Download Volume 28, #1, Winter 2013 Journal

Volume 28
Number 1
Winter 2013
“Teenagers today: Is their
oral health protected?”
Caring for Adolescents
Improving Oral Health
Ten Tips for Talking
with Teens
Oral Piercing and
Body Art
21st Century Realities
and Safety Issues
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In this issue of the
Winter 2013
3
From the Editor’s Desk
Adolescents in the 21st Century
4
CDHA Corporate Sponsors
Thank you for your support
5
President’s Message
I Wish I Were You
6
Caring for Adolescents
12 PracticePointers
Ten Tips for Talking with Teens
14
CDHA NewsNotes
photo by rubatacchini on Flickr
6LifeLongLearning
16StayingHealthy
Oral Piercing and Body Art
20
StudentConnection
A Community of Professionals
Saving Yourself from Drowning in
Dental Hygiene School
24CareerCorner
Katie L. Dawson, RDH, BSDH, RDHAP –
a Career in Excellence
27
EducationExchange
Incorporating Motivational Interviewing
into Tobacco Cessation Intervention Training
30NewsBytes
What’s new around CDHA
Talking with Teens
12
16
27
Journal Sponsored by Philips Oral Healthcare
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
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
611 Bristol Ave. • Stockton, CA 95204
[email protected]
[email protected]
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.
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
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
Peninsula Angela Punaro, RDH
Tri County Darlene Cheek, RDH, BS, MPH
Redwood Tamara Wells, RDH
Valley Oaks Linda Wise, RDH
Sacramento Valley Carol Lee, RDH, BS
Ventura County Erica Johnson, RDH
San Diego County
Jackie Buchanan, RDH
Journal Staff
Editor Cathy Draper, RDH, MS
Advisory Board
Toni S. Adams, RDH, MA
Carol Lee, RDH, BS
Donna Smith, RDH, MSEd
Ellen Standley, RDH, MA
Graphic Design Dorreen P. Davis
Printer
Moore Bergstrom Co.
Calendar of Events
March 2-3, 2013
Student Regional Meetings –
South/North
March 22-23, 2013
Spring Board of Trustees Meeting
Burbank, CA
April 12, 2013
CDHA Spring Scientific Session /
Student Table Clinics
Sheraton Park Hotel, Anaheim, CA
May 31-June 2, 2013
CDHA HOD, Long Beach Hilton
Long Beach, CA
About the Cover: 14 year Jacob LaFlamme is the son of Michael LaFlamme, RDH
Photography by: Jeff Mulvihill, Jr. (www.instaimage.com)
From the Editor’s Desk
Adolescents
in the 21st Century:
Are we meeting their needs?
Broadly defined as the period of time between the ages of 10 to 18, adolescence can be a volatile time for physical and
emotional development. Just take a moment to reflect back on your own middle and high school experiences and ask yourself if
you really want to go back in time and repeat your teen years. Most of us may have some fond memories of the times spent with
family and friends “back in the day”, but wouldn’t necessarily choose to become a teenager all over again.
Teens face a multitude of challenges in today’s world. Technology, social media,
peer pressure and issues of self-esteem all play significant roles in the daily life and
psychological outlook of an adolescent. In the area of general health, adolescents
in the 21st century are facing a number of issues. Obesity, physical inactivity,
poor dietary habits and the increasing incidence of type 2 diabetes will all have
long-term health implications for adolescents. Drug, alcohol and tobacco use in
teens is also concerning. While smoking rates in California’s adult population have
decreased from 23 percent in 1988 to 12 percent in 2011, a report released by the
California Department of Public Health Services in December of 2012 indicates that the decline may have leveled off and that
we may be losing ground in our most vulnerable population, young people under the age of 18. The number of children who
have smoked their first cigarette by age 14 has increased. High school students are using smokeless tobacco more frequently
and hookahs lounges are rapidly growing in popularity.
Adolescents presenting for dental hygiene care come with a wide range of oral health needs. They are at elevated risk for
caries, periodontal disease, orthodontic issues and orofacial trauma, coupled with a number of unique social and psychological
issues including dental phobias. The ability to recognize, communicate and relate to the needs of adolescents is essential for
developing a professional partnership in providing their care.
Considering the potentially complex treatment needs of the adolescent, it is surprising that this age group does not seem to
generate the same level of interest as the periodontally involved adult patient population creates. When was the last time you
found a continuing education course focusing on adolescent oral health? Our emphasis is often on periodontal maintenance
in adult patients or related topics. Yet, periodontal disease is prevalent in adolescents and the oral health habits of adulthood
are often established during this time. Adolescents, whether they are cared for in pediatric specialty practices or in general
practices, require dental hygiene care tailored to meet their needs.
In 2008, there were approximately 41.5 million adolescents in the United States, a little under
20 percent of our total population. Their health and well-being requires a collaborative effort
engaging all healthcare providers, including dental hygienists, caring for the whole person as
they transition from childhood to young adults. We can make a difference in that future.
CDHA Journal – Winter 2013
Cathy Draper, RDH, MS
Editor
3
2011-2012 CDHA Corporate Sponsors
Shanda Wallace, RDH,BSDH
CDHA Celebrates 2011-2012 Corporate Sponsors
Lisa Lee Okamoto, RDH set out to create a community of CDHA members as part of a
very special “It’s A Small World” during her presidential year, 2011-2012. Our association
benefitted greatly from the generosity of a number of companies in spite of fierce competition
in a struggling global 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.
Diamond Sponsors- $15,000 or more
Philips Oral Healthcare
www.philipsoralhealthcare.com
Silver Sponsor
Crest Oral-B
$3,000.00–$5,999.99
www.crestprohealth.com
Bronze Sponsors
Colgate Oral Pharmaceuticals www.colgate.com
Dentsply Professional www.dentsply.com
Educational Designs
www.educationaldesigns.com
4
$1,500.00–$2,999.99
Premier Dental Products
www.premusa.com
VELscope LED Dental, Inc.
www.velscope.com CDHA Journal Vol. 28 No. 1
Message from the President
Author(s)
I Wish I Were You !
“I wish I were you – going forward with the new tools, the new
technologies and the new frontiers”. This is the well-worn phrase
that I passionately bring to every student presentation I give. My
declaration is always followed by the key point of my message,
“More importantly, I want you to be just as enthused, challenged
and rewarded by our profession after twenty, thirty or yes, even
forty years, as I am right now.”
I hope that each of these statements apply to all of us, not just
our student hygienists. This chaotic time in health care history
is providing opportunities for growth in our profession and new
directions for our future. It is an exciting time. These last few years,
although challenging for our economy, have brought advances
to our profession here in California that I have waited forty
years to materialize.
The Dental Hygiene Committee of California, recognition of the
Western Regional Board examination, the first graduating class
of the UCSF Master of Science in Dental Hygiene program and
the passage of SB1202, a step towards control of our education
programs – these seemingly unrelated events have all contributed
to the advancement of our profession, and they have all taken
place in the last five years. How can we not be excited by the
future of our profession in California?
Meaningful changes in dental hygiene are happening here and now
and CDHA is actively “Stepping Up and Reaching Out” to influence
the evolution of our profession. We are reaching out to coalitions
throughout the state to add support to diverse groups. Our liaisons
participate in consortiums representing
a wide range of interests: the Western
Center on Law and Poverty, Children
Now, the California Dental Association,
First 5, the California Rural Indian
Health Board, the California
Department of Public Health, as well
as over one hundred other groups,
forming alliances to address issues of
mutual interest. Health organizations
across the state recognize CDHA
CDHA Journal – Winter 2013
and dental hygienists for the integral
part we play in the overall health
care delivery system and as essential
participants in any discussions on access
to care for all Californians.
Self-regulation, portability of licensure,
postgraduate education programs,
all contribute to the foundation for
expanding our roles as health care
providers. What kinds of opportunities will be available for our
profession in ten years? The activities taking place today are shaping
our future. CDHA’s collaborative efforts with CDA, on legislative
efforts and in our professional scientific sessions, are resulting in a
strengthened affiliation as our associations work together to address
access to care issues. Our professional health care partners outside
of dentistry recognize that the challenges of improving the health of
Californians will require multiple approaches from all providers.
I am glad to be with you, going forward into new frontiers,
representing our profession as your CDHA President. Today’s new
destinations include a public that needs us, a receptive legislature
and numerous allies and partners motivated to implement change.
As we “Step Up and Reach Out”, our future is too exciting, too
challenging and too rewarding not to run towards it together.
To our future together,
Susan Lopez, RDH, BS
2012-2013 CDHA President
5
LifeLongLearning
Julie Coan, RDH, BS
Caring for Adolescents:
Opportunities to Improve Future Oral Health
Meeting the Oral Health Needs of Today’s Adolescent
When we think of teenagers, our thoughts often go to high
school, fast cars, dating, sports and the realities of peer pressure
and popularity. Teenagers today continue to face all of those life
experiences on a daily basis, however lurking just beyond
the obvious, are the less obvious: the current oral
health status of today’s adolescent population
and the realities of caries, periodontal disease,
and even tobacco and drug use in the teenaged
patient. Current statistics in the United States
show that 52% of teens, ages 12-19 years,
have experienced caries in their permanent
teeth. This trend will continue and increase
as they progress through adulthood. While
tobacco use in general has decreased
since 1997, 20% of teenagers today still use tobacco products
and thousands of new smokers are joining the ranks each day.
Cigarettes are not the only problem. The use of smokeless tobacco
products is increasing amongst high school students and the use of
hookahs, a Middle-Eastern style water pipe, is very popular among
young adults. Periodontal disease is also prevalent in teenagers.
Adolescents suffer the highest incidence of gingivitis and are
also susceptible to the devastating effects of chronic periodontal
disease. Unfortunately, those teens who are most affected also tend
to be among the most disenfranchised of our society, members
of low socioeconomic populations and minority ethnic groups.
Disease prevention is key for change; working together to increase
awareness of the potential oral-systemic health problems for our
teen patients can open the door for a better future of oral health.
Learning Objectives
Upon completion of this course, the dental professional should
be able to:
1. Identify the risk factors for dental caries in the
adolescent population
2. Describe the measures that can be taken to reduce
caries risk in the adolescent population.
6
3. Explain the difference between gingivitis, chronic and
aggressive periodontitis in adolescents.
4. Describe the role of the dental hygienist in tobacco use
intervention and adolescents.
Teens and Dental Caries: An Unmet Need
According to the National Institute of Health, teens suffer the
highest incidence of caries in comparison to the other child age
categories. This is due in part to the fact that caries is classified as
a cumulative disease starting in early childhood.1 Statistics support
this fact, as 52% of teens, ages 12 to 19 years, have experienced
dental caries in their permanent teeth.2 Contributing demographic
factors include ethnicity and socioeconomic status. The teens
most often affected by caries are those of Hispanic background
(64.49%) and those living in households at or below 100% of
the poverty level (65.55%).3 Females appear to be more affected
by the presence of caries than males, 62.74% versus 55.66%,
respectively.3 Additionally, it is estimated only 40% of adolescents
have dental insurance coverage, reducing their ability to receive
needed dental care, especially within low-income and minority
populations. This is escalated by the fact that teens are the least
likely to actively utilize dental care services.1 Other contributing
factors increasing the risk for caries within the teen population
include a cariogenic diet, presence of orthodontic appliances, poor
oral hygiene, the presence of gingivitis or periodontal disease,
insufficient exposure to fluoride, susceptible tooth anatomy, fear of
the dentist, and physiological or psychological impairments.4,5
Because of the complex and varied factors contributing to the
prevalence of caries within this population, it is vital that oral health
professionals obtain an accurate and complete medical history
prior to providing oral hygiene care.4 A complete social history
should also be obtained as tobacco, drug and alcohol use, as well
as eating disorders, can be a factor within this age group. This can
be quite challenging as adolescents can be evasive in responding
to questions regarding social and personal habits, and the presence
of parents within the treatment room can limit open conversation.
Encouraging separation from the parent during an appointment and
CDHA Journal Vol. 28 No. 1
LifeLongLearning
developing a trust relationship with the teenaged patient can foster
open dialogue, giving the health professional the opportunity to
provide useful and relevant oral health education.
Caries Prevention and Management
Management and prevention begins with a thorough caries risk
assessment by the patient’s dental care provider.4 Once the
contributing factors to the occurrence of dental caries are identified,
it is important for the oral health care provider to emphasize
the positive benefits received from regular dental and dental
hygiene care, fluoride application, placement of sealants, proper
diet and nutrition, including the introduction of xylitol containing
products, and oral hygiene education.4 Caries Management by Risk
Assessment (CAMBRA) can be utilized to determine the current
caries risk and to design a prevention program specific to the needs
of the patient.
Fluoride: Water flouridation is the most convenient and economical
source of fluoride. Drinking fluoridated water containing the
recommended fluoride level can provide topical benefits.4 Overthe-counter products such as a fluoridated dentifrices should
be used twice daily. Non-alcohol containing 0.05% Sodium
fluoride(NaF) rinses are also beneficial. Depending upon the caries
risk, professionally prescribed fluoride products including 1.1%
NaF gels and pastes, 0.2% NaF rinse, 0.4% stannous fluoride gels
may be recommended for home use, as well as
the professional application of 5% NaF varnish
during dental hygiene care appointments.4,6
Sealants: Occlusal caries have been found
to be the highest occurring type of caries in
children.6 Research has demonstrated sealants
to be beneficial in preventing pit and fissure
caries in posterior teeth.7 Eruption of the
permanent second molars and the first and
second premolars occurs just before or during
the early teen years. Application of dental
sealants to susceptible tooth surfaces soon after eruption is most
effective in providing the greatest amount of protection against the
future development of occlusal caries. Sealant application can be
accomplished through the use of either glass ionomer cement (GIC)
or through use of resin based sealants as currently recommended
by the American Dental Association (ADA).8
Xylitol: Recommendations during dental hygiene appointments may
include daily use of xylitol containing products which are available
in multiple forms including gum, mints, dentifrices, oral rinses, and
sprays. Xylitol, a natural sweetener, possesses a sweetness quality
similar to that of sugar while containing 40% less calories.9 Found
within the same non-nutritive sweetener category as mannitol and
sorbitol, xylitol is produced from natural xylan containing materials
such as birch trees, corn cobs and sugar cane waste products.9
Xylitol reduces the cariogenic effects of Streptococcus mutans by
lowering the overall quantity of cariogenic bacteria in plaque and
saliva. Lower levels of S. mutans lead to less demineralization of
the tooth structure due to the decreased levels of lactic acid present
within the saliva.9
Dental Hygiene Care: Dental hygiene care frequency should be
based on patient needs, including caries risk. Adolescents who are
at an extremely high risk for dental caries should be placed on a
three month recall schedule.6 Appointments should include a dental
prophylaxis, NaF varnish application, oral hygiene care instruction
and diet evaluation with recommended modifications to reduce the
consumption amount and frequency of fermentable carbohydrates.
In particular, an evaluation of the consumption of sweetened
beverages, especially acidic beverages, should be completed. Other
considerations in regards to nutritional patterns and needs include:
physical activity levels, psychosocial aspects of eating patterns,
and any other health related factors which could
contribute to caries development. Physiological
factors should also be taken into consideration
when providing oral hygiene care and education.
Systemic disease and medications contributing
to xerostomia should be considered and
appropriate recommendations regarding oral
saliva substitute should be made. Depending
upon the severity of caries occurrence,
salivary pH and caries bacterial testing may
be recommended. For reduction in bacterial
levels, patients may be advised to rinse with 0.12% chlorhexidine
gluconate nightly for one week each month. Individuals using the
bactericidal chlorhexidine gluconate regimen must be sure to wait
one hour prior to brushing with a fluoride toothpaste to receive the
beneficial effect of the rinse.6 Other recommendations may include
using a baking soda rinse to aid in neutralizing the pH of the oral
Continued on Page 8
CDHA Journal – Winter 2013
7
LifeLongLearning
environment, as well as using a calcium phosphate paste to
aid in remineralization.6
A thorough dental examination and individualized schedule of
radiographs should be completed every six months, and patients
should be strongly advised to complete any dental treatment as
quickly as possible.
Periodontal Disease Begins in Adolescents
Periodontal disease often begins during adolescence, and if left
untreated can result in future tooth loss and compromised health.
The most common forms of periodontal disease identified in the
adolescent population are gingivitis, chronic periodontitis and
aggressive periodontitis.10 Necrotizing forms of periodontal disease
have been shown to occur in less than 1% of this population.11 It is
estimated that 2% to 5% of adolescents and young adults in the
United States experience chronic periodontitis with less than 1%
experiencing aggressive periodontal disease. However, prevalence
of periodontal disease among certain ethnic populations is much
higher, with African-Americans suffering the highest incidence of
both aggressive periodontitis (1-3%) and chronic periodontitis
(8-20%).10 Hispanic (5-10%) and Asian (5-8%) populations also
experience a higher prevalence of chronic periodontal disease than
their Caucasian counterparts.10
Risk factors for periodontal disease among adolescents are
multifactorial, with systemic factors including hormones, chronic
disease, medications, pregnancy, tobacco use, ethnicity and
socioeconomic status. Local factors include the presence of plaque
and calculus, orthodontic appliances (fixed and removable), faulty
restorations, malpositioned teeth, mouth-breathing, and tooth
developmental anomalies.4, 10
Social Health Gradient: Historically, chronic diseases including
cardiovascular disease, cancer, and diabetes, were considered to be
most prevalent in populations falling into the lowest socioeconomic
groups. However, current research has identified a “social health
gradient”, in which chronic disease can be found among all
socioeconomic levels within society, with the risk for chronic
disease increasing as you step down the ladder of social hierarchy.
Additional social determinants influencing susceptibility to disease
include environmental factors, education, ethnicity and genetic
disposition, cultural beliefs and practices, social influences, and
stress levels.12,13 Oral health inequalities, including the incidence of
periodontal disease, have been found to fall into this social health
8
gradient. Although those populations most affected still fall within
the lowest social levels of society, periodontal disease has been
shown to affect adolescents from all gradients of society.12
Gingivitis
Gingivitis is a bacterial/plaque induced disease of the gingival
tissues which does not exhibit attachment loss or bone loss.
However, research has demonstrated that gingivitis can be a
precursor to the onset of periodontal disease and its associated
loss of periodontal structures.14 Adolescents experience a
higher incidence of gingivitis than their prepubescent and adult
counterparts, most likely due to the increased presence of sex
hormones. Elevated sex hormones have been shown to cause
changes to the composition of the oral microflora, impacting
the body’s inflammatory response to plaque, and increasing the
potential for fluid retention within the gingival tissues.4 Actinomyces,
Capnocytophaga, and Leptotrichia, have been identified as the most
commonly associated bacterial species found in gingivitis in children
and adolescents.11 Recommended treatment for adolescent cases of
gingivitis is the thorough sub and supragingival removal of plaque
and calculus deposits accompanied by oral hygiene education
focused on improving daily oral hygiene care.
Chronic and Aggressive Periodontitis
Though more common in adults, chronic periodontitis is also found
in adolescents.11 The disease can present as localized (affecting
<30% of the dentition) or generalized (affecting >30%), with
attachment loss ranging from mild (1-2mm), moderate (3-4mm)
or severe (≥ 5mm).11 Chronic periodontitis in teens and young
adults is most commonly due to systemic diseases affecting the
immune system thus increasing their susceptibility to periodontal
disease.10,11 Adolescents with poorly controlled diabetes also have
a greater potential for increased inflammatory response.11 Other
risk factors for chronic periodontitis within this age group are
plaque-retentive restorations and tobacco use.14 Though many
forms of bacteria are involved in the plaque biofilm contributing to
the presence of chronic periodontitis, Tannerella forsythia has been
identified as being strongly associated with the progression of this
disease in teens and young adults.14
Aggressive periodontal disease can present as localized or
generalized. Both forms demonstrate rapid attachment loss
of periodontal structures, including interproximal bone, on at
least two permanent first molars and incisors.11,14 Localized
CDHA Journal Vol. 28 No. 1
LifeLongLearning
aggressive periodontal disease (LAgP) presents with interproximal
attachment loss not involving more than two additional teeth.
LAgP generally occurs in adolescents with no history of systemic
disease, and the presence of subgingival calculus and plaque
biofilm is not necessarily substantial.11,15 However, research has
linked the occurrence of LAgP with the presence of Actinobacillus
actinomycetemcomitans, and other highly virulent bacterial strains.11
Generalized aggressive Periodontitis (GAgP) involves interproximal
attachment loss of three or more teeth, in addition to the first
molars and incisors. Unlike LAgP, the generalized form of
this disease is usually associated with high levels of bacterial
plaque biofilm and subgingival calculus, as well as the presence
of facultative anaerobic, gram-negative pathogens such as
Porphyromonas gingivalis, and Treponema denticola were
prevalent within gingival pockets.11 Immunological, environmental
and genetic factors seem to play a part in the virulence of the
disease, suppressing the chemotaxic response of neutrophils, and
reducing levels of immunoglobulin G(IgG2) resulting in increased
attachment loss.11
Early diagnosis of both the chronic and aggressive forms of
periodontitis will provide the most successful outcomes for
adolescent patients. Treatment for these forms of periodontal
disease include nonsurgical and/or surgical debridement of root
surfaces as well as antimicrobial therapy, followed by an appropriate
periodontal maintenance schedule.11,14 The use of antibiotics, as
prescribed by the attending dentist, may also be considered.11
Providing age appropriate oral hygiene instruction will help to
ensure patient compliance and a successful treatment outcome.
Adolescents and Traumatic Injury
Traumatic injury to the permanent dentition is prevalent among
this age group. Injury due to falls, automobile accidents, violence
and sports related activities can cause serious and permanent
damage to teeth, including tooth loss. Participation in contact
sports is common during this age period and should be addressed
by the oral health professional. Identification of specific sports
activities such as football, baseball, soccer, basketball, wrestling,
hockey, biking, skateboarding, and other athletic and leisure
activities which promote physical contact should be made,
followed by recommendations to promote the use of safety devices
such as mouth-guards or face shields. Mouth-guards should
be professionally designed and fabricated to assure proper fit,
CDHA Journal – Winter 2013
protection and comfort. Instructions for proper wear and care
should be provided upon delivery of the appliance. Warnings
regarding the modification of mouth-guards in reducing potentially
safety benefits, as well as information regarding the potential for
injury even when wearing a properly fitted appliance, should be
given to both the athletes and their parents.4
Tobacco Use: Prevention is the Key
Although tobacco use among adolescents has decreased by nearly
40% since 1997, currently 20% of our youth still actively use
tobacco products, including cigarettes, cigars and smokeless
tobacco.1 It is estimated that 1.5 million teens start smoking each
year.16 Though tobacco companies are no longer able to market
directly to children due to the implementation of the 1998 Master’s
Settlement Agreement, tobacco companies have been able to
circumvent this prohibition by targeting young adults who are often
in the position of being
role models for kids. The
American Lung Association
(ALA) emphasized that
the exposure to tobacco
use through indirect media
marketing, particularly
movies and television,
can increase the risk of
tobacco uptake 2.6 times
among teens and adolescents.1 Additionally, tobacco companies are
utilizing reduced pricing of target tobacco products to entice more
price sensitive teens to sample their goods.17
Other influencing factors found to increase the risk for uptake
of tobacco use by teens are peer pressure, parental smoking,
depression and psychiatric disorders such as Attention Deficit
Hyperactivity Disorder (ADHD).16 Though gender does not seem
to affect smoking rates, American Indian and non-Hispanic, white
teens have a higher risk of tobacco use than their Hispanic and
non-Hispanic, black counterparts. In addition, those teens who
tend to have fewer social connections in school, as well as those
falling within the lower academic performance category, tend to be
at higher risk for tobacco use.17 Correlations have also been found
between negative body image views in young females and the
use of tobacco as a method for weight loss, control and increased
body image.18 The end result for many adolescents who take their
Continued on Page 10
9
LifeLongLearning
first puff is tobacco addiction, as an
increased regularity in tobacco use
often results in a lifelong addiction to
nicotene.19 Nearly 90% of the current
adult tobacco users started their habit
before the age of eighteen.1
Tobacco cessation as a result of
nicotine addiction is as difficult for
teens as it is for adults, in spite of the
teen attitude of “I can quit anytime”. Adolescent tobacco use results
in an increased incidence of respiratory complications such as
asthma, as well as decreased lung capacity and lung development.
There are also well established causal relationships between
long-term tobacco use and an increased risk for cardiovascular
disease, stroke, cancer, infertility, premature births, respiratory
disease, decreased bone density, and premature death.1, 17,20 The
link between periodontal disease and the use of tobacco products is
also well established. Adolescent smoking has also been associated
with increased risks for alcohol and illicit drug use.16
www.askadviserefer.org
Step 1: ASK
Ask adolescents about tobacco use
at each appointment
Step 2: ADVISE
Advise adolescents to quit; use oral/
systemic health links
Step 3: REFER
Refer patients to National Network of
Tobacco Quit lines, 1-800-QUIT NOW
Follow-up at each appointment
Preventing teens from lighting up their first cigarette, as well as
providing cessation counseling for those who currently use tobacco
products, is the most effective means of reducing the risk of
future tobacco related health problems and nicotine addiction. The
American Dental Hygienists’ Association (ADHA) supports smoking
cessation through their “Ask. Advise. Refer.”(table 1) program
designed to assist dental hygienists in effectively helping patients’
quit.21 As oral healthcare professionals, dental hygienists possess
both the communication skills and most importantly, the one-toone access to adolescent patients, providing ample opportunity
to assess tobacco use status, give the necessary education and
10
Adolescents and the Opportunity for Better Health
As dental hygienists, we each have the opportunity to improve
the current and future health of our adolescent patients. Regularly
performing thorough oral assessments as well as identifying
any current caries and periodontal disease risks provides the
opportunity for early disease detection and treatment in addition to
reducing the potential for future tooth loss. Developing a positive
and open, two-way communication process with adolescent
patients can allow for the identification of social factors which may
negatively impact their oral and systemic health and in turn provide
hygienists the opportunity to share vital information in order to
make an impact on their total health throughout their lifetime.
References are available in the online version of this issue at
www.cdha.org
Table 1
ASK. ADVISE. REFER.
provide referrals. The most difficult part can often be starting the
conversation by asking the question, “Do you, or have you ever used
tobacco?” Dental hygienists often need to remind themselves of the
tremendous impact this simple question can have on the life of an
adolescent and remember to initiate the dialog.
Images courtesy of imagerymajestic at FreeDigitalPhotos.net
About the Author:
Julie Coan is a 2002 graduate of Diablo
Valley College. She completed her BSDH
through the on-line degree completion
program at Loma Linda University in
2009, and is currently working towards a
Master’s degree in public health practice.
Julie has worked in private practice for 10
years and is a part-time faculty member at
Chabot College where she loves working with future dental hygiene
professionals. Julie is the chair of the CDHA Student Relations
Council and a firm believer that association membership is vital for
the future growth and advancement of the profession.
CDHA Journal Vol. 28 No. 1
LifeLongLearning 2 CE Units (Category I)
Home Study Correspondence Course
“Caring for Adolescents: Opportunities to Improve Future Oral Health”
2 CE Units – Member $25, Potential member $35
Circle the correct answer for questions 1-10
1. According to the National Institute of Health, the caries experience
amongst the adolescent population in the United States is:
a. 35%
b. 41%
c. 52%
d. 67%
2. The teen group with the highest caries experience is from
which ethnic background?
a. African American
b. Hispanic
c. American Indian
d. Asian
3. The incidence of gingivitis in adolescents is higher than that of
children or adults primarily due to which of the following?
a. hormonal changes
b. poor oral hygiene
c. lack of sleep
d. xerostomia
4. Which of the following social history considerations can be a
factor in teen caries prevalence:
a. use of tobacco, drugs and alcohol
b. poverty
c. eating disorders
d. only a and b
e. all of the above
5. Which of the following is NOT a risk factor for caries in the
teen population:
a. poor oral hygiene
b. presence of orthodontic appliances
c. fear of the dentist
d. cariogenic diet
e. tooth loss
6. Occlusal sealants for adolescents :
a. are not recommended for most teens since the first molars
are already erupted
b. are recommended for teens since second molars and
premolars can benefit
c. should be placed soon after eruption of molars and premolars
d. both b and c
7. Which of the following is TRUE about exposure to tobacco media marketing strategies and the uptake of tobacco in the adolescent population:
a. can increase the risk of tobacco uptake by 10 times
b. has no more effect on the teen population than on the
adult population
c. can increase the risk of tobacco uptake by 2.6 times
d. only increases the risk for those teens who are in higher
socioeconomic groups
8. The first step in a tobacco intervention strategy is to:
a. advise the patient of the negative consequences of tobacco use
b. refer the patient to a quit line
c. explain the products available to assist in quitting
d. ask the patient if they use or have ever used tobacco
9. Which of the following is TRUE about periodontal disease in
the adolescent population:
a. less than 1% experience aggressive periodontitis
b. 2-5% experience chronic periodontitis
c. African-Americans experience a higher incidence of aggressive
and chronic periodontitis
d. all of the above is true
10.Which of the following bacteria is more often associated with the
progression of chronic periodontitis in the adolescent and young
adults than in the older adult population?
a. Actinomyces species
b. Tannerella forsythensis
c. Capnocytophaga species
d. Streptococcus mutans
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
CDHA Journal – Winter 2013
11
PracticePointers
Toni S. Adams, RDH, MA
There’s an old story from long before the Internet about a
teenager whose grandparents gave her a set of encyclopedias
as she entered high school. The girl’s mother sent the gift
back with this note, “Thank you, but Mary doesn’t need
these references. She already knows everything.” Most
people who have raised, taught, or dealt with teenagers in
any capacity can relate to this story.
Adolescence can be a difficult time, for the teens themselves,
as well as for those who care about them, and for good
reason. Youngsters between the ages of 12 and 19
experience a “tension of opposites…between love and
hate, desire and shame, hope and despair, gain and loss.”1
They struggle to acquire critical life skills, including abstract
thinking, coping, establishing personal identities, defining
moral and ethical standards, and changing the way that they
relate with adults.
Teens are drawn by both the safety and comfort of childhood
and the independence but uncertainty of adulthood, and
the ensuing struggle can make for turbulent times. So,
communication with them can often be challenging. Here are
a few tips to help the process.
1 Listen
The number one complaint of dental patients is that
we don’t listen to them. Adolescents in particular need to
feel heard. Listening demonstrates respect, can help teens
feel more at ease, and can also be a path to a deeper
understanding of their issues. Sometimes getting a teen to
talk is as much of a challenge as getting him to listen, but if
you listen first, you are more likely to obtain the information
and the cooperation that you need.
We have all learned the “tell-show-do” approach to patient
education. I offer the “listen-tell-show-do” approach. In
other words, find out where teens are in terms of oral health
and other concerns, and then communicate from that point
of view. Once you listen to their issues, they may be more
inclined to listen to you – or not. But it’s certainly worth a try.
2 Establish rapport and trust
Begin by spending some social time with teens and
their parents. Roll out the red carpet. Shake hands. Show
12
that you sincerely
like them. Take
some time to engage
in conversation,
especially with new
patients. Get to know
them at a casual
level, and let them
get to know you. It is difficult to find time for a conversation in a busy
clinical day, but the investment will pay off for years to come.
As with every patient, it’s all about the relationship. Try to draw
out personal information. Regardless of attitude, teens want to be
understood. Ask questions about interests and activities, school,
aspirations, friends, or even just the meaning of their slang terms. Ask
them how to use that new application on your smart phone. Chances
are, they’ll know, and they’ll feel good about knowing and appreciate
having been asked.
Gaining trust from teens can be tricky. They may trust you immediately,
over months and years, or never at all. Continue to make the effort.
3 Maintain confidentiality and privacy
Assure confidentiality as much as is legally possible. We can
touch on some very delicate health and personal information during our
conversations with teens, and they want to know that the information
will be kept private. They will not talk with us and may even avoid care
if it isn’t. On the other hand, we can walk some fine legal lines among
patient confidentiality, parent’s rights, and reporting requirements.
As practitioners we must remain current with legal requirements in
the appropriate states.1 However, we can be partly reassured by this
quote, “Confidentiality in adolescent medicine is supported by all major
adolescent health care organizations and is protected by law in varying
forms across all 50 states and the District of Columbia.”2
4 Involve the parents
Of course parents must be involved in decisions about their
children’s care. They can be strong allies in our efforts to lead teens to
higher levels of health, so determine both the patient’s and the parents’
expectations. Sometimes this can be difficult. Remain neutral during
parent and child confrontations, and use judgment to decide whether or
not to try to mediate between them.
CDHA Journal Vol. 28 No. 1
Image courtesy of imagerymajestic
at FreeDigitalPhotos.net
Ten Tips for Talking with Teens
PracticePointers
5
Allow control
Give the teen as much control and the opportunity to make
as many choices as possible. The two things that adolescents fear
the most are embarrassment and loss of control. Most teens want
truthful information. Explain what they can expect during and after
procedures. Teens are more likely to respond to adult help that is
offered sincerely and without an expectation of control.
6 Reserve judgment
Take the teen’s concerns seriously. Try to stifle your
assumptions and reserve judgment about teens, regardless of
dress, attitude, grooming, oral health, or other verbal or nonverbal
messages that they may send. Maintain a conversational tone and
empathize with their issues.
Do not express personal disappointment at their shortcomings,
which invites feelings of shame. Just ask, matter-of-factly, “What’s
going on with your mouth?”, or simply, “What happened?” Then
ask for their involvement, “Can you think of ways to help you
remember to brush your teeth?” Focus on the positive. Notice what
the teen is doing right first and do not lecture.
7
Remain immediate and positive
Stay in the moment and stay positive. Adolescents have
difficulty seeing too far ahead, so motivate with immediate
consequences and focus on positive rather than negative outcomes.
“With good care, your red gums can become healthy and pink
within a few days. Imagine how beautiful your smile will be then.”
8 Consider culture
Adolescents as a group are becoming more and more
diverse, and white adolescents are projected to be in the minority
nationally by the year 2040. California has not had a racial majority
in its population since 1999. Teens who were born in this country
to immigrant parents, or who came to the United States as young
children, may speak and appear the same as most other American
teens. However, they often feel a stronger tug between teen peers
and family cultures compared with other adolescents. Cultural and
family ideas about the causes and treatments of health problems
can be different from those in Western medicine.
“Health care providers working with children may be accustomed
to issues unique to adolescents; however, differences related to
culture may pose challenges that are less familiar and yet have
broad and complex implications for health care.”3 So, be aware
of the possible added influence of culture on teens and attend to
CDHA Journal – Winter 2013
cultural issues if necessary. If your office serves a particular cultural
group, spend some time to learn about their health beliefs, values,
attitudes, and assumptions.
9 Be the professional
Remain the adult professional. Do not try to try to be a
buddy or impress them with your knowledge of the teen culture.
They have friends. They need healthcare providers to guide and
mentor them.
10 Highlight important points
At the end of the appointment, summarize what you
have done and said, what the patient needs to do, and, most
importantly, reiterate why she needs to do it. Keep it simple
and focus on the most significant one or two issues. Try not to
overwhelm with too much information.
Conclusion
Teens prefer healthcare providers who listen, reserve judgment,
and maintain their privacy and confidentiality. They want to know
that we sincerely like and care about them. Maybe, once they come
to trust us, they will realize that they really don’t know everything!
About the Author
Toni S. Adams, RDH, MA, practiced
clinical dental hygiene for 26 years before
returning to school to earn advanced
degrees in communication studies. Toni
speaks and writes about communication
issues in healthcare and currently serves
on the editorial advisory boards of
DentalLearning.net and the CDHA Journal.
Her Dental Communication Brief Book Series was published in
2011. Toni welcomes questions, comments and book orders at
[email protected].
References
1. Campbell, M. E. (2007). Communicating with adolescents. CME, 25(5), 224-227.
2. Lehrer, J. A., Pantell, R., Tebb, K., & Shafer, M.-A. (2007). Foregone health care
among U.S. adolescents: Associations between risk characteristics and
confidentiality concerns. Journal of Adolescent Health, 40, 218-226.
3. Fleming, M., & Towey, K. (2001). Delivering culturally effective health care to
adolescents. American Medical Association. Retrieved November 2, 2012 from
http://www.ama-assn.org/ama1/pub/upload/mm/39/culturallyeffective.pdf
Bibliography is available in the online version of this issue at
www.cdha.org
13
CDHA NewsNotes
Ellen Standley was the
recipient of the 2012 President’s
Recognition Award. Outgoing
President Lisa Okamoto
highlighted Ellen’s decades
of dedication, leadership and
volunteer service to CDHA and the
profession of dental hygiene as
she presented the custom designed plaque at the 2012 CDHA House
of Delegates President’s Luncheon. Ellen, a 1964 graduate of the
University of California San Francisco Dental Hygiene Program, was
a beloved faculty member at Sacramento City College for 36 years
until her retirement last year. In her many years in the profession
Ellen has enthusiastically embraced almost all of the many roles a
dental hygienist can play: clinician, public health hygienist, educator,
administrator, change agent, advocate, speaker, writer, mentor and
above all, a life-long volunteer. She has served in all of the offices
in the Sacramento Valley Component in addition to chairing and
participating on a number of CDHA Councils all before stepping
forward to run for 2011-12 CDHA President. On the national level,
Ellen has represented California as an ADHA delegate for many
years. Known for her kindness, generosity, gracious leadership style,
her smile and sense of humor, Ellen was probably the most surprised
member of the audience as her name was announced for the award!
Congratulations and thank you, Ellen, for all that you continue to do
for the dental hygiene profession.
Redwood component member James Southard, RDH was
granted Life Membership status by the 2012 CDHA HOD.
Nadine Lavell, RDH, MS, from Windsor, CA was elected to
the office of CDHA President Elect.
Cathy Critchfield, RDH from East Bay component was the
lucky winner of the $2,000 gift card drawing held at the CDHA
President’s Installation Luncheon. The “CDHA Raffle” has become
an annual fundraiser for the association, thanks to all the support
it receives from members. Tickets for next year’s drawing are now
available for $10 each. Contact your component Trustee for 20122013 tickets. Remember, if you don’t play you can’t win!
Jenifer McDonald Association
Management took over running the day
to day business of CDHA on January 1,
2013 following the vote of the CDHA Board
of Trustees November 3, 2012 to accept
McDonald’s proposal for management services. McDonald began
her career over 30 years ago in the California State Capitol and
has worked in a number of roles ranging from Chief of Staff
for Assemblywoman Marion La Follette to Executive Director
of the California Association of Collectors. She has provided
comprehensive association and meeting management services
since 2004. Jenifer and her team are based in Sacramento and are
excited for the opportunity to work with CDHA.
CDHA celebrated “It’s a Small World: Reach Out,
Connect, Grow” at the 2012 House of Delegates while adopting
policies with respect to best practices, standard of care, general
and oral risk assessment, evidenced-based care guidelines, dental
hygiene settings, and expansion of our scope of practice. Complete
language on policy and definitions passed by the House can be
found at www.cdha.org. in the members section.
14
San Francisco Dental Hygiene Society Receives
$5,000 Donation from Oral B
As part of their “Power Up” campaign to increase America’s
awareness of the role oral health plays in total health and improve
their oral health care practices, Oral-B presented the San Francisco
Dental Hygiene Society (SFDHS) with a $5,000 check at the
CDHA Journal Vol. 28 No. 1
CDHA NewsNotes
American Dental Association’s 153rd Annual Session held in
San Francisco last October. The SFDHS was honored for their
ongoing work with underserved populations at the Mission
Neighborhood Health Center. SFDHS members have provided
oral health care and instructions to over 300 English and nonEnglish speaking children and their parents at the center for
the past three years. SFDHS plans to use the Oral B donation
to expand the reach of their public service announcements
promoting their “Give Kids a Smile” events during February
as well as to assist in their ongoing work at the Mission
Neighborhood Health Center. Other SFDHS community
outreach activities include their oral care screening and fluoride
varnish application training sessions for San Francisco State
University Nursing School students and the family homeless
shelter screening and educational programs.
Call for Nominations –
Friend and Mentor to the Dental Hygiene Profession
John Stenovich, Passes
John Stenovich practiced
dentistry for over forty
years in Capitola California
but he is far better known
as a beloved instructor
who taught in the Cabrillo
College Dental Hygiene
Program for forty years.
As an oral pathology and
pharmacology instructor, Dr Stenovich inspired his dental hygiene
students to always strive to do their best work. He considered his
students to be like friends and family and spent countless hours
tutoring and mentoring future dental hygienists at Cabrillo College
and later at Carrington College in San Jose. Respected and loved by
both the dental and dental hygiene community, Dr Stenovich always
modeled a collaborative approach to comprehensive patient care.
A supporter of the not-for-profit Dientes Community Dental Clinic
from its inception over 20 years ago, Dr Stenovich emulated the
qualities of a true healthcare professional: a passion for learning,
dedication and compassion for others and will be missed by all who
knew him. Donations in his memory may be sent to Dientes/Attn:
Stenovich Fund, 1830 Commercial Way, Santa Cruz, CA 95065.
Officers for 2013-2014
Step Up, Reach Out, Share Your Passion – Aspire to Inspire!
Be a candidate for election at the 2013 House of Delegates
✦President-Elect
✦ VP of Administration & Public Relations
✦ VP of Membership & Professional Development
✦Secretary/Treasurer
✦ Speaker of the House
✦ ADHA Delegate
Any CDHA member interested or for more information, please contact:
Lisa Okamoto RDH, Immediate Past President, [email protected], 408-598-0656
CDHA Journal – Winter 2013
15
StayingHealthy
Aubreé Chismark, RDH, MS
Oral Piercing and Body Art –
21st Century Realities and Safety Issues
Introduction
Oral piercing and body art has become increasingly popular among
adolescents as well as adults in recent years. What is the motivation
behind this practice? Is it to make a statement, draw attention
to oneself, or simply because it looks good? Studies report that
aesthetics are cited most frequently, followed by sexual motivations
and the desire to “seek a transgressor look.”1,2 When piercings
alone were studied, individuals indicated they were looking for
“uniqueness, self-expression, and sexual expression.”3-5 Reasons
for body art include: “distinguishing one’s self from others; as a
fashion statement; and other personal reasons.”2,6 Oral piercing and
body art have become widespread forms of self-expression in the
21st century however, a bigger issue remains. When an individual
chooses to pierce or tattoo their body, are they always aware of the
health and safety issues surrounding this practice? Does health and
safety play a role in the selection of a tattoo artist or body piercer?
As healthcare professionals, it is important for us to encourage our
patients who are considering an oral piercing or tattoo to carefully
consider the pros and cons of their choice and the importance of
finding an experienced individual who maintains a clean and safe
environment. Many states and counties are requiring practitioners
to comply with state and local requirements relating to client
information, including bloodborne pathogen training, which is a
significant step forward in improving the health and safety issues
surrounding piercings and tattoos. As healthcare providers, it is
our responsibility to educate patients with oral piercings about the
need for appropriate oral care and the negative impact the piercing
and jewelry may have on the oral cavity and periodontium. Dental
hygienists must have an understanding of the evidence behind
the risks involved with oral piercings and body art in order to be
effective health educators.
Oral Piercings
Tongue piercing is the most common type
of oral piercing seen among individuals,
with the mean age of the first piercing
reported as 15.3 years.2 The majority
of individuals reported receiving their
16
piercing at a studio, followed by those who had their piercings
performed at home, or by a physician.1,2,6-10 Tongue piercings
usually involve either a metal or an acrylic barbell that is inserted
into the central portion of the tongue.
Complications from Oral Piercings
One of the drawbacks to tongue piercings is the accumulation of
bacteria around the site. Research has demonstrated that there is
significant bacterial accumulation surrounding tongue piercings,
with higher levels of bacterial growth forming in individuals who
use tobacco.11-13 Calcium formations have also been observed,
including plaque and calculus formation along the ventral
surface of the piercing site, as well as radiographically detectable
calculus.11,12,14-16 Candida albicans have been detected around
piercing sites; the longer a tongue piercing has been in place, the
higher the periodontal-pathogenic potential.12,13
Individuals with oral piercings, especially those with tongue and
lip piercings, put themselves at risk for a variety of complications
throughout the life-span of the piercing. Early complications
include: mild pain; infection; difficulty speaking; and difficulty
eating.1,7,8,14,15 However, research indicates the more time
an individual spends on brushing, the lower the risk of early
complications.7 The most common chronic problems arising from
oral piercings involving the tongue, lips, cheeks and uvula include:
tooth fracture; gingival recession on mandibular anterior teeth;
periodontitis; infection/abscess; scar formation; nerve damage;
metal hypersensitivity reactions; and ingestion of the tongue
piercing. Life threatening complications that have been reported in
the literature include prolonged bleeding, edema, endocarditis and
airway obstruction.1,7-9,14-19
Caring for Oral Piercing Sites
The presence of oral piercings poses increased risks for
complications causing damage to hard and soft tissues.15 As
dental professionals, hygienists need to be aware of the types of
complications associated with oral piercings and counsel patients
about the potential risks.18 While both the American Dental
Association and the American Academy of Pediatric Dentistry have
CDHA Journal Vol. 28 No. 1
StayingHealthy
current policy opposing the practice of oral/perioral piercings and
tongue splitting, the fact remains that the practice is prevalent in
today’s society.20, 21 Individuals considering an oral piercing should
be provided with the resources for selecting registered piercers
who subscribe to safe practices.10,17 Patients presenting with oral
piercings should be seen for regular dental examinations without
discrimination based on their personal choices; be educated on the
potential of pathogenic bacterial accumulation surrounding piercing
sites; and advised to avoid any additional oral habits that may lead
to oral trauma or gingival recession.7,22
It has been suggested that the piercing site be thoroughly cleaned
with a tongue scraper and chlorhexidine digluconate. Patients should
also be advised to remove the piercing jewelry, followed by thorough
cleaning with a toothbrush and daily soaking in chlorhexidine.12,17
Baseline periapical radiographs of the mandibular anterior teeth are
recommended. If bone loss is present, follow-up periapicals should
be taken every six months to monitor the status.16
Body Art
Humans have been marking their
bodies with tattoos for thousands of
years, with the first known tattoos
dating back to the Iceman mummy.
Body art, in the form of tattoos, has
become increasingly more prevalent
in Western cultures as a form of
self-expression in adolescents and
adults of all ages. The mean age
reported for receiving the first tattoo
is 17.5 years, although the 1969
Tattooing of Minors Act specifically
prohibits the tattooing of anyone
under the age of 18. In contrast, there are no age restrictions for
body piercings as long as the individual is able to give consent.2, 24
Inserting ink, by way of a needle
to the outermost layer of the
epidermis, results in a permanent
fixture on the skin or mucosa in
the form of a tattoo. The tattooing
process itself can potentially lead to
blood-borne diseases including Hepatitis B, Hepatitis C, or HIV.23
Bloodborne pathogens are not the only disease risks resulting
CDHA Journal – Winter 2013
from tattoos in the 21st century. The United States Food and
Drug Administration (FDA) recently issued an advisory on nontuberculosis mycobacteria (NTM) infections traced to contaminated
tattoo inks. NTM can cause lung disease, joint infections, eye
problems and other organ infections that are difficult to diagnose
and can require treatment lasting six months or longer. The FDA
further warns that tattoo inks, and the pigments used to color
them, are susceptible to contamination from other bacteria, molds
and fungi. Tattoo artists can minimize the risks of infection by
using inks formulated or processed to ensure they are free from
disease-causing bacteria, and by using sterile water to dilute the
inks. Clients need to be aware that the ointments provided by
tattoo parlors for post-tattoo skin reactions are not effective forms
of treatment for NTM infections.25
Other forms of body art include the following: cutting; body
painting; genital piercing; scarification; digit amputation; beading;
cosmetic tattooing; tongue splitting; branding; and braiding.24
Regardless of the form the body art takes, the primary public
health concern lies in promoting the health and safety of both the
client and the piercer/tattoo artist. Groups such as the Association
of Professional Piercers, the international health and safety
organization for piercing professionals, are working to disseminate
the most up-to-date information about body piercing standards
to fellow members and the public. Federal, state and local health
agencies are also increasing the health and safety requirements
regulating the body art/piercing industry.
Awareness and Risk Behaviors
Adolescents are highly aware of piercings and body art. A recent
European study reported that out of the 4,277 adolescents
surveyed, 6% reported having a tattoo and 20% had a body
piercing. Sixty-two percent of the adolescents with tattoos were
under the age of 18 and a similar number, 66%, had a body
piercing.10,26 Of those adolescents, a little more than half were
aware of the possibility of contracting an infectious disease and
only 40% were aware of the possible complications associated
with tattoo removal. Higher education also appeared to play a
role in choosing to have a tattoo or body piercing. Individuals
whose fathers had advanced education were less likely to show
an interest in body art and had a higher knowledge of the health
risks associated with tattoos and piercings.26 Certain characteristics
Continued on Page 18
17
StayingHealthy
and risk behaviors have been reported among adolescents with
piercings and body art including: depression; sensation-seeking;
dissatisfaction with body image; multiple sex partners; suicide
attempts; regular tobacco users; and users of illegal drugs.4
It has been reported that young adults are aware of the
complications that may occur from body piercing and tattoos
including the possibility of contracting AIDS, Hepatitis B,
Hepatitis C, and tetanus. College level students demonstrated an
increased awareness of additional complications that may occur
such as scarring, allergic reactions, and bleeding as compared to
adolescents.2,6,10 Individuals also report having knowledge about
tattoo removal and the risks involved prior to the procedure, which
are typically communicated by either the artist, another individual,
or through informed consent.2,6 It is important to remember that
tattoos are considered to be permanent. Laser tattoo removal is
possible; however the procedure requires a number of sessions and
can be uncomfortable as well as expensive.23
education can have a significant impact in reducing the number of
complications, as well as encouraging good decision making when
it comes to choosing a body artist or piercer.
Post-piercing Oral Care Fact Sheets
American Dental Association
www.mouthhealthy.org/az-topics
Academy of General Dentistry
www.agd.org/public/oralhealth
Association of Professional Piercers
www.safepiercing.org
Consumer Information from the
Food and Drug Administration Think
Before You Ink: Are Tattoos Safe?
www.fda.gov/ForConsumers
Conclusion
References available in online version of this issue
Health education programs should be led by nurses, physicians, and
school counselors to advise adolescents of the complications that
may occur with piercings and tattoos.2,5,6,10,25 Individuals desiring an
oral piercing or tattoo should find an artist who is experienced and
practices in a sterile environment. The recently enacted Safe Body
Art Act in the state of California now requires all piercers and body
artists to register their businesses with the county and adhere to the
state and local public health department guidelines to provide a safe
environment for employees and consumers. Individuals who obtain
a tattoo or body piercing should also be reminded they will be
ineligible to donate blood for one year in order to ensure they have
not contracted a blood-borne disease.23
at www.cdha.org
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. 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].
As healthcare professionals it is our responsibility to educate
patients about the risks and complications involved with oral
piercings and body art, although it is important to keep in mind
that the final decision truly lies with the individual. For those who
choose to move forward with oral piercings, encouraging healthy
oral hygiene habits and regular dental visits is imperative. And
for those who receive a tattoo, suggesting multiple blood tests
throughout the year is recommended to verify that an individual
has not received a blood-borne disease. Realistically, individuals
are going to continue to receive oral piercings and body art. Getting
the entire team on-board to provide evidence-based patient
18
CDHA Journal Vol. 28 No. 1
California Legislative Update
Senate Bill 1202 was signed into law on August 23, 2012
by California Governor, Jerry Brown.
Key features of SB 1202 include the following:
A special permit may be granted to a registered dental hygienist licensed
in another state allowing the individual to teach in a dental hygiene
program without a California dental hygiene license, provided that all the
requirements set by the DHCC have been met.
All new dental hygiene programs shall submit a feasibility study to
the Dental Hygiene Committee of California (DHCC) prior to seeking
approval for initial accreditation.
Completion of an extended functions course (local anesthesia, soft tissue
curettage and nitrous oxide-oxygen analgesia) is required for initial
dental hygiene licensure.
preceding the applicant’s date of application. Applicants must also supply
proof that they have no disciplinary action in state where they were
previously issued a professional or vocational license.
Applicants for dental hygiene licensure, who have failed the clinical exam
three times or have failed the clinical exam due to causing gross trauma,
must provide proof of remediation prior to re-taking the clinical examination.
Registered Dental Hygienists in Alternative Practice (RDHAP) may
establish mobile clinics for the provision of dental hygiene care.
RDHAP’s must register any additional places of practice with the DHCC.
Providers of continuing education courses approved by the Dental Board
of California may also be approved by the DHCC.
For detailed information on all California legislative actions visit
http://leginfo.legislature.ca.gov/faces/home.xhtml
Candidates seeking to obtain licensure by credential must supply proof
of prior practice experience obtained during the 5 years immediately
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]
CDHA Journal – Winter 2013
19
StudentConnection
Scottie Chapman and Rebecca Ruegg
A Community of Professionals
an Experience of a Lifetime
Learning and growing as a dental hygienist is a lifelong process.
Many people assume that learning ends when a degree is
completed and a license is earned. However, in order to excel
in our profession, belonging to a community of like-minded
professionals is vital to our growth. An organization, such as the
American Dental Hygienists’ Association, ADHA, creates such a
community where dental hygienists can develop as professionals,
continue their education, conduct research, discuss professional
issues, learn career advancement skills, and assist in educating the
next generation of professionals. The ADHA acts as a central hub,
bringing together individuals with different levels of experience and
a variety of perspectives. ADHA allows for the sharing of knowledge
and a diversity of opinions by encouraging participation and pride
in one’s profession along with mentoring the next generation.
As part of ADHA’s outreach to dental hygiene students, we had the
unique opportunity to serve as student delegates for District XI and
experience the inner workings of our professional organization at the
state, district, and national levels. Participating in the CDHA House
of Delegates in Santa Clara followed by the 2012 ADHA Annual
Session in Phoenix, AZ. provided us the opportunity to strive for
continued growth and success within our professional association.
We would like to take a moment to share our thoughts with the
CDHA Journal readers and respond to a few questions on our
experiences as student delegates.
How did you become interested in serving as student
delegates to ADHA?
SC: In choosing to pursue dental hygiene as a career, I was
interested in not only working as a clinician, but also in doing
something about the lack of access to dental care. This had been an
issue in my life and when I started in the dental hygiene program,
it became clear that it is a widespread problem. I also learned
about the ADHA. Naturally, the opportunity to serve as a student
delegate seemed like a great place to start.
RR: The importance of the ADHA was instilled within me from
the beginning of my dental hygiene education at Phoenix College.
Most importantly, active involvement within this organization and
its effect on the growth of our profession was stressed. In the
20
beginning, my view of the ADHA was limited to involvement in our
school’s student chapter. However, as I developed relationships
with my professors, I came to realize that they really practice what
they preach. Faculty members at Phoenix College are involved
in all aspects of our professional organization making priceless
investments in the future of dental hygiene. It is due to their legacy
of involvement and leadership that I became interested in serving
as a student delegate.
Out of the 24 student ADHA delegates and alternates, two
positions were voted on by the students and District XI won
both elections. Tell us about your positions and representing
student voices from across the country?
SC: I was elected Reporting Student Delegate. I was responsible
for presenting a report to the ADHA House of Delegates on the
ideas and solutions developed in the Student Mega Issue Forum.
The forum was a roundtable discussion on the future of the
dental hygiene profession. As the Reporting Student Delegate I
summarized the proceedings of the discussion. We were presented
with two questions; the first one dealt with how our educational
programs can prepare us for a changing profession while the
second one focused on what students themselves should be
doing to prepare for their future. Students felt that coordination
with dental school programs would not only give us a better
understanding of dental procedures, but would also help future
dentists understand our value and scope of practice. Looking at the
future opportunities outside of traditional dental office settings, we
felt that more education about mid-level providers, and business
courses, would be useful. Students also felt that in order to prepare
for the growing elderly population, more rotations to community
clinics and centers would also be beneficial.
RR: I was elected Voting Student Delegate with the responsibility
of representing all dental hygiene students with my vote in the
ADHA House of Delegates. This position gave me the invaluable
experience of interacting with students from across the country
in order to find consensus for the student vote. It was truly
surprising to learn about the variations from state to state within
our profession. As the discussion in the House of Delegates
became passionate, it was interesting to hear the different opinions
CDHA Journal Vol. 28 No. 1
StudentConnection
on issues and to witness the political polarization within our
profession. Although the student delegates may have had differing
opinions about the issues discussed in the House of Delegates,
these disparities were overshadowed by our common purpose. We
were all students entrenched in the rigors of dental hygiene school
who had been given the opportunity to participate in the policy
making decisions of our professional organization. We were united
in our understanding that as student dental hygienists and future
professionals we have an opportunity to make a difference. Most
importantly, we are ready to contribute to the development and
advancement of our profession.
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?
SC: I knew that I want to be involved in helping to increase access
to dental and dental hygiene care from the beginning. Now I have
a much better idea of where to start and what path I need to take
in order to accomplish that. I plan on continuing my involvement
with my local component and hope to become ADHA delegate in
the future.
RR: My observations and experiences as a student delegate
allowed me to realize the amazing opportunity that we, as student
dental hygienists, have in creating and controlling our future.
The ADHA events helped me to understand how many different
ways there are to be involved in the growth of our profession.
The hygienists supporting our professional organization have
established an amazing legacy of dedication and tenacity. They
have created a broad scope of opportunities within our association
and are working to expand our careers. I developed a strong
sense of responsibility for our profession as I witnessed this
group of diverse individuals diligently working together to make
a difference in our future. I began to understand the importance
of being involved, taking pride in our profession, and creating a
secure future. It became clear to me that we too, as student dental
hygienists, can make a difference.
Do you have any final comments on your experience?
SC and RR: Our personal experiences as District XI student
delegates extended far beyond our expectations. We thought
that we would attend meetings and discuss the future of our
profession. However, neither of us expected to find something
deeper and more valuable. Our positions provided us with the
profound and unexpected opportunity to form relationships that
will last a lifetime. Working together with dental hygienists to make
a difference in the future of our profession gave us the chance
to form lifelong friendships with our future colleagues. There are
limitless opportunities for personal and professional growth and
development from these friendships and most importantly, these
bonds will strengthen the foundations of our profession.
About the Authors
District XI student delegate Rebecca
(Becky) Ruegg is a second year dental
hygiene student at Phoenix College in
Arizona and alternate student delegate
Scottie Chapman is in her second year
of study at Diablo Valley College in
Pleasant Hill, California.
Becky Ruegg (left) and Scottie
Chapman (right) at the ADHA
Annual Session in Phoenix, AZ.
Join in the celebration of the 100th
anniversary of the dental hygiene
profession in Boston, June 19-25, 2013 as
a District XI student delegate. Download the application
at www.adha.org/students
Questions? Contact District XI Trustee, Sharon Zastrow, RDH at
[email protected]
ADHA District XI Trustee, Call for Nominations!
Celebrate 100 years of growth for the Dental Hygiene Profession
Step up to leadership at the national level!
Nominations are now open for the office of District XI Trustee,
representing California and Arizona on the ADHA BOT for 2013-15.
Any voting member of CDHA or ASDHA is eligible to run.
Questions? Contact Lisa Okamoto, ADHA Delegation Chair, CDHA [email protected]
CDHA Journal – Winter 2013
21
StudentConnection
Amira M. Elkerdany, BA, RDH
Saving Yourself from Drowning
in Dental Hygiene School
For those of you caught in the throes of dental hygiene school,
this article is for you. Whether you are at the beginning of your
studies, or nearing graduation, the feeling of drowning alive in
clinical work, projects, and the never-end barrage of exams is
overwhelming. You are probably asking yourself, “Who would have
ever thought that dental hygiene school would be so difficult?” It
certainly was a shock for me, and even in the middle of it all, I still
had a hard time convincing my friends and family just how tough
it really was. It is important to remember, however, that you are
not in it alone. Having just graduated this past May, the toils of
dental hygiene school are still fresh in mind. Fortunately, I am no
longer haunted by such questions as: “What are the four stages
of embryonic tooth development?” and “Where in the x-ray head
does thermionic emission take place?” Soon enough, you, too, will
be able to look past such questions, and remember what it was
like to read for pleasure, as opposed to reading to fill your head
with facts for exams.
In writing this article, it is my hope to present some different
studying and coping strategies that you can use in order to survive
the intense academic rigors of dental hygiene school. All of these
strategies were used by me personally or my classmates, and
since we all graduated and passed our exams, there must be some
merit behind them, right? It would be silly of me to discuss the
standard studying techniques, in which I am sure you are well
versed, or else you would not have been able to survive all those
pre-requisite courses! Instead, I hope that you can read this article
with an open mind, and perhaps utilize some of these strategies if
you are finding yourself in need of a little help.
First, if you tend to be a visual learner, consider making drawings
or maps of the material (yes, even if that means drawing out all
the veins and arteries of the head and neck region). When studying
from your book or your notes, use several different highlighters –
the more colorful, the better, but make sure to have some logic to
your color-coding. Also, consider putting notes up in your bathroom.
That way, you can study while you are standing at the mirror or
taking a bath (hopefully your bathroom has good moisture control)!
Flash cards and sorted lists are always good tools, as well. YouTube
videos can also be an excellent resource: consider looking up that
PSA injection technique video as a quick refresher before you
subject your classmate to yet another injection…
22
Auditory learners can greatly benefit by recording class lectures
and listening to them during long commutes, while cooking dinner,
etc. It also helps to read notes out loud, or meet with a study
group to talk through difficult concepts. I know it sounds strange,
but a classmate and I used to read our notes out loud to each
other using different amusing accents, or we would create stories
(such as the story of “Dentin Man” and the story of “The Very
Hungry Macrophage”). I also found that listening to classical music
helped me remember twice as many facts. One of my favorite
study methods during the warmer months was to set up a blanket
outside, put on some classical music, and read my oral pathology
notes (I definitely owe Chopin a thank-you note).
For people who need movement in order to remember key facts,
take a walk around the campus during one of your breaks (if you
even get a break…), and try to grab a classmate to go with you so
that you can read your notes and quiz each other while you walk.
If you are at home by yourself, pace around the house or walk
around the block with your notes – it is studying and exercising all
in one! Other strategies include sitting on a yoga ball so that you
can bounce while you study, or tapping your foot or dancing in your
chair while you do your reading (of course this is even better with
music in the background).
From my own experience, and my classmates’ testimonials, it
seems as though most people require a variety of strategies, and
trial and error is probably the best way to find out which ones will
work for you. For example, I greatly benefitted from talking out
loud with my weekly study group, as well as carrying my notes
with me as I went for a walk. I also had the habit of studying in
the noisiest café I could find, which happened to be located in my
neighborhood grocery store. Somehow, the ambient background
music, along with the whirling of the coffee machines, talking
patrons, and occasional page over the loudspeaker (“Bakery, you
have a call on line 7”), helped me hone in on my studies and kept
me less distracted than trying to concentrate at home or in the
library. I would also find myself bouncing along to the grocery store
music, and I am convinced that this aided my studying. If you find
yourself easily distracted, try napping before an exam (in the car,
perhaps?), or napping before studying. This may help you re-focus.
CDHA Journal Vol. 28 No. 1
StudentConnection
Stress management is also a huge part of surviving dental hygiene
school. Several of my classmates used television as a way to let
their brains rest, while others turned to delicious food for comfort.
Instead of constantly studying, one of my classmates found it more
beneficial to cook meals for the class, as she noted that her success
in school could only be possible if she had a healthy mind and
body, and cooking was her way of de-stressing. Spending time with
friends and family, especially the ones that have an understanding
of what you are going through, is absolutely crucial. Carve out
some time during your week to see those special people in your life.
For me, it tended to be the weekdays and Friday nights since I did
the bulk of my studying on the weekends. As a coping mechanism,
I would listen to very upbeat, positive music during my drives to
and from school, while one of my classmates turned to religious
radio programs. Whatever allows you to forget, or helps you to
see the bigger picture, go for it! I also started taking a dance class
to relieve my stress, and I spent many hours crying to my mom
and to my classmates when I felt overwhelmed or frustrated. As a
class, we also made time to get together and have small parties, or
enjoy the happy hour at the Mexican restaurant across the street
from our school. Albeit small, these casual social gatherings had a
tremendous impact on our stress levels.
After having recently completed dental hygiene school (even
while coping with my father’s passing in my second year), I can
confidently say to you that it is possible to survive it. You, too,
will have the strength and potential to get through dental hygiene
school and board exams. If studying has been a challenge for you, I
invite you to try some of the techniques my classmates and I used.
We were a quirky bunch with some unconventional study habits,
but perhaps our success can be attributed to some of those unique
strategies. So go ahead, take a chance and give them a try!
Remember that you are able to retain:
About the Author
Amira Elkerdany is a recent graduate
from the dental hygiene program at
Chabot College in Hayward, CA. She
also holds a Bachelor of Arts degree
in Peace and Conflict Studies from the
University of California, Berkeley. She
currently works as an RDH in private
practice in Los Angeles and volunteers at
the Simi Valley Free Dental Clinic. She
is a member of the CDHA IT Council and is fiercely
proud of having completed dental hygiene school.
Dental Hygiene
Associates Inc.
Supporting scholarships and research grants
for CDHA members and community service
Advance DHAI’s mission of improving oral health
through education, research and community
service by making a donation today!
Make check payable to DHAI, and mail to:
CDHA
1900 Point West Way, Suite 222
Sacramento, CA 95815-4706
• 10% of what you read
• 20% of what you hear
• 30% of what you see
• 50% of what you see and hear
• 70% of what you talk about with others
Donations are 100% tax deductible.
DHAI is a 501 (c) (3) nonprofit organization.
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• 80% of what you experience personally
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CDHA Journal – Winter 2013
23
CareerCorner
Lisa L. Okamoto, RDH, AS
Katie L. Dawson, RDH, BSDH, RDHAP —
a Career in Excellence
Katie L. Dawson was recently
honored in Phoenix, Arizona as
one of the recipients of the 2012
ADHA Award for Excellence in
Dental Hygiene. This prestigious
award recognizes dental hygienists
whose accomplishments have had
a significant impact on the practice
and future of dental hygiene.
Serving the public – making a
significant difference in people’s
lives – has always been at the heart
of Katie’s passion. Her dedication
to professional excellence, education and increasing access to oral
health care for the underserved, have guided her on a path of
leadership and advocacy here in California and across the country.
Katie has influenced our profession at the highest levels of
leadership as President of the California Dental Hygienists’
Association, the National Dental Hygienists’ Association, and the
American Dental Hygienists’ Association. She was instrumental
in launching the ADHA Tobacco Cessation Project (Ask, Advice,
Refer) and contributed to the development of ADHA’s Advanced
Dental Hygiene Practitioner template for a mid-level DH provider.
But by far, her most significant impact to the overall practice of
dental hygiene has been as a consumer advocate. Katie has worked
tirelessly, speaking out at both the state and national levels on
the need to increase access to oral health care and to advance the
professional roles of the dental hygienist in providing that care.
Without a doubt, dental hygiene here in California would not be
what it is today without the help of Katie’s committed efforts. It
was in recognition of her many accomplishments and her impact on
the dental community that in 2009 Katie was awarded the UCSF
School of Dentistry Alumni Medal, an honor bestowed upon only a
handful of UCSF dental hygiene alumni.
I was able to catch up recently with Katie to ask her a few
questions about her journey as a dental hygienist and her stellar
career that is still going strong.
24
What inspired your career in oral healthcare?
I grew up in Fairbanks, Alaska in the 1950s where there were few
dentists. My family had no dental insurance and limited resources,
leaving very little in the way of access to dental care. I learned to
live with active dental disease. After receiving his dental degree in
1964, my brother volunteered in Native American communities in
the State of Washington. Those were just a few of the many factors
influencing my decision to pursue a career in dental hygiene, a
career impacting oral health from a preventative approach.
You’ve worn many hats as a dental hygienist; one constant
throughout your career has been as a grassroots clinical
dental hygienist.
I graduated with my B.S. in Dental Hygiene from the University
of California in San Francisco over 35 years ago and immediately
sought employment as a clinical dental hygienist in private practice.
Initially for me, there was no desire to seek a position in education,
public health, or the other roles of dental hygiene. My desire was to
have a personal relationship with my clients and their families and
make a positive impact on their total health. Some of my closest
relationships today are with people I met in the dental chair. I’ve
seen two generations of many families, and have followed the
education and marriages
of their children. My clients
know the names of all my
grandchildren and always ask
to see their latest photos and
get updates on their lives.
You recently broadened
your reach by becoming
an RDHAP.
After 35 years of practicing
dental hygiene as an
employee in private dental
offices, I have followed my
dream to own my dental
hygiene practice! Following
completion of the University
Katie Dawson, BS, RDHAP delivering care
to one of her homebound clients.
CDHA Journal Vol. 28 No. 1
CareerCorner
of the Pacific’s Registered
Dental Hygienist in Alternative
Practice (RDHAP) educational
program, I became the
sole proprietor and owner
of Dawson Dental Hygiene
Practice and have become an
in-the-home provider of dental
hygiene care. This decision
required a personal investment
of time and resources, but I
Katie is honored at the ADHA Awards Luncheon
was committed to the concept
on June 17, 2012 with son Tony Dawson and
of providing dental hygiene
granddaughters Sierra (8) and Amaya (7).
care to seniors in the comfort
of their personal environment - whether in the home, a residential care
facility, the hospital or in a community center.
My passion for serving seniors stems from a personal experience that
occurred in 1988. My 84 year old Uncle Henry was involved in a
debilitating accident and required hospitalization for the last five weeks
of his life. The injuries from the accident severely limited his ability to
manage his personal dental hygiene. After the first two weeks he would
complain that he had no appetite or desire to eat because his mouth felt
unclean. Because I was restricted by the California Dental Practice Act’s
scope of practice for dental hygiene, I was limited to removing his dental
appliances and brushing his teeth. I was not allowed by law to provide an
oral prophylaxis. Every evening Uncle Henry would wait for my arrival to
clean his mouth so he could enjoy his dinner meal. Though limited, that
daily debridement made a significant improvement in the quality of life
for his remaining days of hospitalization until he passed on.
Unfortunately, in 1988 the RDHAP was a concept whose time had not yet
come; it would be another 22 years before a new career as an RDHAP
would become a reality for me.
that. The GRC represents CDHA’s interests at the meetings
of the Dental Board of California (DBC) and the Dental
Hygiene Committee of California (DHCC). Working closely
with our highly esteemed lobbyists at Aaron Read and
Associates, the GRC implements the strategic government
affairs action plans of CDHA, and develops and monitors
the legislation impacting our profession. We have had some
great legislative successes and have remained persistent
when setbacks arise. For example, while advocating for the
creation of the DHCC, the nation’s first self-regulating dental
hygiene body, our legislative proposal was vetoed twice
before we were successful on the third attempt.
The legislation that successfully established the RDH in
Alternative Practice in California was introduced during
your term as President of CDHA from 1995-96. Please
share the instrumental role you later played in removing
the final hurdle to establishing educational programs
for RDHAPs.
In 2001, I was appointed to the Dental Board of California
(DBC) by then Governor Gray Davis, as the lone dental
hygienist member of the board. I was persistent in vocalizing
dental hygiene’s concerns regarding the roadblocks to
establishing a “classroom education” program for RDHAPs
at all of the California dental schools. Repeated reminders
to the legislature of our inability to implement the RDHAP
educational programs within the dental school setting led
to the successful passage of CDHA authored legislation
allowing for the RDHAP coursework to be developed on
community college campuses.
I understand you were recently appointed to another
California Consumer Board.
In November, 2011, I was appointed to the Board of
Barbering and Cosmetology by Governor Edmund “Jerry”
Brown. My purpose in seeking this position was to continue
my desire to serve and protect the consumers of California,
and to demonstrate
“I remain committed to improving the quality of life of to dental hygiene
those who receive the oral health services that I and
professionals that our
my colleagues provide by advocating the highest levels participation in consumer
of education and utilization of our professional skills
protection should not
be limited to dentistry.
while protecting the consumers we serve.”
It appears that you realized the limitations of access to care very
early in your career and were able to capitalize on your interest in
advocacy as a means to improve oral health.
Yes, my role as an advocate
has been very rewarding. I
have served as the CDHA
Government Relations Council
(GRC) Chair for the past four
years and as a council member
for a number of years prior to
Continued on Page 26
CDHA Journal – Winter 2013
25
CareerCorner
Barbering and cosmetology have some of the same
“cosmetic” rewards as our dental hygiene care, however,
as with our health profession, cosmetic improvement
is only one of the benefits. Boards of Barbering and
Cosmetology must also provide consumer protection in
the area of education, licensure, scopes of practice, as
well as disease and infection control.
What do you envision for the future of
dental hygiene?
I see a wide array of practice settings coming in the
near future for dental hygiene. Consumers will have
increasing options for selecting the location and
providers of preventative, interim and therapeutic
dental hygiene care. I see dental hygiene practices
growing out as extensions or even satellites of dental
practices for those professionals who don’t choose to
practice as sole providers. With the current studies
and pilot projects utilizing tele-dentistry, and the
new research focused on treating, intercepting and
preventing dental diseases, I see a bright future for
advancing our education into a variety of specialty
areas that will be earned through masters and doctoral
programs in dental hygiene.
About the author
Lisa L. Okamoto, RDH is
Immediate Past President of
CDHA. Lisa has practiced as
a clinical dental hygienist for
over 30 years, and has been
an adjunct clinical instructor
at the Foothill College
Dental Hygiene Program in
Los Altos Hills, CA. As a
member of ADHA throughout
her entire career as a hygienist, Lisa has served as a
leader at all three levels of our association.
26
Thank You Katie for Your
Dedication to Our Profession
“Katie has been a lifesaver. She fills a much needed niche, coming to
our home to treat my husband who is disabled and wheelchair bound. I
wish I could find a dentist who could come and provide dental care for
him as well.” ~ Mrs Green, patient
“Katie was invaluable when I bought the practice. The patients love
her. She is a great asset, and goes above and beyond while providing
excellent clinical care and wonderful oral health instructions.”
~ Dr. Gaime, employer
“Having worked with Katie for over 20 years, I have always been
impressed by her tenacity of spirit. She will work tirelessly to achieve
her goals and to promote the profession of dental hygiene. Katie is
not afraid to speak her mind and take on challenges, an aspect of her
character that served her well when she represented dental hygiene on
the Dental Board of California.” ~ JoAnn Galiano, RDH,MEd,
Past CDHA President,
GRC Legislative Consultant
“Katie and I worked side by side in my first year as ADHA Executive
Director. I was so proud to see her tremendous passion for the dental
hygiene profession and ADHA. She is a true professional! I am fortunate
to have shared a year of advocacy and leadership with Katie and to call
her my friend.”
~ Ann Battrell, MSDH,
ADHA Executive Director
“Katie is an inspiration to all and an accomplished professional. As a
student, I had the pleasure of attending the ADHA annual session during
Katie’s presidency. We were all so proud of what she had achieved and
looked up to her as a great leader and mentor. When I joined EBC, she
continued to mentor us; she is the one we turn to with all our questions.
Katie is the “brains of our component” with her in-depth knowledge and
experience in all areas of dental hygiene. We are all forever grateful for
the many ways she’s touched our lives.”
~ Naleni “Lolly” Tribble, RDH,
CDHA East Bay Component Trustee
CDHA Journal Vol. 28 No. 1
EducationExchange
Cathy Draper, RDH, MS
Kirsten Jarvi, RDH, MS
Incorporating Motivational Interviewing into
Tobacco Cessation Intervention Training
Building Fundamental Skills for Future Healthcare Providers
Motivational interviewing has been defined as a collaborative,
person-centered form of communication designed to guide,
elicit and strengthen motivation for change.1 Initially developed
in 1983 by therapist William R Miller in his work with addictive
behaviors, motivational interviewing has evolved into an evidencebased approach for facilitating change from within an individual.
Motivational interviewing shifts the focus to the individual’s own
values and concerns rather than coercive, externally driven, outside
forces. While motivational interviewing principles can be applied
to a wide variety of patient/client behaviors, incorporating these
techniques as they apply to tobacco habits, can provide student
dental hygienists with the necessary skills to fulfill the ethical
obligations of the healthcare provider in the area of tobacco
cessation counseling.
Motivational Interviewing Principles
A supportive, non-judgmental approach is a key component to
working with patients/clients who use tobacco. The core principles
of motivational interviewing are based on three elements:
collaboration, evocation and autonomy.1
Collaboration between the client and the clinician builds a trusting
relationship and a mutual understanding for problem solving. A
collaborative relationship helps to remove the confrontational role
of the counselor being “right” and the client being “wrong” which
is counterproductive in producing lasting behavior change.
Evocation describes the ability of the clinician to draw out the
client’s own thoughts and ideas for their behavior change. Selfdiscovery of the personal reasons for change along with the
self-determination for reaching the goal is far more effective than
reliance on the clinician or counselor to provide the convincing
arguments for healthier habits.
Autonomy, the core of motivational interviewing, empowers the
individual to be responsible for their own actions. Supporting the
right of the individual to make informed decisions recognizes that
the power and ownership for change lies within the client.
Developing Motivational Interviewing Skills
Before setting out to conduct the first motivational interview, be
it in the classroom or clinical setting, it is important to work on
developing a mindset to support the process.1,2
• Express empathy. Look at the world through the eyes and
experiences of the client to help establish an environment of
openness and collaboration.
• Support success. Help the client explore past successes with
behavior change and highlight existing skills and strengths.
• Resist the “righting” reflex. Allow the client to develop their
own solutions to behavior change rather than imposing the
viewpoint of a healthcare provider. While improved health
may be the “righting” reflex, the client must decide on their
unique motives for change.
• Support self-confidence. Enhance the client’s confidence
in their abilities to overcome their personal obstacles for
successful behavior change.
Developing the “Change Talk” Dialogue for Tobacco
Intervention Discussions
The goal of motivational interviewing in tobacco intervention is to
provide an environment for the client to voice their arguments for
behavior change.1,2 The change talk includes reasons for concern
and the advantages of the good things that will happen by quitting
their tobacco use.
Ask open-ended questions. Begin the discussion with asking the
client with “what”, “how” or “why” questions, allowing the client an
opportunity to describe their tobacco experiences.
“What do you enjoy about using tobacco?”
“What are the downsides of using tobacco?”
“What kind of roadblocks come to mind when you think about
quitting smoking?”
Continued on Page 28
CDHA Journal – Winter 2013
27
EducationExchange
Affirm change talk. Reinforce any client comments that support
past and current efforts towards stopping tobacco use. Recognition
of client strengths builds rapport and reinforces self-confidence that
change is possible.
“Limiting your smoking to evenings, that is a good step towards
quitting the habit. Do you have any other concerns?”
Reflective responding. Demonstrate an understanding of
the difficulties surrounding tobacco cessation from the client’s
perspective. Reflective responding can guide the client towards
change by focusing on the negative aspects of maintaining the
status quo and the positive aspects of change.
“This is what I am hearing you say, one of your main concerns
is how your smoking at home may affect your family.”
Summarize the dialogue. Bring closure to the session by recapping the
dialogue and calling attention to the critical elements of the discussion.
“So, if I understand you correctly, you enjoy smoking because
it helps you relax at the end of the day but you have concerns
about the effect that your second hand smoke may have on your
young children and family members. These are all important
and valid considerations. If it is all right with you, I would like to
check in with you to see how you are feeling about this. I want
you to know that when you are ready to quit your tobacco use,
we can help.”
Incorporating Tobacco Cessation Intervention Training into the
Dental Hygiene Curriculum
Tobacco cessation counseling is a vitally important health care
intervention. Skill development in counseling techniques requires
practice and reinforcement throughout the education program
regardless of when the topic is initially introduced. While resources
for tobacco cessation programs abound, educators need to be able
to provide students with the guided opportunities to develop selfconfidence with their interviewing skills.
• Role-Play. Role-play activities provide an excellent starting
point for learning tobacco cessation skills. Students can take
ownership of this activity by writing their own client scenarios.
Two students can be selected to be client/clinician while
the rest of the class can take notes and make suggestions
to improve the dialogue process using the motivational
interviewing guidelines previously introduced in class.
• Clinical Experiences. Real clinical experiences put the newly
acquired interviewing skills to a test. Tobacco habits should
be discussed in the initial health history intake questionnaire.
Student clinicians should be able to initiate the open ended
dialogue on tobacco use and include the discussion points in
their documentation. Clinical faculty need to be prepared to
support the students in developing their skills and address any
areas that need improvement. Challenges and successes with
tobacco cessation interviews can be discussed during clinic
seminars, to increase the learning experience for all students.
Tobacco Cessation Resources
Ask. Advise. Refer.
California Smokers Helpline
Offers free self-help materials in six
languages, referral to local programs,
and one-on-one, telephone counseling
to quit smoking.
Smoking Cessation Leadership Center
The American Dental Hygienists’
Association’s national Tobacco Intervention
Initiative with resources designed to promote
cessation intervention by dental hygienists.
Resources and partnerships for healthcare
providers with the goal of saving lives by
increasing cessation rates and interventions.
http://www.askadviserefer.org
http://smokingcessationleadership.ucsf.edu/
http://www.nobutts.org
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CDHA Journal Vol. 28 No. 1
EducationExchange
• Student Reflection. Reflection is a key component to the
learning process and overall professional development.
Including a one page reflection paper assignment as
part of the tobacco cessation education requirement can
be critical in identifying a student’s perceptions of their
strengths and weaknesses. Reflection can also help the
student identify the specific areas that they will focus on
to increase their self-confidence in future interviews.
Dental hygienists play a crucial role in tobacco intervention.
Developing the skills and the confidence to assume this role
begins within the dental hygiene education setting.
References
1. Miller W, Rollnick S. Motivational interviewing: preparing people for
change. New York:Guilford Press;2002. 472p.
2. Walsh, MM, Jarvi, KA. Tobacco Cessation. In:Darby, ML, Walsh, MM,
editors. Dental hygiene theory and practice. St Louis:Saunders; 2010.
p 648-50.
About the authors
Cathy Draper, graduated in 1975 from Foothill College and completed
her MS degree in dental hygiene from the University of Michigan in
1978. She is currently a member of the adjunct faculty at Foothill
College and works in private practice in Mountain View, CA. Cathy
has been a library reference associate at the Stanford Hospital Health
Library for the past 18 years and lectures to patients and professionals
on a variety of topics. Cathy is the editor of the CDHA Journal.
Kirsten Jarvi graduated with a degree in
biology from Sonoma State University and
completed her BS and MS degrees in dental
hygiene from the University of California, San
Francisco. Kirsten has conducted research
and has written scientific articles for dental
hygiene publications. Kirsten is currently
designing a new mHealth application for dental
professionals and serves as part of the IT
council for CDHA.
Exceed Your Expectations!
Earn Your BSDH Degree Online
With over 50 years of dental hygiene experience, the Department
of Dental Hygiene is dedicated to providing the highest quality
education. Offering an environment for learning that emphasizes
Christian values, intellectual development and community
service, Loma Linda University encourages personal wholeness
and professional growth.
◆ Online BSDH degree completion program
◆ Designed for licensed dental hygienists with a a
Certificate or Associate degree
◆ Two tracks available:
Dental Hygiene Education
Public/Community Oral Health Services
◆ Courses designed for the working professional
◆ Accepting applications for March 2013 and
September 2013 starts
Contact us Today!
[email protected]
CDHA Journal – Winter 2013
29
NewsBytes
News and Information you can use today!
CDA Cares comes to
San Jose, CA in 2013.
CDA Cares, a joint endeavor of
the California Dental Association Foundation and the CDA is a
rotating free dental clinic targeting the thousands of Californians
who do not have access to dental care. With the goal of relieving
pain and infection, restoring
dignity and creating healthy
smiles, CDA Cares has scheduled
their next clinic at the San Jose
Convention Center, May 17 -19,
2013. The success of this program
is dependent on volunteers
from the oral healthcare
professional community.
Patients will be screened and
triaged for dental hygiene care, oral health education, fillings,
extractions and assistance in finding follow-up care. Volunteer
information, registration forms are available online at http://
www.cdafoundation.org. From the program’s initial 2012 events
held in Modesto and Sacramento, a total of 3,676 patients have
been provided with over $2.8 million in dental services by 2,901
volunteer dentists, hygienists, assistants and other healthcare
professionals exemplifying community outreach at its best.
Are there teens in your
community who are
at high risk for dental
disease and cannot get
care? Tomorrow’s
SMILES®, sponsored
by the Patterson Foundation and Philips Sonicare is the teen
program of the National Children’s Oral Health Foundation, often
known as America’s ToothFairy®. Through this program, volunteer
dentists provide pro-bono restorative services to pre-screened,
underserved adolescents. Participating practices are provided with
complementary products from Invisalign® and Nobel Biocare™.
The teens receiving dental care are then trained to give oral health
lessons to the younger children in their own communities through
the Pay it Forward program. By serving as mentors, these teens
can raise the awareness of the importance of oral health and help
break the cycle of pediatric dental disease. Learn more about
participating in the program by visiting www.TomorrowsSmiles.org.
30
Dental X-ray Radiation
Exposure Guidelines Reviewed
The American Dental Association
Council on Scientific Affairs and the
US Food and Drug Administration
reviewed and updated the
2004 guidelines on dental
radiographic examinations and the
recommendations for patient selection
and limiting radiation exposure.
Current technological advances in imaging along with an increased
public awareness to the risks of radiation exposure led to updating
the guidelines in 2012. While radiographs serve to help diagnose
many oral diseases and conditions, the benefits of radiographs must
be weighed against the risks of x-ray exposures which accumulate
from multiple sources over time. The guidelines state that x-rays
should not be substitutes for clinical examinations and general
and oral health histories. Dentist are advised to conduct a clinical
examination, consider the patient’s signs, symptoms and oral
and medical histories, and consider the patient’s vulnerability to
environmental factors that may affect their oral health in order to
determine the type of imaging to be used or its frequency. These
guidelines, designed to serve as a resource to the practitioner,
not standards of care or regulations, can be found at www.ada.
org/sections/professionalResources/pdfs/Dental_Radiographic_
Examinations_2012.pdf
CDHA Journal Vol. 28 No. 1
NewsBytes
Antibiotic Premedication for Patients with Prosthetic Joint
Replacements : 2012 Guidelines
An American Academy of Orthopaedic Surgeons and
American Dental Association work group recently
concluded a collaborative systematic review of the
existing clinical research published in peer-reviewed
journals to determine the correlation between dental procedures and prosthetic
joint infection (PJI). In a December 2112 press release from the ADA, Council on
Scientific Affairs member Dr Elliot Abt stated that the work group found that the
current evidence does not support routine prescription of antibiotic prophylaxis for
joint replacement patients undergoing dental procedures. The research demonstrated
that invasive dental procedures, with or without antibiotics, did not increase the odds
of developing a prosthetic joint infection. However, it is important to remember that
this clinical practice guideline is not meant to be a stand-alone document. Instead,
it should serve as an educational tool assisting clinicians in making treatment
decisions with their patients to improve the quality and effectiveness of care. The
principle of evidence-based practice incorporates three components: scientific
evidence, the clinician’s experience, and the patient’s values. All three of these
elements should be included in the patient care
decision-making process. Physicians, dentists
and patients should work collaboratively to
customize a treatment plan that is based on
the evidence, clinical judgment and patient
preferences. The full guideline is available
at www.ada.org. In addition to the guideline,
practitioners can also download a “shared decision
making” tool, complete with questions to guide
the collaborative decision making process between
clinicians and their patients in developing the best
treatment strategy.
Dental Hygiene Committee
of California Appointments
Michelle Hurlbutt, RDH, MS
from Upland, was re-appointed for her second
term to the DHCC on August 23, 2012. Hurlbutt,
a dental hygiene educator will serve as VicePresident of the committee for 2013. Public
member, Alex Calero will serve as President and
Registered Dental Hygienist Evangaline Ward will
serve as secretary for 2013.
The following dental hygienists were appointed to
the DHCC in 2012:
• Evangeline Ward, RDH, from Benicia
• Noel Kelsch, RDHAP, from Moorpark
• Nicolette Moultrie, RDH, from Martinez
For complete profiles on the members of the
DHCC and current announcements from the
committee, visit www.dhcc.ca.gov.
Brace yourself.
Tweens will love taking
care of their teeth.
To learn more, please visit www.dentalcare.com
or call 1-800-543-2577.
PH4Me_1/3pgAd_CDHA.indd 1
CDHA Journal – Winter 2013
© 2012 P&G
10/22/12 10:04 AM
31
Why I belong?
Heather M. Steich, RDH, BSDH
University of the Pacific, Arthur A. Dugoni School of Dentistry,
Class of 2008
Active member since graduation
“Where would I be without CDHA? Membership in CDHA has
given me countless opportunities to share my talents, be mentored,
and stay invigorated! I was selected for ADHA’s Unleashing Your
Potential weekend last November because of my local and state
involvement and I continue to grow as a professional and a leader. Dental hygiene is a
profession, not just a job. We can sit and let change happen, or we can help mold our future.
I don’t want to be left behind! That’s why I belong. Thank you CDHA!”
32
CDHA Journal Vol. 28 No. 1
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CDHA Journal Vol. 28 No. 1
Article Title
Author(s)
The Ultimate
Sonicare
Power
Toothbrush
New Philips Sonicare DiamondClean — the ultimate clean for ultimate results.
Help your patients experience the difference of Sonicare technology. It will be love at first brush.
1
• Removes up to four times more plaque than a manual toothbrush after four weeks of use
1
• Powerful yet gentle dynamic cleaning action helps improve gum health in just two weeks
2
• Clinically proven to whiten teeth in just one week
Experience Philips Sonicare for yourself — call 1-800-676-SONIC (7664)
or go to sonicare.com/dp
Be part of your community — join one of our Facebook groups
just for dental professionals. www.sonicare.com/facebookDP
1. Milleman K, Milleman J, Putt M, et al. Comparison of gingivitis reduction and plaque removal by Sonicare DiamondClean and a manual toothbrush. Data on file, 2011. 2. Colgan P, DeLaurenti M, Johnson M, Jenkins W, Strate J. Evaluation
of stain removal by Philips Sonicare DiamondClean power toothbrush and manual toothbrushes. Data on file, 2010.
CDHA Journal – Winter 2013
35
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
Spring
Scientific
Session
April 12, 2013
Sheraton Park Hotel
@ Anaheim Resort
Anaheim, CA
Speaker:
Including:
Continuing Education Programs
and Student Table Clinic Competition
Followed by an additional
RDHAP Education Program
Earn up to 8 CEUs
Anna Pattison RDH, MS
“What’s New in 2013? New Technologies,
New Products, New Techniques”
Registration and information
available at www. cdha.org
or 919-993-9102
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