Dental Hygiene Diagnosis and Care Planning

1 DentalHygieneDiagnosisandCarePlanningS E C T I O NI VAssessDatacollectionDiagnoseIdentify problemsbased onassessmentdataPlanSelect, prioritizeand sequencedental hygieneinterventionsImplementActivatingt he planEvaluateFeedback oneffectivenessFIG UR E IV- 1DH Processof Care: Diagnosisand the in iti al assessmentis completedas describedinSec ti on III, th e da ta ar e as sembled, sequenced,an d ana-lyzed in preparationfo r planningstra tegiesthathelpthepat ie nt acquire an d ma intain or al hea fo rmal writ-tencarepl an is necessar y for ed ucating th e pa tient,secur-in g inf or medconsent fortreatment,and communicatingwi th oth er ora l ca re E DEN TA L Hygiene PROC ES S OF CAREF igureIV-1sh ows th e positio n of di agnos is andcarepla n-ningin the tot al Dental HygieneProcessof Ca DIAGNOSET hedia gn osisseg ment of theDenta l HygienePro cessofCareis relatedto an alyzin g th e ass ess ment da ta th at hasbe en collected.

2 Thedental hyg ien e dia gn osisid en tifiestho se pa tient needs for wh ichth e Dental hyg ienist will pro -vid e int erv ent ion s. Interventions within thescopeof den-tal hyg ien e practice ar e implementedto solvetheproblemsid en tifi ed by the diagnos tic sta tements. Denta l dia gnoses,on theoth er han d, ar e dir ectedat thos e pa rticular diseasesandcondition s for wh ichth e dentist wil l providetreatment. Dental Hygiene Diagnosis sta tem entsfocusattentiononthe behavioralasp ectsas well as deviati ons fromnor -mal ora l health. Chartings, radiogr aphs,his tories, and all rec or dedpa -ti en t da ta are anal yzedtog et her. Each dia gnostic statement identifieswit h a significantoral hygie ne problemof thepa of diag-nostic st atemen ts areshownin Ta ble22-2(page____).

3 A blu ep rin t carepl an,suchas th at des ignedin Figure22-1 (pa ge ____),cl arifiesthi nki ng towardprep arationof dia gn osti c PL ANTheth ir d co mponent of the Dental Hygiene Pr ocessofCareis to developa planfo r pa ti entca dpu rposesfordevelopin g a writtencar e pla n aredescribedin thissection. Th e Dental hyg ienecar e pla n selectsinterventionsthatar e basedon an alysisof assessmentda ta tha t hasbeencon solidatedin to dia gnosticstatementsthatdefinepa -tientneeds. Th e car e pla n is developedto confor m to an d be in te -gratedwith th e to tal tr eatment planof thepatient. Th e over all obj ectivesof th e Dental healthcaretea mfo cu s on the oral heal th of th e pati en t. The ulti ma tegoalwill be th e contro l of or al dis eas ICA L APPL ICA TIONSPr ofe ss io nalethics is part of every componen t in thepr ov ider/patient relationsh ip betweenth e Dental hygienistan d thepat ien t.

4 Th e pote nt ial for an et hic al situa tio narises anytime a Dental hygienist interactswitha patient,withmembers of thedental team,or withindividuals in -vo lvedin thespecialneedsof th e patient, suchas family,ca re givers, or members of specialtypr dentalhy -gienist wh o pr ovideseth icalpatient car e: Is cognizant of therespectea ch patient deserves. Ma intains commun icationamong all partiesresponsi -blefor Dental anddental Hygiene treatment. At ta in s a knowle dgeof curre nt st andardsof car ethr ou gh co ntinuin g educationcourseworkand readingpr ofessional jo ur nal ar ticlesabout new research . Is awa re of ethi cal issues such as conflic t of in terestwhiletr eating patients, th e legalscopeof one sdu ties,an d dealingwithimpaired colleagu es Possessestheabilityto assessan d jus tifyth e reportingof unacceptablepra sic conceptsin healthcar e la w applyto all dentalhygiene pr e Dental Hygiene practiceactsofea ch sta te or pr ovince govern th e scopeof dutiesand th ecr ite ri a forli censure.

5 Profession al liability,standardofca re , inform ed consent,privacy inform ation, an d malprac -ti ce areot he r concernsthat aff ect the dailydutiesandri gh ts of bot h the pati entandthede ntal lec ted le galconcept s andsuggest 4 DentalHygieneDiagnosisandCarePlanningCHA PTER21 Planningfor Dental HygieneCare355 LEGA L AN D ETHICAL CONCEPTSLEGA L CON CEP TEX PL AN ATIONAPPLICATIONP rofessionalLiab ilityA licensedpr ofessional is legallyaccountableScopeand dutiesof the dent al hygienistarefor al l acti ons; boundby the each state sDent al HygienePracti ce PracticeA dentalhygi eni st is legallyboundto provideAdherenceto dentalhygienelicensurecare withi n the dentalhygienescopeofrequirementsand performance of functionspract legal withinin each st ate s DentalHygi ene Pract ice Car eA professional uses the ordinaryand reasonableEvaluatingthe patient schart ing and examinationski ll that is com monly us ed by ot her reputabledata beforedeterminingwhichradiographsdentalh ygi eni sts when caringfor patients.

6 Are neededaccordingto individualizedinvol ves prudentjudgmentand use of labl e ormedConsentVoluntaryaffi rmation by a patientto allowInvolvesthe ongoingprocessof communicatingexam inati on or treatmentby authorizedand educatinga patientaboutoral ,not only a printedform to per for m professionaldutiesaccordingPatientmust show that the dentalhygienisthas ato the acceptedstandard of care. duty to the patient,was derelict andbreachedthat duty, there was evidenceof di rect cause, and that damages performing ci rcumferentialprobingandinform ing/referring a patientwhen periodontalconcernsexi st can be LE IV -1 PlanningforDentalHygieneCareASS ESSMENT FI NDINGSI. The Chief Complai ntII. RiskFactorsIII. Patient s Overall Health Patient sSelf-careAbili tyVI.

7 Documentio n ofAssessmentDataTH E PERIODO NTALDIAGNO SISI. CurrentPerio dontalStatusII. CaseTypeIII. ClassificationofPerio CareTH E DENTALHY GIENE DI AGNOSI SI. BasisforDiagnosisII. DiagnosticStatementsIII. DiagnosticModelsTHEDENTA L HYG IENEPRO GNOSISI. Criteria forVariousPrognosesII . Factors ThatDeterminePrognosisII I. ExpectedOutcomesCONSIDERA TI ONS FOR PROVIDI NG CA REI. Rol e ofthe PatientII . Ti ssueConditioningII I. PreproceduralAntimicr andAnxiety ngDentalTherapyVI. Four- Handed DentalHygieneEVI DENCE-BASEDSEL ECTION OF Dental HYGIENEPROTOCOLSEVERYDAY ETH ICSFACTORS TO TEA CH TH E PA TIENTREFERENCESSUGGESTEDREA DING SCHARLOTTEJ. WYC HE, RDH,MSC H A P T E R2 1 ChapterOutlineInthedentalhyg ie nepro ces s of carede sc ribedinChapte r 1 an d ill us tra tedin Figu re IV-1,assessmentdataare use d to formulate thedentalhygiene dia gn osis.

8 Then,using an ev idence-ba sedapproa ch,a Dental Hygiene carepl an an d appointmentsequence ca n be wor ds use d in conju nction wi th thesesteps arede fin ed inBox21- sessment in cludesth e gather ingof detailsregardin g thehealthsta tusof th e pa tient,followed by analysisan d syn -thesis of th e data . The appli cation of cli ni caljud gm entand cr iticalthinkin g skillsar e necessary to arriveat a den-talhy gie ne Diagnosis . Ass es smentproceduresarede -scribe d in det ai l in Ch apters 6 thr ou gh THECHIEFCOMPLAINTTh e pati en t s stateme nt regardin g the reasonforseekingde nta l an d dent al Hygiene car e is consideredwh en pla n-ni ng . If a pa tient hasa sign ificant co ncern,suchas pain,thisneed is addressedpr iorto RISKFACTORSW hetheror not th e patien t pre sents forde ntalhygieneca re with cur re nt oral di sease, sev er al riskfactors can benotedtha t inc re asethe pat ient s pot entialfor diminishedoralhe al th sta tu s.

9 When a pat ie nt pr es ent s for de ntalhy gi en e ca re exhibiti ng one or more risk fac to rs,it isess ent ia l to dev elo p a car e pl an tha t pro vi de s anticipa -to ry gu ida nce th ro ugh preven tiveed uc ationand co un -se li ng .A. Ri sk Fac torsfor Peri odontal Infectionsor PoorResponse to Periodontal Therapy1 8 Behavi or al factors (in adequa te bio fi lmremoval, diet,no ncompliancewith Dental Hygiene recommendations) Tobaccous e Sys temic conditions(diabetes,decreasedimmune fac -tor s, osteopor osis,os teopenia) Ho rm on al considerations(pr egnan cy, menopause) Nu tr itional status358 SECTION 4 DentalHygieneDiagnosisandCarePlanningADL s (Acti vit ies of Daily Living):a measureof the abilitytocarr y out the bas ic tasks neededfor self- s (I nstr umentalActivities of Daily Livi ng):a measureof the abil ity to perf orm mor e of the complextasksnecessary to functionin our society.

10 Tasks that requirea com bi nationof physicaland :patienteducationand or al hygienein -str ucti ons that anticipatepotentialoral and syst emicheal th pr oblemsas sociat ed with risk fact ors identi fiedduri ng patientas :AmericanSocietyof Anesthesiologists;originallydevel -oped the AS A Clas sif icat ions to determinemodif ica tionsneces sar y to prov ide generalanest hetic to pat ient s dur ingsurgi cal pr ent:the cr itical analysisand evaluationor judgmentof a par ti cular cond ition, situation,or other subj ect of ap -prai sal .Chi ef com plaint:the patient sconcernas stat ed dur ing theini ti al healthhistor y preparation;may be the reasonforseeki ng professiona l car e; a complaintsuch as pain ordi scom for t may isedther apy:initial therapyand continuedper i-odontalmaint enanceprovidedas the therapeutic endpoi nt in cas es wher e the severityand ext ent of the dis -eas e or the age and healthof the patientprecl ude optimalres ul ts of per e car e:complete car e; end point at whichall treat -ment requiredat the time has been :to identifyor recognize a diseaseor :a statem ent of the problem;a concisetechnicaldes cri pti on of the cause,nature,or mani fest ati ons of acondi ti on, situation,or problem.