DH Process of Care - quiz 1

What is Assessment

identify risk factors that could affect treatment outcomes. Frequency will be dependent on individual presentation, treatment response, compliance, and frequency of care continuation. (Ex. Medical history, risk assessments, clinical assessments)

What is Diagnosis

As the identification of an individual's health behaviors, attitudes, and OH care needs for which the DH is educationally qualified and licensed to provide. (Ex. Barriers to care, patient education, treatment, evaluation, prevention, etc.)

What is Planning

Diagnosed patient centered care needs are prioritized, goals and evaluative measures are established, intervention strategies are determined, and appointment scheduling. (Ex. Develop strategy of care, resolution of OH care problems, reflects evidence based practice)

What is the order of care

Emergency → non-surgical → surgical→ restorative → maintenance

Models to consider when treatment planning

Human needs theory and oral health-related quality of life.

What is Implementation

process of carrying out the care plan. Evaluation, evidence-based care. (Goals, Goals, Goals!)

What is Evaluation

measurement of achieved goals, of care plan, and assessment after each appointment. (Ex. no improvement, refer to a specialist.)

What is Documentation

Completion of accurate data, diagnosis, individual involvement, consent for treatment, etc.

D110

Adult prophylaxis

D4910

Periomaintence

D4346

Scaling in presence of gingival inflammation

D4341

4+ teeth per quadrant for SRP

D4342

1-3 SRP per quad

D4355

full mouth debridement

D1206

Topical Fluoride treatment

D1310

Nutritional counseling

D1320

Tobacco counseling

D1330

oral hygiene instructions

D1301

immunization counseling

D9957

screening for sleep-related breathing disorders

Documentation Definition

Complete and accurate recording of all collected data, diagnosed needs, individual involvement in care planning, consent for treatment, implementation of services and monitoring of progress, evaluation of treatment outcomes, prognosis, care recommendations, relevant communication, and other interactions and information relevant to care

Goals of documentation

Maintain continuity of care, communication between collaborating and interprofessional providers, reduce risks of malpractice claims

Why are dental notes important

They are legal documents

What is informed consent and approval

An ongoing process

General supervision

Dentist is not required to be present in the office or on the premises

Indirect supervision

Dentist is in the office while the dental hygienist performs procedures

Direct supervision

Dentist remains in the office and evaluates the dental hygienist's work before patient dismissal

Personal supervision

Dentist operates on the patient while the dental hygienist concurrently performs supportive procedures

Definition of diagnosis

Identification of a condition, problem, or situation based on analysis of its cause and defining characteristics

What are defining characteristics in diagnosis

Signs and symptoms

What disciplines can the diagnostic process apply to

Medicine, nursing, dentistry, and other healthcare disciplines

Dental diagnosis

A holistic approach by the dentist to determine the oral health condition of an individual patient through evaluation of collected data

Dental hygiene diagnosis

"Identification of an individual's health behaviors, attitudes, and oral health care needs for which a dental hygienist is educationally qualified and licensed to provide."

Dental hygiene diagnosis is derived from what

The patient

What type of practice is dental hygiene diagnosis based on

Evidence-based practice

What is the focus of dental hygiene diagnosis

Prevention-focused care

What information gathered during assessment helps formulate a dental hygiene diagnosis

Systemic and health factors, behavioral health factors, social determinants of health, periodontal disease classification, hard and soft tissue conditions, individual needs, values, and preferences

How are dental hygiene diagnoses formulated

By reviewing and interpreting patient case information to identify individualized patient needs

Who developed the 8 Human Needs related to oral health and disease

Darby & Walsh

Wholesome facial image

One of the 8 Human Needs related to oral health and disease

Protection from health risks

One of the 8 Human Needs related to oral health and disease

Biologically sound and functional dentition

One of the 8 Human Needs related to oral health and disease

Skin and mucous membrane integrity of the head and neck

One of the 8 Human Needs related to oral health and disease

Freedom from head and neck pain

One of the 8 Human Needs related to oral health and disease

Freedom from anxiety and stress

One of the 8 Human Needs related to oral health and disease

Responsibility for oral health

One of the 8 Human Needs related to oral health and disease

Conceptualization and problem solving

One of the 8 Human Needs related to oral health and disease

What model did Swigart & Gurenlian develop

A model combining concepts from the Human Needs model and the medical model

What does the Swigart & Gurenlian model include

Systemic conditions, risk factors, and social determinants of health

What approach does the Swigart & Gurenlian model allow

Intra- and inter-professional collaborative approach

Informed Consent

Person's agreement to allow something to happen based on full disclosure of facts required to make an informed decision.

Autonomy

The patient's right to self-determination and to make their own healthcare decisions.

Patient-Centered Care

Begins with communication, compliance, education, and advocacy.

Compliance vs. Informed Participation

Compliance means simply following instructions, while informed participation means the patient actively understands and participates in decision-making.

Informed Consent Process

Informed consent is an ongoing and continuous process, not just a signature on a form.

Key Components of Informed Consent

Patients must be told in a language they understand about: DH diagnosis, proposed care plan, justification, consequences, benefits, risks, alternatives, prognosis, and consequences of no treatment.

Purpose of Presenting the Treatment Plan

To provide patients with enough information to make informed decisions and give informed consent.

Best Practices for Presenting a Treatment Plan

Position the patient upright and face-to-face, be engaging, use visual aids, avoid rushing, and encourage questions.

Patient-Centered Language

Using plain language instead of technical jargon, avoiding acronyms, using relatable analogies, and checking for understanding.

Care Plan Presentation Framework

Tell-Show-Do-Check.

Tell-Show-Do-Check Framework

1. Summarize findings in plain terms. 2. Explain recommendations and why. 3. Describe what the patient should expect. 4. Invite questions and confirm understanding.

Steps in Care Plan Presentation

Define/discuss the dental hygiene diagnosis → explain proposed care plan → discuss prognosis of no treatment → discuss goals → discuss appointments/cost → obtain informed consent.

Written vs. Verbal Consent

Consent can be written or verbal but must always be documented. Written forms also provide legal protection.

Who Can Provide Consent

Competent adults (18+), legal guardians, or authorized individuals with interpreters when necessary.

Pitfalls to Informed Consent

Using technical jargon, rushing the process, treating the form itself as consent, and failing to answer patient questions.

Informed Refusal

A patient's legal and ethical right to decline all or part of treatment after being fully informed about diagnosis, risks, alternatives, and consequences.

Reasons Patients May Refuse Treatment

Cost/no insurance, fear of pain, low value placed on dental care, or lack of understanding.

SRP Risks

Hypersensitivity, gingival tenderness, gingival recession, bacteremia (especially in high-risk patients or patients with history of sepsis/bacteremia).

SRP Benefits

Arrests periodontal disease progression, reduces inflammation, prevents attachment loss and tooth loss.

SRP Alternatives

No treatment/monitoring, referral to periodontist, periodontal maintenance, laser therapy, medicaments such as Arestin or CHX.

Fluoride Treatment

A preventive treatment used to strengthen enamel and reduce caries risk.

Fluoride Risks

Allergic reaction (rare), temporary changes to tooth texture/color, toxicity if ingested causing nausea or upset stomach.

Fluoride Benefits

Caries prevention, enamel remineralization, decreased hypersensitivity, minimally invasive and quick application.

Fluoride Alternatives

No fluoride supplementation, other fluoride gels/foams, prescription toothpaste (Prevident, Clinpro), SDF, nano-hydroxyapatite, OTC toothpaste.

Local Anesthesia

A medication used to block pain sensation in a specific area while the patient remains conscious.

Local Anesthesia Risks

Allergic reaction/toxicity (rare), soft tissue injury from biting, injection site discomfort, temporary or permanent paresthesia (very rare).

Local Anesthesia Benefits

Complete block of pain receptors, patient remains conscious, assists with pain control and bleeding management with vasoconstrictors.

Local Anesthesia Alternatives

No pain management, topical anesthesia, non-injectable anesthetics such as Oraqix, nitrous oxide (N2O).

Consequences of No Treatment

Progression of disease, worsening inflammation, increased risk of tooth loss, pain, and more extensive future treatment.

Checking for Understanding

Asking the patient questions or having them repeat information back to confirm comprehension.

Why Documentation Matters

Documenting informed consent protects both the patient and provider legally and ethically.

Why must clinical examinations include radiographs?

Clinical examinations must include radiographs that are current, sufficient in number, diagnostic, and interpreted.

What are the requirements for acceptable radiographs?

Current, sufficient number, diagnostic quality, and properly interpreted.

Why are radiographs necessary?

They provide information that cannot be obtained from other clinical sources.

How should radiographic interpretation be performed?

Interpret from the outside toward the center of the tooth and surrounding structures.

What findings may be detected during radiographic interpretation?

Mid-root caries, calculus, bone loss, restorations, and other abnormalities.

Why should clinicians examine the mouth before reviewing radiographs?

Current films alone may not accurately represent the clinical appearance of the mouth.

When might a full mouth series (FMX) be needed?

When a new representation of the patient's oral condition is necessary.

How do radiographs protect patients?

They improve diagnosis, treatment planning, and restorative outcomes.

What is an important radiographic skill for dental professionals?

Becoming proficient at diagnostic interpretation.

What does ISBAR stand for?

Introduction, Situation, Background, Assessment, Recommendation.

What is the purpose of ISBAR?

To improve communication, patient safety, and continuity of care.

What are the objectives of ISBAR?

Explain ISBAR, improve patient safety, summarize findings, and develop treatment plans.

Why are organized patient hand-offs important?

They save time, reduce errors, improve confidence, and decrease stress.

How does an efficient hand-off maximize chairside efficiency?

The dentist can begin the exam immediately without searching the chart.

How does an efficient hand-off improve treatment acceptance?

The patient hears findings from the hygienist first, building trust.

How does an efficient hand-off improve time management?

It reduces delays and keeps schedules on time.

How does an efficient hand-off reduce cognitive load?

The dentist enters with relevant information already known.

How does an efficient hand-off enhance patient experience?

It demonstrates teamwork and improves patient confidence.

How does an efficient hand-off reduce provider stress?

It improves workflow and reduces waiting time.