Larissa Odendaal
Client Analysis
The client I found most challenging this term had to be my 6th client who was a healthy 66-year-old female. This client was new to the college and hadn’t been to the dentist in over a year due to the current pandemic and her partner’s ongoing medical issues. When viewing her medical history prior to our first appointment I noticed she was an overall healthy individual with no medical conditions, not taking any prescription medications, consumes multiple vitamins daily (multi, probiotic, vitamin c etc.) to support her body, smokes 10 cigarettes per day, and is under the care of an endocrinologist for
thyroid nodules. In my mind I already knew I wanted to know more about her thyroid nodules, and I could expect to see generalized tobacco staining and fibrotic tissue due to her tobacco consumption.
When the time finally came for me to look inside the client’s mouth, I nearly fell out of my chair due to the poor condition of her oral cavity. She presented with numerous restorations with marginal breakdown, an uncemented crown, generalized moderate-heavy tobacco staining, CIs of 3, GIs of 2, high PRA, extreme CRA, xerostomia, fibrotic tissue, and a textbook worthy black hairy tongue. Her radiographs revealed moderate subgingival calculus ledges, class I and II furcation’s, and generalized bone loss. The periodontal assessment exposed many pockets between the 4-7 mm range, CALs greater than 5, and the presences of unstable stage IV grade C periodontitis. This client has localized areas of recession primarily in the molar region and mandibular crowding of her anterior teeth. Due to the information discovered during my assessments with this client I came to classify her as a DD4-3 with 10 assigned areas of debridement. I knew this client was going to be a challenge right from when I first viewed her oral cavity but after the information my assessments revealed I knew the challenging part was yet to come.
Analysis
When I reflect back on past appointments and care I provided for client #6 no major struggles come to mind. Although probing and debridement had its challenges due to the tenacious subgingival deposits and heavy amounts of tobacco staining, I don’t feel like I struggled or allowed a breach in the dental hygiene process of care. The feedback provided from my instructors has always been positive and my client has continuously left happy with the care I’ve delivered. If I had to choose one area in which I struggled the most with it would be accepting the reality of her oral condition.
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Throughout this program we have viewed images of various oral conditions but have never had the opportunity to see them clinically. I found it shocking to see many of these conditions inside one person’s mouth as the student partners I’ve been practicing on had pristine oral hygiene. When I first viewed my client’s oral cavity, I had to motivate and encourage myself not only to continue but also to be that initial step in restoring her oral health. Along with the client’s periodontal chart and x-rays I decided to incorporate the use of intra oral photos to help supplement my OHC discussions which really helped motivate my client and I feel this would have been a struggle without the visual aids.
I personally feel I am doing a good job with this client and each appointment I get more confident in my abilities to provide DH care. Although I have not yet completed this client, I feel at her next recare appointments I can really reinforce the benefits of maintain good oral hygiene, improve my speed, and time management. After my first appointment with this client, I was scared and honestly dread the next time I had to see her, but my feelings have changed because of how shocked she was to see the poor state of her oral cavity. I am excited each time I see her not only because she’s a nice lady but also because I know I am making a difference in her life.
Critical Reflection
When I reflect back to the start of term four clinic, I would have never imagined myself to be where I am today. I have not only grown as a person because of my experiences with this client but also as a student dental hygienist. My client has taught me a lot about dental conditions and issues such as furcation’s, periodontal disease, decay, black hairy tongue, and heavy calculus just to name a few but also just how important communication and education is when being the professional to initiate change. When I first began the term, I was so nervous to see clients as I felt I wasn’t ready nor were my skills strong enough to provide sufficient care. Now being at the end of the term I see that
each client we’ve treated has helped us learn, grow, and ultimately become better clinician’s as reading about a topic doesn’t measure up to clinically experiencing the issues firsthand.
The CDHO standard of practice in which I feel I have had the most personal growth in this term has been 1. Professionalism: specifically, responsibility and 8. Dental Hygiene Service and Programs. I feel I have grown in my professionalism because I have been able to facilitate referrals (HBP to physician’s), recognize gaps in my knowledge and acquire the knowledge (feeling furcation’s & distinguishing between them), and also provide better information about oral health care to my clients. I have also noticed growth within the dental hygiene service and programs standard of practice because I am more familiar with the flow of an entire appointment from start to finish. This means my ability to evaluate a client, plan the appropriate treatment, and implementation the care has all improved. I know that I still have ways to go but I am happy in the grow I have made thus far. An area in which I feel I am deficient in when referring to the CDHO standards of practice is #4 continuing competency. I feel like am deficient in this area because of the pandemic and the lack of free time we have not only within the clinic but also practicing skills we need to work on (ex. Radiographs/ultrasonic).
By the end of term five, I hope to increase my speed, decrease the number of appointments I am needing per client, and provide better oral hygiene education to each client. I plan to do this by better preparing myself prior to appointments (ex. doing the work at home ahead of time), having a set agenda and trying to complete as much as possible during one appointment, and continuing to expand my knowledge in dental and preparing my OHC sessions prior to delivering them.
Throughout the course of this term, I have had the privilege of providing care to seven patients and with each new patient I saw my confidence level grow. I had moments throughout this journey where I doubted myself and the choice I made to become a dental hygienist, but after completing my first debridement appointment with client #6 I instantly knew this profession was the right one for me. I love clinic, get excited when providing care, and feel a sense of joy when I encourage and educate my clients on bettering their oral health. I am missing the in-class lectures due to the COVID-19 outbreak but still feel all the pieces of the puzzle are now coming together because we are finally experiencing live clinic. I can’t wait to continue to learn, grow, and help more individuals of the community because I am finally at the point in this journey where I feel confident in myself and my ability to be the dental hygiene professional I was destined to be.