Standard Operating Procedures and Protocols
______
SUBJECT
Dental Hygiene Standing Orders
______
Protocol for Services
Patients may receive dental hygiene services via several mechanisms. These may include:
- Patient has had a complete dental exam and has been referred
- Patient has had emergency dental services and has been referred
- Patient is screened in a community setting (diabetes screening, school screenings, WIC)
- Patient has been screened and has requested an appointment
- Patient has had dental services and is being seen for follow ups
If a patient has had a dental exam the physical status has been evaluated by the treating dentist and appropriate measures have been prescribed. All dental hygiene services will be provided according to the physical status the patient’s needs.
Dental Hygiene Co-Signatures
The dental hygienist will perform procedures included on privileging form. The dental hygienist will take appropriate precautions, follow treatment plans, and complete the progress notes according to approved clinic procedures. No co-signature is needed for dental hygiene services.
Physical Status
American Society of Anesthesiologists (ASA) status (attached):
1. For patients with physical status (ASA) 1 or 2:
Review the medical history, follow appropriate precautions (e.g. take blood pressure, measure blood glucose) and treat the patient. Patients who need premedication prior to treatment will be referred to the dental clinic so that appropriate medications can be prescribed.
2. For patients with physical status 3:
The dental hygienist will request a consultation with either the patient’s treating physician OR the dentist on call to determine appropriate treatment precautions.
3. For patients with physical status 4:
The dental hygienist will request a consultation with the dentist on call to determine the need for further consultations or tests. Written authorization from the patient’s primary medical provider for any appropriate treatment precautions is required prior to dental hygiene treatment and will be retained in the patient’s dental record. Appropriate treatment precautions will be determined for each case.
Treatment
Consent for Treatment
Dental hygienists will complete the CPITN, prevention section, and indicate the appropriate exam and x-rays that are needed on the dental exam form at the initial appointment. Prevention services and needed exam services will be explained. Consent for cleaning, evaluation, and routine periodontal and/or preventive services is given by signing the medical history. Children will not be seen without the presence and written consent of the parent/ guardian.
X-Rays
Patients will receive x-rays according to the clinic dental protocols. New patients will not receive x-rays prior to a comprehensive dental exam by the dentist.
Patients who have a complete dental exam scheduled will be given x-rays according to Dental protocols.
CPITN
Dental hygienists will determine CPITN scores or complete a full periodontal probing chart as needed
Sealants, Prophylaxis and Fluoride
Patients without a complete exam may be screened for oral health needs. The dental hygienist may determine the need for sealants and place as needed. Prophylaxisand fluoride treatments will be done as needed. The dental hygienist may draft a Provisional Dental Hygiene Diagnosis to be reviewed and confirmed by the examining dentist. Patients will then be referred to the dentist for a complete dental exam. All definitive diagnoses will be made by the dentist at the time of the comprehensive examination.
Local Anesthesia
The dental hygienist will only administer local anesthesia when a supervising dentist is available.