“Clinical therapy refers to primary interceptive, therapeutic and maintenance procedures which enable the client to achieve optimal oral health and contribute to overall health.” (from Dental Hygiene Definition and Scope, 1994 CDHA)
In the clinical setting, dental hygiene assessment involves the gathering or updating of information relating to the client’s general and oral health, and the hard and soft tissues of the head, neck and oral cavity. The dental hygienist will obtain this information by performing some or all of the following assessment procedures:
- medical and dental history
- wellness habits, including (but not exclusively) nutrition and use of tobacco products
- vital signs
- head and neck examination
- intra-oral soft tissue examination
- periodontal examination
- dental examination
- occlusal examination
- diagnostic tests, including (but not exclusively) pulp vitality tests, bacterial tests to determine caries risk and enzyme tests to determine periodontal disease
- radiographic interpretation – including exposing and processing
- impressions for study models
- intra-oral and extra-oral dental photographs
- preserving and packaging biopsy specimens for shipment
Once assessment data is gathered the dental hygienist critically analyses the data and formulates a dental hygiene diagnosis.
Planning involves the development of a dental hygiene treatment plan, with the mutual agreement and informed consent of the client. Goals and objectives for clinical therapy are identified, including a specific detailed plan for the provision of therapy which outlines the roles of the dental hygienist and the client. The dental hygiene treatment plan is part of an overall plan for the client’s dental care.
Implementation is the initiation of the plan. Dental hygiene services are provided according to the plan. Revisions to the plan may occur, with the client’s informed consent. The dental hygienist provides services following current principles of infection control and dental hygiene practice:
- managing client pain, anxiety and fears
- providing oral health information and instruction relating to the teeth and periodontium, oral tissues, and dental restorations and appliances
- providing nutritional counselling as it pertains to dental and oral health
- providing information about the promotion of general health and wellness
- debriding, scaling, root planning and irrigating supragingival and subgingival tooth surfaces
- removing stain through various methods
- recontouring and polishing restorations
- applying anticariogenic and antimicrobial agents
- applying fissure sealants and preventative resin materials
- applying desensitising agents
- applying and removing surgical dressings and removing sutures
- placing and removing temporary restorations including provisional prosthodontic restorations (including the placement and removal of rubber dam, and matrices and wedges)
- performing orthodontic procedures
- polishing removable prostheses
- performing first aid and other emergency procedures
Evaluation of dental hygiene therapy occurs at every appointment. The results of care are compared to the treatment plan and to the client’s goals and expectations. Changes in general and oral health status are assessed, using common measurements, and the dental hygienist develops a dental hygiene prognosis. The need for further care is discussed and planned, as well as the need for on-going maintenance and referral.