Child Oral Health Clinical Case #3

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Question 1 of 3

1. Question
You work in a community health center in a large urban area. Carlos, a three-year-old boy, is brought in by his mother for a well-child visit. The family has recently emigrated from Mexico. He has not received regular well care and his mother is concerned about cavities in his teeth. She reports that Carlos’ grandmother has reassured her that having cavities at this age is normal and that he need not be treated at this age.

Which behavior best exemplifies the mutual respect and trust that are foundational to interprofessional collaborative practice?
- Inform the patient’s mother that his grandmother’s ideas about oral health are outdated and harmful. While it is important to correct misunderstanding about health practices, to develop a relationship based on mutual respect, it is important to first develop a trusting relationship with patients, families, and other team members.
- Involve dental and medical team-members in the management of Carlos' oral health.
- Offer to help Carlos’ family to understand and embrace the cultural norms of the United States. To maintain a climate of mutual respect and shared values, it is important to embrace the cultural diversity and individual differences that characterize patients, populations, and the health care team. It is important to explain your recommendations in the context of family and cultural norms, such as how accessing early dental care can prevent disease and keep the child healthy.
- Respect the grandmother’s wishes to forgo treatment for Carlos. Not treating Carlos because of family wishes creates an ethical dilemma because it brings the principles of autonomy and nonmaleficence into conflict. To maintain a climate of mutual respect and shared values, it is important to manage ethical dilemmas specific to interprofessional patient- and population-centered care situations.
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Question 2 of 3

2. Question
During the initial visit with Carlos and his mother, you perform a risk assessment and an oral health history. You determine that Carlos has not had regular health care and that his mother has only been to a dentist to have several of her teeth removed. His diet includes frequent juice and sugary snacks.

Which of the following behaviors best exemplifies the acknowledgement of roles and responsibilities of participating members of the healthcare team?
- Encourage each member of the team to work independently. To appropriately assess and address the healthcare needs of patients, it is important to forge interdependent relationships with other professions to improve care and advance learning. In this example, the involvement of a dental provider, a nutritionist, a social worker, and consultation with a case manager to help evaluate needs and barriers to accessing the health care system would all be appropriate. A nurse or medical assistant may be able to provide anticipatory guidance regarding oral hygiene and healthy eating habits. Team members will need to communicate their findings and together create a plan of care.
- Explain your role and responsibilities and how you will work independently to provide the best possible care for your patient. To appropriately assess and address the healthcare needs of patients, it is important to explain the roles and responsibilities of other care providers and how the team works together to provide care. Carlos and family members need to understand all the resources available to them and who best to seek out for specific types of concerns.
- Communicate with other members of the healthcare team when developing a treatment plan.
- Do as much as you can for Carlos first before involving other members of the healthcare team. To appropriately assess and address the healthcare needs of patients, it is important to use the full scope of knowledge, skills, and abilities of available health professionals and healthcare workers to provide care that is safe, timely, efficient, effective, and equitable. Carlos and family members need to understand all the resources available to them and who best to seek out as specific concerns arise.
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Question 3 of 3

3. Question
You perform an oral examination and encounter the following (photo). You determine that Carlos requires the intervention of a dentist for early childhood caries. You discuss treatment options with the family and the medical assistant applies fluoride varnish.

Rocio B. Quinonez D.M.S., M.S., M.P.H

Which of the following behaviors best exemplifies effective teamwork among participating members of the healthcare team?
- Use this opportunity to educate the patient about the specific role of your profession in the provision of oral health care. To appropriately deliver patient-centered care, it is important to apply leadership practices that support collaborative practice and team effectiveness. Focusing on your profession to the exclusion of others is contrary to collaborative practice and team effectiveness.
- Ensure team agreement about the role of medical assistants in this case. To appropriately deliver patient-centered care, it is important to engage self and others to constructively manage disagreements about values, roles, goals, and actions that arise among healthcare professionals and with patients and families. Differences of opinion about team member roles may represent concerns about scope of practice, appropriate training, or overburdening of responsibility. Exploring the reasons behind disagreements may reveal an opportunity for systems change.
- Clarify that the medical assistant is solely accountable for the results stemming from fluoride application. To appropriately deliver patient-centered care, it is important to share accountability with other professions, patients, and communities for outcomes relevant to prevention and care. Everyone involved in Carlo’s care is responsible for the outcome of decisions made. This is why effective communication is essential to healthy team function, as well as patient safety and positive health outcomes.
- Critically evaluate the effectiveness of the team using process improvement strategies.
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Child Oral Health

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