Chapter 22 & 23) Dental Hygiene Diagnosis and Care Planning

DH process of care

- DH diagnosis statements

- formal written plan integrated with total treatment plan used

dental hygiene diagnosis statements

-Identify significant oral hygiene problems

- Behavioral aspects and deviations from normal oral health (high anxiety)

forma written plan integrated with total treatment plan used:

- Identify interventions based on diagnostic statements

- Educate patient

- Secure informed consent

- Communicate plan with other team members

ethical applications

- Law applies to all dental hygiene professionals

- Dental hygiene practice acts of each state govern the scope of practice and criteria for licensure

- Potential for ethical situations to arise when DHCP interacts with: patient, team members, family/caregiver

Providing Ethical Care To Patients:

- Aware of respect each patient deserves

- Maintains communication among all parties responsible for treatment

- Attains knowledge of current standards of care & legal scope of practice

- Possesses ability to assess and justify reporting of unacceptable practices

informed consent can be:

verbal

DH process of care introduction

- Collect and analyze assessment information

- Establish the diagnosis

- Select treatment and education interventions based on diagnostic findings

- Develop formal plan for care

- DH diagnosis= analysis & synthesis of data and application of clinical judgement and critical thinking skills

- Use evidence-based approach, formalize DH Care Plan &appointment sequence

Assessment Findings

- Chief Complaint (CC): patient's statement on why seeking treatment

- Risk Factors: Anticipatory Guidance, Periodontal Diseases, Systemic Conditions, Dental Caries, Oral Cancer

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

ASA classification system

Assessment of Health Literacy

- Oral Healthcare Literacy Level of the Patient: build on current knowledge

- Patient’s Self-Care Ability: activities of daily living classification; Adaptive or assistive aids, caregiver training needed

Periodontal Diagnosis & Risk Level

- Plan for # & length of appointments

- Current Periodontal Status

- Classification of Periodontal Diseases

- Parameters of Care

-gingivitis, stage 1 periodontitis, stage II perio, stage III or IV perio

Dental Caries Risk Level

- adults and children different

CRA= Low, moderate or high. Enter on grade sheet for each patient.

dental hygiene diagnosis

- Part of Process of Care

- Provides the Basis for dental hygiene care plan

- Basis for Diagnosis: interview data (chief complaint, social, med/dental history), physical assessment data (perio chart, clinical exam, dental chart), radiographic series

- diagnostic statements: development of care plan focusing on education, oral self-care, prevention, dental hygiene treatment within the scope of DH practice and referral

examples of dental hygiene diagnostic statements

Factors in Assigning Prognosis

- Individual tooth prognosis: good, fair, poor, questionable, hopeless

- Overall prognosis: age, medical status, oral habits, oral health literacy, rate of disease progression

Putting It All Together

- Evaluation of Assessment Data->

- Selection of DH Interventions->

- Dental hygiene care plan->

Documentation

- Computerized or written in ink (black)

- Entries are dated and signed

- Standardized abbreviates

- teaching the patient

documentation: factors to teach the patient:

- Why disease control measures are learned before and monitored throughout dental hygiene care

- Oral disease prevention and oral health promotion relevant to patient's current level of healthcare literacy

- Long-term positive effects of comprehensive continuing care

Preparation of DH Care Plan

- Address needs of entire oral cavity

- Patient’s individual health factors

- Integrates three-part plan (periodontal/ gingival health, Dental Caries control, and other: ex. Modifiable risk factors, nutrition counseling, halitosis)

- Major influence on future oral health of patient

Preparation of DH Care Plan; description

Sequence of interventions

Preparation of DH Care Plan; rationale

Focus on individualized patient needs & risk factors

Preparation of DH Care Plan; objectives

- Addresses patient needs

- Flexible & realistic

- Treatment & OH goals in collaboration with patient

- Referrals

Preparation of DH Care Plan; Parts of care plan

1. Periodontal/Gingival health

2. Dental Caries Control

3. Other: Personal daily oral biofilm control, Eliminate modifiable risk factors, Desensitizing exposed dentin, Resolving halitosis, Nutritional counseling

Components of a Written Care Plan

- Demographic Data

- Assessment Findings & RiskFactors

- Periodontal Diagnosis & Status

- Caries Risk Status

- Diagnostic Statements

- Patient-Centered Oral HealthGoals

- Planned Interventions

- Expected Outcomes

- Evaluation Methods

- The Appointment Plan

- Re-evaluation

Role of the Patient

- Purpose: Willingness and ability of patient

- Procedure: Determine level of understanding of diseases, risk factors or OH behaviors

Pain & Anxiety Control; procedures

- Treat areas of pain/discomfort 1st

- If no Anxiety -Treat most severe area 1st

- Treat right, then left side

Sequencing & Prioritizing Patient Care

- Provide Evidence-Based, Individualized Patient Care

- Eliminate or Control Etiologic & Predisposing Disease Factors & Prevent Recurrence of Disease

- Eliminate Signs & Symptoms of Disease

Factors Affecting Sequence of Care

- Identify overall treatment & educate patient

- Outline series of appointments: urgency, existing etiologic factors, severity & extent of condition, individual patient requirements

Presenting Dental Hygiene Care Plan; to collaborating dentist

- purpose: Comprehensive treatment plan & Provide coordinated dental & dental hygiene statement to patient

- procedure: follow sequence & summarize demographic data, major systemic and dental health assessment findings, and risk factors

- Indicate suggested intervention strategies, goals, expected outcomes, and referrals

- Outline suggested appointment sequence & services

- Be prepared to give detail and answer questions

Explaining Plan to Patient

- Use radiographs, intraoral camera, motivational interviewing

- Purpose

- Informed consent patient’s role

- Reinforce

- Procedure

- Face-to-face

- Appropriate terminology

- educate patient on: systemic link & oral disease, and recommended DH services, appt. sequence, expected outcomes, referrals

- visual aids

- Engage patient in planning and setting goals

- Give detail & answer questions

- Obtained signed informed consent

Informed Consent

- Provide relevant information

- Aid in making optimal decisions for OH

- Allow shared decision making

- Can exist w/o written documentation

- Lacking even with signed document

- Informed of all treatment options, chooses Tx option, and consents to follow recommendations

- Provide written documentation

- informed refusal: autonomy & informed refusal of care

- additional considerations: cultural differences & age/disability

-documentation