Volume 32 Number 1

Winter 2015

The Developmental Progression of Eating Skills

Interprofessional Collaboration in Public Health to Improve Nutrition and Oral Health Anytime. Anywhere. Introducing the TePe EasyPickTM - interdental cleaning made easy.

Available March 2015 TePe EasyPick™ is the easy and efficient way to clean between your teeth, leaving your mouth fresh and healthy. The polyamide core is both stable and flexible, and the silicone coating cleans effectively between the teeth and feels comfortable on the gums. TePe EasyPick™ will be available in two conical s izes to fit all interdental spaces: • XS/S – orange: for narrow and very narrow gaps • M/L – turquoise: for medium to large gaps

[email protected] / www.tepeusa.com Call Today (714) 991-6700 / Toll Free 888-644-8373 In this issue of the

Winter 2015 3 From the Editor’s Desk Healthy Eating Habits Start at the Beginning… 4 MemberNews 6 CDHA News Makers 5 President’s Message Find Your Passion 6 LifeLongLearning The Developmental Progression of Eating Skills Identification of Early Feeding Issues 12 CommunityOutreach Returning to San Quentin: The 11th Annual T.R.U.S.T. Health Fair 15 PublicHealth Utilizing Interprofessional Collaboration In Public Health

to Improve Nutrition and Oral Health 15 18 StayingHealthy Changing Habits One Day at a Time 20 StudentConnection Healthy Eating and the Dental Hygiene Student Award Winning Table Clinics and Research 23 CareerCorner Improving Overall Health Through Orofacial Myofuncetional Therapy 23 30 CDHA NewsNotes CDHA Leading the Way

Journal Sponsored by

This Journal is printed on 100% recycled paper California Dental Hygienists’ Association 2014–2015 Executive Officers President Karine Strickland, RDHAP, BS The Voice of Dental Hygiene President Elect Lygia Jolley, RDH, BA Contributions of scientific and original articles. VP Membership & The Journal of the California Dental Hygienists’ Professional Development Laurel Bleak, RDH, BS Association is formatted by and published under the supervision of the Editor. The opinions expressed or VP Administration implied in this publication are strictly those of the & Public Relations Julie Coan, RDH, MPH authors and do not necessarily reflect the opinion, Secretary-Treasurer Kristy Menage-Bernie, RDH, BS position or official policies of the CDHA nor are claims or statements by authors verified. Immediate Past President Nadine Lavell, RDH, MS The only permission granted for photocopying or Executive Administrator Jenifer McDonald storage of items is for personal use, or the use by libraries; all other uses require the written permission Component Trustees of the Editor or President. CDHA reserves the right to illustrate, reduce, revise or reject any manuscript Central Coast Tracy Boyan, RDHAP San Fernando Valley Kirsten Thye, RDH submitted. Articles are considered for publication East Bay Lolly Tribble, RDH San Francisco Heather Steich, RDH, BS on condition they are contributed solely to the Journal. Contributors are notified within 90 days if a Kern County Open San Gabriel Valley Mary Dinh, RDH manuscript is accepted for publication. Long Beach Jeannette Diaz, RDH San Joaquin Valley Fred Thomas, RDH Correspondence should be addressed directly Los Angeles Joan Beleno, RDH Santa Barbara Aimee Arnwine, RDH to the Editor: Monterey Bay Brenda Rodriguez, RDH, MA Santa Clara Valley Theresa Guinasso, RDH Cathy Draper, RDH, MS E-mail : [email protected] Mt. Diablo Lory Laughter, RDH, BS Shasta Mary Jacobson, RDH, BS FAX: 408-252-4350 Napa-Solano Ivy Zellmer, RDH Six Rivers Darla Dale, RDHAP, BS Mail: 1310 Regency Drive • San Jose, CA 95129 Orange County Kimberly Cruz, RDHAP South Bay Carole Broder, RDH, BS Display and classified advertising. The California Peninsula Sarah Cutajar, RDH Tri County Reina Wong, RDH Dental Hygienists’ Association does not assume liability for contents of advertisements. Inquiries Redwood Laura Birchett, RDH Valley Oaks Linda Wise, RDH regarding display advertising should be directed to: Sacramento Valley Carol Lee, RDH, MS Ventura County Erica Johnson, RDH Jackie Hopkins San Diego County Jackie Buchanan, RDH CDHA Corporate Relations Consultant 1900 Point West Way, Suite 222 Sacramento, CA 95815-4706 Journal Staff Calendar of Events Phone: 408-338-9498 E-mail: [email protected] Editor Cathy Draper, RDH, MS February 28, 2015 Student Regional Conference, North Copyright ©2015 by the California Dental Advisory Board Toni S. Adams, RDH, MA Hygienists’ Association. The Journal is published on a Aubreé Chismark, RDH, MS March 1, 2015 regular schedule by the California Dental Hygienists’ Carol Lee, RDH, MS Student Regional Conference, South Association. Subscription rate is as follows: Donna Smith, RDH, MSEd March 21-22, 2015 $15: CDHA members Ellen Standley, RDH, MA $25: Non-CDHA members and ADHA members Spring BOT Meeting, South Graphic Design Dorreen P. Davis within the U.S. May 1, 2015 $50: Non-ADHA members outside the U.S. and Printer Moore Bergstrom Co. Spring Scientific Session, Anaheim 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 About the Cover: Lucy Rappaport is shown enjoying a E-mail: [email protected] healthy snack. Photograph courtesy of Mark Sexauer. Internet: www.cdha.org From the Editor’s Desk

“Healthy Eating Habits Start at the Beginning…” Our daily lives revolve around food. Whether we like it or not, thinking about what we are going to eat for the day - be it breakfast on the run, meeting friends for lunch, or starting a new diet - plays a major role in the activities of daily living. Outside of the pure pleasure of eating a delicious meal, our bodies require nutrients to sustain life. Without milk within hours of birth, the newborn infant will cease to thrive; and in the last stages of life, refusing to eat often signals that death is eminent. It is really what goes on between those first experiences with eating that can set the stage for life-long relationships with food. I had the opportunity to hear pediatric occupational therapist, Kary Rappaport, speak recently on infant feeding and the introduction of foods during the first year of life. Her presentation not only explained the developmental changes in the infant swallowing reflexes but also emphasized the critical role the parents play in introducing healthy foods during the first years of life. I found myself wishing that I had this information about 30 years ago when I was feeding my young sons. Eating should definitely be an enjoyable, social activity based on healthy, whole foods, with parents and families setting the tone. Unfortunately, there are many challenges to reaching what appears to be a “back to basics” approach to eating. Obesity has become a global issue with more than 30% of the world’s population classified as overweight or obese. This number is projected to rise to 50% by 2030. In a recent McKinsey Global Initiative report, obesity and its associated chronic disease conditions, was shown to rank next to tobacco use and gun violence as one of the top three social burdens created by human beings.1 Obesity is clearly a complex disease entity. Let’s take a look at one of the aspects of the problem - refined sugar. The average person consumes about 79 pounds of sugar a year. Sweetened beverages are the single biggest source of dietary sugar. In the United States, about $74 billion dollars a year are spent on soft drinks and American teenagers drink twice as much soda as milk. It’s no wonder that the American Beverage Association spent $10.4 million dollars in the San Francisco Bay area alone to try and defeat the soda tax initiatives last fall. Fortunately, Berkeley became the first city in the nation to pass the nation’s first soda tax although it is not clear if adding a few cents to each sugar sweetened beverage purchased will impact consumption in this well-educated, affluent university town. Most of the dollars spent by the American Beverage Association to defeat soda taxes are directed at low income, minority neighborhoods where more sodas are purchased and consumed than in higher income communities. Just imagine if that money could have been spent to actually promote health in those communities! The economic and healthcare burden of poor nutrition choices is significant and addressing this complex issue will require comprehensive and collaborative strategies engaging families, communities, public policymakers, healthcare providers – just to mention a few. Here in California, Champions for Change, a program from the California Department of Public Health, provides mothers and families with the resources and support to make positive health changes for their children and families. Empowering parents to take an active role in promoting change to provide a better future for their children is a good place to start. You can learn more about Champions for Change by visiting www. cachampionsforchange.cdph.ca.gov. In the meantime, what are you planning for your next meal?

1. McKinsey & Company. How the world could better fight obesity. [Internet]. Cathy Draper, RDH, MS McKinsey & Company; 1996-2014[cited 2014 Dec 5]. Available from: Editor http://mckinsey.com/insights/

CDHA Journal – Winter 2015 3 MemberNews

Remembering Debra Jo Johnson, RDH, PhD Developing Your Inner Leader Debra Jo Johnson, educator, leader, dedicated CDHA leaders professional passed away on July 8, 2014. Originally Karine Strickland, from Pennsylvania, Debra Jo moved to California after Julie Coan and graduating from the University of Pittsburg with an Michael Laflamme Associate’s degree in Dental Hygiene in 1971. She headed to Chicago was an integral part of the periodontal program at the Veteran’s Administration Hospital in Los Angeles last November to for many years before relocating to San Diego. While attend the American in San Diego, she worked in periodontal practices Dental Hygienists’ and began teaching dental hygiene at Southwestern Association Unleashing Your Potential (UYP) weekend. Each College where she was on faculty for 12 years. A year, 40 applicants are selected from across the country to lifelong learner, Debra Jo completed her bachelor’s degree in dental hygiene come to ADHA headquarters in Chicago for a weekend of at Northern Arizona University, her Masters of Education in teaching and networking and leadership training. learning from the University of San Diego and her doctorate in leadership and education sciences, also from USD. Debra Jo was the Editor of the Western “If there were any mysteries or fears I had regarding Society of Periodontology newsletter for many years and served on the leadership in our professional organization, they were quelled executive committee of the California Dental Hygiene Educators’ Association. at Unleashing Your Potential. Experiencing the different Debra Jo’s passion was teaching dental hygiene students. During her tenure at personalities and leadership styles of the ADHA Presidents Southwestern College, she was instrumental in developing a clinic lab facility spanning the last 5 years clearly demonstrated that no designed to facilitate the development of fine motor skills. In 2012, Debra Jo specific trait was required to be an effective leader. If you are became the dental hygiene program director of Northeast Texas Community nervous about stepping into a leadership role, or need a more College. Debra Jo will always be remembered for her kindness, joyful outlook hands on approach, look no further than UYP.” and courage in the face of adversity. Debra Jo shared her experiences with breast cancer in the Summer 2012 issue of the CDHA Journal and was a strong Michael Laflamme, RDH, B.A. advocate for breast cancer research. She is survived by her son, Bryan. CDHA Public Relations Chair, ADHA Delegate The Southwestern College Dental Hygiene Program has established a $1,000 “Meeting component and state leaders from all over the student scholarship in Debra Jo’s name. Donations can be made by contacting nation emphasized how each of us has the ability to create Vickie Kimbrough at [email protected] a leadership journey of our own. I discovered that we have similar goals in regards to advancing the profession of dental Sunstar America’s/RDH Magazine’s hygiene, though each of us may be at a different place on Award of Distinction Recipient that path, and that our national association is committed to Kimberly Cruz, RDHAP was recognized for her supporting us to achieve those goals. I was most impressed commitment to increasing avenues to access to care for by the talent and experience of the ADHA support staff. It patients with special needs as one of the 2014 recipients of was clear ADHA is actively working towards keeping our Sunstar America’s/RDH Magazine’s Award of Distinction. professional organization relevant and strong.” A 2005 graduate of Cypress College, Kimberly went on Julie Coan, RDH, MPH to complete her alternative practice education through CDHA Vice President of Administration West Los Angeles College in 2011 and established Ohana and Public Relations Dental Hygiene Practice, specializing in providing mobile dental hygiene care to the elderly, and patients with special health care needs. Kim and her business “UYP is a great step in developing leadership skills which partner, Jennie Phui, RDHAP, chose the name “Ohana” meaning family, to can be utilized in all aspects of your own leadership journey, reflect their philosophy of family based care for all their patients. Kim’s mission whether at a local, state or national level. We all had a great of “no smile is left behind or forgotten regardless of the financial compensation experience, met some amazing people with similar passions involved” is also reflected in her other outreach activities in the Orange County for our profession, and found there are no limits to what we Component. She was the recipient of one of the ADHA/Wrigley’s Community Service Grants in 2012 and the ADHA/Colgate Community Outreach Award in can achieve. We highly recommend this experience for anyone 2013 for spearheading the free dental clinic program for homeless women and who wants to expand their leadership skills!” children from Collete’s Children’s Home in Orange County. As a recipient of one Karine Strickland, RDHAP, BS of the Awards of Distinction, Kim clearly fits the role model of being a generous, CDHA President innovative, perceptive, change agent. Congratulations, Kim!

4 CDHA Journal Vol. 32 No. 1 Message from the President

Find Your Passion! I am proud to share in the passionate profession of dental practicing under general supervision hygiene. As dental hygienists we strive for clinical excellence, to in New Zealand since 1921 and in provide compassionate care delivered with professionalism for all Alaska for the past decade. Respect patients. We work collaboratively, with dental and other healthcare for the individual needs of the professionals, and with each new day we renew our efforts toward patient as well as the application improving the health and wellness of all. of shared knowledge will ultimately improve the public’s oral and overall Dental hygienists are a part of the solution for those without health and well-being. All health access to care. In California, for over 10 years dental hygienists professionals, as well as the patients, in alternative practice, RDHAPs, have been increasing access to will benefit from this collaboration. California dental hygienists care via mobile dental hygiene practices, safely and effectively must work together and focus on answering the call to care. providing periodontal and preventive care for the elderly, children and individuals with developmental disabilities. However hospital The American Dental Hygienists’ Association’s policies highlight the emergency rooms across our state continue to be full of individuals profession’s flexibility in considering various dental hygiene‐based in acute dental pain, costing millions of dollars every year.1 models as well as its commitment to the development of providers The average dental-related emergency room visit results in a who are appropriately educated and personally committed to deliver prescription for antibiotics and pain management and typically safe, quality oral healthcare to those in need. ADHA fully supports our no dental treatment is provided. Dental hygienists with advanced efforts in California as we move into the next decade and face future education and licensure are well positioned to provide the interim opportunities, together. My recent participation at ADHA’s Unleashing restorative, as well as periodontal and preventive care, to reduce Your Potential in Chicago, along with other leader representatives emergency room costs and further improve oral health. Advancing from across the country, served to verify our national association’s this approach provides a meaningful, dynamic, and manageable commitment to the future of our profession. answer to those without dental care access. Dental hygienists, As we move into 2015, the California Dental Hygienists’ Association projecting confidence in their education and a willingness to serve, will need to face new challenges, embrace new perspectives, expand have the power to motivate change and generate the legislation our vision, demonstrate flexibility and achieve an enhanced optimism that will allow us to actively and passionately answer the public’s in order to successfully advance our profession. outcry for care. Let’s do it! Successful legislative efforts will positively impact change in California’s dental care delivery and affect the future of our profession providing increased employment opportunities for all hygienists. The need for improved health outcomes necessitates Karine Strickland, RDHAP, BS collaborative and integrated healthcare delivery systems. Dental CDHA President, 2014-15 therapists in many countries are increasing access to care as valued members of the oral healthcare team. Dental therapists have been 1. California Healthcare Foundation. Emergency department visits preventable dental visits in California [Internet]. Oakland CA: California Healthcare Foun- dation; 2009 [cited 2014 Dec 29]. Available from www.chcf.org

CDHA Journal – Winter 2015 5 LifeLongLearning Kary Rappaport, OTR/L, SWC, CLE

The Developmental Progression of Eating Skills Identification of Early Feeding Issues Introduction provided in this lifelong learning feature as a reference to support From the day we are born, to the last day of life, eating is an parents and answer questions about eating development. essential part of daily living. Few other activities of daily living LEARNING OBJECTIVES have such far reaching implications for physical and mental Upon completion of this course, the dental professional will be able to: health throughout the lifespan. Consider the current myriad of 1. Describe the stages of feeding for the infant, toddler and chronic diseases that are associated with poor nutrition and school-age child. eating habits – obesity, type 2 diabetes and cardiovascular disease just to mention a few. On the other hand, healthy eating 2. Identify three early feeding or developmental experiences that may sets the foundation for wellness in all body systems. Eating, alter the shape of a child’s palate and facial structures. however, is about much more than nourishment. Nearly every 3. Describe the oral-motor, oral-sensory and developmental skills major life event includes food or centers around a meal. Feeding necessary for feeding at each stage. and eating are strongly associated with love and joy. From the 4. Identify the signs and symptoms related to feeding and eating newborn infant’s first suck at the breast or bottle, the bonding skills indicating the need for a referral to another professional with the mother or caregiver is essential and this connection for further evaluation. with food and nourishment continues throughout the lifespan. Feeding and eating is a deeply social activity and defines us DEVELOPMENTAL PROGRESSION OF culturally. Healthy eating plays an essential role in promoting FEEDING AND EATING SKILLS wellness and has gained significant attention over the last 20 Eating is a complex activity that combines a number of factors, including years. Countries around the world, including the United States, precisely coordinated motor patterns, strength, endurance, oral sensory are promoting public health initiatives to help individuals gain awareness, respiratory support, and cognition as well as others. Most a basic understanding of the differences in a healthy diet children develop these interrelated feeding skills without the need for versus an unhealthy diet.1 And yet, picky eating and feeding much external support. While there is a range for skill acquisition, most problems in young children in the United States continue to infants and children follow a similar pattern of oral feeding development. be quite high. Researchers Lefton-Grief and Arvedson found However, every infant is unique and there will be differences in the that the prevalence of feeding related problems or swallowing developmental timeline based on the baby’s temperament, experiences, issues in pediatric populations ranged from 25% to 45% in and individual personality. In addition to this natural fluctuation, children classified as developing typically and 33% to 80% feeding skill attainment can be in children classified as developmentally delayed.2 Parents dramatically influenced by many Most babies transition to need more support in how to promote healthy eating habits. external factors. Early experiences solids around 4-6 months Unfortunately, medical professionals receive limited education such as prematurity, prolonged and wean from a bottle to a in the area of “typical” feeding development and few know hospitalizations or frequent illness cup around 12 to 18 months. how to support parents in actually getting children to adopt can significantly impact feeding When a baby or child is not healthy eating behaviors. As this topic is often excluded from skill development, as well as the meeting these oral feeding skill milestones within the expected the education of many health professionals, it is essential for more subtle lifestyle differences time frame, this can serve as a health care providers who come into contact with parents such as exclusive breast feeding red flag alerting a practitioner of young children to seek out professional development as compared to exclusive bottle or watchful parent to the need opportunities to become more familiar with healthy feeding feeding. for extra support. behaviors. Health professionals can use the information

6 CDHA Journal Vol. 32 No. 1 LifeLongLearning

Birth to 3 Months Special Considerations Feeding is entirely dependent on primitive reflexes; primarily the root, The resting and moving tongue position is important for the suck, and gag reflex. These reflexes can be diminished or absent development of palatal arches. Persistent pressure on any particular based on the infant’s experience, level of alertness, and overall area can lead to malformation of the palate, with the potential health. Reflexive feeding requires months of “practice” in order for to cause malalignment of the teeth. Newborns and young infants the infant to develop the neuro-pathways that will lead to motor are also particularly susceptible to dysfunctional alignment of the coordination and volitional control of foundational feeding skills. jaw and palate due to common conditions including ankyloglossia associated with swallowing and sucking difficulties; prematurity Sucking causing the newborn to be too weak to position themselves against The infant uses a “cupped” gravity, torticollis associated with a unilateral shortening of the tongue to surround neck muscles leading to persistent head turn and plagiocephaly and grasp the nipple. causing a flattening or distortion of the head. Milk is expressed using 3 to 4 Months compression and suction. The infant’s tongue extends The primitive reflexes integrate during this period. Feeding skills and retracts and also moves now must be coordinated as it becomes a volitional versus a up and down. The extension reflexive activity. A good example of this integration is when a and upward movement of nipple is placed in a newborn’s mouth, they will reflexively suck, the tongue compresses the whereas, if a nipple is placed in a 4 month olds mouth, they will nipple to squeeze out milk, choose whether or not they will suck. While sucking is no longer while the retraction and reflexive, it remains as the predominant oral motor pattern for downward movement creates negative pressure inside the mouth the 3 to 4 month old and their primary source of nutrition and to express milk from a nipple. Infants suck using a suck-swallow- hydration. It is also notable that at around 4 months that the breathe pattern at the rate of one suck, for every swallow/ breath. infant should show improved head and neck control will often have This sucking pattern occurs around once per second. Infants in the enough motor control of their body to start rolling over. middle of feeding usually suck with sequential sucks, or a sucking 4 to 6 Months burst, of approximately 20 sucks per burst or more. Both breast and bottle fed infants may use a pacifier during the first year or The American Academy of Developmental signs indicating two of life, however, the American Academy of Pediatrics suggests Pediatrics (AAP) recommends readiness to introduce solid foods delaying pacifier use until a baby is at least 4 weeks old. introducing solid foods (complimentary foods) at • Head/neck control to sit up approximately 6 months of for ~15 minutes Pacifier Use3 age but no earlier than 4 • Trunk control to sit up with Pros Cons months.4 Early introduction of minimal support Calming aid Can detract from early solid foods can be considered • Ability to reach for objects breastfeeding success due to the fact that a large and bring them to the amount of motor development Non-nutritive sucking helps May contribute to increased ear mouth (including a refining with neurologic organization infections occurs during this period and ability to grasp with fingers, in young infants some infants may be ready to not just the palm) progress to solid foods as early Pacifier use, especially at Prolonged and consistent use past • Active interest (cognitive as four months. night offers some protection 2 years can lead to malformation awareness) of food and against SIDS of the palate with possible feeding Between the ages of 4 to 6 mealtime and speech formation issues months, the infant will begin Continuted on Page 8

CDHA Journal – Winter 2015 7 LifeLongLearning to open his or her mouth to approach food or any other inanimate • Model healthy eating habits and let your baby watch you eat. object such as a spoon or a toy. However, the infant will most likely Babies learn best from watching and mimicking what we do use their suck response to manage any solid foods or purees placed so, set a good example! in their mouth. Due to the tongue protrusion response, the 4-6 • Remember the phrase: “food is for fun until age one” which month old will have difficulty transferring food to the pharyngeal means that until around 12 months, a baby should be getting cavity to initiate a swallow. Their chewing skills are still immature most of their nutrition and hydration from breastmilk or formula. and the tongue does not volitionally move to the side of the mouth in order to bring food to the gums or back of the mouth. At this 6 to 8 Months age, the tongue is only able to lateralize, move to the side of the The majority of the 6 to 7 month old infants’ calories, nutrition, mouth, in a reflexive response to tactile stimulation. The gag reflex and hydration should continue to come from breastmilk or formula, is also triggered closer to the front of the mouth (in the middle as they already have the oral motor patterns that allow for the of the tongue). While a strong gag response can appear to be a most efficient intake and management of these foods. In addition, potential emergency, it is actually a natural response which helps to breast milk and formula are significantly higher than other foods in protect a child from true choking, forcing food out of the pharynx the specific nutrients that developing infants continue to require. and mouth before it is able to enter the airway. Around this age, many infants will have an emerging pincer grasp, Tips for Transitioning to Solid Foods although it still lacks coordination. Infants begin to show increased lip closure with solid food feeding or spoon • Begin slowly, remember this is a brand feeding and the top lip is more engaged at new skill and will improve and refine itself this age to clear food from a spoon. Chewing gradually over the next 6-12 months. skills are also emerging if the infant is given • At first, offer solid foods when baby is the opportunity to practice this pattern. The not super hungry so that she or he does chewing pattern however is very immature not become too frustrated. This is a new because the jaw is unstable and the infant is skill and it will take some time before the unable to bite through food easily. If given baby can successfully take in and swallow the opportunity, drinking through a straw purees or solid foods. also emerges at this time. • Babies learn about eating through 9 to 12 Months exploration and play, so allowing the baby to touch, squish, smash and otherwise As a baby approaches 12 months old, he explore the foods you serve can increase or she will begin to show improved control interest and improve acceptance of the muscles of the face and mouth. Most infants develop improved tongue tip elevation and lateralization, • Babies should eat at their own pace and should not be as well as graded biting, all of which lead to improved chewing of “forced” to finish eating on a schedule. soft chewables and mashable foods (for example, ripe bananas, • If the baby is crying, pushing the food away, turning away, or avocados, well cooked pasta, scrambled eggs, etc.) Infants will acting upset, consider backing off for a few days, but continue also show improved lip closure while chewing, which leads to more to bring the baby to the table while you eat so that he or she consistent swallowing of solid foods. While the baby will have can observe you and learn. Keep in mind that he or she get increased solid food intake at around 12 months, keep in mind that their calories and hydration from breastmilk or formula so each child will learn at their own pace and remember that “food stopping the introduction of solids for a few days or a few is for fun until age one.” Therefore, breastmilk or formula volumes weeks should not impact their weight gain or nutrient intake. should be decreased gradually during this time. • Offer healthy foods over and over again, even if baby refuses Babies between the ages of 9 to 12 months are also refining their them. Don’t force, just offer. Many babies need the same food gross and fine motor skills. They explore food, as well as their introduced 10-15 times before they will accept and eat it.

8 CDHA Journal Vol. 32 No. 1 LifeLongLearning environment, with their hands and mouth and are motivated to 25 to 36 Months touch, squish, suck and eat new foods and flavors. Infants this As a toddler approaches 3 years, he or she should be able to use age are developing a pincer grasp as well as the ability to release their tongue to clear the vestibules between the gums and cheek, objects from their grasp, which allows them to pick up smaller food and chew using diagonal as well as rotary movements/patterns. items and successfully bring them to their mouth for eating. At the The 3 year old should be able to run, climb, and use reciprocal same time, infants are getting stronger as they learn to crawl and steps to go up stairs. Their fine motor patterns may be mature pull up to standing. enough so that they are able to peel a tangerine. 12 to 16 Months 36 Months to 5 Years Tongue lateralization and chewing is improving and becoming more During the period between 3 and 5 years, all feeding skills should refined during this period. Toddlers continue to develop their ability be present but they are still refining. The preschooler is building to manage mixed textures and firmer foods although they will still endurance and coordination in their feeding and motor skills during lose food from their mouth. They will also spit out foods that are this time through consistent trial and error and daily practice. Children difficult to chew. Between 12 and 16 months, toddlers should be should be able to tolerate most food textures without issue by the age partially or completely weaned from bottle feeding or breastfeeding of 3 years, and eat without direct supervision by 4 to 5 years. as they increase their solid food intake. The toddler’s gross motor skills will continue to improve as they begin cruising along furniture Making a Referral and eventually will begin walking independently. It is important to remember that every baby and child will develop 16 to 18 Months feeding and eating skills along their own path and the absence or delayed acquisition of one or two skills is not necessarily By this time, toddlers are better able to chew and move food significant to the overall development of the child’s ability to eat. around their mouth, which allows for minimal loss of food from However, assessment of the acquisition and development of these mouth while chewing. They are still developing jaw stability, incremental skills can be used by a health professional to identify leading toddlers to stabilize their jaw when drinking by biting on children who may be at risk of developing feeding issues. Health the rim of a cup. Self-feeding skills are becoming more refined and professionals can then provide the appropriate referrals for parents spoon and fork skills improve as the toddler approaches 18 months. Molar teeth may begin to erupt around 18 months, which increases the ability to grind more resistive foods. Toddlers should also be Signs and Symptoms for a walking independently by 18 months. Specialist Referral 19 to 24 Months • Poor weight gain • Excessive drooling or New feeding skills continue to emerge by 24 months, including • Excessively long feeding drooling that persists the ability to use the tongue to clear food from the lips. The 19 to times past the age of 3 24 month old should be able to transfer a bolus of food across the • Coughing with meals • Very sensitive gag midline of tongue. While the younger toddler uses up and down jaw response movements for chewing, the almost 2 year old should demonstrate • Not transitioning to • Extreme fear or pain more consistently diagonal chewing movements, which are closer solids response with basic oral to the rotary patterns used by an adult. The ability to use diagonal • Refusing certain care chewing patterns allows the 24 month old to safely chew most textures • Persistent refusal of textures, although he or she will still require direct supervision for • Very limited diet safety. By 24 months, the toddler should be able to successfully basic oral hygiene • Picky eating drink from a cup without loss of liquid. Fine motor skills will • Presence of Early continue to refine during this time, the toddler may be able to • Mealtime conflicts Childhood Caries (ECC) button large buttons and pull zippers up and down. Continuted on Page 10

CDHA Journal – Winter 2015 9 LifeLongLearning in order to help diagnose and address problems before the infant or References child develops negative habits or unhealthy eating patterns. 1. Hawkes, C., Promoting healthy diets through nutrition education and changes in the food environment: an international review of actions and The primary referral should be to the child’s pediatrician for their effectiveness. International Conference on Nutrition, 2013, Rome: further evaluation. If the physician believes there is a sensory, Nutrition Education and Consumer Awareness Group, Food and Agriculture Organization of the United Nations. motor, or behavioral issue, a secondary referral can be made to 2. Lefton-Greif, M.A., and Arvedson, J. Pediatric feeding and swallowing an occupational therapist who specializes in feeding, eating, and disorders: state of health, population trends, and application of the swallowing issues to evaluate and treat the child as well as provide international classification of functioning, disability, and health. 2007, 28(3)161-165. support for the family. Referrals can also be made to a dietician, 3. American Academy of Pediatrics, Thumbs, Fingers, and Pacifiers, 2006, psychologist, and/or speech and language pathologist if necessary. Updated 2012. 4. Dietz, W. and Stern, L. Nutrition: What Every Parent Needs to Know 2011, The Dental Hygienist’s Role American Academy of Pediatrics; 2nd Ed. Health professionals who have an awareness of what the typical 5. Morris, S.E, & Klein, M.D. Pre-feeding skills: A comprehensive resource for mealtime development (2nd ed.). 2011, Austin, TX: PRO-ED, Inc. developmental skill acquisition should look like from infancy 6. Townsend E, Pitchford NJ. Baby knows best? The impact of weaning style on through early childhood can help assess whether or not the child is food preferences and body mass index in early childhood in a case–controlled at risk for developing future feeding issues. Dental hygienists are sample. 2012 BMJ Open. 2:e000298. doi:10.1136/bmjopen-2011-000298 in an excellent position to ask key questions regarding feeding and 7. Wright, C. M., Cameron, K., Tsiaka, M. and Parkinson, K. N. Is baby-led weaning feasible? When do babies first reach out for and eat finger foods? eating skills as well as provide guidance to parents who may not Maternal & Child Nutrition. 2011, 7, 27–33. doi: 10.1111/j.1740- be aware of the impact that feeding and eating behaviors can have 8709.2010.00274.x on their child’s current and future health. Dental hygienists may 8. Poyak, J. Effects of Pacifiers on Early Oral Development. International Journal also be able to provide critical support by referring families to the of Orthodontics. 2006, 17(4): 13-6. PMID: 17256438 appropriate specialists or resources in their communities. About the Author: Improved health and wellness is a goal that extends beyond the Kary Rappaport is a pediatric individual specialty areas in healthcare. Feeding is essential to occupational therapist with the overall health and quality of life for our patients and wider advanced training and community at large. Dental hygienists need to be part of the certification in feeding and inter-disciplinary team addressing this critical issue. Poor nutrition swallowing. She has been and feeding skills affects every system in the body, including the working with children with dentition. Dental hygienists who gather a thorough health history special needs, including and make observant facial and intra-oral examinations are perfectly medically complex and fragile poised to identify some of the red flags that may be impacting a patients at Children’s Hospital child’s feeding skills. This information can be shared with other Los Angeles, in addition medical team members for early intervention and support. to working in outpatient, school, and in-home settings since 2005. Her specialty areas include breastfeeding, feeding patterns in infants with cardiac defects, Modified Barium Swallow Study (MBSS) interpretation, picky eating, and feeding aversion. She was recently published in the Journal of Infant, Child, and Adolescent Nutrition and she lectures about feeding practices on the local and national level. You can contact Kary at [email protected]

10 CDHA Journal Vol. 32 No. 1 LifeLongLearning 2 CE Units (Category I)

Home Study Correspondence Course “The Developmental Progression of Eating Skills/ The Early Identification of Early Feeding Issues” 2 CE Units – ADHA/CDHA Member $25, Non-member $35 Circle the correct answer for questions 1-10

1. Early infant experiences which can significantly impact feeding skill 6. Which of the following is considered to be normal eating behavior for development include: a 12 month old? a. prolonged hospitalization and frequent illness a. self feeding with spoon or fork b. prematurity b. drinking from a cup without loss of liquid c. exclusive breast feeding c. spitting out foods that are unwanted or difficult to chew d. all of the above d. all of the above 2. Which of the following are average feeding milestone for infants ? 7. Milestones for the 18 month old toddler include: a. transitioning to solids around 2-4 months and weaning from a a. walking independently bottle to a cup around 8-10 months b. better ability to chew and move food around the mouth b. transitioning to solids around 4-6 months and weaning from a c. developing/ refining spoon and fork skills bottle to a cup around 10-12 months d. all of the above c. transitioning to solids around 4-6 months and weaning from a 8. At what age do the skills develop to allow coordination for diagonal/ bottle to a cup around 12-16 months rotary chewing and clearing of food in the vestibules between the d. transitioning to solids around 10-12 months and weaning from a gums and cheek? bottle to a cup around 18-24 months a. 12-16 months c. 25-36 months 3. Which of the following statements is true about the use of a pacifier? b. 16-18 months d. 4-5 years old a. pediatricians suggest delaying use until a baby is 4 weeks old 9. When making a referral it is important to remember that: b. may contribute to increased ear infections a. each child develops feeding or eating skills at individual rates with c. may help early breast feeding success some variation d. a and b b. the absence or delay of acquisition of one or two skills is not an 4. Prolonged and consistent use of the pacifier past two years of age can absolute indicator but a guideline for potential referral contribute to malformation of the palate. c. assessment of these incremental skills can help identify children a. True b. False who might be at risk of developing feeding problems 5. Which of the following developmental signs indicate readiness to d. all of the above introduce solid foods? 10. The primary referral for eating or feeding problems should be to: a. enough head/ neck and trunk control to sit up for 45-60 minutes a. a child psychologist c. a dentist or pediatric dentist b. the ability to grasp an infant spoon and bring it to the mouth b. a physician or pediatrician d. social worker c. the ability to chew/macerate firm solid foods d. the ability to reach for objects and bring them to the mouth

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 2015 11 CommunityOutreach Laura Birchett, RDH

Returning to San Quentin: The 11th Annual T.R.U.S.T. Health Fair

The annual San Quentin T.R.U.S.T. to all year long. My experience at the 2013 Health Fair, entered its second decade About San Quentin Health Fair was truly remarkable. This year with the completion of the 11th event San Quentin State Prison, California’s I was the only returning hygienist. I was held in August, 2014. The program is oldest and best known correctional joined by Katie DiNapoli from San Jose and organized by the San Quentin T.R.U.S.T., institution, was established on Point San Jessica Wong, a recent graduate of Santa an acronym for Teaching Responsibility Quentin, in July of 1852, as an answer Rosa Junior College. Since we were only Utilizing Sociological Techniques, a to the rampant lawlessness in California. half the size of last year’s hygiene team, re-socialization program for life-term Overlooking the San Francisco Bay, just we decided to eliminate the mouth mirror inmates to train, mentor and prepare 12 miles from the Golden Gate Bridge, screenings in order to serve a larger number short-term inmates to become positive the walled prison is made up of four large of inmates. Using large model typodonts, citizens. From behind prison walls, the cell blocks , a maximum security cell we split up between three tables in a large men of the T.R.U.S.T. must coordinate block, the Adjustment Center, Central room and gave tooth brushing and flossing with volunteers from the outside Health Care Service Building, a medium demonstrations for inmates as they came community in order to make the health security dorm setting and a minimum to us in groups. By the end of the day our fair a success. The entirely inmate-run security firehouse. The state’s only gas small trio had served over 400 inmates! event is unique in its administration chamber and death row for condemned Arriving at San Quentin last year I was and is said to be the largest inmate inmates are located here as well. Outside a bit anxious, after all “back in the day”, coordinated health fair held behind of the death row block, San Quentin San Quentin had earned the reputation of prison walls in the United States. is currently a minimum security prison being one of America’s most dangerous The first San Quentin T.R.U.S.T. Health offering dozens of unique programs penitentiaries, where only the most Fair, held back in 2004, consisted dedicated to the rehabilitation of its treacherous inmates were housed! However, of three small informational tables. inmates and features the nation’s only knowing what to expect this time, I Over the last eleven years, the fair prison newspaper, The San Quentin News, entered the prison gates with a sense of has grown to a much larger event. published by and for the prison inmates. enthusiasm and self-confidence. I had Dental hygienists were first invited to already experienced first-hand, how much San Quentin Prison has its own dental attend in 2013, and I was fortunate the inmates look forward to connecting facility consisting of seven dentists and to be one of the six original RDH with the outside world during the Health two hygienists who serve a population participants. In addition to hygienists, Fair. I also remembered how it made me of over 4,000 inmates. Once an inmate there are volunteers representing feel after participating in their lives and enters the system, they receive a full over a dozen organizations and health the prison community. T.R.U.S.T. Health dental exam and a treatment plan. care professions. The primary focus Fair Coordinator, Leslie Schoenfeld really After the immediate dental concerns are is on health education and basic sums up the essence of the program, “this addressed, all inmates are entitled to an health screening tests including blood event is a gift, because it gives people on annual dental hygiene care and basic pressure, vision, hearing, and glucose the outside an opportunity to connect and dental treatment. testing. Patient education handouts experience the humanity and beauty of were passed out to the attendees with some of the people on the inside.” information on cholesterol control, What came as an absolute surprise to me this hepatitis, HIV and tattoo removal. time was that many of the inmates actually Returning to San Quentin was recognized me, greeted me with familiarity, something I had been looking forward and thanked me for coming back. The most

12 CDHA Journal Vol. 32 No. 1 CommunityOutreach

About the T.R.U.S.T. Program San Quentin adopted the T.R.U.S.T. program in 2003, with the definition, Teaching Responsibility Utilizing Sociological Techniques. Utilizing the collaboration and support of staff sponsors and community volunteers, San Quentin’s T.R.U.S.T program focuses on the development of incarcerated men and deals with issues and topics pertinent gratifying moment occurred in the middle of one of my oral hygiene demonstrations, to their specific population while supporting when one of the men blurted out, “I’ve been brushing like that ever since you showed me the rehabilitative process. More information how last year!” It made me smile knowing that in those few hours that I had spent with on the San Quentin T.R.U.S.T. Program can be the inmates one year ago that I had made a difference in at least one person’s life. found at www.sanquentintrust.org

I recently had the pleasure of volunteering at the San Quentin Health Fair. I wasn’t really sure what I was getting myself into, but I assure you, the experience Awards were presented during the morning blew all of my expectations out of the water! Once our group made it through the orientation session to the many community extensive check-in procedure, we attended an orientation session in the prison volunteers, prison staff members, and church. After our orientation we were escorted by civilian volunteers through inmates whose year-long efforts have made the main yard into a portable classroom where the Health Fair took place. It was the T.R.U.S.T Health Fair a success. Each pretty intimidating walking through the yard; there were prisoners milling about award certificate is printed with the “Tale doing exercises, talking, and staring at us just as curiously as we were them. of Two Wolves” a Cherokee proverb, that While the dental hygiene team’s only duty was to give oral hygiene instructions, eloquently explains the significance of this I got the sense that it meant so much more to the prisoners than just oral health collaborative event. education. The inmates were all very respectful and had lots of questions. I could tell that some of the men just wanted to talk and it was rewarding just to be able An old Cherokee is teaching his grandson to have the time to connect with them. Spending the day with people who are about life. He told him, so grateful and appreciative of a simple, kind smile gave me a feeling like none “A fight is going on inside me; it is a terrible other. I would go back to volunteer at San Quentin again in a heartbeat! fight and it is between two wolves. One is Jessica Wong, RDH – Santa Rosa Junior College, Class of 2014 Evil - he is anger, envy, jealousy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, About the Author superiority, and ego. The other is Good - he Laura Birchett graduated from the Santa Rosa Junior is joy, peace, love, hope, serenity, humility, College Dental Hygiene program in 2010. She also holds kindness, benevolence, empathy, generosity, undergraduate degrees in social and behavioral sciences and truth, compassion and faith. The same fight is physiology. Laura is currently working on a bachelor’s in public going on inside you – and inside every other health with a specialty focus on health behavior at Walden person, too.” University. She practices part-time as a clinical hygienist in The grandson thought about this for a minute Napa, CA and spends much of her free-time volunteering and then asked his grandfather, “Which wolf within the dental community. Laura serves on the CDHA will win?” The old man simply replied, “The Board of Trustees and Student Relations Council and is also one you feed.” active in her local component, the Redwood Dental Hygienists’ Society as the Web Tech and Facebook Administrator.

CDHA Journal – Winter 2015 13 Together with dental professionals TePe has developed an Implant Maintenance Kit for Home Care. With several different brushes this kit provides patients with a safe, easy and effective way to clean their Implants. PublicHealth Brooke Bodart, RDH, MPA

Utilizing Interprofessional Collaboration in Public Health to Improve Nutrition and Oral Health

Nutrition plays an important role in the life of a child. Numerous education of our health care professionals is evident; many health scientific studies have demonstrated a lifelong relationship between care professions have adopted IPE standards into their accreditation nutrition and the integrity of the oral cavity in both health and and licensure requirements. disease. It has been shown that children in lower socio-economic IPCP takes education one level higher and includes the technical households have difficulty maintaining healthy nutrition and skills needed to work with others, especially those within another frequently have a higher incidence of dental caries. Early childhood specialty or profession, within a community, and between caries (ECC) as defined by the American Academy of Pediatrics, organizations. In 2009 the Interprofessional Education Collaborative is an infectious disease in children, aged five and younger, that (IPEC) was formed among six health care professional associations spreads rapidly in the mouth and is often associated with oral pain. to help develop and guide the future of interprofessional education ECC can also impair a child’s ability to chew, affect proper intake and collaborative practice. These professions included: the American of nutrition, and even alter their ability to thrive. Malnourished Association of Colleges of Nursing; American Association of Colleges children often consume diets that are high in simple carbohydrates of Osteopathic Medicine; American Association of Colleges of and sugars, and are frequently deficient in fruits, vegetables, and Pharmacy; American Dental Education Association; Association proteins. This high carbohydrate diet greatly increases the risk for of American Medical Colleges; and the Association of Schools and cavities in young children. These same dental issues can also lead Programs of Public Health. The representatives from each of the to delayed speech-language development, low self-esteem, poor health care disciplines have worked together to define and advance school performance, and costly treatment options. Oral health learning experiences for their respective professions which will help advocates support the concept of including nutritional and lifestyle prepare the future of the team-based approach to health care.2 counseling as part of any comprehensive parent/patient education IPEC has helped develop four general competency domains for program. Taking into consideration the high costs associated with interprofessional collaborative practice: emergency room utilization, the difficultly in accessing care, and low insurance reimbursement rates, new strategies for disease • Values/Ethics for Interprofessional Practice prevention and health promotion are in great demand. • Roles/Responsibilities Health professions, including dentistry, are currently undergoing • Interprofessional Communication Teams paradigm shifts in the education, management, and treatment • Teamwork of patients. Interprofessional collaborative practices (IPCP) have IPEC continues to work on interprofessional issues and develop new been well incorporated into the educational model and will soon ways of integrating collaboration into health care, through yearly be commonplace in most clinical treatment settings. The goal conferences and initiative events that highlight the work that is of interprofessional collaboration is to have cross training and going on in the field. communication between the historically disjointed medical and Many health profession educators have adopted the concepts of dental professions. IPE and IPCP into their didactic curriculums and are continuing Interprofessional education (IPE) is becoming commonplace in the to explore ways to integrate a variety of health care professions education of our future health care providers. While the concept together clinically while educating students to required competencies. is now gaining mainstream attention, it was originally introduced These types of collaborative programs require a great deal of back in 1972 at the first Institute of Medicine conference, to organization, dedication from faculty, and flexibility from all encourage a more team-based approach to medicine. This participants. However, in the real world of health care, there conference focused on utilizing the existing workforce to the full is an ongoing need for more integration of these concepts into scope of their expertise as a means to reduce the overall cost of daily practice. The integration of interprofessional care in health healthcare. Over forty years later, these are the same issues that care organizations also requires the same commitments of time, are discussed when discussing IPE. The push towards IPE in the Continuted on Page 16

CDHA Journal – Winter 2015 15 PublicHealth dedication, and communication among providers in practices that are already busy Western University’s Interprofessional and stressed due to time constraints. However, interprofessional care is becoming Collaboration Pilot Program with WIC the model of care that patients expect from their providers and we must meet the The IPCP curriculum for oral health education, challenges now to be ready for a team based approach. developed by a team led by Dr. Jenny Sun Tjahjono, DMD, Clinical Managing Partner, provides hands- Women, Infants, and Children (WIC) on, interactive patient-care experiences. The patient The Special Supplemental Nutrition population served includes pediatric, geriatric and Program for Women, Infants, and Children special needs. Students work together in teams (WIC) provides federal grants to states for to provide preventive and comprehensive care at supplemental foods, health care referrals, school-based health centers, WIC centers, Head and nutrition education for low-income Start offices, kindergarten classrooms, Special pregnant, breastfeeding, and non- Needs Centers, and Skilled Nursing Facilities. This breastfeeding postpartum women, and to infants and children up to age five, educational model expands the scope of practice who are found to be at nutritional risk. Established as a permanent program for these students, enhancing their communication in 1974, each state administers their own WIC programs through public health skills with other health professions, and creates a departments, hospitals, community centers, schools, mobile clinics, migrant team-approach environment focusing on patient- health centers, or Indian Health Services.3 centered care. The curriculum emphasizes oral disease prevention and health promotion; including Western University of Health caries risk assessment, motivational interviewing, Science College of Dental Medicine anticipatory guidance and nutritional counseling, (WUCDM) opened its door for the fluoride varnish application, and toothbrush inaugural class in 1999 on the campus cleanings. The goal is to promote collaboration located in Pomona, CA. The mission between the primary care provider and dentists to of WUCDM is to educate and train improve the patients’ overall health and quality of highly competent, diverse groups of clinical practitioners who have the life. IPCP will help to remove barriers and will open ability to provide complex, integrative, high-quality, evidence-based care for access to a wide range of patient care and treatment. patients, families, and communities. WUCDM students will be partners in the This approach builds a health care team approach, interprofessional health care delivery systems of the future, as well as leaders rather than silos of individual care providers. of their own oral health care teams, as they enhance and extend the quality of life in their communities.4 In an effort to utilize the skills and knowledge of the other professions in school-based oral health Located on the Western University centers and community outreach sites, the WUCDM campus are nine health care graduate Children’s Dental Care Project (CDCP), under level colleges, which include: the direction of Dr. Timothy S. Martinez, DMD, Optometry, Pharmacy, Graduate Associate Dean for Community Partnerships and Nursing, Physician Assistant, Physical Access to Care, enlisted students from the Graduate Therapy, Osteopathic Medicine, and Nursing and Physician’s Assistant (PA) programs Veterinary Medicine. This collection of specialized health care colleges allows to rotate through community oral healthcare for the integration of IPE and IPCP across all colleges, beginning in the outreach sites. Prior to their rotations, the nursing students first year of education and continuing until graduation. The IPE and PA students had introductory lectures on curriculum begins with small group, face-to-face interactions on case studies childhood caries, oral assessments, fluoride during the first year of education. As students move through their course, the varnish application, and anticipatory guidance in IPE experience evolves into clinical applications and a team based approach preparation for their clinical experiences. to care and health management, continuing to work in small groups with representatives from all of the health care disciplines.4 During the 2013-2014 academic year, over 90 PA students, supervised by Lesa Maugh, PA-C, FAAPA For more information on Western University, visit www. westernu.edu

16 CDHA Journal Vol. 32 No. 1 PublicHealth

College of Allied Health, and 10 nursing students, supervised professionals to focus on the overall health and well-being of WIC by Ruth Trudgeon, MSN, Graduate Nursing, participated in the participants. The students felt that their communication and critical pilot IPCP project with second year dental students, supervised thinking skills had improved while participating in this program. by Dr. Tjahjono. The WIC locations were ideal for this type of The ability to provide care in a public health setting will enable interprofessional interaction because they allowed for engagement these students to develop into professionals who are comfortable of the child and the parent/caregiver in a one-on-one environment. providing care in non-traditional settings with healthcare The participation from the WIC clients was voluntary and consent colleagues from a variety of disciplines. As a result of the positive forms for each child were completed. The dental student and the PA feedback from the students, faculty, and WIC participants, the or nursing student worked together to educate the parent/caregiver program will be continued into the coming academic year. on nutrition, anticipatory guidance, home care, and answered any questions the parent/caregiver had. The student team worked References 1. Touger-Decker, R. Position of the Academy of Nutrition and Dietetics: oral together to screen the oral cavity of the child, record any findings, health and nutrition. J Acad Nutr Diet. 2013 May;113(5):693-701. and discuss the findings with the 2. Interprofessional Education Collaborative. [Internet]. IPECollaboartive.org; parent/caregiver. At the end of 2014[cited 2014 Nov 28]. Available from: http://ipecollaborative.org the session, a fluoride varnish was 3. United States Department of Agriculture. Women, Infants and Children applied to the child’s teeth as a Resources [Internet].Washington (DC): United States Government; 2014 [updated 2014 Oct 8; cited Nov 28]. Available from: http:// fns.usda.gov/wic/ preventive therapy. Any necessary women-infants-and-children-wic referrals for further comprehensive 4. Western University of Health Sciences. [Internet]. Pomona (CA): Western dental care at the school-based University of Health Sciences; 2014 [cited 2014 Nov 28]. Available from: oral health centers were given. http:// westernu.edu. The anticipatory guidance topics About the Author included healthy snacks, how to Brooke Bodart, RDH, MPA is a Registered A Physician Assistant student limit sugary foods, how to clean performing an oral exam on a young Dental Hygienist with a Masters of patient in the Children’s Dental Care babies’ mouth (even when no Public Affairs. She received her BASDH Project Clinic at The Village at Indian teeth are present), the age at at St. Petersburg College and her MPA Hill, Pomona. which a child should be seen by from Indiana University South Bend. a dentist, and the importance Brooke has extensive experience as of dental care during and after pregnancy. During the interactive a dental hygienist in family practice, sessions, many parents expressed difficulty in getting their children prosthodontics, and public health settings. to brush and in weaning the child off of a bottle or pacifier. With Brooke provides clinical and provider the team of health care professionals working together with the education in Southern California. She manages joint efforts to parents, new ideas were generated about oral and overall health. institute coordinated, patient-centered system of care and establish Further discussion led to questions regarding the child’s social and dental homes for thousands of children. mental development, habits, support systems, and how to access community resources. The interdisciplinary teams were able to lead the conversations to more in-depth discussions centering on the health and well- being of the entire family.

Dental screening event conducted Through this pilot project, by dental and graduate nursing WUCDM was able to bring students on community children at a together allied health and dental transitional housing unit in Pomona.

CDHA Journal – Winter 2015 17 Staying Healthy

Changing Habits One Day at a Time The beginning of a new year often brings numerous resolutions two rules: make a product into a daily habit by finding a simple for goal setting and overall self-improvement that are related to cue, something that will trigger the consumer, and secondly – give diet and exercise. So, as we move into 2015, how are those New them the reward. In the case of the toothpaste, the cue Hopkins Year’s resolutions coming along? Have you been using that new used was the “sticky film” or plaque that forms on teeth. As (or existing) gym membership this week? What about those 10 dental health care professionals, we all know that toothpaste is or 20 pounds you plan to lose this year? If you haven’t made it not required for the removal of plaque biofilm, a concept that the to the gym yet or managed to eliminate sugar, chips, chocolate lay public still has trouble comprehending. However the ad-man or cookies from your diet, take comfort in knowing that you are Hopkins was able to draw people’s attention to that “sticky film” not alone. Numerous research studies have shown that the vast by creating posters reading “Get rid of that film. Pepsodent gives majority of people who set goals at the beginning of the year fail at you a beautiful smile.” For the first time, Americans started to buy accomplishing them. So, if making a resolution to (insert your own toothpaste and regular tooth-brushing habits got started. goal) has a more than 50% chance of failure, should we just forget Just brushing with Pepsodent to remove that sticky plaque film, about improving our diet and overall state of health? however, would not have been enough to establish tooth-brushing Understanding behavioral science can make a big difference in as a daily habit. People needed some sort of reward. In the case making those healthy changes. In the late 1800’s, psychologist of regular tooth-brushing, it was the clean, fresh feeling you get William James made the observation that all our life is “just a after brushing with toothpaste. When the consumer does not brush mass of habits” or routines. Author of the best-selling book, “The their teeth, they miss this feeling of freshness. No wonder it is so Power of Habit: Why We Do What We Do in Life and Business” hard to get patients to focus more on their brushing technique! The Charles Duhigg explains how companies cue (sticky- film) and reward (fresh, clean have achieved enormous success by altering feeling) become established over time so people’s habits. Tapping into this powerful that people crave the reward makes the psychological pattern known as the “habit habit occur automatically. loop” not only leads to success in business If we look at habits as the automatic but in life in general. routines that they are, starting small and In his 2012 interview with National Public incorporating new healthy routines to Radio host Renee Montagne, Duhigg replace the unhealthy habits can transform explains that the “habit loop” is a three part a person’s lifestyle and overall health. process: the automatic behavior cue, the Here are a few suggestions to help make behavior itself and the reward which tells our small changes that can lead to improved brain whether we should store this behavior health in 2015. for future use. Duhigg explains this process by taking a look at toothbrushing and the Decide on the changes you want to make. marketing of toothpaste. About a hundred Be realistic. If taking a brisk walk every years ago in America almost no one brushed day is more appealing than going to the their teeth on a regular basis! However gym, you will be more likely to make the in the early 1900’s, when the prominent walk a habit. advertising executive Claude Hopkins Look for the triggers in your daily habits. learned about a new toothpaste product If breaking out the soda and chips is your called Pepsodent, he saw a marketing way to unwind after a long day at the bonanza. Hopkins had made his name in the advertising world office, maybe taking that brisk walk with a friend or a pet can creating habits around products, a man ahead of his times in the replace your craving for a pre-dinner snack. world of sales and marketing. Duhigg explains that Hopkins had

18 CDHA Journal Vol. 32 No. 1 Staying Healthy

Start small. If you are looking at increasing your physical activity, Don’t get discouraged. Setbacks are common. Look at them consider setting a timer when sitting at your desk so you make as an opportunity to explore other habits that might lead to a a point of getting up and stretching or walking more frequently. sustainable change. If you make your goal achievable it will be easier to sustain and Read more about habits and the power of change. increase it. If you are trying to lose weight, remember there are many small habits that contributed to that weight gain and many Ross, M. Change for the better. San Jose Mercury News. 2015 Jan small habit changes will contribute to shedding those pounds. 4: Sect. D:1. Real change takes time. While easy habits such as taking Listen to the National Public Radio interview with Charles Duhigg the stairs instead of the elevator may only take a few days to www.npr.org/2012/02/27/147296743/how-you-can-harness- implement, changing your daily diet and eating habits may take the-power-of-habit much longer to adopt.

Are you a part of the change?

Share what you are doing in your daily practice or community with the Oral Cancer Foundation as part of their “Be Part of the Change®” contest and you can win one round trip coach ticket to either the ADHA annual session in Nashville or this year’s RDH Under One Roof in Las Vegas. The prize also includes, hotel accommodations, meeting registration fee and a $200 VISA gift card!

Go to http://contest.oralcancer.org/ by Friday, April 10, 2015 and apply to win today!

You, and the screenings you perform, are the beginning of the end of oral cancer!

CDHA Journal – Winter 2015 19 StudentConnection

Healthy Eating and the Dental Hygiene Student By Ruhee Jaffer As hygienists, student dental hygienists, and care providers, the face it, many of us are living on a typical starving student (no role nutrition plays in maintaining and promoting oral and systemic pun intended!) budget, and in dental-hygiene school, time (or health is often under-emphasized. However, proper nutrition plays lack of it), is our most valuable asset – the clock has doubled its a key role in everyone’s health. Over 3.5 million deaths and 35% speed. I personally find cooking to be very relaxing, enjoyable, of diseases in children are definitively linked to under-nutrition and delicious; but unfortunately I do not have much time to put annually.1 On the opposite side, obesity, overweight, and various on my chef’s hat every night. However, I found that by making a related diseases are an increasing predicament of modern global few simple changes to my daily routine I could make significant societies affecting more than 1 billion people.2 Each of these improvements to my diet. juxtaposing scenarios (overweight versus underweight) highlights Here are the top three ultimate nutrition tips that have helped me 3 the immense importance of understanding and assessing nutrition. feel better so I can learn more effectively, and have the focus and What exactly does this mean for us as student dental hygienists? energy I need to tackle those subgingival spicules of tenacious In order to be the best care providers possible, we must look after calculus every day. ourselves on a daily basis so that we can in turn offer the highest quality care to our patients – assessing our own diets makes a 1. Water, water, water. I can’t quite stress how important it is to great starting point! stay hydrated. Our days are long, really long! Sometimes we feel lethargic and drained because we are in fact dehydrated. As students, we are particularly vulnerable to poor eating habits. Make a conscious effort to drink your 8-glass minimum For many of us, nutrition is the last thing on the forefront of our and soon enough this healthy thirst-quenching habit will be daily agendas. Amidst completing requirements, perfecting the engrained in your routine. modified pen grasp, working on fulcrums, practicing on typodonts, and endless nights of studying, the stresses of daily living can add 2. Never skip meals, and especially not breakfast. Studies have up quickly. I moved to California a year ago for dental hygiene shown that breakfast has a significant positive effect on 4 school, and suddenly found myself 3,000 miles away from my academic performance. My personal choice for breakfast is home and family, in the throes of a busy city and an incredibly oatmeal, which is a quick, wholesome, effortless meal. As for hectic schedule. That first semester was an interesting one, I had lunch, I try to pack my lunch the night before since I am a definitely missed the “healthy eating” bus at some point along morning snoozer. Sandwiches are always convenient and can the way. Instead, I took to guzzling inordinate amounts of coffee be eaten on the go. Cut up veggies or apple slices are also and caffeine, snacking on chips, and ramen dinners. Worse still, I great additions to your lunch bag. would often forget to eat lunch until a very audible tummy-growl 3. Healthy snacking. This one is sometimes the most difficult one would remind me. I noticed my energy levels plummeting at the to incorporate in your regimen since it is far easier to crunch speed of light, and felt more lethargic, sleepy and less able to focus. on fried, sodium-dowsed treats. I enjoy eating almonds, baby Of course, along the way as a dental hygiene student, I was also carrots, snap peas, yogurt, and fruit. Bananas are super easy learning all about nutrition, and its role in dental diseases, systemic to carry around, and munch on when you need a hint of conditions and all other compounding factors. I had also even sweetness and a little burst of energy during the day. convinced myself for a sliver of a moment that I was invincible to If you would like to see where you currently stand with your the effects that diet had on my overall well-being. personal dietary intake, there are many apps and websites available It wasn’t until my dear brother came to visit me a couple of months for free including MyFitness Pal and SuperTracker. Many of these after I started school that the toll of my less than optimal food applications utilize anthropometrical measurements with data choices became apparent. Siblings can be very honest, and perhaps analytic algorithms to determine caloric intake, and macronutrient harshly blunt at times. He noticed my irritability and erratic energy intake for the average, healthy person. As noted in Whitney’s latest levels and mentioned it to me. The week after he left, I challenged nutrition textbook, adequacy, balance, moderation, variety and myself to take better care of myself and find healthier alternatives calorie control are the five principal areas that comprise a nutritious to my student diet. Healthy eating does not necessarily need to diet.5 Therefore, no matter which nutrition regimen you decide on, be time-consuming, nor should it break your bank account. Let’s make sure that it fulfills all the stated requirements of a good diet.

20 CDHA Journal Vol. 32 No. 1 StudentConnection

Step up and take charge of your life! Refresh your mind, body About the Author and soul. The “Freshman 15” is so out of style, no one wants Ruhee Jaffer completed a BSc. in Biology, and is to wear those extra pounds. Wishing you all a wonderful, currently a second year dental hygiene student at healthy, energizing school year! the Ostrow School of Dentistry at the University References of Southern California. A native Californian, 1. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Ruhee’s cosmopolitan worldview and ethic of Mathers C, Rivera J. Review Maternal and child undernutrition: global and regional exposures and health consequences. Maternal and Child service stem from vast international exposures, Undernutrition Study Group Lancet. 2008 Jan; 371(9608):243-60. including spending a decade in East Africa where 2. World Health Organization Global strategy on diet, physical activity she launched a dental hygiene outreach and and health. Geneva, Switzerland: World Health Organization, 2004. education program that has touched the lives 3. Jehn M, Brewis A. Paradoxical malnutrition in mother-child of orphans in Uganda, Kenya and India. Ruhee pairs:untangling the phenomenon of over- and under-nutrition in underdeveloped economies. Econ Hum Biol. 2009 Mar; 7(1):28-35. continues to serve needy communities stateside through involvement 4. Adolphus K, Lawton L.C, Dye L. The effects of breakfast on behavior in USC’s mobile dental clinics. Passionate about all aspects of dental and academic performance in children and adolescents. Front Hum hygiene, Ruhee is the ADHA Student Chapter President at her school, is Neurosci.2013; Aug 8;7:425. a member of the ADHA Student Advisory Board and is the Health Fair 5. Whitney EN, Rolfes SR. Understanding nutrition. 12th Edition. Co-Coordinator at the Ostrow School of Dentistry. Belmont, California: Wadsworth, Cengage Learning; 2012.

Herman Ostrow School of Dentistry of USC A New Certificate Program Designed for Practicing Dental Hygenists and Dentists Who Want to Develop Competency in Treating a Growing Population in Geriatric Dentistry. The Herman Ostrow School of Dentistry of USC has launched an innovative and unique online certificate program in Geriatric Dentistry aimed for full time practicing Dentists and Dental Hygenists from across the country. Graduates of this 12.5-month Certificate program will gain knowledge and expertise in addressing the unique dental needs of older adults within the context of their medical, psychosocial, and physical conditions using an evidence based medical model. This program may serve as Professional Development. Please check with your institution to see if you are eligible. Applications are currently being accepted and space is limited.

Distance Learning Office Herman Ostrow School of Dentistry of USC UPC DEN 4218 M/C 0641 Los Angeles, CA, 90089 Email: [email protected] Phone: (213) 821-5831 Website: http://geriden.usc.edu

CDHA Journal – Winter 2015 21 StudentConnection

Dental Hygiene Students Present Award Winning Table Clinics and Research Dental hygiene students from all over the state shared their original research and clinical information at the annual California Dental Hygienists’ Association Spring Scientific Session held in Anaheim as well as at the Center for Lifelong Learning for the American Dental Hygienists’ Association held in Las Vegas, Nevada last year. While all of the student presenters were “winners” in their contributions to advancing the art and science of dental hygiene, the following table clinics and research posters received award recognition at both the state and national level: CDHA Spring Scientific Session, Anaheim First Place Informational First Place Research

“Plumping Up the Options for Periodontal Disease Treatment” “Effectiveness of Novel Gel to Reduce Cariogenic Bacteria” Rhea Tatarian, Janine Campanile, Crystal Summers Kayla Marin, Kelli Mertz, Tiffany Setiono Cypress College Loma Linda University Second Place Informational Second Place Research “Losing Your Mind After “Whitening Agents to Losing Your Teeth” Reduce Cariogenic Halyna Le and Bacteria” Lidia Romero Amy Stonehocker, Alin Cerritos College Jabourian, Sara Chavez, Brenda Escolero Loma Linda University Third Place Informational “Stemming into the Third Place Research Future of Dentistry” “Say Cheese” Vi Tran, Vivian Tran, Amanda Renee Barney, Deena Ishwait Kristin Sims Cypress College Cerritos College

ADHA Center for Lifelong Learning, Las Vegas First Place Table Clinic Second Place Table Clinic First Place Research Third Place Research (Informational) (Informational) “Say Cheese” “Whitening Agents to Reduce “Losing Your Mind After Losing “Pool of Thought” Amanda Barney and Kristin Sims Cariogenic Bacteria” Your Teeth” Kristan Braman and Alin Jabourian and Amy Halyna Le and Lidia Romero Idiko Shirazi Stonehocker Cerritos College Cerritos College Loma Linda University

22 CDHA Journal Vol. 32 No. 1 CareerCorner Carol Lee, RDH, MS

Improving Overall Health Through Orofacial Myofunctional Therapy

An interview with Kathy L. Winslow, RDH, COM and may also play a role in the development of airway issues. Orofacial Myofunctional Therapist and Buteyko Breathing Educator Positive behavior modification and motivational therapy are used to eliminate harmful oral habits such as prolonged pacifier, thumb or Introduction finger sucking; fingernail, cheek, or lip biting; tongue sucking; and Kathy Winslow began her first clenching/grinding of the teeth. The goal is to correct the posture experiences in dentistry at the and function, generalize it into everyday life, and habituate it, thus young age of 13 when she worked making the corrected posture and function the new normal pattern. in her father’s southern California This re-education process is gradual and must be integrated over a dental practice, first doing clerical period of time long enough for it to become the more dominantly work and later assisting. She established pattern. OMT works as an adjunct to dental care, went on to study dental hygiene aiding the dentist and orthodontist in achieving and maintaining at Cabrillo College in Aptos, the optimal functional aspects of treatment. California and graduated with How did you become interested in Orofacial Myofunctional Therapy? an Associate of Science degree in 1979. Following a brief period of clinical practice in San Diego I first heard about Orofacial Myofunctional Therapy (OMT) over County, Kathy moved to Massachusetts with her husband. While 35 years ago through my father’s dental hygienist, Joy Moeller. My there, she substituted as a clinical dental hygienist and also worked father had a very progressive, health-oriented general practice, as a research assistant at Forsyth Dental School. Eventually, they with personalized nutritional counseling, plaque control, TMD returned to California to the small community of Half Moon Bay to treatment and orofacial myofunctional therapy. Joy Moeller and my raise their three sons. Kathy worked primarily in private practice father encouraged me to consider OMT but I was happy practicing until 2006 and has been a practicing Orofacial Myofunctional clinically and was busy raising 3 boys, with soccer and Boy Scouts Therapist (OMT) since 2004. In addition to all her advanced consuming any remaining free time. However, after 34 years of coursework related to Orofacial Myology, Kathy is currently in practicing, my neck was showing signs of trouble. I started soul the process of completing her Bachelor of Science Degree in Oral searching for a different professional direction as the prospect Health. Currently her orofacial myofunctional therapy practice is of another 20 years of clinical dental hygiene was becoming spread throughout the greater San Francisco Bay Area. Kathy also unrealistic. The timing was right when I received a brochure for lectures on the principles of OMT to professional and lay audiences. an OMT course and remembered that I had always wanted to look As part of the faculty for the Advanced Lightwire Functionals (ALF) into that specialty but life had always gotten in the way. I didn’t mini residency group based in the Washington DC area, Kathy has hesitate when I saw that Joy Moeller and Barbara Green were had the opportunity to work with functional dentists, osteopathic the instructors. The moment the class began, a light bulb went and pediatric physicians as well as other myofunctional therapists in on and I knew in my heart that I could do this…and be good at developing a team approach to patient care. it. Needless to say, the first day back in my clinical practice there were 2 kids with thumb sucking habits sitting in my chair. With my What is Orofacial MyofunctionalTherapy? new knowledge in OMT, I now had some techniques to help these OMT involves an individualized regimen of therapeutic passive children effectively! and resistive oral and facial muscle exercises. It focuses on the Where did you receive your training in OMT? neuromuscular re-education of the oral facial complex to normalize and correct chewing and swallowing patterns as well as tongue, Licensure as a health professional such as a dental hygienist, jaw, and lip resting postures. These abnormal rest postures may speech-language pathologist, nurse, orthodontist, or dentist is contribute to malocclusion and improper cranial facial development Continuted on Page 24

CDHA Journal – Winter 2015 23 CareerCorner required for any post-graduate training in Orofacial Myofunctional airway and refer patients for assistance to improve health and avoid Therapy (OMT). I found that my experience as a dental hygienist potentially serious consequences. The ability to confidently help was an excellent foundation for this specialty. I began my training thumb suckers, nail biters and others is both rewarding and fun. with my first OMT course at the University of Southern California. An OMT can play an important role in improving a patient’s overall It was an introductory, 4-day, OMT program, after which I health and well being. immediately realized I needed far more education. I wanted to have my Orofacial Myofunctional Therapy armamentarium toolbox full, so I continued with advanced studies followed by some great internship opportunities. I became passionate about helping people with Orofacial Myofunctional Disorders (OMDs) and still continue to seek the most current information to improve my skills. I have trained with almost every instructor and institute available. I began with the Academy of Orofacial Myology and the Coulson Institute. I have also studied under pioneers in the field including Orofacial Myologists William Zickefoose (Founder and first President of the IAOM) and Julie Zickefoose as well as Kim Benkert, RDH, MPH. How did you go about transitioning into practicing OMT full-time? The Academy of Orofacial Myofunctional Therapy (AOMT) also offers the basic and advanced courses that I have taken. Initially I was prompted by a back injury and had already eased back to 2 1/2 days of clinical hygiene per week. After my OMT What are some other areas of education that you sought out to training I started to establish my practice in my home while still complement the treatment of your OMT patients? working in clinical practice. Fortunately, I have a tri-level house I have been trained as a Buteyko Breathing Educator, an additional and was able to designate the entire lower floor as my office. modality to OMT for restorative breathing. It has helped me in I have an operatory, sterilization area, office/reception area, a my personal health as well as my oral breather patients, once place for kids to do homework or to use when eating is part of any existing pathologies have been ruled out. It is not uncommon the therapy; as well as a wheel chair accessible bathroom and to see open mouths and poor posture in just about any setting parking. During my early transition to becoming an OMT, I met an today. I have expanded my knowledge in nutrition as it relates orthodontist who was very excited to have an OMT as a resource to OMDs and I assist my patients in finding health practitioners for the large percentage of her practice who had OMDs as part for individualized, patient centered care. My additional training in of the etiology of their malocclusion. I also met many osteopathic Mastgatova Neuro-Reflex Integration (MNRI) helps with orofacial physicians and functional, airway-centric dentists who embraced and breathing reflexes, complementing OMT care when it is a multidisciplinary approach to patient care. We have been apparent that these reflexes are not integrated, causing the patient collaborating over the last 10 years educating and assisting patients difficulty in accessing new neuro-pathways. to attain health, facial balance, and better airways. Depending on the particular provider, I may also rent space in their practice to As you began your training how did you use your new make it more convenient for the patients to access my services. knowledge with your dental hygiene patients? Using my own home office as a base, along with the help of an The old saying, “You don’t see what you don’t know,” comes to assistant, has been beneficial for keeping the business side of the mind. Once you have an understanding of what an OMD looks practice running smoothly. like and how common it is, it becomes hard not to incorporate it It takes time to establish an independent practice. You really into the assessment and a possible referral as part of your dental have to dive in, start seeing patients and developing referral hygiene care plans. Patients often present with a myriad of oral and sources. Look for mentors in OMT, participate in conferences to health problems. Malocclusion and poor cranial facial development broaden your ability to help your patients and collaborate with are just signs and symptoms of an underlying etiology. Airway other professionals. Part of the fulfillment and difficulty of being issues are prevalent in the general population. As dental hygienists, an independent practitioner is creating the infrastructure. In the we have the opportunity to identify possible concerns regarding the

24 CDHA Journal Vol. 32 No. 1 CareerCorner beginning, I worked 2 days of OMT and had 2 days dental malocclusion and sub-optimal jaw growth/position possibly resulting of clinical dental hygiene. The fifth day was split – I in an abnormal facial profile. Poor cranial facial development may cause worked a half day of clinical hygiene in the morning, other problems with the airway and temporomandibular joint. Changes from then I would run back to my home office to see my a chronic open mouth rest posture may include increased vertical height OMT patients during the after school hours. In the of the face, recessive chin, and hypotonic or flaccid lips. This downward, end, I knew something had to give when one of my backward growth (rather than downward and forward) may contribute to sons become ill and I had to be at the hospital twice a airway obstructions and sleep-disordered breathing or compensations related day. So, I quit practicing clinical dental hygiene, which to neck issues or temporomandibular dysfunction. This is just one example is when my OMT practice really took off. In retrospect, of the many different outcomes of poor oral postures. OMD often plays I believe that focusing on the OMT practice helped a role in open mouth chewing, drooling, digit habits, speech issues, and it to flourish. However, it was certainly less stressful mouth breathing, all of which may lead to social embarrassment, as well as significant health issues. financially to be able to start something completely new (OMT) while having the stability of doing something Describe the evaluation processes you make with a potential patient? familiar, established and comfortable (clinical dental I assess body posture, facial balance, occlusion, function, eating, drinking, hygiene). Emotionally, the transition was really seamless, health history, diet, and school performance. I ask about sleep habits, quality as both professions are focused on optimal patient health of sleep, snoring, the birth histories. I also include questions on the frequency and I utilized strengths refined over years in dental of colds and ear infections, allergies, as well as breathing related problems hygiene clinical practice. such as sinusitis, asthma, and chronic rhinitis. The patient’s functional Describe a typical day in one of your practices speech patterning is evaluated and referrals to a speech pathologist are made as needed. Questions on habits and motivation are included in order I will usually have 1 to 2 consultations, each lasting a to determine whether or not the individual will be a good candidate for OMT. minimum of an hour. I spend a lot of time educating my Since OMT requires time and commitment, the ability to accommodate OMT patients and their parents so that they understand the appointments is also addressed. Measurements and assessment photos are goals and what is required for successful therapy. The taken throughout therapy to track treatment progress and for communication consultations may extend beyond an hour for additional purposes with other professionals. records and intake photographs followed by a first What are your end goals for your patients? lesson. As the day progresses I will see anywhere from Extraoral Observations: Intraoral Observations: 2 to 12 or more patients in varying phases of therapy. Posture: Do they stand straight? Oropharyngeal Bruxism About 1/4 to 1/3 of my patients are adults and the How do they walk? What is their airway size rest are children. Most of my days are fully scheduled static and dynamic head and body posture? however some days I see patients for part of a day and then do administrative work as well. Facial profile Tonsils: presence Swallowing pattern and size What is the prevalence of OMDs? Nares: size and responsiveness Tongue surface and Occlusion: Class I, Numerous studies have been done on the prevalence of size: scalloping, Class II or Class III geographic, coated malocclusion tongue thrusting however, there are very few surveillance studies on the prevalence and impact of OMDs. My Lips: open versus closed, Position of tongue History of temporoman- chapping observed during dibular dysfunction sense from what I see in practice is that the prevalence speech is higher than has been reported and there is definitely a Position of tongue Habits (ie: cheek biting, need for more formal research in this area. when mouth is chewing on objects, etc.) What are some potential consequences of OMD? closed and/or at rest Abnormal habit patterns, functional activities, and Labial and lingual postures may create an environment that can disrupt frenum: attachment and tension dental eruption patterns in children. This may lead to Continuted on Page 26

CDHA Journal – Winter 2015 25 CareerCorner

My patient end goals are to have a palatal tongue rest posture, lip seal, nasal breathing, and a corrected swallow. These goals need to become habit and second nature round the clock. I want my patients to reach the point where they don’t remember how to swallow incorrectly. I also address their head and body posture and refer to other professionals if needed. Correcting OMD helps provide long-term homeostasis for more successful orthodontic outcomes, muscular TMD, and oral health therapies. Bringing harmony to the orofacial muscles provides a stable environment for proper growth, development and function.

Goals of Orofacial Myofunctional Therapy: • Create a palatal tongue rest position • Bring the lips together at rest position through improved area with respect. Through evidence based learning, hygienists strength and tone have the ability to integrate the oral-systemic linkages into • Establish nasal breathing interactive therapeutic lessons for patients’ whole health and well- • Bring posterior teeth together during swallowing being. Hygienists have the ability to educate and motivate patients • Correct drinking incorporating their understanding of the medical/dental aspects of the various etiologies that play a role in the development of OMD. • Establish optimal sleeping positions Hygienists tend to be compassionate about patient care and the • Keep hands and objects away from the face OMT needs to connect with a patient, discover what motivates • Correct dysfunctional habit patterns. them and tailor the therapy to meet their individual needs. Dental • Normalization of the freeway space through improved hygienists are also used to being part of a team, working toward rest positioning (2-3 mm at the molars and 3-5 mm at the common goal of improved patient health. the incisors) How should a hygienist evaluate for OMDs? There are a number of quick chairside evaluations that may identify Approximately how long is the average course of a potential OMD. Dental hygienists are in an ideal position to make treatment for OMT? a number of observations during the extra- and intra-oral exam A typical OMT program will take 9 months to a year. The active that should be included in the individual treatment plan so that phase, weekly or bi-weekly, generally takes 2 to 4 months and is appropriate care considerations and referrals can be made. followed by the habituation phase lasting 4 to 5 months. Re-checks are then scheduled throughout the year and over the next 24 Orofacial Myofunctional Disorders (OMDs) include months or longer if needed. Every patient is unique and the therapy any or a combination of the following: must be customized for the individual’s needs. • Lack of lip seal and mouth breathing Why are Registered Dental Hygienists well suited to • Low tongue rest position become an OMT? • Parafunctional habits Dental hygienists are well versed in the anatomy and function of • Increased and decreased vertical dimensions the stomognathic system and have the knowledge and experience • Chewing disorders to identify cranial facial and malocclusion problems. Hygienists are comfortable working in the oral cavity and treat this vulnerable • Atypical swallowing • Restricted labial or lingual frenums

26 CDHA Journal Vol. 32 No. 1 CareerCorner

Is there anything else about OMT/OMD you would include? About the Author: Modern day living has brought a number of unintended Carol Lee, RDH, MS, has had a full career consequences. There are significant relationships between OMDs, that includes dental hygiene education, oral health and total health. Recent research studies from Stanford clinical practice, and public health. She is University and Brazil are correlating the need of OMT as a resolution a member of the California Dental Hygiene for some of the cranial facial development problems that lead to Educators Association, a fellow in the sleep-disordered breathing. In order to thrive and develop properly American Academy of Dental Hygiene, we need to be able to breathe, suck, swallow, chew whole, non- past CDHA president and currently serves processed food, and be physically active. Over the last 350 years on the CDHA Journal Editorial Advisory the trend in infant feeding (lack of breast feeding and pureed foods) Board and the ADHA Diversity Committee. has changed how our jaw has developed. Eating refined, processed carbohydrates leads to poor chewing, hypotonic muscle, poor craniofacial development, and lack of mandibular condylar cartilage growth. Allergies, as well as inflamed adenoids and tonsils are often an adverse response to poor diet, poor digestion, altered gut flora, and oral breathing. Ultimately, some of the dire health consequences we see today may be manifested as obstructive sleep apnea, sleep-disordered breathing, behavioral and learning problems. Lack of exercise and a sedentary lifestyle does not provide the bio- mechanical stimulation required for proper structural and functional development. Oral healthcare providers should be poised to screen, identify and educate patients at risk for OMDs.

OMT Educational Programs: • Academy of Orofacial Myofunctional Therapy (AOMT) www.myofunctional-therapy.com/courses.html Comprehensive basic and advanced courses offered by the Academy. OMT Associations: • Academy of Applied Myofunctional Sciences (AAMS) www.aamsinfo.net • International Association of Oral Myology (IAOM) www.ioam.com “IAOM approved courses” available through individual instructors

CDHA Journal – Winter 2015 27 EducationExchange Kris Johnson, RDHAP, BA

Incorporating Nutritional Counseling into Dental Hygiene Care – Bridging strategies from dental hygiene education to daily practice The Dental Hygienist and Nutritional Counseling see intra-orally and help make the connections between nutritional status and overall health. Nutritional counseling for the dental hygienist has been defined as a process used to help clients develop healthful food selection State and federal laws regulate the scope of practice for healthcare and eating behaviors that promote overall health.1 Chronic health providers. While the registered dental hygienist is licensed to issues continue to increase in the United States, and healthcare perform nutritional counseling, it is important to remember that providers will need increased collaboration with other healthcare this dietary counseling professionals for improved patient health outcomes. The Centers should not be a substitute for Disease Control and Prevention (CDC) reports that chronic for the expertise of Nutrition Referral Resources disease is one of the most common, costly, and preventable of all a nutritionist. It is Current/Chronic Disease: health problems.2 Lifestyle and dietary factors can significantly considered outside of the Registered Dietician, Naturopathic influence the expression of chronic diseases. The Standards for scope of practice for the Physician, Functional Medicine Clinical Dental Hygiene Practice of the American Dental Hygienists’ RDH to provide specific Nutritionist, or Certified Nutrition advice regarding nutrient Association (ADHA) states that the dental hygienist needs to Consultant understand and discuss systemic and oral health and disease as intake as it relates to well as to educate patients on the importance of good nutrition treating chronic disease. Disease Prevention: for maintaining optimal oral health.3 Dental hygienists usually see It is helpful to be familiar Certified Nutrition Educator, patients on a bi-annual basis for regular preventive dental hygiene with the various nutrition Certified Health Coach, Natural Chef care providing increased opportunities for more comprehensive professionals and their health education including nutritional counseling. area of expertise for patient referrals. Nutrition is often taught as a stand-alone pre-requisite prior to beginning a dental hygiene program. Later on, nutritional Chronic Inflammation, Diet and Oral Disease counseling is incorporated into comprehensive patient care Periodontal disease is a chronic disease accompanied by strategies or patient competency projects. The focus of nutritional inflammation. During inflammation, the microvasculature becomes counseling, for the dental hygienist, is often limited to the more permeable, and cellular messages are exchanged, especially correlation between diet and carious lesions, which is very helpful between various types of lymphocytes and parenchymal cells.5 in reducing the burden of dental disease. However, it is time to Science continues to reveal new ways in which cells communicate, start looking beyond simply identifying what dietary factors may leading to a better understanding of disease expression. Cellular be contributing to caries, and start looking at the interdependent communication is intricate and requires many vitamins, and 4 relationship between nutrition, systemic, and oral health. minerals in the process. Nutritional Counseling and Dental Hygiene Care Nutrients are delivered through foods and liquids. Macronutrients The health history is the dental professional’s guide regarding include protein, carbohydrates, and fat. The prefix “macro” infers an individual’s current and previous health status. Systemic the need for a larger amount of these nutrients. On the other diseases frequently encountered by the dental professional include: hand, micronutrients, while needed in lesser amounts, are of great cardiovascular disease (CVD), diabetes mellitus (DM), metabolic importance to cellular homeostasis. Vitamins and minerals are syndrome (encompassing CVD, DM, stroke), obesity, and a fundamental to maintaining health. 4 variety of autoimmune diseases. Inflammation is the common Dental professionals see a wide range of oral diseases including denominator of most disease. Understanding how nutrition affects gingivitis, periodontitis, burning tongue, angular cheilosis, halitosis, inflammation and disease can aid the dental hygienist to support delayed wound healing, as well as other oral conditions. From a their patients in a more holistic way. Dental hygiene educators nutritional standpoint, it has been determined that deficiencies in are in an ideal position to set the foundation for students to think vitamins A, B complex, C, D, and iron all play an important role more holistically by encouraging them to look beyond what they

28 CDHA Journal Vol. 32 No. 1 EducationExchange in oral health.3 The challenge most individual’s face is that simply can set the stage for meaningful dialogue and problem solving. taking a multiple vitamin is not enough to cure chronic disease. Motivational interviewing techniques can help the individual elicit the The best source of these nutrients is through food, and nutrient changes that are achievable. Remember, making small, incremental absorption depends on a healthy digestive system. Digestive health, changes in daily nutritional habits can have a significant effect on an in turn, is nurtured through healthful eating, and avoidance of pro- individual’s overall health and wellbeing. inflammatory foods. Simple Suggestions for an Anti-inflammatory Diet Simplifying Dietary Advice • Increased intake of “whole” (unprocessed) foods While the 3, 5, or 7-day dietary intake with nutrition analysis • Increase fruit and vegetable consumption as part of a patient competency is a part of the dental hygiene • Limit intake of refined sugars curriculum, comprehensive nutritional counseling is not a usual component of patient care in private practice. Clinicians often • Increase water intake cite lack of time, inexperience and feasibility challenges as • Take more time to enjoy food obstacles for implementing comprehensive nutritional counseling. • Listen to your body With the advent of a multitude of nutrition and dietary analysis applications, hygienists can encourage their patients to visit www. • Increase your oxygen intake by getting a breath of fresh air choosemyplate.gov as a tool for easy to access information about • Consider increasing fruit and vegetable intake through juicing nutrition. Another website: www.supertracker.usda.gov offers • Blend together: 5 kale leaves, 1 cucumber, 1 stalk celery, 1 nutrition analysis free of charge. For smart phone users, there are carrot, 1 handful fresh parsley, 1 green apple, 1 orange. a wide range of personal nutrition applications to References: choose from. 1. Darby, M, Walsh, M. Dental hygiene theory and practice, 4th ed. Elsevier St Louis, MO: Saunders; 2015. 1150 p. The simplest chairside 2. Chronic disease prevention and health promotion [Internet]. Atlanta: Centers advice dental hygienists for Disease Control and Prevention; c2014. [cited 2014 Nov 2]; Available can give to their patients from: www.cdc.gov/chronicdisease/overview/index.htm is to avoid refined, 3. ADHA: Standards for clinical dental hygiene practice [Internet]. Chicago: processed foods as much American Dental Hygienists Association; c2008. [cited 2014 Nov 2]; Available as possible and to focus from: www.adha.org/resources-docs/7261_Standards_Clinical_Practice.pdf on a diet rich in whole 4. Ehizele, A , Ojehanon, P, Akhionbare, O. Nutrition and oral health. J Postgrad Med 2009, Vol. 11 Issue 1, p76-82. 7p. foods, vegetables, fruits, nuts, seeds, and plenty 5. Gurav, A N. The association of periodontitis and metabolic syndrome. Dent Res J [Internet]. 2014 [cited 2014 Nov 2]; Available from: www.ncbi.nlm.nih.gov of water. Many patients need periodic encouragement from their healthcare providers, and easy to understand suggestions can About the Author: provide the necessary encouragement to make the small changes Kris Dowling, RDHAP, BA is a 1993 graduate that are tailored to their individual needs. Successful nutritional of the Shoreline Community College Dental counseling is similar to providing oral health instructions, avoiding Hygiene program in Washington. She holds information overload is critical to implementing long-term change. a bachelor of business management from It is important to take a moment to review nutrition at each dental St. Mary’s College in California, certificates hygiene care appointment and pick one area to discuss. Remember in nutrition education from Bauman College to include the specific discussion topic in the treatment notes so you in Berkeley, CA as well as the Institute for can review the patient’s progress at the next appointment. Integrative Nutrition in New York, NY. She Whether you are a student dental hygienist or a practicing clinician it became a Registered Dental Hygienist in is important to always approach nutritional counseling with openness Alternative Practice in 2008 and is currently enrolled in the Master and empathy. Always take any cultural, religious, socioeconomic of Science in Dental Hygiene degree program at Idaho State factors and personal food beliefs into consideration before offering University. Kris is passionate about dental hygiene, nutrition, and dietary recommendations or strategies. It is important to avoid education and currently works as an adjunct clinical instructor appearing to be lecturing the individual about their dietary choices. at Cabrillo College in Aptos, California, and is a member of the Starting the conversation with open ended questions and asking volunteer clinical faculty at Foothill College in Los Altos Hills, CA. permission to share what you know about oral-systemic health

CDHA Journal – Winter 2015 29 CDHA NewsNotes

CDHA Leading the Way

CDHA Leaders are Champions for Change! parents and kids about the health risks associated with smokeless On October 25, 2014 CDHA leaders joined the tobacco. Foothill College dental hygiene students Taylor Slotte and call to become “Champions for Change” creating Connie Cheng were on hand along with Denise Snarski-Hearing, living billboards to disseminate information via RDH to perform oral cancer screenings and provide education at news and social media that dental hygienists the Grand National Rodeo held in South San Francisco in October. are publicly joining the movement for healthy For more information on getting the anti-tobacco word out in the lifestyle changes. By working collectively toward improving the rodeo world visit www.oralcancerfoundation.org health status of Californians, this statewide movement is helping create environments that support increased fruit and vegetable Orange County Walk for Oral Cancer 2014 consumption and physical activity. Dental hygienists have the opportunity on a daily basis to educate patients regarding healthy eating habits, which plays a vital role in combating obesity and improving oral health. Providing information on the role sugar and sugar–sweetened beverages play in caries and the obesity epidemic should be a high priority. Children with poor dietary habits are at high risk of becoming The Oral Cancer Foundation (OCF) sponsored its first Orange overweight or obese in County Walk/Run for Oral Cancer Awareness in Fountain Valley addition to experiencing on September 27, 2014. The day was promoted as a family- dental caries in their primary teeth. friendly, fun, fundraising event for the entire community. Dental Focusing on the common risk factors of obesity and caries hygienists and students from all southern California were on hand and collaborating with local health departments creates many to support the work of the OCF. Component members came from opportunities to promote, encourage and reinforce healthy Long Beach, Orange County, San Gabriel, Tri-County and Ventura. behaviors among all Californians. Make a difference and be a Cerritos, Concorde Garden Grove, Moreno Valley, and West Coast Champion for Change. Join the Movement today. University students demonstrated their school pride by walking and running for the cause. Added benefits of the day included www.cachampionsforchange.cdph.ca.gov the connections that were made with the healthcare professionals from the Hoag Family Cancer Institute and the Western College of “Be Smart. Don’t Start,” is the theme of the new outreach Health Science Dental School for future collaborations with dental program of the Oral Cancer Foundation and the world of rodeo hygiene professionals. Spreading awareness and early detection athletes. By partnering of oral cancer are keys to long term survival. Interprofessional with Cody Kiser, a collaborations are key to improved patient experiences, outcomes, young, personable, and more cost efficient care – a “win-win” for everyone. bareback bronco rider and Carly Twisselman, To learn about the Oral Cancer Foundation, future awareness a fierce competitor in walks and how you can make a difference, go to barrel racing events, www.oralcancerfoundation.org the OCF has two new ambassadors from the rodeo world to educate

30 CDHA Journal Vol. 32 No. 1 CDHA NewsNotes

California Legislative Update AB 1522, the Healthy Workplaces, Healthy Families Act of 2014, mandates paid sick leave for all employees. Effective July 2015, after 30 days worked within a year, the employee will accrue 1 hour paid leave for every 30 hours worked, up to the maximum required 3 days per year. For more information on the Healthy Workplace, Healthy Families Act and employee rights, visit the California Department of Industrial Relations web site at www.dir.ca.gov/DLSE Keep up to date with what CDHA is doing to represent the needs of the dental hygiene profession in California www.cdha.org/government_legislation

Governor Jerry Brown recently signed legislation impacting Want to support legislative efforts to advance the dental hygiene dental hygiene education and practice in California. profession in California? CalHyPac has your back! AB 1174 expands the scope of practice for RDHs and RDHAPs CalHyPAC is the only to allow for placement of Interim Therapeutic Restorations political action committee (ITRs) both in stand-alone practice settings and in alternative that represents California practice settings, with telehealth or distance supervision, dental hygienists. The PAC provided they have completed additional education. The establishes relationships provisions of AB 1174 will serve to support the operation and with California legislators sustainability of the Virtual Dental Home with the goal of who believe that dental increasing access to care. hygienists are an important and essential part of the health care system. SB 1245 allows the Dental Hygiene Committee of California We support candidates for the California legislature who believe in our (DHCC) to continue to administer the laws regulating the interests, concerns, and goals. Learn more about what CalHyPac is practice of dental hygiene in California until January 1, 2019. doing for you and make a donation today at www.cdha.org/cal-hy-pac At that time there will be another sunset review process to evaluate the operations of the committee. SB 850 authorizes the Board of Governors of the California Community Colleges to establish a statewide baccalaureate degree pilot program at 15 community college districts in order to meet the needs for higher levels of education in a number of skilled disciplines. Currently, no baccalaureate degree programs in dental hygiene are offered at the California State Universities or at the University of California, making dental hygiene a viable discipline for one of the pilot programs. Three community colleges submitted dental hygiene proposals to be considered for the pilot program. On January 20, 2015 the California Community College Board of Governors announced that Foothill College in Los Altos Hills and West Los Angeles College in Culver City had been selected as demonstration sites for dental hygiene baccalaureate degree programs. The schools have until 2017 to begin implementing their bachelor degree curriculums.

CDHA Journal – Winter 2015 31 CDHA NewsNotes

So, why join? Although being a member of CDHA is not required Why I belong? for licensure, I highly recommend it. My CDHA membership Diana Trang, RDH, President, has connected me with great mentors and an enormous Peninsula Component support network of dental health professionals with years Member since 2011 of experience. Belonging to CDHA has allowed me to create professional relationships and endless possibilities for personal Dental hygiene can be a physically and professional growth in addition to the vast array of tangible and emotionally challenging career, resources, journals, CE courses, and job opportunities. but it also comes with great personal rewards! In my career, I have experienced both success and times of stress; however, Now, what can you do to get involved? One of the great I have found that joining CDHA has provided me with a aspects about CDHA is that there are many different levels of professional support network that has helped me through many participation. You can choose to participate at the local or state challenging situations. level, you can attend the local meetings and CE courses, or you can just support our profession by being a member. As a second year dental hygiene student, I was fortunate enough to be sponsored by my local component to attend the annual Just remember, we are our future. It takes all hygienists to House of Delegates. At the HOD, I was able to see how the come together as a whole to make the positive changes that will association operates and how the members come together to advance our profession. help form and shape the future of our profession. Not a member yet? Download an application at www.CDHA.org

Your Future is Near! 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 Contact us Today! Certificate or Associate degree [email protected] ◆ Two tracks available: Dental Hygiene Education Public/Community Oral Health Services ◆ Courses designed for the working professional ◆ Accepting applications for September 2015

32 CDHA Journal Vol. 32 No. 1 A triple burst of better gingival health The new Philips Sonicare AirFloss Pro

Philips Sonicare AirFloss Pro gives your inconsistent flossers everything they need for improved interproximal health. With our new high-performance nozzle design and triple-burst technology, it creates three bursts of micro-droplets to remove plaque biofilm.

Clinically proven as effective as floss for improving gingival health,** AirFloss Pro can be filled with water or antimicrobial mouth rinse, such as Philips Sonicare BreathRx, for targeted treatment. And inconsistent flossers say it’s an easy addition to their daily routine. After all, the best solution is one they’ll use regularly… and effectively.

said it was 95% easy to use* showed improved

UP TO 97% gum health** plaque bio€ lm removal † UP TO 99.9% in the treated area To order, call (800) 422-9448 or visit philipsoralhealthcare.com

* Survey of U.S. patients ** When used in conjunction with a manual toothbrush and antimicrobial rinse in patients with mild to moderate gingivitis. AirFloss is designed to help inconsistent
ossers develop a healthy daily interdental cleaning routine. For more information, please visit www.philips.com/air
oss/faq or reference the QR code. † In a lab study, actual in-mouth results may vary Jenifer McDonald, Executive Administrator California Dental Hygienists’ Association Presorted STD 1900 Point West Way, Suite 222 U.S. Postage Sacramento, CA 95815-4706 PAID Permit No. 104 CDHA14 San Dimas, CA

RETURN SERVICE REQUESTED

FRIDAY 5•1•2015

Noel Kelsch, RDHAP and Registration information available at Marhya Kelsch, MSW,LSW www. cdha.org “Mental Health and Oral Health” and “Understanding the Psychology of Dentistry: Patient Centered Care through Integrated Medicine”

Evening program: Cindy Kleiman RDH,BS “Oral Care is Critical Care”

Plus Student Table Clinics, exhibitors and much more! Earn up to 8 CEUs Spring Scientific Session Sheraton Park Hotel, Anaheim