DHYG 258: LO1- Determine a DH Diagnosis

what are the learning steps to determine a DH diagnosis?

LS1: explain the term DH process

LS2: briefly describe the phases of the DH process of care

LS3: describe the characteristics of a DH diagnosis

LS4: describe various diagnosis models

LS5: describe the process for determining a DH diagnosis

which clinical services do DHs provide?

-preventive care

-therapeutic care

-educational

preventive care

-methods to prevent oral disease & promote health

therapeutic care

-evidence based care employed to arrest or control oral disease

-also supportive care that follows therapeutic

educational

-important care in both preventive and therapeutic aspects of clinical therapy

-includes concepts, goals, self-care, behavioural changes, understanding

DH care

-all integrated preventive & treatment services administered for a client by a DH

DH process

-a systematic approach to DH care used by DHs that involves 6 key steps/phases

what does the DH profession adopt?

-a "process of care"

-considered a framework for professional practice

-various conceptual models or theoretical frameworks are used worldwide

what are benefits of a DH process of care model?

-provides a framework for meeting the individualized needs of clients & fulfilling a professional role of DH

-promotes the identification of causes & risk factors of a condition

-the risk factors may be reduced, eliminated or prevented by the services of a DH

what are the 6 phases of the DH process of care?

1. assessment

2. diagnosis

3. planning

4. implementation

5. evaluation

6. documentation

process of care: assessment

-a foundation for client care (baseline data)

-includes the systemic collection of both subjective data and objective data

subjective data

-lifestyle, concerns, social determinants, personal care (collected by observation and interaction)

objective data

-physical & oral data or findings collected by measuring, inspection, palpating, exploring, and radiographs

assessment: what are we collecting & analyzing

-medical & dental histories, vital signs

-extra and intra oral examination

-perio & dental examination

-radiographs, indices, and assessing risk factors (leads to the identification of a client's OH problems)

-client's chief concern (must be addressed)

what can the DH reach based on all assessment data?

-conclusions about the client's DH needs

what are the assessment tools used at Saskpoly?

-intra and extra oral cancer screening

-funct status

-dental charting

-sens

-deep grooves

-caries risk (CAMBRA)

-perio charting

-gingival assessment

-deposits

-perio diagnosis

-rad interps

-HH

process of care: diagnosis

-involves sorting assessment data into categories

-use of critical thinking skills to analyze & interpret the data (look @ all assessment data and HH)

-client's health behaviours and problems are identified

-data is validated or verified for accuracy

what does diagnosis support/justify?

-the treatment proposed to the client (a plan can be made)

process of care: planning

-plan is constructed using the DH diagnoses & risk factors as a basis and taking into consideration the goals a client wants to achieve

-look ahead to desired or expected outcomes (what will be different/better?)

benefit of planning

-everyone knows & agrees what should happen

process of care: implementation

-activation of the plan

-DH services are explained & performed

-services are referred to as "interventions"

-current, evidence-based interventions are selected

-benefit of implementation

-OG problems (or potential problems) are prevented, reduced or eliminated; goals are met

process of care: evaluation

-measured by clinical assess. and interview

-eval is ongoing & includes the measurement of the extent of achieving goals & expected outcomes of all prev, therapeutic care and supportive

benefits of evaluation

-identifies success of treatment

-identifies need for further tx

-allows the planning of cont. care

process of care: documentation

-assessment data & diagnosis

-interventions planned & provided

-recommendations & referrals

-goals & outcomes

-other info relevant to client care & treatment including signatures

benefit of documentation

-client records are accurate & comprehensive

the role of DH in clinical therapy

-use DH process of care to prevent and/or control oral diseases to help promote health

-provide care to clients based on evidence-based decisions & client needs

-accept clients as partners in their healthcare

-collaborate w/ and refer to other health professionals

-be responsible & ethical

what does the CDHA's client's bill of rights do?

-can help serve as a guide to you for creating and writing care plans & also presenting care plans to clients

diagnose (verb)

-to identify or recognize a disease or problem

diagnosis (noun)

-identification of a condition, problem, or situation based on the analysis of its cause and defining characteristics

-a diagnosis is discipline-specific when it is applied to the practice of the discipline

diagnostic models

-various models that can be used to determine a DH diagnosis

what are common diagnostic models?

-The DH Process of Care Framework

-The Human Needs Theory Model*

-Oral Health-Related Quality of Life Model

-The Client Self-Care Commitment Model

what is the DH diagnosis (DHX)

-made when client assessment is complete

-necessary for planning & implementing effective DH care and for evaluating the outcomes of care

DH diagnosis (DHX) is the link between

-assessment and planning

what are the characteristics of a DH diagnosis (DHX)

-based on client data collected during assessment

-describes problems & potential problems as well as causes and risk factors

-focuses on client conditions, behaviours, and risk factors related to OH care and disease

-limited to the scope of DH practice

-inclusion of the social determinants of health (account for almost 75% of the factors that influence health)

what a DH diagnosis (DHX) is NOT

-a diagnosis of conditions that require treatment legally defined as dental practice (PA abscess, aphthous ulcer, cavity)

why do we use DH diagnosis?

-makes it easy to plan and eval. care

-since problems & causes are identified in the diagnosis, it allows control or elimination of them

-the DH can select interventions that prevent, reduce or eliminate problems

-the DH can measure success by evaluating outcomes of the care provided

-outcomes are compared to the original diagnosis and risk factors

what does the DHX look like?

-the DH diagnoses for different models look quite different even though the conditions are the same

-most models will include the problem & the causes (risk factors

model of care: The DH Process of Framework

-based on clients problems & etiologies

-sorted into categories (general health, soft tissue, perio, dental and oral hygiene

model of care: The Human Needs Model

-based on 7 human needs (problems are noted when needs are not met)

-also includes the signs & symptoms

-connects oral & overall health

-can be varied in extent of need fulfillment

-need fulfillment improves QOL

-developed by DH scholars Michelle Darby & Margaret Walsh

DHx: sensitive teeth

-risk factors: erosion/abrasion, diet-lemons, cola

what are the basic needs of the Human Needs Theory?

-physioological

-safety

-love & belonging

-self-esteem & self-actualization

Human Needs Theory: 8 basic needs used

-protection from health risks

-freedom from fear & stress

-freedom from pain

-wholesome facial image

-skin & mucous membrane integrity of head and neck

-biologically sound & functional dentition

-conceptualization & problem solving

-responsibility for OH

model of care: Process of Care Framework

-identifies problems in terms of response (rather than need)

-problems are in categories: general systemic, soft tissue, periodontal, dental, OH

Process of Care model is an

-assessment

human needs theory is a

- collection & evaluation of eight human needs as being met or unmet

-identification of unmet human needs & the cause as evidenced by signs and symptoms

process of care examples

-lesions

-biofilm-induced gingivitis

-risk of cavities

human needs (unmet) example

-skin & mucous membrane integrity of the head & neck

-biologically sound & functional dentition

human needs model diagnosis statement

-problem: sens to cold & some foods

-risk factors/etiologies: erosion & diet

-DHx: unmet biologically sound & functional dentition due to erosion, diet and habits as evidenced by client reports teeth sens to cold and sour foods

human needs theory setting client-centered goals

-goals: represent the desired outcome of DH care & clarify what the needs are to promote, maintain or achieve OH and wellness

-goals achieved related to human need fulfillment: contributes to the QOL and emphasizes a client-centered, humanistic approach to DH care

OH-Related Quality of Life Conceptual Model

-examines interrelationship b/w health and disease, biologic, psychologic and social consequences

-assesses symptom status, functional status and OH perceptions

Client Self-Care Committment Model

-involves clients as co-therapists in their OH

-increases motivation, commitment and compliance

-DH provides OH (promoting info, prevention and therapeutic care)

STEP 1: Determining DHx: review, analyze & interpret assessment data

-HH

-subjective data- asking questions: cancer, stress, lack of knowledge, tobacco use, meds, diabetes, dental habits, DMD appts, attitudes/beliefs

-objective data: cancer screening/lesions, radiographs-bone loss, calc, caries, clinical findings- gingival signs, probing, deposits, dry mouth, sensitivity, occlusion

Determining DHx: what do we do at the end of the assessment findings/data

-analyze: determine which findings are problems

-problems can be a condition or risk factor (pockets, calc)

-problems can be "current" or "potential future problem"

-problems can be signs and symptoms (bleeding)

STEP 2 Determining DHx: combine the findings

-look for clusters or groups of info that signal a problem

-abrasion, erosion, client concerned w/drinking cold drinks

-deep grooves, frequent sugar intake, biofilm accumulation

-biofilm accumulation, bleeding, edema

STEP 3 Determining DHx: sort or organize into categories

-categories: periodontal, dental and other (general health & soft tissue findings)

-perio: pockets, bleeding, furcation, recession, edema, biofilm

-dental: erosion, sensitivity, deep grooves, defective margins, contact sports, biofilm

-other (general health & soft tissue): high BP, diabetes, smoking, lesions

STEP 4 Determining DHx: write a DHx on a care plan

-record diagnoses: group signs & symptoms into diagnostic terms

-gingivitis, risk for perio: edema, bleeding, biofilm, smoking

-record risk factors: identify etiologies/risk factors (biofilm/smoking)

Determining DHx: problems are crowding, decal, defective margins, biofilm

-risk for cavities (crowding, defective margins, biofilm, decal

Determining DHx: problem=lesions

-lesions (unknown, possible food trauma)

what are the guidelines for writing a DHx (for process of care mofel

1. phrase the DHx as a current condition or risk for future problem/condition

2. include what the problem is & what its related to (risk factors)

3. should be able to show the client evidence of the problem (perio- pockets, bleeding & bone loss on rads, biofilm)

4. use language clients will understand

5. avoid medical diagnoses (example: lichen planus)

what are the steps for determining DHx

-Step 1: review, analyze & interpret assessment data

-Step 2: combine the findings

-Step 3: sort or organize data into categories

-Step 4: write a DH diagnosis on a care plan

-Step 5: validate the diagnosis

-Step 6: consider client-centered goals that reduce the problem

DHx: process of care model diagnostic statement: problem: sens to cold & some foods, risk factors are erosion & diet

-DHx: sens teeth related to erosion, diet and habits

list DH diagnosis & risk factor: client smokes one pack a day

-DH diag: health risk

-risk factors: smoking

list DH diagnosis & risk factor: client presents w/ mod signs of gingival inflammation and heavy biofilm

-DH diag: gingivitis

-risk factors: heavy biofilm (gingival inflammation, lack of brushing/flossing skills?)

STEP 5 Determining DHx: validate the diagnosis

-verify the accuracy of the data

-compare findings from previous assessments or from one area to another

-compare w/ standards (what is common or expected for that age?)

-check references or resources

-discuss findings w/ client

-consult w/ dentist, instructor, or other health professional

category, DH diagnosis, risk factors: biofilm/frequent sugar, broken filling

-category: dental

-DH diagnosis: risk for cavities

-risk factors: biofilm, diet, broken filling or defective resto

category, DH diagnosis, risk factors: biofilm, calc, bleeding

-category: periodontal

-DH diagnosis: biofilm-induced gingivitis

-risk factors: biofilm, calc

category, DH diagnosis, risk factors: high BP reading, lesions on cheek

-category: other (general health/soft tissue)

-DH diagnosis: health risk, soft tissue lesion

-risk factors: high BP readings (stress? lifestyle?) unknown, broken filling? food trauma?

summarize the DH process model

-identifies client's problems in terms of response (rather than need) and states the possible etiology/risks

-group problems into categories – including general health, soft tissue, periodontal, dental

-state the condition or risk for future problem and the etiologic factor (risk factor)

once we have a DHx, what do we do?

-begin to think about how to help a client prevent a problem from occurring or fix/improve a problem or condition

-"what goals or expected outcomes could occur w/ DH care"

STEP 6 Determining DHx: consider client-centered goals that reduce the problem

-desired outcomes that the client aims to achieve through specific DH interventions/strategies to resolve a problem

-should relate to the DH diagnosis as well as signs and reported symptoms

-should reflect the client’s desired outcome of the DH care

-what would be a goal that would suit this client’s needs, values, capabilities?

how to properly make goals:

-use measurable verbs (decrease, increase, eliminate, prevent, stop, improve)

-using measurable goals allows you to evaluate DH care

-clarify what the client needs to do to meet goals

-explain how goals will be measured

goal: elevated BP readings

-have MD evaluate BP (see if appt is made)

goal: gingivitis (heavy bleeding, biofilm present)

-reduce biofilm/bleeding by last appointment, increase BFS score (improve brushing and flossing technique)

-evaluate in 2 weeks for resolution or improvement

goal: sensitivity (exposed root surfaces)

-reduce/eliminate sensitivity (purchase a sensitivity toothpaste and apply desensitizer)

goal: perio (deep pockets, furcations, calc, infrequent hygiene care)

-reduce pocket depths, attend regular hygiene appointments, book perio appt?, maintain furcations)

goal: high caries risk (high sugar diet, pop consumption, heavy biofilm)

-decrease/elimiate sugar intake to around meal times, reduce pop intake to meal time, brush 2x a day with proper brushing technique, increase fluoride, regular hygiene intervals to ensure proper deposit removal

-watch for changes in diet & biofilm, see if appt was made w/ DMD

goal: health risk (smoking)

-reduce or eliminate smoking, smoking cessation

goal: soft tissue lesion (increase in size)

-book appt with MD to evaluate lesion

goal: risk of gingivitis

-education, efficiently remove plaque daily using proper brushing and flossing techniques, maintain regular DH visits

summarize characteristics of a DH diagnosis

-focuses on client conditions, behaviors, or risk factors related to oral health and disease

-derives from client data collected during assessment

-requires interventions within the scope of DH practice

-necessary for planning and implementing effective dental hygiene care and evaluating its outcomes

what does DHx provide the link between?

-assessmennt and care planning

what does DHx focus on?

-individual needs of the client