The critical thinking competency of dental hygienists emphasizes the integration of new knowledge into appropriate practice settings and the application of evidence-based decision-making approaches to information and analysis of current practices. [2]  As a future dental hygienist, exploring the value of critical thinking is important since critical thinking is one of the foundational skills of the dental hygienist. I believe that a dental hygienist essentially should not only perform hands-on technical proficiency skills, but also have personal values that can be used as the person's ability to fit in a particular situation. 

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At the first year of my school, I did not have clear image regarding what the critical thinking for dental hygienist is. I thought simply that critical thinking is think deeply and curious for everything. However, in the theory and practice class, I learn what critical thinking means. It says that "thinking about thinking while thinking to better thinking while thinking”, and it is a high level of way of thinking. [5] Through dental hygiene school curriculum, I have learned how to perform the critical thinking and it always starts from skepticism and curiosity. All information we provide to clients should be proven by scientific evidence and it allows me to develop responsible decisions for client care.  Also it is related to dental hygienists' work ethic and therapeutic treatment, which is the reason for critical thinking as one of the dental hygiene competencies.

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        One of the things I have experienced in dealing with my clients over the past two years is that it is not easy to dramatically change bad habits or misconception they are already familiar with. The behavior modification assignment in the Dental hygiene theory and practice class was a task of deriving conclusions about methods that can correct and change the behavior of actual clients. This assignment applied the process of assess, plan, implement, and evaluate. During workshop, my support groups for this assignment discussed risks of changing a behavior. Using photographic data as evidence, I formally documented, assessed, analyzed and reflected on my behavioral change (i.e. sitting posture), which was related to maintaining functional fitness in my role as a dental hygienist. In the meantime, I attended a gym class called “fit-to-sit” once a week to apply functional fitness, strength training and learned skills to clinical dental hygiene practices.  After planning, my posture was monitored by three supportive group members within 5 consecutive clinics. I found that behavior modification depends on the accomplishments one has made throughout the process. I attached this position to the benefits I have seen through my graphs that allowed me to monitor successes and failures. If the sense of accomplishment aspect was excluded from my change process, I would have thought the change as an unending process. I, therefore, perceive that if patients are not able to measure their achievements, they may find it difficult to believe in the change process. Given the above notes, the role of a dental hygienist is to provide the necessary information, empathy, and support to the change process. A dental hygienist should inform the patient how to assemble their support group, educate them on both short- and long-term consequences of their current behavior, and appraise them on how to measure potential achievements. My behavior modification experience allowed me to relate to the needs of clients who need to modify, adapt or change behaviors that benefit their oral and overall health. A dental hygienist with critical thinking may have passion to acquire and administrate their best knowledge, and they can acknowledge other professions’ different ways of thinking. I believe that dental hygienists have a key to improve their clients’ future oral health and even entire health. As a dental hygienist should continue lifelong education, critical thinking can be the baseline to perform the four dental hygiene paradigm concepts - client, oral health/health, environment and dental hygiene actions. [Evidence 1]

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Evidence 1.  The marking rubric, graph and pictures from behaviour modification

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    Last semester, we had to plan a dental hygiene care plan for a case of a client who worked night shift, was alcoholic and had low social relationships. Based on human needs, we connected the subjects to four paradigms concept of dental hygienists. As a result, it was shown in a diagram that all four are closely related to each other. [Evidence 2] This meant that the care plan had to take into account all four dental hygiene paradigm concepts - client, oral health/health, environment and dental hygiene actions. 

We made a care plan based on these 4 concepts. We listed client's problems based on 4 concepts and tried to find causality between client's sign/symptom and client's habit and living condition. However, we found there is a limited knowledge in certain situation, such as the relationship of night shift worker and high caries risk and harm effect of concurrent use of smoking  and alcohol. This activity allowed us to see 4 dental hygiene paradigm as a whole and learning point to see they are related each other, which lead us to recognize certain causality that we make as our PICO question.

(Patient / Population, Intervention / Indicator, Comparison, Outcome)

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Figure 2. Dental hygiene concept map with 4 dental hygiene paradigms. 

 

   

 

         

 

 

 

 

      We created a care plan based on a treatment plan from our previous experience. When we created PICO questions based on "Problem / Patient / Population, Intervention / Indicator, Comparison, Outcome" (PICO), we came across two PICO questions, "For the night shift worker, does sleeping during the day compared to sleeping at night increase caries risk" and "For those who smoke and drink alcohol, which of these factors increases caries risk more? ". Since then, we had to conduct a literature review to find evidence-base information that could support our PICO questions.

   We used the Paul-Elder's Elements of Thought wheel to help us begin the critical thinking process, reviewing literature and solving client's situations and problems in relation to PICO questions. In the meantime, the literature review itself was not difficult with other tasks, but it took time to study the client's case using the "element of thought" since it was not familiar with, such as assumptions, implications and consequences, and points of view in the elements of wheel. However, all eight elements of the "element of thought" required us to analyze the patient's case critically. We created a patient care plan based on eight elements. Based on the current evidence we have found and analyzed data regarding case-induced caries incidence in proportion to the sun exposure of people who work at night, we researched case studies on the effects of alcohol and tobacco on those who work at night. We believed that the care plan we set up before and after the critical thinking process is very different. Dental hygienist's critical thinking process to analyze the client's life patterns, working conditions, and psychological environment are crucial in order to provide safe and scientific evidence-based treatment. It was a great experience to develop, create and manage care plan based on proper evidence of case studies, as well as to analyze and decide the feasibility of the care plan by ourselves.  [Evidence 3]

 

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Evidence 3. Wheel of Elements of thought and PICO group work.

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       Critical thinkers, as a dental hygienist, may have passion to acquire and administrate their best knowledge and reason in in health care communities and they can acknowledge other professions different way of thinking. As a clinician, I believe that dental hygienists have a key to improve their clients’ future oral health and even entire health. As dental hygienist should continue lifelong education, critical thinking can be the bottom line to perform autonomy for dental hygienist  to solve problem without possible bias or narrow perspective like black and white terms.

 

 

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