By Ann-Marie DePalma, RDH, MEd, FADIA, FAADH
Many patients we treat are healthy with minimal bleeding and inflammation. At other times, patients are excessive bleeders. The bleeding can be caused by stress, local irritants, inflammation, inadvertent trauma, hormones, or from a bleeding disorder. What do you do when confronted with excessive bleeding? Do you ignore it, suction it, and keep going-or determine the cause? What can you do for patients with unexplained bleeding, bleed for more than a longer amount of time than expected, or continually ooze?
Jennifer Kerns, BS, RDH
Jennifer Kerns, BS, RDH, has developed a program titled "Access to Care Initiative for Patients with Bleeding Disorders" to address these issues. The program involves recognizing bleeding disorders, when to refer patients with potential bleeding issues, options for treatment, prevention protocols, and even discusses insurance reimbursements.
Jennifer is a practicing hygienist at the Northern Regional Bleeding Disorder Center in Michigan where she treats patients with a variety of inherited bleeding disorders, such as hemophilia and Von Willebrand disease, or patients who experience bleeding as a secondary side effect of medications. These patients often require special treatment and consideration regarding their dental care. Dental professionals often discuss with Jennifer that they are uncomfortable treating these patients in a traditional practice.
The clinic where Jennifer practices is a Hemophilia Treatment Center (HTC), although care is a coordinated effort. These HTC centers are located across the country. Most clinics provide comprehensive care with a wide range of specialties. An HTC can employ a dentist or hygienist depending on funding and patient needs. Other medical professionals at the centers include physicians, physical therapists, dieticians, nurse practitioners or registered nurses, research and data coordinators, social workers, lab and pharmacy technicians-a truly multidisciplinary team for comprehensive patient care. This medical model is not new and is found in many hospitals across the country allowing continuity of care.
Patients need to understand that their bleeding disorder shouldn't prevent them from dental care or routine home care. Most oral bleeding can be managed with proper infection control methods at home and some tips and tricks in the office. It is often difficult for any patient to understand their action (or lack of action) is what causes infection, discomfort, or bleeding.
With bleeding disorder patients, many often use their diagnosis as an excuse for poor oral care. Patients will often see blood in the sink and immediately stop doing any home care, thinking that they are making themselves bleed. Education, therefore, is the hallmark of Jennifer's day. It requires constant and supportive education to persuade the patient that an infection is causing the bleeding, not their disease. Many are often afraid of any bleeding since treatments can be expensive-$10,000 a treatment! One of Jennifer's patients stated that because of his bleeding he had reached over a $1 million in treatment in one year.
Treating a bleed is something that must be done since, without treatment, tissue damage and arthritis can progress, leaving the patient debilitated. Additionally, Jennifer may see patients that have a care plan in place prior to visiting any dental professional. She can coordinate care for these patients by providing a dental home and ensuring that the proper protocols are followed by the dental professional to prevent bleeds. This allows the patient to build trust in their dental team, something that is not easy for many bleeding disorder patients to do.
The hygienist plays a critical role in helping bleeding disorder patients understand how their disease can affect oral health. From her experiences, Jennifer feels that all hygienists can understand these patients better, prompting her to create her CE program. Jennifer shares her tips and tricks from the hemostasis of wound healing to increasing insurance benefit reimbursements.
Her program includes a packet of cheat sheets including bleeding disorder information, coordination of care forms, tracking forms, and post-op instructions. If patients are using the services of a local HTC, the center may have specific dosing protocols, so Jennifer will coordinate her lectures with the center in the area. Utilizing her resources, the dental professional can provide a true collaboration between medicine and dentistry to help patients achieve strong, healthy lives that reduce the need for costly treatment and the risks associated with bleeds.
At the end of her training programs, Jennifer offers dental practices the opportunity to sign up and accept new patients, thus increasing care for this often-underserved population. Her program is a training class as well as a CE program on how to accept, treat, and bill patients who bleed. Treating these patients helps the patients find a dental home while increasing practice profitability.
Jennifer is a graduate of Michigan State University, where she earned a bachelor's degree in human physiology. She worked in research while she was there, taught in the cadaver clinic, and worked in a free medical clinic. She received her EMT license and worked on an ambulance (she describes herself as a workaholic).
After graduation, she worked in cytology and neurology at hospitals and that is where she found her calling for dental hygiene. During her work in the neurology department she met a man who had his jaw wired after attempting to commit suicide with a shotgun. It devastated her.
She loved life and its many opportunities and here this man had given up. She spent many hours a day working with him and through this experience decided that she had to do more with her life to help people.
She enrolled in the Ferris State dental hygiene program and began saving lives, one mouth at a time. She takes dental hygiene very seriously, loves what she does, and wants to share her passion for education and enthusiasm for hygiene with all hygienists. In addition to her work at the clinic, Jennifer is an adjunct clinical faculty member at the University of Michigan.
When her brain just needs a break, Jennifer has a few motorcycles-dirt and street bikes-so she jumps on board and goes for a ride. She lives in the Lake Ann, Michigan, area with its miles of trails, beautiful lakeshore winding roads, vineyards, forests, and beaches. These rides give her peace and focus so that she returns to work completely refreshed. She is a member of "Stilettos on Steel," a group of empowered women who ride together and have become great friends.
Her work at the bleeding disorder clinic and creating the program on bleeding disorders for dental teams is one of the reasons why she is so passionate about dental hygiene. She has the ability to spread valuable information so that dental teams can become better care providers giving these special patients the best possible health.
For more information about the bleeding clinics or the "Access" program contact Jennifer at: [email protected]
Thought for the month:
"What is called genius is the abundance of life and health." -Henry David Thoreau RDH
ANN-MARIE C. DEPALMA, RDH, MEd, FADIA, FAADH, is the 2017 recipient of the Esther M. Wilkins Distinguished Alumni Award of the Forsyth School for Dental Hygiene/Massachusetts College of Pharmacy. She is a Fellow of the American Academy of Dental Hygiene and the Association of Dental Implant Auxiliaries, as well as a continuous member of ADHA. She presents continuing education programs for dental team members on a variety of topics. Ann-Marie has authored chapters in several texts for dental hygiene. She can be reached at [email protected].