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DH Theory 1 > TEST 5 > Flashcards

TEST 5 Flashcards

1
Q

what is assessed during the oral hygiene assessment

A

dental biofilm, calculus, and stain

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2
Q

define oral hygiene

A

the degree to which the oral cavity is kept clean and free of soft and hard deposits

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3
Q

during the clinical exam, examine teeth and tissues for: (4)

A
  1. amount of hard and soft tooth deposits
  2. oral hygiene status
  3. oral self care effectiveness
  4. motivation related to oral self care
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4
Q

ACQUIRED ENAMEL PELLICLE

  1. description
  2. derivation
  3. removal method
A
  1. translucent, homogeneous, thin, structured film covering and adherent to the surfaces of the teeth, restorations, calculus, and other surfaces
    • supragingival: saliva, oral mucosa, microorganisms
    • subgingival: gingival crevicular fluid
  3. toothbrush and appropriate interdental aid such as floss
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5
Q

ACQUIRED DENTIN PELLICLE

  1. description
  2. derivation
  3. removal method
A
  1. translucent, two-layer structure, adheres to exposed dentin and restorative materials
  2. saliva, gingival crevicular fluid, and dentinal fluid
  3. toothbrush and appropriate interdental aid like floss
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6
Q

MICROBIAL (bacterial) BIOFILM NONMINERALIZED

  1. description
  2. derivation
  3. removal method
A
  1. dense, organized bacterial communities embedded in EPS matrix adheres tenaciously to the teeth, calculus, prostheses, and other surfaces in the oral cavity
  2. colonization of oral microorganisms
  3. toothbrush and appropriate interdental aid such as floss
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7
Q

MATERIA ALBA NONMINERALIZED

  1. description
  2. derivation
  3. removal method
A
  1. loosely adherent, unstructured, white or grayish-white mass of oral debris and bacteria that lies over dental biofilm
  2. incidental accumulation
  3. vigorous rinsing and water irrigation can remove materia alba
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8
Q

FOOD DEBRIS NONMINERALIZED

  1. description
  2. derivation
  3. removal method
A
  1. unstructured, loosely attached particulate matter
  2. food retention following eating
    • self cleaning activity of tongue and saliva
    • rinsing vigorously removes debris
    • toothbrushing, flossing, and other aids
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9
Q

CALCULUS MINERALIZED

  1. description
  2. derivation
  3. removal method
A
  1. calcified dental biofilm; hard, tenacious mass that forms on the clinical crowns of the natural teeth and on dentures and other oral appliances
  2. biofilm MINERALIZATION
  3. see further subtypes
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10
Q

CALCULUS MINERALIZED (SUPRAGINGIVAL)

  1. description
  2. derivation
  3. removal method
A
  1. occurs coronal to the margin of the gingiva, is covered with dental biofilm
  2. source of minerals is saliva
    • manual instrumentation
    • ultrasonic instrumentation
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11
Q

ACQUIRED PELLICLE

Interface between the _________ and the _________

thin, _________, ___________ film

Forms over__________, existing ________, _________ and _________

Composition:
- primarily __________
- derived from the _____, _________ cells, microorganisms, and _______________

A

Interface between the TOOTH SURFACES and the ORAL ENVIRONMENT

thin, ACELLULAR NONMINERALIZED film

Forms over EXPOSED TOOTH SURFACES, existing CALCULUS DEPOSITS, RESTORATIONS and PROTHESES

Composition:
- primarily GLYCOPROTEINS
- derived from the SALIVA, ORAL MUCOSA cells, microorganisms, and GINGIVAL CREVICULAR FLUID

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12
Q

acquired enamel pellicle

  1. clear, transparent and _______ until a _________ has been applied
  2. pellicle can take on _________ and become gradations of ______, __________, or other colors
  3. when stained with a _______, pellicle appears _____, with a ________ that contrasts with the thicker, darker staining of _________
A
  1. clear, transparent and NOT READILY VISIBLE until a DISCLOSING AGENT has been applied
  2. pellicle can take on EXTRINSIC STAINS and become gradations of BROWN, GRAY, or other colors
  3. when stained with a DISCLOSING AGENT, pellicle appears THIN, with a PALE STAINING that contrasts with the thicker, darker staining of DENTAL BIOFILM
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13
Q

acquired dentin pellicle:

occurs on ___________

A

occurs on DENTIN EXPOSED BY RECESSION

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14
Q

FUNCTIONS OF PELLICLE

  1. protective
  2. lubrication
  3. host defense
  4. microbial colonization
A

PROTECTIVE: provides barrier against acids; impacting remineralization and demineralization. May protect against erosion

LUBRICATION: keeps surfaces moist and prevents drying; enhances the efficiency of speech and mastication. May also protect against abrasive damage

HOST DEFENSE: 8% of proteins in the pellicle have antimicrobial functions

MICROBIAL COLONIZATION: pellicle participates in biofilm formation by aiding the adherence of microorganisms

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15
Q

ORAL DEPOSITS: DENTAL BIOFILM

  1. ___________ of microorganisms that are enclosed in an _____________ (EPS); forms a ________ around microcolonies
  2. Known as ______, __________, and __________
  3. Exhibits ________ and ________ properties
  4. Plays a major role in ______ and ________ of ______ and __________; significant in the formation of __________ (mineralized dental biofilm)
A
  1. STRUCTURED COMMUNITY of microorganisms that are enclosed in an EXTRACELLULAR POLYMERIC SUBSTANCE (EPS); forms a SLIME MATRIX/LAYER around microcolonies
  2. Known as MICROBIAL PLAQUE, DENTAL PLAQUE BIOFILM, and BACTERIAL PLAQUE BIOFILM
  3. Exhibits SELF-SUSTAINING and PROTECTIVE properties
  4. Plays a major role in INITIATION and PROGRESSION of DENTAL CARIES and PERIODONTAL DISEASES; significant in the formation of DENTAL CALCULUS (mineralized dental biofilm)
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16
Q

EPS SLIME MATRIX/LAYER (of dental biofilm)

  • composed of ________, ________, and other compounds
  • _______ biofilm from _________ and ___________
A
  • composed of POLYSACCHARIDES, PROTEINS, and other compounds
  • PROTECTS biofilm from HOST’S IMMUNE SYSTEM and ANTIMICROBIAL AGENTS
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17
Q

what are the stages of biofilm formation

A
  1. pellicle formation
  2. initial adhesion/colonization
  3. maturation
  4. detachment and disperation
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18
Q

describe the stages

  1. pellicle formation
  2. initial adhesion/colonization
  3. maturation
  4. detachment and dispersion
A

PELLICLE FORMATION: formation of a pellicle

INITIAL ADHESION/COLONIZATION:
- attachment of planktonic bacterial cells to the pellicle
- creation of layers of immobile colonies
- EPS slime layer forms:
- stickiness facilitates microbial adhesion
- limits antibiotic therapy/host immune response
- water insoluble

MATURATION:
- later colonizing bacteria attaches
- cell-to-cell communication
- mass/thickness increase

DETACHMENT AND DISPERSION:
- bacteria detaches to relocate and form new biofilm colonies in other areas of the mouth

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19
Q

BIOFILM FORMATION TIME FRAME

days 1-2
- _____ biofilm consists primarily of ________

days 2-4
- ______ dominate while increasing numbers of ________ form and slender rods join the surface of the ________ along with more ___________
- gradually, cocci adhere to _________ in a ________ appearance
- dental biofilm is said to have matured by _____ and is capable of _________

days 5-10
- filaments _______ in number and ________ appears comprised of ____, ________, and _________ with heavy accumulation of _______
- __________ bacteria present

days 10-21
- ________ clinically evident

A

days 1-2
- EARLY biofilm consists primarily of GRAM-POSITIVE AEROBIC COCCI

days 2-4
- COCCI dominate while increasing numbers of GRAM-POSITIVE FILAMENTOUS form and slender rods join the surface of the COCCI COLONIES along with more LEUKOCYTES
- gradually, cocci adhere to FILAMENTOUS BACTERIA in a “CORN COB” appearance
- dental biofilm is said to have matured by 72 HOURS and is capable of INITIATING THE INFLAMMATORY PROCESS

days 5-10
- filaments INCREASE in number and MIXED FLORA appears comprised of RODS, FILAMENTOUS FORMS, and FUSOBACTERIA with heavy accumulation of LEUKOCYTES
- GRAM-NEGATIVE ANAEROBIC bacteria present

days 10-21
- GINGIVITIES clinically evident

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20
Q
  1. a freshly cleaned tooth surface immediately develops a thin layer of salivary glycoproteins (the acquired pellicle)
  2. fibers of proteins, antibodies, salivary enzymes, bacterial debris, and other salivary molecules adhere to the pellicle
  3. the earliest tooth colonizers are the streptococcus mutans group (s oralis and s gordoni). these bacteria have specific receptors that adhere to the outer pellicle molecules. the streptococci likewise bind to each other, forming the initial base of plaque.
  4. the next phase involves cell-cell signaling and coaggreation with additional colonists. the most common bacteria to add to the biofilm during this phase are filamentous rods in the genus actinomyces. other species of streptococcus use dietary carbohydrates to secrete glucans that add bulk to the matrix and serve as a source of sugars
  5. once this initial framework has been laid down, it enters a second phase of aggregation which creates the final dense mat of plaque. Bacteria that colonize at this point are frequently anaerobes such as fusobacterium, porphyromonas, prevotella, vellonella, and treponoma
  6. see upper left, initial damage to the enamel occurs when streptococci near the enamel surface ferment the sugars in plaque to lactic, acetic, and other acids. when these acids are trapped against the tooth surface and etch through it, a dental caries has developed
A

…

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21
Q

CHANGES IN MICROBIOFILM

The formation and destructive nature of oral biofilm highlights the need for its _________ by _________

The longer the oral biofilm remains undisturbed, the greater its _____________

Can lead to _____, ______, and eventually _______

The host’s _________ is activated and eventually ________, causing __________ destruction in periodontitis

A

The formation and destructive nature of oral biofilm highlights the need for its DAILY REMOVAL by MECHANICAL MEANS

The longer the oral biofilm remains undisturbed, the greater its PATHOGENIC OR DISEASE-PRODUCING POTENTIAL FOR THE HOST

Can lead to CARIES, GINGIVITIS, and eventually PERIODONTITIS

The host’s IMMUNE SYSTEM is activated and eventually OVERRESPONDS, causing TISSUE AND BONE destruction in periodontitis

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22
Q

CHANGES IN BIOFILM MICROOGANISMS

  • -
A

Bacteria associated with periodontitis are predominantly ANEROBIC, GRAM-NEGATIVE, and include (but not limited to):

  • PORPHYROMONAS GINGIVALIS
  • TANNERELLA FORSYTHIA
  • PREVOTELLA INTERMEDIA
  • AGGREGATIBACTER ACTINOMYCETEMCOMITANS
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23
Q

ASSESSMENT TOOLS REQUIRED

A
  • light
  • compressed air
  • mouth mirror
  • periodontal explorer
  • gauze
  • disclosing solution
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24
Q

CLINICAL ASSESSMENT OF ORAL BIOFILM

the presence of oral biofilm is most commonly assessed by __________ over the _________

_________ are used to make the oral biofilm _______

A

the presence of oral biofilm is most commonly assessed by PASSING A DENTAL EXPLORER over the TOOTH SURFACE

DISCLOSING AGENTS are used to make the oral biofilm CLINICALLY VISIBLE

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25
Q

USE OF DISCLOSING SOLUTION

describe the tones and color

A

2 tone: (what we use in clinic)
- red/pink: new plaque
- blue: old plaque

1 color: (trace)
- dyes all plaque pink

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26
Q

MATERIA ALBA

  • ____, ____ tooth deposit
  • ______ without ______
  • unorganized accumulation of ________, ________,_________, _________, _________
  • removed with ______, ________, or _______
A
  • SOFT, WHITISH tooth deposit
  • CLINICALLY VISIBLE without APPLICATION OF DISCLOSING AGENT
  • unorganized accumulation of LIVING AND DEAD BACTERIA, DESQUAMATED EPITHELIAL CELLS, DISINEGRATING LEUKOCYTES, SALIVARY PROTEINS, AND FOOD DEBRIS
  • removed with WATER SPRAY, ORAL IRRIGATOR, OR TONGUE ACTION
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27
Q

FOOD DEBRIS

  • food remnants may collect around the _________ and _____ of teeth
  • define food impaction
  • if left unattended:
A
  • food remnants may collect around the CERVICAL 1/3 and PROXIMAL EMBRASURES of teeth
  • FOOD FORCED INTO OPEN CONTACT AREAS DURING MASTICATION
  • left unattended: the accumulation of food debris adds to the GENERAL UNSANITARY condition of the mouth and can contribute to INITIATION OF DENTAL CARIES and oral MALODOR
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28
Q

DENTAL CALCULUS

Dental calculus (____) is oral biofilm that has been mineralized by _______ and _______

can be ______ or _________

A

Dental calculus (TARTAR) is oral biofilm that has been mineralized by CALCIUM and PHOSPHATE SALTS FROM SALIVA

can be SUPRAGINGIVAL or SUBGINGIVAL

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29
Q

what is the difference between supragingival and subgingival calculus

A

supra
- calculus coronal to the free gingival margin

sub
- calculus apical to the FGM, often on the root surface

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30
Q

what are the 3 basic steps of calculus formation

A

pellicle formation, biofilm formation, mineralization

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31
Q

CALCULUS FORMATION

  • approximately ____ are typically required for oral biofilm to become ________, though mineralization starts in _______
  • __________ formers have higher _________ of ______ and ________ than light calculus formers
A
  • approximately 10-20 DAYS are typically required for oral biofilm to become FULLY MINERALIZED CALCULUS DEPOSITS, though mineralization starts in 24-48 HOURS
  • HEAVY CALCULUS formers have higher SALIVA CONCENTRATIONS of CALCIUM and PHOSPHATE than light calculus formers
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32
Q

what are the sources of minerals for supra or subgingival calc

A

supragingival: saliva

subgingival: gingival crevicular fluid and inflammatory exudate

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33
Q

CONCEPTS FOR ORAL HYGIENE ASSESSMENT

_____ and _____ dental deposits are assessed:

  1. ______
  2. ______
  3. ______
A

SOFT and HARD dental deposits are assessed:

  1. LOCATION: supragivial/subgingival
  2. AMOUNT: slight, moderate, heavy
  3. EXTENT AND DISTRIBUTION
    - Generalized (more than 30% of dentition)
    - Localized (less than 30%)
    - If localized, must include where it is localized to
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34
Q

CALCULUS PREVENTION

  • _______ related to calculus formation are similar to those for ______ and relate to the ______
  • two ways that prevent calculus
  • anti-calculus toothpaste and mouthrinse may contain: (3)
  • select the appropriate method for _____. Identify/do _____ with the patient. ______ during recare. Identify ______ behaviors
A

CALCULUS PREVENTION

  • RISK FACTORS related to calculus formation are similar to those for DENTAL BIOFILM FORMATION and relate to the PATIENTS DAILY BIOFILM REMOVAL REGIMEN
  • effective daily biofilm removal and regular professional continuing care
  • anti-calculus toothpaste and mouthrinse may contain PYROPHOSPHATES, ZINC, AND SODIUM HEXAMETAPHOSPHATE
  • select the appropriate method for REMOVAL. Identify/do HANDS-ON DEMO with the patient. FOLLOW UP during recare. Identify DIETARY behaviors
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35
Q

TOOTH STAINS

Tooth stains are ________
that contrast with the _______

Adhere _______ on tooth surface, contained
__________ and _________, or
incorporated within the ________ or ________

A

Tooth stains are DISCOLORED AREAS ON THE TEETH that contrast with the COLOR OF THE REST OF THE TOOTH

Adhere DIRECTLY on tooth surface, contained
WITHIN CALCULUS and SOFT DEPOSITS, or
incorporated within the TOOTH STRUCTURE or RESTORATIVE MATERIAL

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36
Q

EXTRINSIC STAINS

  • occur on the _________
  • can usually _________ with _________, _______, or _______
A
  • occur on the EXTERNAL TOOTH SURFACE
  • can usually BE REMOVED with TOOTHBRUSHING, CORONAL POLISHING, OR SCALING
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37
Q

INTRINSIC STAINS

  • occur ______
  • cannot__________
  • improved by _______
A
  • occur WITHIN THE TOOTH
  • cannot BE REMOVED BY SCALING OR POLISHING
  • improved by USING WHITENING AGENTS
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38
Q

CLASSIFYING STAIN

Endogenous
vs
exogenous

A

ENDOGENOUS
- originate form WITHIN the tooth
- ALWAYS intrinsic
- dentin discoloration through the enamel

EXOGENOUS
- originate from sources OUTSIDE the tooth
- may be extrinsic or intrinsic

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39
Q

SKILL, MOTIVATION, AND COMPLIANCE

the clients _________ must be assessed through the following means

questioning the client about _______

______ the clients _______

A

the clients ABILITY TO MANAGE ORAL SELF CARE must be assessed through the following means

questioning the client about THIER ORAL SELF CARE

RECORD the clients ORAL HYGIENE STATUS

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40
Q

ORAL HYIGENE INDICES

oral hygiene indices measure the _____

what 4 things does it accomplish

A

oral hygiene indices measure the CLIENTS LEVEL OF ORAL HYGIENE

to accomplish
- establish a baseline for an individual
- survey the oral hygiene status within a population
- establish a baseline for a target population
- evaluate an intervention, drug, or device

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41
Q

RECORD KEEPING AND DOCUMENTATION

  • maintaining a ______ is an important part of the assessment
  • document the _____ and the _______
  • compare the ____________
A

maintaining a RECORD OF A CLIENTS ORAL HYIGENE STATUS is an important part of the assessment

document the ORAL HYGIENE PRODUCTS USED and the PREVIOUS INSTRUCTION GIVEN

compare THE CLIENTS CURRENT AND PREVIOUS PLAQUE SCORES

42
Q

DOCUMENTING IN AXIUM

A

In axiU, document:
- located (generalized/localized) and degree (slight, moderate, or heavy)

EX: Gen/slight

43
Q

ADPIED

A

assessment: data collection

*diagnose: identify problems based on assessment data

planning: select, prioritize, and sequence dental hygiene interventions

implementation: activating the plan

evaluation: feedback on effectiveness

documentation: comprehensive record-keeping

44
Q

DENTAL HYGIENE DIAGNOSIS

identification of a ____, ______, or _______ based on ________ and its _______

A

identification of a CONDITION, PROBLEM, or SITUATION based on THE ANALYSIS OF ITS CAUSE and its DEFINING CHARACTERISTICS

45
Q

what are the defining characteristics of a dental hygiene diagnosis

A
  1. focuses on CLIENT conditions, behaviors, or risk factors related to oral health and disease
  2. is derived from client data (collected during assessment)
  3. requires interventions within the scope of dental hygiene practice
  4. is necessary for planning and implementing effective care and evaluation outcomes
46
Q

making a dental hygiene diagnosis includes identifying the following:

A
  1. UNMET HUMAN NEEDS that can be met through dental hygiene care
  2. factors CONTRIBUTING TO OR CAUSING the unmet human needs (causes and risk factors)
  3. EVIDENCE to support the dental hygiene diagnosis (signs and symptoms)
47
Q

DENTAL HYGIENE DIAGNOSIS VS DENTAL DIAGNOSIS (dental)

A

dental:
- identifies a specific oral disease
- identifies conditions or problems for which the dentist directs the primary treatment
- often deals with the actual pathophysiologic changes
- remains the same for as long as the disease is present

48
Q

DENTAL HYGIENE DIAGNOSIS VS DENTAL DIAGNOSIS (hygiene)

A
  • identifies unmet human need
  • identifies conditions or problems within the scope of dental hygiene
  • often deals with the clients perceptions, beliefs, attitudes, and motivations regarding his or her own oral status
  • may change as the clients responses and behaviors change
49
Q

A ___________ and _______ are indicated
if a client displays signs and symptoms of an
_________ that requires _______ and
__________ by the dentist

A __________ and _________ are
indicated if a client displays signs and
symptoms of __________ that require
_________ and __________ by a physician

A

A DENTAL CONSULTATION and REFERRAL are indicated if a client displays signs and symptoms of an ORAL DISEASE that requires DIAGNOSIS and TREATMENT by the DENTIST

A MEDICAL CONSULTATOIN and REFERRAL are
indicated if a client displays signs and
symptoms of SYSTEMIC CONDITIONS that require DIAGNOSIS and TREATMENT by a PHYSCIAN

50
Q

a classification of _____ creates a standardized language for identifying client oral health conditions

classification uses ____ that focus on ______

A

a classification of EIGHT POSSIBLE DIAGNOSES (EIGHT HUMAN NEEDS) creates a standardized language for identifying client oral health conditions

classification uses DESCRIPTORS that focus on THE CLIENTS HUMANS NEEDS

51
Q

what are the 8 human needs

A
  1. protection from health risks
  2. freedom from fear and stress
  3. freedom from head and neck pain
  4. wholesome facial image
  5. skin and mucous membrane integrity of the head and neck
  6. biologically sound and functional dentition
  7. conceptualization and problem solving
  8. responsibility for oral health
52
Q

what is the protection of health risks human need

what are indications that the patients need for protection from health risks are unmet

A
  • patient needs to be in a state of good general
    health

Patient has uncontrolled disease
- High blood pressure
- Diabetes HbA1c of 8 or greater
Lifestyle practices that place patient at risk
- Smoker
- Inconsistent use of athletic mouth guard

53
Q

what is freedom from fear and stress

what are the indications that this is not met

A
  • Patient needs to feel safe and free from
    emotional discomfort in the oral healthcare
    environment
  • patient states they are afraid of needles
  • previous negative experiences
  • signs of stress
54
Q

what is freedom from pain

what are indications that it is unmet

A
  • patient needs to be exempt from physical discomfort in the head and neck area

Patient self reports pain
- sensitivity
- tooth ache
Signs of discomfort
- wincing or squinting of the eyes

55
Q

what is wholesome facial image

how do we determine this

what are indication that this need is unmet

A
  • patient needs to feel satisfied with ones own oral-facial features and breath
  • ask the patient: “Are you satisfied with your teeth and mouth?”
  • patient expresses dissatisfaction with tooth stain, calculus, receding gums, discolored restoration, tooth loss, misaligned teeth, disfigurement from facial trauma
56
Q

what is skin and mucous membrane integrity

what are indications this need is unmet

A

MOST COMMON

patient need for an intact and functioning covering of the persons head and neck area including the periodontium

extraoral and intraoral lesions
tenderness and swelling
periodontal bleeding
bleeding
nutritional deficiency manifestation

57
Q

what is a biologically sound and functional dentition

what are the indications this need is unmet

A

patient need for intact teeth and/or protheses and restorations

suspected caries
defective restorations
fractured tooth
missing teeth

58
Q

conceptualization and problem solving

indications this need is unmet

A

patient need to understand ideas in order to make sound judgments of ones oral health

patient has misconceptions or a lack of knowledge about oral healthcare interventions, cause of an oral problem, or relationship to overall health
- patient does not understand caries process
- patient refuses flouride
- patient does not understand how periodontal disease works

59
Q

what is responsibility for oral health

what are indications this need is unmet

A

patient needs for accountability for ones oral health

  • inadequate oral self care
  • lengthy periods of time in between oral exams
  • statements like: “my mother had bad teeth so I always had bad teeth.”
60
Q

USING STANDARDS TO VALIDATE DIAGNOSIS

To arrive at a valid __________,
compare data (______or _____) with an ________

Changes in a client’s usual oral or systemic health patterns that are unexplained by expected ___________, _________, and __________

Oral and systemic health status that ________

_______ or _________ that indicates a risk to _______ or _______

A

To arrive at a valid DENTAL HYGIENE DIAGNOSIS, compare data (ASSESSMENT OR PATIENT RECORD) with an ACCEPTED STANDARD

Changes in a client’s usual oral or systemic health patterns that are unexplained by EXPECTED NORMS FOR GROWTH, DEVELOPMENT, AND MATURATION

Oral and systemic health status that DEVIATES FROM NORMAL LIMITES

BEHAVIOR or CONDITION that indicates a risk to HEALTH or PERSONAL SAFETY

61
Q

RECOGNIZING PATTERNS

Dental hygiene diagnoses should always be based on __________ rather than ________

Gathering ________ to support a _________ prevents the __________

A

Dental hygiene diagnoses should always be based on A CLUSTER OF SIGNIFICANT INFORMATION rather than A SINGLE SIGN OR SYMPTOM

Gathering COMPLETE DATA to support a RECOGNIZABLE PATTERN prevents the FORMULATION OF AN INCORRECT DIAGNOSIS

62
Q

IDENTIFYING UNMET HUMAN NEEDS

__________ determines whether the
identified condition requires a ________, _________, or a __________

Clients may also indicate that they are ____
for ______ an unmet human need

Dental hygiene diagnoses have __________

A

CRITICAL THINKING determines whether the
identified condition requires a DENTAL DIAGNOSIS, DENTAL HYGIENE DIAGNOSIS, or a MEDICAL DIAGNOSIS

Clients may also indicate that they are AT RISK
for DEVELOPING an unmet human need

Dental hygiene diagnoses have IMPLICATIONS FOR PLANNING INTERVENTIONS

63
Q

FORMULATING AND VALIDATING DENTAL HYGIENE DIAGNOSES

writing a diagnostic statement should include what 3 components

A
  1. unmet human need (deficit)
  2. cause (due to)
  3. evidence (signs and symptoms)
64
Q

a diagnostic statement should be accompanied by noting what 3 things

A
  1. factors that led to the condition or potential problem
  2. objective signs observed by the hygienist
  3. subjective symptoms reported by the client
65
Q

what are 4 common errors while writing a diagnostic statement

A
  1. using EMOTIONAL terms
  2. including a DENTAL or MEDICAL diagnosis (not within our scope of practice)
  3. presenting the CAUSE as the DIAGNOSIS
  4. presenting signs and symptoms as the diagnosis rather than in terms of the clients UNMET NEEDS
66
Q

What questions should you ask yourself (and answer yes to) to ensure that your statement is of diagnostic quality

A
  1. is the database complete, accurate, and based on scope of dental hygiene
  2. does the data reflect the existence of a pattern
  3. does it include both subjective and objective data that supports the existence of the unmet human need identified in the dental hygiene diagnosis
  4. is the diagnosis based on scientific knowledge and evidence
  5. can the dental hygiene diagnosis be prevented, controlled, or resolved by DENTAL HYGIENE interventions
  6. given the same data, would other qualified practitioners formulate the same dental hygiene diagnosis
67
Q

is this a good or poor statement, correct it if it is poor

generalized gingival bleeding and attachment loss of 5-8 mm.

A

POOR

Unmet need for skin and mucous membrane integrity due to periodontitis, as evidenced by generalized bleeding and clinical attachment loss of 5-8 mm.

68
Q

is this a good or poor statement, correct it if it is poor

Inadequate self-care related to laziness.

A

POOR

Unmet need for responsibility for oral health due to lack of adherence to oral self-care regimen, as evidenced by heavy biofilm accumulation and patient reports.

69
Q

correct this statement

cigarette smoking

A

Unmet need in protection from health risks due to cigarette smoking, as evidenced by patient reports.

70
Q

OUTCOMES OF DENTAL HYGIENE DIAGNOSES

Facilitates _________ by focusing on _______

Patient needs are more _______ which supports _______ and __________

Since dental hygiene diagnoses are based on ________, communication among _________ is enhanced

Provide a measurement of _______, which has several implications: _________, ________, ________, etc.

A

Facilitates PROFESSIONAL AUTONOMY by focusing on DH SCOPE OF PRACTICE

Patient needs are more ACCURATELY COMMUNICATED which supports TREATMENT and APPROPRIATE REFERRALS

Since dental hygiene diagnoses are based on DIAGNOSTIC CLASSIFICATION SYSTEM, communication among ORAL HEALTH PROFESSIONALS is enhanced

Provide a measurement of CLINICAL OUTCOMES, which has several implications: PATIENT EDUCATION, RESEARCH, PROFESSIONAL ACCOUNTABILITY, etc.

71
Q

PLANNING

The purpose of the planning phase is to __________ that will result in ____________, the __________, or the __________

Phase of the process of care in which __________ are prioritized, __________ are established, and _________ are determined

A

The purpose of the planning phase is to DEVELOP A PLAN OF CARE that will result in THE RESOLUTION OF AN ORAL HEALTH PROBLEM, the PREVENTION OF A PROBLEM, or the PROMOTION OF ORAL AND GENERAL HEALTH

Phase of the process of care in which DIAGNOSED CLIENT NEEDS are prioritized, CLIENT GOALS AND EVALUATIVE MEAURES are established, and INTERVENTION STRATEGIES are determined

72
Q

PLANNING PHASE OF THE DENTAL HYGIENE PROCESS OF CARE

The term _______ rather than
________ is intentional

Denotes broad range of ________,
_________, _________ and _______ that are within the scope of dental hygiene practice

A

The term CARE PLAN rather than TREATMENT PLAN is intentional

Denotes the BROAD range of PREVENETIVE, EDUCATIONAL, THERAPEUTIC, and SUPPORT SERVICES that are within the scope of dental hygiene practice

73
Q

PLANNING

the ________ and ________ both discuss _______, _________, and __________ for goal attainment.

  3. 4.
A

the DENTAL HYGINEST and CLIENT both discuss CLIENT GOALS, PRIORITIES, and INTERVENTIONS for goal attainment.

  1. set goals and evaluate measures
  2. identify interventions
  3. establish priorities
  4. write a care plan
74
Q

what are the component of a dental treatment plan (4)

A
  1. dental diagnosis
  2. all essential phases of therapy to be carried out by the dentist, the dental hygienist, and the client to eliminate or control disease and to promote health
  3. prognosis
  4. the dental hygiene care plan supports the overall dental treatment plan
75
Q

what is the SEQUENCE of DH care plan development (5)

A
  1. link the DH care plan to the dental hygiene diagnosis
  2. establish priorities
  3. set goals
  4. select evidence based interventions
  5. establish an appointment schedule
76
Q

ESTABLISHING PRIORITIES

Priorities are based on the degree the DH diagnosis:

  • Threatens the _______
  • Poses the greatest threat to _____, _______, and ________
  • Can be addressed _________ with other diagnoses
  • Is a client priority (__________)
  • Protection from ________ - may require _______
  • Responsibility for __________ is a ______ priority
  • ________ is a priority
A

Priorities are based on the degree the DH diagnosis:

  • Threatens the CLIENTS WELL BEING
  • Poses the greatest threat to THE PATIENTS SAFETY, HEALTH, and COMFORT
  • Can be addressed SIMULTANEOUSLY with other diagnoses
  • Is a client priority (CHIEF COMPLAINT)
  • Protection from HEALTH RISKS - may require PRELIMINARY EMERGENCY CARE
  • Responsibility for ORAL HEALTH is a PRIMARY priority
  • ORAL DISEASE is a priority
77
Q

factors that influence how priorities are established include (5)

A
  1. The VALUES, BELIEFS, and ATTITUDES of the client
  2. The philosophy of the HEALTHCARE PROVIDER
  3. The goals of the COLLABORATING DENTIST
  4. The HEALTH STATUS of the client
  5. Whether the client is experiencing INFECTION, DISCOMFORT, ANXIETY, or PAIN
78
Q

SETTING GOALS

  1. what is a client centered goal
  2. what is a cognitive goal
  3. what is a psychomotor goal
  4. what is an affective goal
  5. what is an oral health status goal
A

CLIENT CENTERED GOAL: the desired outcome the client aims to achieve through specific dental hygiene intervention strategies to satisfy an unmet human need related to DH care

COGNITIVE GOALS: target an increase the client’s knowledge and understanding

PSYCHOMOTOR GOALS: target the client’s skill
development and mastery

AFFECTIVE GOALS: involve changing the client’s
values, beliefs, and attitudes

ORAL HEALTH STATUS GOALS: addresses the signs and symptoms of oral disease

79
Q

you will make ________ and _____ goals WITH your patient FOR your patient

what is SMART goals

A

you will make REALISTIC and PERSONAL goals WITH your patient FOR your patient

Specific
Measurable
Attainable
Realistic
Timely

80
Q

what should each client-centered goal have (4)

at least _____ goal should be established for each ______

A
  1. subject: client or the clients caregiver
  2. verb: action to be performed by the client to achieve the desired outcome
  3. a criterion for measurement: observable behavior or tangible outcome
  4. a time dimension for evaluation: when the client is to have achieved the goal

at least ONE goal should be established for each DENTAL HYGIENE DIAGNOSIS

81
Q

give an example of a client centered goal; include a subject, verb, and time

A

COGNITIVE (increase in knowledge and understanding)
1. Client will report using disclosing tablets daily before brushing by appt #3.
2. Client will verbalize the periodontal disease process by appt #2

PSYCHOMOTOR (skill development and mastery)
1. Client will demonstrate the correct use of a floss holder by appt #4.
2. Client will demonstrate correct c-shape flossing by appt #4

AFFECTIVE (desired changes in values/beliefs)
1. Client will verbalize the importance of dental hygiene appointments every 6 months by appt #2.
2. Client will verbalize the benefits of improved oral hygiene by appt #3

ORAL HEALTH STATUS (signs and symptoms or oral disease)
1. Client will eliminate 100% of bleeding on probing by recare.
2. Client will decrease 50% of pocket depths >3mm by 1mm by appt #4.
3. Client will seek DDS evaluation for suspected caries by 1 month

82
Q

INVOLVING THE CLIENT

Client goals are best established by _______ in collaboration with __________

individuals are more likely to express _________ and a __________ if they have a share in the ______, ________, __________

A

Client goals are best established by THE DENTAL HYGIENIST in collaboration with the CLIENT.

individuals are more likely to EXPRESS COMMITMENT TO A CARE PLAN and a WILLINGNESS TO CHANGE if they share in the DEVELOPMENT OF GOALS, PRIORITIES, INTERVENTIONS, AND APPOINTMENT PLANNING

83
Q

SELECTING DH INTERVENTIONS

interventions address the:

A

factors that contribute to the clients human need deficit

84
Q

what factors contribute to an unmet need

A
  • lack of knowledge
  • Lack of protective factors
  • Skill deficit in oral self-care
  • Low value placed on oral health
  • Low self-esteem
  • Inadequate financial resources
  • Culture as a barrier to professional care
  • Presence of other risk factors
85
Q

the APPOINTMENT SCHEDULE is a guide for implementing the PROPOSED INTERVENTIONS

it specifies:

A
  • number of visits
  • time needed for each visit
  • interventions to be implemented at each visit
86
Q

after the interventions have been chosen, they must _________

A

BE PUT INTO ACTION AT THE PLANNED APPOINTMENTS

87
Q

When an appointment schedule is planned, what is to be considered (4)

A
  • time needed for each intervention
  • logic of grouping interrelated procedures
  • status and severity of the clients unmet human needs
  • clients tolerance for long sessions
88
Q

CARE PLAN PRESENTATION

Before presenting the care plan to the client, the dental hygienist __________

When satisfied with the completeness of the dental hygiene care plan, the hygienist _________ and _________

A

Before presenting the care plan to the client, the dental hygienist ASSESSES THE COMPREHENSIVE NATURE OF THE PLAN

When satisfied with the completeness of the dental hygiene care plan, the hygienist DISCUSSES IT WITH THE CLIENT and MAKES MODIFICATIONS TO INCLUDE THE PATIENT

89
Q

the presentation and discussion of the DH care plan should include: (7)

A
  • nature of the condition
  • proposed care plan
  • risks involved
  • potential for failure
  • prognosis if the problem goes untreated
  • expected outcomes
  • alternative treatment options
90
Q

INFORMED CONSENT

involves the ________ or care ____ discussion with the _________ regarding ________ and _________

client must be _______ about what is the healthcare provider plans to do, have __________, and give _________

informed consent should NOT be viewed __________ but rather as ___________ during which the client is _____________ of the terms of care

A

involves the CLIENTS ACCEPTANCE of care AFTER discussion with the HEALTHCARE PROVIDER regarding THE PROPOSED CARE PLAN and THE RISKS OF NOT RECIEVING CARE

client must be KNOWLEDGABLE about what is the healthcare provider plans to do, have ENOUGH INFORMATIN TO MAKE A RATIONAL CHOICE, and give PERMISSION FOR THE PLAN TO BE CARRIED OUT

informed consent should NOT be viewed AS A ONE TIME ACTIVITY but rather as AN ONGOING PROCESS during which the client is CONTINUOUSLY REMINDED AND INFORMED of the terms of care

91
Q

for informed consent, the client must:

A
  • give consent for a specific treatment
  • Give consent for a procedure that is legal
  • Give consent under truthful conditions
  • Be legally competent to give consent for care
92
Q

what is informed refusal

A

a client may decline all or part of the proposed care plan

93
Q

GOAL OF EVALUATION

evaluation is performed to _______ the _________

although it is indicated as the _____ phase of the dental hygiene process, _________ is linked to _________

**GOAL: to _______ the extent to which the ________ the goals defined in the _______

A

evaluation is performed to DOCUMENT the ACHIEVEMENT OF DESIRED THERAPEUTIC OUTCOMES

although it is indicated as the SECOND TO LAST phase of the dental hygiene process, EVALUATION is linked to EVERY PHASE OF CARE

GOAL: to MEASURE the extent to which the PATIENT HAS ACHIEVED the goals defined in the DH CARE PLAN

94
Q

EVALUATION STRATEGIES ARE: (2)

A
  • defined by client centered goals during the planning phase
  • applied during the care implementation phase, at the completion of care, and at continued care visits
95
Q

evaluation is ______ so that the clinician can:

  3. 4.
A

evaluation is ONGOING so that the clinician can

  1. Modify the plan because the client is having
    difficulty with achieving the goal
  2. Modify the plan because the client is not
    ready to achieve the goal
  3. Continue the plan with more time added to
    achieve the goal
  4. Terminate the plan of care because the client has achieved the goal
96
Q

EVALUATION OF CLIENT CENTERED GOALS

evaluation strategies include: (4)

A
  1. asking open ended questions (cognitive goals)
  2. having the client demonstrate the technique (psychomotor)
  3. having the client report a change in bebavior (affective goals)
  4. showing the client clinical improvements (oral health status goals)
97
Q

EVALUATION OF CLIENT CENTERED GOALS

determines whether __________ has achieved the clients _______

evaluation methods should _______, which may reflect ____, ______, _____, or _____ concerns

A

determines whether DENTAL HYGIENE CARE has achieved the clients CLIENTS UNMET HUMAN NEEDS

evaluation methods should REFLECT THE INTENT OF THE GOAL STATEMENT, which may reflect COGNITIVE, PSYCHOMOTOR, AFFECTIVE or ORAL HEALTH STATUS concerns

98
Q

based on findings, the hygienist determines one of the following outcomes:

A
  • goal met
  • goal partially met
  • goal not met
99
Q

MODIFYING OR TERMINATING THE CARE PLAN

Client reassessment identifies ______ that continue to ______ to the client’s ________

If the goal is______ or ________, the hygienist reassesses:
- Client’s ________ as well as the client’s ___, _____, _____
- New findings are then discussed with the ______: may lead to ______, ______, or _______

After it is clear why the client has ________, the evaluative statement can be used to _________

When evaluation determines _______ of client goals and no _________ are identified, the care plan is _______

A

Client reassessment identifies BARRIERS that continue to CONTRIBUTE to the client’s UNMET HUMAN NEEDS

If the goal is PARTIALLY MET or UNMET, the hygienist reassesses:
- Client’s READINESS TO CHANGE as well as the client’s ATTITUDES, BELIEFS, AND PRACTICES
- New findings are then discussed with the DENTIST: may lead to NEW DIAGNOSIS, REVISED GOALS, or ALTERNATIVE INTERVENTIONS

After it is clear why the client has FAILED TO ACHIEVE THEIR GOALS, the evaluative statement can be used to REDIRECT THE CARE PLAN

When evaluation determines SUCCESSFULL ATTAINMENT of client goals and no NEW PROBLEMS are identified, the care plan is TERMINATED

100
Q

OUTCOME AT CONTINUED CARE VISITS:

what are the goals of a continued care visit

A
  1. document evidence that previous care plan has addressed patients needs
  2. identify any reoccurrence of an unmet need
  3. identify any new condition that may be present
  4. formulate a care plan that supports the clients continued needs
101
Q

DOCUMENTATION OF SERVICES RENDERED

Documentation is necessary to _______ during _______ and _______ for _______ maintenance care

__________ in the client record is the ______ against a client’s ___________

A

Documentation is necessary to MONITOR THE CLIENTS HEALTH STATUS during ACTIVE THERAPY and OVER A LIFETIME for REGULAR maintenance care

DOCUMENTATION in the client record is the BEST DEFENSE against a client’s ACCUSATION OF NEGLIGENCE

102
Q

TIPS

  • link the ______ to the _______
  • each goal should have ________
  • each goal must have _______
A
  • link the DENTAL HYGIENE CARE PLAN to the DENTAL HYGIENE DIAGNOSIS
  • each goal should have 4 PARTS
  • each goal must have ITS OWN NUMBER

DH Theory 1 (9 decks)

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