How Do You Define a Dental Hygiene Diagnosis?

A memo I was asked to sign regarding periodontal treatment guidelines does not mention the dentist’s responsibility for diagnosing periodontal disease, advising the patient, treatment planning, or referring to a periodontist. Am I outside of my practice act for performing these functions?

By Michele P. Carr, RDH, MA, EdD On Oct 11, 2018 0

QUESTION: I am an experienced New York-based dental hygienist. Recently, I was asked to sign a memo regarding periodontal treatment guidelines. The memo states if patients show evidence of periodontal disease, I must inform them and treatment plan for scaling and root planing if they have 3 mm or more 4 mm pockets in a quadrant or refer them to the periodontist if they have three or more 5 mm pockets or greater in a quadrant. The memo does not mention the dentist’s responsibility for diagnosing periodontal disease, advising the patient, treatment planning, or referring to a periodontist. Am I outside of my practice act for performing these functions?

ANSWER: Every state has a dental practice act to which dental hygienists must adhere. In New York, the practice act states: “The practice of dental hygiene may be conducted in the office of any licensed dentist or in any appropriately equipped school or public institution but must be done either under the supervision of a licensed dentist or … pursuant to a collaborative arrangement with a licensed and registered dentist … The commissioner shall promulgate regulations defining the functions a dental hygienist may perform that are consistent with the training and qualifications for a license as a dental hygienist.”¹

Dental hygienists are taught to assess, recognize, and treat all types of periodontal diseases. It is their responsibility to present their findings to the supervising dentist and discuss these findings with patients. This is consistent with the training for all dental hygienists who graduate from Commission on Dental Accreditation-approved programs.²

The topic of “diagnosis” continues to be controversial. In 2015, the American Dental Hygienists’ Association created a definition of a dental hygiene diagnosis as “the identification of an individual’s health behaviors, attitudes, and oral health care needs for which a dental hygienist is educationally qualified and licensed to provide.”³ The dental hygiene diagnosis involves a thorough patient assessment and informed decision making. The hygienist then develops the dental hygiene treatment plan which is incorporated into the comprehensive treatment plan developed by the dentist. Although a dental hygiene diagnosis is not recognized in most state dental practice acts, Colorado, Connecticut, and Oregon allow a dental hygiene diagnosis. California, Colorado, Iowa, Kansas, Nevada, New York, North Dakota, and Oregon allow dental hygienists to treatment plan, and two states (Idaho and New York) recognize a “dental hygiene assessment.”⁴ Even if dental hygiene diagnosis, treatment plan, and assessment are not recognized in every state, the definition of a dental hygiene diagnosis supports our obligation to recognize periodontal diseases and present the patient’s treatment needs to the dentist. The dental hygiene diagnosis can then be incorporated into the overall diagnosis of oral disease and help determine an appropriate treatment plan.

In the scenario described above, the dentists are creating a protocol for the office so that all clinicians understand the philosophy of the practice regarding the expectations for recognizing, diagnosing, and referring for periodontal disease. It is ultimately the dentist’s responsibility to diagnose periodontal disease and formulate a treatment plan, but it is the dental hygienist’s responsibility to present his or her findings, supporting the diagnosis. Therefore, diagnosing periodontal disease, advising the patient, and treatment planning the scaling and root planing, or referral to the periodontist is not a violation of the dental practice act, as it states the dental hygienist practices under the supervision of the dentist.

Dental hygienists are not responsible for failure to diagnose and treat periodontal disease, as long as the dental hygienist thoroughly documents his or her findings and clearly explains them to the dentist and the patient. If the patient is seated in another operatory for the exam by the dentist, there should be a mechanism to communicate the dental hygienist’s findings to the dentist. Collaboration and clear communication between dental hygienists and dentists is crucial to assure there is a unified protocol, which will help meet the comprehensive treatment needs of the patient.

REFERENCES

New York State. Office of the Professions, Laws, Rules and Regulations. Available at: op.nysed.gov/prof/dent/part61.htm#dhpract. Accessed September 15, 2018.
Commission on Dental Accreditation. Accreditation Standards for Dental Hygiene Education Programs. Available at: ada.org/~/media/CODA/Files/dh.ashx. Accessed September 15, 2018.
American Dental Hygienists’ Association. Dental Hygiene Diagnosis. Available at: adha.org/resources-docs/7111_Dental_Hygiene_Diagnosis_Position_Paper.pdf. Accessed September 15, 2018.
American Dental Hygienists’ Association. Dental Hygiene Practice Act Overview: Permitted Functions and Supervision Levels by State. Available at: adha.org/resources-docs/7511_Permitted_Services_Supervision_Levels_by_State.pdf. Accessed September 15, 2018.

The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele Carr, RDH, MA, and Rachel Kearney, RDH, MS, on ethics and risk management; Durinda Mattana, RDH, MS, on fluoride use; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpening; Stacy A. Matsuda, RDH, BS, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Jessica Y. Lee, DDS, MPH, PhD, on pediatric dentistry; Bryan J. Frantz, DMD, MS, and Timothy J. Hempton, DDS, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. Log on to dimensionsofdentalhygiene.com/asktheexpert to submit your question.

From Dimensions of Dental Hygiene. October 2018;16(10):60.