Whole Dental Health
My Ongoing First Person Living Publication Reflecting Both Personal and Professional Developmental Changes in the Life of a Client Centred Dental Hygienist
Mark’s Professional Developmental Planning and Reflection
There is only one way to get good at anything. You surround yourself with the bad motherfuckers who are doing exactly what you do and force yourself to keep up and inspire each other. Joe Rogan
Today is Waitangi Day, a national Public Holiday here in New Zealand. On the main road through Canterbury a 17 kilometre convoy of protestors, some may call them dissidents, head north, similar processions are occuring around the country as I write. They are supported by many as they pass under bridges, this is, it appears, is in support of the “Canadian Trucker” convoy many miles and an ocean away. It is also a protest against the current COVID management policies of the government in New Zealand. Life here in New Zealand appears to lag behind the progress of the countries COVID 19 deeply affected nearly two years ago. When I say “progress” I mean the current approach they are charting now rather than the success ( or apparent lack of it ) in reducing its initial impact back then. Ironically it seems that New Zealand is now doing the inverse of that. The clarion call of Ardern, the Prime Minister of New Zealand, is still one of the creeping frequencies of vaccines, predominantly of the Pfizer variety, to which this country appears dominated by and wedded too. The mandated vaccinations policies for the healthcare sector have seen some medical and dental professionals leave or be made redundant for not abiding with these authoritarian policies. Much of the population, I believe, are unwilling participants, unable to be as uncompliant for a variety of reasons, mainly financial, I suspect, including me presently. HOWEVER, what I can do is vote with my feet and get out of Dodge to coin a phrase. Since my last post, whilst reflecting on the present professional journey I am undertaking, it has become clear to me that this is the right thing to do through the experiences of the last two years. I will focus on the record in this essay, the reasons for this decision to depart. New Zealanders are obsessed with “stuff” and their properties. The acquisition of wealth runs deep here. There is innate racism, which I’ve experienced personally on occasion and bigotry that divides this country. “Woke” justice warriors and petty post-modernism are as endemic as Omicron will soon need to be.
If the freedom of speech is taken away then dumb and silent we may be led, like sheep to the slaughter. George Washington.
Despite this, I’d like to look at what I think I have achieved since my return to New Zealand in September 2019, a few months before the official arrival of the pandemic to these shores. The messages I gleamed for that odyssey was of tangential and specific relevance. Mycology and mushroom cultivation were fruit-bearing destinations. Travelling into territories around apiculture, community gardening, and therapeutic uses of CBD and THC were also productive. These connections were researched, tested, evaluated, reflected upon, and applied into my personal and, in part, practice life. They still belong there. Some of these explorative journeys are still ongoing, being tested, new knowledge and understanding attained. The purpose of wholedentalhealth.com was to highlight these.
One of the most fascinating lessons I’ve absorbed about life is that the struggle is good. Joe Rogan
In a nutshell, how have I changed in these sub three years professionally? Firstly, due to my ageing frame, I am a little slower in my process, with the idea of beginning slightly later and finishing earlier being utilised. This ultimately means I work for four and half days a week, but I hope to make myself more productive. The thirty-minute standard appointment of the UK has only a partial, personally directed presence. Forty-five minutes is the standard. I wonder if it will remain in the UK? Perhaps this will be the norm with post patient fallow time ? I am now far more client-centric, meaning being interested in the whole person, their concerns, expectations and hopes regarding their present oral health status and where they want the appointment(s) to take them. This robust process sets the scene and theme(s) of the moment(s). It reveals how their previous experiences have altered their perception of what to expect. Pain and discomfort are the obvious primary concerns. Reassurance is critical, adapting treatment techniques essential. Most of my clients have a left-field attitude to the dental mainstream narrative. It manifests in the contentious fluoride debate, greater knowledge of their health and well-being, be it breathing, nutrition or cleaning aids and methods. They also bear witness to the growing understanding of self-directed citizen scientist research. The best appointments appear to have more meaningful discourse and the physically ( not chemically ) managed healthy mouth.
The population is made up of four types of people. A small number hunt witches. A large number go along with the hunt. A large number are silent. A tiny number oppose it. The final group, as if by magic, become witches. Bret Weinstein
The main thread of discussion is always about the mouth’s environment, its constituent parts, the hard and soft structures, the ecology that thrives or struggles within it, and the pressures exerted upon it, both positive and negative. Adaptation is the centrepiece of knowledge creation for the motivated client to listen. Some aren’t, which is fair enough. I always take the simple route to evolve the environment into enhanced oral health. Sustaining it follows, with the theme always being a trilogy of care and support. Being from diverse supportive or benign bacterial flora influences the mouth ECOLOGICALLY. Whatever works, the CLIENT plays a crucial role in ENVIRONMENTAL protection. Their breathing, dietary and hygiene behaviours are the key to switching off unnecessary IMMUNOLOGICAL responses, inflammation and pathology. Seeing things in a more whole ( naturally mediated ) perspective and less industrial ( mouthwashes and rinses ) interventions aligns totally with my ecological approach to practice. When I compare how I operate clinically, I am surprised that others see this as fringe, left field even, in nature ( ironically ). This I celebrate, as I see it in my empirical research and observational experiences with mycology and apiculture. Again, the irony is not lost here. I feel we have lost a deep and essential connection, naturally reflected intraorally, something very explicit, intimate even, and connected to us.
The keeping of bees is like the direction of sunlight. Thoreau
The beekeeping sojourn is already documented in this publication, but here are a few thoughts resulting from that ongoing process. The apiculturist is at the tender mercies of the weather, the seasons and the bees themselves. The health and well-being of the colonies they tend is paramount. There are many different approaches to this form of husbandry, some based on past historical practice, organic or a contemporary modern process. Our training and initial experiences touched on all canons. Rather like my primary training in dentistry, both as a dental assistant and hygienist, were a mere taster on what you expected would be a baptism of fire after qualification. Beekeeping is similar to that: the sting’s fear soon goes and mistakes and lessons learned until the next one comes into view. It is a constant learning journey. The comparisons between the hive and the mouth are uncanny. A culture, an environment, an evolving real-time theatre of activity, balance, imbalance, interactions and behaviours that determine them. The beekeeper plays a quasi omnipotent role in all these proceedings, always a step behind the action, occasionally interceding to help out to productivity or health of the bee collective.
You can be technically free but not really free. If you’re concerned about being wiped out by a healthcare crisis ( so you are not free to move freely through the world ) or you’re concerned that you may lose your job, you’re not really free. Real liberty, realized liberty, is liberty you can act on. Bret Weinstein
The mycological angle is still about the seasons, the weather and the specific sites where they spread the mycelial tendrils. Knowledge born of my experience gained plays the critical cornerstone of the “gentle hunt”. Awareness of certain trees and the association between them and the vast, intricate fungal root systems beneath our very feet. The lack of knowledge brings about prejudice to the fruiting bodies, some of it well earned. Fear is a powerful force, only research, detailed research, and a degree of courage will win the day and fill your belly with delicious notes and powerful nutritional benefits. I found the French at one with this dynamic. The chemists were all able to identify edible, sickening or fatal varietals. In its smaller microcosm, the mouth relies on diversity and balance to bear fruit. Yeast and fungi are part of the oral microbiome, vital to ensure and promote a balance favouring health. When out of balance, they play a different game that negatively affects the habitat in which they dwell. Mushrooms will always be a passion for me, like bees, and the ongoing quest for knowledge and experiences will always amaze, surprise, delight and confound me til my dying day.
Gardeners, scholars say, are the first sign of commitment to a community. Anne Rover
Community gardening has a personal history stretching back to the early noughties when the last exodus from New Zealand, post-family trauma, saw us needing to grow our own food. This is documented in a separate publication at http://www.offtheplot.wordpress.com. The journey to Boulder, Colorado and Portland, Oregon, provided the contrast between a community-supported agricultural model, where the growers interact with the general public to get an audience for their produce. The strong bond of the community link provides a powerful message to the “big food” industry. These bold, environmentally driven farmers believe in their organic and sustainable approach and positively welcome public engagement as a source of income and, moreover, aligns with their values, principles and purpose. The Portland city farm incorporated the organic and sustainable model with alternative health and well-being improvement therapies, led by complementary and alternative thinking professionals in those disciplines. Both are inextricably mindful of the mantra that food is medicine. Both promote their practices to the public for scrutiny and engagement.
I do smoke, but I don’t go through all this trouble just because I want to make my drug of choice legal. It’s about personal freedom. We should have the right in this country to do what we want. If we don’t hurt anybody. Bob Marley
THC, or Tetrahydrocannabinol, and CBD, or Cannabidiol, are by far a more contentious subject matter than shrooms or honey. In this respect, I will be honest and tread wisely, I hope, around this touchy subject. To say I enjoy these naturally occurring chemical substances isn’t strictly correct. I have been, until now, extremely cautious of them. What changed my mind was listening to Sam Harris, Michael Pollen, Paul Stamets and Joe Rogan. All are learned proponents of this contentious product’s medicinal and recreational applications. Chronic pain and poor sleep hygiene have dogged my life and partner Toni more so. A past journey to Oregon and Washington State where it is legal and for sale over the counter in a well-controlled and regulated environment set the scene for more reseacrh in the therapeutic context. Indeed, our good friend Dan, from the USA, was allowed by prescription from a doctor to grow his own, being allowed a certain amount to not make it a nefarious business on the side. This was a prescription born of trauma and well-being issues resulting from military combat in the Gulf and Afghanistan. In certain more liberal States, the Americans had a whole approach to treating their veterans who suffer from post-traumatic disorders with a menu of choice. With the troubles that prevail regarding drug abuse and overuse, this appears to be a step forward as an alternative therapeutic, more natural drug of choice.
Upon my return to New Zealand, I found the experience compelling and was encouraged to see the incumbent government encourage the populous to vote in a referendum on this matter. I hoped that positive engagement would be substantial, considering the amount of cannabis grown illegally here. Its widespread use, perceived criminality, endless petty prosecutions and pursuit of those supplying or using it is a dividing subject. If it were to be legalised, in the context of the Canadian or US State model, it may more than likely bring a reduction in the policing of a plant, profit gained from its production and supply, with quality overcoming the dangerous synthetic varietals causing concern.
Your beliefs become your thoughts, your thoughts become your words, your words become your actions, your actions become your habits, your habits become your values, your values become your destiny. Ghandi
Step in politicians, the church and the medical establishment to divert the attention from its legalised benefits to scare the population into seeking assisted suicide above chronic pain relief and sleep support after the vote was counted. This country and its lame-ass politicians never cease to surprise me, even today with COVID. When it comes to mandating a population for experimental vaccines with little or no long term research in efficacy or potential side effects, the opportunity to ease the housing crisis with a capital gains tax that generates income for social housing, taking the homeless off the streets and helping those in pain beyond “pill-popping” convention medicine, they, in my humble opinion, have failed miserably.
Quin Dental was founded on the philosophy of providing the very best natural dental care for the whole family. We believe in preventative care with a minimal intervention approach. We call this our “natural care philosophy”. Gerry Quin, Nelson.
Working in a mixed general and orthodontic/orthotropic practice has seen the last part of the clinical jigsaw puzzle found and correctly placed into the cannon of my professional life. I’m glad I found it. Being a Dental Hygienist in the workplace environment has allowed me, with the grace of my clinical lead and amazing colleagues, the scope and breadth to explore a more accurate, more personal evolution in my approach to dental health promotion and disease prevention. The research undertaken in wholedentalhealth.com adventure enhanced working at Quin Dental and my clinical collaborators and exemplars. Their professional, cultural and social ideologies have resonated with me, and I feel I am a better individual, team player, clinician and person for it.
The greatness of community is most accurately measured by the compassionate action of its members. Coretta Scott King
What I have found hard to assimilate of late is the draconian vaccination mandating dentistry with coercion, intimidation and what I believe to be a one size fits all policy. I am not anti-vax, far from it. I am pro-choice and pro personal responsibility. It has to be said that when one has a co-morbidity or more, chronic health conditions that align with increased risk or of a certain age even, that “tough” governmental love needs to be applied, with a degree of choice, to those. Many, I am sure, would be willing to oblige and seek protection, albeit to what extent I would be able to comment further. Individuals must be accountable for their actions and choices, this is the point of our forefathers and mothers struggle to improve their and the future quality of life for their progeny. In this regard, I am flabbergasted by the lack of personal responsibility advocated by those in power. Why are they not listening to more progressively-minded health experts regarding well-being, exercise, decent nutrition, supplementation where appropriate, reducing co-morbidity risk, and encouraging or endorsing behaviours that promote a less enhanced response to COVID infection? The one size ( or jab ) fits all policy cannot apply now. What are the costs, both financially and socially, of this?
I am appalled how ill-prepared we were for this, but more so that moderate and deeply concerned experts in medical and biological sciences, well-intentioned, advocating for alternative approaches, have been cancelled into silence as a consequence. Are we, who live in a free society, too damn lazy to understand alternative perspectives and knowledge? Are we confident that those wielding the vaccines at and into us know of their actual long term outcomes and efficacy? It appears that as the next vaccine boosters are delivered with three-month intervals, what next? I am highly suspicious now that a recipe based upon the initial Wuhan strain hasn’t evolved as quickly as nature. We appear to be behind the curve, which seems now to be running away from us. Choice and innovative new vaccines must now follow, especially those deemed at risk.
I am returning, consequently, to the UK in June. The decision is made, and I regret nothing. I will hold dear those experiences and memories, the people I value and their part in my improvement and growth. All that is to do now is to register, which is underway, gain what I can from the last four months here and depart amicably. New Zealand isn’t all bad, far from it, but I feel it has a hollow centre. The beating heart that once resounded is weaker than ever as those who plunder its reputation of fairness and equality for profit, and personal gain continue regardless of the long term cost. A so-called Labour government continue to reside over the out-of-control housing and rental costs, so poorly planned affordable housing. They continue to instigate further social engineering to divide this country on racial lines and expect its population to disregard their freedom of personal agency for want of a decently funded and prepared health system. Its phoney leadership found its muse with the “team of 5 million” and “kindness” slogans, but they are nowhere to be seen now. Their grim determination to see through their plans to continue with the vaccine at all costs and exclude those who don’t comply is a place I will not tread any further.
If you want others to be happy practice compassion, if you want to be happy practice compassion. Dalai Lama
As a modern civilised society, we need to know we can trust those who command our obedience. Where I am going to, it appears, has learned hard-won lessons, but in Australia, Canada, and New Zealand, these are yet to be heeded. Maybe the relative hardship of Britain’s COVID experiences has taught its majority leadership not to go where the new world is now treading carelessly. That’s where I will be, live, grow old, and prosper.
Ultimately, well-intended and meaningful words frame this project’s journey. They are hard-won and easily lost. The most precious gem is freedom. Freedom combined with expression of one’s personal truth and values, whatever that may be and finally, community, the emotional and/or physical structure where you find and give support to those in your tribe is epitomised within wholedentalhealth.com. Where are the ripe, brightly lit uplands of my learning future? It belongs where those crazy words abide. I want to continue freely expressing my opinions and thoughts that link my professional learning to my personal values. I desire community, the home of those who seek similar truths and have experiences to share. This I will pursue in the UK, and in particular, born of an uncanny expectation of a need to understand the benefits of nasal breathing and the importance of tongue tone and behaviour in those who mouth breath and need arch expansion to correct an orthodontic malalignment. I am toying with the idea of video blogging, a future project that combines all my interests, both personal and professional. Not just in words, capturing the essence of a subject is hard for me, but visually which will add a new dimension, appealing to my inner creative and curious self. This will be how I promote my professional value system in the form of an unconventional but unique efolio, expressed in words in a resume and cover letter to prospective employers. The future is whole, whole dental health.
Success is completion. Success is being able to complete what we set out to do. Each individual action, each specific step, each desired experience whether a big project or a very small errand. Susan Collins
A New Hope? Re-Registration for Dental Professionals in New Zealand. A Whole Dental Health Perspective, Appraisal and Reflection.
“A competent Dental Hygienist understands current biological, physical, cultural, social, and psychological factors involved in dental and oral disease, and in attaining and maintaining oral health”. NZDC, Scope of Practice for Dental Hygienists
Dental Hygienists are called, under a set of professional guiding standards, by the New Zealand Dental Council (NZDC) in their daily clinical and professional practice approach. They include putting our patients’ interests first, ensuring safe practice, communicating effectively, providing good care and maintaining public trust and confidence in the dental profession.
The NZDC also provides a legal Scope of Practice (SOP) document for Dental Hygienists in New Zealand, that compliments the Standards by guiding the practitioner to the boundaries of clinical activities pertinent to their specific qualifications. This demonstrates what is determined as “Best Practice” by understanding current scientific knowledge and skills, attitudes, communication, judgement, and demonstrate a commitment to real health promotion.
“Enable patients to maintain and enhance their individual well-being by increasing their awareness and understanding of “health matters”. NZDC Standards Framework Document section 22.
The Dental Hygienist has a legal commitment to follow the NZDC’s continuing professional development (CPD) 2-year recertification cycle presently by being able to demonstrate compliance through a portfolio of evidence if required. The Framework Document and Scope of Practice aligns the clinician with what is deemed necessary to do to achieve future recertification, as well as, of course, paying a practice certificate fee. The cost of that to a New Zealand Dental Hygienist is not unsubstantial, in fact far cheaper than that of a UK Hygienist, and very near to want a practising general Dentist has to pay. 1.
The recertification process has recently come under scrutiny by the NZDC. In February of this year, a summary of the critical features of a final design for their new recertification programme was published and disseminated to the registered body. It has been the subject of focus group attention for several weeks before the approval of its principles. We await the final draft details, but in the meantime, we can posset its incarnation and comparison with the same outcomes that Dental Professionals adopted in the UK in 2018. I find it interesting that the NZDC derives their inspiration for such change from the UK and Europe, once again. Interestingly though it appears they have done things a little differently and, it seems to me, slightly better. Perhaps this alludes to the historical and cultural differences between practice cultures in New Zealand and the UK, as well as the size of the professional populations of both countries.
“Will attending the course change the way you think, or carry out your role in your practice?” Postgraduate Medical and Dental Education for Wales, UK
The key features of the new design include the creation of a Professional Dental Plan (PDP), Professional Dental Activities (PDA’s) replacing the present learning title of CPD, annual online self-declaration to the effect of completion or attendance, a Professional Peer Relationship (PPR) and written reflective practice. These are radical departures from what is presently the norm, and they will come into effect, it is reported, from the 1st April 2021. All the above components are found at the General Dental Council (GDC) of the UK with minor nuanced changes from 2018. 2.
The roots of changes in the UK stem from the need to identify and develop personal, professional skills, in line with your present skill set and workplace environment. The PDP allows you to track and achieve those goals. A degree of flexibility and review of your learning journey is set into the PDP criteria. It is further boosted by the critical and supportive input of a skilled and qualified mentor, in the UK case and, here in New Zealand, a Professional Peer (PP). The PP “must be able to provide knowledge and credible feedback relevant to the practitioners’ professional development”. The New Zealand method is more personal, it can be one on one, via teleconferences or by email. The responsibility of the clinician/professional peer relationship is further emphasised by official confirmation that. “Before a practitioner applies for an Annual Practising Certificate (APC) each year, the PP will need to provide confirmation online that the practitioner has interacted with them during the year, has a PDP, participated in PDA’s and has reflected in writing”. The PP can also assist in developing and reviewing PDP’s and assist in PDA developmental choices.
“Fail to plan, and you plan to fail”. Benjamin Franklin
Primarily though, it allows the clinician learner the ability, responsibility and accountability of self-directing their own knowledge creation. There are a variety of sources to effect meaningful learning. Traditionally we as a professional body have leaned heavily upon the local professional study groups and associated learning events. The annual professional body seminars, Dental Trade Industry (DTI) sponsored events and roadshows are traditionally well-trodden sources of knowledge. There is a cost element attached to belonging to associations and paying for events, mollified by the DTI to some extent, more so in recent years. This brings into focus the issue of PDA’s being overtly linked to commercial interest, in part, where the Industry is in direct contact and potentially influencing the decision making of professionals. Historically the DTI has been on the fringes of conferences and meetings but now appear to be more directly involved in providing CPD. This is effectively brought to the attention of the discerning clinician by Gillis and McNally (2010) who state “University-industry relationships are becoming increasingly common in academe. While these relationships facilitate curriculum relevance, they also expose students to external market forces”. They continue, “Industry’s presence in academe is a concern. Dental educators (and dental health professionals from 2021 – author’s note), as stewards of the profession, must be nimble in brokering Industry’s presence without compromising the integrity of both the educational program and the teaching industry as a whole”. It appears that the NZDC’s move to create a new recertification process has considered this as well. Allowing self-directed study, independent research and authentic learning negate this influence, in part. 3.
“Before you decide to attend a course or an educational event, you need to question the relevance to you of the subject being covered”. Postgraduate Medical and Dental Education for Wales, UK
Additionally, in what I feel is a further bold move, there will be “No mandatory requirement to meet a quota of PDA hours.” There will also be no requirement for PDA’s to be verifiable and will be linked to “Any activity relevant to maintaining and building a practitioners competence in their SOP. PDA activities need to be aligned with “Specific developmental outcomes”. Think about your workplace, your roles within in it, clinically or non-clinically, the nature of the practice and its clients. For example, I work in a general and modern orthodontic practice, I treat both disciplines from a dental hygiene perspective, the parents of the younger orthodontic cases tend to be very involved with their children’s care, they are included too. I work collaboratively with orthodontic auxiliaries, dental assistants, dentists and reception and office staff and managers too, as a team. Planning meaningful and practical PDA may see learning in non-dental related subjects such as leadership, communication or team building.
Writing a PDP begins with an honest appraisal of where you are now professionally, your workspace, where you feel you need to go by identifying your specific career goals and learning needs to ultimately accomplish them. Consider your timeline, the NZDC are preparing a move from it being 2 to 3 years, whereas the GDC, UK have structured 5 into theirs. I’m not sure how I feel about this, the longer would be preferable as learning can be more open-ended and reviewing your PDP might lead to more changes as a consequence, as well as workplace changes leading to modifying learning goals. A 3-year cycle might be justified initially as trialling the new regime, but alterations to future timelines might require adjustment from feedback and experience. The templates for PDPs will be necessary too, created individually or by supportive professionally bodies or the DTI.
“You may wish to reflect after every activity, or at intervals during the year, reflect with your employer, or a peer or mentor”. Postgraduate Medical and Dental Education for Wales, UK
Reflection may be the most significant educational challenge that Dental Professionals face as part of this educational development change process. I had the opportunity to be exposed to reflection during a degree programme at the University of Kent several years ago. Initially, the process was very confusing, understanding the methodology, learning to write and express the sentiment of something you do mentally, every day in many clinical and ordinary experiences. Consider cooking a new recipe, you taste it and realise it may need seasoning or more of something and less of the other to enhance it, the next time you repeat it you alter your process again. This reflective critical self-appraisal doesn’t have to be a novel or a work of literal art but just an honest and revealing attempt to describe a situation in your professional environmental. We need to demonstrate learning that has occurred, what we alluded from it, or not, what would we do differently as a consequence of it. Eventually, it leads onto planning improved practise, and what future developmental directions do you think you need to go.
“Self-reflection is a humbling process. It’s essential to find out why you think, say, and do certain things – then better yourself”. Sonya Teclai
I can remember re-registering with the NZDC in 2013, returning to New Zealand from the UK with a portfolio of evidence of learning, with a PDP, PDA log and reflections linked to education. I was advised that at that time that there were gaps in my portfolio, and I needed to catch up with CPD hours to comply. I was horrified to think that what I had learned from a UK university while doing a dental education degree wasn’t deemed enough. Ironically now, it seems that the NZDC is adopting those things I presented way back then. I will fall back on what I originally learned and prepare a PDP, construct PDA’s and continue to reflect upon my processes. I will find a PP and form a relationship which will help me evolve my practice further. Also, as part 2 of this piece, I will delve further into self-directed learning methods that can help the independently minded critical thinker/learner/researcher to move forward in this COVID19, post COVID19 clinical environment “Brave New World”.
Sources
Annual renewal and fees, GDC, UK.
https://www.gdc-uk.org/registration/annual-renewal-and-fees
Enhanced CPD guidance, GDC, UK. https://www.gdc-uk.org/docs/default-source/enhanced-cpd-scheme-2018/enhanced-cpd-guidance-for-professionals.pdf?sfvrsn=edbe677f_4
Gillis, MR & McNally ME (2010). The influence of Industry on dental education. https://www.ncbi.nlm.nih.gov/pubmed/20930240
A Personal and Professional Reflective Journey into an unknown and uncertain future. Whole Dental Health, A Brave New World.
Reflection will soon become a requirement of recertification as a Dental Hygienist in New Zealand. I’m not sure how many within the profession have written reflectively but what you find below is a quick example of reflective practice about my recent and ongoing experiences regarding the COVID 19 pandemic as a Dental Hygienist. It is both personal and professional, it could be written in a variety of ways, using different approaches of reflection from Kolb, Gibbs or Schon as examples but I’ve decided to use a What, So What, Now What pathway for its ease of use. For more information and examples, please use the referenced links at the end of the piece. Good luck and remember how beneficial it is they think about what you’ve experienced, how it has affected you and the changes you may consider making as a consequence of them.
“Necessity is the mother of all invention”. Old Proverb
Just three months ago I was looking forward to March, especially the 17th, when I was completing a six-month locum stint in practice in Blenheim, Marlborough. I had work organised in Nelson to replace what I was leaving behind and my professional life, for once, looked peachy. Little did I know that by that date, I had reappraised and adapted my clinical approach to dental hygiene treatment. At the same time, I was feeling underwhelmed by the lack of concern and fragility of fellow professionals being displayed in the clinical environment and in online professional chatline on social media. COVID 19 was a “Clear and present danger” to me and those I respected and cared for both personally and professionally. I had started giving it consideration by about mid-January when the news was slowly filtering from Wuhan via the media that a novel virus was causing lockdowns, infections and, the start of what was to be, many deaths being reported. The concerns of a rising epidemic becoming very real.
After listening to RNZ, I began to think about how I’d respond if it came to New Zealand. I could potentially be seeing asymptomatic, pre viral or even viral cases not far off in the distance. Ironically the first thing I did was to pick up a few masks and brought them home, we had a few boxes of gloves in the house from my Wife’s old locum midwifery practice. She had given me the “are you a conspiracy theorist” look initially but found a quiet place for them, just in case. My children and their respective partners had recently been to Europe on holiday, and all but 1 had experienced colds and fevers either during or on their return. I kept my distance from them and as the epidemic continued the realisation of it going pandemic grew. I started to consider how I was going to modify how I worked, my concerns being the safety of my clients and myself. About this time, a rush on not only toilet roll but hand sanitiser saw both items being panic bought and dental supply companies running out of stock rapidly overnight.
We had intended to have a practice meeting, scheduled on the 25th February, and I was going to present on a “Sustainable Approach to Dental Health”. This I withdrew from and advised the Practice Owner and Manager to consider the meeting’s topic changed to what might potentially happen over the next few days and weeks regarding COVID 19 and how protected and safe our clients and ourselves would be. It felt like we were transitioning to a weird kind of war footing (I had experienced this during Gulf War 1 in 1991) and felt some of our colleagues weren’t as aware of all the facts and even concerned as much as they should be. I’m glad we had the meeting as it began the process of mental adjustment for all and adapting to the threat of COVID. We placed information notices on doors, put out hand sanitisers for clients to use and took stock of the supplies we had and began to order more, especially hand gel, masks and gloves. The unknown became very real when on 28th February when” case of COVID 19 in New Zealand was announced.
One of my Wife’s friends is an Emergency Department Nurse who lives in Canada. Her Son, a young, healthy man in his early Thirties was one the first to die of COVID in his country. We heard this sad news about mid-March, Toni was devasted. She and I began to make the growing COVID risk more apparent to all our friends and family. Some found it too extreme, others were still unconcerned, but very soon the reality was setting in that things were not going to stay the same for much longer. The March Fest in Nelson, a Beer Festival, on the 14th, March was the last event I was to attend with my Sons for some time to come. New phrases like “Physical distancing” and “Flattening the curve” began to become accepted norms, similar as our forefathers call to action with phrases such as “Dig for Victory” and “Careless talk costs lives”. Regular visits to the shops to quietly stock up on food and groceries gathered a pace and our cupboards, once empty began to fill to support our “Bubble” isolation for the weeks to come.
The government initiated a COVID 19 strategy of “Going hard and fast” on protecting the population, stepping up testing and self-isolation for those returning to New Zealand after the 25th March. That week, a rapidly created Alert state had been implemented, we were at level 3 by the 23rd and total lockdown, Level 4, by the 25th, March. My routine and regular practice, something very familiar to me in various clinic guises for some 30 years, ceased that Monday and we held a final impromptu “socially distanced “practice meeting. The future and our careers seemed very uncertain, all of a sudden.
Way before the end of March, I started to reduce and then cease all my aerosol producing clinical activity, despite others continuing it. In particular, I hung up my ultrasonic and airflow systems and began making sure that I displayed to my clients super visual hand washing techniques as reassurance. However, I did continue to use slow handpieces continued, which do create a droplet field. My dilemma was genuine that clients were paying and expected to feel that their teeth were effectively cleaned. Aspiration was the best barrier to reducing its potential contamination. Cleaning down after treatment and set up processes for the next client were more deliberate and measured. I work without chairside support. This will need to change.
The New Zealand Dental Council with the Ministry of Health directed all unnecessary treatment cease from the 23rd, March as previously stated. They drew up unambiguous guidance on what is deemed an emergency and what is not. It was crushing to think that everything I did was effectively non-essential and that would remain true until we drop back to Level 2 from 4. The initial 4-week lockdown could be extended, if required, and no suggestion of when Level 2 is on the horizon as yet. However, the Prime Minister is now asking businesses to plan and consider how they restart or reset when that time approaches. What does this mean to me? I’m using the time to catch up on many things, educational I’m writing the blog, and this is fifth so far. I’ve a plan, set out last year and every excuse under the sun has held me back completing it. Not now. Additionally, and perhaps more importantly, I need to familiarise myself with all the recent updates and mentally preparing myself for an alternative, uncertain professional future.
I am also a little uncertain of this new clinical reality, one which will mean the wearing of Personal Protective Equipment beyond my previous norm in the course of routine dental hygiene treatment. One very visual video I saw on YouTube by the Auckland DHB demonstrated how to dress with PPE, hand sanitisation four times for one process of gown, gloves, masks and protective eyewear being put on and taken off. How many would our practice need and wherein these times of shortages of such items would we get them from? How much would they cost and would our clients accept the changes and additional fees is added to the treatment costs? These decisions I, fortunately, don’t have to make but how I approach my clinical practice, beyond the PPE debate, is evident to me.
PPE will need to be updated with visor and if required gowns. A few trial runs getting to know how to put it on, that’ll be interesting.
- Aerosol creation limited or ceased.
- Really good evaluation and assessment.
- Hand instrumentation, even for periodontal cases.
- Dental Assistant required for helping with aspiration, note-taking and infection control.
- More time will be required to undertake treatment.
So, as per NZDA guidance, all my cases will be categorised as Low-Risk Care, not positive for COVID 19 or any associated exhibiting symptoms, or in close contact with those who do. The international travel aspect will shortly not apply for sure, for some time. No aerosol-generating equipment, all appropriate PPE equipment required, including gowns and our routine surgery use.
I wonder how many of the profession think everything will return to normal rapidly? Some, like myself, may align to that notion only when vaccination is developed and tested, produced in the numbers required to globally distribute and facilitate it. Essential healthcare and general workers, those at risk, the immunocompromised and the elderly will undoubtedly and rightfully be first in the queue. This will take time, and until then I will subscribe to the immortal words of the great Clint Eastwood, “Improvise, Adapt and Overcome” because “Tomorrow is promised to no one”. However, the lingering thought is this, how much will it ultimately cost the profession, additionally the client and will they return in the numbers they used too?
Sources
1. Ministry of Health, Dental Council and Professional Associations’ joint statement: COVID-19 update*
https://www.dcnz.org.nz/resources-and-publications/updates/update-on-covid-19-novel-coronavirus/
2. What is a Critical Reflection? Introducing the “What, So What, Now What” Model – Use the Course environment as your workplace and learning environments
3. Reflecting on a Personal Experience Using the “What, So What, Now What” Model https://youtu.be/_mQ_zDUX9nE
4. Sample Reflection: Reflecting on a Course Activity
Developing my PDA’s and PDP in the light of future changes to recertification. Redesigning from 2019 to 2022. Whole Dental Health – A Brave New World.
From April 2021, to gain recertification as a Dental Hygienist, I am required to create a Professional Developmental Plan (PDP) that lays out my learning and developmental aims and goals for my regulatory board. The New Zealand Dental Council (NZDC) has changed the criteria for Dental Healthcare Professionals (DHP). This is in line with many other regulatory organisations to add depth and quality to continuing professional development (CPD), involve the learner in educational attainment work directed towards their workplace culture and environment. In addition to these, a Professional Peer (PP) will be required to act as a mentor, advocate and overseer of this process combined with a personal written reflective practice of Professional Development Activities (PDA). The method that is demonstrated in figure 1.
Fig 1. GDC UK reflective cycle for PDA’s
In this account, I wish to look back on the previous year, starting April 2019, as the beginning of the new cycle, as the initiation of my PDP. Then account for the learning undertake from then to the present and consider the current situation with COVID 19 disrupting clinical practice for non-essential care. This is also, paradoxically, an excellent opportunity to find where you presently are professionally and where you feel you want or need to go in planning your learning journey. Historically I had created a PDP and record on it my PDA when I was studying at The University of Kent several years ago. It is something I lost touch with coming to New Zealand in 2013 but having prior knowledge of it has led me back to my archives to dust off the means of recreating them.
When choosing goals, I look at the NZDC standards framework guidance, feedback from clients and colleagues, appraisals from employers and management. Give consideration to non-clinical aspects of practice too, leadership, communication, research and teaching skills may form ideas for learning objectives. Prioritise, if possible, your goals in order of importance or in a timeline (authors note). The various methods of achieving learning objectives include conferences be they regional, national or international, the setting whether online learning or workplace training or shadowing. You could also create your own learning journey, focused on your needs where they can’t be met more formally. Authentic learning and action research, similar to inquiry learning, can offer self-directed alternative approaches to new claims to knowledge and more meaningful first personal development in addition to convention education.
Fig 2. PDP log
My practice culture and status over the last year has changed, from a general dental practice setting to a mixed but mainly orthotropic – arch expansion – orthodontic setting with 3 orthodontic auxiliaries, 1 dentist, 3 Dental Assistants, a Manager and Receptionist. The COVID crisis has seen the practice shed a dentist and Dental Assistant. The move from Blenheim to Nelson has seen a role shift into a new dimension of dental hygiene with a greater onus on a strict regime of infection control, being less liberal than the previous practice by some margin. My learning goal became one of catching up.
I constructed a way to present it through a website portal. I used WordPress to create a website that could additionally support the goal-setting, evidence gathering and writing. Getting the right themes and menus has been a challenge, the intricacies of knowing how to create pages and posts, how to tag and edit, insert pictures and keep up with new ideas and technical difficulties has been rewarding and, at times, a little stressful. Potentially It could be a useful device for colleagues to adopt if so inclined as a simple way to demonstrate compliance, development and transparency. Below are two links, created by the same person on how to go about creating one.
How To Make a WordPress Website – For Beginners https://youtu.be/8AZ8GqW5iak
How To Make a WordPress Website – In 24 Easy Steps https://youtu.be/2cbvZf1jIJM
It was my intention to develop my role in my current practice by travelling to Melbourne to complete a course in Oral Myofacial Function so I could evolve my practice and create my clinical time. This was cancelled due to the COVID 19 crisis, and there appears to be little prospect of undertaking it in the foreseeable future and, in effect, it is on hold. I am presently considering how I move forward with my PDA goals and have come to the conclusion that writing about topics that interest me, that are linked to my workplace and the future recertification process can take precedence for now. My colleagues have advised me on CPD topics related to orthotropics and oral myofacial function. Still, I’ve decided to engage those when the current Alert state reduces, and I have the inevitable clinical white space at work. The opportunity to focus on professional writing has been scarce until now. Below are two links to those subjects which will be added to the PDP shortly with a duel reflection and discussion with my professional peer.
Growing Your Face by Dr Mike Mew
A Speech Therapist’s Approach to Myofunctional Therapy
During my first few months in Nelson, I began to realise, very quickly, that many of my clients were somewhat “alternative” and investigative in their approach to subjects like fluoride and nutrition. There was also a cohort of clients interested in environmental issues and sustainability. This made me consider my approach to that, as well. In comparison to Blenheim cliental, where I continued to work as a locum for two days of the week, this posed a paradoxical living challenge. The contrast between the two client bases was stark both in terms of their dental knowledge and expectations of the nature of my delivery of care which makes me reflect. One I was cosy with, having worked there for several years and the other new. I had to move deeper into researching and investigating their positions on it. I was curious and willing to listen, to understand without judgement and I was careful to recognise and affirm other people’s opinions, and offer tailored alternative advice or options, especially regarding topics like nutrition and fluoride.
Moving forward, we still await the proposed changes to recertification to be officially confirmed. The NZDC response to the COVID crisis has allowed the professional to breathe a sigh of relief regarding compliance with the strict verifiable CPD hours. This allows an opportunity for all to reflect on the PDA and future educational goals with the time created by the lockdown. This is precisely what I’m doing, I have a project, begun last year to complete, I can continue on the theme of changing practices and direction within the new one, displayed via a website online for the sake of transparency. It also demonstrates my learning journey for others to view and to comment on and promotes my passion for self-directed, appropriate and authentic learning as a juxta-position to the norm.
Reflection 9/11/20 A Learning Day In The Workplace
The day went very well. My presentation went off without a hitch and we all retired to the bar after to relax and reflect.
The day started at 08.30am and the whole team arrived in eager anticipation, a degree of anxiety and earnestness. We knew what to expect in terms of the activities of the day, we had been briefed. We did our 2 yearly CPR catch up, about 5 hour’s worth of theory and practical and I presented on protocols in my dental hygiene practice and an investigation into the oral health products we recommend and their application. I could tell there was a tad of tension in the air, there always is when you venture outside of your clinical comfort zone, ironically to learn about events that can happen inside of one’s clinical comfort zone. I think that this is the consequence of a fear, not of the need to learn, but due to the concern that you might have in making an error in front of your colleagues or failing an on the spot exam. I had also asked my team in an earlier meeting as to what they wanted to learn about my proposed presentation but had not had too much feedback so I kind of went into it blind. I hoped it would be interesting, engaging and a learning experience for everyone.
Preparing my presentation was a timely affair. It must have consumed about 30 hours of reading and writing, slide after slide created for power point and quite a few withdrawn because of time restrictions. However, at 10pm the evening before the day I completed it with animations and slide transitions and was satisfied that, without going through it into much detail before the event, I’d be fine. I had a minor concern regarding technical problems with linking it to the flat screen monitor in the conference room, a previous occasion had uncovered glitches and faults and it couldn’t be screened. Fortunately, I’d had the forethought to check it the week before. I was scheduled for the afternoon so I made the conscious effort to forget about it completely and focus on the main event, CPR.
The two instructors were professional emergency department nurses and had an incredible presence. They were both extremely proficient and gauged the mood precisely. The education was practical and visual, just my style, and for once, after all these years and previous CPR training had no concern or fear, like I had before. Maybe I was distracted by the thought of getting my afternoon session right but I really enjoyed the occasion and learnt some really relevant knowledge especially regarding anaphylaxis. We had a simulation in my chair about this exact same emergency. The irony was not lost on me as some of the oral hygiene products in the market place have the potential to create such as extreme physical reaction. It was also enlightening as it is important in my new hobby of bee keeping and the potential for bee stings to do the same. The need for adrenaline, in my case the need to draw up 0.5 mgs and the opportunity to give an additional dose 5 minutes after if required was new knowledge. I was also mindful of the 2:15 breaths to compression for children and 30: 2 for adults. The technology that helps us get a realistic physical sense of the breathing and compression rates has come a long way since my late teens when I began my professional journey.
The afternoon soon arrived and my turn came to add to the learning day. I had no technicals and the flow was good, I enjoy the moments when the subject can be discussed and was aware that there were some quiet voices in the room but moments arose to bring everyone into the debate. A particular subject, fluoride, demonstrated this perfectly. Some of the team aren’t aligned to the argument there is a problem with it whereas some were interested to question its relevance and validity. This is supported by previous feedback surveys we have undertaken at the practice that had determined that 75% of clients were opposed to it in the water supply and another 50% weren’t happy to use it in toothpaste. It seems to me we need to open to both camps and the many who site in varying positions between the two. Some even need to know the pros and cons with a balance and information to make a self-determined decision. What is important is that we know the noted benefits and the perceived negatives to not only fluoride but additional products, fair and fowl, which cause so much controversy.
Some contemporary oral health products, toothpastes included, have now within them, pre and probiotics. The science in this regard is still in its infancy but is growing exponentially, some are well established like xylitol. The addition to the inventory of products will include these as well as toothpastes that have specific applications to the needs of disease risk reduction in our practice. It was a great moment to explain the appropriate use of these and to whom, in what amount and for how long. It was also important to demonstrate and discuss the contra indications of them too. It was opportune to shed light on calcium phosphate in relation to tooth strengthening, desensitisation, pH balance and elevation as well as our oral biofilm benefiting from its directed use. My mind was changed from recommending no spitting out of fluoridated toothpaste to them clients to deciding for themselves after being given information about it.
What would I do differently and what feedback did I get? I think I’d adjust the presentation slightly, add the slides I edited and extend the length of it from 90 minutes to 2 hours with a break to sample some of the products. The content is sound but I’d like to add a slide or two to add more context. The feedback came back from the receptionist and she was perfectly correct in her request. I was awaiting it as a consequence of self-reflection and will act upon it immediately. I’m going to write a crib sheet for her about the products and their component parts, their benefits, how best to use them and who needs to avoid certain ingredients. I am also going to focus on toothpaste contents and write a briefing sheet for clients, colleagues and myself as they seem to be of great interest to many I see. My learning journey needs to encompass ALL the ingredients of the items we sell. I will also get myself an anaphylaxis syringe, needle and adrenaline vile kit too. All in all, it was a day well spent.
Quin Dental Orthodontic/Tropic Hygiene Protocol
GREEN No intervention
No risk
Plaque below 1/3 and less than 10% bleeding
No enamel demineralisation or not considered a risk presently
AMBER Intervention required (cost to be wavered at discretion of clinician)
Medium risk to gums and/or teeth
Plaque up to 2/3 the tooth and between 10 and 30% bleeding
Localised enamel demineralisation
Hygiene appointment and review – when GREEN refer to Gerry or Anna
Intervention Disclose – Demo need – Adjust OH ETB MTB IDB ISB – Confirm understanding – Apply topical fluoride/Ca locally – Tooth Mousse Plus/ 3m Espe Tooth Crème – Mousse for non-fluoride clients – Possible Prebiotic/ Probiotic combination – Nutritional behaviour review – Mouth breathing/ Dry mouth – check MH
RED Intervention required (Cost applied and quoted)
High risk to gums and/or teeth
Plaque over 2/3 of the tooth surface and over 30% bleeding
Generalised enamel demineralisation and caries
Hygiene appointment and review – when GREEN refer to Gerry or Anna
Intervention Disclose – Demonstrate need – Adjust OH ETB MTB IDB ISB – Confirm understanding – Apply topical fluoride/Ca locally – 3m Espe Tooth Crème 5000 – Mousse for non-fluoride clients –Prebiotic/ Probiotic combination – Nutritional behaviour review – Mouth breathing/ Dry mouth – check MH
PROCESS – PATIENT
- Your first appointment with our hygienist will be the only one we hope you will require.
- Intervention will only be required if you are not in the green zone. It will be discussed and determined by the team and you all.
- You will be supported and guided in a strategy back to green. Remember to stay keen, stay in the green.
- We will together be responsible for the maintenance of your dental health. You are in charge of your daily care, but we will support and guide any changes that are required for you to sustain your mouth’s management during treatment.
The first appointment will be looking at a combination of essential factors important in supporting oral health and well-being. These include;
Your dental disease risk status. Do you have any tooth or gum issues? We will evaluate your dental fitness and inform you of anything that needs attention.
Your plaque control status. This will be determined by disclosing or colouring your teeth with a special dye. Pictures may be taken to support your awareness of this if required.
Your dietary status. This includes foods and drinks which frequently dehydrate your mouth, reduce pH ( the acid/alkaline balance of your mouth ) and increase the growth, stickiness and acidity of your plaque.
Your lifestyle status. This will identify any lifestyle factors that may increase the risk to your teeth or gums. This includes mouth breathing or tiredness.
Your medical status. You may be taking prescribed medication which can cause oral dryness or conditions that bring acidity into your mouth from your body.
Your toothpaste status. You may need to consider the use of special toothpaste, some which may or may not contain topical fluoride, depending upon need and determination by your guardians.
PLEASE BRING IN ALL YOUR CLEANING DEVICES AND MATERIALS FOR THIS APPOINTMENT. REMEMBER ALSO TO UPDATE US ON ANY CHANGES TO YOUR STATUS DURING TREATMENT
Fact 1 – The fewer visits you need, the better it is.
Fact 2 – The fewer visits you need, the cheaper it is.
Fact 3. The fewer visits you need, the more you are managing successfully and independently.
Remain the green – keep keen – the health of that amazing smile will be seen.
YOUR DENTIST AND ORTHODONTIC VISITS
Visits to the dentist and orthodontic auxiliaries are just as important. They will want to see health in your mouth and good management of your teeth and gums.
Quin/Nelson Dental Centre Hygiene Protocol
Routine
Code 0 < 10% BOP Stable or just Phrophy 30 – 45 minutes $105/125
No risk/ No Airflow recall 12/12
Code 1 10-30% BOP Unstable/localised 45 minutes $110/140
Low – Medium risk / Airflow? recall 6-12/12
Code 2/P >30% BOP Active /generalised 45 – 60 minutes $120/155
High risk – possible two visit appointment recall 3,4-6/12
ALL CODE 3 & 4 CLIENTS need CODE 2/P and ORAL HYGIENE PHASE before COMPLEX CARE
Complex
Code 3 Perio unstable advanced 60 – 90 minutes $200 – $300
per appt quadrant/half/full mouth
Code 4 Perio unstable+ Complex Combination therapy as above
Or refer as above
Maintenance
Code 2PS Perio stable Maintenance 45 minutes $120/155
Remission recall to be determined
Codes 3/4 to be determined by Mark/Kelsey, discussed with Dentists or referred to Periodontist
2020, THE YEAR THAT WASN’T AND WAS. A PERSONAL REFLECTION. NEVER GONNA GIVE YOU UP!
Toni, Rick and Clare in March at Christchurch Horncastle Arena
We meet him, in Christchurch, the man responsible for one of the greatest Eighties hits, a hand shake, a smile of delight and the presentation to him of a bottle of Pinot Noir. It had been a long journey from my cousin Sally in Somerset to the drive from Nelson to the venue. Along with us that day was Clare, my colleague’s wife. She had no idea of what was to happen, she was only aware that we were meeting up to see him play. The look on her face when we were escorted back stage before the gig was priceless and greatly enhanced when he appeared with his agent. This was the week before lockdown came into force. Rick Astley was the perfect antidote the coming storm at the time as was the MarchFest in Nelson a few days later, the last time I’d see any of my family for several weeks.
It is New Year’s Eve in New Zealand as I write and the weather is surprising mild with cloud cover masking the blue sky and sun. This is unusual for the time of year but was predicted as a consequence of global climate change. It happened several years ago when our close friends from the UK came over the same time of the year in search of clear skies and warmth. Sadly, I listened to the BBC radio this morning to hear the news of yet another leap in the COVID body count, this time 981. The radio presenter was discussing this tragic milestone, the worst daily total since April and the grimly predicted a similar picture in the coming weeks, despite the development and introduction, at astounding speed, of a variety of vaccines. Their uptake has just begun but it appears weeks will be required to build immunity and additional boosters necessary to increase their immunological effect.
Knee jerk signage but not at the time!
Who would have considered the word “lockdown” in 2019 to be so contentious and emotive? It seems to me, so far flung from the present UK epidemic of restrictions and curtailments of normal life hard to comprehend. Those living there I’ve communicated with or have heard off appear to be struggling with the immensity of this. It’s long term effects, of isolation from friends and family, to businesses dependent upon those locked down and the greater economy as a whole will be difficult to calculate. What seems to be remarkable though is that the UK health service continues to manage in the way it does. Surely the message of this pandemic is that for the national economy to thrive, even survive, in unique and unprecedented events demands a robust and resilient health service. This aligned with the leadership of the country carefully listening to and appropriately reacting in accordance with their scientific advisers has been the success story of those, including me, living in New Zealand. This is born out by the resulting repatriation of tens of thousands of Kiwis back to their home land when the borders here were reopened in June. This in itself has created many new and unforeseen problems including the unaffordability of housing increasing on an already struggling marketplace.
“What has socialism ever done for us?”
Despite this the country is prospering, comparatively, to other western nations affected by COVID 19. I still go to work, can plan holidays and weekend breaks, am free to travel within New Zealand unrestricted and see friends and family without restriction. This was not the case back in late March. The tumultuous nature of the government’s decision to do a hard lockdown came as a surprise with many doubters and push back. Several weeks later with alert states returning to relative normality and only a handful of fatalities life began to resemble its pre March picture. Contact tracing and testing continued and the pulse of life led to the occasional local outbreak which was dealt with remarkable effectiveness. This I confess has its own problem, that of complacency, and many not conforming to the ritual of scanning QR codes when entering premises and shops anymore.
This reflection on those heady events will now turn to how we, Toni and myself, have adapted to this new normal which really began in January of this year, 2020. It was then that events became more news worthy. Our daughter and her partner were planning a trip to Europe and the UK and I was becoming increasingly concerned about their welfare and ability to return in the event of this news becoming more serious. It seemed that any cold or flu like symptom was an indicator of a COVID infection. An old school friend of Toni’s, living in Canada lost her young Son to COVID in March, or so we thought. The anxiety of this and the rapid onset of measures to combat and control this, its immediacy and the somewhat draconian response was breathtaking. A workplace presentation on sustainability in dental practice was soon changed to become the forum to discuss what we do if or when the inevitable decision to lock down occurred. Toni, as a core midwife at Nelson Hospital, had no choice but to continue regardless of the pandemic but we soon both adopting the strip off at the back door to go directly into the shower, unceremoniously throwing our work clothes into the washing machine. This became the norm until lockdown and continued for Toni through the early weeks of the crisis. I became head chef and gardener and was kept very busy on various projects that were in the long grass. It wasn’t long, however, before New Zealand returned to work and in particular for me stood some obstacles before my headspace and mental health accepted this new reality. I had made this decision based upon the notion the dental hygiene profession would suffer as a fear of COVID, this was reinforced by the fact that we as clinicians deal with all manner of oral flora and our mechanical processes, our instrumentation of biofilms can create bacterial fields potentially harmful to us and others. This concern was reiterated by the governing and regulatory bodies decision to ban the use of ultrasonic and sonic scaling equipment in higher alert levels. I’ll return to this shortly.
Banksy at his best extolling the virtues of essential workers during COVID
At this point I must allude to the role that social and main stream media played during this time. I was glued, like many others at the time I suspect, to the only real form of immediate communication, the internet. I must have spent many hours listening to podcasts and media broadcasts to either understand the nature and response to COVID nationally and globally but also as a distraction. My mother, at the tender age of 81 years, and myself began a Zoom thread that continues weekly to this day. Respect to her, adapting to the new technology scene and adopting this a form of real communication with us. At one point I was organising meetings from here between her, her sister and nephew, all in the UK! Strange times indeed. The media I believe will take some responsibility for its reporting of events during COVID when all the facts are known and lessons learned from it. Social media in particular will be more cautiously approached by those of a more discerning persuasion. Feverish and hungry consumption of any news be it verified or wholly misleading will change I hope after infections and vaccines bring an effective degree of heard immunity and normality return.
A menacing dark cloud taken from our balcony summing up the moment of lockdown
In May, whilst stationed in my home I decided to apply for a new profession, the fear that dental hygiene as I knew it would cease or irreparably change drove my application to train as a nurse at Nelson College. I was surprised that my application was immediately accepted and my headspace began to accept the inevitable move from dentistry, after 38 years. I kept this quiet from my colleagues initially and uncertainty with this decision began to appear when I considered the income I’d lose and debt I’d incur after 3 years of training. I was also perturbed by the fears and anxiety shown by my daughter-in-law who was into her final year of training locally. The idea that you were in a lottery after graduation as to where you ended up working appeared totally Dickensian to me. This affected me and a few counselling sessions and medication helped me traverse the stormy seas of my emotions. Life felt tough to me and affected my workspace as well as my headspace.
Herman our German Toyota Mini Campervan
I am very thankful that we did our odyssey back in 2019. We learned much from it especially the decision to make it our last for quite some time. We decided to buy a tent and all the finery that goes with the camping scene, a tow bar for the Volvo and a decent bike rack to transport the Ebikes around this country. The purpose of this was to save the expense of long haul travel, it’s environmental footprint and impact as well as the time in transit, jet lag and organising headaches. We were also fortunate to meet Cedric in August. He was a traveller from Northern Germany, like many thousands of young folk making a pilgrimage to these showers, supporting the economy with their presence and promoting to future fellow tourists this country. Annoyingly to me they get a bad press in this country, free campers for which Cedric was one have been bad mouthed by poor toilet behaviour. A few have been responsible for this feverish media assassination but most are abiding and responsible, furthermore they add to the economy in multiple ways and buying Cedric’s converted Toyota Estima was acknowledgement of that and support of him. Herman, the aforesaid Toyota is now a firm family favourite and we thank Cedric for his attention to detail in converting this MPV to a mini mobile home. This is an addition to the travel inventory and Oli, our Spaniel, can now be part of our journey too.
Social Distancing during vintage at Neudorf Winery – Germans and French playing their part
Another positive from 2020, from a completely unforeseen angle was the provision of free training for primary industries. Apiculture being one of these. Now bees have been off my radar of interest until the last few years. Dear friends of ours have been drawn to the beauty and necessity of beekeeping and have inspired me to consider it as a hobby, if not a job in the future. I wasn’t really aware of this opportunity provided as a COVID response to aiding the economy but thanks to Facebook and the Nelson Beekeeping page I fortuitously stumbled upon it. The class of 18 features more females than males, they are really passionate about their learning and contribute much to this journey. I’ve now 2 hives, in the 2 corners of the garden, have endured many ups and downs with Queen bee dramas that many an expert hasn’t had to endure, several stings and a curious obsession with watching them landing on the hive laden with pollen. Anyone who thinks that a foray into keeping bees is an easy ride be warned it is far from that. There is a need for regular inspections, checking for a variety of infestations and diseases and a need to conform to a responsible yearly management plan to protect the bee colonies of New Zealand and their welfare throughout the year.
Bees in a brood box and feeder with bracken as a gym
To sum up 2020 has been a rough ride, an emotional and physical rollercoaster to me and I would reliably assume many others. I’m not in the super COVID risk age group unlike my mum and the in – laws. I have learned much about myself, faced a few demons and changes along the way. I am lucky, as part of the team of 5 million New Zealanders, that we had decisive leadership who took the right advice from the right advisers and the right time. The damage was minimal and the social consequences I hope less than predicted. I will continue as a dentalcare professional, as a gardener, a writer, and now as a budding hobbyist beekeeper. Where this coming year will take me I’m not certain, Toni will hopefully get her new hip and our friends from the States, returning to Aotearoa will find a place and settle back into this great country. I wish all who read this and friends and family the very best, health, happiness and a greater degree of certainty for your future. Kia Ora.
An eternal memory where nature felt more powerful than manned flight – Air New Zealand paralysed and on the deck
The Journey Along The Way
Whole Dental Health 