open to first and second
year dental hygiene students. Two $1,000 scholarships are awarded to a first and second year student annually by Dental Hygiene Associates
Incorporated (DHAI), the not-for-profit foundation of the CDHA. This year’s scholarship recipients are outstanding examples of Cora Ueland’s
commitment to excellence in education and service to others.
Tiffany Setiono, a first year dental
hygiene student at Loma Linda University,
earned her Bachelor of Arts degree,
majoring in biology, from Westmont
College in Santa Barbara. In 2012 while
working as a dental assistant in Boston,
Massachusetts, Tiffany was part of an
interdisciplinary team providing care
to homebound older adults associated
with the Boston University Henry M.
Goldman School of Dental Medicine. As part of the Geriatric
Dentistry Fellowship program, she assisted her dental colleagues
in researching oral health and systemic health co-morbidities in
centenarians and their offspring. The results of the group’s research
were later presented at the Special Care Dentistry Association’s
annual meeting and at the International Association for Dental
Research meeting. Participating
in this program inspired Tiffany’s
commitment to serve vulnerable
populations both locally and
globally while advancing the
practice of dental hygiene.
Chelsey Brown is a second year dental
hygiene student at West Los Angeles College.
She received an Associate of Science degree
from Brigham Young University in Rexburg,
Idaho and then continued on to complete
her education at Brigham Young University
in Laie, Hawaii where she was an active
member of the dental club. Committed to
providing public health education and services to needy populations
both locally and internationally, Chelsey traveled to Uganda where
she was able to provide dental hygiene education to children and
adults in remote villages. As a student in the West Los Angeles College
Dental Hygiene Program, Chelsey and two of her classmates organized
“Running for Healthy Smiles” to raise money for the MEND not-forprofit dental clinic. Chelsey’s passion for the profession clearly shows
and she is hoping to pursue a master’s
degree in public health and become
a dental hygiene educator. Chelesey
is honored to receive the Cora Ueland
Scholarship and would like to thank her
family, classmates and faculty for their
support in her ongoing education.
National Boards – Are You Prepared?
Preparing for the National Board Examination is one of the most
stressful experiences in the life of a dental hygiene student. Just ask
any graduate about the many hours of studying spent to get ready
for this comprehensive test of dental hygiene knowledge! With that in
mind, the California Dental Hygienist’s Association will be sponsoring
a unique opportunity for students on Saturday, November 2, 2013 at
the Hilton San Francisco Bayfront Hotel. “Applying Critical Thinking
to Case Studies: An Advanced Review for the National Board
Exam” is a 5-hour review course designed to assist students with
the strategies needed to address both stand-alone and case-based
questions. This fast-paced, non-traditional program is geared to help
students apply the concepts learned in dental hygiene coursework
to a variety of case studies. Topic areas include preventative agents,
systemic/oral relationships, caring for medically compromised
patients, patient assessments, and planning for dental hygiene care.
Presenter Pam Hughes, RDH, MS brings over 33 years of experience
to the program she has specifically designed
to strengthen and enhance critical thinking
skills. A nationally recognized speaker,
Pam practices clinically and holds a faculty
position at the Ostrow School of Dentistry
of the University of Southern California in
the Division of Periodontology, Diagnostic
Sciences, Dental Hygiene and the Master
of Science Dental Hygiene Graduate Program. She has presented
this course to dental hygiene students across the country and has
received excellent feedback from program participants. You won’t
want to miss this opportunity to kick off your preparation for the
National Board Exam! Course tuition is only $75 and includes
breakfast. This program is supported by an Educational Grant from
P&G Oral Health, Crest Oral-B. Download the registration form
at www.cdha.org or call 916-993-9102 to reserve a space.
21
StudentConnection
Student Delegates to the American Dental Hygienists’ Association
Celebrating 100 Years of the Profession
Students from California and Arizona were well represented by the District
XI student delegate, Sarah Micek (left), from Chabot College in Hayward,
California. Sarah, along with
alternate student delegate Katie
Silke (right) from Moreno Valley
College in Riverside County, CA
recently returned from the 90th
Annual Session of the American
Dental Hygienists’ Association
held in Boston, Massachusetts.
The CDHA Journal recently
caught up with Sarah and Katie after their busy week at the celebration of the
century to ask them about their experiences meeting students and hygienists
from across the country.
How did you become interested in serving as student delegates to ADHA?
Sarah: Membership in CDHA and ADHA is required of dental hygiene
students at my school. When I joined I had a vague idea of what CDHA and
ADHA stood for but I knew I was missing something. One of my instructors
informed my class of the opportunity to apply for the student delegate
position, and I was fortunate enough to be selected. I want to take every
opportunity as a student to learn more about my chosen profession. It was
truly an experience of a lifetime for me, and it was an honor for me to be able
to actively participate in the House of Delegates at CDHA and ADHA.
Katie: As a first year dental hygiene student I joined ADHA and CDHA. I felt
that as a student member of the dental hygiene profession it is important to
support and be involved in my professional organizations. I was interested
in the opportunity to participate in the association as a student delegate
and learn more about how the ADHA supports dental hygienists and the
profession. Dental hygiene is growing and evolving. I believe that I have a
responsibility to my patients, as well as to myself and my new profession, to
stay current and be actively involved in the changes that continue to move
dental hygiene forward.
Out of the 24 student ADHA delegates and alternates, two positions
were voted on by the students. Sarah was elected to be the voting
student delegate and sit on the floor of the ADHA House of Delegates.
Please tell our readers about this position and what it was like to
represent student voices from across the country?
Sarah: As the voting student delegate, I was able to participate in the
debate as resolutions were being proposed and I was also able to represent
the students with my vote. This position was really a challenge because our
country is so vast and diverse. There are many differing opinions on how we
should move the profession forward. Although the students all had differing
backgrounds, we shared a common goal – professional autonomy and
22
advancing our ability to promote health in a variety of settings. I always tried
to focus on this shared goal when voting on behalf of all of the students.
Katie: I could not have been happier that Sarah was elected the Voting
Student Delegate. She is so passionate about the profession and is not afraid
to ask questions or to share her outlook about the issues at hand. She is
also able to listen to all the different sides of a discussion and formulate a
response or decision on what is best not just for her or the students in our
district, but for dental hygiene students across the country.
How will your experiences as student delegates shape your future as
leaders and members of the dental hygiene profession now that you are
second year students?
Sarah: My idea of what it means to be a dental hygienist has really matured.
I learned about a number of future career possibilities including employment
in schools, hospitals, and research facilities. I feel empowered knowing that
I can be more creative in what I want my career to look like and I will take
a more proactive approach to my future instead of letting the job market
determine where and how I will practice.
Katie: My experience as District XI Alternate Student Delegate was
empowering, motivating, and inspiring. I have had the opportunity to see
first hand how members can have a voice and play a part in advancing
the dental hygiene profession and increasing access to care. Through this
experience I have witnessed the importance of being a member of the ADHA
and CDHA as well as my local component. I know that I will stay involved
and would like to further my involvement as an ADHA Delegate from
California once I graduate.
Do you have any final comments on your experience?
Katie: Having the opportunity to attend the 90th Annual Session and
House of Delegates in Boston to celebrate 100 years of the dental hygiene
profession was priceless and I am so grateful for this opportunity. I would
like to extend my gratitude to the ADHA and District XI for making this
experience possible and so memorable. I am already looking forward to next
year’s Annual Session.
Sarah: I had no idea what to expect going into this experience. I really
enjoyed participating in the process of deciding on the resolutions that will
shape the policies and future direction of the dental hygiene profession. It
was exciting to listen to the wide range of opinions and viewpoints while
also contributing your own perspective. I now realize that it has been a
collaborative process bringing the profession to its current standing. Our
profession needs to remain collaborative and continue to move forward in a
positive direction for the next 100 years. I am excited to learn more and I
definitely plan on continuing my involvement in our association. I have already
marked my calendar to attend next year’s Annual Session in Las Vegas!
StudentConnection
California Students Shine in 2013 Table Clinic and Research Competitions
Hundreds of dental hygiene students from dental hygiene programs
throughout the state came together in Anaheim for the Annual
CDHA Table Clinic Competition in April. This year marked the
second year of collaboration with the California Dental Association,
bringing additional judges from the CDA along with funding for
monetary awards for the winning presentations. Selecting the
winners is never an easy task and this year was no exception.
Considering the many hours of research and preparation that goes
into each presentation, all of the student participants are truly
“winners” by making valuable contributions to the exchange of
information amongst professional colleagues.
Abstracts from the award winning presentations can be found
at www.cdha.org
Informational Table Clinic Award Recipients
1st place
“Rheumor Has It”
Nicole Pelc and
David Whaley
Cerritos College
2nd Place
“Teeth Strengthening
with Cocoa”
Alana Kerr, Joanne Laqui
and Nguyen Nguyen
Cypress College
3rd Place
“The Perio Path to Alzheimer’s”
Kathleen Kirchner and
Kathryn Marshall
Cypress College
Research Table Clinic Award Recipients
1st Place
“ The Effects of Mineral
Oil Based Products on
Latex Gloves”
Nicole Black, Jeanelle
Junn, Leah Regan and
Kimberly Swanson
Loma Linda University
2nd Place
“Unmasking the Truth”
Nadia Nava, Madona Nova
and Susanna Magana
Cerritos College
3rd Place
“Effects of Probiotics in
Reducing Cariogenic Bacteria”
Christine Galindez, Patricia
Malubay, Brynn Meza and
Wendy Wu Sotelo
West Coast University
Special thanks to Crest Oral B, the CDA and the CDA Foundation
for sponsoring this year’s table clinic competition
Students from Cerritos College, Loma Linda University, University
of Southern California and West Coast University travelled in
June to Boston, Massachusetts to present their original research
and informational table clinics at the 90th Annual Session of the
American Dental Hygienists’ Association. Over 70 presentations
were made by undergraduate students alone during the landmark
session celebrating 100 years of the dental hygiene profession.
Once again, California students shone with their presentations.
Students Cristina Chavez and Tamae Glover from Cerritos College
placed first with their table clinic “An Intimate Relationship…
HPV and Oral Cancer” and their classmates Nicole Pelc and David
Whaley placed second with their clinic “Rheumor Has It”.
23
CareerCorner
Aubreé Chismark, RDH, MS
Michelle Smith, RDH, BA – Overcoming Physical
Challenges in Practicing Dental Hygiene
Michelle Smith is a native
of San Juan Capistrano,
California and has been
practicing clinical dental
hygiene for 36 years. She
began her education at
Saddleback College and
hoped to complete her
dental hygiene education
at a school in southern
California, but ultimately
settled on Idaho State
University. After completing
three challenging years
in Pocatello to earn her
bachelor’s degree in dental
hygiene and taking board exams in three states, Michelle was happy
to come back and settle down in Orange County. Her first position as
a registered dental hygienist was with Dr. Philip Potter, a University
of Southern California (USC) graduate. She was his first hygienist
and was surprised that he actually hired her since she was not a
Trojan! After 27 years, orthopedic problems dictated that Dr. Potter
sell his practice and Michelle began to look for other opportunities.
She met her current employer, Dr. Collins Harrell, while attending
the California Dental Association (CDA) convention several years
ago and later inquired about working in his San Clemente dental
practice. Since Dr. Harrell has been a long-time believer that “God
puts people in his path for a reason” he responded, “Let’s give it
a try.” That was six years ago and their working relationship has
been another good fit. Outside of private practice Michelle is happily
married and the mother of two grown sons. Michelle’s career as
a dental hygienist would probably not be particularly remarkable
except for the fact that her life changed dramatically when 18 years
into her career, she was thrown from an all-terrain vehicle. She
sustained a spinal cord injury leaving her a paraplegic. Michelle has
worked the second half of her career from a wheelchair. I had the
opportunity to interview Michelle Smith recently to get some insight
on what it is like to maneuver through the world of clinical practice
with a physical disability.
24
Can you describe what happened during the accident?
My family and I had been in the desert riding all-terrain vehicles
and as I was going down a steep hill, I hit a bush and launched
myself up into the air. This was my first and only ATV accident
after about 10 years of riding. I don’t have any memory of the
impact of the fall. As there were very few cell phones back in
1995, my husband was forced to leave me to go back to the
camp and find someone to call for help. I tried to remain as
calm as possible in front of my kids, who were only nine and
seven years old at the time, until the helicopter eventually came
to rescue me. The impact of the fall broke my back causing a
spinal cord injury that rendered me a paraplegic. It also broke
my left humerus requiring a metal plate to be surgically placed
into my arm. Incidentally, both of my sons have grown up to be
firefighters and the younger one is a paramedic.
How much time did you take off from work and what were
your thoughts regarding your career after the accident?
My rehabilitation took 18 months for me to learn to drive again
and navigate life in a wheelchair. I went to physical therapy three
times a week for a year
to learn strength training
and how to cope with
paraplegia. Through it all,
one of my greatest concerns
was, “How can I get back
to work?” I credit my
employer at the time, Phil
Potter, with a huge part of
my recovery. He made it
clear that I would still have
my job if I could find a way
to come back. His faith brought me to tears because it gave me
hope. Knowing his expectations I thought, “Okay, let’s see what
we can do!”
Remembering that I had once read about a dentist or a hygienist
practicing in a wheelchair, I needed to find a way to locate him
or her to learn how it was done. I called the American Dental
Hygienists’ Association (ADHA) and the California Dental
CareerCorner
Hygienists’ Association (CDHA) to inquire about a network of
disabled dental personnel and found that no such network existed
at that time. I was disappointed and started combing through old
magazines looking for leads as this was long before the Internet.
Then it occurred to me to try the dental equipment companies to
see if they had any experience with practitioners with disabilities.
That’s when I contacted A-dec.
Many years before I needed help, A-dec had designed a hand
control for disabled dental practitioners who were unable to use a
rheostat. I also found out that A-dec would provide me the hand
control free of charge. The hand control was developed by the
former president of the company, Ken Austin, along with another
long-time employee engineer. The device enables me to easily
activate a handpiece, piezoelectric, and a Cavitron scaler ®. Ken
Austin, who has a background in Industrial Arts, later called me
personally wanting to know if I could think of anything else that
would make my job easier. I responded, “I can think of one thingbut it may be a pretty tall order; I would love to have a wheelchair
that goes not only front and back, but moves from side to side.”
He laughed and said, “Yes, that’s a tall order. What a great idea!”
Unfortunately, I am still waiting on that one.
How long did it take for you to adjust to practicing again
and what were some of your biggest challenges when
returning to work?
It took about two months for me to feel comfortable working in
private practice again after my accident. Initially, I worried about
what our patients would think about a hygienist working from a
wheelchair, but most everybody
at Dr. Potter’s office already
knew about my accident due
to the quarterly newsletter
he regularly mailed to our
patients. There were definitely
some limitations. For example,
due to the small operatory
size, I couldn’t roll around
patients very easily and I was
occasionally limited visually,
especially on the lower left side
of a patients’ mouth, depending
on the stature of the patient. My patients were most understanding
and at my request, Dr. Potter checked my work regularly.
After Dr. Potter retired and I changed practices, my new employer
was able to incorporate some of my special needs into the
office space. When Dr. Harrell decided to add an operatory, he
immediately went to A-dec after hearing about their generosity with
my hand controlled rheostat.
The hand control and
Cavitron® were incorporated
into the new unit, which can
also be used by our ablebodied staff members. The
chair works beautifully for me
and my patients. I can take
digital radiographs, including
panoramic images, plus I can
access the sterilization area
to clean my own instruments.
Because of the spacious
layout of this office, I can do everything all of the other staff
members are able to do and for this I am so grateful.
How many days are you currently working and how many
more years do you plan on continuing to practice?
Currently, I’m practicing two days a week and see one patient
every hour. I hope to practice clinically for another 5 to 10 years.
I have casually entertained the thought of teaching dental hygiene
some day especially because of my experiences. However, ever
since my spinal cord injury, my greatest passion has been for
Juice Plus+®, a nutritional supplement I first learned about back
in 1996. Juice Plus+® is a capsule filled with fruit and vegetable
extracts containing fiber, vitamins, minerals and other natural
substances with antioxidant properties. I found that after adding
these supplements to my diet that my overall health has been
excellent. As an independent distributor of this product I have been
able to establish a home-based business that can follow me into
retirement, and is also the perfect adjunct to the dental health
education I provide my patients with on daily basis.
What advice would you like to offer to dental hygienists
currently practicing and do you have any inspirational
thoughts you would like to share regarding life in general?
The best advice I can share with other dental hygienists includes
the following: stay true to yourself; speak up when necessary;
work from your heart; enjoy life; stay current with continuing
education; get loupes if you don’t have them; go digital; try new
25
CareerCorner
instruments; have productive staff meetings on a regular basis;
learn to get along with and enjoy each member of your team;
improve your nutrition and get adequate rest to minimize illness
and absenteeism.
Make sure you have disability insurance, especially when
engaging in risky activities! I didn’t have any insurance when
the accident occurred and it was a huge regret. You never know
when a catastrophic event will occur and you are unable to work
either temporarily or permanently. Pursuing a higher education
degree is another great option since it can open the door to other
employment opportunities.
Working with a responsible, reliable, cohesive team is vital to a
long-term, gratifying career in clinical practice. Dental hygiene is a
great profession and I have really enjoyed working with Dr. Harrell.
I love the way he talks to our patients. He is an honest and casual
man of integrity who has facilitated the formation of our cohesive
team which, in turn, enables each one of us to deliver the best care
to our patients.
If something happens in your life always remember, “Don’t give up!”
Try not to freak out and go crazy because it never benefits anyone;
calm down, relax, think, pray/meditate, seek advice, and then
typically something good will happen. Blaming others is pointless.
“Life’s not fair and you simply have to accept that reality sometimes.”
My motivation for agreeing to be interviewed for this feature is to
be available for others who may have experienced a life-changing
event like me or for anyone interested in developing a home-based
business that can fit perfectly with oral/systemic health education.
Please feel free to contact me at [email protected]
About the Author
Aubreé Chismark, RDH, MS, is an
Assistant Professor in the Dental Hygiene
Department at West Coast University
in Anaheim, CA, as well as a registered
yoga teacher with the Yoga Alliance.
She is a member of the CDHA Journal
Advisory Board. Her research interests
include ergonomics and the use of
Complementary and Alternative Medicine
to reduce chronic musculoskeletal pain. She can be contacted at:
[email protected].
26
Thank You Michelle for Your
Dedication to Our Profession
Michelle is the one of the happiest,
most optimistic, positive and energetic
people I know. The fact that she
practices dental hygiene from a
wheelchair does not slow her down one
bit! All the patients love her. Anytime I
think I have a challenge or something
to whine about, I just consider
Michelle’s amazing attitude toward life
Michelle and
and I feel inspired to charge ahead
Collins Harrell, DMD
with a smile on my face and gratitude
in my heart. She is an amazing part of our team!
~ Collins Harrell, DMD
I have worked with Michelle since 1993. I can honestly say that
she is as kind, caring, professional, upbeat, and inspirational
as she was before her spinal cord injury. If it could be possible
she is even more so now. In all of the years since her accident I
have only heard say once that she didn’t want to be in a wheel
chair. She is a pillar of strength, faith, and love.
~ Patty Wise, Office Manager
Michelle has been an inspiration to me both inside and
outside the dental practice. Not a day goes by that Michelle
is not her “perky” self, always cheery and never a “BAD” day
attitude. She is a health care provider who practices what
she preaches. Preventive care all the way - healthy diet,
exercise, oral hygiene - the total package. Her patients love
her. She has a way of letting you know that you are special
to her and she is there for you in any way you need her!
~ Lynn Kolodziej, RDH
There are some people you just look forward to seeing at
the start of your day and Michelle is that person. Maybe it’s
because she always makes you feel good about yourself. She
is the person who reminds us to see the positive in all we
do. By her example, she is teaching me that our attitudes
are a choice and with the right attitude and perspective, we
have the opportunity to bless many lives.
~ Christian Macey, RDA
EducationExchange
Vickie Kimbrough-Walls, RDH, PhD
Educators will find many references to pedagogy
when it comes to student learning and teaching
methodologies. In fact, Merriam Webster defines
pedagogy as “the art, science or profession
of teaching”, and Roget defines it as “the act,
process or art of imparting knowledge and skill”.
The root of pedagogy stems from the Greek
words paidos, meaning “child”, and ágõ, meaning
“lead”. However, traditional pedagogy methods
do not always work well when it comes to
teaching adults. Another Greek term, andragogy
has been found to be more appropriate to address
the teaching of adults. “Andros” refers to man –
so “leading man or adults” is more suitable for
adult learners. Andragogy was originally used
by the German educator Alexander Kapp back in
the 1800’s, yet the theory of andragogy was first
developed by Malcolm Knowles in 1967 as he
defined adult education.1
Though, just what is an adult learner? Knowles,
spent many years and a great deal of energy
answering this question. He identified adults by
two criteria: an individual who performs roles
associated by our culture as adults (worker,
spouse, parent, soldier, responsible citizen) and as
an individual who perceives himself or herself to
be responsible for his/her own life.1
The majority of college
students today are
young adults. The
American Association
of Community Colleges
reported in 2012 that
the average age of
community college
students as 28 years old,
with 45% falling between the ages of 22-39 and
15% reported as being 40 years of age or older.
Adult learners enter healthcare education
programs at varying stages of life. Knowles,
explains that experience is one way for educators
to engage students in their learning process.3
Experiential and problembased learning techniques are
commonly used in healthcare
education programs allowing
adults to participate as active
learners. Using experiential and
problem-based methodologies
also assists teachers in helping
students develop critical thinking skills, apply knowledge to patient cases, and
reflect on whether or not desired outcomes were achieved.
Community college educators realize that students in healthcare programs,
including dental hygiene, are generally older, work more hours outside of school,
have families, and also live at home.2 As a result, there are many outside influences
in how students learn dental hygiene content. The curriculum is also impacted
with required competencies mandated by the Commission on Dental Accreditation
(CODA), therefore students can be overwhelmed in meeting the requirements for
all of their courses in any given semester or quarter. So, what does it take in today’s
learning environment to be successful in programs such as dental hygiene?
Dental hygiene educators advocate that good teaching begets effective learning in
students, yet today’s students have different learning styles and require more active
teaching methodologies than traditionally practiced. Student learning styles have
been historically categorized as visual, auditory, and kinesthetic. While these styles
are still recognized, today’s students require more stimulation to maintain interest
in the subject, and seek more one-on-one demonstration to learn technical skills.
Furthermore, dental hygiene educators must acknowledge the impact social media
has had on students in general, and their need to text, tweet, and Facebook while
sitting in classrooms. Educators have an enormous
amount of content to distribute to students during the
program, yet traditional, formal teaching methodologies
still take precedence. PowerPoint presentations,
handouts, reading assignments, quizzes, tests, and
performance competencies are still the primary
methods used to impart knowledge.
Today’s students, adults with busy lives outside of
school, are tech savvy, and easily bored. They don’t
want busy work; they want work that is meaningful and
applicable to their career goal. Students often expect to be handed the required
information and don’t want to feel as though their time has been wasted. Adult
learners are also sensitized to using social media and technology throughout the
day. They want real-world examples from instructors versus off topic tangents
which take them away from the concepts they are expected to master.
27
EducationExchange
Adult learners tend to take a more casual approach to learning
content and learn better through the more informal processes
used by educators. Even large corporate organizations report that
informal learning accounts for 75 percent of all learning acquired
in the workplace.4 What is informal learning? Informal learning
as described by Marcia Conner, is a lifelong process whereby
individuals acquire attitudes, values, skills and knowledge from
daily experience and educational influences.4 Knowledge can be
acquired from many other resources in the student’s environment
- from family and neighbors, work and play, the market place, and
the mass media, just to name a few. Therefore, adult students learn
in the classroom and clinic as well as from other life experiences.
Dental hygiene is considered formal education and often taught
as such, yet students have so many more interactions with faculty
and peers that informal learning takes place as an unintended
consequence. Educators need to acknowledge the role that informal
learning plays and its impact on the adult learning process.
A second category identified by Conner, non-formal learning,
is defined as any organized educational activity outside the
established formal system. Non-formal learning may take place
separately or as an important feature of some broader activity
intended to serve identifiable learning objectives. The various
learning processes that take place in any given environment are
illustrated in Figure 1.
Figure 1. Conner’s depiction of formal and informal learning segments.
Despite the formal education process and the traditional thinking
of visual, auditory, and kinesthetic learning previously mentioned,
dental hygiene students’ learning styles may fit better into
categories such as those developed by Skip Downing creator of
the “On Course” program. Downing promotes learning styles such
28
as thinking, doing, feeling, and innovating.5 Thinking learners
are energized by the “what” questions, so they can ponder the
facts. These learners respect the logical argument, and want
to participate in discussion. Doing learners are energized by the
“how” questions. Doers enjoy taking action with practical examples
and prefer objective testing methods. Feeling learners focus on the
“why” and “who” questions. These students benefit from personal
connections with faculty and classmates and supportive learning
environments. The innovative learners thrive in the “what if”
situations. They seek new possibilities and alternatives. Learning
environments encouraging discovery and intuition allow for more
creativity and critical thinking. A variety of informal learning
techniques that can be used with all students, regardless of any
cognitive learning challenges, are described in Table 1.
Table 1. Examples of informal classroom learning
and assessment techniques
Cell Phone Polling6
Poll questions are embedded into slide
presentations during lectures and
have students respond providing ‘live’
immediate feedback.
Muddiest Point7
Students write a topic or question that
remains unclear on an index card. The
instructor clarifies for enhanced student
understanding.
Individual and
Group Testing8
Students take a quiz or test individually,
then merge into small groups to learn
correct answers and discuss.
Visual Lists9
Students work in groups and list subjectmatter content items on a white board
for discussion.
The principles of andragogy are definitely applicable to the adult
students currently enrolled in dental hygiene programs. Because
students vary in age, life experiences, and personal obligations,
their learning is influenced in multiple ways. Today’s dental hygiene
education environment may be well suited to modification and
the inclusion of more informal learning experiences providing
opportunities for students to be thinkers, doers, feelers, and
innovators. Student success can be enhanced through the
implementation of a variety of teaching techniques and methods
that are more supportive of contemporary adult learning styles.
EducationExchange
About the Author
References
Vickie Kimbrough-Walls has been
in the dental field for 44 years. She
worked as an RDA for 19 years
beginning her college education for
dental hygiene. A 1993 graduate of
the Cerritos College dental hygiene
program, she began her teaching
career at Taft College in 1997.
Vickie has been a program director
for Shasta College, Truckee Meadows Community College
and currently Southwestern College. She earned her MBA at
University of Phoenix and doctorate in educational leadership
at University of Nevada, Reno. She is the co-author of two
dental hygiene textbooks “Ethics, Jurisprudence and Practice
Management in Dental Hygiene”, and “Oral Health Education”.
A past president of CDHA and a recipient of the ADHA Irene
Newman Award, Vickie is currently the Chair for the ADEA
Council of Allied Dental Program Directors and the CDHA
Speaker of House of Delegates.
1. Thoms, KJ. They’re not just big kids: Motivating adult learners. [Internet] St. Cloud,
(MN): St. Cloud State University; 2001; [cited 2013 May 29] [1 screen]. Available
from http://www.eric.ed.gov/PDFS/ED463720.pdf
v
2. American Association of Community Colleges [Internet]. Washington (DC). AACC:
Community Colleges Students; 2013 [cited 2013 May 29] [about 3 screens].
Available from http://www.aacc.nche.edu/AboutCC/Trends/Pages/default.aspx
3. Knowles, MS, Holton III, EF, Swanson, RA. The adult learner. 5th ed. Houston:Gulf
Publishing;1998.
4. Conner, M. Informal Learning [Internet] Concord (MA) [1997-2012; cited 2013, May
29] [1 screen]. Available from http://marciaconner.com/resources/informal-learning
5. Downing, S. On Course: Strategies for success in college and in life.
Boston:Wadsworth Publishing; 2012.
6. Poll Everywhere Instant Audience Feedback [Internet]. Walnut, (CA)
Poll Everywhere; 2013 [cited 2013 May 29]. Available from
http://www.polleverywhere.com
7. Angelo, TA, Cross, KP. Classroom assessment techniques, a handbook for college
teachers, 2nd ed. San Francisco; Jossey-Bass Publishers;1993.
8. Fink, D. Designing courses for significant learning [Internet] Norman (OK) 2013
[cited 2013, May 29] [2 screens]. Available from
http://www.deefinkandassociates.com/
9. Paulson, D, Faust, J. Cooperative Learning [Internet] Los Angeles (CA) 2013 [cited
2013 May 29] [1screen]. Available from
http://www.calstatela.edu/dept/chem/chem2/Active/main.htm
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29
NewsBytes
Mary Camarena, RDH, Coordinator for
CommuniCare Health Centers’ Smile Savers
Dental Outreach Program, was the recipient of a 20122013 Wm. Wrigley Jr. Company Foundation Community Service
Grant. For nearly 20 years Smile Savers has been working with
local school nurses and teachers to reach children in the classroom
in order to help establish good dental health habits as a vital part
of a healthy lifestyle, and provide dental intervention services with
the goal of preventing more serious oral health complications later
in life. The Smile Savers program visits preschools, elementary
schools and special education classes throughout Yolo County, a
rural region in the Sacramento Valley, providing age-appropriate
oral health education, dental screenings and fluoride treatments.
The program also provides for the placement of dental sealants
on the molars of those age-appropriate students screened and
presenting with the greatest need to prevent more serious dental
caries and tooth decay. In 2012-13 Mary and her Smile Savers
volunteer staff took their portable dental clinic to classrooms
to offer oral health education to nearly 2,000 students, and
proformed 1,200 dental screenings, in addition to applying fluoride
varnish to 649 students,
and placing sealants on
the molars of 138 children.
CommuniCare’s Smile
Savers program began
with state funding that
has long ended due to
budget cuts. Without the
support of volunteers,
student hygienists, local
funding through United
Way and the grant funding
of the Wrigley Foundation,
the program would have Mary Camarena, RDH, checks a student’s oral
health using portable dental equipment set up
to scale back classroom
on-site at a local elementary school.
services by up to 50%.
CommuniCare, a Federally Qualified Health Center, is the main
provider of dental care to the low income and uninsured population
of Yolo County, and the only dental provider seeking to ensure
access to dental care to all those in need, regardless of their ability
to pay for services.
30
News and Information you can use today!
Kimberly Cruz, RDHAP and the Orange County
Dental Hygienists’ Society (OCDHS) were the recipients
of two honors at the recent Annual Session of the American Dental
Hygienists’ Association in
Boston, Massachusetts.
Under the leadership
of Immediate Past
President Cruz, OCDHS
received a Wm. Wrigley
Jr. Company Foundation
Community Service Grant
as well as the Colgate/
ADHA Community
Outreach Award for their annual free clinic for the residents of
Colette’s Children’s Home. The event takes place during National
Dental Hygiene Month in October and brings dental hygienists,
assistants, dentists and students together to provide comprehensive
care for the homeless women and children who are served by
Colette’s home. The clinic takes place in the Cypress College dental
hygiene clinic and is open to all current Colette’s Home residents
as well as graduates from their transition program. The goal of
the one day event is to treat each patient until completion; and
because of the many volunteers, every patient is provided with
comprehensive dental hygiene
care, sealants, fillings, and
any necessary extractions.
Additional volunteer support
has come from neighboring
Long Beach Dental Hygiene
Society (LBDHS) with
donations of clothing and
other essential items for the
residents. LBDHS members
also organized a health fair during the day of the clinic to provide
general and oral health education for the program participants.
Many hearts and hands have worked together to ease the
emotional and physical burden of untreated oral disease in this
group of special women and children. Funds from the awards will
be directed towards the purchase of necessary equipment and
supplies to sustain the clinic well into the future.
NewsBytes
Health literacy is defined as the
degree to which an individual has
the capacity to obtain, process and
understand basic health information and
services needed to make appropriate
health decisions. Approximately 80
million adults in the United States are
reported to have low health literacy,
contributing to a multitude of healthrelated difficulties. While great emphasis
has been given to general health literacy, relatively little attention
has been paid to oral health literacy and its impact on oral health
particularly in vulnerable populations until the recent Institute of
Medicine’s Oral Health Literacy Workshop. The IOM Roundtable on
Health Literacy was interested in exploring the findings from oral
health literacy research and how such findings are being translated
into oral health practice. Limited oral health literacy is associated
with inaccurate knowledge about preventive measures such as
water fluoridation, dental care visits, and oral health-related quality
of life. The general public along with health care providers are
largely unaware of the basic risk factors and preventive regimens for
many oral diseases. Read the full report and learn more about the
impact of low oral health literacy and strategies for becoming more
literate at www.iom.edu/Reports/2013/Oral-Health-Literacy.aspx
Reaching Out to the Underserved - CDHA hygienists
from across the state have been participating in the wide range
of rotating and mobile clinics designed to provide dental care to
at-risk populations over the past year. Highlights of some of the
outreach programs include:
The 2012 Care Harbor/
LA free clinic in the Los
Angeles Sports Arena
reached out to the at-risk,
uninsured and underinsured
populations of Los Angeles
County and beyond.
The preventive dentistry
station, served 500
patients a day
and featured an
educational video
presentation, a
consultation with
a hygienist, a
fluoride varnish
treatment, and
a take-home oral hygiene kit. In addition to the RDH volunteers,
who provided over 700 dental hygiene cleaning appointments,
students from the University of California, Loma Linda University,
West Coast University, West Los Angeles City College and Cerritos
Community College participated in the four day event.
CDA Cares San Jose provided a total of $1.6 million
dollars on dental services to over 2,000 patients in May of this
year. Volunteer RDHs along with dental hygiene students from the
San Francisco Bay area participated in dental screenings, provided
dental hygiene care and
oral health education during
the two day event. Hosted
by the California Dental
Association Foundation
along with the CDA, the
rotating free dental clinic
has provided treatment
for 5,878 patients since
the program’s inception
in 2012. The next CDA
Cares clinic is scheduled to
be held at the Del Mar Fairgrounds in San Diego, December 7-8.
Volunteer information and registration forms are available
online at http://www.cdafoundation.org.
Foothill College dental hygiene students sponsored
the second annual walk for oral cancer awareness on April 13,
2013 on the Foothill College campus. Students solicited pledges
from the community at large as well as family and friends to
support the work of the Oral Cancer Foundation, a national public
service, non-profit entity dedicated to reduce suffering from oral
cancer and save lives through prevention, education, research,
31
NewsBytes
advocacy, and patient support activities. First year
dental hygiene student Angela Borlaza was the
top fundraiser, bringing in $3,000 in donations.
Altogether, the students raised $10,000 for the Oral
Cancer Foundation.
Lin Sarfaraz, RDH, was recently installed as the
District XI Trustee to the American Dental Hygienists’
Association at the 90th Annual Session held in Boston,
Massachusetts. Elected by the ADHA delegates from
California and Arizona, Lin will be serving as one of
twelve Trustees to the largest professional association
representing the interests of dental hygienists across
the United States. Highlights from Lin’s many years
as an association leader include serving as President of the California Dental
Hygienists’ Association from 2005-2006 and most recently completing two
terms as Speaker of the CDHA House of Delegates. A graduate of the Cerritos
College dental hygiene program, Lin has been a delegate to ADHA from
California since 2000. As a member of the ADHA Board of Trustees, Lin will be
part of the administrative body responsible for adopting the strategic plan and
conducting the business of the national association.
Why I belong?
Arlene Dale Parker, RDH
University of Alberta School of
Dentistry, Dip. DH, 1977
CDHA Membership Council Co-Chair
Membership in my professional
association has always been important
to me. I cannot imagine being a hygienist without belonging.
When I graduated from dental hygiene school from the
University of Alberta in 1977, fewer than 250 licensed hygienists
practiced in the province. Hygienists were very much in demand
in Alberta in the 1970’s and we all had jobs before finishing
school. After graduation, I immediately transitioned from student
to active membership in the Canadian Dental Hygienists’
Association. I was excited to begin my career. Membership
provided me with mentors and the opportunity to network
and communicate with other hygienists. I quickly accepted
leadership roles in the southern Alberta component. My career
development and professional growth were off to a great start!
My term as President of the Southern Alberta Component was
cut short by a move to California with my husband, just five
years after graduation. I had no California license, no California
connections and my spousal visa did not have work privileges.
I felt isolated and alone in those pre-Internet days. My CDHA
32
(Canadian) membership was my lifeline to the profession. My
Canadian journals and publications helped keep me informed
and connected while I prepared for licensure in California.
My first contact with the California Dental Hygienists’
Association, (the other CDHA), was when I took the California
Boards. I met a member of the Los Angeles component who
came to encourage the clinical board exam candidates. I was
keen to connect with fellow hygienists and eagerly took her card.
Once my California license arrived, membership in the American
Dental Hygienists’ Association was my top priority and I have
been an active member for the past 23 years. I currently belong
to the Long Beach Dental Hygiene Society. The great CE events
offered by the LBDHS and the professional networking and
friendship opportunities prompted me to become active on the
board. More recently, I have become involved on the state level
as the co-chair of the CDHA Council on Membership.
Our CDHA leaders embrace dental hygiene and all that it has
to offer with passion. Their dedication to the growth of the
profession inspires me. Dental Hygiene may be just a job and a
paycheck for some but it can be so much more. Membership is
essential to me; the voice of one person does not have power
like the voice of an entire profession. I am proud to associate
with the best our profession has to offer!
No a member yet?
Download an application at www.CDHA.org
Online References
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to oral health care for vulnerable and underserved populations. National
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33
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• Clean: Low, Medium and High
• White: Low, Medium and High
• Gum Care: Low, Medium and High
Sonicare FlexCare Platinum removes significantly more plaque
than Oral-B Professional Care 5000 in all areas of the mouth.2
Contact your Sonicare representative to set up a demonstration
or to purchase a specially priced trial unit.
philipsoralhealthcare.com
(800) 422-9448
1 Than a manual toothbrush. M. Ward, K. Argosino, W. Jenkins, J. Milleman, M. Nelson, S. Souza. Comparison of gingivitis and plaque reduction over time by Philips Sonicare FlexCare Platinum and a
manual toothbrush. Data on file, 2013.
2 Defenbaugh J, Liu T, Souza S, Ward M, Jenkins W, Colgan P. Comparison of Plaque Removal by Sonicare FlexCare Platinum and Oral-B Professional Care 5000 with Smart Guide. Data on file, 2013.
Single use study.
34
Jenifer McDonald, Executive Administrator
California Dental Hygienists’ Association
1900 Point West Way, Suite 222
Sacramento, CA 95815-4706
Presorted STD
U.S. Postage
PAID
Permit No. 104
San Dimas, CA
CDHA2008
RETURN SERVICE REQUESTED
Continuing
Education Extravaganza
Hilton San Francisco Airport Bayfront Hotel • Burlingame, CA
Speakers:
Susan Wingrove, RDH, FADIA
“Optimal Peri-Implant Maintenance: Science,
Systems, and Success.” 3 CEUS
Kristy Menage Bernie, RDH, BS
“SHIFT HAPPENS” aka: “Paradigms vs.
Reality: Implementing Emerging
Preventive & Therapeutic Protocols
Pam Hughes, RDH, MS
into Practice.” 3 CEUS
“Applying Critical Thinking to
Event sponsors TePe and Philips
Case Studies: An Advanced Review
for the National Board.”
National Board
Review Course
Supported by an Educational Grant
from P&G Oral Health, Crest Oral-B
November 2, 2013
Registration and information
available at www. cdha.org
or 916-993-9102

Dental Hygiene for Special Patients

Transcription

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