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Give us an overview of your current and/or past experiences in private practice.
I have been working in dentistry for about 17 years. I spent 6 years of my career as a dental assistant and 11 years as a dental hygienist. Most of my career I worked in the public health setting, I just transitioned a year ago to the private practice sector full time. What I have noticed from my past experiences to my current experience is that in public health we did not only focus on oral health, we also focused on the patient’s overall health and addressed any barriers that may have prevented them from achieving optimal health outcomes. I worked for a health center that provided medical, behavioral health and dental services. When a patient came into the dental clinic, we started with gathering information and completing a social determents of health screening to address areas of their lives they may need assistance with. Some questions would ask about transportation, food insecurities, shelter, domestic safety, etc. If anyone had a positive screening, we would introduce them to our community health workers. They would provide resources and assistance to our patients. After reviewing medical and dental health history if patients did not have a primary care doctor, we would connect them with the medical department to establish care. It was important to share the same EMR system which provided comprehensive communication and care between the dental department and the other two departments. The collaborative care that was provided was so important for the patient and rewarding as a provider being able to not only help patients with their oral health but also in other avenues of their lives. My current experience in private practice is mostly focused on patients’ oral health. The office that I practice out of has two general dentists, one prosthodontist, a part-time endodontist, and a part-time orthodontist. Having different specialists all in one office makes it and beneficial and convenient for the patient but also helpful in the patient’s continuity of care and follow-up.
Reflect on how you use evidence-based practice in your routine patient care.
I use evidence-based practice when I conduct the oral cancer screening. I conduct this screening on every patient that I treat. Prior to starting the oral cancer screening, I thoroughly review patients’ medical history which will include but not limited to medication list, allergies, acute or chronic conditions, past conditions, hospitalizations, surgeries, history of tobacco, drug, and alcohol use. The importance of the extensive review of medical history already gives me, as the clinician an idea of my patients’ risk factors. For example, if my patient has a history of smoking, I know that they are most likely at a higher risk for oral cancer than a patient that does not have a history of smoking. (Shahi et al., 2023). I proceed to conduct my extra and intra oral examination. As I am examining, I am paying close attention to any areas that appear “suspicious” or are not considered within normal limits. Any area that appears to fall in this category I capture with an intra-oral picture, document its size, color and shape, also review with patient if they noticed lesion and length of time. Proceeding my examination, I will review with the dentist to discuss next steps. In determining steps that need to be taken I follow the ADA clinical practice guidelines: Clinical Pathway for the Evaluation of Potentially Malignant Disorder in the Oral Cavity These instructions provide guidance to the clinician by directing pathways to take if there is a suspicious lesion present, refer to fig.6 (Lingen et al., 2017).
Compare and contrast the ADHA Standards and AAP Statement as they relate to non-surgical periodontal care.
The ADHA standard and the AAP statement both are set of guidelines for dental hygienists focusing on the process of care in relation to clinical and risk assessment, diagnosis, planning, implementation, evaluation, and documentation (2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.Pdf, n.d.) The AAP statement has focus on the treatment procedures including removal of supra and subgingival biofilm and calculus, as well as the periodontal maintenance program specified to individual’s need (“Comprehensive Periodontal Therapy,” 2011). The ADHA standard also focuses on the role and responsibilities of the dental hygienists as well as discussing collaborations and referrals in the planning standard (2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.Pdf, n.d.) The AAP statement also discusses the importance of keeping patients informed of changes of periodontal prognosis (“Comprehensive Periodontal Therapy,” 2011).
Reflect on your strengths and weaknesses in each component of the process of care.
Standard I Assessment
Strength: I make sure that the first thing I do with the patients is review their medical history and document any changes to their health including medication, allergy list, and any recent surgeries. I complete a full mouth perio charting minimally on an annual basis.
Areas of improvement: I would like to get better at getting a baseline blood pressure reading on all patients. Prior to administering anesthesia, I do take a blood pressure reading on all patient to ensure that it is safe to proceed with procedure as well as determining if I can administer lidocaine or change to carbocaine. Also, in the area of risk assessment (CAMBRA) as an overall office we could do better in addressing all areas of contributing risk to patients’ oral health.
Standard II Dental Hygiene Diagnosis
Strength: Following the assessment, I believe I communicate well with my patients to explain what my recommendations are as well as I like to educate and provide visuals of radiographs, perio charting, and intraoral pictures to explain why I recommend the following treatment plan.
Areas of improvement: I want to work on pacing myself when delivering information to patients. Especially when patients are nervous being in a dental office, providing them with a lot of information at one time, is sometimes overwhelming.
Standard III Planning
Strength: Once patients receive the information, I make time to answer questions and if it something that I cannot answer I will involve the dentist in the conversation. We will review all the benefits and risks of the treatment plan. I will provide appropriate referrals if necessary.
Areas of improvement: Most of the time the front desk will handle obtaining informed consent and refusals. I would like to do better in my follow up and make sure that patients do sign the consents and refusals.
Standard IV Implementation
Strength: I make sure that prior to starting any procedure I explain the process and ask patients if they have any questions or concerns. My office does offer nitrous oxide for patients that have high dental anxiety. At the end of procedures, I provide post-op instructions.
Areas of improvement: I want to get better at making post op calls to all my patients that I have completed SRP, to follow up how they are feeling after the procedure.
Standard V Evaluation
Strength: I make sure that I tailor the dental hygiene plan per individual needs. I try not to overwhelm the patient; we focus on a specific goal whether it be flossing more or transitioning from a manual toothbrush to an electric. At re-care appointments I will evaluate the oral health condition and see if there has been improvement to BOP and probing depths, I will record if there are improvements to biofilm control as well. I will discuss with the patient areas that have improved and areas that still need focus.
Areas of improvement: As an office it would be beneficial to incorporate a patient satisfaction questionnaire, I think this would be helpful in getting patients input to see what areas we are doing well in and areas that we need to focus on when it pertains to their oral health.
Standard VI Documentation
Strength: One thing I always carried out of dental hygiene school when it relates to documentation is: “If it is not documented it do not happen!” I do my best to document all important details of the appointment, especially when it relates to the oral cancer screening. I make a point to document recommendations, patients’ acceptance of plan, and what areas we plan to focus on. Especially relating to the areas of focus is important to document so that we address at the re-care appointment and are able to document results from the recommended intervention.
Area of improvement: It is important to document in patient’s chart if they do not keep appointment, patients that miss appointments affect the prognosis of their oral health outcomes.
Are there barriers to implementing the changes you would like to incorporate in your patient care? Share at least one innovative idea for addressing the barrier.
The barriers that I sometimes will experience when implementing changes to patient care depend on how receptive the patient is to the change. Overall, I have had positive patient engagement in their oral health, and I do my best to relate their oral care to their overall health; I do notice hits home for some patients. It is a very rewarding feeling when patients come back and have incorporated the oral health instructions provided and see the improvements to their oral health. Some patients come in want their cleaning and don’t want me to provide any feedback or recommendations, “I just want my teeth cleaned.” I still explain that I must provide feedback and it’s their decision to follow the recommendations, I always will provide the risk and document. One innovative idea for addressing the barrier that comes to mind is what we are doing in our office now is we are using the iTero scan which is a 3D image for patients to get a visual of their dentition. It has been a great tool in encouraging custom night guards. We are able to show patients their wear patterns in relation to bruxism.
References
2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf. (n.d.). Retrieved January 7, 2024, from
https://www.adha.org/wp-content/uploads/2022/11/20…
Comprehensive periodontal therapy: A statement by the american academy of periodontology. (2011). Journal of Periodontology, 82(7), 943–949. https://doi.org/10.1902/jop.2011.117001
Lingen, M. W., Abt, E., Agrawal, N., Chaturvedi, A. K., Cohen, E., D’Souza, G., Gurenlian, J., Kalmar, J. R., Kerr, A. R., Lambert, P. M., Patton, L. L., Sollecito, T. P., Truelove, E., Tampi, M. P., Urquhart, O., Banfield, L., & Carrasco-Labra, A. (2017). Evidence-based clinical practice guideline for the evaluation of potentially malignant disorders in the oral cavity. The Journal of the American Dental Association, 148(10), 712-727.e10. https://doi.org/10.1016/j.adaj.2017.07.032
Shahi, Y., Kakkar, K., Samadi, F. M., & Mukherjee, S.
(2023). Tumor necrosis factor-alpha genetic variants and its interaction with
smoking and tobacco chewing in oral precancerous lesions and oral cancer. Oral
