Test 2 Flashcards
Client goals should be:
Client-centered
Specific, clear, concise
Measureable & observable
Time-limited
Realistic
Goals should include:
Subject
Verb
Criterion
What are the 8 human need deficits?
- Protection from health risks
- Freedom from fear and stress
- Freedom from pain
- Wholesome facial image
- Skin and mucous membrane integrity of head and neck
- Bioloigcally sound and functional dentition
- Conceptualization and problem solving
- Responsibility for oral health
What is the “related to” portion of the dental hygiene diagnosis?
Etiology (cause)
What is the “evidenced by” portion of the dental hygiene diagnosis?
Supporting facts of diagnosis
True or False: goals need to be numbered
True
What records does a dental hygiene need to keep in regards to the Dental Hygiene Act 1991 - Records Regulation?
Clinical notes of treatment
Equipment service record
Equipment sterilization record
Financial record for each client
Health record
What does the client’s health record need to contain?
Name
Address
Date of birth
Date of each professional contact
Amount of time for each intervention
Name and address of primary care provider
Name and address of client’s primary care dentist
Name and address of any referring health professional
Appropriate medical and dental history
Every written report received by the member respecting examinations, tests, consultations or treatments performed by any other person
Copy of every written communication
Each examination, clinical finding and assessment relating to the client
Medication list
Any dental hygiene treatment plan
Each treatment or procedure performed
Any advice given by the member
Every controlled act including the source of authority to perform the controlled act
Every referral of the client by the hygienist
Every procedure that was commenced by not completed
A copy of every written consent
Every refusal of a treatment
What needs to be included in the ROC for cornoal polishing?
Name of the product
Grit
Flavour
Location
Time spent in minutes
What needs to be included in the ROC for Fluoride?
Chemical name
Percentage of fluoride
Flavour
Application technique
POI
What is needed in the ROC for desensitizing?
Reason for use
Location
Product name
Percentage
Time spent
POI
Client satisifcation where previously done
What is needed in ROC for pit and fissure sealants?
Location
Materials
Occlusion
Adjusted if needed
Instructor who checked
What is needed in ROC for alginate impressions?
Tray size
What was taken
How many were taken
Material used
Client reaction to procedure
What information is needed in ROC for topical anaesthetic?
Reason for use
Product used
Percentage of active ingrediant
Specific location applied
Flavour if applicable
What is needed in the ROC for local anaesthetic?
Reason for use
Percentage of active ingredient
Name of product
Ratio of epinephrine or none
Injection location
Number of carpules
Client reaction
The name of DDS providing injection
What does Adj mean?
Adjust (ed) (ment)
What does BW mean?
Bitewing x-rays
What does Ct mean?
Client
What does CR mean?
Composite resin
What does EO mean?
Extra-oral
What does Fl mean?
Fluoride
What does APF mean?
Acidulated phosphate fluoride
Wbat does NaF mean?
Sodium fluroide
What does FMS mean?
Full Mouth Series (x-rays)
What does IO mean?
Intra-oral
What does Imp mean?
Impressions
What does Md mean?
Mandibular
What does Max mean?
Maxillary
What does PR mean?
Plaque record
What does MH mean?
Medical history
What does NC mean?
No change
What does OHI mean?
Oral hygiene instruction
What does PFS mean?
Pit and fissure sealant
What does PA mean?
Periapical (x-ray)
What does POI mean?
Post operative instruction
What does Sc mean?
Scale(d)
What does Var mean?
Cavity varnish
Wht does Min mean?
Minutes
What does Sup by mean?
Supervised by
What does ICO mean?
Informed consent obtained
What is the dental hygiene evaluation for?
To determine whether the client’s goals have been attained
To determine if the care outcomes have been attained
To verify that the client has received the planned services
True or False: evaluation includes measuring the client’s level of satisifaction
True
True or False: evaluation does not allow the dental hygeinist to modify the dental hygiene intervention plan
False. The evaluation allows the dental hygienist to modify dental hygiene intervention plans and programs based on outcome measures, changing needs, and new information
To determine the future needs, and further care for the client interval for on-going preventative care or any consultation or referal to another health professional the hygeinist must complete
Evaluation
When must the dental hygienist communicate and collaborate with the client about goals, outcomes, and/or interventions performed or to be performed?
At every appointment
The evaluation framework is a plan within a plan or program that measures:
The outcomes using a set of key indicators that have been established based on the initial assessment and the client’s identified needs.
What is the failure to evaluate an indication of?
The unwillingness to assume responsiblity for quality of care provided.
What are the three levels of goal attainment?
- Goal met
- Goal partially met
- Goal not met
What are the types of evaluation used in dental hygiene?
Process evaluation
Outcomes evaluation
Structural evaluation
Can goals be met at various appointments?
Yes
If the goals are met at various appointments what needs to be recorded when the goal is met?
The date and how it was met
What are the three components requires when writing/recording an evaluation?
Decision of the dental hygienist
Supporting evidence
The date on which the evaluation took place
What future needs/care are determined by the evaluation results?
Future needs priorities
The necessity of further care
Consultation/referral to another health care provider
The client re-care interval
What is the client satisfaction survey?
A Durham College Dental Clinic Feedback survey that is provided to the client in a link at the end of care.
What does the client satisfaction feedback help the hygiene student understand?
That you met your client’s chief concerns
If the service you provided met teir expectation related to their comfort level
The success of your communications
What happens to clients who are not maintained in a supervised recall program?
They show obvious signs of recurrent periodontitis
Should motivational techniques and reinforcement of the importance of the maintenance phase of treatment be considered before performing periodontal treatment?
Yes
What are the considerations when establishing recare intervals?
Caries
Unresolved inflammation
Periodontal condition
Medically compromised
Family history
Ortho concerns
What will happen if you don’t indicate the continous care interval in the Dentrix Family File?
You will lose marks on your chart audit
What factors indicate a 4-6 week re-eval is needed?
Systemic factors
Risk factors
Agressive forms of the disease
Pockets of 6mm or greater
Advanced bone loss or attachment loss - furcations, mobilities
Adherence on the part of the client requires the discussion of the need for the re-evaluation visit as an essential part of the NSPT care plan at the time of case presentation and informed consent
In semesters 4, 5 and 6, what DD levels may be asked to return for 4-6 week re-eval?
DD3
DD4
What does a 4-6 re-eval include?
MH update
EO/IO update
Discussion with client regarding how they are doing with previously taught education and determine/document if changes are required
Soft and hard deposit assessment Assessment of the soft issues
Full mouth probing
CAL
Bleeding Index
Plaque Record
Full debridement/deplaquing
All findings are to be compared to previous findings and recorded in ROC
What happens if during the re-eval there are extensive deposits that have reaccumulated?
The client must be reappointed for a continuous care appointment
Are additional credits awarded for re-evaluations?
No
What may be prescribed at the reevaluation?
Chlorhexidine rinse
Who determines if Chlorhexidine rinse needs to be prescribed?
The student in conjunction with the RDH instructors and the DDS who will prescribe and dispense the chlorhexidine
What needs to be recorded in the ROC for the re-eval?
Addressing improvement in gingival health - yes or no?
Comparison of pocket depths - reduction? Indicate areas
Assess clinical attachment level - indicate areas
Any removal of calculus - where? time spent?
Client treatment goals - were any evaluated?
Review OHI and client compliance
When can the appropriate recare interval be determined for a client that requires a re-eval?
Upon completion of the re-eval
What are the reasons for referral?
Caries
Perio
Night guard
Ortho
Oral surgeon
Periodontist
What forms need to be completed for a referral?
A paper copy to give to the client signed by RDH or DDS
An electronic copy in Dentrix signed by RDH or DDS
What needs to be documented in the ROC for a referral?
Client has been informed of the nature of the referral
The benefits of following up as well as risks ad possible side effects of not following up with referral have been explained and documented
Indicate hard copy given to client and electronic copy completed
What is the rationale for a chart audit process?
Quality control
Understanding areas of record keeping that may have not been met
Legal guidelines
Why is quality control a rationale for the chart audit process?
Shows Standards are being met
Why are legal guidelines a rationale for the chart audit process?
Allows the office to ensure all are their part
What do you do if you find an ROC is missing information during your audit?
Add an addendum
Who needs to correct the information if an instructor indicates changes need to be made from the audit?
The student
Where does the student put their name to show they were the provider in the client’s Family File in Dentrix?
In the driver’s lisence spot
What needs to be put under Prov 2 on the client’s file?
DH3A (DH + semester + group)
What happens when a client in the middle of care fails to attend a scheduled appointment with or without notice?
Determine the reason and provide another opportunity.
What needs to be recorded in the client’s ROC if a client fails to attend an appointment with or without notice?
Record information regarding why the client missed the appointment and document the conversation you had with the client.
What happens when a client missed more than one appointment and the reasons are not substaintial?
You may defer their treatment to a time when it is convenient for you, or you may need to advie them you no longer have appointments available for them, if the case warrents this decision.
When a client misses more than one appointment, and the reasons are not substantial, and you are unsure how to proceed, what do you do?
Discuss options with your advisor, and/or the recepionist. Every phone conversation must be recorded in the clinical notes.
What needs to be done to the client file is they indicate they are not returning?
The client needs to be inactivated
What needs to be added to the Post Care Evaluation form if a client does not complete care?
Identify any goals complete or incomplete and future needs, and signed off by an instructor.
What happens if care is incomplete and you are on break the following semseter?
Care needs to be transferred to another student (speak to receptionist/advisor)
What is the expectation of the RDH/DH Student with respect to the Client who smokes tobacco?
Education about health risks, connection between tobacco use and oral cancer, periodontal disease
Motivate clients to quit
Provide cessation options
Refer
What is tobacco cessation?
Quitting or stopping the use of tobacco
True or False: Most tobacco users require mutliple attempts at stopping their tobacco use before they are ultimately sucessful.
True
How many smokers will return to smoking within a year?
85%
People who relapse after 6 weeks of not smoking usally don’t do it because of nicotine withdrawl. Why do they do it?
They find themselves in situations that make them want a cigarette.
A UofT study found people quitting smoking requires up to ____ attempts.
30
What happens to the brain from chronic exposure to nicotine?
With chonric exposure to nicotine, brain cells adapt to compensate for the actions of nicotine.
What is the process of brain cells adpating to compensate for the actions of nicotine with chonric exposure to nicotine called?
Neuroadaptation
True or False: Over time, less nicotine is required to achieve the rewarding effects.
False. Over time, more niotine is required to achieve the rewarding effects.
What are the physical aspects of nicotine addiction?
Dopamine = pleasure
Serotonin = Mood modulation
Beta-endorphin = Anxiety reduction
Acetylcholine = Cognitive enhancement (stimulant)
Vasopressin = Short-term memory enhancement
Norepinephrine = appetite suppression
How does the scientific cycle of nicotine addiction work?
Nicotine binding = increased dopamine
Dopamine = pleasure
Dopamine decrease between cigarattes = withdrawl/stress
Cravings for nicotine/dopamine
Competetive binding nicotine = desensitization
Nicotine levels decrease, receptors revert which leads to cravings
How does the nicotine addiction cycle work in short?
Nicotine = increase dopamine
Dopamine = pleasure
Dopamine goes down in between hits
Cravings of nictotine to restore dopamine/pleasure
Starts over
What are the psychologic aspects of nicotine addiction?
Stress
Depression
Boredom
What are the behavioural aspects of nicotine addiction?
Gratification from tobacco use in certain situations
Environment clues trigger need for cigarette
Learned anticipatory response
How long can the learned anticipatory response to nicotine addiction last?
6 months after the physical dependence to nicotine is overcome
What are the sensory aspects of nicotine addiction?
Oral gratification
Appetite supressant
True or False: People trying to quit will often swap out smoking for food
True
How much weight will the average person gain when quitting nicotine?
10 pounds
What are the sociocultural aspects of nicotine addiction?
Peer pressure
Social networks
Families/cultural
What should the dental hygienist mention when approaching the topic of tobacco cessation focus?
Tissue damage through cytotoxic substances
Decreased salivation
Increased calculus
Vasoconstriction
Periodontal disease
Nicotine causes what percentage decrease of blood circulation in the mouth?
70%
DId dentists ever recommend tobacco?
Yes, many many years ago before harmful effects were well known
True or False: Tobacco is the number one cause of preventable death in Canada
True
Can the DH see early tissue changes?
Yes
Smoking increases the chance of developing oral cancer by
400%
What illnesses are caused by tobacco use?
Oral cancer - lips, buccal, gingiva, tongue
Laryngeal/pharyngeal cancer - esophagus, voice box
Oral disease - gingivitis, periodontitis
What are the oral effects of tobacco?
Halitosis
Stained teeth
Recession
Chewing tobaccos increase sugar and caries
Mouth sores
Poor healing
Low salivation
Leukoplakia/erythroplakia (tissue changes)
Hairy tongue
Candidasis
Decreased sense of smell
Sensitivity to hot/cold
How much more likely are smokers to have periodontal disease?
400%
What is nicotine stomatitis?
A reaction seen on the roof of the mouth caused by extreme heat in the mouth, most commonly from smoking
What is leukoplakia?
A white lesion
What is erthroplakia?
A red lesion
What is erythroleukoplakia?
A red and white lesion
Where to commonly find pre-malignant oral lesions?
Lateral borders of tongue
What are the five A’s for?
An evidenced-based strategy we can implement to help a client become tobacco free.
What are the five A’s?
Ask
Advise
Assess
Assist
Arrange
What is the Ask part of the five A’s approach?
Ask clients about tobacco use
What is the Advise part of the 5 A’s approach?
Advise clients to quit
What is the Assess portion of the 5 A’s approach?
Assess client’s readiness to quit through questioning
What is the Assist portion of the 5 A’s approach?
Assist client with the quitting process based on the client’s readiness to quit
What is the Arrange portion of the 5 A’s process?
Arrange follow up.
Set an appointment visit or phone call to the client.
Provide a referral to a tobacco use cessation program
What needs to be completed if the client idicates they would like to quit tobacco?
Tobacco cessation questionnaire
What is included in the tobacco cessation questionnaire?
Number smoked per day
Time of the first cigarette of the day
History of smoking
Quitting attempts
Confidence and motivation to quit
How can we effectively assist our clients with quitting?
Encourage serious effort
Emphasize complete abstinence
Provide self help materials
Quitline - www.smokershelponline.ca
What to do if a client is not ready to quit when you reach the assist part of the 5 A’s?
Provide some information about the benefits of quitting and link their tobacco use to oral findings
What is motivational interviewing?
Person-centered, goal directed method of communicating for eliciting and strengtheing intrinsic motivation for positive change
What are the four general principles of motivational interviewing?
- Express empathy
- Develop discrepancies between current behaviour and important goals/values
3.Roll with resistance and avoid arguing
- Support self-efficacy and optimism
What is the first thing you should do during a motivational interview?
Ask permission to share information. It sets the collaborative spirit and you are not infriging on their personal freedom.
What kinds of questions should you ask during a motivational interview?
Open ended questions to gain information about values, attitudes, and beliefs held by the client
What is change talk in a motivational interview?
It is a strategy that elicits reasons for changing from clients by having them give voice to the need or reason for changing.
What is the Stages of Change model?
Precontemplation
Contemplation
Preparation
Action
Maintenance
*Relapse
What should the DH do during the precontemplation stage?
Remind the client that services are available to them when they are ready.
What should the DH do during the contemplation stage?
Offer them self help material, assist with planning or referrals to other health professionals who can assist them with quiting/planning.
What should the DH do during the preparation stage?
Same as contemplation - Offer them self help material, assist with planning or referrals to other health professionals who can assist them with quiting/planning.
What should the DH do during the action phase?
Encourge and provide them with information about relapse
What should the DH do during the maintenance phase?
Same as action - Provide them with encouragement and informaton about relapse
What are the key elements of intensive tobacco cessation treatment programs?
Assessing: motivation, reasoning, previous attempts, nicotine dependence
Setting a quit date
Establishing a plan for quitting
Offering coping skills training
Encouraging the enlistment of support from others
Recommending pharmacologic agents
Preventing relapse
Following up
What are action responses in coping skills training?
Avoid
Distract
Alternatives
Relaxation
Use of oral substitutes
On the quite date
What are thinking responses of coping skills training?
Positive thinking
Delay - decide later
Rewards - pride
True or False: clients are encouraged to tell family, friends, and co-workers when trying to quit.
True
How long does nicotine withdrawl last?
2-4 weeks
How long does the tobacco temptation last?
Years
What is a good tip for relapse prevention?
Clients should identify 3 tough situations in which they will be tempted to smoke and plan ways to remain tobacco free.
What are the two basic methods or quitting tobacco use?
Cold turkey
Gradual nicotine reduction
What are nicotine replacement therapy options?
Patch
Gum
Lozenges
Oral inhaler
Combination
What does nonmaleficence mean?
Do no harm
What is the goal when it comes to caries detection?
By enhancing caries detection skills demineralization and caries can b detected at the earliest possible stage.
What is important to remember when using technologies to detect caries?
Evidenced research must support the claims they are making
The clinican must understand the underlying principles
Be aware of drawbacks
What is fibre optic transillumination?
A caries detection method
What is laser fluorescence (ex. DIAGNOdent)?
A caries detection method that measures laser fluorescence within the tooth structure.
What will laser flourescence show on a healthy tooth?
No fluorescence will pass through
How will demineralized tooth stucture appear from laser fluorescence?
Demineralized tooth structure will allow fluoresence to pass through
How does a laser florescence unit like DIAGNOdent work?
The unit measures the fluorescence and sends it to a small countertop unit that emits an audio signal, registers a digital read-out and identifies cavities developing below the surface.
What is a drawback to DIAGNOdent?
Increased incidence of false positives
How does an electrical caries monitor (ex. CarieScan) work?
Low voltage current detects change in mineral density of occlusal surface
What are the drawbacks of electrical caries monitor like CarieScan?
Results showed low ability to disclose occlusal caries in non-cavitated lesions
Time consuming
How does laser based (eg. Canary System) caries detection system work?
It analyzes and measures the crystallin structures of a tooth within a depth of 5mm on all tooth surfaces.
What class of laser is Itero?
Class I
What type of technology is Itero?
Near-infrared imaging (NIRI) technology
What is PSR?
Method of screening clients for periodontal disease
What is the measurement from the ball tip of the PSR probe?
0.5mm
Where is a PSR probe colour coded?
3.5mm to 5.5mm
What does PSR stand for?
Periodontal Screening and Recording
What is the goal of PSR?
To screen clients to decide if a more comprehensive assessment is necessary
Is PSR a replacement for full-mouth-periodontal evaluation?
No
What are the 6 sextants?
1: 18-14
2: 13-23
3: 24-28
4: 38-34
5: 33-43
6: 44-48
How to use a PSR probe?
Walk the probe around each tooth
Record the highest score for each sextant
How many numbers are assigned per quadrant?
One
What is the measurement of a PSR probe recording called?
A Code Number
What is a PSR Code 0?
Coloured area of probe remains visible
No calculus, bleeding or defective margins
Gingival tissues are healthy
What is a PSR Code 1?
Coloured area of probe is visible
No calculus or defective margins
There is BOP
What is a PSR Code 2?
Coloured area of probe is visible
Supra or subgingival calculus
and/or
Defective margins
Whare is a PSR Code 3?
Coloured area of probe remains partly visible
What is a PSR Code 4?
Coloured area of probe disappears completely
What does the * symbol mean next to a PSR Code?
Abnormal findings such as:
Furcation involvement
Mobility
Mucogingival problems
Recession extending to the coloured area of probe
What are the treatment recommendations for PSR Code 0?
Appropriate preventative care
What are the treatment recommendations for PSR Code 1?
OHI
Hygiene therapy including subgingival plaque removal
What are the treatment recommendations for PSR Code 2?
OHI
Treatment including subgingival plaque removal, calculus removal, corrections of overhangs and defective restoration margins
What is the recommended treatment for PSR Code 3?
Comprehensive periodontal assessment
What is the recommended treatment for PSR Code 3?
Comprehensive periodontal assessment
What are the benefits of PSR?
Early detection
Fast method to screen client at each appointment
Simple to complete and communicate results to the clients-pictures
Documentation is easy, only six scores recorded
Risk management - legal and ethically should be probing each client
What are the limitations of PSR?
Screening system only
Not complete baseline data collection
What is Premier’s “PerioWise” Screening Report?
Another periodontal screening program
What are the options of the PerioWise screening report?
Health
Gingivitis
Periodontitis
How is the mouth divided and recorded in the PerioWise screening report?
By sextant
What should be done with the PerioWise screening report?
It should be reviewed with the client and then given to them
What is one of the best tools to get clients engaged emotionally with their oral health?
The intraoral camera
What are the benefits of an intraoral camera?
Insurance Billing
Store pictures in client charts
Referrals
What is one of the most important uses of the intraoral camera by dental hygienists?
Educating clients about periodontal disease
What is the criteria ( other than intaoral) to consider when advocating for the prescription of radiography?
Date of last dental care and radiographs
Type of last radiographs
OH
Chief Complaint/Concern
Nutrition survery
What intraoral criteria should be considered when advocating for the prescription of radiographs?
Decalcification
Probing depths
History of decay/restorations
Xerostomia
Impacted or partially erupted teeth
What is radiographic intepretation?
An explanation of what is viewed on a radiograph
What is radiographic diagnosis?
The identification of disease by examination or analysis
Why is client education about the value of radiographs in dentistry critical?
Clients must be able to make evidence informed decisions to provide information consent or understand the ramifications, risks, and potential outcomes if radiographs are denied.
What are the arrows pointing to?
Cortical bone
What is the arrow pointing to?
Cancelleous bone
Label 1
Incisive foramen
Label 2
Median palatal suture
What are the arrows pointing to?
Incisive foramen
What are the arrows pointing to?
Median palatine suture
What are the arrows pointing to?
Nasal septum
What are the arrows pointing to?
Anterior nasal spine
What are the arrows pointing to?
Inverted Y
What are the arrows pointing to?
Zygoma
What are the arrows pointing to?
Zygomatic process
What are the arrows pointing to?
Max Sinus
What are the arrows pointing to?
Septa within the max sinus
What is in the circle?
Genial tubercles
What is the arrow pointing to?
Mental foramen
What are the arrows pointing to?
Border of the mandibular canal
What are the arrows pointing to?
Hamulus
What are the arrows pointing to?
Myloguoid ridge or interal oblique ridge
What are the arrows pointing to?
External oblique ridge
Label A
Enamel
Label B
Dentin
Label C
DEJ
What is the arrow pointing to?
Broken scaler tip
Explain uniocular
One compartment
Explain Multiocular
Multiple compartments
Explain coricated
White defined border line
Explain non-corticated
No border
Explain moth eaten
A pattern that appears like moth-eaten clothing
Explain multifocal
Multiple radiolucent spots
Explain widened PDL
Widened black border of the tooth
Explain focal opacity
Well defined radiopaque lesion
Explain target lesion
Localized radiopaque lesion with surrounding black border
Explain multifocal confluent radiopacities
Multiple radiopactiies that overlap/flow together
Irregular radiopaque lesion
Poorly defined white pattern
(Very rare)
Explain ground glass radiopacity
Pebble like or orangepeel like look of black lesion with white spots
Explain mixed lucent opaque lesion
Has both radiopaque and lucent compartments. A radiolucent area with opaque flakes.
What could an irregular radiopaque lesion represent?
A malignant condition
What descriptions need to be documented of a lesion found on a radiograph?
Appearance
Location
Size
