Acute Dental Problems Clinical Case #2

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Question 1 of 3

1. Question
Katy is a 14-year-old high school student who is brought to the clinic by her mother. The mother was upset to learn that Katy had her lower lip pierced over the weekend, and wants to discuss this today during her check-up.

What key message should the primary care clinician communicate to Katy and her mother about oral piercing?
- “Your lip jewelry can cause gingival recession.” Primary care clinicians should organize and communicate information with patients in a way that is understandable. For example, in common language, gingival recession can be described as gum tissue surrounding the teeth wearing away or pulling back and exposing more of the tooth.
- “I agree with your mother. You should remove your lip jewelry.” Primary care clinicians should embrace cultural diversity and respect the patient’s values, priorities and preferences for care. For example, adolescents frequently choose activities that challenge their parents’ authority. Working with the family on communication might be more productive to your long term relationship with Katy and mom and communication between family members.
- “Let’s review some important information to prevent oral piercing complications such as infection and damage to your teeth.”
- “Look at these pictures. This should convince you and your friends not to pierce.” Primary care clinicians should take time to develop a trusting relationship. Primary care clinicians should advise adolescents about safety measures, oral health hygiene, and prevention of oral piercing complications, including, but not limited to, gingival recession, tooth fracture, infection. Importantly, primary care clinicians should take the time to ensure that patients understand the information shared with them.
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Question 2 of 3

2. Question
Six months later, Katy returns to the clinic presenting with chipped enamel of her upper central left incisor due to her lip jewelry. You inspect her oral piercing site and jewelry, a metal ball screwed into a barbell shank, to be intact and with no signs of infection. To address Katy’s chipped tooth, you make a referral to a dentist, but Katy claims the last dentist “did not think the piercing was a big deal”.

How should a primary care clinician collaborate with the dentist to meet Katy’s oral health care needs?
- “If dentists were doing their job educating adolescents about oral piercings, then we would see less piercings.” This statement may contribute to interprofessional conflict. Primary care clinicians express their knowledge and opinions in a clear and respective manner.
- “I will refer Katy to another dentist if you don’t tell her to remove her lip jewelry.” This statement may contribute to interprofessional conflict. Primary care clinicians communicate with other health care professionals in a way that supports a team approach to health promotion and disease prevention.
- "Let's discuss an oral health promotion and prevention plan together with Katy."
- “Dentists should keep up on the latest research regarding oral piercings complications.” This statement may contribute to interprofessional conflict. Primary care clinicians use respectful language in difficult situations.
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Question 3 of 3

3. Question
As a primary care clinician working in this clinic you have seen an increase number of young patients with oral piercings, and note that most adolescents are unaware of the potential complications. There is a lack of knowledge and differing perspectives among your colleagues about oral piercings. You take the lead and convene an interprofessional team to develop clinical practice guidelines related to oral piercings.

What should members of the interprofessional team do to support collaborative practice and team effectiveness?
- Disregard disagreements about values that arise among team members related to oral piercings. Primary care teams should constructively manage disagreements about values, roles, goals and actions that arise among healthcare team members. A key action in healthy team function is respecting team member values.
- Exclude the dentist from joining the team to avoid interprofessional conflicts. Primary care teams should integrate the knowledge and experience of other professions, appropriate to the situation, to inform patient care. A dentist could bring expertise on gingival recession and information on microfractures.
- Place the interest of the clinic at the center of this interprofessional work. Primary care teams place the interest of patients and populations at the center of interprofessional health care delivery. In a healthy system, the clinic and patient have a similar set of interests.
- Work together to maintain a climate of mutual respect and shared values.
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Acute Dental Problems

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