A new client had an appointment scheduled with me this week, her first appointment within our practice. Although our administrative department is well-versed in explaining the importance of a comprehensive oral evaluation (COE) to our clients, both new and existing, I did find myself seated with someone that “just wants a cleaning for today.” So it began, my explanation of the dental hygiene process of care to this new smile we have welcomed into our practice.
At times, this explanation may take me one minute, or it may take me fifteen, depending on whether or not I need to “look inside” the oral cavity (as if to confirm that yes, we do need to complete a COE), take a few intra-oral photographs, complete a PSR, or perhaps initiate a discussion of the periodontal disease process with my well-used periodontal flip-chart.
I always find myself at ease as I explain the dental hygiene process of care to people as I’m a strong supporter of it. The dental hygiene process of care works, time and time again.
When we consider debridement, an implementation procedure, it is so much more than the seemingly simple act (for those that take it for granted) of adapting the leading third of a periodontal instrument to the tooth. How can I even consider picking up a periodontal scaler without thorough knowledge of the periodontal status, tooth anatomy, restoration integrity, referral urgency, and other important client-specific assessment data? Without said assessment, I have no foundation for a dental hygiene diagnosis, and certainly not even a hint of an individualized dental hygiene care plan.
The dental hygiene process of care provides the framework, or structure, necessary to provide the highest calibre of dental hygiene care to every client (which is fair and just) yet it manages to do this in an individualized fashion. The process needs to be followed in order to optimize oral health and the support that oral health lends to total health. When we deviate from the process, we compromise outcomes which can and do negatively affect oral health.
It’s important to remember that the process is a cycle, and at times, a cycle within a cycle. At a single appointment we may complete all five components from assessment through to evaluation on a small scale. For other measures, we may need several months to complete the cycle, but in both cases, the process starts all over again to either maintain or improve the oral health. The process has a beginning, but no end.
The initial assessment, the comprehensive oral assessment (COE), is lengthy, and may take anywhere for fourty-five to ninety minutes, but this information is vital for a solid foundation upon which the rest of the process will be supported and built. The length of time required is often directly related to the complexity of the assessment data.
How the assessment data is analyzed and interpreted is our dental hygiene diagnosis, which often, but not always, presents itself as some type of deficit. Errors can easily be made within the dental hygiene diagnosis, such as developing a dental diagnosis or confusing client-centered goals with dental hygiene interventions. (For instance, the client tells you they “want a cleaning” but is this really their goal or is it a part of our intervention? Why does the client “want a cleaning?” Isn’t their goal more accurately described as to achieve oral health, fresh breath, or a pleasing smile?) The dental hygiene diagnosis may seem abstract, at times difficult to grasp and convey, but it serves as the basis for the client-centered goals. And it is the goals that feed the dental hygiene care plan.
The dental hygiene care plan is a strategy of all of the interventions within our scope of practice, what will be done, when to do it based on priority sequence, and how long it all will take.
And now the moment we’ve all been waiting for: implementation! Putting the dental hygiene care plan into action isn’t always what we thought it would be; snow falls into blizzards, calculus is much more tenacious than we ever anticipated, children/spouses/pets become ill, and well, people simply change their minds. So we amend the plan, we do the very best we can, and we move on.
And did it work? Were the interventions successful? Were the client- (not the dental hygienist) centered goals met? Partially met? Unmet? Why or why not? What is the next step? Where do we, the client-dental hygienist team, go from here? This is why we evaluate. And this is where I find the greatest amount of professional satisfaction in clinical practice, is evaluation. This is where I truly feel I have made a difference. And this is because of a process that is none short of brilliant.
