Expanding the Scope of Dental Hygiene By: Gordon J. Christensen, DDS, MSD, PhD

"Dental hygienists have made an impressive contribution to the dental profession over the 87 years they have been a profession. Their conventional role has been scaling, root planning, polishing teeth, and oral hygiene instruction. Are these tasks enough to keep hygienists interested and motivated, or should dental hygienists have more responsibilities? Certainly, in a busy practice, the conventional hygiene tasks are important and greatly appreciated by dentists and patients. However, it is still a mystery to me why about 28% of practicing general dentists and 35% of all dentists do not employ dental hygienists. Are there other responsibilities dental hygienists could assume? I contend that there are many clinical and educational responsibilities dental hygienists could assume.

Why should hygienists have more responsibilities? Hygienists are among the brightest and most motivated people in dental offices. Most hygienists have a relatively broad dental education, but their conventional clinical responsibilities are limited to only a few tasks. Early “burn-out” is common among hygienists. Patient education is essential in the current age of elective dentistry, and dental hygienists are the logical persons to deliver this education. This article discusses one of the most important responsibilities I feel should be delegated to dental hygienists.

Diagnostic data collection has become more important in recent years, because of the continued expansion of elective procedures in the profession, about which most patients know little or nothing. While in dental school, most dentists did not learn how to accomplish a rapid, thorough diagnosis and treatment plan. Usually, treatment plans in dental school are accomplished slowly and with some disagreement on the part of participating faculty members. As a result, some new dental graduates do not recognize the importance of thorough diagnosis and complete treatment plans, and because of the frustration of starting a practice, they do not learn how to accomplish this procedure rapidly. Most patients do not know the diverse procedures dentists accomplish. Most patients think dentists “fill teeth”. Of course we restore teeth, but this procedure is only one of the many procedures accomplished by dentists. Patients need to know dentists have a broad repertoire of clinical skills. Unless dentists or their staff tell patients about the many procedures now present in the profession, patients do not know about the procedures, and they may have interest in them.

Hygienists are the logical staff personnel to educate patients. For many years, I have promoted the concept of an auxiliary-oriented diagnostic appointment. Using this concept, the staff person collects all of the necessary information about the patient, and educates the patient about the potential procedures before the dentist comes in for the diagnosis and treatment plan.

This auxiliary-oriented diagnostic appointment includes the following steps in about a one-hour appointment:
Assist the patient in filling out informational forms

Panoramic radiographs

Bitewing radiographs (if enough teeth are present)

Periapical radiographs (as needed)

Diagnostic Casts:
None if only operative dentistry is needed and the occlusion is acceptable

Unmounted casts if: 1) one or more teeth are missing, but enough teeth are present to articulate casts, and there are no occlusal problems; 2) edentulous arch.

Mounted casts if: 1) there are obvious occlusion problems; 2) opening the vertical dimension of occlusion is contemplated.

Education of the patient in any area of potential treatment need, whether mandatory or elective

Demonstration of all oral conditions to the patient using an intraoral camera and television.

Periodontal charting of all of the remaining teeth with gingival sulcus depths over 3 millimeters

Blood pressure recording

Charting of previous restorations or endodontic therapy

Charting of obvious carious lesions

Vitalometer testing of suspect teeth

Charting oral soft tissue lesions present

Charting occlusal disease present

Bruxism

Clenching

Primary occlusal trauma

Secondary occlusal trauma TMD Charting missing teeth

Charting any other pathosis present

Determination of the patient’s apparent desires relative to treatment The diagnostic appointment consists of about 40-50 minutes of staff data collection by a hygienist, and about 5-15 minutes of treatment planning by the dentist with the hygienist present. Usually, counting the time to fill out typical forms, accomplish the data collection, and have the dentist develop a treatment plan, the appointment requires about sixty minutes. I have worked with this concept for over twenty years, and my experience with it has been excellent.

What happens to dental hygienists when they become involved with diagnostic data collection? I have watched the behavior of numerous hygienists as they have learned to accomplish diagnostic data collection. They become more interested in all aspects of dentistry, their knowledge grows, and their ability to educate patients is greatly enhanced.

There are many more tasks I feel should be delegated to dental hygienists, and diagnostic data collection is only one of them. The challenges I see when many tasks are delegated to hygienists are that there is less time for hygienists to accomplish conventional dental hygiene, and more hygienists are needed to staff the dental offices in any community.

One technical point should be emphasized. When staff persons, either dental hygienists or dental assistants, accomplish diagnostic data collections, it should not be called diagnosis and treatment planning. Diagnosis and treatment planning by staff persons are illegal in almost all geographic areas. It should be called diagnostic data collection.

Educating dental hygienists to accomplish diagnostic data collection requires several in-service education sessions. Dentists anticipating incorporating this concept should plan for a few educational sessions with the hygiene staff to allow them to become proficient in diagnostic data collection.

SUMMARY Dental hygienists are essential for all aspects of adequate oral hygiene in a typical general dental practice. However, their skills can be expanded to further aid dental practices. This article supports the concept of dental hygienists accomplishing diagnostic data collection, lists the various aspects of typical diagnostic data collection, and suggests the advantages of expanding the activities of hygienists into this activity.

Dr. Gordon Christensen is co-founder and currently Senior Consultant of Clinical Research Associates, which conducts research in all areas of dentistry and relates it to clinical practice. The well-known CRA Newsletter has published research findings for the dental profession on a monthly basis since 1976.

Dr. Christensen is also Director of Practical Clinical Courses, a continuing education career development program for the dental profession initiated in 1981. Each year thousands of dentists from around-the-world participate in PCC seminars, hands-on courses, and video tapes. Contact Dr. Christensen at: Practical Clinical Courses, 3707 North Canyon Road, Suite 3D Provo, Utah 84604-4587 FAX: 801-226-8637.

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Three 60-minute Practical Clinical Courses video presentations are directly related to the concepts presented in this article:
V1180- Diagnostic Data Collection By Auxiliaries

V4775- Educating Auxiliaries For Practice Growth

V4750- Achieving Optimum Acceptance of Treatment Plans

For more information or to order these suggested videos, please call (800) 223-6569 or visit the Practical Clinical Courses website at www.pccdental.com.

Practical Clinical Courses have clearly illustrated videos to assist with techniques commonly used in dentistry as well as instructing dental assistants on proper procedures. Two of their newest videos, Multiple Unit Fixed Prosthodontics (2nd Edition, V1990) and The Perfect Impression (C101A) are now available at www.pccdental.com or by calling 800-223-6569

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