Chapter 1 - The Dental Hygiene Profession

Dental hygienists

Licensed healthcare professionals — oral health, prevent disease, promote health

• Can work in different environments

  • Patients, families, groups, community

• Accountable legally & ethically for care they provide

• In Standard Occupational Classification (SOC) — Accounting to Bureu of Labor statistics…

  • DH are classified as professionals who provide direct patient care, similar to dentists

  • Expected to take ownership of portion of practice regardless of where they work

History of dental hygiene

1913 — Dr. Alfred Fones opened first dental hygiene school in Bridgeport, Connecticut

• Promote preventive oral health services

• Educate children in self care

1917 — Irene Newman is first licensed dental hygienist

1923 — American Dental hygiene association (ADHA) developed

• Art and science of preventing oral disease and promoting health

1952 — All 50 U.S states had licensed dental hygienists

1963 — CDHA established (Canadian DH association)

• Communicate values of DH

1986 — IFDH established (international federation of DH)

• DH is key provider

Process of dental hygiene care (ADPIED)

Foundation for DH practice

Assessment

• Collect and analyze info

  • Health history, intra/ extraoral exams, periodontal and hard tissue (dental charting), and risk assessment

Diagnosis

• Identify problems based on assessment

  • Uses critical decision making to interpret findings based on assessment, evidence, client behaviors, attitude, oral healthcare needs

• Offer referral if needed

Planning

• Establish goals/ intervention

• Hygienist works with patient to provide care plan

• Must lead to informed consent

Implementation

• Carry out dental hygiene services

  • Carrying out plan — patient is cotherapist (patient is a partner in their own treatment and decision making)

  • patient education, treatment, follow up

Evaluation

• Determine if goals/ outcomes were achieved

  • Assess oral and health conditions, collect data

  • Occurs throughout entire process of care — modify if needed

Documentation

• Record assessment, care, outcomes

  • Record all assessment, diagnosis, treatments, outcomes

  • Including: environmental factors, age, gender, culture, lifestyle, beliefs, socioeconomic status, physical disabilities

  • Occurs throughout entire process of care

• Why?

  • Legal record — protect against malpractice claims

  • communicate between providers

Art and science of dental hygiene

Art

• How you care for people

• Care, ethics, professional judgement, critical thinking, reflection, patient provider interactions

Science

• What you know and apply

• Biological, psychological, social science

• Clinical skills

• Evidence based practice

Dental Hygiene’s Paradigm (CEHD)

Widely accepted worldview of a discipline (field)

4 major paradigm concepts

• Client

  • Recipient of DH care (any individual, family, community, age, gender etc)

  • Why use client?

    • Client is broader than patient

    • Patient = refers to someone receiving clinical care because they have a health problem

    • Client = Someone receiving health education, health promotion etc

• Environment

  • Factors that affect a client’s ability to receive optimal oral health (ex: geographic, economic, education, culture)

• Health/oral health

  • Fluctuation of client’s health or state of well being

  • Health/ oral health = continuum (wellness → illness)

  • Improve oral health = improve client’s health

  • Intervention by DH to improve oral health

• Dental hygiene actions

  • Affected by environment

  • What the hygienist does (ADPIED)

Professional roles of dental hygienists (CCPREA-E)

• Clinician

• Corporate

• Public Health/Interprofessional

• Researcher

• Educator

• Administrator

• Entrepreneur

All = want to improve oral health

5 main roles of DH

Clinician, administrator or manager, researcher, advocate, educator

Midlevel oral health practitioner

• ADHA says it’s a license dental hygienist who graduated from an accredited DH program

• Can provide care outside traditional dentist office (expanded scope)

  • Improve acess for underserved populations

• Dental hygiene therapist

Direct access

Ability of DH to initiate treatment based on assessment

• No need dentist

How?

• Midlevel provider

• Independent practice

• RDHAP (RDH alternative practice) — CA only

• Extended care permits (ECP) — kansas only

• Limited access permits (LAPs) — oregon/ montana

Collaborative practice model

Dentists and hygienists work together as colleagues to enhance each other’s skills w/ their own roles

• Collab with other dental professionals

• Cotherapist relationship

Includes

• DH can initiate treatment

• DH services

• Dental records

• Referral methods

Independent dental hygiene practitioners

• Owns own business

• Provides preventive oral care as primary providers

• Unsupervised practice

• Independent own business w/ supervision is not independent practice

Interprofessional practice

Healthcare professionals from different disciplines (field) work together

• Physicians, nurses, dietitians, PA, etc

  • Can collab w/ dieticians and pediatrics about sugar intake

  • Collab w/ nurses for denture care, referrals

Professional regulation

Accreditation

• Formal, voluntary, nongovernmental process

• Minimum standards for educational programs

  • Is educational program meeting established standards?

Dental hygiene practice acts

• DH laws vary by state/ province/ jurisdiction

Licensure

Legal process where government authorizes someone to practice a profesion within its jurisdiction

Every state requires

• Graduation from accredited DH program

• Complete National Board DH exam (NBDHE)

• State clinical board exam

• State law and ethics exam

License can be

• Denied, revoked, or suspended due to

• Incompetence, negligence, illegal practice

National board Dental Hygiene exam (NBDHE)

• Tests recall biomedical, dental science

• problem solving

• case based exam

Standards in DH practice

ADHA standards for clinical DH practice

• provides guidance for DH, educators, researchers etc

• Doesn’t substitute clinical judgement

American dental hygienists association

ADHA

• 1923

• supports DH latest training, info, oral health

3 levels

• Local (component)

• State (constituent)

• National

National Dental Hygienist associate (NDHA)

• 1932

• Founded by African american DH to address the challenges of minority DH

• Helps assist oral health to underserved communities

• Increase minority DH

Canadian Dental Hygienists associate (CDHA)

• 1965

• Therapeutic oral healthcare

International Federation of Dental Hygienists (IFDH)

• 1986

• Promote oral health, knowledge, spread awareness, international collab

Other associations mentioned

American Dental Education Association (ADEA)

• Focuses on dental education.

Special Care Dentistry Association (SCDA)

• Focuses on people with special healthcare needs.

National Center for Interprofessional Practice and Education (NEXUS)

• Focuses on interprofessional education/practice.

International Association for Dental Research (IADR)

• Focuses on dental/oral health research.

American Public Health Association (APHA)

• Focuses broadly on public health.

American Academy of Oral Medicine (AAOM)

• Focuses on oral medicine.

American Association of Dental Office Management (AADOM)

• Focuses on dental office management.

Dental Trade Alliance (DTA)

• Represents companies serving the dental industry.