Healthy Living in the North

Public dental health: A career that makes a difference

Spirit the Cariboo holding a toothbrush with a poster that shows how adults should brush with children.I’ve been working in dental prevention since I was 16 and I was extremely fortunate that my career found me. One of my childhood Girl Guide leaders worked at a dental office and called my mother to ask if I’d be interested in working part time. She said the dentist would train me.

Doors of opportunity

Saying “yes” to this opportunity opened many wonderful doors. I first worked as a “Girl Friday” doing errands for the dentist, and trained to do infection control. Next, I helped the dentist with checkups, fillings, extractions, and cleanings. I was lucky enough to study dental assisting and dental hygiene, and to become registered and licensed. After school, a door finally opened for me to work in dental public health, so I moved to Terrace.

Improving the health of many

Over 30 years of practice, I’ve met hundreds, probably thousands of people, and being trusted with their dental health has been an honour. A dental career in public health is particularly satisfying because we apply a population health approach, which means we look at improving everyone’s health by reducing inequities or unfair health factors. One way to reduce these is to design targeted programs to people who have less advantages.

I recently read a report called “Key Health Inequalities in Canada” where poor oral health was listed as an indicator of poor overall health. Poor health can mean that a person might not have the same advantages as others. At Northern Health, we design programs that consider the social, political, and economic disadvantages that people face. In the dental program, we focus on the youngest population – children six and under and their caregivers – because working with children has the potential for the most long-term impact. As a team, we need to work efficiently and effectively, so we can stretch health care dollars.

Dental health prevention in action

The Northern Health dental team screens all one-year-olds for tooth decay, and uses the results to decide which preventive services families need.

We also offer fluoride treatments to children of at-risk families, as well as supportive and non-judgemental counselling on preventive dental care. We encourage parents to use their best parenting strength or skills and then build on that.  We then encourage families to decide on the dental goals and path that work best for their situation. It’s a rewarding experience to see a worried, sleep deprived mother learn about tools she can use in her home to stop decay in her one-year-old’s teeth.

Supporting small steps in a healthy direction

Cavities are a chronic disease caused by bacterial acid’s progressive damage to teeth over time. Giving a family fluoride toothpaste and toothbrushes so they can brush twice daily reduces the acid’s impact and empowers change. Telling families to consider how much carbohydrate children eat, and how often, is also key in supporting better oral health.

Mothers have told us they‘re telling their friends to come to the program because of the benefits they’ve experienced. It’s rewarding to see people take small steps in a healthier direction. Not all of our clients are able to make our recommended changes, yet we continue to offer to see them and provide services to build meaningful relationships over time.

Working in Public Health Dental: making an impact

As we honour and meet people in the situations they’re in, I believe both dental staff and the clients see benefits. I feel very fortunate to be able to help someone with a skill that’s so critical to their long-term health. If you‘re a dental professional already, I encourage you to consider public health as a career path to explore — you won’t be disappointed. And if you’re exploring career options, consider dental health! You’ll impact families who need you, and it’s work that’ll make both your heart and mouth smile.

Shirley Gray-Kealey

About Shirley Gray-Kealey

Shirley is the Team Lead for Dental Programs at Northern Health. She moved to Terrace for a two year position as a Dental Hygienist and has stayed for 27 years! She feels it's a privilege to live and work in the North. She loved teaching children and has been mistaken for the tooth fairy! She is not magic like the tooth fairy, but she is proud to lead a real team of preventive dental specialists in the North who work hard to ensure children keep their teeth healthy for a lifetime.

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Oral health is not an out of body experience

Spirit the Cariboo at a fluoride varnish clinic with an NH staff member.One of the things that always strikes me as odd is that the mouth is often considered a separate body part when we’re discussing health issues. Did you know an unhealthy mouth can affect your appearance, social acceptance, and ability to eat and sleep? An infection in the mouth comes from a bacterial infection; these bacteria have the potential to travel through the bloodstream and affect other organs. Many people don’t realize that oral infections can impact chronic diseases such as diabetes, asthma, arthritis, and even birth rates.

Your mouth is an important part of your body! And we all need to treat it as such in order to be and stay as healthy as possible.

Empowering healthy dental behaviours

I’m a dental regional program lead – I teach and provide resources and tools to empower public health staff to support our northern population around adopting healthy dental behaviours. Dental public health staff work towards helping people achieve the skills they need to start making small changes – commonly called brief action planning. We want them to start today to make a small change.

How small changes can make a big difference

If someone decides today to use fluoride toothpaste daily (or better yet, twice daily), when previously they did not, the science tells us that their long range dental decay rate will reduce.

If today, a teenager starts chewing a sugar-free piece of gum after a snack, the length of time of the acidic attack on their teeth will diminish, and they will have less decay over their lifetime.

If someone makes a small change every day, the dental preventive effect is maximized and continues to increase.

I dream of a day when all dental treatment needs are covered by a universal dental plan; however, at this time, I am happy to focus my attention on what I can practically influence.

The cost of prevention: a positive return on investment

My perspective is that the cost of prevention is cheaper than the cost of chronic disease treatment in hospital. I once had a client who had diabetes and a mouth full of decayed teeth, coupled with no funding to fully treat the oral health issue. Not being able to eat impacted this person’s diabetes, and uncontrolled diabetes affected their emotional stability, resulting in a long hospital stay. Chronic and untreated oral infections take a toll on the body and in this case, the finances of the health care system.

Advocating for change

I continue to advocate for the best avenues to help clients access dental care, but every day I encourage my staff to implement the practical applications of dental prevention. Some of these include:

  • Using fluoride toothpaste twice a day.
  • Reducing frequent sipping on sweetened beverages.
  • Practicing empathy and respect so patients feel comfortable.

It takes many caring individuals across a broad spectrum of disciplines to implement change. I continue to believe change for the better is always possible… even if it’s only one tooth brushing session at a time.

Shirley Gray-Kealey

About Shirley Gray-Kealey

Shirley is the Team Lead for Dental Programs at Northern Health. She moved to Terrace for a two year position as a Dental Hygienist and has stayed for 27 years! She feels it's a privilege to live and work in the North. She loved teaching children and has been mistaken for the tooth fairy! She is not magic like the tooth fairy, but she is proud to lead a real team of preventive dental specialists in the North who work hard to ensure children keep their teeth healthy for a lifetime.

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Imagine a cavity-free world

Spirit the Cariboo holding a large toothbrush, standing against a mural of handprints.The Alliance for a Cavity-Free Future tells me to embrace the dream of a cavity-free world. It’s hard to capture what the burden of dental decay is, but estimates indicate that 35% of the population has cavities, which means 3.9 billion people are affected.

The World Dental Federation states that poor oral health affects our ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain or discomfort. Around the globe, 60-90% of school-aged children and nearly 100% of adults have experienced tooth decay. In fact, dental caries (or tooth decay) are the most common, yet preventable, chronic disease — so what’s the problem and what can we change to make a difference moving forward?

The levels of preventive dentistry

I’ve been working in various levels of preventive dentistry since I was sixteen. Every action I did as a chair-side dental assistant was to help the dentist help people to keep their teeth for their lifetime. My “after school job” turned into my career and I first trained to become a certified dental assistant and then a few years later, a registered dental hygienist. My goal was to work one-on-one with people to  support and teach them how to stop cavities in their mouths.

Next, I was lucky enough to move from the private-practice dental world to work in public health at Northern Health. We see at-risk clients and support them as individuals to adopt prevention strategies.

We also target groups and professionals who could share preventive messaging in their work. My career has given me room to grow — from serving the individual client, to serving a population.

I’ve recently grown into a position that supervises dental staff in our region. I continue to encourage dental staff to embrace the dream of preventing cavities in our patients. We often see poverty as an underlying driver of decay, so we look for ways to support and serve them; we advocate for policy changes that support our patients.

Making a difference

Over the years, we’ve made a difference in people’s lives — the staff can tell you rewarding stories of gratitude from the families we serve. However, dental decay is such a big problem that it makes our efforts seem small.

When I discovered that there’s a worldwide body of people championing a cavity-free world, I was very excited! The Alliance for a Cavity-Free Future works together to advocate for good dental prevention practices. They could reach beyond the local dental office and public health sphere and shift dental outcomes in our culture. As Steve Jobs said, “Those who are crazy enough to think they can change the world, usually do.”

The Alliance for a Cavity-Free Future

Here’s some history of this world-changing group: In February 2016, the Alliance for a Cavity-Free Future put on the World Caries Prevention Symposium in Dubai. The event brought together experts from key disciplines, including nutrition, education, behaviour change, cariologists (how-to stop cavity experts), public health, clinical practice, and integrated management of cavities.

These experts came from across the globe to debate and strategize the practical steps to move the world toward a cavity-free state. Researchers report that more and more people around the world are getting cavities.

Some of the group’s goals to stop decay were:

  • Educate the whole medical team to champion dental prevention.
  • Support the most effective behaviour change models to be used in dentistry, like Brief Action Planning (a short discussion to help people to make a new health goal).
  • Experts on cavities think the best way to stop decay is to wait longer between meals, so our mouths have time to rest.
  • The same experts also think reducing the amount of sugar we eat to only 10% of our daily calories would help reduce cavities.

For more information

Shirley Gray-Kealey

About Shirley Gray-Kealey

Shirley is the Team Lead for Dental Programs at Northern Health. She moved to Terrace for a two year position as a Dental Hygienist and has stayed for 27 years! She feels it's a privilege to live and work in the North. She loved teaching children and has been mistaken for the tooth fairy! She is not magic like the tooth fairy, but she is proud to lead a real team of preventive dental specialists in the North who work hard to ensure children keep their teeth healthy for a lifetime.

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A lifetime of healthy smiles

Did you know that tooth decay is the third most common disease in Canada? And that four in 1000 children require dental treatment in hospital operating rooms? Not only that, but dental caries (cavities) interferes with a child’s ability to eat, sleep and thrive.

The good news is that dental caries is a preventable disease! Simple changes to you and your child’s diet and dental health behaviour can have a great impact on the development of a healthy mouth and a bright smile. Oral Health Month is a great time to start these changes!

Display with food photos

There are some foods that seem to protect against tooth decay, including hard cheeses like cheddar and mozzarella, nuts, meats, fish, poultry, and eggs.

What can you do?

  • Take care of your own dental needs. Decay-causing bacteria can be spread from person to person so brush and floss daily and have the dentist remove active decay. Limit passing bacteria to infants by not sharing toothbrushes or cutlery and by not licking soothers to clean them.
  • Once teeth appear, brush your child’s teeth twice daily with a rice-sized amount of fluoride toothpaste. Don’t rush your brush! Starting at one point, slowly work your way around the entire mouth until the fronts, backs, and chewing surfaces of both the upper and lower teeth are done – this will take you three to five minutes.
  • At least once a month, lift your child’s lip to check for newly erupted teeth and white or brown spots on the teeth.
  • Teach your child to drink from a regular, lidless cup. Offer plain water instead of other liquids for thirst between meals. Limit acidic drinks like pop and fruit beverages.
  • A balanced diet is crucial to the development and maintenance of healthy teeth and gums. Choose a variety of healthy foods that do not stick to teeth. There are some foods that seem to protect against tooth decay, including hard cheeses like cheddar and mozzarella, nuts, meats, fish, poultry, and eggs.
  • Start regular dental visits at age one or after teeth start appearing. Refer children with signs of dental decay to dental staff at your local health unit. Public health dental staff offer free counseling and fluoride varnish treatments.

For more information, visit the BC Dental Association or HealthLink BC.


Look for this article – along with several other stories about child health – in the upcoming (Summer 2016) issue of Healthier You magazine!

 

Shirley Gray-Kealey

About Shirley Gray-Kealey

Shirley is the Team Lead for Dental Programs at Northern Health. She moved to Terrace for a two year position as a Dental Hygienist and has stayed for 27 years! She feels it's a privilege to live and work in the North. She loved teaching children and has been mistaken for the tooth fairy! She is not magic like the tooth fairy, but she is proud to lead a real team of preventive dental specialists in the North who work hard to ensure children keep their teeth healthy for a lifetime.

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Certified Dental Assistants: A passion for healthy smiles!

Two toothbrushes

Northern Health has a dedicated team of public dental health professionals who are busy promoting healthy dental behaviours!

April is Oral Health Month!

You may not know that Northern Health has a dedicated team of public dental health professionals who are busy promoting healthy dental behaviours! This Oral Health Month, I’d like to celebrate and acknowledge the work that our Certified Dental Assistants (CDAs) provide. CDAs are educated, trained dental professionals who make important assessments about patient care every day. The five ladies who make up this team are often the first person that clients meet in their community – whether it’s at family health events, Strong Start, or our fluoride varnish clinics.

I had the privilege of interviewing each of the CDAs last month and discovered the deep passion each has for working with children and families. I asked that they share a few stories and reflections here with you.

Thank you for taking time to read and consider the support these ladies provide in our communities!

Pamela:

I am a Certified Dental Assistant working as a Community Dental Assistant for Northern Health. I’ve been working for six years and during that time, I have been in contact with multiple families. The families that made the biggest impression on me were the ones who had children with early childhood caries. Sometimes these children are in pain and you can really tell that their self-esteem is low. They also struggle to eat well.

After these children are treated and their pain is alleviated, the difference can make you cry! I like to compare it to a flower that is blooming – so beautiful and happy! There is nothing better than watching a child start to thrive again, eat, and be healthy and happy! This is what makes me love my job and makes me passionate about healthy children.

Wendy:

I appreciate the variety that my job as a dental assistant in public & population health offers. I love working with young children and their parents and especially enjoy working with immigrant families. Recently, our dental program was invited to the multicultural society in Prince George to meet with several new refugee families from Syria. A co-worker and I did basic teaching around oral health, screening and referral for obvious dental needs, and did fluoride applications for children under 6 years. The children and I got a great laugh as I attempted to pronounce their names. They had no problem with my name! All in all, it was a great privilege to meet these families and to be a small part of not only helping them on the road to achieve better dental health, but also to show compassion and friendship as they face many new challenges in adjusting to their new life in Canada.

Louise:

When I think of a success story in my time as a Certified Dental Assistant, I remember the first time I went out to see families in a remote community. I was screening children and doing fluoride varnish with the parents present. One mom had several children at the Health Unit. She brought her 18 month old last. We did a “knee-to-knee” dental exam and “lift-the-lip.” As we looked at this child’s teeth, I noticed the start of cavities. Not just white lines, but brown, stained upper anterior teeth with ditching in them. Further investigation revealed that the mom was breastfeeding ad lib, wasn’t brushing for the child, and that the family had cavities themselves.

I encouraged brushing at least 2-3 times a day with fluoride toothpaste and showed how to brush. I also discussed decay-causing acids from the frequency of sugary drinks, such as juice, pop, or even milk. Breast milk was the best option for her child so I encouraged continuing on, but really stressed the importance of brushing with fluoride toothpaste, having fluoride varnish done, and taking her child to the dentist. I said if we did these things, her child may not have to have work done in the hospital within the next year or two, and we could keep those cavities “at bay” until the child was able to sit in the dental chair to have the work done.

The next time I spoke with mom, she had taken him to the dentist and was brushing lots with fluoride toothpaste. The dentist had scooped out some decay and burnished the fluoride varnish into the cavitation. The fluoride varnish was done routinely (about every 2-3 months) and the teeth strengthened. We built a relationship of trust through these fluoride varnish appointments. Her child had some dental work done while sitting in the chair at 5 years of age. The upper anterior teeth weren’t involved; it was the back molars that had fillings done. There was no hospital work done and fewer cavities/fillings. Overall, we saw much better outcomes. We still have a trusting relationship when I see her and her family in the community. Now, her children are having children: the next generation. Hopefully there will be more great changes in their dental health and overall health!

Thank you card

Thank you card received by a Certified Dental Assistant.

Dianne:

This is a very special card to me. The inside note says, “You have been an amazing ‘Tooth Fairy’ for us!”

This was given to me by a very grateful young mother. This mom’s 2.5 year old was in urgent need of dental treatment. When they came to me, he had already been on antibiotics and was not sleeping or eating very much. Mom was very worried and did not know where to start to help her son.

Because of some special circumstances, this mom had spent over two years trying to figure out the paperwork to get dental coverage for her son. She had even started some personal fundraising for dental care, but even these funds had to be redirected to a family emergency.

I got involved and supported the many levels of communication required in this case. There was communication to coordinate with a dental office (which took the case knowing that they may not be paid), local government staff for travel arrangements, local and regional administrators, doctors’ offices, Save a Smile program, dental therapist, and a local church.

Ultimately, people worked together and this child received full treatment within one month of their visit with me! The family was not able to pay the dental office in full at the time but the mom is still committed to sending this office extra money as she is able to. Mom is so thankful that her child sleeps and eats well and can run and play as a child should. I see him regularly for fluoride varnish; he is doing very well and will start kindergarten in the fall. He and others like him are why I love my job!

Kim:

After I graduated as a Certified Dental Assistant and started working, I quickly realized that chair-side assisting wasn’t for me. I wasn’t proud of the work I was doing or the setting I worked in. I job-hopped for a while gaining experience and looking for something that would satisfy my mind. The job-hopping stopped when I was hired as a Public Health Certified Dental Assistant!

Public health has given me the opportunity to use my life skills and personal abilities in my daily work in a way that I wasn’t able to in an office setting. I’ve also had a lot of personal growth in this career. It has come to me through different work experiences such as teaching clients, presenting to groups, coaching clients through oral hygiene changes, learning about statistics and cultures, gaining computer skills, and the freedom to use my creativity to reach people when the “usual” way doesn’t work.

My career as a Public Health Certified Dental Assistant has contributed to me being a well-rounded person with the confidence to tackle whatever is in front of me.

Shirley Gray-Kealey

About Shirley Gray-Kealey

Shirley is the Team Lead for Dental Programs at Northern Health. She moved to Terrace for a two year position as a Dental Hygienist and has stayed for 27 years! She feels it's a privilege to live and work in the North. She loved teaching children and has been mistaken for the tooth fairy! She is not magic like the tooth fairy, but she is proud to lead a real team of preventive dental specialists in the North who work hard to ensure children keep their teeth healthy for a lifetime.

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