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HYGIENIST HANDBOOK
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HYGIENIST HANDBOOK
oralhygiene A NEWCOM Media Inc. Publication
Managing Editor: Jillian Cecchini 416-510-5125 jillian@newcom.ca Circulation: Mary Garufi 416-614-5831 mary@newcom.ca Advertising Services: Karen Samuels 416-510-5190 karens@newcom.ca Art Direction: Michael Chimienti 416-510-6813 mike@newcom.ca Digital Content Coordinator: Marley Gieseler 416-510-6777 marley@newcom.ca
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The Business Of Dental Hygiene Jodie Cantarelli, AAS, RDH, Dip. AdEd
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The 2 “Rules” Of Job Search Michele Bush
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Contracts: What You Need To Know Stuart Rudner, Employment Lawyer & Mediation
OFFICE:
Located at 5353 Dundas Street West, Suite 400 Toronto ON M9B 6H8 Telephone 416-614-5831, Fax 416-614-8861. Oral Hygiene serves dental hygienists across Canada. The editorial environment speaks to hygienists as professionals, helping them build and develop clinical skills, master new products and technologies and increase their productivity and effectiveness as key members of the dental team. Articles focus on topics of interest to the hygienist, including education, communication, prevention and treatment modalities. Please address all submissions to: The Editor, Oral Hygiene, 5353 Dundas Street West, Suite 400, Toronto ON M9B 6H8 Subscription rates: Canada $25.00/1 year; $47.00/2 years; USA $46.95/1 year; Foreign $46.95/1 year; Single copies Canada & USA $10.00, Foreign $18.00. GST/ HST #103862405RT0001.Printed in Canada. All rights reserved. The contents of this publication may not be reproduced either in part or in full without the written consent of the copyright owner. From time to time we make our subscription list available to select companies and organizations whose product or service may interest you. If you do not wish your contact information to be made available, please contact us via one of the following methods: Phone: 416-614-5831; Fax: 416-614-8861; E-mail: mary@newcom.ca; Mail to: Privacy Officer, 5353 Dundas Street West, Suite 400 Toronto ON M9B 6H8 Canada Post product agreement No. 40063170. Oral Hygiene is published quarterly by Newcom Media Inc., a leading Canadian magazine publishing company. ISSN 0827-1305 (PRINT) ISSN 1923-3450 (ONLINE)
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13. Leveraging New Technologies To Enhance Patient Experience And Increase Patient Retention Julie Gaffney, Manager of Dental Hygiene Programs at dentalcorp 15. Strategies To Help Land Your Dream Job Irene Iancu, BSc, RDH, CDTP 18. Financial Tips, Tricks And Traps For The Dental Hygienist David Chong Yen, CPA, CA, CFP; Louise Wong, CPA, CA, TEP; Eugene Chu, CPA, CA of DCY 21. Why CE Goes Beyond Professional Obligation Beth Parkes, RDH, BSc 23. 7 Career Boosting Reasons To Be Healthy And Fit Uche Odiatu, DMD; Masha Bakhshandeh, RDH 27. How To Craft The Perfect Recall And Re-Care Program Jodie Cantarelli, AAS, RDH, Dip. AdEd, Manager of Dental Hygiene Programs at dentalcorp 29. The Dental Hygienist As A Trusted Resource Provider: There Is A Resource For That! Natalie Muccioli Emery, RDH, BHA
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THE HYGIENIST HANDBOOK
THE BUSINESS OF DENTAL HYGIENE A
Jodie Cantarelli AAS, RDH, Dip.AdEd Manager of Dental Hygiene Programs at dentalcorp Jodie is a Manager of Dental Hygiene Programs at dentalcorp. In her role, she partners with dental teams across Canada to help them provide optimal patient care. Jodie earned her degree in Dental Hygiene, diploma in Adult Education at St. Francis Xavier University. Her professional experience includes private practice, a clinical evaluator for the College of Dental Hygienists of Ontario, a clinical and didactic instructor, program director, past advisory board member, published author and professional speaker.
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s a practicing dental hygienist, I focused on the delivery of patient-centred care, avoided the financial and operational aspects of a dental practice, and had no need for business acumen. Over time working in dental clinics, my interests and horizons expanded, and I became more and more fascinated by the economic underpinnings of an oral health care clinic. However, as a practice consultant, I find myself seeking the bigger picture. I am intrigued by a practice’s foundation, culture, patient demographics, metrics and financials. This has been a major shift for me but the one constant between the two roles is ensuring the patient is expertly cared for. When I discuss the business of dental hygiene with other practitioners, they often pause, unsure of what to think. In dental hygiene school, we were never trained to think about financials, metrics or high-level business projections. Some dental hygienists even resist the notion that quality health care and profit can coexist. So, what exactly does dental hygiene have to do with the business of dentistry? Let’s take a closer look at the different elements that are driven by the hygiene team. Hygiene production as a per-
centage of total production is on average 30%. This means that the hygiene department generates 30% of the gross practice revenue.
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Case acceptance: Dental hygienists are the key to building long term relationships with patients. Patients will ask their dental hygienist about a procedure and trust them to guide them to a treatment that suits them best. Pre-planning and scheduling routine morning meetings to review the day, prepare and communicate as a team are crucial to all around customized patient care. Revenue per visit: As a benchmark, dental hygienists should produce roughly four times their wages. Patient retention: Dental hygienists significantly contribute to the practice’s patient retention through the relationships they develop with patients. Restorative revenue: 72—75% of restorative needs come from the dental hygiene operatory. Dental hygienists are professionally trained to screen and spot potential problems to bring issues to the dentist’s attention and are
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favorably positioned to promote restorative and elective procedures. Communication, respect, teamwork and professionalism, along with a proper exam from the dentist, is what keeps his/her chair busy.
responsible for the success of the practice; however, not all practice leaders share their business goals and projections with the team.
seeking a mentor that can help you understand business fundamentals and develop skills that will enable you to thrive in your career inside and outside the operatory.
Key contributors to practice success Comprehensive patient care starts with the dental hygiene team. Dental hygienists are major contributors to practice production and—when empowered— the hygiene team can have a tremendous impact on the financial health of a practice. When the entire team is supported and valued, the practice will flourish. Great practice leaders understand that all team members are
Engaging with the business As a team member and key contributor to practice success, it is advantageous for dental hygienists to learn and apply new skills. If you find yourself disengaged from the business side of the practice, actively seek opportunities to learn about the business. Initiate a discussion with your practice leader and let him/her know you would like to develop your business acumen. Additionally, experienced mentors can offer invaluable guidance and help facilitate your professional development. Consider
A win-win situation Above all, optimal patient care needs to be the number one priority of the practice. When patient needs are being met, it will inevitably benefit the practice – what’s good for patients is ultimately good for the business. Further, when the practice’s finances flourish, opportunities present for professional growth, financial gain and flexibility for the entire team. Contribution to the practice’s financial success is a direct impact to your success. It’s a win-win situation for everyone!
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THE HYGIENIST HANDBOOK
THE 2 “RULES’’ OF JOB SEARCH M
Michele Bush Michele is an insightful and inspiring Career Coach, Business Advisor and Speaker. She is a passionate promoter of how employee engagement drives business success. She works with her clients to increase their confidence and improve their professional brand so they can realize their full potential. With over 25 years as a Human Resources Professional, Michele has taken her vast corporate experience as a recruiter, trainer, facilitator and communication specialist to develop a successful consulting practice. For customized Job Search support including resume writing and interview preparation or interviewing training for managers, contact Michele through Linkedin at linkedin.com/in/michbush/ or by email at michelebush4m@cogeco.ca
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any believe that a successful job search is based primarily on our resume – education, previous employment, certifications, involvement in extracurricular activities. Yet there is so much more to it, especially for those who may not have a lot of work experience yet. There are two key things that can give a candidate an edge over the competition: being respectful and standing out for the right reasons. Why? Because it’s not just WHAT we do, it’s HOW we do it that makes the difference. The human connection we have with one another, with our teachers, co-workers, clients and potential employer is what professional relationships are based on. As an example, think about the importance of your communication skills when it comes to your clients. A dental hygienist can have all of the academic qualifications and technical knowledge required to perform the functions of the job – that’s the WHAT, but they also need to be able to make clients feel comfortable, ask the right questions and clearly explain procedures and preventative measures – that’s the HOW. This essential combination of WHAT and HOW is critical in the job search
and interview process. Reflect on this statement: talent may get you in the door but your character is what will keep you in the room. This is even more important with the ever-increasing pace of technological communication. Despite all the tech advancements in recruitment, which includes online application tracking systems (ATS), resume review programs and artificial intelligence software that matches a candidates’ skills to a job description, there is still one constant that will never change – the users of all this technology are humans. Being respectful and standing out does require you put in effort and thought but it can make all the difference. A genuine commitment to the job search process and to your future career will set you apart from the robo-applicant who simply drafts one version of their resume, cutting and pasting straight from the job posting, sends out the same untailored application to every dental office or online job advertisement and then just sits back and hopes that someone will contact them for an interview. If you remember and follow the two “rules’’ of job search, you will have an advantage over other applicants.
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Rule #1: BE RESPECTFUL Understand what is involved in the recruitment process from the hiring manager’s perspective. • Take some time to consider all the hours, energy and costs that go into finding a new member of the team. There are business plans, budgets, costing, headcount decisions, resume reviews, pre-screening, interviews. Hiring is just one of the many administrative activities for the office manager or dentist and can be one of the most time consuming. So, be sure to conduct yourself in a way that respects their investment. • Carefully review the job posting and the expectations of the job. See if it’s potentially a fit. Don’t waste the valuable time of others by submitting your application for a position if you know that the location/commute are going to be an issue and you wouldn’t likely accept the job even if it was offered to you. • Do the upfront work so the hiring staff doesn’t have to. Make sure that your resume, application, cover letter, email communications are relevant, succinct and tailored to what they are looking for. They don’t have spare time to be searching throughout the content of your documents looking for how your qualifications might match their needs. • Understand the impact of mis-hires. A mis-hire occurs when a candidate accepts a position and doesn’t stay in the job for at least 12 months. The cost and time to search, interview, on-board, train and integrate are significant and if the new hire doesn’t work out, then it must be done all over again.
Talent may get you in the door, but your character is what will keep you in the room.
Rule #2: STAND OUT Be the candidate whom the hiring staff will remember for the right reasons. • Network. Be connected, be visible, be aware of the value of meeting peers in the industry, continue to attend events and workshops, be notable because of your professional demeanor. • Online presence. Review your social media profiles. People will search for you when you apply for a job. Think about what your personal brand says about you. Do you appear professional/friendly/welcoming/conservative or do you come across as sassy/a partier/a judgemental sharer of very strong, personal opinions? • Resume. Make the layout relevant to the job posting. If required education is listed first, consider putting it first on your resume. Don’t NOVEMBER 2019
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just copy and insert the words from the job posting. Tailor it and ensure the content reflects the requirements listed. Include powerful, succinct and related accomplishment statements to describe your experience. If your work experience is limited, include accomplishment statements that make a connection to the job requirements. E.g. Volunteered at the local hospital admissions desk, assisting children and their guardians through the out-patient surgery check-in process, ensuring they were made to feel comfortable. • Cover letter. Even if it is not required, submitting a cover letter shows that you are willing to put in the extra effort. If there is no place to upload a cover letter, you can add it as
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the last page of your resume or include it in the body of an email. Research something about the job or the practice. Don’t just repeat information from your resume or tell them how wonderful you think you are, be sure to show them how you can be of help to them. E.g. I noticed that your office is located near several retirement homes and you have a lot of clients who are seniors. From my experience at a long-term care facility, I understand working with aging clients and can support the practice to enhance the services for that client base. • Emails. Ensure that they are professional, addressed to the correct person and that your personal email address is not inappropriate or juvenile. Avoid acronyms, emojis, short forms, or terminology that may not be commonly used by various types of readers. • Proofread. Check Grammar. Spellcheck. Have a friend or family member review your written communication. Their and there. You’re and your. Documents with findable and fixable spelling and punctuation errors are not acceptable. • Interview Preparation. Research and anticipate interview questions and prepare relevant answers using the STAR story format. STAR stories are expanded descriptions of the one-line accomplishment statements on your resume. Situation (what was happening?) Task (what was the problem you needed to address or solve?) Action (what did you actually do?) Result (what was the positive outcome of your involvement?). These are brief and to the point to show WHAT you did and also HOW you did
When you are prepared,
professional and positive, it will be you who they remember over the
other applicants.
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it. Be ready for something unique: there could be a panel, a group interview, a Skype call, the need to do a presentation or answer a scenario, even an online video application. • The Interview. Know where you are going, how long it will take to get there and who you will be meeting. Be early but not too early (about 10 minutes). Turn off your cell phone (not just to Vibrate, but Off). Be professional and polite to everyone. Anyone you interact with could be part of the decision-making process. Bring 2 copies of your resume and a note pad. Jot down the names of the interviewers. It is very important to have relevant and intelligent questions prepared in advance that you will ask the interviewers. This should be a 2-way conversation and your opportunity to learn about their working culture, client load, instrumentation etc. How you fit in with the team and their approach to patient care is a critical part of this decision for both of you. And one more thing, never assume that you are the smartest person in the room. • Follow-up. Ask the interviewer for their email and send them a thank you note. Wait 24 hours instead of sending it from the lobby or your car. Think about it, briefly comment on something you learned in the interview about their practice, reminding them how your skills and experience are a fit with them. Even if you were not the successful candidate, send a thank you note then, too. Maybe it wasn’t meant to be this time, but how you behave and respond to a decline, increases your chance of being remembered for next time or them commenting about you to their colleagues who may have an open position.
Job search and interviewing can be daunting, especially if it’s not something you have a lot of experience with. Being Respectful and Standing Out – for the right reasons can increase your confidence and give you an advantage. When you are considerate of the hiring team’s investment of time and cost that goes into the recruit-
ment process, when you make their job easier by doing the work to align their needs with your skills and when you are prepared, professional and positive, it will be you who they remember over the other applicants. It’s not just WHAT we know, it’s HOW we do it that makes the difference.
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THE HYGIENIST HANDBOOK SO, YOU JUST GOT A JOB OFFER…
Stuart Rudner Employment Lawyer and Mediator Stuart Rudner is the founder of Rudner Law, a firm specializing in Employment Law. The team at Rudner Law works with dentists, hygienists and dental practices to help them understand their rights and obligations. Stuart can be reached at stuart@rudnerlaw.ca or 416-864-8500.
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CONTRACTS: WHAT YOU NEED TO KNOW P
erhaps you’re fresh out of school, looking for your first position as a hygienist. Or maybe you have been working as a hygienist for many years and are looking to move to a new practice (or multiple practices). Or, perhaps the dentist you have been working with has just asked you to sign a very legalistic new contract. When you are presented with that contract, what should you do? Should you sign? What difference can it really make? The short answer: Signing a Contract, or even an offer letter, can…
• cost you tens of thousands of dollars (or more), • expose you to unwanted changes in your duties, compensation, and even location of work, • deprive you of vacation, statutory holidays, and entitlement to basic rights like overtime pay, and • limit your ability to work elsewhere, even if they let you go.
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We work with hygienists, dentists, and dental practices. We understand the unique elements of the industry and the relation-
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It is not unusual for hygienists to be paid as contractors. Sometimes, the dentist will tell you that it will be better for you from a tax perspective. That may be true, but true contractors are not protected by employment laws.
ships that exist. We also understand the risks. Employee or Contractor? Speaking of relationships, when you assess your current or potential role, what is the legal relationship - are you being treated as an employee or an independent contractor? And is that defensible if questioned by CRA, the Ministry of Labour, or a court? Have you unknowingly given up some of your rights by agreeing to be paid as a contractor? It is not unusual for hygienists to be paid as contractors. Sometimes, the dentist will tell you that it will be better for you from a tax perspective. That may be true, but true contractors are not protected by employment laws. So, they are not entitled to basic rights like vacation, statutory holidays, breaks, overtime pay, or severance.
eral “clients” and operating independently, then you may meet the legal definition of an Independent Contractor. Or you may be a hybrid: what the courts call a “dependent contractor”. What is important to remember is that 1. you should understand the impact of the legal relationship you choose - it is not just a question of how you are paid, but what your legal rights will be; 2. no matter what the parties say the relationship is, courts and government agencies like CRA can and will impose their own assessment and may decide that you have been mischaracterized – that can result in a substantial debt for unpaid taxes and other premiums.
The term “independent contractor” refers to more than how you are paid. It reflects the nature of the relationship. If you are effectively in business for yourself, offering your services to sev-
There are many advantages to truly independent relationships. The contractor is able to work with significantly more independence than an employee and has the freedom to decide how (and often when) work will be performed. They are also entitled to deduct business earnings and expenses, and can earn income from several different organizations at one time. In order to take advantage of these benefits and freedoms, some people will proceed as if the hygienist is an independent contractor when the reality is that the relationship is more like one of employer-employee. Misclassifying an employee as an indepen-
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Imagine working in a practice for twenty years and then being let go with 30 days’ notice, as opposed to months or even years of severance. That’s what happens if you are a Contractor.
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dent contractor can have serious implications for both parties. Just Because You Say You are Independent Doesn’t Make It So Many hygienists believe they are safe from liability as a result of the existence of a written agreement which states that the hygienist is an independent contractor and not an employee. However, the courts and the Canada Revenue Agency are not bound by such an agreement. Courts have repeatedly ruled that the written agreement is only one factor to consider, even where the parties confirm that their intention was to create an independent contractor relationship. In other words, courts will assess the reality of the situation rather than deferring to the parties’ characterization of the relationship. Assessing the Relationship The CRA, the courts and adjudicators such as employment standards officers will consider various factors when attempting to determine whether an individual is an employee or an independent contractor, including: • The degree of control that the hygienist has over her or his activities; • Whether the hygienist or the employer provides the required equipment and tools; • Whether the hygienist hires his or her own helpers; NOVEMBER 2019
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• Whether the hygienist can work for other practices or must provide exclusive services; • The hygienist’s degree of financial risk (chance of profit and risk of loss); and • The hygienist’s responsibility for investment and management. The bottom line often comes down to whether the individual is truly an integrated or integral part of the organization, or whether the individual is carrying on business on his or her own account. In that regard, any indicia that the Hygienist is a part of the organization will weaken the argument that they should be seen as independent. Such indicia can include: • Business cards • Corporate email address • Provision of benefits • Participation in company events, and • Mention on the website as a member of “our team” While there may be tax advantages to being a contractor, you may also lose out on significant protections that they would otherwise have as an employee. Remember that the question to be answered is not “do you want to be paid as a Contractor or an Employee?” The question is what the reality of the relationship will be. No contract will change that. Every Employee has a Contract You may be thinking that you have been working for years without a contract. However, contrary to popular belief, every employee in Canada has a contract. However, most are verbal, with a number of “implied terms”. Those implied terms are intended to protect employees, but written contracts can remove many of those protections. You need to understand NOVEMBER 2019
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what they mean before you sign. Whether it is a one-page letter or a lengthy legal document, your contract sets out the fundamental terms of your relationship. You may be excited about the new opportunity, but “look before you leap” is good advice in this context. Signing a contract is not something to be taken lightly. Employers are becoming more aggressive in their use of contracts. If someone wants you to sign an agreement, it is usually because they have something to gain. It is critical that you understand what you are giving up before you agree, particularly if you are being lured away from your previous organization, or if you have been provided with a contract containing extensive terms and conditions. Signing without understanding will undoubtedly come back to haunt you later on. Imagine if you were to find out, years from now, that your severance entitlement was a few weeks, rather than months or years. Unfortunately, it is all too common for us to meet with an individual who has recently been dismissed and is baffled by the minimal severance they have been offered, and we have the unfortunate duty of advising them that this is because of the contract they agreed to when they were hired. As discussed above, the first thing is to consider the very nature of the contract: does it treat you as an employee or a contractor, and is that both 1) to your benefit and 2) consistent with the true nature of the relationship? Signing a contract should never be treated as a formality; it can dramatically impact your legal rights.
missal. That can be extensive, especially if you are older, or were lured away from prior employment, or are in a small town. However, this entitlement can be displaced by a termination clause, which can dramatically reduce your entitlement at the most critical time: when you lose your job. Furthermore, independent contractors do not have this entitlement. It is a sad reality that we routinely meet with people that have been let go and are shocked to realize what they agreed to back when they accepted the job offer. Watch out for clauses that try to limit your entitlement to the minimum amounts required by employment standards legislation. It can be the difference between 14 days of notice or two years of severance. Look for a Probationary Clause If there’s a probationary clause in your contract, you have absolutely no protection in the first few months. If the termination clause limits your entitlement to the minimum amounts required by employment standards legislation, the result is the same: you can be dismissed without any notice or severance in the first few months. Particularly if you are being recruited away from secure employment, you should be entitled to more security, not less.
Check the Termination Clauses By default, all employees are entitled to “reasonable notice” of dis-
Make sure Compensation is Clear and Not Discretionary Sometimes, people are told their compensation package will be worth $x, but the contract provides for a lot of variable compensation that is not guaranteed. Watch out for bonuses or other payments that are purely discretionary, because that means the company can simply decide not to pay them.
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You should also make sure that the contract does not provide that you must be “actively employed” when bonuses or other compensation are paid out. Otherwise, you will not be entitled to them during any severance period, which will further reduce your severance entitlements. What’s Not There Can Be As Important As What Is It is also crucial that you consider what is not in the contract, and that the contract is consistent with verbal discussions and with your expectations. You may have discussed and agreed on certain terms (like a guaranteed number of hours per week), but if they are not explicitly set out in the agreement, then you should not assume they will be in place. This is particularly important because most contracts include an “entire agreement” clause which means that unless it is stated in the contract, it is not part of your agreement – any other discussions or agreements are meaningless. Even if you have a separate email message confirming a signing bonus, or that you can work from home two days each week, you will probably not be able to enforce it. What they promised you doesn’t matter; what matters is what is written in the agreement.
Watch Out For Limits On What You Can Do Now And In The Future Many dental practices will insert language which limits your ability to work anywhere else during and after the contract. For example, the contract might say that for a period of six months, or even longer, after the contract ends, you cannot work for another dental practice within 50 km. That can restrict your right to work, even if they let you go. Look Out For Changing Duties And Other Terms By default, employers cannot unilaterally impose significant changes into key terms of the contract, such as your role, duties, or compensation. However, some contracts contain language that allows the employer to change your title, duties, reporting relationships, location of employment and other key terms at their discretion. Imagine being told that as of next week, you have effectively been demoted, or that you have been transferred from Toronto to Winnipeg. Unless you want to run this risk, make sure any discretion to change the terms of employment is limited and reasonable. See An Employment Lawyer This may sound self-serving, but it is critical that you receive legal
advice from someone with expertise in Employment Law before you sign a contract that may dramatically limit your rights. An employment lawyer will be able to point out any potential pitfalls that you may not be able to see. A termination clause is a perfect example of this. We understand that legal advice costs money. However, there is truth to the old adage that it is unwise to be “penny wise and pound foolish”. You may save a little money by not seeing a lawyer before you sign the agreement, but it can cost you and your family a lot more in the long run. This is your career and your livelihood; do not blindly sign away your rights. You need to make informed decisions. That’s where a lawyer comes in. They explain how the law applies to your situation, discuss the options and strategies available to you, and the pros and cons of each. You can then take all of that into account, and decide what makes sense for you. They will then work with you to develop an effective strategy and negotiate on your behalf where it is appropriate, or can guide you while remaining in the background. At the end of the day, you will either end up with a better contract, understand enough to reject a bad contract, or at the very least, enter into a contract knowing the impact on your legal rights.
It is also crucial that you consider what is not in the contract, and that the contract is consistent with verbal discussions and with your expectations.
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THE HYGIENIST HANDBOOK
LEVERAGING NEW TECHNOLOGIES TO ENHANCE PATIENT EXPERIENCE AND INCREASE PATIENT RETENTION Julie Gaffney RDH, BSc, Manager of Dental Hygiene Programs at dentalcorp Julie Gaffney, RDH, BSc, is a Manager of Dental Hygiene Programs at dentalcorp, specializing in the integration of Invisalign and iTero into their practices. A Registered Dental Hygienist with over 28 years of experience in dentistry, Julie brings a wealth of industry knowledge and experience in both the US and Canada. Throughout her extensive career, Julie has held a number of positions, including dental assistant, office manager, educator, orthodontic and pediatric dental hygienist, marketing specialist, author and international speaker. Julie is also one of the prestigious Hygiene Faculty Speakers for Align Technologies. She enjoys the outdoors and travelling with her son, husband and labrador retriever.
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T
he dental patients we once knew are a thing of the past – much like your old flip phone. Today’s patients are tech savvy, well educated and likely to have researched all of their symptoms and dental treatments prior to arriving in your chair. In today’s competitive landscape, dental care professionals need to inform and engage patients in a way we never could before. We need to be prepared to filter through the myths (and truths) they are reading online and educate them in a patient specific way to ensure we are providing them with comprehensive care options. Through the use of digital technology, we can provide the elevated and individualized care our patients expect and deserve. Technology as a tool for engagement and education By 2020, patient experience will surpass price as a key differenti-
ator among service providers . It is important to think about the experience your patients are getting from the second they walk into your door. Incorporating technology into your practice can take your patient experience from average to exceptional. Let’s reflect on how we have educated patients in the past when we found a cavity. We tirelessly tried to explain the cavity we discovered in a radiographic or clinical examination to a patient and watch their eyes glaze over. Now, think about how this process has since changed with the introduction of digital radiographs. The patient can now see their cavity when we zoom in or change density, allowing them to take ownership of their oral care and leave with a clear understanding of why treatment was needed. Take that experience one step further with the intraoral camera.
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Now, the patient is truly accepting ownership of the broken-down picture of the tooth that came from their mouth. There is no denying the necessity of the treatment and the fees associated with improving the situation. We also have an opportunity to take this educational experience even further with digital scanning. We can scan a patient’s entire dentition and surrounding structures in 3-6 minutes, and then show them a 3D model of their teeth that reveals alignment, recession, wear, abfractions and occlusion in a way we never could before. The intraoral camera is a highly beneficial tool for promoting single tooth dentistry, while 3D digital scanning can promote comprehensive overall care to help our patients keep their teeth for a lifetime. That said, it is no secret that many of our patients are driven by insurance coverage. However, if we are properly educating our patients on the reasons behind a recommended treatment, the coverage becomes less of an issue. Depending on what service we are providing, we can actually save our patients money over time by investing in their teeth. We need to tip the scale between value and cost, knowing that our goal is comprehensive oral care. I encourage teams to use the Problem, Consequence, Solution Model (PCS) when educating their patients. If the patients in our chairs are not aware of a problem, they cannot fix it. If they aren’t aware the problem will lead to negative consequences, they are not motivated to fix the problem. If the consumer is not offered a solution to the problem, they cannot improve their oral health. Using Digital Radiographs, Intra oral Cameras and 3D digital scans
will allow them to make educated decisions, feel involved in the process of improving the oral health and, above all else, give them the best opportunity for optimal oral health. Insurance coverage is available as a means to help them financially obtain improved oral health, but it will not be the key determining factor in proceeding with recommended solutions for problems noted in the oral cavity.
A long-term investment Incorporating new technologies into our practices requires sourcing products and determining the best fit for the needs of the practice and its patients. These prod-
ucts are certainly an investment, so it is important to do your due diligence when researching the pros and cons of each. Attending conventions is ideal, since each company will have their products on display for you to see and try out. In the same way that people choose one practice over another, word of mouth and other people’s experiences are important to consider. Consumer reports and reviews are also helpful. Lastly, the representatives of large manufacturers or distributors can help provide an unbiased opinion based on experiences with other practices. They may also help you negotiate the best price for the products you decide upon. It is very important to remember: you get what you pay for. These products are investments and cost should not be the number one factor in the final decision. Ensure you invest in technology that will stand the test of time with a strong backing of support as the technology advances. Every operatory should have an intraoral camera, and each practice should have a digital scanner. You will begin looking at the scanner as a team member and might consider allocating a separate column for it on the schedule. You will surely be amazed at the contributions these technologies can provide your patients and practice when properly implemented. It is easy to see how keeping up with technology can increase efficiency, accuracy and engagement within your practice. It will also enhance the patient experience, improve retention and increase referrals leading to a more successful practice. Don’t let the fear of change hold you back – dive into the digital revolution today!
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Technology for patient retention Dentistry is a highly competitive industry, leaving patients with many options for oral care. Keeping up with new products and technology, although an initial investment of time and resources, can help you retain patients and grow your practice. Patients trust us with their oral health and do not desire to build relationships with other providers if they are already happy with you and the services you provide. However, if you are not providing them with the level of care they perceive to be the best, it’s a short walk to another dental practice to see if their needs will be met there. That said, patients won’t be tempted to leave your practice if you are meeting their needs through a high level of engagement and affording them the autonomy to make educated decisions on their oral health. Once a solid foundation of loyalty and trust has been built, even an advertised $500 less for a treatment down the street won’t tear them away.
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THE HYGIENIST HANDBOOK
STRATEGIES TO HELP LAND YOUR DREAM JOB I
Irene Iancu, BSc, RDH, CDTP Irene Iancu has worked in various specialties including Paedo, Perio, General Practice and Orthodontics. Her goal in her current holistic practice is preventing and maintaining an optimal mind, mouth and body. Irene connects the systemic effects of oral conditions to her clients, while making a change for overall health and wellness. As a Peer and Quality Assurance Mentor contacted by the CDHO, a Clinical and Theoretical Dental Hygiene instructor at Oxford College, and a practicing dental hygienist in Toronto, Irene shares her passion for education with us today in the hopes we can change the lives of our clients and their loved ones. Irene can be contacted at Irene@toothlifestudios.ca, www.toothlifestudio.ca, IG: @ToothLife.Irene, @Toothlife, @Toothordare.podcast.
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vividly remember my interview, first job and very first day. I thought outside of the box to secure my first job. Writing my resume was a challenge being a new graduate without any dental experience. Unlike some of my 2007 graduates, I wasn’t a dental assistant first, and aside from having a dentist of my own, I hadn’t set foot in a dental office as a staff member. Prior to dental hygiene school, my main areas of experience were working retail sales at shopping malls, catering for a Kosher catering company, and teaching tennis. At the time, these skills didn’t seem very transferable to a position as a dental hygienist. So, when I went into my first interview with a Periodontist, I wasn’t very confident I would get the job as a temp hygienist for an extended maternity leave. As the Periodontist walked out of the consult room, gesturing to the reception area where three other candidates were sitting, the last thing I could think of was, “I’ll work for free!” This was immediately followed by, “I’ll work for free for three months and if you don’t believe that I’m a good fit by then, I’ll call this a work placement experience and you hire someone else.” I didn’t realize how appealing
this was to a highly profitable Periodontist, who at the time was looking to replace someone that had been with him for nearly a decade. “See you on Monday” were the sweetest five words I could have ever heard. A close second to, “You passed your board exam.” Let’s be clear: I’m not saying to work for free, or even to consider it. I now realize how gutsy that move actually was and not to mention, extremely naïve. However, it was the best thing I could do at a time when dental hygiene positions were a sacristy. I absolutely wish that mentorship and articles like this were available to a young and inexperienced Irene. Here are a few things that I wish I had known before trying to negotiate for myself as a new graduate, navigating new terrain in the very scary world of employment.
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Interviewing For Your Dream Job The interview phase is exciting though it can definitely be stressful. With the many online resources available to dental hygienists, it is often difficult to know where to go for high-paying opportunities. In my experience, I’ve seen job listings on sources like Indeed.com, Simplyhired.ca,
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d. “Are we provided with any continuing education?” e. “When are individual reviews and raises conducted?”
Workopolis.com, Wowjobs.ca, Kijiji and even Facebook. All very different resources; some paid and some free. It’s essential to read each posting before applying, as some positions are more detailed than others. My suggestion would be to use those job postings a guide. They can be extremely helpful in identifying skills that you already have and those you may not. For example, if a job posting is asking for a laser certification, knowledge of a specific product, or experience with various whitening procedures, don’t be discouraged. Write them down and figure out a way to get trained with those items. A potential candidate can’t fault a new graduate for not having these credentials, however, going into an interview saying you’re aware of these items and are working to gain experience can be a beautiful thing to an employer. It shows you’ve done your homework and are working towards being able to provide the services their office offers to patients and clients. Recruitment agencies are also highly recommended as they take out all of the maintenance and support required for the employer and directly connect employers with candidates. When using such resources for a potential job, make sure to do a little research before you go into your interview. Do some online digging about the office, employer and with the beauty of social media, you can take in a glimpse of the office from their Facebook and Instagram accounts. This might help you find some common goals and hobbies between you, the doctor, or hygienist. This is what I did prior to my interviews and I ended up having meaningful conversations with multiple office managers about tennis, their staff outings, promo-
tions the office offered, and even the doctor’s pet, which ultimately led to a second working interview. Preparing for your interview should take you at least an hour. Here are some things to consider when preparing: a. Online research about the office b. Print off a hardcopy of your resume c. Find the location on a map, plan your route, locate the closest parking lot or subway station d. Always be a few minutes early and never late e. Dress for the interview, not the job. Often, we wear scrubs to work but never to an interview, unless you’re asked to work on a patient or client Remember – You’re Interviewing Them, Too! When heading into an interview, it’s key to remember that you’re interviewing the office just as much as they are interviewing you. Don’t be afraid to ask tough questions. This could be a longterm professional home for you. We can spend anywhere between six to 22 hours a week at work, and for some people, we spend more time at work than we do with family and friends. It’s important to make sure that the office is a good and comfortable fit for you. Be sure to ask questions that can help you figure out the office culture and the daily operation: a. “How long have the staff been working here?”- long-term staff is a good thing! It means that people love working there and that there’s a good office culture. b. “How much vacation time does a new employee get?” – This is also something to negotiate as part of your contract. c. “Does the office participate in any team building activities and if, so how often?”
Know Your Worth The average dental hygienist bills anywhere between $145 to $700 per hour depending on the procedure he/she provides. Patient/client specific care and dental hygiene treatment plans vary based on the patient/clients’ needs. With that said, knowing your provincial standards is important so that you can go in asking for the right amount. Historically, inexperienced dental hygienists (myself included) often go into new jobs asking for less than they are worth. This might put you in a tough spot down the road. Fighting to ask for raises will simply get you to the national standards. Utilizing numbers provided by our associations might help you go into an interview with a figure in mind. In the province of Ontario where I practice, the ODHA provides researched metrics broken down by city, practice specialty, and years of experience. Putting a new graduate in the city of Toronto pays anywhere between $31 to $45. Our goal as dental hygienists is to work together to raise these industry standards – not lower them. The CDHA also has a job market and employment survey that is released every two years. They conduct survey analyses and collect data to depict industry aver-
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By asking these types of questions, you may also get a sense of the management and organization of a practice. Having these processes in place is very important and can help alleviate some stress throughout the year.
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ages, employment rates, and provide projections into the future of dental hygiene across Canada. By entering the workforce at a significantly lower rate ultimately this brings the provincial and national standards down. Try your best to appreciate the time, effort and sacrifices you have made achieving your dental hygiene registration and know how valuable you are to an employer. On the practice management side, dentists and practice owners are expecting that about 25 to 30 per cent of hygiene gross billings is allocated to salary. Meaning, if a dental hygienist is producing on average $150 per hour, he/she should be making roughly $37.50 per hour. With the increase in skillset and procedures, a dental hygienist could expect to increase that hourly amount as the gross billings increase. Try Temping To Find Your Groove Using an agency to secure a temp job is also a good way to find your groove. Caution – it can be challenging as a new graduate to navigate a new office but it also can be extremely exciting to see how
multiple offices work. It offers the opportunity to build and enhance strong skills on various procedures, demographics, specialty practices, using different instruments, and practice management software, just to name a few. When I graduated, I worked for a temp agency on weekends as the Perio practice was closed Friday to Sunday. I learned some valuable skills by visiting multiple offices on what generally is the busiest time of the week. Weekend appointments are highly sought after and having a temp hygienist in to help alleviate some stress can be a valuable asset. Over the course of a year, I worked with seven different practice management software systems, learned unique instrumentation techniques for a variety of new instruments, and built great relationships with other dental hygienists and office staff. It was like speed dating for dental offices; some fantastic experiences, and others I’ll chalk up to just a learning experience. Another advantage of temping is the opportunity to have a little more control over your hours. By outlining your availability with
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the temp agency, you can stick as closely to those hours as possible and there could be a lot of offices that might be aligned with those operating hours. Always Remember That You’re Not Alone Out There Looking for your dream job might be instantaneous. My two dental hygiene besties, Jessica and Emilija, have been working for the same practices since we graduated in 2007. And for me, well, it has taken over 50 per cent of my career to finally realize that I need to be my own boss and open my own practice. No two roads are the same. Some have higher climbs and deeper drops but, in the end, it’s the journey that builds us to be the clinicians we are today. Explore dental hygiene and the profession in all of its forms. Remember every day, every interview, and every office will serve as an experience to guide you to where you’re going. The final destination isn’t always clear and that’s okay. Welcome to the dental hygiene tribe. @Toothlife.Irene
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THE HYGIENIST HANDBOOK
FINANCIAL TIPS, TRICKS AND TRAPS FOR THE DENTAL HYGIENISTS A
s we approach the end of the year, it’s common for many people to look at their bank accounts and question where all the money they made has gone. Taking control of your finances requires discipline and we have provided some tips and tricks that will help you keep more money in your pockets as well as avoid some potential headaches.
Employee versus Independent Contractor Hygienists can be either employees or independent contractors. The distinction is important because it will determine not only how you file your income tax return, but what you can deduct and how much taxes you will have to pay. If you are not sure if you are an independent con-
Employee
Advantages • Receives statutory holiday pay and vacation pay • May be eligible for severance/ termination pay • Employer portion of CPP/EI is paid by employer • May be eligible for EI benefits (Unemployment, maternity leave etc.) Disadvantages • Tax deductions are limited (i.e. RRSP and Childcare etc.)
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tractor or employee, take a look at your last paycheque. Employees receive a paycheque with income taxes, CPP and EI already deducted. For example, if you earned $2,000, you may have only received $1,500 because $500 of income taxes, CPP and EI was paid to the CRA. In contrast, independent contractors would receive the full $2,000 and pay
Independent Contractor
• Wider variety of tax (Automobile expenses, cell phone, meals and entertainment, office supplies, continuing education etc.)
• Does not receive statutory holiday pay or vacation pay • Must pay for employer portion of CPP and EI (where applicable). • Not eligible for severance/ termination pay • Only eligible for EI benefits if enrolled into EI for self employed individuals
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the taxes when they file their personal tax returns. We have identified the advantages and disadvantages of each in the table below. It’s important to note that while you may prefer one over the other, the CRA may have a
different opinion and will use the following factors below to determine your status. Non-taxable benefits Instead of asking for a raise or bonuses, consider whether a
non-taxable benefit would provide a bigger impact. For example, instead of a bonus, ask for a gift. Each employer is allowed to provide unlimited number of non-cash gifts and awards to employees up to a total of $500
Factors to Consider • You determine the work to be performed on patients
Level of control • Employer determines treatment plan and work. • You rely on the Employer’s professional judgement and oversight
• You work autonomously
• You must work set office hours or schedule
• You can accept or refuse to perform work • You are not an integral part of the place you work.
• You do not have flexibility with which patients and services to perform
• You are usually able to choose your own schedule
• You are an integral team member of the place you work, attending staff meetings, staff parties etc. Tools and equipment • The employer provides all tools and equipment
• You provide your own tools and equipment
Opportunity for profit • Remunerations are fixed (i.e. hourly wage)
• There are no restrictions on the number of patients you see and the work you perform. You control the amount of income earned.
• You receive a salary
• You work at more than one clinic increasing control of your income Financial risk • Principal is responsible for legal, financial liabilities from patient complaints, malpractice, professional misconduct etc.
• You are responsible for legal, financial liabilities from patient complaints, malpractice, professional misconduct etc.
This article was prepared by David Chong Yen*, CPA, CA, CFP, Louise Wong*, CPA, CA, TEP and Eugene Chu, CPA, CA of DCY Professional Corporation Chartered Professional Accountants who are tax specialists* and have been advising dentists for decades. Additional information can be obtained by phone (416) 510-8888, fax (416) 5102699, or e-mail david@dcy.ca / louise@dcy.ca / eugene@ dcy.ca . Visit our website at www.dcy.ca. This article is intended to present tax saving and planning ideas and is not intended to replace professional advice.
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each year. These gifts are not taxable, they won’t show up on your T4 or personal tax return. Other examples include health insurance/health spending account, discounted or free dental care for employee and their families. Incorporation You may have heard from colleagues, friends and family about incorporating and how it saved them thousands in taxes. While it’s true that a significant amount of taxes can be saved/delayed due to the low corporate tax rate of 12.5% in Ontario, hygienists who are considering incorporating should ask themselves the following first:
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Am I an employee or independent contractor? Employees who incorporate are at risk of being labeled as a “Personal Service Business” (PSB). CRA restricts the tax deductions available to PSB as well as increases the corporate tax rate from 12.5% to 44.5%. In short, if you are an employee, it is not tax beneficial to incorporate.
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How much money do I make? The more money you make, the more tax savings are available through incorporating. It costs money to incorporate and to maintain a corporation. Legal and accounting fees to incorporate can be thousands of dollars. Annual corporate tax returns and financial statements will likely be much higher than filing just a personal tax return. In general, you would need taxable income of at least $120,000 for the tax savings to start outweighing the costs.
corporation is that you can delay your taxes as long as you leave the money inside the corporation. If you take out all the money for personal use then there would be no benefit of having a corporation. You may wish to track your personal expenses (mortgage, car payments, child care, groceries, restaurants etc.) and determine whether you would be able to leave say 25% of your earnings inside a corporation without missing a bill payment. If not, then a corporation may not provide any benefits. Planning for retirement Saving for retirement may not be high on your priority list, but it’s something you need to consider because the earlier you start the easier it becomes. Here are some ways to get started: Tax free savings account (TFSA) TFSAs allow you to earn tax-free investment income. For example, if you have $50,000 in your TFSA invested and it earns 5% ($2,500), you won’t have to report the $2,500 on your personal tax return. When you withdraw from a TFSA, there will also be no taxes to pay. Check with CRA to determine your TFSA balance. If you have never contributed to a TFSA you may have up to $63,500 in contribution room. Every year you can contribute up to the annual limit ($6,000 for 2020) towards your TFSA.
Do you need all your money right now? One of the primary benefits of a
Registered Retirement savings plan (RRSP) RRSPs give you a tax deduction on your personal tax return. For example, if your income is $100,000 and you contribute $15,000 towards your RRSP. You would pay taxes on $85,000 of income, not $100,000. In the future when you retire, the
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money you withdraw from the RRSP would be taxable. Any investment income earned on your RRSP would also grow taxfree until it’s withdrawn. The idea behind RRSPs is that you get a tax break now in your working years when your income is higher and in the future, when you have little income, you will be able to withdraw the contribution plus any investment earned on it at more favourable tax rates. Paying down debt You don’t want to go into your retirement years with debt. Historically low interest rates have made many families defer paying off loans. This can become a slippery slope and small changes to how you manage money can make a huge impact. For example, many people will have money sitting in a savings account earning 1% or less versus making a lump sum payment towards their mortgage or line of credit which charges interest at 3%-4% or more. There’s no one size fits all plan. Your individual circumstances will dictate which of the above you should prioritize. Some advisors will tell you to invest in an RRSP then use the tax refund from the RRSP to pay down debts or contribute to a TFSA. Other advisors might say TFSAs are the way to go because you can always take the money out if you need it without penalty. TFSA’s provide the most flexibility, paying down debt carries the least risk and RRSPs will provide immediate tax relief. Whichever you choose, all three are a step in the right direction.
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THE HYGIENIST HANDBOOK
WHY CE GOES BEYOND PROFESSIONAL OBLIGATION Beth Parkes, RDH, BSc Educational Director and QA Coach, rdhu bethparkes@rdhu.ca Beth Parkes is an engaging presenter who has been a Registered Dental Hygienist for 15 years. She has worked in General practice, Independent Dental Hygiene Practice, Orthodontics and Periodontics. She is proudly the Educational Director of rdhu in Burlington, Ontario, and a Quality Assurance coach at rdhu. Her vision is to help create leaders in the Dental Hygiene Profession, empowering them with knowledge and skill sets that will set them apart.
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A
s dental hygienists across Canada, we are united and bonded by one major, collective fear: The Continuing Competence, Quality Assurance auditing process. The mere mention of the term elicits a sequence of events including; but not limited to, sweating, blurred vision, increased heart rate and blood pressure, and a sense of overall dread. For many of us, this fear brings us to a full-on stop. We get in our own way and cannot make a move forward as we stand immobilized by the daunting task ahead. What if this could be different? Is it possible to replace fear with determination, and perhaps even a sense of pride? As registered dental hygienists in our beautiful country, we are highly educated, extremely skilled health care professionals that hold ourselves to a standard of practice leaving many other professions in admiration. Whether you are
responsible for collecting continuing education points, writing a comprehensive exam, or creating a professional portfolio, you have put in an extraordinary amount of work to become who you are today. Our schooling was simply the beginning of our learning and growing as professionals. I for one, have made the decision to change my perspective on the Provincial auditing processes. Ladies and gentlemen, we have got this one. Our professional portfolio is our masterpiece, and the chance to parade our dedication to this profession. You are a health care provider who is so engaged in your profession, that you spend a Saturday afternoon learning about the latest advancements in infection control to protect the public. You are so driven to provide the most optimal debridement, that you spend your Thursday evening at a study club to learn about new
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Create a Learning Plan: Having direction with your continuing education will optimize both your learning outcomes and your enjoyment. By being specific with the subjects you chose to learn about, you are working smarter and not harder by eliminating the need to gather up random CE hours in an attempt to make the puzzle pieces fit into some semblance of organization. Respect your time and energy by being selective with what you choose to participate in.
instrument technology and techniques. You even bring your dental representatives in over your lunch hour to research new oral hygiene products available to improve the oral health practices of your faithful clients. Use your portfolio to track and organize this learning. Show off the work you put in and look back at it often to see how far you have come. You have gained so much more in the weeks, months, and years since the person sitting hopeful and enthusiastic in your dental hygiene graduate photo. Don’t let fear distract you from the astounding dental professional you have become and are continuing to develop into. Continuing education is the fuel we need to stay engaged and excited about our profession. Let’s take a practical look at our requirements and create a strategy to optimize this undertaking.
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Finally, rather than
fearing the audit, take the opportunity to ignite your passion by writing about everything you have learned.
Keep an Open mind: Sometimes our plans change. You may start on one path, only to be presented with a new, exciting opportunity for growth. Although direction is important, and will keep us on track, don’t be afraid to veer off or venture into something unknown. We should always be in a state of assessment, implementation and self-evaluation. If your learning path is leaving you unfulfilled, perhaps it’s time to change course. The key is staying organized and not allowing yourself to fall behind for fear of failure or merely avoidance.
Complete an Annual Self-Assessment: Regardless of what Province you reside in, either use the tools provided to you by your regulatory college or simply create your own. Think about your daily practice. Are there topics that make your stomach uneasy, or questions you hope your clients won’t bring up? Use these areas of uncertainty and turn self-doubt into a learning goal. Ask questions, read articles, and look for courses specific to this topic. You just might ignite a passion for an otherwise daunting subject.
Finally, rather than fearing the audit, take the opportunity to ignite your passion by writing about everything you have learned. You just might be surprised by how much pride the end product provokes. We have a responsibility to pursue continuing education, this much is true: however, the decision is up to you to perceive privilege where others see obligation. Create a plan, ask for help, find resources and regularly check in with yourself to evaluate your process. The future of our profession is in those who strive for more and put in the hours to achieve excellence. “Education is not the filling of a pail, but the lighting of a fire”~ William Butler Yeats
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THE HYGIENIST HANDBOOK
7
CAREER BOOSTING REASONS TO BEING HEALTHY & FIT
Uche Odiatu DMD; Masha Bakhshandeh RDH Uche Odiatu, DMD, is a Toronto area dentist and a professional member of the American College of Sports Medicine and lectures throughout North America on total patient health. Instagram: @Fitspeakers
Mahsa Bakhshandeh, RDH, graduated from Durham College and has been in private practice for nine years. She enjoys travelling and exploring the world, its many cultures and their variety of wonderful cuisines. Mahsa is a licensed Zumba Instructor. Instagram: @Mahsa.RDH
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orget trying to lose weight for the next selfie on Instagram – get healthy and fit to boost productivity and mental clarity. You see being physically fit has major physiological benefits that go far beyond fitting into your skinny jeans. Exercise scientists have demonstrated that a fit body supports boundless energy, a more robust immune system, an improved memory, lowers anxiety and ultimately, your ability to do every aspect of a hygienist’s job. Combat “Sitting Disease” Sitting for long periods of time has now been linked to a wide variety of illnesses and disease (Christine Friedenreich, Senior Epidemiologist, Alberta Health Sciences). Numerous stud-
ies in the American College of Sports Medicine’s journal have reported on the immense negative impact of sedentary living and its ability to decondition your miraculous body. Sitting has been called “the new smoking”. Harsh words for the couch potato. Seventy per cent of our waking time is spent sitting on our largest muscle. This is the most that humans have sat in thousands of years of history, and it’s shrinking our postural muscles and melting our joints. Chiropractors for years have been telling us about the long-term damage that sitting does to our posture and lower backs. Well, physiologists are now seeing that sitting all day has negative implications on breathing, core strength, lymphatic drainage and blood pressure. Incorporat-
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But (with a capital “B”) we must walk our talk, all while experiencing less chronic pain in the process. It seems paradoxical to lecture to patients on developing more discipline to choose tooth friendly foods and better home care if we ourselves are sedentary or smell like a cheeseburger and fries. Psychological studies have shown role modeling is the best way to influence behavior in the dental office. John Quincy Adams’ words keep ringing in my ears. “If your actions inspire others to dream more, learn more, do more and become more, than you are a leader.”
Lower Your Overa ll Disease Risk “The most powerful way to reduce your inflammatory factors (a leading cause of chronic disease ie heart disease, cancer, Alzheimer’s, metabolic syndrome) is to lose excess weight,” Walter Willett, PhD, Chair of the Nutrition Department at the Harvard School of Public Health. If you have noticed that many serious diseases (meningitis, encephalitis, colitis, pancreatitis, arthritis, osteomyelitis, esophagitis, appendicitis, cellulitis, hepatitis, periodontitis, etc.) have inflammation at their core, you might be motivated to maybe lose that last five
Seven out of 10 people in the North America are overweight or obese, and with our extended amount of patient contact time, it would be easy to make a difference in someone’s life by gently sharing your own experience getting in shape. And why not make it a gentle journey to getting fit? Add more whole foods to your diet. Choose foods mindfully. If you have a low activity day, eat accordingly. Reducing body fat is not about eating less. The new science says it’s about eating right. Once your body is getting the foods that it craves, essential fats, fiber, and high-quality proteins, it gently turns down hunger cravings. This is much easier than simply cutting calories. And it’s not painful to do it this way. This is a mind-blowing concept for many, as most people still believe health is a “no gain” plan. This style of getting in shape is
Lower Anxiety & Stabilize Emotions Studies have shown that an inactive lifestyle is associated with a higher risk of depressive symptoms. Depression is one of
to ten pounds. Hygienists could very well be the patients’ number one role model for healthy living with the reduction of their own inflammatory burden with some simple tweaks to dietary habits. There are a number of simple weight loss plans we could easily suggest to patients directly or in passing. It’s the gentle non-judgmental guidance in our chairside conversations that would support positive lifestyle change.
old school. Throw away your MC Hammer pants and your Vanilla Ice CD’s and get current. A sixyear Stanford study reported in the American College of Sports Medicine Journal showed that a simple walking just once a week could decrease your chances of mortality from cardiovascular disease by almost 50 per cent. As dental professionals, it is well within our scope of practice to talk nutrition with our patients.
the most debilitating mental disorders and the leading cause of disability in the western world (American College of Sports Medicine Feb 2012). Depression is associated with poor sleep, disrupted digestion and chemical disruption of the brain. We aren’t talking about occasional sadness – we are referring to immobilizing chronic depression. It is linked to heart disease and over a lifetime, cognitive decline.
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ing core exercise and resistance training into your exercise program would be an ideal way to strengthen your postural muscles and decrease the odds of a career-ending injury.
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Get FIT, Get SMARTER! Exercise scientists and neuroscientists have shown being physically active improves brain function. This little-known fact is an insider strategy. The better your brain works, the more you will earn. One way to increase your credentials is to get more
the amount of the neurotransmitter BDNF Brain-DerivedNeurotrophic-Factor, which acts like Miracle Grow in your brain – increasing communication between your 100,000,000,000 neurons. A review of 900 papers over 50 years has provided strong evidence of the benefit of physical activity on your brain. Afraid of aging and the diseases that go along with advancing years? Regular exercise can reduce your risk of getting Alzheimer’s disease by nearly 40 per cent (Ontario Brain Institute 2013). A regular physical activity habit appears to be best over your entire life, but Laura Middleton, an Assistant Professor of Kinesiology at the University of Waterloo, has revealed that a specific window of time in the active teenage years (12-19) was strongly associated with lowering the incidence of cognitive decline later in life.
Create A Body That Is An Impenetrable Fortress Against Disease As people get older, their immune systems get cluttered from fighting a lifetime of infections. An overcrowded immune system increases the risk of infection. Exercise DE-clutters and makes space in an older immune system (Exercise and port Sciences Reviews January 2011). The metaphor we use is defragging your laptop of old software or programs you no longer use – and by doing so, your laptop performs better. Isn’t this enough to
degrees, another way is to absorb more knowledge, improve your vocabulary and deductive reasoning. Norm Doidge, MD, author of The Brain that Changes Itself, wrote that being fit boosts the brain’s ability to make new stem cells, and therefore, its ability to remain youthful. Harvard professor of Psychiatry and the author of the groundbreaking book, Spark, John Ratey, MD, showed that regular exercise habits boost
High amounts of physical activity in this key window was shown to have a correlation with a protective effect over developing cognitive decline. She theorized it was between 12 and 19. So, if you missed it, are you ruined? No! If the best time to have enjoyed a regular exercise habit was when you were a teen, the second-best time is RIGHT NOW! A meta-analysis of physical activity studies showed benefits to
make you want you to keep up your exercise schedule? Again, we can’t help but bring up quality sleep. Getting a minimum seven hours of sleep a night will not only help strengthen your immune system and reboot your brain, but it will also leave you rested with more energy to follow-through on your healthy habit resolves. It is one of our most ardent personal and professional desires to get people passionate about their
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There are many ways to prevent and treat this but a new way of lowering your chances of this disease would be incredible. Did you know that many UK physicians recommend a regular walking regimen for patients with mild depression? What are the benefits? Mood boosting endorphins and serotonin. Being a healthcare provider is rewarding but the day-to-day duties can overwhelm the reserves of the best intentions, especially if you don’t have the tools to balance a busy professional and personal life.
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increased cognitive functioning, deductive reasoning and reaction time (Journal of Medicine & Science in Sport & Exercise June 2012). A better functioning brain will support every aspect of the health care provider’s professional and personal life.
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Improve Your Ability To Take In Oxygen & Be Energetic This is the most valuable resource on the planet. Mitochondria are valuable organelles in your body and they need oxygen and glucose to make ATP. The human body makes over 147 pounds of these energy packets a day. Why don’t we gain 147 pounds a day? Because we use every one of those energy packets to beat our hearts 86,000 times a day, inhale 12,000 times a day, see six to eight patients a day and scale hundreds of teeth each day. We have loads of these energy factories as kids
you’re 25 or 35 and now can you just start when you reach 50? If you’re not active now the chances of you being active later are slim. You simply have to condition your mitochondria now. According to the Medicine and Science of Sport and Exercise journal, it is reported that active people can epigenetically turn back on tired dysfunctional mitochondria, increase their size and number. Can you think of the benefits in your clinic life? More exercise fueled energy means it increases your ability to see that extra patient or act authentically with enthusiasm, versus faking it with coffee or energy drinks. Family and friend benefits? You will have more energy for these beautiful people after work. BONUS!
but with age, they start falling into disrepair. This is one of the reasons young kids fly around at birthday parties and the parents only have the energy to talk and take multiple pictures on their iPhones. Michael Colgan, PhD, wrote in his book Saving Your Brain that with mitochondria failing with age, so does our ability to generate energy. By age 50, almost half of most people’s mitochondria are no longer functioning at capacity. Hence the lack of drive, vitality and mojo in that demographic. Okay, so
Slay the Stress Dragon Regular exercise trains your nervous system to be less reactive to stress: reducing oxidative stress, blood pressure swings, and immunosuppression (American College of Sports Medicine 2005). Stress has been implicated as a huge force to be reckoned with in the battleground of modern dental practice. Dental professionals are well aware of tight scheduling, working on anxious patients, challenging team relations and full family commitments. Not having
team to have a bigger vision for their jobs and their lives. For those who have a challenge lighting the torch of leadership in their offices, here is an interesting piece of literature that may give you a helping hand: People are more likely to listen to and follow people who are energetic and healthy. This was written about in the book Why Some People Lead, Why Others Follow and Why it Matters by Mark van Vugt.
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personal health, get them moving again and to reclaim their health that is their birthright.
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a successful stress management strategy is a prescription for emotional and physical disaster. In the March 2012 Journal of Medicine and Science in Sport and Exercise, there was a powerful article showing the ability of a single session of exercise to improve one’s mood and decrease anxiety. How valuable would this tool be at the end of a hectic clinic day before you head home to spend time with your family? The benefits of regular physical activity for the dental professional transcends a nicer reflection in your bathroom mirror. It has the ability to enhance every aspect of your personal and professional life. Every dental professional would love to be the kind of leader that inspires their
We will see you in the gym or on the walking trails.
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THE HYGIENIST HANDBOOK
HOW TO CRAFT THE PERFECT RE-CARE PROGRAM Jodie Cantarelli AAS, RDH, Dip.AdEd Manager of Dental Hygiene Programs at dentalcorp Jodie is a Manager of Dental Hygiene Programs at dentalcorp. In her role, she partners with dental teams across Canada to help them provide optimal patient care. Jodie earned her degree in Dental Hygiene, diploma in Adult Education at St. Francis Xavier University. Her professional experience includes private practice, a clinical evaluator for the College of Dental Hygienists of Ontario, a clinical and didactic instructor, program director, past advisory board member, published author and professional speaker.
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n the world of dental hygiene, we commonly refer to routine follow up exams with patients as ‘recall’ appointments. More appropriately, these can be considered re-care exams, as our patients aren’t recalled per se, rather compassionately re-cared for through the ongoing monitoring and maintenance of their oral health. Re-care exams play a very important role in the retention of patients and the success of a practice at large. The repeated face-to-face interactions afforded by re-care appointments have the potential to build long term relationships between practitioners and patients. Effectively managing your re-care exams is essential in creating a smooth and positive experience for patients that will keep them coming back to your practice. The tips below will aid you in
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crafting a successful and efficient re-care program that will benefit both patients and team members. Start the day with a team huddle. A key component of a successfully run practice starts with a pre-planned daily morning huddle that must include the entire team. Effective re-care programs are a collective effort and require the active involvement of all practice team members. Ensure that the team is prepared for the day by organizing and reviewing the schedule, confirming lab cases, anticipated patients, what support is needed, equipment required, financial issues, and other factors that will help streamline the day. Synergy fosters a prepared and organized team where patient experience is always at the forefront. Be prepared and present in the operatory. Know the patient’s
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name and prompt the dentist by saying the name out loud (e.g. “Dr. Jones, you remember Mrs. Smith?”). Eliminate the hallway talk and create a system with an organized flow between you, the dentist and the patient through step-by-step communication that clearly outlines the re-care exam. Sit in front of the operatory chair rather than behind. Your body language speaks volumes. Create a 3-way conversational setting to physically involve all parties and allow for eye contact. Outline the key points of the patient’s chief concerns and medical history, as well as oral cancer screening. This includes blood pressure reading, medical conditions and treatments, medications, allergies and other factors important to note. Invite the patient to chime in about their medical history. Speak in laymen’s terms. Allow the patient to understand and own their oral care. If they understand, they will feel valued and more likely follow through with treatment. Use the evidence and don’t lecture. Maximize your opportunity to connect and guide the patient through their exam by taking real life intra-oral photos of their teeth and gums, and specific areas with new or pre-diagnosed issues. Ensure that intra-oral photos are ready and posted in front of the patient where he/she can see and be engaged in their diagnosis with the dentist. A picture speaks a thousand words. Guide and direct the dentist where your findings are. It’s important to outline all your findings in a step-by-step method rather than all at once. As the hard tissue exam is performed, follow the flow to outline your findings in a quadrant that the dentist is
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Be prepared and present in the operatory. Know the patient’s name and prompt the dentist by saying the name out loud (e.g. “Dr. Jones, you remember Mrs. Smith?”). Eliminate the hallway talk and create a system with an organized flow between you, the dentist and the patient through step-by-step communication that clearly outlines the re-care exam. examining (e.g. “Dr. Jones, in that lower left area, can you please assess the first molar.”) Recap, document and review the dentist’s diagnosis and hygiene co-diagnosis with the client. Outline the patient’s oral health, completed treatment and periodontal status according to the AAP Guidelines, your plan and recommendations for hygiene treatment, and possible referrals if needed. It’s important the dentist and dental hygienist complete the exam together to create a customized treatment plan and clarify any questions the patient may have before the dentist leaves the operatory. Review radiographs or document prescribed radiographs for the next dental hygiene exam. Outline and discuss current radiographs with the dentist to ensure the radiographic interpretation is documented and included in the patient’s treatment plan. In addition, maximize planning and time management by obtaining documented prescription or plan for radiographs at the next dental hygiene appointment. Pre-schedule next dental hygiene appointment(s). For consistency and effective treatment outcomes, ensure that appointments are preplanned, secured and organized to maximize the patient care plan. Provide patient specific instructions and oral hygiene aids. Out-
line specific home care instructions. Provide written prescription or instructions outlining optimal home care followed with next visit expectations. If applicable, maximize a digital platform to support specific home care plan. Personally escort the patient to the administration area and verbally transfer the care to the appropriate business team member. (e.g. “Karen, Mrs. Smith is all done for today. I have scheduled her next dental hygiene visit. Dr. Jones requested two appointments to treat the upper left back molar. I have outlined everything in the chart for you. Mrs. Smith, Karen will now take over and look after you from here. Please remember to contact me should you have any further questions or concerns. I will see you in three months. Have a great day.”) The business team needs to ensure that all financial and scheduling aspects are always organized and completed while supporting the patient’s specific clinical care, regardless of their insurance or financial status. The most common mistake is enabling the insurance to dictate a patient’s specific care. As dental hygienists, it is our professional responsibility to support and allow the patient an opportunity to fully understand what the treatment is and why it is necessary, rather than solely relying on the financial perception.
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THE HYGIENIST HANDBOOK
THE DENTAL HYGIENIST AS A TRUSTED RESOURCE PROVIDER: THERE IS A RESOURCE FOR THAT! H
Natalie Muccioli Emery, RDH, BHA Natalie Muccioli Emery is a dental hygiene educator at Oxford College, she is dedicated to addressing oral health inequalities and issues surrounding access to oral health care. She received her bachelor’s degree in Health Administration, Health Services Management from Ryerson University and worked in private dental practice for 12 years. She serves on the Board of Directors for the Gift from the Heart project. Natalie hopes for a future where dental hygienists will be valued members of interdisciplinary health care teams helping to improve overall health outcomes.
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istorical thinking about the role of the dental hygienist as a member of the health care team is that their purpose is primarily auxiliary or clinical.1 However, a paradigm shift in the profession has been in process for several years.2 The shift in dental hygiene emphasizes the roles of educator and health promotor as primary roles, giving these roles as much significance as the traditional clinical role. This emerging multidimensional view of dental hygienists seems to align with the growing body of evidence highlighting the many ways oral and overall health are linked.3 With increased knowledge of oral and overall health linkages, dental hygienists will become more proficient at providing resources to clients who would benefit from an interdisciplinary approach to health care. Therefore, the dental hygienist may act as a trusted resource provider for the community and colleagues. What does it mean to be a trusted resource provider? Traditionally, when a dental hygienist recognizes a condition that requires a dental diagnosis, medical diagnosis or consultation from
another health care professional, a referral is provided.4 However, acting as a trusted resource provider elevates the referral process to a collaborative process where the dental hygienist becomes further integrated into the community and a partner on the interdisciplinary healthcare team. Embracing the role of a trusted resource provider can feel daunting. However, starting with the simple steps of awareness of available resources, knowledge of the needs of local communities, and commitment to increasing dental hygienists’ profile in the community can set the wheels in motion. By using these steps as a starting point, dental hygienists can be well on their way to experiencing an exciting and impactful dimension of their role as a health care provider. Acquisition of knowledge is an essential first step when the dental hygienist has committed to exploring the role of trusted resource provider. There are numerous, accessible, high-quality resources available for dental hygienists, covering topics such as oral health and overall health linkages, oral health and the aging population, resources for caregivers, and sen-
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sitive issues such as abuse and neglect. Dental hygienists can access several of these resources through their professional associations. These resources include webinars, courses and links to other reliable organizations such as the Centers for Disease Control and Prevention and the Canadian Interprofessional Health Collaborative.5 The key to realizing success as a trusted resource provider is to be able to anticipate what resources clients may require. To expect what resources clients may require, the dental hygienist must establish an understanding of the needs of the local community which they serve. It is necessary to note this does not mean that dental hygienists need to be well versed on every single topic where they may potentially need to act as a resource provider, that level of expectation is unrealistic. However, dental hygienists can hone their resource providing skills through understanding the needs of their community and effective therapeutic communication. Local Public Health Units provide up to date health surveillance and epidemiological data presented in a ready to interpret format.6 In larger metropolitan centers, data about the needs of an area is often further broken down by neighbourhood, providing insight on potential community needs. For example, if a dental hygienist finds their practice setting in an area that experiences a heavy burden of diabetes, the dental hygienist can anticipate that clients affected by or at risk for diabetes may benefit from additional resources related to their condition.7 When a situation arises where a dental hygienist is unsure of what resources may be beneficial for a client, consider going back to the first step and
acquire the knowledge and assess what is available. There is nothing wrong with saying to a client, “let me do some research and get back to you” or “I am not sure, but I know someone who might be able to help.” The client will appreciate the honesty, communication and commitment to collaborative practice of their dental hygienist. Lastly, and most importantly, the role of the dental hygienist in the community is fundamental to realizing the full potential of the benefits related to acting as a trusted resource provider. Arbitrarily dispensing information to clients with no follow-through will have little to no impact on improving health outcomes.8 Where acting as a trusted resource provider differs is in the element of the trust itself. Trust is defined as “assured reliance on the character, ability, strength, or truth of someone or something” or “one in which confidence is placed”.9 The dental hygienist can help to
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build trust through community engagement.10 Examples of community engagement include; participation in community-building initiatives such as events related to the local chapter of the Canadian Diabetes Association, charitable events such as the Gift from the Heart project and fostering meaningful connections with community members. Even a simple action such as wearing dental hygiene flare can spark a conversation about the role of the dental hygienist on the health care team. Acting as a trusted resource provider is an exciting and rewarding facet of dental hygiene practice, no matter what practice setting the dental hygienist may find themselves. Working as a trusted resource provider provides the dental hygienist with an opportunity to expand their knowledge base, enhance understanding of community health needs and actively engage in the community in various capacities to improve health outcomes.
References: 1. Gillis M, Praker M. The professional socialization of dental hygienists: from dental auxiliary to professional colleague. NDA Journal. 1996; 47:7-13. 2. Richardson F. Evolution, Not Revolution. Probe. 2002;36(1):24. 3. Canadian Dental Hygienists Association. Position Statements: Heart Disease and Diabetes [Internet]. 2006. Available from: https://www.cdha.ca/pdfs/Profession/ Resources/heart_diabetes_statement_eng.pdf 4. College of Dental Hygienists of Ontario. Guideline: Interprofessional Collaboration [Internet]. 2016. Available from: http://www.cdho.org/docs/defaultsource/pdfs/reference/guidelines/gui_interprofessional_collaboration.pdf 5. Interprofessional Collaboration Resources [Internet]. Ontario Dental Hygienists’ Association (ODHA). 2019 [cited 28 October 2019]. Available from: https://odha. on.ca/students/ipc-resources/ 6. Health Surveillance and Epidemiology Reports [Internet]. City of Toronto. 2019 [cited 28 October 2019]. Available from: https://www.toronto.ca/city-government/ data-research-maps/research-reports/public-health-significant-reports/healthsurveillance-and-epidemiology-reports/ 7. Toronto Public Health. Health Surveillance Indicator: Diabetes [Internet]. Toronto; 2017. Available from: https://www.toronto.ca/wp-content/uploads/2017/12/8c72tph-hsi-diabetes-july18f.pdf 8. Impact of Communication in Healthcare | Institute for Healthcare Communication [Internet]. Healthcarecomm.org. 2011 [cited 28 October 2019]. Available from: https://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/ 9. Definition of TRUST [Internet]. Merriam-webster.com. 2019 [cited 28 October 2019]. Available from: https://www.merriam-webster.com/dictionary/trust 10. Community engagement for quality, integrated, people-centred and resilient health services [Internet]. World Health Organization. 2019 [cited 28 October 2019]. Available from: https://www.who.int/servicedeliverysafety/areas/qhc/ community-engagement/en/
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