What are the purposes of a patient record
keep history, recognize changes, provides a basis of evaluation, allow info for continuity of care
What are the components of a patient record
history, vital signs, clinical assessment/diagnosis, recommendations and treatment plans, progress notes, acknowledgment of confidentiality, informed consent, radiographs, perio and caries risk assessments
What are advantages/disadvantages of electronic records
faster/convenient, can be accessed anywhere, allow for voice recordings; if system crashes, info is not accessible and info cannot be added
What are the advantages/disadvantages of handwritten records
may not be legible, forms may not be completed, natural disasters ruin information, paper is easily contaminated, takes up a lot of space
What is the purpose of HIPAA
to establish a notional standard to protect individuals privacy and access to medical records and health info
Who does HIPAA apply to
healthcare facilities, insurance companies, and providers
What is subjective data and how is it used in documentation
characteristics stated by the patient or perceived by the clinician; age, gender, type of appt's, medical history, chief complaint, self-care regimen, social history
What is objective data and how is it used in documentation
characteristics observed during examination; head/neck exam findings, perio exam findings, hard tissue exam findings, radiographic findings, comparison with past exams
What are the 4 parts of the SOAP acronym
Subjective, Objective, Assessment/Analysis, Procedures
Why are disclosing agents important
helps patients visualize problem areas, helpful to clinician in computing index score, helpful to clinician in descriptive notes.
technique for applying and utilizing disclosing agent for patient education
-"Paint" the disclosing agent over all tooth surfaces
-Avoid contact with extra-oral soft tissues
-Give patient a small amount of water
-Have patient gently swish to distribute disclosing OR
-Use GENTLE stream of water from A/W syringe
-Use suction / have
calculation of the biofilm index used in the WSU DH clinic.
0-no biofilm
1-Film adhering to free gingival margin and adjacent area. May be recognized only after application of disclosing or by running explorer across tooth surface.
2-moderate accumulation of soft deposit within the gingival pocket than can be seen
manual toothbrush
moved manually, comes in different sizes and designs
powered toothbrush
brush does the work, powered by electricity
characteristics of an effective manual toothbrush
it should aid in cleaning teeth of soft deposits: biofilm, food particles, materia albla.
-It should massage the gingiva which promotes keratinization, keeps free and attached gingiva healthy.
Handle
dimensions, easy to grip, does not slip
Shank
straight, angled
Head
bristle arrangement, bristle type
elements influencing toothbrush bristle quality and stiffness
Softness/stiffness determined by length and diameter of bristle, arrangement of tufts
-stiff:close groupings of bristles or bristles positioned straight.
-softer: multi-tufted angled
Nylon
sanitary, consistent, stable, rinses cleanly, dries rapidly, durable
Natural
hog or boar bristle, irregular and rapid wear, hollow, may harbor bacteria, soften when wet
What influences toothbrush bristle stiffness?
Length of bristles, the shorter the stiffer.
Frequency of Brushing
one brushing and flossing each day usually is sufficient for biofilm control; adult with periodontal involvement needs minimum of two brushings and one flossing daily with additional aids
Bass Technique
soft bristle toothbrush, angle into cervical area at 45 degree apically, gentle, short vibratory strokes, massaging action at the gumline.
Modified Stillman's
incorporates several different procedures, begins on attached gingival tissues and migrates coronally, vibrating/ rolling. Good therapeutic technique after PD.
Rolling stroke
rolling the toothbrush down
Charter's
45 degree angle opposite of Bass
Fone's
circular method ideal for children, easy to learn, small rotations.
various designs of tongue scrapers, their benefits and limitations.
-some are metal or plastic
-control bacterial accumulation and halitosis, many different designs.
-may cause gag reflex.
potential detrimental effects of inappropriate toothbrushing methods
Too much pressure can wear down enamel overtime
Perio-aid
handle with hole in the end designed to hold toothpicks
stimudent
Gingival stimulation, reshaping, toning, circulation, epithelial thickening
-massaging motion angled adjacent to papillary gingiva
Interproximal brush
Small, soft-bristled brush attached to a metal or plastic handle for cleaning open contact areas, around orthodontic braces and wires, around exposed bifurcation or trifurcation of the roots, or on abutment teeth of a hygienic bridge
End tuft brush
This is a small brush head addresses special maintenance concerns including orthodontic bands, implants, and other hard-to-reach areas.
unwaxed dental floss
indicated for cleaning proximal areas on patients with normal gingival contours, contraindicated for patients with moderate to severe recession. Advantages: nylon fibers spread out and gives wider surface for plaque removal, thins out.
waxed dental floss
indicated for tight proximal contacts and slides more easily. Advantages: slides through contact area with ease, wax prevents tissue trauma, resists breaking and shredding, strength and durability. Limitations: waxed floss feels thicker than unwaxed, poor
PTFE polytetrafluoroethylene (i.e. Glide�, Satin�) floss
a. indicated for tight contact areas and patients with numerous proximal restorations, advantages: fiber slides easily through tight contacts and around rough restorations.
tufted floss (Superfloss)
tufted, indicated for wide embrasures, under pontics and proximal surfaces of abutment teeth or orthodontics. Contraindicated for tight contact areas, advantages: better plaque removal in above described areas, limitations: too thick for tight contact are
dental tape
a. wider and flatter waxed floss product, indicated for Class I embrasures (mild), class III furcations, fixed bridges, implants, open contacts.
-Contraindicated for tight contacts.
floss holder
plastic device with Y end, floss wound around and across the Y, prestrung. indicated for persons with disabilities, large hands, parent use on a child, people don't like hands in their mouth, contraindicated with people with normal motor skills.
disposable floss 'picks'
Similar to floss holders but whole thing is disposable
floss threader
plastic or wire, looks like a needle with a large or small loop. Indicated for flossing fixed bridges, orthodontics. Contraindicated in any other areas.
End-tuft brush
excellent for rotations, versions, prosthodontics, edentulous areas, posterior distals.
toothpick-in-holder (Perio-Aid)
interdental toothpick aid, hold 90 degrees or slightly angled toward apex, work up and down on proximals, trace softened end along gumline F&L.
Flossing technique
Yard of floss, wrap length of floss around one middle finger.
-Catch remaining end with other middle finger.
-"see-saw" floss through the contact area.
-Slide floss up and down proximal surface of one tooth, pull the floss to "wrap" around the tooth in a
oral irrigation
Targeted delivery of water or solution to specific locations within the mouth
Process of care
ASSESS
DIAGNOSE
PLAN
IMPLEMENT
EVALUATE
DOCUMENT
Assess
Provides a foundation for patient care by collecting both subjective and objective data. Systemic collection
Diagnose
Identifies health behaviors as well as actual or potential oral health problems that hygienists are educated and licensed to treat. Identification of client strengths and oral health problems that dental hygiene interventions can improve.
Plan
Selection of interventions to be performed by the patient, hygienist, or others to meet the needs of the patient in obtaining oral health. Establishment of realistic goals and the selection of dental hygiene inter
Implement
activation of care plan. Act of carrying out the dental hygiene plan
Evaluate
Determine if the patient needs to be retreated, referred or placed on maintenance. The measurement of the extent to which the client has achieved the goals specified in the plan. Judgment to continue, discontinue, or modify the dental hygiene plan of care
Document
Process of detailing assessment data, diagnosis, care plan, treatments, teaching, and evaluation in a condensed consistent format for the patient's permanent record.
advantages to maintaining sharp instrument cutting edges
More effective, reduces risk of slipping and patient discomfort
Describe the hazards of using dull instruments
May cause you to slip, patient discomfort, dull instruments crush and fragment calculus, clean removal not accomplished
Describe and demonstrate two ways to determine instrument sharpness.
light test: light reflects off of rounded surface.
-test stick: sharp edge will "grab" surface of plastic test stick.
Natural stone
Arkansas oilstone natural stone, fine abrasiveness.
Artificial Stone
India is commonly used, fine to medium abrasiveness. Carborundum and ruby, coarse artificial stone. Ceramic is artificial stone fine to medium abrasiveness
Coarse stone
large abrasive crystals, more rapid cut
Fine stone
smaller abrasive crystals, slower cut
Describe the correct technique for sharpening universal and area-specific curettes and sickle scalers.
Choose appropriate stone shape and abrasiveness, use a sterile stone during patient care.
-Establish proper angle between stone and instrument.
-Maintain a stable, firm grasp. Avoid excessive pressure.
-Avoid formation of a "wire-edge"
o Use both up and d
Describe some common technique errors for sharpening and ways to prevent them
Mounted, rotary:
-Not for routine use, can wear instrument too quickly, can generate heat.
Unmounted
-Easier to control, stone or instrument must be stabilized.