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Dental Hygiene Diagnosis and Therapy
by Howard M. Notgarnie, RDH, MA
As the scope of dental hygiene broadens and the practice becomes more specific, definitions of dental hygiene diagnosis and care must follow suit. This article calls for a taxonomic system of nomenclature for dental hygiene diagnosis and treatment, which can be used for current treatment modes available from dental hygienists and can expand along with the breadth of care and depth of knowledge.
The current terminology used to describe dental hygiene diagnosis and treatment is minimal. Furthermore, diagnoses and treatments have been defined from outside the dental hygiene profession, leaving dental hygienists to practice within guidelines that do not fit the goals of dental hygiene practice toward client care. Dental hygienists need to define diagnoses and treatments more specifically than the currently available descriptions provide. Definitions as such should reflect the profession's holistic focus on prevention and early intervention of disease rather than on a perspective of pathology. This philosophy will help distinguish dental hygiene care from other forms of health care and accentuate its complementary, rather than competitive, relationship to dentistry and medicine.

The growth in dental hygiene’s scope and practice settings suggests a need for dental hygienists to formulate more distinct diagnoses and treatment plans. Furthermore, the dental hygiene diagnosis is becoming a more widely recognized entity. Noted organizations recognizing the dental hygiene diagnosis include the American Dental Hygienists’ Association1, 2 and the Oregon Board of Dentistry.3 Krisberg looks at the role dental hygienists are playing in rural areas of Maryland, Vermont, Washington, and Wisconsin to fill the void left by dentists. Dental hygienists are the key to prevention of oral diseases that are much more prevalent in rural areas due to the deficiency of dentists in those areas.4 Additional factors suggesting the need for a formal lexicon of dental hygiene diagnosis and treatment include:

  • The complexity of conditions and treatment options that may exist
  • The increasing frequency with which dental hygienists lack other qualified practitioners to whom to relinquish the responsibility of a thorough dental hygiene diagnosis
  • The increasing number of dental hygienists practicing in settings where they are unsupervised by individuals conversant on clinical issues facing dental hygienists

While ceding to the legal restrictions opposing the dental hygiene diagnosis, Levin5; identifies the centrality of the dental hygienist in diagnosis and treatment. He suggests that dental hygienists “evaluate the level of periodontal health … help create a system of standard diagnoses … and … initiate the majority of treatment.”

Gurenlian6 demystifies diagnosis as the identification of a condition, recognized through deductive reasoning based on objective and subjective criteria, which can be addressed by further professional actions of the diagnostician.

A diagnosis entices a practitioner to make responsible therapeutic decisions. The diagnosis justifies the therapy offered and performed, provides reason to the wide range of services available, and provides the basis for measuring the standard of care. Clinical decisions must uphold to legal measures as well. Dental hygienists’ education and professional association define dental hygiene standard of care. Dental hygiene education accreditation standards recognize the dental hygiene process of care, which includes diagnosis. The ADHA supports this process of care. Many dental hygiene schools teach this process of care, and the dental hygiene diagnosis is a part of several texts used in dental hygiene schools.

Dental hygienists have been reluctant to accept diagnosis as part of their professional repertoire. This reluctance stems from several bases:

  • Lack of acceptance of capabilities
  • Fear of error
  • Lack of clarity on what constitutes a diagnosis
  • Fear of embracing responsibility to clients
  • Tradition of relinquishing to dentists the definition of dental hygiene’s profession

Consequently, Gurenlian recommends that the dental hygiene diagnosis be made more palatable to dental hygienists by:

  • The ADHA creating a position statement indicating the necessity of the dental hygiene diagnosis;
  • Changing legislation to recognize the dental hygiene process of care;
  • Finding and using the professional socialization mechanisms that will lead to dental hygienists accepting the responsibility for the diagnoses they make; and
  • Accepting that there will be opposition to our professional growth from outside entities

Indeed the profession is responding to the above recommendations. The American Dental Hygienists’ Association formally recognizes the dental hygienists’ capability and responsibility to formulate a diagnosis. ADHA characterizes the dental hygiene diagnosis as following nursing diagnosis by identifying challenges to general health and function rather than following medical and dental diagnosis that focus on systemic processes and pathology.7 Furthermore, the American Dental Association Commission on Dental Accreditation specifies dental hygiene education must develop students’ competency in dental hygiene diagnosis and treatment planning.&sup8; Likewise, the American Dental Education Association stresses that someone entering the profession of dental hygiene must be competent in diagnosing a client’s needs and planning appropriate treatment using data collected during assessment and collaboration with other health professionals.9 Mueller-Joseph and Peterson describe the formulation of a dental hygiene diagnosis from the processing of data collected during the assessment phase of the dental hygiene process. The dental hygienist makes an inference using evidence from a variety of sources. The dental hygienist then determines how the findings will lead to a dental hygiene care plan and continuously validates the decision as more information is accumulated. The dental hygiene diagnosis describes conditions amenable to dental hygiene care. It consists of two statements: a response and its relationship to an alterable etiological factor. Guidelines to keep in mind when formulating a dental hygiene diagnosis are to keep it factual rather than judgmental; make the first statement a problem that summarizes the signs and symptoms; make the second statement the etiology that resulted in the problem; and define the problem and etiology in terms that can be addressed by a dental hygienist.10

Pamela Emard, RDH, described herself as "member of the ADHA, CDHA, IFDH, focused on patient quality care and an advocate for the advancement of the dental hygiene profession."

Annette Comey Billups, RDH, BS, stated she "graduated from the dental hygiene program at the University of Southern California, in 1998. Works in a private practice in Los Angeles, and is raising a beautiful daughter in Corona with her husband."

Mary Glassock Johnston, RDH, earned an Associate of Science in Dental Hygiene from Asheville Buncombe Technical Community College, in Asheville, North Carolina. She is the "Primary Dental Hygienist for Extended Care Rehabilitation Center for VA Medical Center, Asheville, NC." Her work includes "Oral care for Cancer, Hospice, Rehabilitation, and Long Term Care geriatric patients as well as Educator for Nursing Staff."

Howard M. Notgarnie, RDH, MA, practices dental hygiene in Colorado, and has eight years’ experience in official positions in dental hygiene associations at the state and local levels.

July 1, 2008