Dental Hygienist Competencies PDF

TABLE OF CONTENTS Competencies for the Dental Hygienist Page 5 Clinic Evaluation Page 17 Medical History Page 31 Oral Exam and Oral Risk Assessment...

TABLE OF CONTENTS Competencies for the Dental Hygienist Page 5 Clinic Evaluation Page 17 Medical History Page 31 Oral Exam and Oral Risk Assessment Page 48 Caries Risk Assessment and Dental Charting Page 59 Periodontal Risk Assessment and Charting Page 71 Dental Hygiene Treatment Planning and Referral Page 97 Preventive Educational Services Page 109 Addendum to Preventive Ed. Section (Intro to Basic OHI) Page 256 (Part 2) Fluoride Treatment Page 121 Instrumentation Page 130 Clinical Management Page 142 Professional Appearance Page 143 Records Page 147 Equipment Page 161 Addendum to Equipment Section (Using the Midwest RDH Freedom) Page 249 (Part 2) Time Utilization Page 184 Aseptic Technique Page 190 Infection Control Protocol Page 194 PART 2 PART 2 Chemical Hygiene Plan Page 3 OSHA Laboratory Safety Guidance Page 59 Tuberculosis Infection-Control Program Page 101 Clinical Conduct Page 108 Assistant Duties Page 115 Addendum Assistant Duties (Floating Assistant Duties) Page 258 Sterilizing Assistant Page 122 Clinic Assistant Page 133 Re-Evaluation of Dental Hygiene Services Page 139 Hard Deposits Page 143 Soft Deposit and Light Stain Removal Page 156 Addendum to Soft Deposit Section (MI Paste Plus Guidelines) Page 246 Adjunct Services Page 162 Indices Page 178 Bio-Materials Page 187 Radiology Page 206 Addendum to Radiology Section (Schick Sensor Care) Page 247 Addendum to Radiology Section (Instructions – Panoramic X-ray) Page 253 Medical Emergency Protocol Page 220 INTRODUCTION 4 COIDpetencies for the Dental Hygienist 5 New Version 4/02 COMPETENCIES FOR THE DENTAL HYGIENIST INTRODUCTION Competency as an Educational Concept This document has been organized around the concept of “competencies". The term competent is defined as the level of special skill and knowledge derived from training and experience. Competencies can be more specifically described by several basic characteristics: 1. a typical part of the practice of dental hygiene 2. a combination of knowledge and attitude, psychomotor skill, and/or communication skill 3. performed at or above an acceptable level of defined standards ORGANIZATION Domains The general organization of this document is structured from the general to the more specific. Three “Domains” have been identified: Professionalism, Health Promotion and Disease Prevention, and Patient Care. These represent broad categories of professional activity and concern which occur in the delivery of dental hygiene care. Major Competencies Within each Domain, “Major Competencies” are involved with that Domain’s activity or concern. A Major Competency is the ability to perform or provide a particular, but complex, service or task. For example, “the dental hygienist must be able to systematically collect and accurately record baseline data on the general and oral health status of patients using methods consistent with medicolegal principles.” The complexity of this service suggests that multiple and more specific abilities are required to support the performance of any Major Competency. Supporting Competencies The more specific abilities could be considered sub-divisions of the “Major Competency” and are termed “Supporting Competencies”. Examples of Supporting Competencies would include “the ability to evaluate the periodontium, and identify conditions that compromise periodontal health and function.” The acquisition and demonstration of a “Major Competency” requires a level of mastery of all Supporting Competencies related to that particular service or task. While less complex than a Major Competency, a Supporting Competency also requires more specific abilities termed “Foundational Knowledge, Skills and Attitudes”. 6 Foundational Ability Foundational ability is the product of didactic and laboratory instruction which imparts the information and experience that are prerequisite for satisfactory mastery of Supporting Competencies. Foundational ability encompasses knowledge, skill and attitudes. Foundational knowledge is the ability to use information and correctly answer specific questions when asked, for example, on an examination. Foundational skill is the ability to follow specific rules to produce acceptable results in standardized situations, for example, charting periodontal readings and bleeding points. Foundational attitudes are positive intellectual and behavioral actions, such as scheduling appointments in the patient’s best interest and not the student’s convenience. The basic medical and dental sciences, behavioral sciences, and clinical sciences all provide instruction at the foundational level. Didactic, small group, seminar, and laboratory instruction provide information and psychomotor experiences that enable students to acquire and demonstrate competence in the clinical setting or context. The inclusion of any specific foundational ability in the curriculum should be based on the direct support of one or more of the “Supporting” and “Major” Competencies. I. PROFESSIONALISM The competent dental hygiene practitioner provides skilled care using the highest professional knowledge, judgment and ability (ADHA Code of Ethics). This skilled care should be based on contemporary knowledge, and the practitioner should be capable of discerning and managing ethical issues and problems in the practice of dental hygiene. However, the practice of dental hygiene occurs in a rapidly changing environment where therapy and ethical issues are influenced by regulatory action, economics, social policy, cultural diversity and health care reform. Additionally, dental hygiene is trying to create a unique identity for the profession and increase the knowledge base. Thus, the competent dental hygienist must have regular involvement with large and diverse amounts of information in order to be prepared to practice in this dynamic environment. 1. Ethics. The dental hygienist must be able to discern and manage the ethical issues of dental hygiene practice in a rapidly changing environment. Specifically, the dental hygienist must: 1.1 Apply ethical reasoning relevant to dental hygiene and practice with professional integrity. 1.2 Comply with state and federal laws governing the practice of dentistry and dental hygiene and take the appropriate measures when confronted with the incompetent, impaired or unethical practitioner. 2. Information Management and Critical Thinking. The dental hygienist must be able to acquire and synthesize information in a critical, scientific, and effective manner. Specifically, the dental hygienist must: 2.1 Solve problems and make decisions based on accepted scientific principles utilizing scientific literature as a basis for dental hygiene decision making. 7  2.2 Communicate professional knowledge verbally and in writing to patients, colleagues and other professionals. 2.3 Commit to self assessment and life-long learning in order to provide contemporary clinical care 3. Professional Identity. The dental hygienist must be concerned with improving the knowledge, skills, and values of the profession. Specifically, the dental hygienist must: 3.1 Advance the profession through leadership, service activities and affiliation with professional organizations. 3.2 Assume entry-level roles of the profession (clinician, educator, researcher, change agent, consumer advocate, administrator), as defined by the ADHA. II. HEALTH PROMOTION AND DISEASE PREVENTION The dental hygienist serves the community in both practice and public health settings. Public health is concerned with promoting health and preventing disease through organized community efforts, which is an important component of any interdisciplinary approach. In the practice setting, the dental hygienist plays an active role in the promotion of optimal oral health and its relationship to general health. The dental hygienist, therefore, should be competent in the performance and delivery of oral health promotion and disease prevention services in the public health, private practice and alternative settings. 4. Self-Care Instruction. The dental hygienist must be able to provide planned educational services using appropriate interpersonal communication skills and educational strategies to promote optimal health. Specifically, the dental hygienist must: 4.1 Encourage patients to assume responsibility for their health and promote adherence to self-care regimens. 5. Community Involvement. The dental hygienist must be able to initiate and assume responsibility for health promotion and disease prevention activities for diverse populations. Specifically, the dental hygienist must: 5.1 Assess, plan, implement and evaluate community-based oral health programs. 5.2 Provide dental hygiene services in a variety of settings and use screening, referral and education to bring consumers into the health care delivery system. 8 III. PATIENT CARE The dental hygienist is a licensed preventive oral health professional who provides educational and clinical services in the support of optimal oral health. The dental hygiene process of care applies principles from the biomedical, clinical and social sciences to diverse populations that may include pedodontic, adolescent, adult, gerodontic and medically compromised patients. 6. Assessment. The dental hygienist must be able to systematically collect, analyze and accurately record baseline data on the general, oral and psychosocial health status using methods consistent with medicolegal principles. Specifically, the dental hygienist must: 6.1 Obtain, review and update a complete medical, dental and personal history. 6.2 Determine medical conditions that require special precautions or considerations or that pose medical emergency risks and be prepared to assist in the management of an emergency should it occur during an appointment. 6.3 Perform an intraoral and extraoral examination and accurately record the findings. 6.4 Perform and document a dental and periodontal examination. 6.5 Obtain radiographs of diagnostic quality and distinguish normal from abnormal findings. 7. Planning. The dental hygienist must be able to discuss the condition of the oral cavity, the actual and potential problems identified, the etiological and contributing factors, as well as recommended and alternative treatments available. Specifically, the dental hygienist must: 7.1 Establish a planned sequence of educational, preventive and clinical services based on the dental hygiene diagnosis using the problem-based approach. 8. Implementation. The dental hygienist must be able to provide treatment that includes preventive and therapeutic procedures to promote and maintain oral health and assist the patient in achieving oral health goals. Specifically, the dental hygienist must: 8.1 Perform dental hygiene interventions to eliminate and/or control local etiologic factors to prevent and control caries, periodontal disease and other oral conditions. 8.2 Manage pain and anxiety during treatment through the use of accepted clinical techniques and appropriate behavioral management strategies. 9  8.3 Implement and evaluate measures to minimize occupational hazards in the work place and utilize accepted infection control procedures. 9. Evaluation. The dental hygienist must be able to evaluate the effectiveness of planned clinical and educational services and modify as necessary. Specifically, the dental hygienist must: 9.1 Determine the clinical outcomes of dental hygiene interventions using assessment data, to determine the appropriate maintenance schedule. 9.2 Determine the need for referral to appropriate health professionals. Adapted from the Caruth School of Dental Hygiene, Baylor College of Dentistry’s document entitled “Competencies for the Dental Hygienist” (1994). 10  Senior Clinic Competency Statement As you progress through the Dental Hygiene Program and enter senior clinic it is necessary to recognize that as second year students you will be building on the fundamentals introduced in the first year and learning higher level skills and knowledge. In Competency-Based Education, the learning continuum of novice to beginner to competent status of each student is considered. The senior clinical appointment has been adjusted to reflect student progression from novice level to beginner level in several areas. (See Clinic Manual: OE Section- WNL protocol; Dental Charting Section- Instructions on Updating; Periodontal Assessment- Updating Charts/Advanced documentation). Successful second year clinicians experience the progression to the beginner level by 1) reviewing fundamentals, 2) striving to become less dependent on resources ("clinic resource cards or notes "cheatsheets"") and faculty and 3) self-reflection and assessment of clinical skills and seeking help. Students must incorporate newly introduced knowledge and skills into the clinic appointment at the novice level (Dental Bio Materials Requirements) while managing and strengthening of first year skills and knowledge for patient care. Please read and review the competency statements under the major domain of Patient Care to prepare for senior clinic and understand the essential skills, knowledge and attitudes of a competent dental hygienist prepared to begin practice. The POHS requirements are evidence of clinical experiences of each student and are mandatory to ensure that the competencies are met. However, the learning experience and quality of patient care should not be compromised by the student or faculty in order to complete requirements. Completion of a requirement may be denied if the learning or quality have been compromised in any way. 11 (' INTRODUCTION This clinic manual is designed to be used as a tool. It is a reference and a guide for students and faculty alike. Each aspect of clinical dental hygiene care is categorized into a section of the clinic manual. Within each category, the following information may be found: 1..Standards of Clinical Practice. They specify exactly what is expected of the student. They define process and product performance criteria. They apply to all students who are in clinic (semester 2-4). These standards are the foundation for clinical performance and conduct. "Product" refers to the end-product or end result of performing a procedure. "Process" refers to the manner in which a procedure is performed. It includes skills in communication, assessment, planning, implementation and self-evaluation. c 2. Where applicable, guidelines or protocol may be found which are specific to a particular aspect of treatment. The product or process criteria are based on these guidelines or protocol. For example, in the section labeled "Clinical Conduct"; it is the process which is to be applied in clinic. Another example can be found in the section labeled "Periodontal Assessment and Charting:, where there is a handout entitled "Periodontal Charting: Instructions". It details the procedure and sequencing of charting (the process as well as the key to notations to be used (which will result in the product). 3. "Clinical Memorandum" sheets. They are written and distributed by the faculty in didactic courses. They serve to alert clinical instructors that didactic course material has been presented to the students, and it is now expected that it be integrated into clinic. TIley contain specific instructions, or objectives, or guidelines which contain the expected higher level of performance. 12.r> -2- { l An example topic would be the use of ultra-sonic scalars. A "Clinical Memorandum" is distributed early in the 3rd semester which informs faculty that, as of a certain date, second year students may use ultra-sonic scalars in clinic. A process form is attached to the Clinical Memorandum which specified expected performance. As Clinical Memoranda are received, they are inserted into the specified section in the clinic manual. Clinical "memos" are always printed on green paper for easy location. A sample can be found in this section. 4. Evaluation tool. (These specific guidelines are printed on yellow paper for easy location.) It explains when a student is evaluated during the course of a clinic session, and the performance ratings which are used. (Refer to "Clinical Evaluation" section of this clinic manual for detailed explanation. 13 CLINICAL MEMORANDUM FROM: _ EFFECTIVE DATE: _ Pertains to: Jr. Class Sr. Class _ Faculty INSERT INTO CLINIC MANUAL SECTIONS: 14  APPOINTMENT TYPES A “New Appointment Sequence” (NAS) refers to an appointment or a series of appointments in which a patient’s needs are assessed, a treatment plan is created, and dental hygiene care is rendered. The patient may be new to our clinic, or he/she may be returning (recall) patient. For a NAS, a patient may be scheduled with any student who is (1) available, or (2) needs the particular case type or experience which the patient offers. 15 EVALUATION Competenc~esAddressed: i' ,1.1; 1.2; 2.1-2.2; 3.2; 8.1-8.3 ---- --- ---~-iII= C4.a:..... =Iii--- ,S» t!_.., 16  ,... CLINIC EVALUATION - 17  Clinical Evaluation Clinical evaluation is based on performance criteria defined in the Standards of Clinical Practice, clinical memoranda, and written guidelines and/or protocol. Performance is based on both process and product. (See “Introduction” section for a detailed explanation.) Students are evaluated at the end of each clinic session in order to provide them with immediate reinforcement and feedback. The student may receive an “A” (acceptable), “U” (unacceptable), or “N” (not graded) for each of the Standards. For many of the Standards, there is an acceptable range of errors allowed for the performance. This range becomes more narrow as the student progresses through the clinical courses. Specific evaluation performance ratings are located in each topic section (printed on yellow paper). Clinical Performance Evaluation. Daily clinical evaluations are not given a numerical value. They reflect only acceptable or unacceptable performance. The “A” and “U” grades are totaled at the end of the semester and a numerical grade is arrived at based on the following criteria: 10% - Medical History 8% - Extra/Intra Oral Exam 7% - Dental Charting 7% - Periodontal Assessment 10% - Treatment Planning 5% - Preventive Education Services 10% - Instrumentation 10% - Clinical Management 5% - Aseptic Technique 13% - Clinical Conduct 5% - Soft Deposit Removal 10% - Hard Deposit Removal 100% - Total To compute the clinical grade, please refer to the worksheets at the back of this section. R. 8-24-17 18  -2- Unacceptable Performance If an instructor evaluates a student's performance as "unacceptable", this evaluation will be noted on student's Clinical Progress Form which is maintained by the clinical coordinator. Should the student receive 3 "unacceptable" evaluations in anyone category, he/she will be required to meet with the clinical coordinator. During this meeting the clinical coordinator will determine the cause of the poor performance and do one or more of the following: A. request that the student give an explanation of the correct procedure; B. direct the student to the appropriate source and assign a course of action to correct a technique or clarify a concept; c. arrange for the student to receive help. If the clinical performance continues to be unacceptable, the student will be examined by two clinical instructors. The examination will be verbal or written if the student's poor performance is conceptual in nature. If the student was unable to perform a task or demonstrate a technique, the student will be required to take a competency examination. If the student's examination performance is still unacceptable, he/she will be released from clinic for the semester, which will result in a failing grade. 19  FORMULA FOR DETERMINING CLINICAL GRADES (Page 1 of the Worksheet) 1. Count the number of times the “A” grade was achieved for each skill and place number in the “A” column. 2. Count the number of times the “U” grade was achieved for each skill and place the number in the “U” column. 3. Divide the #A for each skill by the total of #A + #U. Record that number in the “%A” column. 4. Multiply the number in the %A column times Weight to find the Total for each skill. 5. Add all numbers in the totals column and record at the bottom of the column. (Page 2 of the Worksheet) 1. Using the appropriate course syllabus, determine if the clinical services requirements have been met by circling “S” or “U” next to the requirement. 2. If a “U” is recorded, list the unmet requirement in the appropriate space. 3. Record Total % from page 1 of the worksheet on the line next to “Clinical Services Grade”. 4. Deduct two points for incomplete clinical requirements. 5. Deduct two points for each incomplete adjunct clinical service requirement. 6. Deduct one points for each “U” adjunctive clinic services grade. 7. Deduct one points for each failed competency exam. 8. Deduct two points for each zero over maximum allowed. 9. Deduct one points for each “U” in Medical Emergencies. 10. Deduct one points for each unacceptable Assistant Duty. formula for determining clinical gradesr.8-26-15 20 Page 1 of 2 WORKSHEET FOR GRADE DETERMINATION STUDENT NAME: DATE: COURSE: SKILLS A U %A WEIGHT TOTAL Medical History E/I Exam Dental Charting Periodontal Assessment Treatment Plan Preventive Educational Services Instrumentation Clinical Management Aseptic Technique Clinical Conduct Deposit Removal Soft Deposit Removal Hard TOTAL % WS for grade determination.5-13-19 21 Page 2 of 2 Student Name Course Number Date WORKSHEET FOR GRADE DETERMINATION Adjunct Clinical Services Impressions S U NG Trim (pour) S U Geo Trim S U Sealants S U Radiographs BW S U FM: FILM S U DIGITAL S U PAN S U Indices S U Dietary Analysis S U Local Anesthesia S U Nitrous Oxide Sedation S U Competencies S U NOTE: All “U” requirements must be completed by the following semester. Grade Computation Final CPES % Grade Minus 2 points for incomplete clinical requirements Minus 2 points for each incomplete adjunct clinical service requirement Minus 1 points for each unacceptable adjunct clinical services grade Minus 1 points for each failed or incomplete competency examination Minus 1 points for each unacceptable Assistant Duty Minus 2 points for each zero over total of 4 Minus 2 points for each unacceptable in Clinical progress Final Grade Incomplete Requirements: H:\Clinic Manual\clinic manual part 1.docxP.20R.8-26-15 22  R.8/15 ORANGE COUNTY COMMUNITY COLLEGE Department of Dental Hygiene CLINICAL PERFORMANCE EVALUATION SYSTEM Continual Evaluation Report: This system is designed to record infractions of the Clinical Performance Evaluation System (CPES) and all criteria in the Student Handbook and College Code of Student Conduct. This documentation of a student’s failure to adhere to or perform the various criteria and standards will be marked on a NCR form with notations of the infraction, date and approximate time. A copy will be supplied to the student as notification. Infractions resulting in an unacceptable grade will be recorded for that date in the Clinical grading system regardless of the time of the incident. This system may also be used for documentation and evidence of below average performance in the professionalism and participation areas of the syllabus for lectures or laboratories. This System may include the use of a warning of an infraction as a teaching tool or it can be notification of unacceptable behavior for such infractions that are deemed critical and were not marked on the clinical evaluation form during a clinic session. ________________________________________________________________________ Continual Evaluation Infraction Warning Student Name:___________________Date:________________Time:__________ Description of Infraction:______________________________________________ Warning Unacceptable Code of Clinical Conduct Infection Control Professionalism Ethics Student Conduct Other Comments:_________________________________________________________ Faculty Signature:________________________________________ Clinical performance eval system.docxR.8-26-15 23  R. 8/13 Criteria for Adjunctive Services A U The student has satisfactorily The student has failed to met the criteria for pit and satisfactorily meet all of the Sealants fissure sealant placement criteria for pit and fissure without critical error. sealants. One or more critical errors are present. The student has satisfactorily The student has failed to Impressions met the criteria for impressions satisfactorily meet the criteria without critical error. for impressions. One or more critical errors are present. The student has satisfactorily The student has failed to met the criteria for indices satisfactorily meet all criteria Indices without critical error. for indices. One or more critical errors are present. The student has satisfactorily The student has failed to Radiology met the criteria for radiology satisfactorily meet the criteria without critical error. for radiology. One or more critical errors are present. The student has satisfactorily The student has failed to met the criteria for the satisfactorily meet the criteria Medical Emergencies management of medical for the management of emergencies without critical medical emergencies. One or error. more critical errors are present. The student has satisfactorily The student has not met the criteria for an satisfactorily met the criteria Pain Control adjunctive pain control process for an adjunctive pain control without critical error. process. One or more critical errors are present. A= Acceptable U= Unacceptable N= Not evaluated * Criteria for each adjunctive service listed below is according to and can be found on the clinic process forms. These forms are utilized when that specific adjunctive service is being provided. For the remaining adjunctive services grading criteria, refer to the clinic manual, course syllabi and your course faculty/instructor. Sealants Impressions Indices Pain Control 24  PATIENT DEPOSIT DATE: INSTRUCTOR: CASE TYPE: CLASS CLINIC PERIOD: AM / PM APPT. #: TIME IN: TIME OUT: STUDENT: PATIENT: AGE: SN: Standard Assessment A U N COMMENTS I Medical History II Extra./Intra Oral Exam III Dental Charting IV Periodontal Assessment V Treatment Planning Implementation VI Preventive Educational Services VII Instrumentation 1. Patient/Operator Positioning 2. Treatment Environment 3. Instrument Usage 4. Tissue State VIII Clinical Management 1. Professional Appearance 2. Records 3. Equipment 4. Time Use IX Aseptic Technique X Clinical Conduct Evaluation 1-2-3-4-5 A U N 6-7-8-9-10-11 A U N 12-13-14-15-16 A U N H S 32-31-30-29-28 A U N 27-26-25-24-23-22 A U N 21-20-19-18-17 A U N H S Referral: Y N TREATMENT PERFORMED: Report Card Y N Recall Card: Y N Pt. Sat. Sur. Y N XII Adjunct Clinical Services A U N Sealants Impressions Indices Radiology Medical Emergencies Pain Control Complete: Incomplete: Clinical Progress: S U R. 1/20 daily grade sheetR.1-15-20 25  Clinic Requirements Log R. 8/19 Student Name: AY: Requirements by Age Children 0-12 year old (5) Adolescents 13-19 year old (5) Geriatric 55+ years old (10) Requirements by Case/Deposit - Completed Adults 20+ y/o Patient Case 1 (5) Patient Case 2 (5) Patient Case 3 (3) Patient Case 4 (2) Segmented Cases (5) Patients with Special Needs (2) Radiology FMS: Adult (5) Digital (2) Film Partially Edentulous (1) Rec. Pedo Series (2) BWX: Loop (3) Digital or Film Panelipse (3) Adult (1) Pedo/Adolescent Bio-Materials Impression (3) Nongeometric Trim (2) Geometric Trim (1) Sealants (VLC) (15) Custom Trays/Mouthguard (0) *Minimum number in parentheses. clinicalrequirementslog.docR.8-27-19 26  Log of Procedures Performed Requirements Indices Required Dates-Initial Follow-Up Calculus Bleeding Gingival Plaque Dietary Analysis Clinical Case-Based Requirements Completion Date Periodontal Geriatric Portfolio Observations Date/Faculty Competency Ultrasonic Scaler: (2) Garmer Clamps: (1) Fluoride Varnish: (1) Fluoride Tray: (1) Topical Anesthesia: (2) Subgingival Topical Anesthesia: (1) Desensitization: (2) Calculus Detection and Removal Probing Unacceptable Performance Date Competency (2) Failed competency exam Assistant duties Sealants Impressions Local Anesthesia Infiltration Indices # Date Radiology Medical Emergency Pain Control clinicalrequirementslog.docR8-27-19 27  ORANGE COUNTY COMMUNITY COLLEGE Middletown, New York DEPARTMENT OF DENTAL HYGIENE NO PATIENT EVALUATION FORM STUDENT: DATE: CLINIC PERIOD: AM / PM REASON FOR NOT HAVING A PATIENT (Ex: late cancellation): Document below: How did you spend your time? (circle all that apply) Portfolio Radiology/Digital Radiography Dietary Analysis Perio Case Advanced Functions Case Studies Instrumentation Lab work X-rays Assisting Front desk Other (Must be cleared by an Instructor): Instructor: Comments: R. 9/19 28 CLINICAL MEMORANDUM FROM: Mrs. Smith EFFECTIVE DATE: _---"8=/3"-"'1=/O~9 _ Pertains to: ~ I.J Jr. Class Sr. Class I· X I Faculty Clinical Evaluation Form - "Clinical Progress" Category This new category has been added to the evaluation form to alert the student as to whether or not he/she is performing at an acceptable level as defined in the "Standards of Clinical Practice." INSERT INTO CLINIC MANUAL, SECTION: Clinical Evaluation 29  ASSESSMENT Competencies Addressed: 6.1 - 6.5 ---- ---11=.-...... !. 30 MEDICAL HISTORY 31  STANDARDS OF CLINICAL PRACTICE MEDICAL HISTORY AND VITAL SIGNS - STANDARD I Product 1. Complete (or update) the medical history form, and question in detail any positive response (or changes), supplied by the patient. A new form must be completed every three years. 2. Use Drug Reference Book or other reference books to clarify prescribed medications’ actions, indication and consideration in dental treatment and record information on Medication sheet. 3. Recognize conditions which may require further medical consultation prior to treatment, and obtain the appropriate written clearance. 4. Identify possible medical emergencies related to the patient’s history and be prepared to handle the emergency should it occur. 5. Appropriately flag in red any significant findings. 6. Obtain and record blood pressure, pulse and respirations as directed by Vitals Protocol. 7. Assign ASA Classifications. 8. Obtain all appropriate signatures on medical history and/or radiation history. 9. Record medical and medication considerations on the oral exam form. 10. Determine if the patient’s radiation history is within the department’s Radiation Protection guidelines to allow for radiographs to be taken and document. 11. Correctly identify conditions which necessitate medical consultation, prophylactic premedication and/or specialized treatment planning. B. Process 1. Display listening skills. 2. Verbal communication is clear and concise. 3. Communication is appropriate for the patient’s level of comprehension. 4. Adequately address questions. 5. Communication is professional, and confidential. Clinic Manual\clinic manual part 1.docxP.27R.8-20-15 32  CLINICAL EVALUATION MEDICAL HISTORY - STANDARD I After the student has obtained, or updated, the medical history, taken and recorded vital signs, obtained the patient's signature, and signed the history her/himself, the instructor will review the information. No further patient treatment can take place until the instructor reviews and signs the medical history, and gives the student permission to continue. GRADING *Criteria Remains the Same for Each Semester. A = 0 errors U = 1 or more errors 33  ORANGE COUNTY COMMUNITY COLLEGE R. 9/18 Middletown, New York DEPARTMENT OF DENTAL HYGIENE MEDICAL HISTORY NAME: DATE OF BIRTH: SEX: M F Key * -Pre-disposed to postural hypotension ** - Prophylactic antibiotics may be indicated *** - Medical Consult necessary # -Increased susceptibility to infection 1. How would you describe your general health? NOTES 2. Date of last medical exam: __ 3. Are you now or have you been under a physician’s care or been hospitalized in the past 5 years? YES NO 4. Are you allergic to or have you reacted adversely to any of the following: a. local anesthetics (xylocaine, novocaine, etc.)? YES NO b. penicillin or other antibiotics? YES NO c. codeine, aspirin, other pain medication? YES NO d. latex? YES NO e. Other? (foods, pollen, etc.) YES NO 5. Do you have or have you had any of the following YES NO Cardiovascular Disease (heart attack, congestive heart failure, high blood pressure, arrhythmias, angina, stroke)? a. Do you have pain in chest upon exertion? YES NO * b. Are you ever short of breath after mild exercise or when you lie down? YES NO * c. Do your ankles swell? YES NO * d. Do you require extra pillows when you sleep? YES NO e. Do you wear a cardiac pace maker? Date: YES NO 6. Rheumatic fever or rheumatic heart disease? YES NO 7. ***** YES NO *** d. Hemophilia? *** Leukemia YES NO 14. STD (gonorrhea, syphilis, herpes, HPV)? YES NO 15.*** Immune suppression, Immune deficiency disease? YES NO 16.*** HIV or AIDS? YES NO 17. Arthritis? YES NO 18. Cancer? YES NO a. Type: __ b. Treatment: __ OVER 34  Key * -Pre-disposed to postural hypotension ** - Prophylactic antibiotics may be indicated *** - Medical Consult necessary # -Increased susceptibility to infection 19. Do you have a history of tobacco use, alcohol use, NOTES or substance abuse? YES NO 20. Are you taking or have you taken any of the following medications: a. Antibiotics or sulfa drugs? YES NO b. Anticoagulants (blood thinners)? YES NO *c. Medicine for high blood pressure? YES NO *d. Medication for heart trouble? YES NO *e. Nitroglycerin? YES NO #*f. Antihistamines, tranquilizers? YES NO #g. Anti-convulsant? YES NO #** h. Cortisone (steroids)? YES NO ***i. Fen-phen (fenfluramine & phentermine) or Redux? YES NO j. Other? (Over-the-counter, Nicotine patches/gum, herbs, bisphosphonates (oral or IV***), etc. YES NO 21. Have you ever been on Steroid Therapy? YES NO If no longer, when was therapy discontinued? If less than 6 months ago, MEDICAL CONSULT NECESSARY 22. Do you have any limitations regarding activity or diet? YES NO 23. Do you have any vision or hearing problems? YES NO Do you wear a hearing aid? YES NO 24.***/**Do you have any prosthetic replacement? YES NO (heart valve, joints, breast implants, shunts, etc.) 25. Have you ever had an unpleasant experience in a dental office? YES NO 26. Are you pregnant? YES NO a. Last menstrual cycle? __ 27. Are you nursing? YES NO 28. Have you ever been treated for an eating disorder? YES NO 29. Is there anything of importance in your medical history that has not been asked? YES NO 30. Most recent medical x-rays? Date: 31. Most recent dental x-rays? Date: BP: Pulse: Respirations: ASA CLASSIFICATION: Patient Signature: Date: _____ Student Signature: Date: Reviewed by: Date: Additional Comments: medical history form.r.9-26-18 35  ORANGE COUNTY COMMUNITY COLLEGE R. 6/12 Middletown, New York DEPARTMENT OF DENTAL HYGIENE ADDENDUM TO MEDICAL HISTORY /' PATIENT'S NAME: Date: BP: ----- Pulse: ----- Fae. Sig.: - - - - - - - ASA CLASSIFICATION: - - - - - Respirations:------------- Student: ------------- Patient Sig: - - - - - - - - - - - - - Date: BP: ----- Pulse: ----- Fae. Sig.: - - - - - - - ASA CLASSIFICATION: - - - - - Respirations:------------- Student: -----,..--------- PatientSig: - - - - - - - - - - - - - Date: BP: Pulse: ----- Fae. Sig.: - - - - - - - { 'ASA CLASSIFICATION: - - - - - Respirations:------------- Student: Patient Sig: - - - - - - - - - - - - - Date: BP: ----- Pulse: ----- Fae. Sig.: - - - - - - - ASA CLASSIFICATION: ----- Respirations:------------- Student: Patient Sig: - - - - - - - - - - - - - Date: BP: Pulse: Fae. Sig.: _ _ _ _ _ __ ------- ----- ----- ASA CLASSIFICATION: ----- Respirations:------------- Student: ------------- Patient Sig: - - - - - - - - - - - - - Date: ------- BP: ----- Pulse: ----- Fae. Sig.: - - - - - - - /' CLASSIFICATION: - - - - - Respirations:------------- Student: Patient Sig: - - - - - - - - - - - - - 36 Date: BP: Pulse: ----- Fae. Sig.: ASA CLASSIFICATION: Respirations:------------- Student: Patient Sig: ------------- -------------- Date: - - - - - - - BP: Pulse: Fae. Sig.: ASA CLASSIFICATION: ------ Respirations:------------- Student: Patient Sig: - - - - - - - - - - - - - - Date: BP: Pulse: - - - - - Fae. Sig.: - - - - - - - ASA CLASSIFICATION:----- Respirations: Student: -------------- Patient Sig: - - - - - - - - - - - - - - Date: BP: Pulse: Fae. Sig.: ASA CLASSIFICATION: - - - - - Respirations:------------- Student: -------------- Patient Sig: - - - - - - - - - - - - - - Date: BP: Pulse: ----- Fae. Sig.: ASA CLASSIFICATION: Respirations:------------- Student: Patient Sig: Date: BP: Pulse: ----- Fae. Sig.: ASA CLASSIFICATION: - - - - - Respirations:------------- Student: Patient Sig: Date: ------- BP: Pulse: Fae. Sig.: ASA CLASSIFICATION: Respirations:------------- Student: Patient Sig: -------------- 37  Department of Dental Hygiene R. 2000 Patient Name: If no longer being taken, Medication was it (+ dosage To be authorized by for Pre-med Indications taken physician? and (Why is it When? Date of Date Nitroglycerin taken?) How often? discontinuance? Side effects (significant to dentistry) 38 Original: Patient takes to Doctor and must be returned to us. Copy: Stapled inside front cover of patient chart. ORANGE COUNTY COMMUNITY COLLEGE R. 4/18/2024 Middletown, New York DEPARTMENT OF DENTAL HYGIENE (845) 341-4315 [email protected] MEDICAL CONSULTATION/CLEARANCE REQUEST FORM Patient’s Information: Doctor’s Information: Patient's Name: Doctor's Name: Address: Address: Telephone No: Telephone No: Date: _____________________________________ Dear Dr. : This person presented for dental hygiene treatment at our clinic. The procedure includes scaling, probing (and possibly local anesthesia injections) with subsequent probable bleeding. Each appointment period is 2-3 hours. The patient's medical history indicates medical clearance is needed prior to treating this patient in our clinic for the reasons indicated below. The patient's Blood Pressure is outside the "normal range" policy of our clinic: / Risk of Infective Endocarditis or Hematogenic Joint Infection: ____________________________________ Risk of Prolonged Bleeding (Clotting Disorder or Anticoagulant Therapy): ____________________________ Other Concerns/Comments: __________________________________________________________________ I hereby authorize the release of medical information as requested: Patient's Signature: ________________________________________________ Date: ___________________________ ***Physician’s Response: Please complete ALL that is applicable for the patient*** The patient may be seen as long as the blood pressure does NOT exceed / The patient NEEDS prophylactic antibiotics* as indicated: Indefinitely: ___________ Until (Date): _____________ *must be prescribed by medical doctor _______ The patient SHOULD discontinue anticoagulant therapy ____ (hours/days) prior to treatment and resume ____ (hours/days) after treatment. The patient does NOT need prophylactic antibiotics. _______ The patient should NOT discontinue anticoagulant therapy. _______ The patient should NOT have dental treatment at this time. _______ The patient should contact me before treatment is started. _______ There is NO contraindication to dental treatment at this time. Physician’s Signature: __________________________________________ Date: _____________________ 39  PROPHYLACTIC PREMEDICATION WITH ANTIBIOTICS The Orange County Community College dental hygiene clinic protocol follows the guidelines established by the American Heart Association. Therefore, the following conditions indicate the need for prophylactic premedication. Preventive antibiotics prior to a dental procedure are advised for patient with: 1. Artificial heart valves 2. A history of infective endocarditis 3. Certain specific, serious congenital (present from birth) heart conditions, including o unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits o a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure o any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device 4. A cardiac transplant that develops a problem in a heart valve. 5. Total joint replacement and/or at increased risk of hematogenous total joint infection. Other conditions may warrant prophylactic pre-medication (e.g., sickle cell anemia, diabetes, breast implants, etc.). Endocarditis prophylactic pre-medication is recommended for the following dental hygiene procedures. -Periodontal procedures including surgery, scaling and root planing, probing, and recall maintenance. -Subgingival placement of antibiotic fibers or strips. -Prophylactic cleaning of teeth or implants where bleeding is anticipated. Procedure: Medical consult letter is completed by a faculty member, signed by the patient, and sent to the patient's physician. In all cases, the final decision rests with the patient's physician. NOTE: Certain procedures (radiography, sealants, impressions, local infiltration anesthesia) do not require pre-medication. Limit the oral exam to a soft tissue assessment without instrumentation. In certain instances, patients may require antibiotic coverage for non- invasive procedures depending upon their oral health status and/or other extenuating circumstances. In all cases, final judgment will be made by the faculty. Patients who are pre-medicated with an antibiotic will not be allowed to stay for back to back appointments. Subsequent appointments should be made with a minimum of two weeks between them. Frederick Melone Frederick Melone, DDS Supervising Dentist Source: American Dental Association 41  Management of Patients with Prosthetic Joint Replacements Undergoing Dental Procedures: Antibiotic Prophylaxis The most recent (January 2015) recommendation of the American Dental Association (ADA) states: – “In general, for patients with prosthetic joint implants, prophylactic antibiotics are NOT recommended prior to dental procedures to prevent prosthetic joint infection.” – “The individual patient’s circumstances and preferences should be considered when deciding whether to prescribe prophylactic antibiotics prior to dental procedures.” Prosthetic Joint Replacement Patients with the Following Conditions are at Increased Risk for Prosthetic Joint Infection: – Immunocompromised/immunosuppressed patients – Inflammatory arthropathies (e.g.: rheumatoid arthritis, systemic lupus erythematosus) – Drug-induced immunosuppression – Radiation-induced immunosuppression – Co-morbidities (e.g.: diabetes, obesity, HIV, smoking) – Previous prosthetic joint infections – Malnurishment – Hemophilia – HIV infection – Insulin-dependent (Type 1) diabetes – Malignancy – Megaprostheses 42  Therefore, our clinical policy will be as follows: Faculty will decide whether or not a medical clearance is required. – NOTE: Patients with pins, plates, screws or other orthopaedic devices which are NOT within a synovial joint are NOT at increased risk for blood–borne infections (hematogenous seeding by microorganisms) Reference: “The Use of Prophylactic Antibiotics Prior to Dental Procedures in Patients with Prosthetic Joints”, January, 2015 43  Adapted from The American Society of Anesthesiologists Physical Status Classification1 ASA PS DEFINITION ADULT Examples, Including PEDIATRIC Examples, Including but OBSTERTRIC DENTAL CLASSIFICATION but not Limited to: not Limited to: Examples, TREATMENT Including but not CONSIDERATIONS Limited to: ASA I A normal Healthy, non-smoking, no or Healthy (no acute or chronic disease), Elective treatment healthy patient. minimal alcohol use. normal BMI percentile for age. can be implemented. No modifications are necessary. ASA II A patient with Mild diseases only without Asymptomatic congenital cardiac Normal Elective mild systemic substantive functional disease, well controlled dysrhythmias, pregnancy*, well treatment can disease. A limitations. Current smoker, asthma without exacerbation, well controlled be implemented patient with a social alcohol drinker, controlled epilepsy, non-insulin gestational HTN, with minimal diagnosed pregnancy, obesity dependent diabetes mellitus, controlled risk; minor anxiety (30 33% BL Usually accompanied by tooth mobility and/or furcation involvement Extent of Disease Localized = ≤ 30% of sites meet criteria Generalized = > 30% of sites meet criteria R. 8/19 92 93 9 II. Periodontitis (slight: 1-2 mm CAL; moderate: V. Necrotizing Periodontal Diseases 3-4 mm CAL; severe: > 5 mm CAL) A. Necrotizing gingivitis A. Localized (< 30% of sites are involved)  Localized necrotizing ulcerative gingivitis  Chronic localized slight periodontitis  Generalized necrotizing ulcerative gingivitis  Chronic localized moderate periodontitis  Chronic localized severe periodontitis B. Necrotizing periodontitis  Localized necrotizing ulcerative periodontitis B. Generalized (> 30% of sites are involved)  Generalized necrotizing ulcerative periodontitis  Chronic generalized slight periodontitis  Chronic generalized moderate periodontitis VI. Abscesses of the Periodontium  Chronic generalized severe periodontitis A. Gingival abscess B. Periodontal abscess III. Aggressive Periodontitis (slight: 1-2 mm CAL; C. Pericoronal abscess moderate: 3-4 mm CAL; severe: > 5 mm CAL) VII. Periodontitis Associated With Endodontic Lesions A. Localized (< 30% of sites are involved) A. Combined periodontic-endodontic lesions  Aggressive localized slight periodontitis  Aggressive localized moderate periodontitis VIII. Developmental or Acquired Deformities & Conditions  Aggressive localized severe periodontitis A. Localized tooth-related factors that modify or predispose to plaque-induced gingival B. Generalized (> 30% of sites are involved) diseases/periodontitis  Aggressive generalized slight periodontitis 1. Tooth anatomic factors  Aggressive generalized moderate periodontitis 2. Dental restorations/appliances 3. Root fractures  Aggressive generalized severe periodontitis 4. Cervical root resorption and cemental tears IV. Periodontitis as a Manifestation of Systemic Diseases B. Mucogingival deformities and conditions around teeth A. Associated with hematological disorders 1. Gingival/soft tissue recession 1. Acquired neutropenia a. facial or lingual surfaces 2. Leukemias b. interproximal (papillary) 3. Other 2. Lack of keratinized gingiva 3. Decreased vestibular depth B. Associated with genetic disorders 4. Aberrant frenum/muscle position 1. Familial and cyclic neutropenia 5. Gingival excess 2 Down syndrome a. pseudopocket 3. Leukocyte adhesion deficiency syndromes b. inconsistent gingival margin 4. Papillon-Lefèvre syndrome c. excessive gingival display 5. Chediak-Higashi syndrome d. gingival enlargement (See I.A.3. and I.B.4.) 6. Histiocytosis syndromes 6. Abnormal color 7. Glycogen storage disease 8. Infantile genetic agranulocytosis C. Mucogingival deformities and conditions on edentulous 9. Cohen syndrome ridges 10. Ehlers-Danlos syndrome (Types IV and VIII) 1. Vertical and/or horizontal ridge deficiency 11. Hypophosphatasia 2. Lack of gingiva/keratinized tissue 12. Other 3. Gingival/soft tissue enlargement 4. Aberrant frenum/muscle position C. Not otherwise specified (NOS) 5. Decreased vestibular depth 6. Abnormal color D. Occlusal trauma 1. Primary occlusal trauma 2. Secondary occlusal trauma Source: AAP "Development of a Classification System for Periodontal Diseases and Conditions"; Annals of Periodontology, Volume 4 Classification 95 PAGE INTENTIONALLY BLANK 96  DENTAL HYGIENE TREATMENT PLANNING AND REFERRAL Competencies Addressed: 2.1; 4.1; 7.1 97  TREATMENT PLAN/INFORMED CONSENT 98  STANDARDS OF CLINICAL PRACTICE TREATMENT PLAN AND INFORMED CONSENT - STANDARD VI To be completed after all assessment has been completed of a NAS (new appointment sequence) and updated at subsequent appointments. A. Product 1. After doing OHI, assess the data gathered on the medical history, oral exam, dental and periodontal charts and personal data sheet for conditions which may affect dental hygiene treatment. 2. Assess present knowledge, attitudes and behavior about prevention of oral disease through the interview with the patient or care giver and personal data sheet. 3. With the patient as an active participant, determine oral health program priorities and establish goals to meet the patient’s oral health needs. 4. Determine interventions necessary to meet the patient’s oral health needs (considering special needs) and estimate time needed to accomplish goals. 5. Complete a thorough dental hygiene treatment plan for clinical and educational services on each new patient. Continual care appointments (CCA) should be included. (Use pencil initially.) 6. Use correct notations and abbreviations on the treatment plan. (See Treatment Planning Instructions.) 7. At the end of each clinic session, record in ink completed treatment, assess the treatment plan and modify it when necessary for subsequent appointments. 8. Explain to the patient the condition of the oral cavity, treatment proposed, and the number of appointments that will be needed and any additional fees that might be incurred. 9. Ask the patient to read, sign and date the informed consent form. 10. Refer to the treatment plan at the beginning of each appointment. It should be consistent with the treatment provided. B. Process 1. Use terminology appropriate to patient’s level of comprehension. 2. Display listening skills. 3. Adequately address questions or concerns which the patient may have concerning treatment. 4. Communicate clearly and concisely, in a confident and professional manner. Standard VI treatment plan.12-17-15 99  CLINICAL EVALUATION TREATMENT PLAN AND INFORMED CONSENT - STANDARD VI The treatment planning phase of the Dental Hygiene Process of Care is initiated by analysis of the assessment data and formulation of the Dental Hygiene Diagnosis. The treatment plan is developed from the assessment data and treatment is outlined and sequenced on the Treatment Planning form. The faculty will check the PDS, Treatment Planning forms, Informed Consent and the Patient Report Card/Referral Form before instrumentation begins. GRADING POHS II: A = 0-3 errors U = 4 or more errors or the student failed to obtain the patient’s signature on the Informed Consent Form. POHS III: A - 0-2 errors U = 3 or more errors or the student failed to obtain the patient’s signature on the Informed Consent Form. POHS IV: A = 0 errors U = 1 or more errors. R.9/6/13 100  CARE PLAN Caries Risk Assessment: Low Moderate High Very High Patient Name: Periodontal Risk Assessment: Low Moderate High Score: _____ Clinician: Oral Cancer Risk Assessment: Low Moderate High Date: Oral Risk Assessment Findings: 1. 4. 2. 5. 3. 6. Dental Hygiene Diagnosis Problem Related to (Risk Factor Etiology) 1. 2. 3. 4. 5. 6. Care Plan and Evaluation Partially Oral Risk Concern Clinical Goals Preventive or Therapeutic Intervention Evaluation Method Met Unmet Met 1. 2. 3. 4. 5. 6. Goal Attainment: List and discuss barriers to goal attainment if goals were not fully met. Faculty Comments: Care plan back of Tx plan.7-12-23 102  ORANGE COUNTY COMMUNITY COLLEGE DEPARTMENT OF DENTAL HYGIENE Patient Information and Agreement Form Welcome to Orange County Community College’s Dental Hygiene Clinic. We would like to assure you that everything possible will be done to give you excellent dental hygiene treatment. The following are descriptions of the operations of the clinic. SERVICE: The Dental Hygiene Clinic is operated for teaching purposes. A patient is accepted for treatment only if proper instruction can be given to the dental hygiene student who performs the treatment. Not all patients can be accepted for treatment because some cases are not suitable for teaching purposes*. *It is expected that every patient have a yearly examination by a dentist. Dental hygiene treatment is limited in scope to services allowed by the state dental practice acts and taught to clinical competency in the program. However, you will be advised of your treatment needs and, if necessary, referred for procedures that cannot be provided in our Clinic. There is a list of area dental clinics available from the receptionist. You will also be advised of an appropriate recare time frame. Your treatment will be done by a dental hygiene student, supervised by a dental hygiene faculty member of Orange County Community College, and will therefore require more time and be slower than if done by a private dentist or a dental hygienist. The patient must plan on remaining for the entire appointment time and be prepared for several return visits to complete treatment. The Dental Hygiene Clinic complies with local, state and federal agencies regarding the transmission of bloodborne and infectious diseases by following safety guidelines recommended by the U.S. Public Health Service, the CDC and the New York State Department of Health. These infection control procedures are referred to as Standard Precautions and are followed by all students, faculty and staff and are continuously monitored for compliance. All medical information will be handled in a strictly confidential manner in accordance with the procedures and requirements in effect at Orange County Community College that have been established to ensure compliance with federal, state and local laws. APPOINTMENTS: Your appointments will be made by the student assigned to you or the receptionist, and you are required to be on time for appointments. If you are unable to keep an appointment, you must notify the student, or the office (phone: (845) 341-4315) 24 hours ahead. Two cancellations, or two failures, or two unsuccessful attempts by the student to make an appointment, will cause a patient to be discontinued from treatment in the clinic. FEES: Fees for treatment performed are minimal and all patients must be prepared to pay for services accomplished on the first appointment. A fee schedule is available from the receptionist. DENTAL X-RAY IMAGES: Complete Dental Image examinations are required for some patients. For all others, the most recent images from your dentist are recommended prior to providing dental hygiene care. Images acquired here are kept on file. They must be sent electronically or as a hard copy to your dentist. RECORDS: Your records, images, photographs, models, etc. are the property of the Department of Dental Hygiene and Orange County Community College. A set of images will be sent to your dentist unless you request that they be sent to you. Patient’s Rights: As a patient in our clinic, you are entitled to: 1. Considerate, respectful and confidential treatment; 2. Continuity and completion of treatment; 3. Access to complete and current information about your condition; 4. Advance knowledge of the cost of treatment; 5. Informed consent; 6. An explanation of recommended treatment, treatment alternatives, the option to refuse treatment, the risk of no treatment and expected outcomes of various treatments; 7. Treatment that meets the standard of care in the profession. We hope that your visits to the clinic will be pleasant experiences for you. IN APPLYING FOR PREVENTIVE ORAL HYGIENE SERVICES, I UNDERSTAND AND AGREE TO THE ABOVE. Signature of Patient (or Guardian) DATE pt info agreement consent.R.8-16-23 103  INFORMED CONSENT FORM The preventive services which we offer are described below. The treatment which we are suggesting for you involve those procedures which are checked in the left column. Scaling: to remove the hard, calcified deposits called calculus (tartar) from the teeth using various hand and or mechanical instruments. If these deposits are not removed, an inflammatory condition may result, which may lead to the eventual loss of teeth. You may experience short term sensitivity after the procedure. Polishing: a procedure to remove biofilm or light stain from the tooth surface. Fluoride Treatment: a topical application of fluoride is effective in reducing tooth decay and tooth sensitivity. It is beneficial to adults as well as children. The decision to give a fluoride treatment is based on your specific dental needs, plus the amount of fluoride you are already receiving (in the water supply, supplements, dentifrices, rinses). Every effort is made to ensure that you do not ingest any fluoride during this treatment, as nausea can result from ingestion. Pit and Fissure Sealants: this is a procedure to reduce tooth decay in which a clear or opaque material is placed into the pits and grooves of the tooth surface. It acts as a physical barrier to prevent oral food and bacteria from collecting in these hard to clean areas. Alginate Impressions: this is an imprint of the teeth and supporting structure. The plastic material is initially soft, and then "sets" while in the mouth. It is then used to make a "study model" which is an exact likeness of your teeth and tissues; this study model helps in developing a course of treatment for you. It is also necessary in order to fabricate a custom fluoride tray or an athletic mouthguard. Desensitization: this procedure uses an agent to reduce tooth sensitivity on (non-decayed) root surfaces. Topical Anesthesia: if a procedure which we are performing is uncomfortable for you, a topical anesthetizing ointment can be used which will temporarily numb the area. It is water soluble, and its effect will probably be gone before you leave the clinic. Local Anesthesia: is a drug that is injected in the oral cavity to temporarily block the sensation of pain. Nitrous Oxide Analgesia: is a drug used in the form of a gas in conjunction with oxygen which reduces pain and anxiety and results in mild sedation. Subgingival Irrigation: this procedure places an anti-microbial agent deep into diseased pockets. The flushing action plus the bacteria-killing activity results in faster, longer-acting tissue healing. Many anti-microbial agents contain alcohol. If you have an alcohol intolerance, please inform your clinician. The estimated number of appointments it will take to complete the proposed treatment is.. I understand and agree to the proposed procedures. Signature: Date: Updates: Date: R. 8/23 pt info agreement consent.R.8-16-23 104  DENTAL HYGIENE TREATMENT PLANNING GUIDELINES 1. Dental Hygiene treatment will be determined according to the PSR code for each sextant. To determine treatment, you need: a. Adult Patient: Assign PSR code to each sextant Child Patient: Age 3-12: Assess gingival description and hard deposits (exploring). Assign PSR codes 0-2 for each sextant. Adolescent: Age 13-17: Assess gingival description, hard deposits, (exploring), and spot probe depths (permanent 1st molars and central incisors). Assign PSR codes 0-2 for each sextant. Age 18-19: Full probe, assign PSR codes for all sextants. b. Assign Treatment according to PSR code (or above mentioned assessment criteria for child patient). PSR Code 0 No pocketing. No calculus or defective margins are detected. Gingival tissues are healthy with no bleeding after gentle probing. 1 No pocketing. No calculus or margins are detected. There is bleeding after gentle probing. 2 No pocketing. Supra- or subgingival calculus and/or defective margins are detected. 3 Probing depths of 4 or 5 mm. 4 Probing depts. of 6+ mm. c. Document PSR on Treatment Plan form on the Dental Hygiene Treatment Plan Form. Example: Patient PSR Code: 3 0 4 2 1 2 d. A PSR Code of 4 indicates that a referral form for periodontal examination and diagnosis will be completed and given to the patient. 105 2. Sequencing Dental Hygiene Treatment: a. Radiographs should be taken at the first appointment if possible! Adjustments to the treatment plan may be necessary after evaluation of the radiographic survey. b. Treat sextant with areas of urgency first (discomfort of pain reported by patient). c. Sequence debridement (deplaquing and/or scaling) by starting the area with the most inflammation and/or deepest probe depth. (Use PSR Codes to determine most involved sextant.) d. Consider also the patient’s needs and goals for treatment when determining the treatment sequence. e. When two sextants are to be treated during the same appointment, select a maxillary and mandibular sextant on the same side of the mouth (if possible). f. If the patient is very apprehensive about dental hygiene treatment, start in least involved area first. 3. Documenting the Dental Hygiene Treatment Plan a. Use pencil to formulate the plan in entirety after completing initial assessments (MH, OE, PSR, perio probe, dental chart, OHI). b. At the end of each appointment, documents treatment completed during that appointment in pen. If necessary, make revisions in the treatment plan at this time. c. Use the following symbols when formulating the treatment plan: sextant approach quadrant approach  = to be performed R = to be reviewed Universal tooth numbers may be used for localized treatment. √ = procedure to be performed on maxillary and √ mandibular right quadrant = procedure to be performed on mandibular √ anterior sextant = 106  d. Abbreviations: Essential Selective Polishing: TB = Toothbrush H = Handpiece Agents: Nonabrasive Bosworth Prophy Paste – Bos. fine paste = fp medium = mp course = cp Fluoride: Sodium = NaF Acidulated Phosphate Fluoride = APF Stannous = SnF Antimicrobials: Chlorhexidine = CHX Listerine = L Water = H2O Stannous Fluoride = SnF2 4. Oral Irrigation: a. Document areas where O.I. is planned. For full mouth O.I., use sextant signs. For localized O.I., use sextant signs or tooth numbers. b. Document agent to be used: CHX, H2O, SnF2, L c. Example: CHX Or CHX: #19, 30 5. Essential Selective Polishing: a. Document specifically using sextant signs or tooth numbers. b. Example: TB H TB or TB √ √ √ , H #25, 26 TB TB TB √ √ √ c. Note the polishing agent. 6. Tissue Evaluation: Evaluate the tissue of previously scaled areas at the next appointment. (There is a category called “Tissue Evaluation” on the Treatment Plan Sheet.) If the tissue resolution is good, it is indicative that no further periodontal debridement is needed. If local areas still show signs of inflammation, more periodontal debridement may be indicated. Make revisions in Dental Hygiene Treatment Plan as indicated. Tissue resolution, or lack of it, may also be due to home care procedures. Document the results on the Personal Data Sheet. 107 7. The last column on the treatment plan sheet is used for procedures which will be scheduled and performed at a later date, or perhaps by a different clinician. Examples: a. Sealants are indicated for the maxillary permanent first molars of a child, but the teeth are not yet fully erupted. In the Recall column, after sealants, write in #3, 14, indicating the exact teeth to be worked on at some later date. b. A second semester clinician, after consultation with a faculty, sees that the amalgam on #19 is in need of polishing. However that is a procedure performed by a 3rd or 4th semester student. In the Recall column, after amalgam polishing, write in #19. 8. Informed Consent: All dental hygiene treatment planning decisions and revisions will be fully discussed with the patient (Informed Consent) and the form must be signed. R. 9/02 3/97 2/95 6/12 7/15 DENTAL HYGIENE TREATMENT PLANNING GUIDELINESR.1-23-23 108 PREVENTIVE " EDUCATIONAL SERVICES 109 IMPLEMENTATION Competencies Addressed: :6.2; 8.1 - 8.3; 9.2 110  STANDARDS OF CLINICAL PRACTICE PREVENTIVE EDUCATIONAL SERVICES - STANDARD VI A. Product 1. Perform a risk assessment related to the patient’s current oral condition. (Consider biofilm control; use of therapeutic products; caries risk; periodontal classification; knowledge, values, and skill capabilities. 2. Plan and provide appropriate patient education based on the risk assessment. 3. Educate the patient regarding the oral-systemic link (based on the risk assessment). 4. Provide appropriate mechanical biofilm control instruction for each patient (include toothbrushing and interdental care) according to patient’s needs and abilities. 5. Assist the patient as necessary in performing complete biofilm removal during the oral hygiene instruction phase of each appointment. Provide remediation. 6. Recommend appropriate therapeutic products according to the patient’s needs. Explain indications and contraindications and recommend frequency and dosage guidelines. 7. Monitor and evaluate patient progress. Teach the patient methods of self-evaluation. 8. Provide clear and thorough documentation on the Personal Data Sheet. 9. Document recommendations for mechanical and therapeutic biofilm control and appropriate recare interval on the Patient Report Card. 10. Recommend a dental home. Have the patient utilize the “referral list” if the patient does not have an oral health care provider. B. Process 1. Assess the patient’s readiness to learn the value of health and oral health. 2. Implement the plan for educational services using facilitative communication techniques. 3. Communicate to the patient etiological factors related to the patient’s existing oral health condition. 4. Use disclosing solution to assess biofilm removal at each appointment and to help patient to visualize biofilm. Utilize bleeding points to help patient visualize inflammation. 111  5. Select appropriate instructional strategies to facilitate cognitive, psychomotor, and affective skill development. 6. Provide clear and concise instructions to patient. Provide a “menu” of home care options. 7. Provide reinforcement and repetition of key messages. 8. Employ motivational strategies including positive reinforcement. 9. Utilize evidence-based decision making as a foundation for all patient education interactions. 10. Appropriately sequence oral health instruction. R.7/21/2011 112  CLINICAL EVALUATION PREVENTIVE EDUCATIONAL SERVICES - STANDARD VI Preventive education is provided to the patient after the clinical examination (oral exam, dental charting, perio charting) and instructor check. The student utilizes the (pink) patient personal data sheet (PDS) to assess, plan, implement, and evaluate oral hygiene instruction for the patient. The instructor uses the PDS to review preventive education given to the patient. Therefore, the student must fully document the PDS prior to the instructor check. The PDS can be updated for a period of 3 years, at which time a new PDS should be started. The update sheets should be placed in reverse chronological order with the most recent sheet on top in the patient’s file. At the first appointment, the instructor will provide a scheduled check to review preventive education and the PDS with the clinician. At reappointment visits, the PDS will be reviewed by the faculty but a separate instructor “check” is not necessary. GRADING POHS II: A = 0-3 errors U = 4 or more errors POHS III: A = 0-2 errors U = 3 or more errors POHS IV: A = 0 errors U = 1 or more errors H:\Clinic Manual\clinical evaluations.doc(p.9)R.8-15-14 PATIENT EDUCATION AND USE OF DISCLOSING SOLUTION Formal patient education is provided at each appointment. 1. Use of Disclosing Solution: Application a. Apply Vaseline to lightly patient’s lips, composite and other esthetic restorations. b. Use the mouth mirror to retract the cheek. Apply disclosing solution with cotton tipped applicator while providing retraction to labial and buccal mucosa. c. Sit patient upright and allow patient to spit and rinse once with water. d. Evaluate. 2. Indices Disclosing solution is also used for some indices (Plaque Control Record). After documenting Index form, proceed with oral hygiene instruction. Disclose teeth after assessment phase and before initiating oral hygiene instruction. 3. Oral Hygiene Instruction: Apply the disclosing solution after the initial check-in as a means of questioning the amount of biofilm present, and as a teaching tool. Instruct patient to look for areas where disclosing solution remains in the mouth. Instruct patient on why and how best to remove it. 4. Polishing: Self-evaluation and faculty evaluation: Use disclosing solution to self-evaluation polishing. Then re-apply disclosing solution directly before faculty polish check. 5. Clean Up: Make sure all disclosing solution i