Applied Learning: Hygienist Puts Brush-On Education to Use

Trinity Cleveland, RDH, was volunteering at the Arizona Dental Mission of Mercy (AZMOM), an annual two-day event that provides dental services to underserved populations. It was her ninth time helping at AZMOM.

“In Arizona, very few adults have access to dental benefits in Medicaid,” Cleveland says. “There’s a very small population that has that benefit. So, a lot of people come to these events.”

This time, working in the dental hygiene section of the event was different for Cleveland. As in past years, she came with the same spirit of optimism and desire to help. And it certainly wasn’t her first time treating patients with caries — Cleveland has seen countless cases as a dental hygienist.

But this was the first time she used silver diamine fluoride (SDF) as a treatment.

Cleveland gained knowledge about SDF — and other brush-on therapies — with more than 650 peers during the CareQuest Institute webinar “SDF and Beyond: Patient-Centered Brush-On Therapies for Caries Management” held just a few days before the AZMOM event. In the webinar, the expert panel talked about SDF, a water-based tinted liquid that can be brushed on teeth every six months to stop them from decaying. SDF is a form of minimally invasive care (MIC) — a nonsurgical alternative to help preserve teeth. It’s not as expensive or invasive as drilling and filling the tooth, and it reduces pain and hypersensitivity.

“I was able to get enough information from that webinar that I could very comfortably pass along to the patients to help them make an informed decision,” Cleveland says. “It was a great feeling.”

During the webinar, the expert panel explored minimally invasive therapies and how to offer them based on patient needs. They also discussed how to empower oral health teams to use them to provide patient-centered care and how to navigate future advancements. 

“The quality of the content and presenters is phenomenal. It’s just top-notch, and I appreciate that,” she says.

Applying Practical Knowledge — and Applying Brush-On Therapies

One patient from the event sticks out in Cleveland’s mind.

“She was probably mid-30s. Rampant class V caries just everywhere,” Cleveland says. “There’s no way we’re going to be able to take care of most of her dental needs.”

Cleveland walked the woman through the pros and cons of SDF, explaining the main side effect: SDF will stain any caries on the teeth black.

“She goes, ‘My teeth are already black. Why do I care if they’re stained? If this is going to help buy me some time, I’m all in,’” Cleveland says.

After Cleveland applied the SDF and finished the cleaning, the patient went on to the dentist for more care.

“I felt confident when I went in to use it,” she says. “I wasn’t apprehensive about it at all.”

Cleveland ran into the patient later in the day, an interaction that has stayed with her for weeks.

“I saw her when she was sitting in line to do the extractions, and she was just so grateful,” Cleveland says. “And as is typical with a lot of people, she was scared, but she was smiling and crying and hugged me and was so grateful that we were able to give these things to her to give her a jump-start to change that trajectory.”

Improving Outcomes for Medicaid Beneficiaries

Cleveland began her career as a dental hygienist for a private practice, but for the last four years she’s been a government healthcare consultant at Mercer, a consulting firm that provides services ranging health and benefits to investments and retirement.

“I try to improve the health outcomes of Medicaid beneficiaries, essentially,” she says. “We help the state to come up with innovative ways for care delivery and services and help them set up new programs or revamp their standing ones.”

She has volunteered in 9 of the 10 AZMOM annual events, which are run by the Central Arizona Dental Society.

“Everything is by volunteerism and donations,” Cleveland says. “And it is absolutely amazing. I have goosebumps right now talking about it. We provide dental services to anybody who shows up. Everything is free, but we can’t do everything for everybody.”

This year, more than 1,100 people received dental care valued at a total of $1.7 million.

This wasn’t the first year AZMOM offered SDF to patients — they’ve had it at the event since 2019. But it was the first time Cleveland had used it. That’s because in prior years, she worked in the local anesthesia part of the clinic, not the dental hygiene part. She wasn’t the only one using SDF on her patients that day.

“It was frequently off of the table where all the central supplies are, so I’m assuming it was used quite a bit,” she says.

Later that day, Cleveland was able to apply even more knowledge gained from the brush-on therapies webinar when a woman in her 40s walked in.

“She had some cavities — not a bunch, but she had a few — and so she was going to get a couple of them fixed,” Cleveland says. “And she had told me that she had either been rinsing with or swabbing on povidone iodine onto her cavities because she read somewhere that that might be helpful to stop decay.”

The webinar Cleveland attended also covered the benefits of another form of MIC — povidone iodine, a water-based liquid that can prevent tooth decay.

“And she definitely had caries there, but they were arrested (stopped). They were in a good spot,” Cleveland says. “And I was like, ‘Wow, this is amazing.’ And I told her, ‘Oh my gosh, I just learned about this a couple days ago on this webinar I took.’ So, I was able to validate that information for her. She was just thrilled that she wasn’t messing something up.”

The Value of CareQuest Institute Webinars

Cleveland says the CareQuest Institute webinars are extremely helpful, and she has attended many on topics ranging from value-based programs to mobile care. The knowledge she gains is helpful to her not only as a dental hygienist but also as a government healthcare consultant.

She takes the information from those webinars back to her team of nurses, pharmacists, behavioral specialists, and other colleagues, and shows them how better oral health leads to better overall health — something she couldn’t do as a hygienist at a private practice.

“Even though I miss getting my hands wet in the clinical setting,” she says, “I just feel like I’m in a really good position to touch millions of lives instead of the 8 or 10 we might see in a day, and that makes me very happy.”