Dental Hygiene Process of Care

Dental Hygiene Process of Care

Overview of the Dental Hygiene Process of Care

  • The dental hygiene process of care consists of the following steps:
    1. Assessment
    2. Dental Hygiene Diagnosis
    3. Dental Hygiene Care Plan
    4. Implementation
    5. Evaluation
    6. Documentation

Step 1: Assessment

  • Chief Complaint:
    • Pain considered a primary concern.
  • Health History:
    • Includes medical and social history, vital signs, pharmacologic history.
    • Uses ASA classification to ascertain physical status:
    • ASA I: Healthy
    • ASA II: Mild systemic disease
    • ASA III: Severe systemic disease but not incapacitating
    • ASA IV: Incapacitating disease
    • ASA V: Dying
    • ASA VI: Declared brain death
  • Behavioral and Lifestyle Factors:
    • Risk factors such as caries and periodontal disease are evaluated.
    • Assess oral health knowledge and self-care abilities.
  • Dental Charting:
    • Documentation of treatment history, iatrogenic dentistry, and type of care received.
  • Intra and Extra-oral Examination:
    • Comprehensive exam of hard and soft tissues.
  • Periodontal Data:
    • AAP (American Academy of Periodontology) classification.
    • Description of gingiva, calculus level, and biofilm score.
  • Radiographs:
    • Essential for patient care assessment.

Recognizing Risk & Modifying Factors

  • Factors related to caries behavior and self-care include:
    • Dietary habits
    • Fluoride exposure
    • Tooth morphology
    • Xerostomia (dry mouth)
    • Personal/family history of caries
    • Developmental and genetic factors
    • Last caries event
    • Existing restorations
    • Recession, oral cancer, tobacco use, alcohol use, sun exposure, HPV status
    • Systemic issues, hormonal changes, nutritional status, biofilm and calculus presence
    • Consideration of personal habits

Step 2: Dental Hygiene Diagnosis (Dx)

  • This step identifies patient needs that can be met through dental hygiene interventions, including:
    • Current periodontal classification.
    • Dental caries risk assessment.
    • Dental hygiene prognosis.
    • Considerations for care provision.
    • Evidence-based selection of dental hygiene protocols.

Step 3: Forming the Dental Hygiene Care Plan

  • Care Plan Definition: A formal, written plan designed to:
    • Inform patients of their health or disease status.
    • Secure informed consent for treatment.
    • Communicate planned interventions by both the patient and dental hygienist to achieve oral health that integrates with overall health needs.
    • Specify necessary interventions and prioritize patient needs.
    • Be evidence-based, outlining costs and time expectations.
    • Requires patient signature for informed consent to treatment.
Additional Considerations for The Dental Hygiene Care Plan
  • Patients have the right to accept or decline the treatment plan.
  • Dental hygienists must explain potential outcomes of not proceeding with treatment.
  • The rationale for treatment and expected prognosis must be provided, addressing implications of no plan developed.

Components of a Master Treatment Plan (Table 25-1)

Included Phases in the Dental Hygiene Care Plan:
  • Preliminary Phase:
    • Assessment data collection including emergency care (pain management, biopsy).
  • Phase I Therapy:
    • Dental biofilm control and preventive measures (diet changes, fluorides, mouthguard).
    • Calculus removal and corrections of irritants from restorations/prostheses.
  • Outcomes Evaluation of Phase I: Assessment of probing depths and clinical signs of inflammation, improving dental biofilm control, and patient participation.
  • Phase II Surgical: Focused on periodontal care.
  • Phase III Restorative: Final restorations, including fixed/removable prostheses, and assessments of periodontal responses.
  • Phase IV Maintenance: Appointments for ongoing care and refining biofilm control techniques.

Development & Presentation of the Care Plan to the Patient/Guardian

  • Utilizes core values of the dental hygiene profession:
    • Autonomy: Respecting the patient’s right to self-determination and decision-making.
    • Beneficence: Delivering services for the patient’s good.
    • Nonmaleficence: Preventing harm during treatment.
    • Justice: Ensuring fair treatment for all patients.
    • Confidentiality: Protecting sensitive patient data.
    • Veracity: Commitment to truth-telling and transparency in patient interactions.

Step 4: Implementation

  • Focus on reducing or eliminating the etiology of dental issues.
  • Implementation involves more than just scaling and polishing teeth.
  • Provide personalized daily oral care instructions and actionable recommendations with rationale to empower patients in their oral health journey.

Anticipatory Guidance as Part of Implementation

  • Education provided about growth and developmental milestones and potential oral/systemic health issues related to identified risk factors. Examples include:
    • Informing parents about upcoming tooth eruptions and the benefits of sealants.
    • Educating patients on medications causing xerostomia and associated caries risks.
    • Advising pregnant patients about the timing for their child’s first dental visit.

Step 5: Evaluation

  • Evaluation aims to determine:
    • Whether the patient needs further care or referral to a specialist.
    • Establish a maintenance plan post-treatment.
    • Evaluation checks the maintenance of health at follow-up and recall appointments, looking at responses to the provided care.

Step 6: Documentation

  • The formal care/treatment plan must be documented in the patient’s dental record, capturing:
    • All components of the DH process: assessment data, diagnosis, care plan, implementation actions, evaluation, and referrals if required.
    • Pertinent patient responses, satisfying ethical and legal responsibilities.

Legal and Ethical Concepts

HIPAA (Health Insurance Portability and Accountability Act)
  • Establishes standards for protecting sensitive patient data and mandates adherence to security regulations.
  • Requires a legal form signed by the patient, confirming the provision of data protection.
Professional Liability
  • Dental hygienists are legally accountable for actions as defined by their state’s Dental Hygiene Practice Act.
Scope of Practice
  • Dental hygienists must operate within the legal parameters established by state laws and licensure requirements. Some states allow for unsupervised practice under specific conditions.
Standard of Care
  • Refers to the expected level of clinical performance for safe and ethical practice, based on current evidence and practices. Any deviation can be viewed as negligence.
Informed Consent
  • Essential communication with the patient about treatment options prior to the signed agreement for procedures.
  • Implied consent applies to examination settings but must be clarified to the patient.
  • Patients must be informed about potential consequences of refusing treatment.

Ethical Considerations

  • Ensure respect for each patient and maintain effective communication among care parties.
  • Continuous education to stay current with standards of care.
  • Ability to identify reporting needs for unacceptable practices.

RCTC Treatment/Care Plan Protocol

  • Introduced a new Treatment Plan Worksheet in 2024 including:
    • Risk factors checklist for diagnosis determination.
    • Periodontal status/diagnosis and caries risk assessment guidelines.
    • Fluoride recommendations and patient oral care goals.

Recap of Key Concepts

Scope of Practice
  • Dental hygienists are licensed experts supporting preventive dental care and hygiene, supervised by dentists, except in specific states like Minnesota where independent practice may be allowed.
Dental Hygiene Diagnosis
  • Defined by ADHA as identifying health behaviors, attitudes, and care needs where a dental hygienist is qualified to provide care.
  • Communication is vital for trust-building; discussing health status, treatment options, expected outcomes, and the patient’s decision-making role.

Case Study: Assessment Data for Joe Smith

  • Patient Profile: 48-year-old male.
    • Health History: Non-smoker, no medications, low-carb diet, regular exercise.
    • Blood Pressure: 132/74, Pulse: 78.
    • Caries Risk Assessment: No recent caries; regular dental visits; localized recession noted.
    • Radiographs: Full mouth X-rays from 2023, bitewings 6/2024; no loss of bone density observed.
    • Clinical Exam: Free gingiva is healthy with some rolled margins; attached gingiva has proper firmness and stippling; plaque manageable with localized biofilm concerns.