Dental hygienist

A registered dental hygienist (RDH) is a licensed dental professional who specializes in preventive oral health, typically focusing on techniques in oral hygiene. Dental hygienists provide three types of services to their patients. The first of these is preventive services to promote and maintain good oral health. The second is educational services to help patients develop behaviours that promote better oral heath and help them understand the importance of practicing these behaviours. The third type of service provided is therapeutic services which are treatments meant to stop disease and maintain healthy tissues in the mouth.^[1] Local dental regulations determine the scope of practice of dental hygienists. In most jurisdictions, hygienists work for a dentist, and some are licensed to administer local anesthesia. Common procedures performed by hygienists include cleanings known as prophylaxis, scaling and root planing for patients with periodontal disease, taking of prescribed radio graphs, dental sealants, administration of fluoride, and providing instructions for proper oral hygiene and care.
Dental hygienist work together with dentist to contribute to a co-therapist environment, while providing optimum oral health care to the public. Dental hygienists also offer expertise in their field and provide the dental hygiene diagnosis, which is an integral component of the comprehensive dental diagnosis.^[2]

Dental hygiene process of care

A dental hygienist at work

The dental hygiene process of care has five steps:

• Assessing the patient: This includes, but is not limited to, a full review of the patient's medical history, necessary x-rays to be taken, a clinical exam, and a periodontal assessment by probing and exploring areas of the patients mouth. During this stage a thorough documentation must be implemented.
• Dental hygiene diagnosis: Assessing of data pertaining to a client's condition/state in terms that will help identify problems so as to lead to a professional treatment plan/ therapies. The final diagnosis of disease and/or treatments solely lies with jurisdiction and/or approval granted by the doctor.
• Planning: creating a sequential treatment plan for the patient. The treatment plan will vary based on the patient's immediate needs.
• Implementation: Carrying out the plan in a timely and effective manner.
• Evaluation: Determining the effectiveness of the treatment plan that was administered. If ineffective a complete evaluation on how to approach the patient's needs differently

Over a period of months or years, a dental hygienist may evaluate the client's conditions several times, altering the diagnosis and plan as the client's condition changes.

Training

Australia

See also: dental therapist

Dental hygienists in Australia must be graduates from a dental hygiene program, with either an advanced diploma (TAFE), associate degree, or more commonly a bachelor's degree from a dental hygiene school that is accredited by the Australian Dental Council (ADC).
All dental hygienists in Australia must be registered with the Dental Board of Australia, after completing a minimum of three years of training.
A Bachelor of Oral Health is the most common degree program. Students entering a bachelor's degree program are required to have a high school diploma or equivalent. Most Bachelor of Oral Health programs now qualify students as both Dental Hygienists and Dental Therapists, collectively known as Oral Health Therapist

Canada

Dental hygienists in Canada must have completed a 3-year diploma program. Three universities in Canada offer Bachelor of Science degrees in Dental Hygiene: Dalhouise University, University of Alberta, University of British Columbia.[2][3][4]

[5]

[6][7][8] In Ontario, hygenists may take further training to become a restorative hygienist. ^[3]
Dental hygienists in BC, ON, NS and AB are able to open their own private clinics and practice without a dentist on staff.

United States

Dental hygienists in the United States must be graduates from a dental hygiene program, with either an associate degree (most common), a certificate, a bachelor's degree or a master's degree from a dental hygienist school that is accredited by the American Dental Association (ADA).^[4]
All dental hygienists in the United States must be licensed by the state in which they practice, after completing a minimum of two years of school and passing a written board as well as a clinical board exam.^[5] State requirements vary by state, and are controlled by state dental boards.^[6]
Dental hygienists school programs usually require both general education courses and courses specific to the field of dental hygiene. General education courses important to dental hygiene degrees include college level algebra, biology, and chemistry. Courses specific to dental hygiene may include anatomy, oral anatomy, materials science, pharmacology, radiography, periodontology, nutrition, and clinical skills.
A Bachelor's of Science in Dental Hygiene is typically a four-year program. Students entering a bachelor's degree program are required to have a high school diploma or equivalent, but many dental hygienists with an associate's degree or certification enter the bachelor's degree programs to expand their clinical expertise and help advance their careers.
Graduate degrees in the field of dental hygiene are typically two-year programs and are completed after the bachelor's degree. Common graduate courses in dental hygiene include Healthcare Management, Lab Instruction, and Clinical Instruction.
After completing one of the more than 200 accredited dental hygiene programs in the United States, dental hygienists must be licensed in the state in which they work. Licensure requirements for becoming a Registered Dental Hygienist (RDH) vary from state to state, but most require a two-year degree, a written examination, and a clinical examination. The National Board Dental Hygiene Examination is intended to fulfill the written examination requirements. The clinical examination is typically administered by the state licensing board.
In addition, the American Dental Hygienists' Association has defined a more advanced level of dental hygiene, the Advanced Dental Hygiene Practitioner otherwise known as a dental therapist.

Tooth Whitening and Total Patient Care

Has a dental procedure ever commanded as much attention from the public as the current tooth-whitening phenomenon? Consumer media articles and advertisements remind patients daily to brighten their smiles, creating a demand for a cosmetic dental procedure that is within reach of the average budget. The low cost of over-the-counter (OTC) products and their retail availability make them accessible to the masses. Even in-office or dentist-prescribed take-home procedures are affordable. They are among the least expensive of all esthetic procedures performed by dental professionals, and are significantly less expensive than any medical/surgical cosmetic procedure. When we combine the low costs, strong advertising, and the sheer presence of individuals seeking youthful appearances with the air-brushed images of Julia Roberts, Britney Spears, or Brad Pitt, dental professionals know that some challenging expectations have been established.

By providing the rationale for professional monitoring of treatment, as well as the latest information about tooth-whitening options, this article will assist the practitioner in harnessing the current enthusiasm for whiter teeth, obtaining the best possible outcomes, and managing the patient's expectations in the context of total dental care.

Living up to expectations

When patients walk through the door of your office, many of their perspectives are based on what the media is telling them. Advertisements sell the idea of tooth whitening in the same manner as nail polish or hair coloring; it is an inexpensive way to improve your looks and your life. In a recent article for Retail Industry, Melody Vargas reports that Leonard Lauder, Chairman of the Estee Lauder Companies, states that over the years, the company has noted that as the U.S. economic prospects decrease, the sales of lipstick increases. This may be because lipstick is a low priced luxury item that helps folks to feel good in difficult times. Today, as patients shift their shopping from high-end department stores to discount chains, they may be shifting their medical cosmetic dollars from the high-end surgical face-lift to more affordable whiter teeth.

The question for the dental professional to ponder is, "What convinces patients to choose your services for professional whitening over the retail store version of a similar product?" Perhaps it is because when patients walk into your office they place the responsibility for the outcome in your hands. In essence, they are saying to you, "I am willing to pay you five to ten times more money for your care, skill, and judgment because I trust you and expect you can achieve the best outcome while assessing any risk to my teeth."

With the responsibility to produce the same kind of results with tooth whitening as we have been able to achieve for our patients with other procedures in our practices, we must understand the treatment options and potential outcomes.

It is important that both the dental team and the patient understand that tooth whitening is a part of a total esthetic, preventive, and restorative treatment plan that is commensurate with the patient's expectations. For example, vital night-guard whitening without consideration of other dental issues may be very successful and achieve absolutely wonderful results under the right circumstances. On the other hand, stains due to amalgam restorations, fluorosis, pulpal trauma, white spots from febrile illnesses, hypocalcification, erosion, or mottled enamel require a more sophisticated treatment than a to achieve biologically sound and esthetic result.

A simple question

A simple question on your office's medical/dental history form — "Are you satisfied with the color of your teeth?" — provides a lead-in for the patient who may be uncomfortable asking your advice on how to look more appealing. This question opens the door for patients to express their esthetic or cosmetic concerns. It provides you with the opportunity to discuss the difference between a self-administered OTC whitening product and an office-supervised professional treatment plan. It also gives you the opportunity to evaluate the type of stain, the existing restorative materials in the mouth, the health of the gingival tissues, and other factors that may affect the treatment outcome. Because dental restorative materials do not respond to peroxide whitening, failure to have this discussion prior to rendering treatment may result in disappointing esthetic results or the need to redo anterior restorations such as veneers, crowns, or composite restorations after the whitening treatment.

Whether it is the dentist, dental hygienist, or dental assistant, the entire staff should fully understand and be able to articulate the following points when discussing whitening options with the patient.

• Safety — Most of 500-plus research-based and published articles that have been written attesting to the safety of the whitening/bleaching procedure are based on the premise of adherence to proper protocol during dentist-supervised treatment. Issues such as over bleaching, reaching the saturation point for enamel, effect on restorative material bond strength, and soft tissue management are but a few of the considerations to discuss in advance with a patient as you recommend their whitening be supervised in your office.

• Managing sensitivity — In a professionally monitored whitening treatment plan, the dental professional is available to help with complications, the most common being sensitivity. Despite claims that some bleaching products do not create tooth sensitivity, double-blind clinical studies have shown that sensitivity occurs in 55 to 75 percent of treatment groups. Treatment with a 2 percent neutral sodium fluoride gel, such as All Solutions™ (Dentsply Professional), applied with a tray before or after the bleaching session, has been reported to successfully reduce sensitivity to the active whitening ingredients.

Orthodontic forces, due to a poorly fitting tray, can also cause sensitivity. This problem can be avoided if the tray is constructed with reservoirs and is made of soft material. The tray should be scalloped and adjusted to not impinge on the gingival or soft tissue, creating sore spots. Patients should be instructed to bring the tray to the office at each evaluation appointment so any adjustments can be professionally performed.

If the sensitivity is not be relieved by any of the above methods, the patient should reduce the amount of time the tray is worn at each treatment session, or adopt an every-other-day treatment schedule.