Dental Hygiene Diagnosis Notes

DENTAL HYGIENE DIAGNOSIS: CHAPTER 22 NOTES

OBJECTIVES

  • Compare and contrast dental hygiene and dental diagnosis with nursing and medicine as parallels.

  • Discuss and demonstrate the dental hygiene diagnostic process utilizing the Human Needs and Oral Health-Related Quality of Life models to inform diagnostic decision-making.

  • Implement the dental hygiene diagnostic process in action which includes:

    • Identifying interventions that support various dental hygiene diagnoses.

    • Writing dental hygiene diagnoses.

    • Educating and motivating clients for positive behavior changes.

  • Assess the importance of validating dental hygiene diagnoses and the process involved.

  • Gather comprehensive data to identify recognizable patterns for formulating diagnoses.

  • Discuss the outcomes and benefits of dental hygiene diagnoses.

DIAGNOSIS DEFINED

  • Diagnosis: Identification of a condition, problem, or situation through the analysis of its cause and defining characteristics.

    • Social Determinants of Health: Economic and social conditions influencing health on individual and community levels.

DENTAL HYGIENE DIAGNOSIS

  • Focuses on modifying oral hygiene instructions based on individual cognitive abilities.

  • Involves identifying health behaviors, attitudes, and oral health care needs.

  • Forms the basis for dental hygiene care plans.

  • Emphasizes the importance of collaboration with medical professionals.

EXPANDED SCOPE OF PRACTICE

  • Expansion of dental hygiene practice acts to include diagnoses has been gradual.

  • As direct access has improved, the scope of dental hygiene practice has evolved.

  • ADHA Diagnosis White Paper: Provides clarity and guidance concerning dental hygiene diagnosis and its scope of practice.

SLOW EXPANSION OF PRACTICE ACTS

  • Factors contributing to the slow expansion:

    • Historical actions by CODA:

    • 1998: CODA Standards for Dental Hygiene Diagnosis (DHD) established.

    • 2007: Removal of DHD from CODA accreditation standards for DH education.

    • 2010: CODA removed DHD and DHCP.

    • 2016: Release of third edition of Standards for Clinical Dental Hygiene Practice by ADHA.

    • 2017: Limited definition of DHD included in CODA standards for DH programs.

DENTAL HYGIENE DIAGNOSTIC PROCESS IN ACTION

  1. Analyze and interpret all assessment data.

  2. Formulate the dental hygiene diagnosis or diagnoses.

  3. Communicate the dental hygiene diagnosis to clients.

  4. Identify patient needs that can improve through dental hygiene care.

  5. Identify necessary referrals within dentistry and other healthcare disciplines based on the diagnosis.

1ST STEP IN DENTAL HYGIENE DIAGNOSIS

  • Involves comprehensive assessment and analysis of data, referred to as Biopsychosocial data:

    • Biological and Physiologic Variables: Medical and dental history.

    • Psychological Variables: Effects of symptoms, function, and health perception on oral conditions.

  • Dental hygiene diagnosis based on Biopsychosocial data promotes a person-centered care approach, where patients are seen as equal partners in their care planning.

CASE STUDY 22.1: PATIENT HISTORY

  • Intraoral and Extraoral Examination Findings:

    • Gingiva: Generalized firm and pink, localized severe inflammation.

    • Missing teeth: 1, 16, 17, and 32; multiple restorations found; presence of active caries on specific teeth.

    • Periodontal Evaluation:

    • Attachment loss: 3-7 mm.

    • Generalized recession: 1-3 mm; localized increased pocket depth.

    • Bleeding Index (BI): 17%; Plaque Index (PI): 100%.

  • Social History:

    • Patient recently became an RN specializing in pediatrics and highly values dental health.

  • Socioeconomic Factors:

    • No dental insurance, concerned about paying out of pocket, but prioritizes health expenses.

APPLYING HUMAN NEEDS MODEL TO DIAGNOSTIC DECISION MAKING

  • Review of Case Study 22.1 indicates unmet human needs including:

    • Wholesome facial image.

    • Mucous membrane integrity of head and neck.

    • Biologically sound and functional dentition.

    • Conceptualization and problem-solving abilities.

    • Responsibility for oral health.

DENTAL HYGIENE DIAGNOSIS SUMMARY

  • Unmet Needs and Their Evidence:

    • Wholesome facial image's etiology due to Class II mobility, knowledge deficits, and stress-related immune responses.

    • Active periodontal disease evidenced by inflammation and recession.

  • Client Goals (Expected Outcomes):

    • Verbalize understanding of periodontal disease etiology and discontinue risky behaviors (e.g., barbell tongue piercing).

    • Decrease Biomarkers (e.g., BI below 10%) and reduce probing pocket depths by the end of treatment.

APPLYING ORAL-HEALTH RELATED MODEL TO DIAGNOSTIC DECISION MAKING

  • Oral Health-Related Quality of Life (OHRQL):

    • A multidimensional construct reflecting individuals' comfort, self-esteem, and overall satisfaction regarding their oral health.

  • The dental hygiene process includes assessment of biopsychosocial variables using OHRQL questionnaires.

WRITING DENTAL HYGIENE DIAGNOSES

  • After analyzing data, conclusions drawn may include:

    • Treatment Required: Collaboration with the patient to develop and validate dental hygiene diagnosis.

    • No Active Problems: Identify risk factors without needing immediate treatment.

RISK FACTORS

  • For Periodontal Disease:

    • Poor oral hygiene, tobacco use, orthodontics, stress, etc.

  • For Caries:

    • Current caries, demineralization issues, inadequate fluoride exposure, dietary habits, etc.

  • Disease Indicators include active cavities and enamel lesions.

  • Caries Risk Assessment suggests various classifications based on identified risk factors and protective measures.

RISK FACTORS FOR ORAL, HEAD, AND NECK CANCER

  • Includes tobacco and alcohol use, family history of cancer, stress, nutritional concerns, specific viral infections (e.g., HPV), and age-related factors.

RISK FOR TEMPROMANDIBULAR DISORDER (TMD)

  • Identifying TMD involves recognizing a range of risk factors such as stress, bruxism, and jaw issues.

VALIDATION OF DENTAL HYGIENE DIAGNOSES

  • Validation is essential for supporting the establishment of a dental hygiene diagnosis.

  • Involves comparing observed data with accepted standards, considering evidence, regulations, and continuous data patterns.

RECOGNIZING PATTERNS

  • Effective dental hygiene diagnoses depend on utilizing a cluster of significant data rather than relying on individual signs or symptoms.

  • Comprehensive data gathering prevents incorrect diagnosis formulation.

OUTCOMES OF DENTAL HYGIENE DIAGNOSES

  • Facilitate professional communication among oral health workers.

  • Provide accuracy in clinical outcome measurements and define the role of dental hygienists within their practice scope.