Chelsea Chagnon

While on a service learning rotation through the Park Place Dental Clinic I was
personally involved in an incident that raised important personal and professional issues for me.
My 10:15 patient had a Premedication sticker on her chart, and review of her medical history
indicated that she had undergone a hip replacement in April 2014. Review of her treatment
history revealed that she had been seen once before for an extraction and had premedicated
with 2g of amoxicillin an hour prior to that appointment for antibiotic prophylaxis due to joint
replacement. When I asked the patient if she had premedicated that day she stated that she
had not and seemed confused as to why she would have to. I explained the possibility of a
prosthetic joint infection to the patient and excused myself to consult with the attending dentist
present that morning. Upon explaining the situation to the dentist, he asked me if the patient
was here for an extraction. I stated that no, the patient was presenting for hygiene services.
His reply was that I should go and treat the patient. I displayed hesitation with his decision and
he informed me that he would sign the chart. At that, I explained to the patient the risks once
more and proceeded with treatment.
To me, this event was profound because I was treating a patient in a manner that goes
against the clinical guidelines set forth by VCU School of Dentistry. As I was the clinician
providing treatment, I was the one personally putting the patient at risk. The conversation
occurred in the presence of a dental assistant, but no other VCU students were present as they
were all involved in their own appointments that morning. On another day, one of the dental
students had a similar situation with a patient who had presented without premedicating. She
informed a different attending dentist of the situation and her plans to send a medical consult to
the orthopedic surgeon prior to providing treatment. The attending dentist agreed and signed
off on the medical consult.
Upon reviewing the patients medical history and gathering information, it was my belief
that the patient needed to be dismissed for the day so that a medical consult could be obtained.

Chelsea Chagnon
The attending dentist wanted me to treat the patient without seeking a medical consult or having
them premedicate. As a student, I am not licensed. I followed his directions and noted in the
chart that the patient was seen under his advice. When I have a license and am practicing, I
may have to make these decisions myself on in collaboration with my doctor. I think this speaks
to the importance of working for a doctor with similar view points. I would not want to work for a
doctor who would treat a patient who is not medically cleared to receive treatment just to have
someone in the treatment chair. This can be tied into the standards of professional
responsibility of a dental hygienist.
If I was placed in the same situation again, I may choose to approach the issue
differently. When I approached the attending dentist, I simply stated that the patient had
undergone joint replacement in April 2014 and had not premedicated for her hygiene services
despite having premedicated previously for an extraction. If I had a change to do this over, I
would present the case differently. If I had gotten a medical consult form ready and approached
the attending dentist with a plan for sending out a medical consult and re-scheduling the patient,
perhaps it may have been better accepted. Instead, I approached the Dr. without a plan, which
perhaps limited the situation.
It is important for a dental hygienist to have a philosophy of practice and recognize limits
they will set for themselves professionally and ethically. It is important to have a mutually
respectful working relationship with the dentist or dentists you are employed by or work under
the supervision of. Having taken numerous classes with the dental students, I would hope to
work for someone who understands and respects the level of education and knowledge that a
VCU hygienist brings to their position. Clinical practice guidelines set forth by the American
Dental Association and the American Academy of Orthopedic Surgeons have used evidencebased guide found no direct evidence that dental procedures involving gingival manipulation
cause prosthetic joint infections. However the VCU Clinic manual requires that a medical

Chelsea Chagnon
consult be obtained prior to making decisions regarding antibiotic prophylaxis for joint
replacement patients, and that those decisions be made with consideration of the patient wishes
and the procedure to be performed. I feel that this system is appropriate for me and the
philosophy of practice that I hope to practice under, allowing me to protect myself and my
patient. This is in line with the principle of non-maleficence set forth by the Code of Ethics for
Dental Hygienists stating We accept our fundamental obligation to provide services in a
manner that protects all clients and minimizes harm to them and others involved in their
treatment.1

References:
[1] American Dental Hygienists' Association. Bylaws and Code of Ethics. 2014 June 23:31.