The Journey Begins.

“Come forth into the light of things, let nature be your teacher”.

William Wordsworth

“Does a holistic approach to dental hygiene practice, required as part of my professional standards, align with an environmental, nutritional, and ecological approach to dental health? An authentic, first-person, reflective narrative account into personal new knowledge creation and practical application.”

“Natural ecosystems regulate themselves through diversity”. The biggest little farm, 2018

Introduction

“A holistic approach is all-inclusive; it requires you to give consideration to the patient’s overall health, their psychological and social situation, their oral health needs (immediate and long term), and their desired outcomes. Provide patients with oral health advice and treatment options relevant to their situation, and discuss associated benefits, likely outcomes, and potential risks. Carefully balance the patient’s oral health needs with the patient’s wishes and be able to explain your approach to care, which could include declining to treat. Restrict your treatment to the activities permitted by your registered scope of practice. Refer patients who present with issues beyond your area of practice or competence.

https://www.dcnz.org.nz/assets/Uploads/Practice-standards/Standards-Framework-for-oral-health-practitioners.pdf

This begins a detailed narrative account of first-person, active learning discovery, seeking where necessary alternative and sometimes unorthodox routes to solving unanswered questions within one’s professional life. It is also an empirical journey, combined with traditional sources of research, putting the walk into the talk, using the experience of new knowledge gain, utilising the insight and awareness of it, to add deeper texture, relevance, and meaning into personal practice. There are unique moments and profound occasions that require such answers and begin your inquiry. This, unwittingly, came knocking on my surgery door in 2017 to hasten this journey. I was working as a self-employed dental hygienist in general practice in Marlborough, New Zealand. A client, younger than myself, with a serious pre-existing health condition, had made a monumental effort to improve their oral health, under my care. They patiently waited for a heart to become available for transplant. The day I saw them for the final review, praise was lavished at vast improvements and very evident clinical stability. This should have been the green light to anticipated surgery but was, alas, the last day of their life on earth. It wasn’t enough despite my client’s earnest efforts to prevent a massive heart attack and its fatal consequence. Around the same time, I attended a progressive dental health event in Switzerland. Moments of clarity amongst the events of that international occasion brought greater resonance to a growing sense of unease within the professional me, my wedded ideology, and beliefs. I was drawn away from the threads of the mainstream conference agenda to smaller, just as well attended, but more abstractive presentations that covered holistic and nutritional subject matter. They were freed from the constraints of convention, and were to me, a breath of fresh air.

My locus of intent was switching from reductivism of just teeth and gums to looking at the mouth as a whole, becoming more investigative into the broader context of health-related benefits to improved oral hygiene. I started to read books by journalists and influencers in food science, Michael Pollen, Gary Taubes, and Nina Teicholz. I also began listening to podcasts by endocrinologist Dr. Robert Lustig, paediatrician Dr. Robert Ludwig, and complex problem-solving engineer Ivor Cummings debating systemic health, lifestyle behaviours, and watched heart health related documentaries by the likes of Azeem Malhotra, a cardiologist. The ventures into these works drew my attention to profession contention, the gated establishment of food and health politics versus the alternate and burgeoning intelligentsia who challenge the contemporary landscape. They believe that the modern food environment and culture require change for broad health, general wellbeing, and economics. They have been profoundly influential, and the push back has been rapid from pharmaceutical, food, and related industries and interests. South African nutritionist and author Dr. Tim Noakes, and Australian senior orthopaedic surgeon Dr. Gary Fettke, have been the subjects of recent high-profile lawsuits. These being brought to bear by their regulatory bodies over contentious claims they have made defying the established thinking.

“It is not the strongest of the species that survives, nor the most intelligent, but the one that responds to change”. Charles Darwin

My headspace has been a flurry of comparative conflict with my established ideology. It has been born of over more than two decades of traditional professional development and a reckoning with my past learning approach. Over the proceeding months, many a long dog walk had me listening to the challenges these individual voices were making to the greater online audience, and the tone and texture of their message began to make more sense to me by the day. I designed an academic presentation, delivering it in a local and national venue, with a colleague, to a paying professional audience. I found “walking the walk rather than talking the talk “profoundly influencing, although scary at times. Upon these experiences and knowledge, I realized that other people, many amongst my clients, follow a similar path. How would I make the next developmental  journey, what would it look like, could it be more experiential and meaningful?

The plan was drawn up on paper, on the dining table, over a few days. The journey would begin in the UK, onward to France and into Scotland, to the States and back home to New Zealand, learning, feeling, experiencing, reflecting, and enjoying along the way. I thought I had a clear picture of what would be gained and set out on the scroll of cello-taped paper. People contacted, meetings arranged, and all the panoply of its facilitation organised, times and places plotted, and transport booked to set the project in motion. What was not, at that point, thought out was what would be the outcome of it. I knew that, as many students in the art of warfare acknowledge, is that planning, in reality, doesn’t survive contact with the enemy. I was prepared for it and welcomed it. Tangential flexibility would prove to be the best armour and protection against a rigid and fundamental ideological foe.

Upon my return to New Zealand in the early spring of the southern hemisphere were harbingers of change, a new home, location, and workplace environment. We started the journey in full knowledge of this, but the reality of the situation saw me embarking on another explorative journey. It leans heavily on the symmetry between past practice, recent experiences, and my new professional environment. It also looked at distinct healthcare subject matters like alcohol, fluoride, cannabis, nutrition, and the much-maligned historical figure of Weston A. Price, as well as the evolving and testing my ecological, nutritional and environmental co-existence hypothesis. What follows are accounts of both of these journeys in the context of authentic learning, and dramatic world events, founded within my established principles of empiricism and observation, linked to evidence guided practice.

The full account is designed loosely around the learning and developmental model of action research. The term action research was coined by social psychologist Kurt Lewin in the United States around 1944,  aimed to promote social action through the democratic decision making and active participation of practitioners in the research process. The project sheds light upon action research throughout the narrative, and I will leave it there for the reader to discover and understand it more thoroughly. I have also decided to use a first-person, narrative style of writing, mainly because it reveals the unique nature of the project and the character of the individual participating. The sources and references reflect the mood and headspace I’m in at the time and the decisions made to demonstrate the association between research and action in a way that appears less formal but allows the reader to refer to them directly online if desired.

The main body is really divided into two parts.  One the physical and secondly, the academic learning journeys. The first part demonstrates learning on the hoof, so to speak, being influenced and motivated by real-time experiences and appetite, sometimes literally, to describe those events as they occur, when and where they happen. The second part of the story reveals an evolving workplace journey, adapting knowledge through an action research context developing into personal clinical behaviour change.  It will culminate in a final piece of work, drawing upon them in the context of action research, but using my own style of referencing.

Finally, the work’s body will be an extensive edit from where the research was deposited during its construction. This was derived from two blog sites, posted to them, designed as a portal for the professional and general public to read and review, but also as a repository for them to be used at a future date. The context of each individual post can be referred to and seen in its unfettered form, with photos and pictures included in the initial post and a rawer, less refined written account.

Mark is a registered dental hygienist with over thirty years of varied clinical and learning experience. His practice began in the military, where he witnessed the fall of the Berlin Wall in 1989 and received a royal commendation for his community learning support to service schools. Mark continued his journey in the Highlands of Scotland, the warmth of the Mediterranean, working again in community learning, and an oral maxilla facial department. He also saw clinical service in the turbulent environment of post-communist Moscow as a member of a diplomatic dental team for several years. After his military service, Mark moved onto private, NHS, specialist practice, and affiliations to the trade industry as a key opinion leader and influencer in both the UK and New Zealand. Mark has further highlighted his endless curiosity to engage in learning presently by creating websites and blogs that share his thoughts, demonstrate new knowledge creation processes, and continues to do so today. He is also an active mentor for O’Hehir University, an online tertiary learning hub for postgraduate dental health professionals.

“Nothing has such power to broaden the mind as the ability to investigate systematically and truly all that comes under thy observation in life”. Marcus Aurelius

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