Competencies of Dental Hygiene Professional Practice

Fones School of Dental Hygiene Competencies

Students will demonstrate professionalism, ethical behavior, evidenced-based decision making, competent client care, health promotion, and disease prevention. A set of competencies has been developed to verify ability to perform total client care and develop professionally. Students must demonstrate successful completion of these competencies in order to graduate. Completion of competencies confirm that the student has the ability to safely provide dental hygiene care at an entry level, or what is minimally expected in performance as a new graduate. As a licensed professional who continues in his/her career, experience and continued learning leads one in becoming proficient, or eventually, even an expert in the delivery of care.

CORE COMPETENCIES (C)

C1. Apply a professional code of ethics in all endeavors.

C2. Adhere to state and federal laws, recommendations, and regulations in the provision of oral health care.

C3. Use critical thinking and comprehensive problem-solving to provide oral health care that promotes patient/client health and wellness in the provision of evidenced-based practice.

C4. Assume responsibility for dental hygiene actions based on the accepted standard of care.

C5. Continuously perform self-assessment and direction for life-long learning and professional growth.

C6. Advance the profession through leadership, service activities and affiliations with professional and public organizations.

C7. Communicate effectively with diverse individuals and groups, serving all persons without discrimination by acknowledging and appreciating diversity.

C8. Facilitate a collaborative approach with all patients when assisting in the development and presentation of individualized care plans that are specialized, comprehensive, culturally sensitive, and acceptable to all parties involved in care planning.

C9. Integrate emerging technologies, accepted scientific theories and research into educational, preventive, and therapeutic oral health services.

C10. Facilitate consultations and referrals with all relevant health care providers for optimal patient care.

HEALTH PROMOTION AND DISEASE PREVENTION (HP)

HP1. Promote the values of total health and wellness to the public and organizations within and outside the profession.

HP2. Respect the goals, values, beliefs and preferences of the patient/client while promoting optimal total health and wellness.

HP3. Identify individual and population risk factors to develop, implement and evaluate strategies that promote health and prevent disease.

HP4. Evaluate and utilize methods to ensure the health and safety of the patient/client and the dental hygienist in the delivery of oral health care.

COMMUNITY INVOLVEMENT (CM)

CM1. Assess the oral health needs of the community and the quality and availability of resources and services to determine action plans.

CM2. Provide screening, referral and educational services that allow patients/clients to access the resources of the health care system.

CM3. Implement community oral health services in a variety of settings.

CM4. Facilitate patient/client access to oral health services by influencing individuals and/or organizations for the provision of oral health care.

CM5. Evaluate the outcomes of community-based programs and plan for future activities.

CM6. Advocate for effective oral health care for underserved populations.

PATIENT/CLIENT CARE (PC)

PC1. Patient/client population- Provide dental hygiene care for members of diverse populations. This competency includes:

  1. Provide quality, safe and comfortable dental hygiene care for the child, adolescent, adult, geriatric and medically compromised patient/client.
  2. Provide quality, safe and comfortable dental hygiene care for patients/clients with special needs and those from diverse cultural backgrounds.

PC2. Assessment – Systematically collect, analyze and record data on the general, oral and psychosocial health status of a variety of patients/clients using methods consistent with medico legal principle. This competency includes:

  1. Assess patient/client concerns, goals, values, needs and preferences to guide patient/client care.
  2. Recognize the relationships among systemic disease, medications, and oral health that impact overall patient care and treatment outcomes.
  3. Identify patients at risk for medical emergency, and manage the patient care in a manner that prevents an emergency.
  4. Accurately collect, record and interpret a medical/dental history and vital signs recognizing conditions that require consultation, referral, special precautions or considerations prior to or during oral hygiene care.
  5. Perform extra-oral and intra-oral examinations of hard and soft tissues and accurately record and interpret the findings.
  6. Identify the need for and safely expose radiographs of diagnostic quality.
  7. Distinguish normal from abnormal radiographic findings and correlate those findings with clinical exam data.
  8. Recognize predisposing and etiologic risk factors that require intervention to prevent and control disease.
  9. Accurately complete appropriate supplemental examinations to obtain, validate and interpret diagnostic information, recognizing advantages and limitations.

PC3. Dental Hygiene Diagnosis – Use assessment data, diagnostic technologies, and critical decision making skills to determine the patient/client’s oral health needs. This competency includes:

  1. Use critical decision making skills to analyze and interpret the assessment data to formulate an accurate dental hygiene diagnosis
  2. Collaborate as needed with a dental hygienist, supervising dentist, and/or other health professional to finalize the dental hygiene diagnosis.

PC4. Planning – Formulate a comprehensive patient/client-centered care plan based on assessment information and current scientific evidence. This competency includes:

  1. Design a comprehensive individualized dental hygiene care plan collaboratively with the patient/client/caregiver to facilitate optimal oral health.
  2. Provide a dental hygiene care plan for the patient/client using effective interpersonal and communication skills.
  3. Obtain the patient/client’s informed consent based on a thorough case presentation.

PC5. Implementation- Provide specialized treatment that includes educational, preventive, and therapeutic services designed to achieve and maintain oral health. This competency includes:

  1. Partner with the patient in achieving oral health goals.
  2. Efficiently deliver effective preventive and therapeutic dental hygiene care.

PC6. Evaluation- Evaluate the effectiveness of the provided services, and modify care plans as needed. This competency includes:

  1. Determine the outcomes of dental hygiene interventions using indices, instruments, examination techniques, and patient self-reports as specified in patient goals.
  2. Compare actual outcomes to expected outcomes, reevaluating goals, diagnoses, and services when expected outcomes are not achieved.

PROFESSIONAL GROWTH AND DEVELOPMENT (PGD)

PGD1. Pursue career opportunities within health care, industry, education, research, and other roles as they evolve for the dental hygienist.

PGD2. Access and critically evaluate scientific literature to make evidence-based decisions that improve the quality of care to patients/clients.

PGD3. Access professional and social networks to pursue professional goals.

FONES SCHOOL OF DENTAL HYGIENE CURRICULUM IN ACCORDANCE WITH CONNECTICUT DENTAL HYGIENE PRACTICE ACT

To practice dental hygiene, a dental hygienist must obtain a license from the state in which they are employed. The legal duties of a dental hygienist are spelled out in the respective states’ dental practice act.

Chapter 379a, Connecticut General Statutes, addresses the general laws pertaining to the practice of dental hygiene. As a student enrolled in DH 228, Clinic Practice IV, you will be required to access the www.dph.state.ct.us website and print a copy of the Practice Act – to be discussed in class. If you will be practicing dental hygiene in another state, you will want to access individual states information.

As you begin your studies in dental hygiene, it is important that you know the content of Chapter 379a, sec 20-1261. Administration of local anesthesia is effective as of October 1, 2005.

Sec. 20-1261. Definitions. Scope of practice. Limitations. Continuing education.

(a) As used in this section:

(1) “General supervision of a licensed dentist” means supervision that authorizes dental hygiene procedures to be performed with the knowledge of said licensed dentist, whether or not the dentist is on the premises when such procedures are being performed;

(2) “Public health facility” means an institution, as defined in section 19a-490, a community health center, a group home, a school, a pre-school operated by a local or regional board of education or a head start program; and

(3) The “practice of dental hygiene” means the performance of educational, preventive and therapeutic services including: Complete prophylaxis; the removal of calcerous deposits, accretions and stains from the supragingival and subgingival surfaces of the teeth by scaling, root planning and polishing; the application of pit and fissure sealants and topical solutions to exposed portions of the teeth; dental hygiene examinations and the charting of oral conditions; dental hygiene assessment, treatment planning and evaluation; the administration of local anesthesia in accordance with the provisions of subsection (d) of this section; and collaboration in the implementation of the oral health care regimen.

(b) No person shall engage in the practice of dental hygiene unless such person (1) has a dental or dental hygiene license issued by the Department of Public Health and (A) is practicing under the general supervision of a licensed dentist, or (B) has been practicing as a licensed dental hygienist for at least two years, is practicing in a public health facility and complies with the requirements of subsection (e) of this section, or (2) has a dental license.

(c) A dental hygienist licensed under sections 20-126h to 20-126w, inclusive, shall be known as a “dental hygienist” and no other person shall assume such title or use the abbreviation “R.D.H.” or any other words, letters or figures which indicate that the person using such words, letters or figures is a licensed dental hygienist. Any person who employs or permits any other person except a licensed dental hygienist to practice dental hygiene shall be subject to the penalties provided in section 20-126t.

(d) A licensed dental hygienist may administer local anesthesia, limited to infiltration and mandibular blocks, under the indirect supervision of a licensed dentist, provided the dental hygienist can demonstrate successful completion of a course of instruction containing basic and current concepts of local anesthesia and pain control in a program accredited by the Commission on Dental Accreditation, or its successor organization, that includes: (1) Twenty hours of didactic training, including, but not limited to, the psychology of pain management; a review of anatomy, physiology, pharmacology of anesthetic agents, emergency precautions and management, and client management; instruction on the safe and effective administration of anesthetic agents; and (2) eight hours of clinical training which includes the direct observation of the performance of procedures. For purposes of this subsection, “indirect supervision” means a licensed dentist authorizes and prescribes the use of local anesthesia for a client/patient and remains in the dental office or other location where the services are being performed by the dental hygienist.

(e) A licensed dental hygienist shall not perform the following dental services: (1) diagnosis for dental procedures or dental treatment; (2) the cutting or removal of any hard or soft tissue or suturing; (3) the prescribing of drugs or medication which require the written or oral order of a licensed dentist or physician; (4) the administration of parenteral, inhalation of general anesthetic agents in connection with any dental operative procedure; (5) the taking of any impression of the teeth or jaws or the relationship of the teeth or jaws for the purpose of fabricating any appliance or prosthesis; (6) the placing, finishing and adjustment of temporary or final restorations, capping materials and cement bases.

(f) Each dental hygienist practicing in a public health facility shall (1) refer for treatment any client/patient with needs outside the dental hygienist’s scope of practice, and (2) coordinate such referral for treatment to dentists licensed pursuant to chapter 379.

(g) All licensed dental hygienists applying for license renewal shall be required to participate in continuing education programs. The Commissioner shall adopt regulations in accordance with the provisions of Chapter 54 to: (1) define basic requirements for continuing education programs, (2) delineate qualifying programs, (3) establish a system of control and reporting, and (4) provide for waiver of the continuing education requirement by the Commissioner for good cause.

All procedures listed above in sec. 20-126-1(a)(3) are taught to clinical competence with the exception of administration of local anesthesia.

Those procedures taught to laboratory competence are not legal duties for dental hygienists to perform in the State of Connecticut (i.e., amalgam finishing, impression for the fabrication of an appliance).

Throughout your studies, your course outlines for DHYG 129, DHYG 130, DHYG 227, DHYG 228 and DHYG 250 will specify those procedures taught to clinical competence and/or laboratory competence.

THE FOLLOWING PROCEDURES ARE TAUGHT TO CLINICAL COMPETENCY:

  • Clinical Infection Control Procedures
  • Medical and Dental Histories
  • Vital Signs
  • Intraoral Inspection (including charting carious lesions, periodontal diseases, existing and missing teeth)
  • Extraoral Inspection
  • Dental Hygiene Assessment/ Dental Hygiene Treatment Planning
  • Evaluation of Dental Hygiene Services
  • Radiographs (digital and film based)
  • Impressions for Study Casts
  • Oral Health Education including Health Promotion, Disease Prevention and Behavior Modification
  • Intra-Oral Imaging
  • Desensitization
  • Care for Removable Appliances and Prostheses
  • Dental-Related Nutritional Counseling
  • Supragingival Scaling
  • Subgingival Scaling
  • Root Planing
  • Coronal Polishing
  • Application of Chemotherapeutic Agents
  • Application of Anticariogenic Agents
  • Polish Restoration
  • Pit and Fissure Sealants
  • Application of Topical/Non-Injectable Anesthetic Agents
  • Application of Locally Applied Antibiotics
  • Assessment Using Caries Diagnostic Scan
  • Pulp Vitality Testing
  • Administration of Local Anesthetic: Infiltration
  • Administration of Local Anesthetic: Mandibular Block

THE FOLLOWING PROCEDURES ARE TAUGHT TO LABORATORY COMPETENCY:

  • Administration of Nitrous Oxide/Analgesia
  • Periodontal and Surgical Dressing: Place
  • Periodontal and Surgical Dressing: Remove
  • Suture: Place
  • Suture: Remove
  • Rubber Dam: Place
  • Rubber Dam: Remove
  • Matrix: Place
  • Matrix: Remove
  • Temporary Restorations: Place
  • Temporary Restorations: Remove
  • Temporary Crown: Fabrication
  • Temporary Crown: Placement
  • Temporary Crown: Removal
  • Amalgam Restorations: Place
  • Amalgam Restorations: Carve
  • Amalgam Restorations: Finish
  • Composite Resin Restorations: Place
  • Composite Resin Restorations: Finish
  • Application of Cavity Liners and Bases
  • Removal of Excess Restorative Materials
  • Fabrication of Custom Impression Tray
  • Mouth Protector Fabrication

CODE OF ETHICS FOR DENTAL HYGIENISTS

1. Preamble
As dental hygienists, we are a community of professionals devoted to the prevention of disease and the promotion and improvement of the public’s health. We are preventive oral health professionals who provide educational, clinical, and therapeutic services to the public. We strive to live meaningful, productive, satisfying lives that simultaneously serve us, our profession, our society, and the world. Our actions, behaviors, and attitudes are consistent with our commitment to public service. We endorse and incorporate the Code into our daily lives.

2. Purpose
The purpose of a professional code of ethics is to achieve high levels of ethical consciousness, decision making, and practice by the members of the profession. Specific objectives of the Dental Hygiene Code of Ethics are:

  • To increase our professional and ethical consciousness and sense of ethical responsibility.
  • To lead us to recognize ethical issues and choices and to guide us in making more informed ethical decisions.
  • To establish a standard for professional judgment and conduct.
  • To provide a statement of ethical behavior the public can expect from us.

The Dental Hygiene Code of Ethics is meant to influence us throughout our careers. It stimulates our continuing study of ethical issues and challenges us to explore our ethical responsibilities. The Code establishes concise standards of behavior to guide the public’s expectations of our profession and supports existing dental hygiene practice, laws, and regulations. By holding ourselves accountable to meeting the standards stated in the Code, we enhance the public’s trust on which our professional privilege and status are founded.

3. Key Concepts
Our beliefs, principles, values, and ethics are concepts reflected in the Code. They are the essential elements of our comprehensive and definitive code of ethics, and are interrelated and mutually dependent.

4. Basic Beliefs
We recognize the importance of the following beliefs that guide our practice and provide context for our ethics:

  • The services we provide contribute to the health and well being of society.
  • Our education and licensure qualify us to serve the public by preventing and treating oral disease and helping individuals achieve and maintain optimal health.
  • Individuals have intrinsic worth, are responsible for their own health, and are entitled to make choices regarding their health.
  • Dental hygiene care is an essential component of overall healthcare and we function interdependently with other healthcare providers.
  • All people should have access to healthcare, including oral healthcare.
  • We are individually responsible for our actions and the quality of care we provide.

5. Fundamental Principles
These fundamental principles, universal concepts, and general laws of conduct provide the foundation for our ethics.

Universality
The principle of universality assumes that, if one individual judges an action to be right or wrong in a given situation, other people considering the same action in the same situation would make the same judgment.

Complementarily
The principle of complementarity recognizes the existence of an obligation to justice and basic human rights. In all relationships, it requires considering the values and perspective of others before making decisions or taking actions affecting them.

Ethics
Ethics are the general standards of right and wrong that guide behavior within society. As generally accepted actions, they can be judged by determining the extent to which they promote good and minimize harm. Ethics compel us to engage in health promotion/disease prevention activities.

Community
This principle expresses our concern for the bond between individuals, the community, and society in general. It leads us to preserve natural resources and inspires us to show concern for the global environment.

Responsibility
Responsibility is central to our ethics. We recognize that there are guidelines for making ethical choices and accept responsibility for knowing and applying them. We accept the consequences of our actions or the failure to act and are willing to make ethical choices and publicly affirm them.

6. Core Values
We acknowledge these values as general guides for our choices and actions.

Individual autonomy and respect for human beings
People have the right to be treated with respect. They have the right to informed consent prior to treatment, and they have the right to full disclosure of all relevant information so that they can make informed choices about their care.

Confidentiality
We respect the confidentiality of client information and relationships as a demonstration of the value we place on individual autonomy. We acknowledge our obligation to justify any violation of a confidence.

Societal Trust
We value client trust and understand that public trust in our profession is based on our actions and behavior.

Nonmalificence
We accept our fundamental obligation to provide services in a manner that protects all clients and minimizes harm to them and others involved in their treatment.

Beneficence
We have a primary role in promoting the well being of individuals and the public by engaging in health promotion/disease prevention activities.

Justice and Fairness
We value justice and support the fair and equitable distribution of healthcare resources. We believe all people should have access to high-quality, affordable oral healthcare.

Veracity
We accept our obligation to tell the truth and assume that others will do the same. We value self-knowledge and seek truth and honesty in all relationships.

7. Standards of Professional Responsibility
We are obligated to practice our profession in a manner that supports our purpose, beliefs, and values in accordance with the fundamental principles that support our ethics. We acknowledge the following responsibilities:

To Ourselves as Individuals…

  • Avoid self-deception, and continually strive for knowledge and personal growth.
  • Establish and maintain a lifestyle that supports optimal health.
  • Create a safe work environment.
  • Assert our own interests in ways that are fair and equitable.
  • Seek the advice and counsel of others when challenged with ethical dilemmas.
  • Have realistic expectations of ourselves and recognize our limitations.

To Ourselves as Professionals…

  • Enhance professional competencies through continuous learning in order to practice according to high standards of care.
  • Support dental hygiene peer-review systems and quality-assurance measures.
  • Develop collaborative professional relationships and exchange knowledge to enhance our own lifelong professional development.

To Family and Friends…

  • Support the efforts of others to establish and maintain healthy lifestyles and respect the rights of friends and family.

To Clients…

  • Promote ethical behavior and high standards of care by all dental hygienists.
  • Serve as an advocate for the welfare of clients.
  • Provide clients with the information necessary to make informed decisions about their oral health and encourage their full participation in treatment decisions and goals.
  • Refer clients to other healthcare providers when their needs are beyond our ability or scope of practice.
  • Educate clients about high-quality oral healthcare.

To Colleagues…

  • Conduct professional activities and programs, and develop relationships in ways that are honest, responsible, and appropriately open and candid.
  • Encourage a work environment that promotes individual professional growth and development.
  • Collaborate with others to create a work environment that minimizes risk to the personal health and safety of our colleagues.
  • Manage conflicts constructively.
  • Support the efforts of other dental hygienists to communicate the dental hygiene philosophy of preventive oral care.
  • Inform other healthcare professionals about the relationship between general and oral health.
  • Promote human relationships that are mutually beneficial, including those with other healthcare professionals.

To Employees and Employers…

  • Conduct professional activities and programs, and develop relationships in ways that are honest, responsible, open, and candid
  • Manage conflicts constructively.
  • Support the right of our employees and employers to work in an environment that promotes wellness.
  • Respect the employment rights of our employers and employees.

To the Dental Hygiene Professions…

  • Participate in the development and advancement of our profession.
  • Avoid conflicts of interest and declare them when they occur.
  • Seek opportunities to increase public awareness and understanding of oral health practices.
  • Act in ways that bring credit to our profession while demonstrating appropriate respect for colleagues in other professions.
  • Contribute time, talent, and financial resources to support and promote our profession.
  • Promote a positive image for our profession.
  • Promote a framework for professional education that develops dental hygiene competencies to meet the oral and overall health needs of the public.

To the Community and Society…

  • Recognize and uphold the laws and regulations governing our profession.
  • Document and report inappropriate, inadequate or substandard care and/or illegal activities by any healthcare provider, to the responsible authorities.
  • Use peer review as a mechanism for identifying inappropriate, inadequate or substandard care and for modifying and improving the care provided by dental hygienists.
  • Comply with local, state and federal statutes that promote public health and safety.
  • Develop support systems and quality-assurance programs in the workplace to assist dental hygienists in providing the appropriate standard of care.
  • Promote access to dental hygiene services for all, supporting justice and fairness in the distribution of healthcare resources.
  • Act consistently with the ethics of the global scientific community of which our profession is a part.
  • Recognize and uphold our obligation to provide pro bono service.

To Scientific Investigations…

  • We accept responsibility for conducting research according to the fundamental principles underlying our ethical beliefs in compliance with universal codes, governmental standards, and professional guidelines for the care and management of experimental subjects.
  • We acknowledge our ethical obligations to the scientific community:
  • Conduct research that contributes knowledge that is valid and useful to our clients and society.
  • Use research methods that meet accepted scientific standards.
  • Use research resources appropriately.
  • Systematically review and justify research in progress to insure the most favorable benefit-to-risk ratio to research subjects.
  • Submit all proposals involving human subjects to an appropriate human subject review committee.
  • Secure appropriate institutional committee approval for the conduct of research involving animals.
  • Obtain informed consent from human subjects participating in research that is based on specifications published in Title 21 Code of Federal Regulations Part 46.
  • Respect the confidentiality and privacy of data.
  • Seek opportunities to advance dental hygiene knowledge through research by providing financial, human, and technical resources whenever possible.
  • Report research results in a timely manner.
  • Report research findings completely and honestly, drawing only those conclusions that are supported by the data presented.
  • Report the names of investigators fairly and accurately.
  • Interpret the research and the research of others accurately and objectively, drawing conclusions that are supported by the data presented and seeking clarity when uncertain.
  • Critically evaluate research methods and results before applying new theory and technology in practice.
  • Be knowledgeable concerning currently accepted preventive and therapeutic methods, products, and technology and their application to our practice.