Screenings during dental hygiene appointments

Sept. 15, 2011
Stacy McCauley, RDH, MS, says that if the hygienist is not spending adequate time performing the necessary screenings before picking up a scaler, an opportunity has been missed to collect the information necessary to evaluate risk and make a definitive diagnosis. McCauley discusses three screenings that she believes should be included during the dental hygiene exam phase of the recare or periodontal maintenance appointment.
By Stacy McCauley, RDH, MS
As the research continues to grow supporting the notion that oral health and systemic health are interrelated, the importance of the dental hygiene appointment has gained a new sense of importance. The screenings that are performed during a dental hygiene visit are not only important, but could be life saving. Wouldn’t you agree? This article will look at the disconnect between what we know and what we do.If you had to prioritize, what is the most important service you provide to clients during their visit with you? Now that you have selected the most important service, break down your dental hygiene appointment into sections: the beginning of the appointment (hygiene exam), the middle of the appointment (scale & polish), and the end of the appointment (the doctor exam). What service in the dental hygiene process of care do you dedicate the most time to? Is it the beginning, middle, or end? Are you dedicating the most amount of time to the service you identified earlier as the most important? As a dental hygiene productivity coach and speaker, I almost always hear hygienists say, “I think the health history update, blood pressure, periodontal charting, and the oral cancer exam are the most important services I should provide. However, I typically don’t have time to do those screenings because the bulk of my time is spent scaling during my clients’ appointments.” When you hear comments like that, does it make you wonder how the dental hygiene process of care has moved so far away from being a part of the healthcare model? The profession of dental hygiene is at risk of being perceived as a technical skill if clinicians prioritize the appointment as “successful” if they’ve scaled every tooth in the arch, while eliminating extremely important screenings in order to do this. Therapeutic scaling is important. However, if the clinician isn’t spending adequate time performing all of the necessary screenings before picking up a scaler, they’ve missed the opportunity to collect all of the pieces of information necessary to evaluate risk and make a definitive diagnosis. This article will detail some of the screenings that should be included during the dental hygiene exam phase of the recare or periodontal maintenance appointment. For brevity, the author has selected three screenings to highlight: blood pressure screening, the extraoral exam, and the intraoral exam. Hypertension is a major risk factor for heart disease and stroke, end-stage renal disease, and peripheral vascular disease and is a chief contributor to adult disability.(1) Approximately one in four adults in the United States has hypertension.(2) Many Americans see the dental hygienist more than their primary health care provider. Therefore, screening for high blood pressure during the dental hygiene appointment proves invaluable for early detection and prompt referral to their primary care physician. Are you providing blood pressure screenings as a courtesy to your patients at every visit? The incidence of thyroid cancer has increased in the past two decades. A comprehensive extraoral exam is one way to detect abnormalities in the thyroid gland. Thyroid cancer incidence is almost three times higher in females than in males and more than two times higher in whites than in African Americans.(3) All dental hygienists are taught to perform extraoral examinations, to competence, on all of their patients in dental hygiene school. Palpating the thyroid area can be one of the best diagnostic assessments of thyroid irregularities. Are you providing head and neck extraoral examinations as a standard screening provided to all patients? What about the intraoral cancer exam? Death rates associated with this type of cancer are not attributed to issues with diagnosis. The death rates are directly related to late diagnosis. Epidemiologists state that until we have standardized, comprehensive programs to screen for oral cancer, patients will continue to get diagnosed far too late in the disease progression; the late stage discovery where the disease is already metastasized is extremely common. Between 1988 and 2004, the incidence of HPV-positive oropharyngeal cancers increased 225%.(4) Considering the new findings related to how the human papilloma virus impacts oral cancer incidence, dental hygiene oral cancer exams must be performed by the dental hygienists along with the dentist during each dental hygiene appointment. How often do your perform an intraoral exam on your clients? The author feels strongly that with an appropriate amount of time scheduled for a dental hygiene preventive care appointment or a periodontal maintenance appointment, dental hygienists will have adequate time to perform a complete examination, formulation of risk assessment and a treatment plan based on diagnostic findings, prior to picking up the scaler. Forty, 45, or even 50 minute appointments, make it almost impossible to perform these potentially life saving screenings along with the prophylaxis or periodontal maintenance. Dental hygienists, given an hour with each client, have adequate time to perform comprehensive screenings and provide therapy for clients. As stated earlier, this article focused on three screenings that can be performed during a dental hygiene examination; it is in no way a comprehensive list. In a future article, the author will include the definitive periodontal screenings in order to make a definitive periodontal diagnosis. For additional information on hygiene coaching programs available through Inspired Hygiene, Inc., please visit www.inspiredhygiene.com.References
1. US Department of Health and Human Services, National Institutes for Health, National Heart, Lung, and Blood Institute. High blood pressure: who is at risk? www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP_WhoIsAtRisk.html.2. American Heart Association. Heart disease and stroke statistics 2004 update. Dallas, TX: American Heart Association.3. Cancer Trends Progress Report progressreport.cancer.gov4. Incidence Trends for Human Papillomavirus Related and Unrelated Oral Squamous Cell Carcinomas in the United States. Chaturvedi, A. et al J. Clin. Oncol. 2008;26:612-9.
Stacy McCauley, RDH, MS, has 18 years of experience in dentistry. She has worked in private practice, dental hygiene education, the corporate dental industry, and as a hygiene productivity coach. She is currently a lead hygiene productivity coach with Inspired Hygiene, Inc. and is an Adjunct Assistant Professor at the University of North Carolina School of Dentistry. Contact Stacy at [email protected].