Introduction to Dental Hygiene and Professional Standards

Course Logistics and Educational Resources

• Class Scheduling: Lectures take place on Fridays from $9:00$ to $12:00$. Attendance is mandatory for the full duration because of the density of the curriculum.
• Textbooks and Materials:
  • Clinical Practice of the Dental Hygienist (The Purple Book): Authored by Esther Wilkins. Often referred to as the "bible" of dental hygiene. It covers everything from patient communication to instrumentation and is structured in an outline format.
  • Case Studies Book: Used throughout the semester, next semester, and into the senior year. Instructions on when to bring this book are provided as needed.
• Software and Technology:
  • Patient records and data are managed using Eaglesoft dental software.
  • Wireless, Bluetooth-enabled keypads are used in the clinic for perio charting to streamline data entry into the software.
• Interprofessional Education (IPE): Accreditation bodies for pharmacy, occupational therapy (OT), and other healthcare professions mandate interprofessional modules. These events focus on professional communication between disciplines (e.g., a dental hygienist consulting with a doctor regarding a patient with a cleft lip or palate).

History and Foundations of Dental Hygiene

• Alfred Fones: Known as the "father of dental hygiene." He established the field to focus on prevention rather than just restorations or extractions. He founded the Fones Dental School of Dental Hygiene.
• Irene Newman: The first dental hygienist, trained by Alfred Fones in $1910$ (the era when the profession began). She served as a dental nurse initially.
• Primary Philosophy: The core mission is the prevention of disease and the education of patients as preventative caregivers.

Roles and Career Settings for Dental Hygienists

• Education: Informing patients about oral health and teaching skills like brushing and flossing.
• Assessment: Collecting data (medical history, vitals, X-rays, charting) before deciding on a treatment plan.
• Diagnosis: While hygienists do not legally diagnose for the patient in many jurisdictions, they perform a "quiet diagnosis" to identify issues like decay on the buccal of number $2$ or bone disease to report to the dentist.
• Therapy: This includes Scaling and Root Planing (SRP) or periodontal therapy to remove bacterial deposits.
• Research: All practice is evidence-based. Practitioners must evaluate peer-reviewed articles to determine the efficacy of products.
• Administration: Roles include managing community clinics (e.g., Federally Qualified Health Centers), ordering supplies, and organizing schedules.
• Specialties:
  • Public Health: Working in government-funded clinics, Head Start programs, or nursing homes.
  • Corporate Dentistry: Working for large companies (e.g., Aspen) that provide benefits like $401(k)$ plans.
  • Orthodontics: Maintaining oral hygiene around brackets and wires to prevent decay.
  • Pediatric Dentistry: Working specifically with children in schools or specialty offices (e.g., Riser Elementary and Middle School clinic).
  • Periodontics: Focusing on bone disease and deep scaling under the supervision of a periodontist.
  • Traveling Hygiene: Temporary placements in different offices for higher daily rates (e.g., up to $500$ per day in some cities).

Scope of Practice and Legislation

• State Regulation: The scope of practice is determined by each state's Board of Dentistry. When moving between states, a new license exam and fee (e.g., approximately $250$) are usually required.
• Louisiana Regulations:
  • Anesthesia: Hygienists can administer local anesthesia (blocks and infiltrations) and Nitrous oxide.
  • Supervision: General supervision allows a hygienist to see a recall patient (regular $6$-month check-up) even if the dentist is not physically present in the building.
• Regulations in Other States:
  • Texas: Limits certain types of anesthesia and is still developing Nitrous oxide permissions.
  • Colorado: Hygienists can own their own clinics (independent practice).
  • Oregon: Allows hygienists to perform restorations (fillings) and assistants to administer local anesthesia.
  • Minnesota: Has a master's level degree for Advanced Dental Therapists who perform extractions and restorations.

The Dental Hygiene Process of Care: ADPIE

• Assessment: The first component involving the collection of subjective and objective data.
  • Objective Data: Measurable findings, such as gum pocket depths measured with a probe.
  • Subjective Data: Patient-reported items, such as sensitivity or pain levels.
• Diagnosis: Determining the health status of the gingiva and bone (Gingivitis vs. Periodontitis).
• Planning: Creating a individualized treatment strategy for the patient.
• Implementation: Activating the treatment (e.g., polishing, fluoride, scaling).
• Evaluation: Checking the patient’s progress during follow-ups (every $3$, $4$, or $6$ months).
• Documentation: Recording all findings and communication in the software. "If it isn't written down, it didn't happen."

Professional Ethics and Core Values

• Autonomy: Treating every patient with respect and acknowledging their right to self-determination.
• Confidentiality: Maintaining patient privacy and adhering to HIPAA regulations.
• Integrity: Being honest and professional in all interactions.
• Justice/Fairness: Providing consistent care without discrimination.
• Non-maleficence: Doing no harm (e.g., deciding whether to radiate a pregnant patient).
• Ethical Dilemma vs. Ethical Issue: An issue is a clearly defined problem, whereas a dilemma may involve two morally correct choices with no single right answer.
• Professional Memberships: Joining the American Dental Hygiene Association (ADHA) is the primary way to advocate for the profession and influence legislation.

Research and Evidence-Based Decision Making

• PICO Process:
  • P: Patient Problem/Population.
  • I: Intervention.
  • C: Comparison.
  • O: Outcome.
• Information Hierarchy:
  • Highest Level: Systematic reviews.
  • Second Level: Randomized controlled clinical trials.
  • Lower Levels: Case reports, case studies, animal/in vitro research.
• Source Veracity: Use scientific databases and educational (.edu) or governmental (.gov) sites. Professional journals like JADA (Journal of the American Dental Association) or JDH (Journal of Dental Hygiene) are preferred.

Patient Communication and Interaction

• Verbal vs. Non-verbal: Verbal includes language and translators (e.g., Google Translate). Non-verbal includes facial expressions, eye contact, and body positioning (Personal space).
• Health Literacy: Assessing what the patient understands about their health to tailor education.
• Pediatric Care:
  • Play Visits: "Get to know you" visits for toddlers to touch the "Mr. Slurpee" (suction) and move the chair.
  • Ages $6$-$11$: Explain procedures using non-scary terms; parents usually sign consents but stay in the hall.
  • Ages $12$-$21$: Direct communication; clinical consent required from a legal adult.
• Geriatric Care: Be mindful of mobility (wheelchair transfers), hearing (positioning towards the "good ear"), and terms of endearment (which some textbooks advise against).
• Motivation: Connect with patients by documenting personal details (e.g., a trip to Disneyland) to build rapport for future visits.

Questions & Discussion

• Question: Someone was asking yesterday about uploading the syllabus receipt?
• Response: If you're having trouble uploading the screenshot, email the instructor. It is a new system and there might be glitches.
• Question: Will class meet in this room on September 11 during the Open House?
• Response: I will keep you posted because the governor is coming and there is an open house, but we still have an exam and CPR that day. We cannot cancel.
• Question: What are the requirements for the research article assignment?
• Response: It is a three-page article review on an assigned topic using a peer-reviewed professional journal. Follow the rubric for a high grade.
• Question: If you did travel dental hygiene, would you have to take the test in every state?
• Response: Yes, license exams must be taken for each state you practice in. Most are online now, though some states still coordinate through physical schools. Fees apply for each.
• Question: Are there other states where a hygienist can own their own clinic?
• Response: Yes, Colorado is a primary example of where hygienists can practice independently, similar to a nurse practitioner.
• Question: Do patients have to be awake for laser treatment?
• Response: Yes, they are awake but numbed up. Laser therapy is used to kill bacteria and can be painful without anesthesia.
• Question: On November 6, the IPE event—is it after our test?
• Response: Most likely from $10:00$ to $12:00$. It is a grade for the class, and points will be deducted for non-attendance.
• Question: Are we getting patients from the school?
• Response: There is a pool of over $2,000$ patients. First-semester students usually start with easier cases like friends or family for the first $2$-$3$ completions.