Literacy In Dental Hygiene

Literacy In Dental HygieneWho sponsors the literacy in dental hygiene in communications between clinicians and patients?

Paige Dunn

Hi, my name is Paige Dunn, and I chose to look into my secondary discourse community of dental hygiene for my research project. I chose to look at the literacy between clinicians and patients, and who sponsors that type of literacy, or teaches dental hygienist how to interact with different patients. 1What Is A Discourse Community?James Paul Gee says that Discourses are ways of being in the world; they are forms of life which integrate words, acts, values, beliefs, attitudes, and social identities as well as gestures, glances, body positions, and clothes. (Gee, 526)There are different types of discourse communitiesPrimarySecondary

First and foremost, it is important to describe what a discourse community is before beginning this research project. It seems quite hard to delve into a discourse community without actually describing it first. James Paul Gee says that Discourses are ways of being in the world; they are forms of life which integrate words, acts, values, beliefs, attitudes, and social identities as well as gestures, glances, body positions, and clothes. (Gee, 526). Gee describes discourses as a persons identity kit, something that makes that person who they are. There are different types of discourse communities also. There are primary discourse communities, which are communities that a person is born into, and there are secondary discourse communities, which are communities that a person can become a part of through different experiences in their lives. 2What is a dental hygienist? According to Wilkens, The dental hygienist is a licensed primary healthcare professional, oral health educator, and clinician who provides preventive, educational, and therapeutic services supporting total health for the control of oral diseases and the promotion of oral health. (Pg. 4)

The scope of practice of dental hygiene and the abilities and qualifications of a dental hygienist are so broad that it is hard to narrow it down into a simple definition. Here, as described in Wilkens, The dental hygienist is a licensed primary healthcare professional, oral health educator, and clinician who provides preventive, educational, and therapeutic services supporting total health for the control of oral diseases and the promotion of oral health. (Pg. 4)

3Roles of Dental HygieneDental hygienists are found serving in several interrelated roles, including clinician, educator, researcher, administrator/manager, and advocate (Wilkens, pg. 5)

Many people see the dental hygienist in an office and view them strictly as a clinician, however the dental hygienist serves in many different roles in the dental office. All of these roles serve and important function in the office, and play a vital role in the treatment of the patients that are under their care. 4Dental Hygiene CareTypes of services offeredPreventative ServicesEducational ServicesTherapeutic Services

A dental hygienist provides an individualized care plan to every patient that walks through the door. However, when all of those care plans or treatment plans are broken down, they mainly consists of three different services. These services include preventative services, educational services, and therapeutic services. 5Preventative ServicesPreventative services are the methods employed by the clinician and/or patient to promote and maintain oral health (Wilkens, pg. 6). There are three stages of preventative services:1.) Primary-primary services prevent the disease from actually happening. 2.) Secondary- secondary services treat early diseases, and prevent the disease from progressing further.3.) Tertiary- tertiary services are services that repair the oral cavity back to a level of function.

Preventative services are used to promote or maintain oral health once a disease is present. Preventative services can be broken down in to three separate categories: primary, secondary, and tertiary. Primary services prevent oral diseases from occurring, secondary services treat early disease in hopes of keeping it from progressing, and tertiary services repair the mouth once the disease has progressed too far. 6Educational ServicesEducational services are the strategies developed for an individual or a group to elicit behaviors directed toward health (Wilkens, pg. 6). Patients understanding is key to the success of dental hygiene treatment!!!!

A main role in patient care by a dental hygienist is educational services! The long term success of a patients treatment depends on how well the patient can understand the importance of oral health. A patient needs to be able to understand the importance of preventative services and need to be able to participate in therapeutic services (discussed later) to maintain positive treatment outcomes.7Therapeutic ServicesTherapeutic services are clinical treatments designed to arrest or control disease and maintain oral tissues in health (Wilkens, pg. 6).

The third type of service provided by a dental hygienist is therapeutic services. Therapeutic services are there to help stop disease progression, and it is important for the dental hygienist not to take these services lightly. An example of these services would be placing a sealant on the teeth of children. 8Now that you understand what a dental hygienist is, and the functions of a dental hygienist.Lets talk about the sponsors of literacy in the dental hygiene discourse.

Sponsors of LiteracyLiteracy between clinicians and patients

For this research project, I have chosen to look at literacy in the dental hygiene profession as communication between a clinician and a patient. Communication between a clinician and a patient is extremely important in planning treatment for a variety of different patients. Each patient that comes into the office has a unique case to offer, and how well a dental hygienist communicates with these patients is key to how well he/she can provide services. 10Different Types of Patients Call For Different Communications!Types of patients that a hygienist might see:A patient in Orthodontic appliances (braces)A patient wearing prosthetics (dentures or partials)Patients with special needsPatients with mental disabilities

Throughout my research, I was not please with the results that I was getting from the different places that I was looking for information. After a few frustrating weeks, I went back to a trusted old friend, Wilkens. Wilkens is the textbook that we are introduced to as soon as we step foot in the dental hygiene program. This book becomes a best friend to all dental hygiene students. It offers information on how to treat every type of patient that could possibly walk through the door in a dental office. In these next few slides, I will only be dealing with some of the more common cases that walk through, but Wilkens goes into detail on even more than just the common ones. From how to treat and interact with patients who have muscular dystrophy to scleroderma, Wilkens has it all. For this reason, I consider the Wilkens textbook to be a huge sponsor of literacy when it comes to interacting and communicating with patients. Along with Wilkens, the clinical instructors that work with the dental hygiene students and other dental hygienists in the community are a huge sponsor of literacy in this discourse community. Throughout conducting my field research, I stayed with an observation approach to gather the information that I wanted. I am in clinic every week, and I also go out on outside rotations to different dental offices, where I get to observe how other students and dental hygienists communicate with their patients. The above patients are all types of patients that I have had the experience working with, and the experience of observing other people working with. 11The Orthodontic PatientAn individualized preventive program that includes a specific plan of instruction, motivation, and supervision is essential for the patient with orthodontic appliances (Wilkens, pg. 458)Factors to teach the patient with orthodontic appliances:The significance of dental biofilm around orthodontic appliances and teeth (Wilkens, pg. 469)How to apply the toothbrush (power or manual) and adjunctive devices to remove dental biofilm from the bracket, the arch wire, and the teeth (Wilkens, pg. 469)The frequency of professional follow-up during and after orthodontic therapy (Wilkens, pg. 469)

The patient that comes into the office wearing orthodontic appliances is a very special case. Wilkens sponsors the literacy in how to communicate with these patients by giving the dental hygienist information on how to treat this patients and what to teach them. According to Wilkens An individualized preventive program that includes a specific plan of instruction, motivation, and supervision is essential for the patient with orthodontic appliances (pg. 458). That treatment plan should employ all of the following information to the patient as well: 1.) The significance of dental biofilm around orthodontic appliances and teeth (Wilkens, pg. 469)- This is important because dental biofilm is another way of saying plaque, and a patient that has orthodontic appliances, is more susceptible to diseases in the oral cavity caused by plaque (i.e.. Gingivitis), because there is more plaque retention around their bands and brackets. 2.) How to apply the toothbrush (power or manual) and adjunctive devices to remove dental biofilm from the bracket, the arch wire, and the teeth (Wilkens, pg. 469)- This is important because teaching these patients how to properly clean around their orthodontic appliances, can prevent any type of disease or infection from occurring in the first place. 3.) The frequency of professional follow-up during and after orthodontic therapy (Wilkens, pg. 469).- The frequency of dental treatment for these patients is very important. They need to have regular frequent cleanings while they are in orthodontic appliances, to prevent the demineralization of their teeth, because that can lead to weaker teeth which are susceptible to cavities.

12Field Research of Patients With Orthodontic AppliancesGingivitis is very common!Most patients with braces do not floss, making a very high plaque score!Stress the importance of oral hygiene!

I have not necessarily had the opportunity to observe an outside dental hygienist cleaning a patient who had orthodontic appliances. However, I have had the experience of cleaning a patient myself in clinic. These patients require a lot of communication when it comes to instructing them on oral hygiene. Flossing under orthodontic appliances can be extremely time consuming and frustrating for the patient, which means that a lot of them dont do it! Without flossing, these patients have a very high plaque score. A plaque score is a type of dental index that measures the amount of plaque in a patients mouth. When a patient with orthodontic appliances doesnt floss, their plaque score becomes really high. With a high plaque score, a lot of these patients experience gingivitis. This leads to swollen and bleeding gums when the patient brushes or flosses. Gingivitis can become really painful for a patient also. Throughout observing different people in our clinic, I have seen the clinical instructors stress the importance of communicating oral hygiene instruction with the patient. Educating these patients is very important to the success of their treatment. 13A Patient Wearing Dental Prostheses Awareness of the types and characteristics of prostheses, supporting tissues, and the common issues a patient may experience with prostheses is needed to provide information, comprehensive oral hygiene instruction, and treatment for the patient who has prostheses (Wilkens, pg. 473)Factors to teach the patient:Significance of regular maintenance appointments: intraoral/extraoral screening for pathology, especially oral cancer screening; and adjustments if needed (Wilkens, pg. 487)

Wilkens sponsors the communication between a clinician and a patient, by teaching the dental hygienist different factors to educate these patients on. Wilkens states that Awareness of the types and characteristics of prostheses, supporting tissues, and the common issues a patient may experience with prostheses is needed to provide information, comprehensive oral hygiene instruction, and treatment for the patient who has prostheses (pg. 473). Wilkens also stresses the importance of teaching the patient the Significance of regular maintenance appointments: intraoral/extraoral screening for pathology, especially oral cancer screening; and adjustments if needed (pg. 487). This is a very important thing to teach the patients, because a lot of times, patients who wear dental prostheses, can tend to regard their oral health, because they see these prostheses as fake teeth that dont need to be cared for. 14Field ResearchTeach the patient the importance of caring for the prostheses just as they would for their regular teeth.Conduct at home screenings of oral tissuesStress importance of oral hygiene even with a prostheses

Throughout my field research, Ive noticed the different ways that our clinical instructors sponsor our communications between ourselves and edentulous patients. They teach us and stress to us the importance of teaching these patients proper oral hygiene, even though they have a dental prostheses. A dental prostheses requires just as much attention as a patients regular teeth. Regular brushing and flossing are conducted to get rid of food particles and bacteria that may accumulate on the teeth. The same goes for dental prostheses. Throughout the day, these prostheses can accumulate food particles and bacteria as well, because they are in the oral cavity. Our instructors have worked with us closely to teach these patients how to brush their dentures, clean them after eating and soak them for a certain amount of time each day to remove debris. Also, they have worked closely with us on conducting very thorough oral cancer screenings on these patients and teaching the patients to do this themselves at home. Screening the oral cavity becomes very important for a patient that wears dental prostheses. A screening can detect marks and sores made by an ill fitting denture as well as any suspicious lesions that a dental hygienist might want to keep tabs on and monitor closely for a while. The patient should be instructed to complete screenings at home as well. If any type of sore or lesion appears it should be monitored for two weeks. If after two weeks the lesion has not started to heal or has begun changing they should report to their dentist. Communication with these patients and the dental hygienist is extremely important. These patients may not make it into the dental office as much and when they do, they spend a lot more time with the hygienist than they do the dentist, so it is imperative for the dental hygienist to be able to communicate and educate these patients. 15Treatment of Patients With Mental DisabilitiesMore people with developmental disabilities are seeking dental care in private and community settings as the trend towards deinstitutionalization grows and emphasis on special training and education in local agencies and schools increases (Wilkens, pg. 969)Factors to teach the patient:Why assistance from others is an important supplement to the patients own efforts (Wilkens, pg. 979)How to use and show their cooperation skills (Wilkens, pg. 979)

Treatment of patients that have mental disabilities can be a challenging thing for the dental hygienist. According to Wilkens, More people with developmental disabilities are seeking dental care in private and community settings as the trend towards deinstitutionalization grows and emphasis on special training and education in local agencies and schools increases (pg. 969). What this means is that with more and more patients leaving institutions, and coming into regular dental offices, the dental hygienist will begin to treat more people with mental disabilities. Wilkens prepares the dental hygienist for this by offering different things that the patient needs to be educated about. The dental hygienist should educate the patient on:1.) Why assistance from others is an important supplement to the patients own efforts (Wilkens, pg. 979)- This is important because some patients may be extremely stubborn to accepting help from others. While patients with mental disabilities may be capable of maintaining their own oral health, it is important to have somebody else there to help them if they need it. 2.) How to use and show their cooperation skills (Wilkens, pg. 979)- This goes hand-in-hand with number one. It is important for these patients to cooperate with others to receive the best possible care that they can receive. 16Field ResearchListen to the patients needs and wants.Be understanding, yet stern.Provide the best possible care, with maintaining patient comfort.

Throughout my time in dental hygiene school, I have had the chance to treat and observe other people treating patients that have mental disabilities. In clinic at school, I treated a young boy who had autism. The clinical instructors that I worked with were very understanding, and provided me with a lot of useful information. They instructed me to make sure that I listened to what the patients needs and wants were. They also instructed me to be understanding of his disability, yet firm when I needed to be. This was probably one of the most helpful tips I received, because he was so distracted by a lot of things that I was understanding, yet I knew it was ok to be firm when I needed him to pay more attention to me. Also, a lot of time patients that have mental disabilities can be apprehensive in a dental setting, so it is important that the dental hygienist provide the best care necessary without pushing it too far. There will be some patients that will not let the hygienist complete treatment, or they will get to a certain point and want to stop. It is important to try to continue with treatment and provide the best treatment necessary, but it is also important to stop if they become extremely uncomfortable or scared. A hygienist wants these patients to feel safe under their care and in the dental office, it is important not to change that during any type of treatment. 17Patients With Special Needs (Spinal Cord Injuries)The oral cavity has added significance for those who have lost sensation in other areas of the body (Wilkens, pg. 912)Four-handed dentistry:Four handed dentistry is a necessity (Wilkens, pg. 912)Assist with all procedures to make the total treatment time as brief and efficiently used as possible without sacrificing patient comfort (Wilkens, pg. 912) For treating wheelchair bound patients:Allow frequent changes of the patients body position by lifting and turning at intervals to prevent pressure sores and pain in muscles and joints (Wilkens, pg. 912).

In Wilkens, it states that The oral cavity has added significance for those who have lost sensation in other areas of the body (pg. 912). Wilkens provides dental hygienists with very important information in treating these patients in many different aspects. One aspect is how to treat a patient that is in a wheel chair. Wilkens does not cover in depth any types of wheel chair transfers, because some patients can not be moved out of their wheelchairs at all. However, there is useful information in how to treat these patients in the dental office. One of the most important things for providing treatment for these patients is their comfort. In order to maintain a level of comfort for the patient, the clinician should Allow frequent changes of the patients body position by lifting and turning at intervals to prevent pressure sores and pain in muscles and joints (Wilkens, pg. 912). Another way to increase the patients level of comfort is to provide four-handed dentistry. Four handed dentistry is when the clinician works with an assistant, so essentially there are four hands involved in the treatment instead of the clinicians own two. According to Wilkens, an assistant should Assist with all procedures to make the total treatment time as brief and efficiently used as possible without sacrificing patient comfort (pg. 912). These tips in how to increase a patients comfort level, and how to interact and treat a patient with a spinal cord injury are very helpful to the dental hygienist.

18Field ResearchMonitor the patient very closelyAssistant should provide suction Always listen to the patient, they know their body and their condition better than the hygienist does. Be prepared to work with caregivers.

I, myself have never had an opportunity to treat a patient with a spinal cord injury, however I have had the opportunity to observe the treatment of these patients. In our own clinic I observed one of my classmates treat a quadriplegic patient. The clinical instructors were very adamant about what needed to be done during the treatment of this patient. They made sure that there was always an assistant with the clinician to provide suction and an extra pair of hands. Some patients with spinal cord injuries have their respiratory systems affected, so it is very important to make sure that there is an assistant to suction any excess water and saliva produced during the treatment, so that the patient does not choke. The clinical instructors always made sure to ask the patient if they were comfortable and if anything needed to be done to increase the comfort level of the patient. The patient will know what needs to be done to improve their comfort level, so it is better to ask than to just have the dental hygienist assume. Lastly, our clinical instructors have provided us with a wealth of information on how to deal with patients that have caregivers. A lot of patients that come into the dental office with spinal cord injuries will have a caregiver. This caregiver may be a family member, or somebody outside of the family who is hired to take care of the patient. When a patient comes in with a caregiver, never automatically assume that they are not capable of doing things on their own. Always acquire what the patient is capable of, and direct everything that you say to the patient if they are able to understand. If the patient has control over their hands and fingers, always teach them their oral hygiene instructions. Afterwards, you can review them with the caregiver and send them home with written instructions, but always talk to the patient first, because not all patients who have caregivers are incapable of understanding your instructions. Always educate the patient, and then the caregiver if able. Never neglect that the patient is the one who is there to receive the treatment. 19The End(:

This research project was all about exploring the literacy between patients and clinicians. I used certain types of patients so that I could put in my field research, which was the observation of treatment of these patients. The two main sponsors of literacy that I focused on for the dental hygiene discourse were the clinical instructors that I interact with on a daily basis, and the textbook of Wilkens that each incoming dental hygiene student receives in their first year. Both the instructors and Wilkens are a wealth of knowledge and are available to teach student dental hygienists how to interact with their patients. This project explored the roles of Wilkens and the clinical instructors as sponsors of literacy in the dental hygiene discourse community. 20