Chapter 2 - Dental Hygiene Metaparadigm Concepts and Conceptual Models applied to practice

Paradigm

• Professional’s concept or way of thinking that shapes how they

  • View the world, understand, conduct research, educate, etc

Metaparadigm

• Broad accepted view of discipline

4 paradigm concepts (CHED)

• Client

• Health/ oral health

• Environment

• Dental Hygiene actions

Client ↔ Health/Oral Health ↔ Environment ↔ Dental Hygiene Actions

• Each one influences other

Positionality: Salutogenesis vs Pathogenesis

Salutogenesis

• Health creation

• What makes people healthy, wellness

Pathogenesis

• Origins of disease

• What disease does patient have?

Explainations of paradigms

• Client

  • Individuals, family, groups, community of different age, genders, socioecultural and ecnomic backgrounds

  • Client used instead of patient → wellness instead of illness

• Health/oral health

  • Health and oral health is on a cotinuum from max wellness to max illness

  • Health is not “you have a disease” vs “you don’t have a disease”

  • A person can be anywhere along this continuum

  • Oral and health are interrelated (affect each other)

• Environment

  • Access to care, financial, educational, geographic location—rural vs urban etc

  • Factors can be a: barrier or facilitator

• Dental hygiene actions

  • Inteventions provided by dental hygienist to promote oral wellness

  • Can occur in private, public, school settings

  • Includes screening, assess, ADPIED, interprofesional collab

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Concept	Simple meaning
Client	Who receives/participates in care
Health/Oral Health	The person's position on the wellness–illness continuum
Environment	Surroundings/factors affecting the client and hygienist
Dental Hygiene Actions	What the hygienist does to promote health/prevent disease

Conceptual models

• Represents concepts and relationships between them — framework for thinking

There are 3 models

• Dental Hygiene Human Needs conceptual model

• Oral health related quality of life model

• Client self care commitment model

Dental hygiene human needs conceptual model

• Michelle Darby and Margaret Walsh

• From nursing theory

• Concept: Human behavior is motivated by fulfillment of human needs

• DH must identify client’s unmet human needs through assessment, diagnosis, and care plan

8 human related needs

Safety

• Protection from health risks, fear and stress, pain

Appearance

• Wholesome facial image

• Skin and mucous membrane integrity of head and neck

• Biologically sound and functional dentition

Knowledge

• Conceptualization and problem solving

• Responsiblity for oral health

Protection from health risks

• Avoid medical contraindications

• protected from harm/ danger/ have good health

• DH must do referrals to other providers based on patient’s health history or lifestyle

  • So patient’s needs at met

Freedom from fear and stress

Patient needs to feel free from

• emotional discomfort

• feel appreciated, respect

DH must pay attention to

• unmet needs like fear of needles, clenched hands, previous negative dental experiences, anxiety, contracting diseases etc

• offer interventions and communicate w/

  • empathy, reassurance, explaining procedures, nitrous oxide and local anesthesia

• Realize that the appointment itself can create fear/ stress

Freedom from pain

• patient should be free from physical discomfort

• self report or signs of discomfort (wincing, squinting eyes, reposition in chair etc)

Wholesome facial image

• patient needs to feel satisfied w/ facial features (subjective)

  • May reduce social contacts out of fear of people’s reaction

Skin and mucous membrane integrity of head n neck

• Unmet if client contains intraoral/ extraoral lesions, tenderness, swelling, periodontal disease, nutritional deficiency and manifestations

• DH job to examine this — early detection of abnormalities, screened for cancer lesions

Biologically sound and functional dentition

• need intact teeth, dental restorations

• Unmet if: dental caries, calculus, biofilm, stains, missing teeth, sensitivity etc.

• DH: identify/ document conditions of teeth, signs of disease

  • Provide fluoride, fissure sealants, dietary counseling

Conceptualization and problem solving

• Patient needs to understand own oral health to make informed decisions

• Unmet needs: If patient’s statements are incongruent w/ oral conditions

  • Misconceptions

  • Lack of knowledge

  • Difficulty understanding

• DH: Provide patient education, self care methods, disclosing agent to show biofilm etc

Responsibility for oral health

• patient needs to take responsiblity for their own oral health

• Unmet needs: Poor oral self care, long periods between dental visits, lack of motivation

  • “my family has bad teeth, so I do too”

• DH: encourage patient, enhance brushing, flossing

Simultaneously meeting needs

• DH does not need to address only 1 human’s needs at a time

• Some needs have higher priority

  • Patient comes in w/ painful gingivitis

→ Hygienist must priority: Freedom from pain

• While simultaneously considering:

  • Skin/ mucous membrane integrity, freedom from fear etc

Highest priority needs met first, then address other needs simultaneously

Oral health related quality of life model

Looks at how individuals or population defines their own satisfactory levels of oral health, comfort, and function

• Oral health is overall quality of life

• How condition affects the patient’s life

• Patient may have condition DH not know about / DH knows but patient doesnt

6 domains of oral health related quality of life model

Domain = specific area or sphere of knowledge

Health and preclinical disease domain

• Health is defined by the individual as their desired level of well being

  • Physical, psychological, social, emotional health

• Disease related changes can occur before they’re clinically observed

  • Tobacco cessation education

  • Pits/fissure sealants

  • Oral health education

  • Exercise

Biological and physical clinical variables

Clinical findings

• Diabetes, caries, systemic disease

• DH intervenes based on those findings ADPIED

Symptom status domain

Based on patient’s subjective experience (state of well being)

• Dry mouth, pain, discomfort

However paitnet can have clinical problem w/o any symptoms

Clinical finding ≠ necessarily symptom

Functional status domain

Patient’s oral function

• Chewing, speaking, swallowing

• Affects daily living

• Can reduce social interaction, self esteem, psychological functioning

Ex: missing anteriors can affect speech/ social interactions

Health perception domain

• Patient’s subjective opinion about their own health (oral and general + psychological)

2 patients w/ same clinical conditions have different perceptions

• Losing all my teeth doesnt bother me vs

• Keeping my natural teeth is important to me

• DH must understand patient’s perception

General Quality of Life Domain

• Patient’s genral quality of life satisfaction

Client self care commitment model (IAN-CE)

• Patient is cotherapist in their own oral health decisions

• Client self care

• DH helps patient become motivated and commit to self care

5 domains

• Initiation

• Assessment

• Negotiation

• Commitment

• Evaluation

Initiation

• Patient comes into care w/ existing beliefs or values

• DH: Should not assume patient shares hygienist’s beliefs

Ex: “Pia and her husband don’t believe in fluoride”

→ Hygienist can’t say “you’re wrong”

Assessment

• Assess patient’s self care practice w/ open ended questions and respect rather than controlling convo

Ex: Instead of pushing Pia to use fluoride, DH can rec more oral hygiene, dietary habits to reduce sugar and s.mutans

Negotiation

• After patient shares their perspective, the DH and patient can become co-therapists

• Negotiate self care practices, treatment interventions, goals

• DH can’t lead patient towards a decision

Ex: You must floss everyday (bad)

• DH must explain why flossing matters, pros n cons etc

Commitment

• After negotiation, patient decides what they want to commit to

Ex: Flossing 4x a week, goal should be realistic/ achievable

Evaluation

• Patient self reports their self care practices, progress, difficulties, etc

• Hygienist shares clinical findings

  • Then process repeats again ADPIED

  • Modify or continue plan

All models summary

Model	Main focus
Dental Hygiene Human Needs Model	Identifying and meeting human needs
Oral Health-Related Quality of Life Model	How oral health affects the patient's quality of life and lived experience
Client Self-Care Commitment Model	Patient participation, self-care, motivation, and commitment