A hygienist’s responsibility
The importance of dental hygiene is changing. Direct access has been approved and hygienists are opening their own practices. The dental health care system is evolving and your role is greatly increasing within its boundaries.
It has been estimated that at least half of the adult population in the UK has some degree of periodontal disease. As this population ages, links between systemic and oral disease rises greatly, thus increasing the need for a more efficient, effective and modern approach to periodontal therapy and maintenance. Yet, as of March 2014, there are only 6,430 registered dental hygienists with the General Dental Council (GDC) and 39,258 dentists working in 22,830 dental surgeries within the UK. The necessity for dental hygienists and proper periodontal care is greater than ever.
Let us review the GDC’s Scope of Practice and your legal duties. Take some time to assess your clinical duties as a dental hygienist. Are you familiar with the various methodologies, therapies and techniques? Have you implemented them within your treatment plans? Think about how you can involve the dental team and what you can improve and update this year.
1. Consultation, medical changes and updates
Are you involved in the initial treatment planning? Are you regularly educating the patients about oral disease and the link to their general health? Do you have a protocol for updating health histories and taking X-rays? You should be updating and reviewing each patient every visit. It only takes a few minutes but is essential in determining overall possible links to periodontal disease and other dental conditions.
- Provide dental hygiene care to a wide range of patients (correct communication and education is key)
- Plan the delivery of care for patients to improve and maintain their periodontal health (together with the dentist to show co-management of patient treatment)
- Give appropriate patient advice (answer the ‘why’)
- Obtain a detailed dental history from patients (update with signature yearly)
- Evaluate their medical history (record changes in health, medications, hospitalisations, lifestyles)
- Prescribing radiographs – take, process, and interpret various film views used in general dental practice.
Never work without updated X-rays. Bitewings will work as long as you can see the bone levels.
2. Periodontal risk assessments
These assessments are of extreme importance for determining therapeutic options for patients. Complete yearly periodontal charting including measuring of bone loss, pocket depths, recession, furcation involvement, mobility, abrasion and/or any other defects found. Plaque indexes, bleeding/inflammation indexes, oral hygiene indexes, taking, updating and interpreting X-rays, and DNA testing of subgingival bacterial colonies help evaluate the status of disease or health of a patient. These findings are evaluated during the first several visits and then monitored at each consecutive visit. (How comfortable do you feel in implementing periodontal treatment? Do your skills need to be optimised, improved or renewed?)
3. Other risk assessments
Caries risk assessments includes: caries detection and control, DNA saliva testing and nutritional analysis. Also important to the general health of patients is smoking cessation, oral cancer screening, and intraoral and extraoral examinations. They are carried out when the patient shows signs of high risk factors contributing to each specific condition. Have you implemented any of these advanced screenings into your oral hygiene programmes? If not, its time to start doing so.
- Complete periodontal examination and charting and use indices (yearly for periodontal patients)
- Screen and monitor periodontal disease (every maintenance visit)
- Provide preventive oral care to patients and liaise with dentists over treatment of caries, periodontal disease and tooth wear (we see patients from different perspectives. Co-therapy is vital for optimal results)
- Identify anatomical features, recognise abnormalities and interpret common pathology, and carry out oral cancer screening (should be done by the dentist but we are also responsible for recording and marking any findings, informing the dentist and referral to oral pathologist. Do you know who you recommend?)
- Give patients advice on how to stop smoking. Ask how many cigarettes per day, how many years have they smoked. Number one cause of periodontal disease is smoking. Educate your patients about the risks and how to reduce and eventually quit. If you smoke, quit. Practise what you should preach.
4. Therapeutic treatments
After assessing the patient, a dental hygienist must develop an individual treatment plan. General light plaque debridement with ultrasonic power scalers, hand instruments, polish and some oral care instructions, which can be split into two appointments depending upon the condition of the disease and time allotment. Using hand instruments for removing rough root surfaces and dead tissue in deep pockets can be completed in multiple separate visits by non-surgical periodontal treatment (curettage) and pre-surgical periodontal treatment (soft and hard tissue curettage). Are you advancing your skills for periodontal therapy? Are you using the latest instruments and techniques for optimal treatment results?
- Undertake supra and subgingival scaling and root debridement using manual and powered instruments
- Ultrasonics or hand scaling? Both are critical. Get some new instruments and update hand skills
- Use appropriate anti-microbial therapy to manage plaque related diseases (get informed about the advantages and disadvantages of oral rinses and gels)
- Give infiltration and inferior dental block analgesia (pain free always helps better acceptance of treatment).
Other advanced duties, if needed:
- Adjust restored surfaces in relation to periodontal treatment
- Apply topical treatments and fissure sealants
- Place temporary dressings and re-cement crowns with temporary cement
- Take impressions
- Placing rubber dam
- Tooth whitening to the prescription of a dentist
- Administering inhalational sedation
- Removing sutures after the wound has been checked by a dentist
- If necessary, refer patients to other healthcare professionals.
A dental hygienist is not a ‘tooth cleaning person’ as many may think. Our duties are complex and multifaceted. We must wear many different hats. Consultant, confidant, guidance counsellor, teacher, oral therapist, visionary, technician, motivator, conservative periodontal specialist, brand manager, sales representative, team leader and psychiatrist are some of the roles dental hygienists occasionally slide into.
Are you working to your highest potential or just providing supervised neglect?
I encourage you to review your duties as a dental care provider, make some goals and plans to improve your skills, update your knowledge and apply modern therapies to become that professional you started out to be.
Make the small changes today to create a solid foundation for tomorrow.
Tracey Lennemann is an international professional speaker, trainer, published author and coach. She has been a practicing clinical periodontal dental hygienist since 1986 in the USA and in Europe and is co-author of the new book, First Aid for a Wounded Dental Business.
In addition to completing her associate degree in dental hygiene, Tracey also holds a bachelors degree from Eastern Washington University and is working on her PhD at DMU in Leicester, UK. She is also an honorary lecturer at Warwick University for the masters programmes in non-surgical periodontal therapy and CEO of In2motion, Ltd, a training company for dental professionals.
You can contact her at: [email protected]