PLANNING FOR DENTAL HYGIENE CARE

What is assessment?

The step in the dental hygiene process of care that involves collecting and analyzing systemic and oral health data with the purpose of identifying a patient or client’ s needs

What are some assessment instruments?

• explorer

• mirror

• air water syringe

Four basic steps when PLANNING patient care

• Collect and analyze assessment information

• Establish the diagnosis

• Select treatment and education interventions

• Develop a formal plan of care

Clinical assessment findings play a key role in…

the development of the dental hygiene diagnosis and dental hygiene care plan

Chief Complaint:

the patient’s statement regarding the reason for seeking dental and dental hygiene care

• It is a significant concern expressed by the patient, such as pain; and is addressed before initiating dental treatment.

Risk factors

increase the patients potential for diminished oral health status

Anticipatory guidance through preventive education and counseling is

an essential component of the care plan for a patient exhibiting one or more risk factors

Individual risk factors for periodontal diseases

• Diabetes (poorly controlled)

• Cigarette smoking

• Age (not direct but can effect)

• Inflammatory burden

Current research suggest the presence of periodontal infection is associated with a variety of systemic conditions including:

• Cardiovascular disease

• Diabetes Mellitus

• Metabolic Syndrome

• Obesity

• Respiratory Disease

• Adverse Pregnancy outcome

• Osteoporosis

Risk factors for dental caries

• Heavy biofilm

• Dietary factors

• Low fluoride exposure

• Visible caries or white spot lesions

• Recent restorative treatment

• Tooth morphology and position

• Xerostomia

• Recreational drug use

• Orthodontic Appliances

• Low health literacy/low socioeconomic status

• Children (primary caregiver has current/recent history dental caries)

Risk factors of oral cancer

• Tobacco use of any kind

• Betel quid and gutka

• Heavy alcohol use

• Excessive sun exposure

• Exposure to the human papillomavirus

• Male gender

• Older than 55 years

• Genetic susceptibility

Physical Status

• The extent of the patient’s medical, physical, and psychological risk determines modifications necessary during treatment

• Systemic approaches to assess physical status: ASA Classification System and OSCAR Planning Guide

ADPIED

• assessment

• diagnose

• plan

• implement

• evaluate

• document

Tobacco Use

Tobacco in all forms affects oral status and dental hygiene treatment outcomes

Review ASA classifications

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OSCAR planning guide

oral, systemic, capability, autonomy, and reality planning guide

Assessment findings also determine…

• Oral Healthcare Literacy Level of Patient

• Patient’ s Self-Care Ability

Measures of patient functioning

know levels

level 0 (patient functioning)

ability to perform the task without assistance

level 1 (patient functioning)

ability to perform the task with some human assistance

• may need some divide

level 2 (patient functioning)

level 3 (patient functioning)

Planning for the number and length of appointments in a treatment sequence is influenced by:

• Patients modifiable risk factors

• Periodontal diagnosis

Dental caries risk level

• Diagnosis and restorative treatment of caries is provided by the dentist or dental therapist

• The plan for dental hygiene care includes interventions aimed at managing risk factors for dental caries- hygienist

dental hygiene diagnosis

• Fundamental component of medical and dental care

• Part of the process of care, involving the use of evidence based analysis of the assessment findings to determine the patient’s or community’s dental hygiene needs

• Provides a basis for the dental hygiene care plan (therapeutic and preventive)

basis for diagnosis

• Patient interview data

• Physical assessment data

• Radiographic series

diagnosis statements provide…

the basis for development of the care plan that focuses on education, oral self- care, prevention, dental hygiene treatment within the scope of dental hygiene practice and referral

• Diagnostic statements include the diagnosis and the risk factors contributing to the conditions diagnosed

examples of dental hygiene diagnosis statement

view image

Prognosis

forecast of the outcomes of a disease or condition

• component of the medical and dental care

Dental hygiene process of care prognosis refers to the following:

1. A look ahead to an anticipated outcome or endpoint expected from the dental hygiene intervention selected for an individual patient

2. Expressed in general terms for either and individual tooth or the overall prognosis for the patients teeth

(overall prognosis will be determined in consultation with dentist)

3. Based on treatment and self-care behavior goals agreed upon by patient and clinician during planning phase of care

the steps all together:

1. Evaluation of the Assessment Data

2. Selection of Dental Hygiene Interventions

3. Dental Hygiene Care Plan

the dental hygiene care plan is

A formal, written, evidence based dental hygiene care planis an essential component of the comprehensive dental treatment plan

Dental Hygiene Care Plan Objectives

• Address patient needs identified from assessment data

• Reassess previous treatment goals and identify barriers to success

• Develop treatment goals in collaboration with the patient to address problems and modifiable risk factors

• Identify treatment option interventions and recommendations based on current scientific evidence include need for referral

• Prioritize sequence of education, preventive services and treatment in the care plan

• Collaborate with dentist to integrate the dental hygiene care plan into the comprehensive dental treatment plan

patient =

client

A dental hygiene care plan:

• may be written in a variety of formats

• software for electronic records include a treatment plan template that can be used to develop a dental hygiene care plan

components of a written care pan (10):

1. Individual Patient Considerations

2. Assessment Findings and Risk Factors

   1. Medical, social and dental history

   2. Health risk factors

3. Periodontal Classification

4. Caries Risk

5. Diagnosis

6. Patient Centered Oral Health Goals

7. Planned Interventions

8. Expected Outcomes

9. Re-evaluation

10. Appointment Sequence

Individual Patient Considerations

• Basic demographic information

• Chief complaint

• Social determinants of health

• Health and oral beliefs/cultural beliefs

Medical, Social, and Demographic Data

• ASA Classification

• Systemic diseases and conditions (current and past)

• Medications

• Health behaviors

• Dental Anxiety

• Cultural Factors

• Functional Assessment

Health risk factors

• Increased risk of systemic disease due to oral infection

• Potential for compromised treatment outcomes

Periodontal Classification is based on…

stage and grade

Use patient’s caries risk level to guide…

preventive aspects in dental hygiene care plan

• Ex.) oral self care, sealants, fluoride….

Dental Hygiene Diagnosis (DHDX): The ADHA defines dental hygiene diagnosis as…

the 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

Problem (Diagnostic Statement)

• Part of the process of care involves the use of evidence-based analysis of the assessment findings to determine the patient’s dental hygiene needs.

• Provides a basis for the dental hygiene care plan (therapeutic and preventive)

• Provides the basis for development of the dental hygiene care plan that focuses on education, oral self- care, prevention, dental hygiene treatment within the scope of dental hygiene practice, and referral

In the diagnostic statement…

There may be multiple diagnoses based on analysis of assessment data

• Provides basis for dental hygiene care plan

• Is a two-part statement which describes an oral condition & possible etiology

statement of problem, statement of cause, as evidenced by statement of defining characteristics

ex.) inflamed gingiva related to heavy biofilm

Diagnostic statements based on the diagnosis (from assessment findings) require the creation of patient-specific goals linked to dental hygiene disease status and modifiable risk factors

• Goals are broad

• Goals must address the problem

  • the goal is to resolve the oral health problem

• Prioritize the modifiable risk factors for oral health disease.

• Addresses cognitive, psychomotor, affective aspects of the patient specific oral health care needs

Example of goals related to dental caries:

• Absence of any new demineralized areas

• No new carious lesions

• Change dietary habits

Problem statement example:

Palatal irritation related to wearing dentures all night as evidenced by self report and tissue tenderness

Goal statement example:

To resolve denture oral tissue irritation/trauma