Superior Dental Health Hygiene Core Values & Standard Of Care
Superior Dental Health Hygiene Core Values & Standard Of Care
Patient education is arguably the most important part of being a dental hygienist. While most think of home care education when they hear this, there is so much more that a hygienist educates on. A great example is a New Patient Comprehensive appointment.
We start with educating why certain radiographs are important (pano every 5 years, alternating bwx and anterior PAs at 6 month appointments – these help not only the doctor to properly diagnose, but give us baseline radiographs. In addition, they allow us to be comprehensive with our oral cancer screening, helping the hygienist in their periodontal diagnosis by seeing bone levels. They are also necessary for submitting to insurance and helps with visual aids for the patient, etc.)
Later we educate ourselves on the periodontal diagnosis. During this time we really emphasize that a hygiene appointment isn’t to make your teeth “feel good,” but rather is preventative in nature and is necessary for proper oral health. Even if a patient doesn’t have gingivitis and/or periodontitis, we talk about each (gingivitis is an infection of the gums while periodontitis is an infection of the bone).
Example: “While at this time I’m seeing great bone levels on your radiographs, I did have generalized 4mm pockets with bleeding, indicating severe gingivitis. The great thing is that we can work to actually reverse this through a special treatment called a ‘gingivitis scale’, followed by proper home care and routine 6 month appointments. I worry that if you don’t stay on top of your oral hygiene, we could potentially see your bone start to be affected, and we would then have to classify the infection as periodontitis. Periodontitis is irreversible and requires even more meticulous home care and more frequent hygiene visits. I don’t say this to scare you, but rather to show you how important proper dental hygiene is. These appointments aren’t to make your teeth ‘feel clean’, but rather to be preventative and thoroughly clean the bacteria out so that we don’t keep seeing these issues.”
There are all kinds of different examples we could use for so many different situations, but no matter what the diagnosis is, we tend to stick pretty closely to this narrative.
During this first appointment, we will have a comprehensive exam. You need to be backing up the doctor and emphasizing just how important it is to have the recommended treatment done; when something is treatment planned, it isn’t “for when you feel like it,” or “when you get to it” – now is the best time to move forward with the treatment. It’s never going to be easier or more affordable than it is right now. Educate the patient properly on the consequences of waiting or what the treatment could turn into if they put it off – it’s for THEIR benefit.
Patient education is all about training the patient – whether it be to get them to show up to their hygiene or restorative appointments, why fluoride is recommended and important, why proper home care is important, informing them of the mix of services we offer (whitening, desensitizer, sealants, etc.); all of this is to help the patient have a better handle on their oral health!
Working Cohesively With Your Doctor(s)
- Understand what your doctor appreciates in a hygienist
- Know how your doctor typically gives their diagnoses
- Both the doctor and the hygienist need to back each other up – the doctor must support a hygienists periodontal diagnosis and a hygienist must support a doctor’s treatment diagnosis
- Overall, this ties in with what was discussed in the patient education section – patients will have more trust in us and trust us as professionals if we can work seamlessly with our doctors and if the doctors can work well with the hygienists; it’s all for the patients and to make their experience with us the best it can be
Per SDH policy (which follows the ADA perio policy), this is an oversimplified version. Full SDH perio policy can be found on google drive:
- < 3mm = healthy tissue requiring prophylaxis.
- 4mm, no bone loss = can be “gray area”; if generalized BOP, consider gingival scale (D4346). If no BOP, providers may consider shortening recare intervals according to their discretion.
- ≥ 5mm = with bone loss and bleeding, unhealthy tissue, requires periodontal therapy
- We have had weird cases where bone levels were perfect and we had 5mm or even 6mm pockets – this was a unique case where we did a gingival scale (4+ teeth D4341; 1-3 teeth D4342).
- Full mouth debridement (D4355): supragingival calculus, heavy plaque, and/or debris buildup is interfering with doctor’s diagnosis; comprehensive exam and FMD CANNOT be completed on the same day, FMD first and comp scheduled on another day (typically hygienist will diagnose this and let doctor know that we will be doing exam another day, helping save the doctor time). A prophy or SRP will be completed following this preliminary procedure.
- Gingival scale (D4346): generalized heavy bleeding upon probing with NO bone loss (cannot be periodontally involved).
- Once a patient has had SRP, they will be a periodontal maintenance patient, not a prophylaxis.
- For periodontal treatment refusal, we have a periodontal refusal form. We have done a prophy on someone that has refused periodontal treatment and signed the form, but we would actually highly discourage anyone from doing this as the patient will feel like you cleaned them and may not believe in the importance of SRP. We have also heard that you can lose your license doing this (negligence or something like that), but we would have to do some research and figure out if this is true in Nebraska.
Radiographic / Intraoral Photo Policy
Per SDH policy:
- Pano once every 5 years
- Bitewings once a year (alternate with anterior PAs at 6 mo appts); if vertical bitewings are able to be taken, they should
- Anterior PAs once a year (alternate with bitewings at 6 mo appts)
- PA of endodontically treated teeth and implants one time yearly
- Again, this is for the benefit of the patient (some patient’s think it is excessive – just remind them that they won’t “feel” anything going on with that tooth or implant until it was severe and we don’t want an infection that severe in the body. Also, you can always remind them that they invested a lot of time and money into saving/replacing that tooth, and we want to keep a close eye on it for them). We always want to remind patients as hygienists that our priority is always prevention!
- Intraoral Photo Policy
- At least 1 intraoral photo should be taken per appointment