Dental Hygiene Diagnosis CH22

4 basic steps to considered when planning patient care are

1. Collect & analyze assessment information

2. Establish the diagnosis

3. Select treatment & education interventions based on diagnostic findings

4. Develop a formal care plan

Dental hygiene diagnosis (DHD) is the result of

analysis & synthesis of assessment data and the application of clinical judgment and critical thinking skills.

A dental hygiene care plan is developed and an appointment sequence is formalized using an ___ ___ approach

evidence-based approach

Assessment findings Basics

-Chief compliant

-Risk factors

-Patient’s overall health status

-Oral healthcare literacy level of patient

-Oral self-care ability

Periodontal Risk and Diagnosis Basics

-Current periodontal status

-Classification of periodontal disease

Chief compliant

patient’s reason for seeking dental and dental hygiene care

significant concern (pain) is ALWAYS addressed before initial dental hygiene treatment

Risk factors

• Increase the patient’s potential for disease (dental caries & periodontal)

• Modifiable risk factors identified + controlled to reduce probability or progression of disease

• Goal: To REDUCE risk by intervention (patient education and counseling); use anticipatory guidance when a patient has risk factors

Anticipatory guidance

preventative education and counseling for patients exhibiting risk factors

Risk factors for periodontal disease

poorly controlled diabetes

smoking

Age as related to radiographic bone loss (RBL)

Inflammatory diseases (Ex: systemic like heart disease) measured by C-reactive protein (CRP)

Emerging risk factors for PD disease include

obesity

specific genetic factors

nutrition

physical activity

Periodontal disease association with systemic conditions

cardiovascular disease

diabetes

metabolic syndrome (increase risk for heart disease)

obesity

respiratory disease (asthma, pneumonia, COPD)

adverse pregnancy outcome

osteoporosis

Assessment findings used to help with DHD

Medical, dental, social history review

vitals

IO/EO

comprehensive periodontal exam

radiographs

dental caries/risk for caries

biofilm, calculus, stain

patient’s overall health status

Risk factors for oral cancer

tobacco

betel quid and gutka

heavy alcohol use

sun exposure (lips and face)

male

older than 55 yrs

genetic susceptibility

Patient’s overall health status

Physical:

-medical physical, psychological risk determines modifications

-can use ASA physical status classification system

-can use Oral, Systemic, Capability, Autonomy, Reality planning guide

Tobacco

ASA Classification Chart

ASA I

ASA II

ASA III

ASA IV

ASA V

Oral, Systemic, Capability, Autonomy, Reality Planning guide chart

Oral Self-care ability

determines success of planned interventions

modifications for disabilities or physical limitations

can use activities of daily living (ADL/IADL) to determine if aids or caregiver training is needed

Periodontal Risk and Diagnosis (Descriptive)

Current PD status: past and current conditions and risk factors affecting progression

Classification of periodontal disease: gingivitis, periodontitis

Parameters of care:

-clinical diagnosis, therapeutic goals, treatment considerations, outcome assessment

-planning considerations determined by infection severity

Dental caries risk level

-restorative treatment provides by dentist or dental therapist, but dental hygiene care plan includes interventions of risk factors

Dental hygiene diagnosis

Basis: 1) patient interview data (CC, oral problem identification, comprehensive patient histories) 2) physical assessment data (vitals, EO/IO, dental + periodontal charts) 3) radiographs

Diagnostic statements: diagnosis and risk factors contributing to the condition diagnosed; Ex) xerostomia due to medication side effect

Dental hygiene prognosis

future/anticipated outcome of a disease or condition

describes individual tooth or overall prognosis of patient teeth

overall prognosis determined by dentist

based on treatment and self-care behavior goals agreed by patient and clinician during planning phase of care

Prognosis criteria chart

Factors in assigning a prognosis

Individual:

-% bone loss

-CAL

-extent and type of bone loss

-presence + severity of furcation involvement

-mobility

-caries

-tooth position

-occlusal trauma

-crown to root ratio

-root form (Ex: fused)

Overall:

-age

-medical status

-rate of disease progression

-patient cooperation and compliance

-oral habits and behaviors

-oral health literacy

Prognosis factors (individual tooth)

-% bone loss

-CAL

-extent and type of bone loss

-presence + severity of furcation involvement

-mobility

-caries

-tooth position

-occlusal trauma

-crown to root ratio

-root form (Ex: fused)

Prognosis factors (overall)

-age

-medical status

-rate of disease progression

-patient cooperation and compliance

-oral habits and behaviors

-oral health literacy

Putting it all together

evaluation of assessment data: can use comprehensive patient assessment diagnosis worksheet to gather info together to help in diagnosis, prognosis, care, treatment plan

selection of dental hygiene interventions: evaluation of patient needs to develop personal goals + interventions to improve oral health, clinical findings, evidence based interventions to prevent or manage oral disease (professional literature; must be able to access and evaluate to benefit patient!)

dental hygiene care plan:

Evaluation of assessment data includes the following

summary of histories

chief complaint

summary of PD examination findings

summary of radiographic interpretation

PD classification

diagnosis

prognosis

Documentation

all assessment findings in prep for dental hygiene care plan development

written in ink if not computerized

entries dated and signs

standardized abbreviations only for legal reasons

Step 1

Identify patient’s overall health status:

Extent of patient’s medical, physical, and psychological risk determines modifications necessary during treatment.

Use ASA Classifications

Identify tobacco use:

Tobacco in all forms affect oral status and dental hygiene treatment outcome

Step 2

Determine health literacy of patient

Step 3

-Determine patient’s oral self-care ability

-Activities of daily living (ADL/IADL): classification level to summarize an individual’s ability to carry out/perform basic tasks.

Step 4

determine periodontal risk and diagnosis

planning for number and length of appointments in a treatment sequence influenced by classification of periodontal disease

Periodontitis Staging

Periodontitis Grading

Gingivitis

Inflammation of gingiva is characterized by changes in color, shape, form, size, and position of margin, with bleeding on probing.

No attachment loss

Does NOT receive a periodontal stage or grade

Why?

Stage I periodontitis

mild

progression of inflammation into the deeper periodontal structures

slight bone loss and connective tissue attachment

Stage II periodontitis

moderate

Increased destruction of the periodontal structures

Increased probing depths, noticeable loss of interdental bony support

Early to moderate furcation, mobility, fremitus

Stage III and IV periodontitis

Major loss of bony support

Increased probing depths

Furcations

Increased tooth mobility and fremitus

Other signs and symptoms

IUSB Degree of difficulty (is/isn’t) a diagnosis

isn’t

IUSB Calculus level

Step 5

determine caries risk level

managing risk factors

Child less than 6 yrs Caries risk level assessment (0-6 yes)

Caries risk assessment more than 6 yrs

Develop the DHD

1) Use of evidence-based analysis of the assessment findings to determine the patient’s or community’s dental hygiene needs

2) Diagnostic Statements: Include the diagnosis and risk factors contributing to the condition diagnosed + Provide the basis for developing the care plan focusing on:

+ Education

+ Oral self-care

+ Prevention

+ Dental hygiene treatment

(all within scope of dental hygiene practice and referral)

Dental hygiene prognosis

forecast of the anticipated outcome

how’s the patient going to respond to treatment?

based on treatment and self care behavior goals set by clinician with the patient during the planning phase

Factors for individual tooth prognosis: Individual tooth prognosis, percentage of bone loss, clinical attachment loss, Extent and type of bone loss, presence & severity of furcation involvement, Mobility, Caries, Tooth position, Occlusal trauma

Factors for overall prognosis: Age, Medical status, rate of disease progression, patient cooperation and compliance with recommendations, Compliance with recommendations, oral habits and behaviors, Oral health literacy

Putting it all together

Evaluation of Assessment Data:

+Significance of medical & dental history

+Chief complaint

+Risk factors

+Summary of periodontal examination findings

+Summary of radiographic interpretation

+Periodontal classification

+Diagnosis

+Prognosis

Selection of dental hygiene interventions:

+Evidence-based interventions to prevent or manage oral disease

Develop a care plan

Document!! Where in IUSB?

Under DHD in clinical notes

Comprehensive patient assessment and diagnosis worksheet