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Your Path to Dental Hygiene Success Begins Here

Hello, I’m Fatimah Datoo, and I’m here to guide you on your journey to success in the field of dental hygiene. With years of experience as a dental hygiene educator, I understand the challenges and aspirations of students like you. Our mission is clear: To make dental hygiene education easy, accessible, effective, and fun

Meet Fatimah Datoo, RDH, BDScDH, MEd., EdD(c)

Hello, I’m Fatimah Datoo , and I’m here to guide you on your journey to success in the field of dental hygiene. With years of experience as a dental hygiene educator, I understand the challenges and aspirations of students like you. Our mission is clear: To make dental hygiene education easy, accessible, effective, and fun.

Master Complex Case Studies

Becoming a proficient dental hygienist means mastering case studies and problem-solving. Our immersive "Dental Hygiene Case Study Sessions" course is your ticket to sharpening your analytical skills, gaining clinical insights, and excelling in solving complex dental hygiene case studies. Join a diverse group of motivated peers and learn from experienced dental hygiene professors

In-Depth Client Case Studies

A key feature of our course is using dental hygiene textbooks that review case studies. The case studies we use offer a thorough health history, radiographs, periodontal assessments, and more that we will examine together to ensure we can best answer the case study questions.

Expert Guidance

Our Dental and Oral Health Case Studies course offers more than just theoretical knowledge; it's a platform for real-world application. Students will collaborate in the classroom in solving these intricate case studies.

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Free Case Study Session!

Unsure about signing up for our Dental Hygiene Made Easy board exam prep courses? Why not give our free case study session a try first and see if our teaching style suits you! During this session, we will thoroughly review a comprehensive case study and provide an opportunity to practice critical thinking skills when answering the questions. Don't miss out on this valuable FREE opportunity! Register now!

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Elevate your dental hygiene board exam skills.

This course is strategically designed to elevate your capabilities in dental hygiene, whether you are approaching graduation or studying for the boards.

1.  In-Depth Curriculum :

Master the critical concepts essential for excelling in the dental hygiene board exams.

2. Hands-On Learning

Engage in practical exercises involving board exam questions and case studies to apply your knowledge effectively.

3. Guided Expertise

Benefit from the tutelage of a seasoned dental hygiene educator committed to your success.

4. Resource-Rich Environment:

By registering for our affordably priced course, you’re taking a crucial step in securing your success in the upcoming Dental Hygiene Board Exam.

Case Study Sessions

This course is strategically designed to elevate your capabilities in dental hygiene, whether you are entering school or approaching graduation.

Affordable Board Exam Practice Online Sessions

Stressing over your Dental Hygiene Board Exam? Stop right there! We offer an incredibly affordable board exam review practice course at just $75 CDN.

Our course offers a thorough examination of key topics, ensuring you’re well-prepared for the Dental Hygiene Board Exam.

2. Engaging Interactive Sessions : 

Benefit from study sessions that are not only informative but also interactive, making the learning process more effective.

3. Extensive Question Practice :

 Get hands-on practice with questions that closely mirror those you’ll encounter on the board exam, giving you a competitive edge.

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Cases for Online Study 2024

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Review With

Dental Anatomy Coloring Book, NEW

4th Edition from Elsevier, 2023

Studies also show that adult coloring is therapeutic, reducing stress similarly to meditation. The gentle and repetitive motion of your hand bringing color to paper helps quiet your mind, bringing your usual rapid-fire thoughts down to a much slower pace while leaving the fast-paced digital world behind.

Each page of the new edition contains a brief statement describing the body part featured and its orientation view, followed by a crisp easy-to-color illustration(s). Numbered leader lines clearly identify the structures to be colored and correspond to a numbered list appearing below the illustration.

This 4th edition fully delivers complete anatomic coverage of the head and neck. Beginning with an overview of body systems, and then moving on to specific regions of the head and neck as well as the oral cavity, the text follows the anatomic systems, including orofacial anatomy, dental anatomy, as well as the skeletal system, the muscular system, the vascular system, the nervous system, and much more! This book will help you to visually understand the various parts of the head and neck as well as the oral cavity and how they relate to each other. In addition, the final chapter on fasciae and spaces will give the reader a better overall regional feel for the anatomy of the head and neck.

Back-of-book multiple-choice test with answers and rationales enables you to gauge your mastery of dental anatomy.  Access to online materials for Illustrated Anatomy of the Head and Neck includes practice quizzes, Elsevier's online anatomy coloring book, and a skull bone identification interactive exercise.

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Cases for Online Study 2024 for SDHs

Dental Hygienists are a community of professionals devoted to the prevention of oral disease and the promotion and improvement of the public's health. Dental hygienists are preventive oral health professionals who provide educational, clinical, and therapeutic services to the public. As a healthcare professional, a dental hygienist is called on to know a wide range of information related to patient care.  These links noted below only begin to show the range of information needed as a competent dental professional working within quality dental care.

Student dental hygieniss can browse through the sites of interest as listed below. Be sure to check out DH Links for even more in-depth information on research, patient care, and dental professional associations. Also check out 2024 Updated ASA PHYSICAL STATUS CLASSIFICATION SYSTEM (referenced in Dental Section that is continually undergoing peer review, including Author as Referred Dental Science Editor in Wikipedia !).

Unless otherwise specified, the production group of this site is not responsible for the content of any of the outside sites linked to this webpage. The listing of this site's name with any of these sites should not be misconstrued as an endorsement of the information in them.  The addresses of these web sites are subjected to change and may need updating over time and may contain advertising which is not in control of the author of this website. 

Updated 10/1/2024

Production by Fehrenbach and Associates

Evolving Online Resources

(No Alpha Listing)

The Happy Flosser RDH

NIH Imaging Case s

Lesion Cases from Dentistry IQ

Path Pack from Dentistry IQ

Clinical Tips from Perio-Implant Advisory

Inside Dental Hygiene

Compendium of CE in Dentistry

Breakthrough Clinical

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Oral Cancer Screening Guide

Oral Path: Soul of Dentistry

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Music for Study    More Music for Study

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Oasis Dental Library

One of the largest libraries of free dental books, journals and videos

Case Studies in Dental Hygiene 3rd Edition

• Evelyn M. Thomson

Description:

Case Studies in Dental Hygiene, Third Edition, is designed to guide the development of criti-cal-thinking skills and the application of theory to care at all levels of dental hygiene education–from beginning to advanced students. This textbook is designed to be used throughout the dental hygiene curriculum. Because the questions and decisions regarding treatment of each case span the dental hygiene sciences and clinical practice protocols, this book will find a place in enhanc-ing every course required of dental hygiene students. Introducing this text at the beginning of the educational experience may help the student realize early on the link between theory and patient care. Students then progress through the program with a heightened awareness of evidence-based practice.

Students also perceive an increase in confidence regarding preparation for board examina-tions when they have been given the opportunity to practice case-based decision making. Case Studies in Dental Hygiene, Third Edition, is a viable study guide to help students prepare for suc-cess on national, regional, and state examinations with a patient care focus. This revised edition also is an excellent review text for the graduating dental hygiene student who is preparing to take the National Board Dental Hygiene Examination.

ISBN: 978-0-13-291308-9

Published Date : 2013

Page Count:  337 , File Size: 8 Mb

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OASIS DENTAL LIBRARY (2018-2024)

Prepare for the NBDHE ®

Getting ready for success with the nbdhe.

The National Board Dental Hygiene Examination is overseen by the Joint Commission on National Dental Examinations (JCNDE), an independent agency of the American Dental Association, in collaboration with the Department of Testing Services (DTS). Examinations are administered by Pearson VUE at authorized test centers across the country.

Below you will find helpful tools and resources that can assist you in preparing for your upcoming examination. For complete details on the examination, refer to the NBDHE Candidate Guide. Frequently asked questions are covered on the NBDHE home page.

View the NBDHE Candidate Guide  (PDF)

View the Common Acronyms and Abbreviations (PDF)

Visit the NBDHE home page

More test preparation resources

Learn about updates to the NBDHE and other National Board Examinations in this brief webinar.

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You may also want to explore the Pearson VUE examination software to help you navigate the exam format more easily. Use this link to download and install the tutorial so you can become familiar with how it works.

Navigate the tutorial

This test day checklist is a useful resource as you prepare for your examination. It was created as a summary of the most frequent issues that create complications for examinees on the day of testing. The Department of Testing Services (DTS) encourages you to read the entire guidebook for the test you are taking and to call the DTS at 800.232.1694 with any questions.

• I am bringing two original, current (not expired) forms of identification (ID) to the testing center: one government-issued ID, with my photograph and signature (e.g., driver’s license or passport) and one ID with my signature (e.g., Social Security card, credit card, debit card or library card).
• The name on my application matches my IDs exactly. I will contact the DTS if there is any possibility of a mismatch. Examples of names that do NOT match: Joseph Anthony Smith and J. Anthony Smith, Joseph A. Smith, or Joseph Anthony Smith-Johnson.
• I will leave all non-essential items at home.
• I will store all personal items – cell phone, food, candy, beverages, pens, pencils, lip balm, wallets, keys, jackets, etc. – in the assigned locker at the testing center. I understand that I may not access these items during testing or an unscheduled break.
• I will double-check my pockets to ensure they are empty before I sign in to test.
• I will follow the instructions of the test administrator and the rules of the testing center.
• I know what to do if I encounter a problem at the testing center. If I experience a problem with testing conditions, I must notify the test administrator immediately.
• I have made arrangements for my ride or to notify my family or friends after I complete my test and have signed out of the test center. I will not use my cell phone or other electronic devices in the test center or during my testing session.

Download the checklist

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Case Studies in Dental Hygiene 1st Edition

• ISBN-10 013018571X
• ISBN-13 978-0130185716
• Edition 1st
• Publisher Pearson
• Publication date January 1, 2003
• Language English
• Dimensions 8 x 0.25 x 10.5 inches
• Print length 200 pages
• See all details

Editorial Reviews

From the back cover.

Designed to guide the development of critical thinking skills at all levels of dental hygiene education, Case Studies in Dental Hygiene provides diverse scenarios that span the curriculum, applying theory to care. Patterned after the Dental Hygiene National Board Examination, it provides "snap-shots" of pediatric, periodontally involved, geriatric, special needs, and medical compromised cases.

• Unique! The only text solely devoted to case situations on the market.
• Concise, specifically defined case studies.
• A team of authors provide expertise for a variety of case study development.
• Case-based questions from basic to advanced encourage critical thinking.
• Encourages application of dental hygiene theory to client care.
• Incorporation of the Human Needs Conceptual Model to Dental Hygiene Practice as a reflective activity for each case.

Excerpt. © Reprinted by permission. All rights reserved.

Educators need case-based learning tools that may be integrated throughout the dental hygiene curriculum. Within the educational environment exists the goal to assist students in linking basic knowledge to dental hygiene care that is evidence-based and client-centered. With the constantly evolving knowledge base and changing technologies, dental hygiene faculty are challenged to incorporate educational technologies that exceed knowledge acquisition and focus on critical decision making. Case Studies in Dental Hygiene is a viable educational tool to help students learn to apply basic knowledge to client care and to prepare them for success on national, regional and state examinations which have a client care focus.

Case Studies in Dental Hygiene is designed to guide the development of critical thinking skills and the application of theory to care at all levels of dental hygiene education—from beginning to advanced students. Additionally, during the course of their formal education, dental hygiene students can be exposed only to a small spectrum of cases they might encounter in the real world. The diversity of the cases in this text provides an avenue for simulating experiences students might not encounter in their education. This text is designed to cover a broad array of topics, to be adaptable for use in a variety of courses, and to be used across student knowledge and skill levels.

This text is designed to be utilized throughout the dental hygiene curriculum. Because the questions and decisions regarding treatment of each case span the dental hygiene sciences and clinical practice protocols, this text will find a place in enhancing each and every course required of dental hygiene students. It is expected that Case Studies in Dental Hygiene would be introduced at the beginning of the student's educational experience and be utilized throughout the program of study. As the students' knowledge base develops, the answers to the more complex questions would become apparent. If the text were introduced early in the program, students would realize the link between theory and client care immediately. Once exposed to the cases, students progress through the program with a heightened awareness, a "need to know," a's new material is introduced which can be applied to answer case-based questions. Additionally, Case Studies in Dental Hygiene makes an excellent review text for graduating dental hygiene students preparing to take the Dental Hygiene National Board Examination.

Case Studies in Dental Hygiene presents oral health case situations representing a variety of clients that would typically be encountered in clinical settings. There are 10 cases, 2 each representing the following client types: pediatric, adult periodontally involved, geriatric, special needs, and medically compromised. Each case contains a medical history, dental history, vital signs (including blood pressure, pulse, and respiratory rates), radiographs, dental and periodontal charting, intraoral photographs, and photographs of study models, where applicable. Additionally, learning objectives and multiple-choice questions are identified for each case. Questions are subdivided into the following categories: assessing client characteristics, obtaining and interpreting dental radiographs, planning and managing dental hygiene care; performing periodontal procedures, using preventive agents, and providing supportive treatment services. Each question is clearly identified as "basic" or "complex," further guiding educators and students to use each case to maximum benefit. Students will be challenged to seek answers and select appropriate care for the clients in each case scenario. Correct answers and rationales for incorrect responses are provided for all questions. Providing descriptive rationales for incorrect answers further enhances learning. Reflective activities and a section incorporating the Human Needs Conceptual Model to Dental Hygiene Practice guide the instructor in developing additional learning activities for the student. The rapidly increasing, constantly changing knowledge base and technologies associated with clinical practice mandate that dental hygiene professionals be prepared to provide oral care that meets the needs of the whole client. The Human Needs Conceptual Model to Dental Hygiene Practice has been established as a means of linking oral care with the general health of an individual. Although many dental hygiene programs have incorporated the Human Needs Conceptual Model into their curriculum, others are in need of educational tools which assist with this incorporation. Case Studies in Dental Hygiene, provides educators with a bank of ready-made cases with which to guide students to integrate client needs or deficits with dental hygiene care planning. Each case lists suggestions for creating decision-making opportunities for the students, regarding client care and treatment recommendations that promote oral health and prevent oral diseases.

HOW TO USE THIS BOOK

Each chapter contains one case scenario, making it a stand-alone module that may be introduced in any order and at any time during the curriculum. While there are a variety of ways in which to utilize the case studies, educators may benefit from the suggestions listed here. Cases C and D, The Periodontally Involved Adult Client, could be used as required reading for the preclinical student to introduce the dental hygiene process of care. Because each case contains questions that are knowledge-based as well as complex decision-making questions, the beginning student may be directed to answer the "basic" questions. During theory class, a discussion of these answers may help to increase the incidence of critical thinking skills and can reinforce and facilitate learning in a dynamic, stimulating manner motivating the student to more fully participate in the learning process. Because the questions for each case are subdivided into client assessment, radiographic services, planning and management of care, periodontal procedures, and supplemental services, instructors of basic dental hygiene sciences may easily identify those questions which supplement learning in their disciplines. The radiology instructor may utilize the "basic" questions of all the cases, directing the beginning student to those questions under the subdivision "obtaining and interpreting dental radiographs" while the pharmacology instructor may use Cases I and J, The Medically Compromised Client, to provide a realistic setting to assist students in linking drug interactions which may contraindicate dental hygiene care with planning and managing treatment. Cases A and B, The Pediatric Client, may provide an opportunity for the student to identify eruption patterns, learned in head and neck anatomy or tooth and root morphology courses. Applying theory and knowledge gained in the basic dental hygiene sciences to solve problems encountered through case-based questioning allows the student to become actively involved in the learning process. After all, the challenge of case-based instruction is to maximize students' synthesis of theoretical material and provide a link between science, theory, and clinical practice. Case Studies in Dental Hygiene may compliment and enhance material learned in other texts. For example, students learning instrument design from a theory book may link application of this knowledge when challenged by case photographs and charts to choose an appropriate instrument for scaling a specific area. Radiographic problem solving skills are further enhanced by examination of the case radiographs when the student is challenged not only to identify technique and processing errors, but also to recommend corrective action.

In addition to basic questions, each case contains complex questions that challenge advanced students to develop improved clinical reasoning that will assist them in real-world clinical practice. As students progress through the curriculum, the same cases may be revisited through the use of complex questions. Students usually respond favorably to the opportunity to apply knowledge gained in the classroom to fictional cases. The ability to plan treatment and simulate implementation through case study provides the student with a stress-free environment in which to make decisions. Students report increased confidence when faced with treatment planning and implementation decisions regarding clients in the clinical setting. Students also perceive an increase in confidence regarding preparation for national and regional board examinations when they have been given the opportunity to practice decision making.

In case-based teaching, a frequent faculty complaint is that students and faculty have difficulty integrating information from various courses within the discipline to the case-based format. Healthcare educators are fully cognizant that effective clinical judgment only comes from experience, since it is the use of real life situations which encourages student analysis and decision making in areas relevant to professional practice. However, most faculty do not consider themselves experts on all dimensions of a problem, and as a result may be limited in their use of case studies. To overcome the limited use of case studies to specific disciplines, Case Studies in Dental Hygiene was written by several authors, each an expert in a specific aspect of dental hygiene care. This multi-author approach to the development of the cases contained in this book, is intended to provide other dental hygiene educators with a ready-made bank of cases upon which to build meaningful learning activities' for the student. Additionally, the authors hope that the format and content of Case Studies in Dental Hygiene will provide students with an opportunity to practice critical decision-making skills and reinforce and facilitate learning in a dynamic, stimulating manner, thereby motivating students to more fully participate in the learning process. This book was designed specifically to encourage dental hygiene students to base client care decisions on knowledge gained in theory, thus fostering in students an appreciation of the link between theory and clinical practice.

Product details

• Publisher ‏ : ‎ Pearson; 1st edition (January 1, 2003)
• Language ‏ : ‎ English
• Paperback ‏ : ‎ 200 pages
• ISBN-10 ‏ : ‎ 013018571X
• ISBN-13 ‏ : ‎ 978-0130185716
• Item Weight ‏ : ‎ 13.6 ounces
• Dimensions ‏ : ‎ 8 x 0.25 x 10.5 inches
• #75 in Dental Hygiene (Books)
• #257 in Preventive Dentistry

About the author

Evelyn m. thomson.

Evelyn Thomson, BSDH, MS, served 20 years as educator at Old Dominion University's Gene W. Hirschfeld School of Dental Hygiene in Norfolk, Virginia, receiving awards for Faculty Excellence; Continuing Education Teaching & Leadership; Outstanding Author; and Distinguished Alumni. In addition to teaching in the undergraduate dental hygiene program and mentoring graduate students in the master’s degree program, Thomson developed and taught numerous continuing professional education courses; served as a consultant to the Virginia Board of Dentistry; and conducted seminars for the American Dental Hygienists’ Association. Thomson’s expertise has been validated by membership in the American Academy of Oral and Maxillofacial Radiology, and with an appointment on the National Board Dental Hygiene II Test Construction Committee by the Joint Commission on National Dental Examinations. Thomson is author and co-author of three textbooks: Exercises in Oral Radiographic Techniques: A Laboratory Manual; Case Studies in Dental Hygiene; and Essentials of Dental Radiography for Dental Assistants and Hygienists and has published numerous manuscripts in peer-reviewed dental hygiene journals. Evie lives at the Virginia Beach oceanfront with her husband Hu Odom.

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Dental hygiene diagnosis: A qualitative descriptive study of dental hygienists

Darlene j swigart.

* Assistant professor, Department of Dental Hygiene, Oregon Institute of Technology, Klamath Falls, OR, USA

JoAnn R Gurenlian

§ Professor and graduate program director, Department of Dental Hygiene, Idaho State University, Pocatello, ID, USA

Ellen J Rogo

‡ Professor, Department of Dental Hygiene, Idaho State University, Pocatello, ID, USA

The purpose of this qualitative descriptive study was to explore dental hygiene diagnosis (DHDx) to gain an understanding of how dental hygienists experience this phenomenon while providing dental hygiene care.

A qualitative descriptive research design was employed using purposive sampling. Data were collected from semi-structured interviews with 10 dental hygienists actively practising in California, Oregon or Colorado. The interviews were audiorecorded, transcribed verbatim, and verified for accuracy. Data analysis included open coding and axial coding to determine larger, related segments of data called categories providing an overall descriptive summary of DHDx. Two independent peer examinations and member checks established validity of the data analysis.

Four categories emerged from the study: expertise and confidence; client communication; dental hygiene care plan; and dentists’ trust. Participants revealed that expertise and confidence in performing the DHDx was gained through clinical practice. During client care, discussing the DHDx with clients helped to make them aware of their health condition. The development of the dental hygiene care plan was based on the results of the assessment data and the DHDx. Participants stated that their employer/dentist trusted them to diagnose.

Conclusions

A qualitative descriptive study was conducted to summarize dental hygienists’ experiences with DHDx in 3 US states; 4 categories emerged. The DHDx informs the client, increases understanding, and engages the client in the decision-making process. Further study is warranted to identify a more contemporary definition of DHDx and to compare how DHDx is utilized by dental hygienists in other countries.

Le but de cette étude descriptive et qualitative était d’explorer le diagnostic d’hygiène dentaire (DxHD) pour bien comprendre comment les hygiénistes dentaires vivent ce phénomène, tout en fournissant des soins d’hygiène dentaire.

Méthodologie

Une méthodologie de recherche descriptive et qualitative a été employée au moyen d’un échantillonnage choisi à dessein. Les données ont été recueillies à partir d’entrevues semi-structurées avec 10 hygiénistes dentaires qui exercent activement en Californie, en Oregon ou au Colorado. Un enregistrement sonore des entrevues a été effectué et les entretiens ont été transcrits textuellement et leur exactitude a été vérifiée. L’analyse des données comprenait un codage ouvert et un codage axial pour déterminer les segments de données plus volumineux et connexes appelés catégories, produisant un résumé descriptif global du DxHD. Deux examens indépendants effectués par les pairs et des vérifications effectuées par les membres ont permis d’établir la validité de l’analyse des données.

Résultats

Quatre catégories sont ressorties de l’étude : expertise et confiance, communication avec le client, plan de soins d’hygiène dentaire, et confiance des dentistes. Les participants ont révélé que l’expertise et la confiance dans la performance du DxHD ont été acquises par l’exercice clinique. Au cours des soins du client, le fait de discuter du DxHD avec les clients a aidé à leur faire prendre conscience de leur état de santé. L’élaboration du plan de soins d’hygiène dentaire a été fondée sur les résultats des données d’évaluation et sur le DxHD. Les participants ont déclaré que leur employeur ou dentiste leur faisait confiance pour poser un diagnostic.

Une étude descriptive et qualitative a été menée pour résumer les expériences de DxHD des hygiénistes dentaires dans 3 états américains et 4 catégories en sont ressorties. Le DxHD guide le client, augmente la compréhension, et incite le client à participer au processus de prise de décisions. Une étude plus approfondie permettrait de cibler une définition plus contemporaine du DxHD et pour comparer comment le DxHD est utilisé parmi les hygiénistes dentaires dans d’autres pays.

PRACTICAL IMPLICATIONS OF THIS RESEARCH

• Dental hygiene diagnosis is an essential step in the dental hygiene process of care and guides the creation of dental hygiene care plans.
• Graduates of entry-level programs develop expertise and confidence in implementing the dental hygiene diagnosis through clinical care experiences.
• Dentists trust dental hygienists to perform a dental hygiene diagnosis.

INTRODUCTION

Diagnosis refers to the identification of a disease based on the presentation of signs and symptoms. 1 Health care professionals in all fields use diagnosis as a means to identify and discuss diseases with patients and formulate a plan for treatment. Dental hygienists incorporate diagnosis, specifically called dental hygiene diagnosis (DHDx), into clinical practice to assist in the prevention and treatment of oral diseases. 2

Historically, various models of DHDx began to appear in dental hygiene textbooks in the early 1990s. Gurenlian 3 introduced a model for dental hygiene diagnostic decision making in 1993, which was followed in 1995 by the first method for formulating a DHDx by Mueller-Joseph and Peterson. 4 At that same time, Darby and Walsh presented a DHDx model based on the Human Needs Conceptual Model. 5 This version of the DHDx has appeared in subsequent editions of their textbook. Swigart and Gurenlian proposed a practical approach for integrating the DHDx for clinical care. 6 , 7

American Dental Hygienists’ Association: Standard 2

Source: American Dental Hygienists’ Association. Standards for clinical dental hygiene practice. Rev. ed. Chicago (IL): ADHA; 2016 [cited 2018 Jun 30]. Available from: https://www.adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf

Both the Canadian Dental Hygienists Association (CDHA) and the American Dental Hygienists’ Association (ADHA) have included DHDx in their respective standards of practice for dental hygienists. 8 , 9 The CDHA reference to DHDx is found in Standard 2: “Dental Hygiene Process: Assessment.” Item 2.5 states, “Analyze all information to formulate a decision or dental hygiene diagnosis” 8 p.9 . The ADHA standard for DHDx appears in Table 1. 9 Table 2 displays the similarities in DHDx definitions between these 2 associations; both require the dental hygienist to think critically about assessment data and formulate conclusions to address clients’ needs. 10 , 11 A DHDx is paramount to providing individualized, appropriate client education, dental hygiene care planning, disease prevention, and therapeutic and re-evaluation procedures. 6

In health care globally, there has been a focus on person-centred care, which is an individualized, holistic approach to care where the decision making is shared by the clinician and the client, and at times, includes the client’s family or caregiver. 12 , 13 Instead of viewing the client as a collection of symptoms, person-centred care fosters communication to take into consideration the client’s values and goals. 12 , 13 Dental hygienists have an ethical responsibility to provide opportunities for clients to make informed decisions about their treatment. 14 Communicating the DHDx to the client is part of that responsibility. 9

In 2018, Gurenlian, Sanderson, Garland, and Swigart surveyed dental hygiene clinic coordinators in the United States to ascertain opinions regarding the importance of a DHDx and to understand how the DHDx is incorporated into educational programs. 15 Of 188 survey respondents, 98% confirmed that the DHDx is a necessary component of dental hygiene care and determines dental hygiene interventions. 15 Program administrators consider a DHDx a valuable and necessary element of client care.

Health care professionals in other disciplines recognize the importance of the DHDx to client overall health and collaborative care. In 2012, Jones and Boyd investigated whether a dental hygienist would be a valuable member of an interdisciplinary pediatric feeding team by assessing the importance of the dental hygiene process of care, advocacy, and health education and promotion. 16 Team members surveyed included registered dietitians, speech-language pathologists, occupational therapists, registered nurses, and advanced registered nurse practitioners. The 4 areas pertaining to DHDx in the study were 1) identifying existing or potential oral problems associated with teeth, 2) periodontal disease, 3) oral lesions, and 4) sensor,y disorders. All team members rated the role of the dental hygienist on the pediatric feeding team as “very important/most relevant.” 16

Canadian and American DHDx definitions

Even though dental hygienists are ethically responsible for and qualified to recognize oral diseases and use the DHDx to formulate an appropriate individualized dental hygiene care plan, 9 , 11 no research has been conducted to understand the process of the DHDx as performed by dental hygienists in practice. The purpose of this qualitative study was to explore the DHDx in order to gain an in-depth understanding of how dental hygienists currently licensed and practising in the US experience this phenomenon. The following research questions guided the conduct of this study: 1) How do dental hygienists learn to value the DHDx? 2) How do dental hygienists perform the DHDx in clinical practice? 3) Why do dental hygienists perform the DHDx in clinical practice? 4) How do dental hygienists create a dental hygiene care plan based on the DHDx?

Study design and participant recruitment

A qualitative descriptive approach was adopted to facilitate the in-depth exploration of dental hygienists’ experiences with DHDx in clinical practice. This research design is appropriate to explore phenomena where little theoretical or practical knowledge exists. 17 Based on the limited knowledge of the implementation of DHDx during clinical care, this qualitative approach was used to gain an understanding of this aspect of the dental hygiene process of care and provides a foundation on which other investigations are conducted. The study design underwent full IRB review from the University’s Human Subjects Committee and received approval (IRB-FY2017-252).

Purposive sampling is commonly implemented as the sampling plan for a qualitative descriptive study. 17 The recruitment of individuals who have experiences with the phenomenon (DHDx) and are able to inform data collection are important considerations of purposive sampling. 18 Participants were initially recruited through personal networking by the researchers who emailed an IRB-approved announcement to colleagues in California, Oregon, and Colorado. These states were selected because the dental hygiene scope of practice includes direct access to dental hygiene care. Additionally, in Oregon and Colorado, DHDx is specifically identified in the practice act as a procedure for dental hygienists. 19 Furthermore, the snowball sampling method 18 was implemented to gain referrals of other dental hygiene colleagues who could be recruited for the study.

Inclusion and exclusion criteria

Inclusion criteria were dental hygienists who were actively practising at least 16 hours a week and had a minimum of 1 year of experience. Exclusion criteria eliminated dental hygienists who were currently or previously employed as educators in dental hygiene programs or worked less than 16 hours per week. When potential participants were identified, a screening questionnaire was completed to establish who met the inclusion criteria and determine procedures they completed during client care.

Participant selection

The 10 dental hygienists selected were those who collected assessment data, evaluated risk factors for oral disease, and determined dental hygiene treatment based on the assessment data and client risk factors. Additionally, demographic questions were asked on the questionnaire to establish maximum variation in the sample.

Maximum variation was implemented to gain diversity within the sample 18 based on demographic (gender, age, years in practice) and type of practice (general private practice, direct access practice, corporate practice) variables. Using maximum variation in a qualitative descriptive inquiry provides researchers with the opportunity to explore similar and unique experiences across varied contexts. 17 During the interview process, saturation determined the final sample size. Saturation involves increasing the sample size until no new information surfaces during the interviews. 18

Data collection and data analysis

The 4 research questions directed the development of the interview guide as depicted in Table 3. The guide included major questions and subordinate questions to elicit additional detail in responses. The content validity of the questions was established by using the Standards for Clinical Dental Hygiene Practice of the ADHA and previous DHDx research. 9 , 15 Using the guide ensured that all topics were covered in a valid and reliable manner during each interview. 18 Two members of the research team conducted a pilot interview to determine whether the major and subordinate questions would collect data to answer the research questions as a validation process. The interview guide was sent to participants at least 1 week prior to the interview to help them formulate responses.

Written informed consent was obtained prior to interviews being conducted by the principal investigator through an audiorecorded phone interview. Interviews were conducted with semi-structured methodology allowing for additional follow-up questions to collect more in-depth data or new data. The conversation was audiorecorded using the Olympus WS-300M 256 MB Digital Voice Recorder and Music Player. All audiorecordings were transcribed verbatim by a professional transcriptionist. Participant pseudonyms were used during the interview and on the interview transcript to protect confidentiality and ensure anonymity. The principal investigator listened to the audiorecorded interviews to verify the accuracy of the transcriptions.

Data regarding the DHDx generated from the interviews were analysed simultaneously with data collection; both processes reciprocally influenced each other. 17 The data analysis method of choice for qualitative descriptive studies is qualitative content analysis. 17 The result of this analysis is a descriptive summary of the data, which is less interpretive than data analysis other qualitative approaches use. 17

Interview guide

Transcripts were read numerous times by the investigators to become familiar with the data and to develop a contextual understanding of factors related to perceptions of DHDx. Open coding deconstructed the data into manageable one-word or short phrases describing the participants’ experiences relevant to answering the research questions. 18 During the next phase—axial coding—open codes were combined to form larger segments of data indicated as categories. Each research team member coded the same interview, compared and discussed findings until consensus was reached. Common categories were then analysed and organized to summarize the data, following Merriam and Tisdell’s 18 recommendation that categories should be responsive to the purpose of the research, exhaustive, mutually exclusive, sensitizing, and conceptually congruent.

Establishing rigour

Two research team members conducted an independent peer examination of the data analysis to ensure validity. Another procedure used for validity was respondent validation. 18 Member checks by participants evaluated the preliminary findings and provided feedback on the accuracy of the researchers’ interpretation of the data. All 10 participants reported they agreed with the analysis.

Study participants

Demographic data for the 10 participants were analysed using descriptive statistics and are presented in Table 4. Six dental hygienists from California, 2 from Oregon, and 2 from Colorado participated in the study. The majority of participants were between the ages of 34 and 44 years, female, and had over 13 years of experience. Eight participants worked in private practice under the supervision of a dentist; 2 worked in independent practices without the supervision of a dentist. These independent practitioners provided care in long-term care facilities, at a senior citizen centre, and with a mobile dental clinic.

Four categories emerged from the study: expertise and confidence; client communication; dental hygiene care plan; and dentists' trust.

Expertise, and confidence

Participants revealed that, while foundational learning of the DHDx began in dental hygiene education, expertise and confidence in performing the DHDx was gained through clinical practice. Most participants reported learning to perform the DHDx in their dental hygiene education program. Hannah described being taught in a clinical setting, with a client present, and under the guidance of the dental hygiene faculty. She learned to diagnose periodontal case types and elaborated on her oral pathology education, stating:

We were always encouraged to look out for unusual findings in the mouth. If we did see anything, we were to describe it, to actually measure it, and write it down.

Mike stated, “we’re really good at diagnosing periodontal disease,” and detailed also being taught to diagnose bruxism, wear patterns, abfractions, dental caries risk, and dental caries on radiographs. Mia explained how she was educated to assess for dental caries and determine the dental caries classification. Jane confirmed learning to diagnose not only dental caries, but also radiolucencies around tooth apices. Nikki discussed that her postgraduate advanced practitioner training developed her use of the DHDx because she would be working in independent practice without a dentist present.

I really probably learned [DHDx] through the training I received at my postgraduate AP [advanced practitioner] class. They really stressed that on us, more so than my bachelor degree dental hygiene class twenty-four years ago. A lot has changed and because we’re seeing these patients independently, you get better at evaluating things and being confident in your evaluation and referrals.

Other ways participants learned DHDx were through reading articles in professional journals and attending continuing education courses.

In contrast, Michele and Leah specifically acknowledged they did not learn to determine the DHDx during their dental hygiene education. Michele was educated to recognize different levels of periodontal disease and discuss the findings with the supervising dentist who would provide the diagnosis and referrals. Furthermore, Michele expressed, “I like the fact that I don’t have the legal responsibility of diagnosis because that is left to the doctor’s hands.” Leah stated, “We weren’t specifically taught a DHDx and how to write that up, with that title.” She explained how she was taught to do an oral assessment, oral cancer screening, and to recognize abnormal oral conditions to be diagnosed by the dentist. Even without specific terminology for the DHDx, Leah was expected to identify dental caries, both clinically and radiographically, in addition to decalcification and root caries.

Developing confidence in and appreciating the value of conducting a DHDx occurred through clinical experiences in practice. All participants confirmed that their increased confidence in diagnosing improved communication skills regarding the DHDx and strengthened the value they place on DHDx. Jane specifically credited the dentist by whom she is employed for increasing her knowledge of diagnosing and motivating her to perform the DHDx.

I had a lot of good foundational knowledge and then was able to apply it [DHDx] to all the many patients in clinical practice. It just expands upon what you’ve already learned. I’ve also learned a lot from the dentist I work for. I feel like he’s taught me a lot. I do have a lot more confidence in saying yes, this is what I think this is and explaining that to the patient. And I think that would come with time.

Multiple participants confirmed that the more years they were in practice and performing the DHDx, the more confident they became in their diagnosis. As Elizabeth explained:

When I was first out of school, if I got hesitation [about recommendations] from a patient, it would make me feel uncomfortable and make me second guess whether my diagnosis was correct or not. And now that I’ve been practicing so long, I know what my diagnosis is and it’s MY job to help the patient understand why I’m making that diagnosis. I’m not going to be talked out of what I’m recommending for a patient.

Additional supporting quotations illustrating how DHDx expertise and confidence develop through clinical experiences are presented in Table 5.

Participant demographic data

Supporting quotations for category 1

Patient communication

The DHDx helps to make clients aware of their health condition and provides the dental hygienist with an opportunity to explain the DHDx to the client. Albert, Hannah, and Mary each described how they present the DHDx to their clients.

An example of how I take a DHDx. I had a patient in her 60s. She had several missing teeth, crowns, and very large fillings. She had failing restored margins, pockets, clinical attachment loss, radiographic evidence of bone loss, heavy plaque, and debris on the gingival surface of those teeth. She stated disappointment with failing treatment that she attributed to herbs by her previous dentist. And she said (quote), “Dr. Oz said I don’t need fluoride.” She was on several medications for hypertension and diabetes. Her DHDx was generalized mild to moderate chronic periodontitis, high caries risk, restorative needs requiring a dentist’s attention, anxiety, high risk of perceived or actual failure of treatment, high risk of oral systemic complications, pockets of deficits related to effects of treatment, fluoride and personal health habits, affective deficits related to interaction with health professionals and sources of information, and psychomotor deficits related to home care habits. (Albert)

To the patient I described earlier, I explained that because she had problems with her dental treatment in the past, I would like to have her release prior records to us before I begin providing treatment. To the event, to prevent the same pitfalls from happening again. I also asked her to have Dr. Oz send his diagnostic and treatment notes so I could understand why he did not think she needed fluoride. I explained the effects of fluoride on dental health, the characteristics of her periodontitis and treatments. I also explained the treatment I recommended for her would help the longevity of her restoration and interact positively with her systemic health. (Albert)

I need to feel I’m doing the best possible thing for my patient. There needs to be honesty between the hygienist and the patient which will develop trust. The DHDx is a true representation to the best of my knowledge of the patient’s condition which is the baseline which I work from to perform the best possible care, and I value that. Because periodontal disease can have no symptoms, many people don’t realize they have it. Explaining to the patient the diagnosis is educational and they should know if there is a problem so it can be addressed as soon as possible. (Hannah)

I would sit the patient up and we usually take photographs and radiographs and show the patient in their own mouth what’s going on. Explain to them how their systemic condition relates to their oral health. Explain to them what we’re finding as far as pocketing and bleeding and calculus and let them know what their options are for treatment. (Mary)

In some cases, participants divulged that clients are not always informed of their oral health status. Michele, Mike, Elizabeth, and Mia reported occasions when clients had been shocked to learn their DHDx because they had never previously been told of their disease state.

I’ve had patients that are shocked. They have been going to their office and seen routinely for care, and all of a sudden, they come in, they see me for the first time, and when I tell them what the diagnosis is and the treatment plan, they are shocked. They’ll ask questions why or how did this happen? Or what do I do to prevent it? (Mia)

Participants reported the significance of educating the client while informing them of the DHDx. When clients are made aware of their disease status through the DHDx, they are more likely to accept dental hygiene ,treatment. Mike explained, “By telling the patient and educating them, you’ll get a lot better results. They’re a lot more aware and so they’ll take more action.”

Leah discussed how dental hygienists back up the DHDx with “a lot of information for the patient to make sure the patient understands.” She further detailed her direct access practice at a senior citizen centre, stating that some clients she treated would not seek oral care at a dental office. The only care some clients were willing to have involved dental hygiene procedures completed at the senior citizen centre. Leah stressed that referrals were made to dental offices, but clients did not always follow through with them. In one case, she informed a client of an abscess. By helping the client understand the diagnosis, she was able to convince the client to seek treatment. Furthermore, Leah called a clinic to schedule an appointment, thus fulfilling the role of a case manager of oral health care to ensure the spread of infection did not affect systemic health. Additional supporting quotations for this category appear in Table 6.

Dental hygiene care plans

A dental hygiene care plan consists of formulating conclusions about dental hygiene treatment based on the results of the assessment data and the DHDx. Participants described how they relate the dental hygiene care plan to the DHDx.

I begin explaining the assessment data, the implication of that data, and the diagnoses that emanate from that data. Then I explain the diagnoses and how the recommended treatment will address the diagnoses. (Albert)

After the initial therapy, we’ll be seeing the patient for a six-week evaluation appointment. That allows us to see what healing has occurred. It is a long-term commitment on their part because it requires them to come in every three to four months for at least the first year. If we see any inflammation, bleeding, pocketing remaining after one year, then we will keep them on a three- to four-month periodontal maintenance program. I explain the difference between periodontal maintenance and a prophylaxis. We typically go over recommendations for flossing. If they don’t like regular floss, we recommend soft picks or water flosser. We typically recommend using an electric toothbrush and tongue brushing. (Elizabeth)

Supporting quotations for category 2

Participants described many aspects of the dental hygiene treatment planning process, including the importance of the DHDx. The care plans included detailed information on what treatment, nutritional counseling, education, and referrals were recommended. Additionally, participants determined the number of appointments, length of each appointment, and what treatment would be included at each appointment. These dental hygienists proposed necessary referrals, discussed the cost of the treatment, and at times assigned insurance codes. Recommended re-evaluation and recare intervals were generally determined by the dental hygienist. This information was given to the dentist to get final approval for proposed treatment if needed, to the front office staff for financial considerations, and to the client to obtain informed consent.

Albert discussed how presenting an individualized dental hygiene treatment plan, based on the DHDx, to a client gave the client the necessary knowledge to accept or decline treatment. In regard to finances, clients gained “confidence that their money was going toward something worthwhile.” Michele emphasized that an important aspect of care planning was to explain to the client not only what treatment was recommended, but also why it was necessary. The goal of the care plan is to provide the best possible care and referrals to improve the client’s oral and overall health.

Further, participants discussed the referral of clients to medical and dental professionals in multiple disciplines as a necessary component of the care plan. Mike described interprofessional practice by referring clients to physicians to evaluate the status of diabetes, high blood pressure or medications. Jane referred to a dermatologist when a suspicious lesion was observed on a client’s face or lips. Elizabeth explained how the recognition of possible acid reflux, visible by lingual erosion, required further evaluation by a physician. She described to clients the importance of further evaluation by stating “this is a major concern because it puts you at a high risk for esophageal cancer and oral cancer, as well as eroding away the enamel.” Summing up her thoughts, Elizabeth stated, “The body is all interconnected and interlinked.”

Mia discussed the importance of referrals for emotional health and for alcohol dependency problems. She also explained the need for an interprofessional referral to a physician for a client who had excessive bleeding problems or for those who were not responding to appropriate dental hygiene treatment. She made clear to those clients that a medical examination was recommended to ascertain if a systemic problem existed. Nikki, in independent practice, stressed to the clients and to family members of cognitively impaired clients the importance of understanding the relationship between oral health and general health when recommending frequent dental hygiene visits. This recognition of the oral–systemic link confirmed the significance of including health factors when making care plan recommendations.

In addition to systemic conditions, many participants reported intraprofessional referrals to dental professionals, such as dentists, periodontists, orthodontists, endodontists, and maxillofacial surgeons. These dental hygienists recognized the need for a dentist or dental specialist referral. Intraprofessional practice was described by Elizabeth as “a partnership” between the dentist and the dental hygienists working to help one another and facilitate collaboration. Nikki, who works in independent practice, referred to a dentist or mobile dentist for conditions requiring a dental diagnosis and dental treatment. Supporting quotations pertaining to the referrals that participants make as part of the dental hygiene care plan appear in Table 7.

Dentists' trust

From the participants’ experience, dentists trust dental hygienists to diagnose. Participants related that the dentist does not perform an oral examination of the client at every dental hygiene appointment. In some cases, a dental examination is only performed once per year or if there is a chief complaint. Therefore, the dentist relies on the dental hygienist’s ability to diagnose oral conditions and inform them of relevant findings. Nikki, in independent practice, explained how the dentists rely on accurate dental hygiene diagnosing.

Supporting quotations for care plan referrals

I feel that they [mobile dentists] count on us to diagnose correctly because they are making a trip based on the diagnosis that I see. And they base their treatment plan for that mobile visit based on what I see. They’re coming out [to treat the patient] with the knowledge and the anticipation that those are the lesions that they would be treating. (Nikki)

Leah described how communicating the DHDx to the dentist and then having the dentist reinforce the DHDx to the client “solidifies in the patient’s mind what is important.” This communication between the dental hygienist and the dentist ensured that the client received the necessary care.

Lastly, participants noted they have observed important findings to assist the dentist in performing a comprehensive diagnosis, and for the most part, the dentist has agreed with the DHDx. Specific quotations supporting these concepts are provided by Mia, Michele, and Jane.

There have been times where I brought a new patient, he’s done his exam, he’s diagnosing, and then they [patients] hop in my chair and then I find things that maybe he didn’t find. He’s thanked me on several occasions when these things have happened. The hygienist is a second pair of eyes for him. (Mia)

He [the dentist] makes my input seem valuable to the patient and that has given me a lot of confidence and makes me want to make sure my diagnosis is good and that I’m looking for those things and just not leaving it in his hands; 99 times out of a 100 my dentist does agree with what I’ve suggested for the patient. (Michele)

The dentist says, “Good job, Jane, that’s a good catch and good eye.” More times than not, he agrees with my diagnosis. That is a cavity. That is a problem. I trust you and 99% of the time he agrees with my diagnosis and my treating plans. (Jane)

This qualitative descriptive study explored DHDx in clinical practice and is a unique addition to the scientific body of knowledge. The findings from this investigation might expand the breadth of professional associations’ definitions of DHDx. Similarities between this study and current association definitions of DHDx exist in the areas of assessment findings determining the DHDx and the use of the DHDx to plan dental hygiene interventions.

According to the professional standards of practice established for the dental hygiene discipline, DHDx is an essential step between collecting assessment data and planning for dental hygiene care. 8 , 9 Participants in this study verified that DHDx is a necessary component of the dental hygiene process of care. They used their data collection findings to create a DHDx, which then supported the development of an individualized, comprehensive care plan. Further, Santana et al. explained the importance of health care providers sharing information so “patients make informed decisions in relation to their diagnosis and treatment plans.” 13 These authors stressed the importance of “building a partnership with patients” throughout this decision-making process. 13 Participants in our qualitative descriptive study recognized the difference in how clients responded when their DHDx and treatment plans were shared with them. Clients were more engaged in the decision making about their treatment options when they understood their diagnosis.

Although participants acknowledged the importance of the DHDx, they were confused by the instruction received during their education. They noted that dental hygiene program educators taught students how to diagnose in multiple areas. However, educators also informed students that they could not legally diagnose based on state regulations. Gurenlian et al. 15 conducted a survey to determine how dental hygiene educators taught DHDx in entry-level educational programs. Results revealed that 98% of responding dental hygiene educators taught the dental hygiene process of care and DHDx, including DHDx diagnostic terms. 15 There might still be opportunities to educate students in using the DHDx in clinical practice to uphold their professional standard of care.

Most participants reported needing years of experience in practice to achieve full confidence in performing the DHDx. Once experience was gained in clinical practice, the true value of DHDx was appreciated. This gap in time before fully incorporating the DHDx step in practice could be detrimental to client care especially if the dentist is relying on the dental hygienist to diagnose and plan care for dental hygiene interventions. This finding is supported by the research of Williams et al. 20 on dental and dental hygiene students’ knowledge of diagnosing, treating, and referring for periodontal disease. Their results demonstrated that only 40% of dental students and 36% of dental hygiene students “reported confidence in diagnosing, treating, and appropriately referring” periodontal clients. 20 The authors concluded that dental and dental hygiene programs might not be preparing students to transfer knowledge learned into clinical practice appropriately. 20

A unique finding of this research was the trust that developed between clients and dental hygienists, and between dental hygienists and dentists based on the DHDx. Clients reported feeling more informed about their oral health when dental hygienists notified them of the DHDx, and they trusted the treatment plan that was recommended based on that diagnosis. These clients appreciated the time and money that was being invested in their oral health care. In addition, dentists trusted dental hygienists to diagnose oral conditions based on clinical assessments, so they could make informed decisions about further care needed. In some cases, the DHDx enhanced the care of underserved populations including residents of long-term care facilities.

From the participants’ perspectives and experiences, DHDx included the identification of multiple oral diseases including dental caries and periodontal diseases. Dentists relied on and trusted the dental hygienists’ diagnoses. Many states within the US have expanded regulations to include direct access practice. 19 Because the DHDx is critical for comprehensive dental hygiene care, it should be recognized within all state practice regulations as a necessary responsibility of the dental hygienist.

Participants reported having the responsibility in practice to create the dental hygiene care plan, which included multiple intra- and interprofessional referrals. This holistic team approach to care is at the forefront of health care. These results align with the discussion by Walji et al. 12 which included the importance of a long-term relationship between the person and the provider and the significance of a holistic approach to care. An example of interprofessional practice was reported by An and Ranson 21 in a literature review conducted on obstructive sleep apnea (OSA), a potentially fatal condition. The researchers concluded that dental hygienists are in a primary role to perform screenings for OSA and recognize the need for referrals. 21 In medical practice, Graber et al. 22 discussed the importance of diagnosis being a “team-based activity” that involves collaboration between all health care providers involved in a particular case as well as the client. The goal of this holistic team approach was to improve the diagnostic process. This approach “takes advantage of each team member’s particular expertise and involvement” and, increasingly, the teams were led by health care professionals other than physicians. 22

Dental hygienists must become advocates to expand the scope of practice to include DHDx. Practitioners should educate state legislators about professional care standards related to DHDx and its importance to clinical practice. Compromising these DHDx standards could affect client care and treatment outcomes. Therefore, state regulations must align with the professional standards regarding DHDx to ensure that quality care is provided. Clients need to be able to consent to treatment based on having been informed of their diagnosis. This expectation is routine for other health care providers. Assisting stakeholders in understanding that diagnosis is as relevant to dental hygiene practice as it is to dental practice, nursing practice, medical practice, and other health care practices might provide the insight needed to support language changes to uphold dental hygiene standards in rules and regulations governing the practice of dental hygiene.

A noticeable missing aspect of diagnosis among the participant responses was the consideration of social determinants of health. In addition, when reviewing the CDHA and ADHA definitions of DHDx, neither mentions social determinants of health. 10 , 11 The World Health Organization (WHO) defines social determinants of health as:

The conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries. 23

Health care providers, in this case dental hygienists, should be aware of the inequalities and access-to-care challenges that their clients face. They should includ,e these determinants in the DHDx and address them in the dental hygiene care plans. Gurenlian and Swigart 7 included “social hindrance to care” as a DHDx on a process of care operatory chart model. This step in the right direction for dental hygiene care may not have reached the clinical practice of dental hygienists. The current versions of the associations’ definitions need to be revisited to include provisions related to informing the client for increased understanding and improving unmet needs and social determinants of health.

Limitations of the study pertain to only interviewing dental hygienists from 3 states from the western region of the US. Dental hygiene practice might be different in these states compared to other states. Reflexivity or researcher bias is a core characteristic of qualitative research and may also be a limitation of this type of descriptive study. 18 Additionally, the qualitative descriptive study is less interpretive than other types of qualitative designs. 17 Although 10 interviews might seem to be a limitation as a small sample size, this number was sufficient because saturation was reached for this exploratory study. 18

Dental hygienists have the responsibility in practice to determine dental hygiene care. Further research could include a comparison study of DHDx among Canadian dental hygienists and US dental hygienists to identify similarities and differences in clinical practice specifically as it relates to DHDx. In addition, a study is needed to investigate direct access dental hygienists and how DHDx informs their intra- and interprofessional referrals. Further, a Delphi study could be conducted to construct a new definition of DHDx based on current parameters of health care, theoretical models of care, social determinants of health, and interprofessional collaborative practice.

A qualitative descriptive study was conducted to investigate dental hygienists’ experiences with DHDx. Dental hygienists in 3 US states—California, Colorado, and Oregon—were interviewed. Four categories regarding DHDx emerged: expertise and confidence, client communication, dental hygiene care plans, and dentists' trust. The DHDx informs the client, increases understanding, and engages the client in the decision-making process. A DHDx is educational, improves communication, and supports the building of trusting relationships.

CONFLICT OF INTEREST

The authors declare no conflicts of interest

CDHA Research Agenda category: risk assessment and management

• Free Samples
• Best DSOs to Work For
• Infection Control
• Patient Care
• Career & Profession
• Solutions Lab

Case Study: A 58-year-old male presented to a dental office

Case Study: A 58-year-old male presented to a dental office for a routine checkup. Examination revealed a nonhealing ulceration of the lower lip.

Joen Iannucci Haring, DDS, MS

When questioned about the area, the patient claimed the ulcer had been present for at least six months, maybe longer. No pain or discomfort was noted by the patient. When questioned about excessive sun exposure, the patient stated that he spends many hours outdoors and does not use sunblock. The patient denied a history of smoking and alcohol use. No history of trauma to the area was noted.

The patient had a previous history of regular and routine dental care. At the time of the dental appointment, the patient was not taking medications of any kind. No significant problems were noted during the health history.

Examinations

Physical examination of the head and neck region revealed no abnormal findings. The patient`s vital signs were all found to be within normal limits. No palpable lymph nodes were detected. No other abnormal extraoral findings were noted. Oral examination revealed an ulcerative lesion of the vermilion of the lower lip, measuring one centimeter in diameter (see photo). When palpated, the periphery of the lesion felt indurated.

Clinical diagnosis

Based on the clinical information presented, which one of the following is the most likely diagnosis?

* erosive lichen planus

* actinic cheilitis

* squamous cell carcinoma

* traumatic ulcer

* recurrent herpes labialis

squamous cell carcinoma

Squamous cell carcinoma (SCC) is derived from the squamous epithelial cells, which are the flat and scaly cells found on the surface of the oral mucosa. When these squamous cells become cancerous, the cancer is referred to as a carcinoma, which is defined as a malignancy of epithelial origin. SCC is found both on the lips and inside the oral cavity. An estimated 90-95 percent of all oral cancers are squamous cell carcinoma. SCC behaves differently depending upon its location; therefore, a separate discussion of SCC of the lip and intraoral SCC is warranted.

The major causative factor for SCC of the lip is prolonged sun exposure. In addition, certain forms of tobacco use play a contributing role - pipe and cigar smoking are often linked to SCC of the lip.

Clinical features

Although SCC of the lip may occur at any age, this lesion most often occurs in adults between the ages of 50 and 70; men are twice as likely to be affected as women. The lower lip is affected by SCC far more frequently than the upper lip.

SCC of the lip has a variety of clinical appearances. The usual presentation is that of a nonhealing ulceration and crust. Raised and indurated borders may be present. The size is variable; a larger lesion may appear as a crater-like defect. SCC of the lip is typically not painful and very slow to metastasize (spread) to the regional lymph nodes or other organs.

If a lip lesion is suspected to represent SCC, the patient must be promptly referred to an oral surgeon for biopsy. A biopsy and histologic examination is necessary to establish a definitive diagnosis of SCC.

Staging is the process of determining if and how far a cancer has spread. Both treatment and prognosis are dependent upon the stage of a cancer. Staging information is obtained from the physical exam, endoscopy, and imaging studies (CT scan, MRI, chest X-ray, or nuclear medicine scans).

The most common system used to stage oral SCC is termed the TNM System. This system describes three pieces of information: T refers to the size of the primary tumor, N describes the extent of spread to regional lymph nodes, and M indicates whether the cancer has metastasized (spread) to other organs.

Once a diagnosis and staging has been determined, treatment can be rendered. Treatment options for SCC of the lip include surgical excision and radiation therapy. Smaller lesions may be surgically removed or irradiated, while larger lesions may require a combination of both surgery and radiation.

Moh`s micrographic surgery may be used to remove some lip lesions. This method removes the tumor in thin slices. Each slice is then immediately examined under the microscope to look for cancer cells. The surgeon continues to remove slices until the cancer is completely removed. This method minimizes the amount of normal tissue that is removed along with the tumor.

Treatment success is based on the size of the lesion and metastasis. SCC of the lip is slow to metastasize to regional lymph nodes and other organs. Consequently, the overall prognosis for SCC of the lip without such metastasis is favorable, with an 85 percent five-year survival rate.

Upon completion of treatment, a patient with SCC of the lip should receive frequent follow-up physical and oral examinations; approximately 80-90 percent of recurrent lesions appear within the first two post-treatment years. Patients are usually examined every other month during the first year, four times during the second year, and then once a year thereafter.

Oral cancer and the dental professional

Both the dentist and the dental hygienist can play an important role in the detection of oral cancer by performing a cancer screening examination. It is important to remember that early detection is critical; the earlier a lesion is diagnosed and treated, the better the prognosis.

The cancer-screening examination

A cancer-screening examination is a standardized exam for the detection of oral cancer that is recommended by the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH).

A color poster illustrating each step of this cancer screening is available (at no charge) from the NIH. Detecting Oral Cancer: A Guide for Health Care Professionals can be obtained by contacting the National Oral Health Information Clearinghouse, 1 NOHIC Way, Bethesda, MD 20892-3500.

Additional resources

For additional information concerning oral cancer, the following resources are recommended:

Y American Cancer Society, (800) ACS-2345, www.

Y National Cancer Institute, (800) 4-CANCER, www.

nci.nih.gov

Y National Oral Health Information Clearinghouse,

(301) 402-7364, www.aerie.com/nohicweb

Cancer-screening steps

A thorough cancer screening must include the following steps:

> A review of the medical history. Question the patient concerning any changes in overall health since the last dental visit.

> An examination of extraoral structures. Examine and palpate the head and neck region for any enlarged and nontender lymph nodes.

> An examination of oral soft tissues. Examine all intraoral tissues at every visit with special emphasis on the three most common locations for oral cancer: lower lip, tongue, and floor of the mouth. If any suspicious lesion is noted, proceed with the following steps ...

> Careful questioning of the patient. Question the patient concerning the lesion: duration; changes in size, color, texture, or consistency; signs; symptoms; and history of injury to the area.

> Identification of risk factors. Question the patient to determine if there is a history of tobacco use, alcohol use, or excessive sun exposure (lip lesions).

> Identification of sources of irritation. Examine the adjacent areas for potential sources of irritation. Eliminate any sources of irritation (repair any chipped teeth or broken dentures).

> A follow-up evaluation of the lesion. If the patient is uncertain about how long the lesion has been present, instruct the patient to return for follow-up evaluation of the lesion in 10-14 days.

> Careful documentation of findings. Make certain to document the following: (l) any changes in medical history; (2) appearance, location and size of lesion; (3) duration of lesion; (4) any history of changes associated with the lesion; (5) any history of injury, signs, or symptoms associated with the lesion; (6) any risk factors or sources of irritation; and (7) any instructions to the patient concerning re-evaluation of the lesion.

> Recognition of the need for a biopsy. Recognize the need for further evaluation of any lesion that lasts longer than 14 days. The biopsy of a persistent lesion can be ordered by a dentist or a physician. If the result of the biopsy is negative and a strong clinical suspicion for oral cancer exists, the lesion should be re-biopsied.

Joen Iannucci Haring, DDS, MS, is an associate professor of clinical dentistry, Section of Primary Care, The Ohio State University College of Dentistry.

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The role of desiccants in the management of periodontitis

Radiographic Interpretations

COURSE NUMBER: 513

Connie M. Kracher, PhD, MSD

Credit Hours:

The primary objective of this course is to increase your general knowledge of radiographic interpretations by examining case studies. Radiographic interpretation is an important part of diagnoses. This course features case studies with radi...

(Use this feature to create assignments for your students and staff.)

The primary objective of this course is to increase your general knowledge of radiographic interpretations by examining case studies. Radiographic interpretation is an important part of diagnoses. This course features case studies with radiographic images to assist dental professionals in diagnoses of certain conditions of the oral cavity.

The information in this 12-module syllabus is intended (1) to meet elements of initial educational/training requirements for Dental Students, Dental Hygiene Students, and Dental Assistant Students related to dental radiography; (2) to provide a framework for an in-service training program in oral healthcare settings to meet annual educational/training requirements as mandated by federal, state, local and professional organizations; and (3) to serve as a resource for oral healthcare personnel wishing to review evidence-based information on specific topics related to dental radiography. A PDF is available for each module that may serve as a convenient resource.

Intended Audience:

Dentists, Dental Hygienists, Dental Assistants, Dental Students, Dental Hygiene Students, Dental Assisting Students

Date Course Online:

Dec 1, 2018

Last Revision Date:

Feb 9, 2022

Course Expiration Date:

Feb 8, 2025

Self-instructional

AGD Subject Code(s):

Technical Requirements:

Stable internet connection and the latest version of browser and device software are recommended.

Learning Objectives

Upon the completion of this course, the dental professional should be able to:

• Describe dentigerous cysts and understand the implications associated with this condition.
• Describe mesiodens and explain the anatomical and regional perspective relating to these supernumerary teeth.
• Define siaoliths and describe the potential complications associated with this condition.
• Describe odontomas and be able to explain their origin and potential complications.
• Explain idiopathic osteosclerosis and discuss its radiographic appearance.

Disclaimers

• P&G is providing these resource materials to dental professionals. We do not own this content nor are we responsible for any material herein.
• Participants must always be aware of the hazards of using limited knowledge in integrating new techniques or procedures into their practice.  Only sound evidence-based dentistry should be used in patient therapy.

Note:   Registration is required to take test.

Conflict of Interest Disclosure Statement.

• The author reports no conflicts of interest associated with this course.

Connie M. Kracher PhD, MSD

Dr. Kracher is an Associate Professor of Biology and Director of University Research and Innovation at Purdue University Fort Wayne. Dr. Kracher is a national Key Opinion Leader (KOL) for several R&Ds, consultant for national dental organiza...

Submission Information

Academy of General Dentistry (AGD) Submission For credit transfers to appear in your AGD account in real time, make sure to add your AGD membership number in the field provided on the “Share Your Test Score” page.

CE Broker For all states that use CE Broker for licensure, “proof of completions” are electronically reported the first of every month. If a course was taken in November, the “proof of completion” will be submitted the beginning of December.

Recognition

Approved PACE Program Provider

THE PROCTER & GAMBLE COMPANY

Nationally Approved PACE Program Provider for FAGD/MAGD credit.

Approval does not imply acceptance by any regulatory authority or AGD endorsement.

8/1/2021 to 7/31/2027

Provider ID# 211886

AADH Approved Program Provider

Procter & Gamble is designated as an approved Provider by the American Academy of Dental Hygiene, Inc. #AADHPGC (January 1, 2024-December 31, 2025). Approval does not imply acceptance by a state or provincial Board of Dentistry. Licensee should maintain this document in the event of an audit.