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Professional

Practice Discussions

Kellie Watson, RDH, MBA

SDHA Registrar-Executive Director

SDHA Related Q & A • Opportunity to ask questions

Record Keeping • Importance of adequate chart documentation

• Review standards relating to chart documentation

• Components of a dental hygiene record

• Examples/Samples

Dental Hygiene Billing • Review standards relating to dental hygiene billing

• Dental Hygiene Billing Communication

• Appointment Examples

CCP Guidelines • Review CCP Guidelines

• Changes to PL Tools

Jurisprudence • The SDHA

• History

• Dental Hygiene Self-Regulation

• Jurisprudence

• Legislation

Record Keeping

• Importance of adequate chart documentation

• Review standards relating to chart documentation

• Components of a dental hygiene record

• Examples/Samples

Importance of Chart Documentation

• Legal document to accurately and adequately depict a

client’s general and oral health, concerns, and services

provided

• Assists dental hygienists in their day-to-day practice.

• Accurate chronological records help practitioners provide

comprehensive care and ensure continuity and consistency

between practitioners

• Rising trends in complaints and inquiries from insurance

providers

• Financial implications

• Forensic odontology

Accurate dental records

protect both the client and

the oral health care provider

Good recordkeeping will also be useful to the other

members of the oral health care team:

• Dentists

• Current or new (if the client changes offices)

• Other dental hygienists

• Dental assistants and support staff

• i.e. for scheduling or billing purposes

Continuity of Care

Clients are entitled at any time to a report of your assessment, treatment

and prognosis.

• Clients may request them for use by others, such as insurers, employers

and lawyers.

• Clients may need the information for legal proceedings, such as a

disability claim, a motor vehicle accident benefit, a custody battle, or a

discrimination suit on the basis of disability.

Preparing Reports

Failure to provide an adequate report because

of poor records may not only embarrass you

but will also increase the likelihood of your

being asked to testify in court as a witness.

Clients, employers, payers and the SDHA will rely heavily on your record in

assessing the adequacy of your conduct or competence. Accountability is

not restricted to disputes with clients.

The quality of your records is generally seen as a good measure of the

quality of your practice.

Dental Hygienists Accountability & Professional Responsibility

The SDHA is seeing an increasing amount of complaints

and getting inquiries by insurance providers

An adequate and accurate client

record is the first line of defense with

inquiries and complaints

If it wasn’t recorded,

it wasn’t done

Common Documentation Errors

Failure to complete and/or document:

• Medical history

• Dental hygiene diagnosis

• Dental hygiene treatment plan

• Informed consent or refusal

• Entries with adequate details

• Provider initials after entries

Why?

• BUSY!

• Tedious

• Takes time away from client contact

• Postponed until the last minute or is completed at the end of

the day

• Electronic records

• Dental practice routines/protocols

A dental health record…

Is the comprehensive, ongoing file of assessment findings, treatment

services rendered, dental outcomes, notations and contacts with a client.

Simply…it should give a clear idea of not only WHAT happened

during a visit but WHY it was done as well.

A dental health record should include…

Date

Personal data on the client that must be updated routinely Contact information, insurance providers, physician

A health history, including medication, habits and health conditions

A dental history, including information on previous treatments and

the client’s response to those treatments

Care & Treatment, (according to the ADPIE process of care) including

a careful recording of: Assessments

Dental Hygiene Diagnosis

Treatment plan

Treatments rendered, including post-op care

Evaluation

Informed Consent/Refusal

Notes from contact with the client

Referrals/Consultations

Results/letters from specialists

Initials of provider

Time spent performing procedures

Comments about the client/appointment:

• Can be recorded in the dental record, but should relate to the care

of the patient

• Be stated in objective, professional, non-judgmental terms

Example:

If you suspect that a client is under the influence of excessive alcohol,

describe this in the record according to the conditions observed:

• Heavy odor of alcohol

• Slurred speech

• Unsteadiness requiring my assistance

“Client was drunk”

Comments about the client:

Notes about the client’s personal life (job, family, holidays, etc) can

be made in the record, but on a

sticky note is best.

Errors in an entry:

• Make the correction in a timely manner

• A single line (strike-through) should be drawn through the entry, followed by a note that an error was made. The initial text should be able to be seen (no white out or scribbling over)

• The correct information should then be recorded and the entry signed and dated

• If a correction is distanced from the error by intermediate entries, a notation should be made regarding the location or the error and its correction.

• Do it yourself! Do not delegate to another staff member

• If it is in an electronic record, the above principles should still apply:

• Ensure original entry still exists

• Initial or electronic signature

Record Keeping Tips:

• Consistent for all clients

• Develop a system everyone is comfortable with or guidelines for your dental practice

• Templates make life easier (pre-printed chart, or e-templates)

• Tick boxes/options (CHX pre-rinse )

• Review the records regularly, especially medical and dental history being updated to reflect current conditions/issues/trends

• Entries should be clear, concise, legible and permanent (INK)

• Initials or provider logins are a must!

• Acronyms or jargon should be avoided as much as possible unless a clear glossary of terms is used within the dental practice

Electronic Records

• Permanent entries

• Corrections added as a late entry

• Initials (not just selecting your provider number/code)

• Individual staff logins

How many of you have paperless

offices?

Informed Consent/Refusal

• Obtaining informed consent is a process

• Rests on the principle that clients should make their own treatment decisions

• The role of the dental hygienist is to provide information (risks, benefits, costs) and make recommendations that will enable clients to make informed choices

Rationale for Informed Consent/Refusal

• Individuals have control of their bodies.

• We should not touch, examine, or otherwise interfere with another person’s body without true consent.

• Meaningful consent requires that the client knows all the information needed to make an informed choice

• Quality service for a dental hygienist includes advising them of their options and partnering with them.

• The “best possible service” means that the individual client’s goals, expectations, needs and abilities direct the selection of all preventive and therapeutic interventions

Rationale for Informed Consent/Refusal

• Dental hygienists have a fiduciary duty of good faith and loyalty to their clients. We have specialised knowledge and expertise that the clients do not. Clients are vulnerable and it is our responsibility to act only in the client’s best interest

3u scaling, prophy, fluoride on every

client is not meeting our fiduciary duty.

Why is Informed Consent Is Not Always Obtained

• We assume a level of understanding that does not always exist

• We live day in and day out with oral health matters, but clients do not

• We are in a rush

• Tremendous pressure to “get through” your client visits

• Poor communication skills

• Making a statement of need is not communication. We have to allow for feedback and understanding

• Ignorance of the requirements for informed consent

• Does not just apply to invasive procedures. Should be FOR ALL treatment decisions.

How many of you get CONSENT from

your clients at hygiene appointments?

Elements of Informed Consent

• Informal – medical history

• Who will be providing treatment • Your name, what profession you belong to, if another provider is scheduled to see

them that day

• Reason for the treatment • Client should understand the expected benefits, and goals of the treatment,

prognosis, how long it may take to achieve them, etc

• Material effects, risks and side effects

• Alternatives to the treatment

• Consequences of declining the treatment

• Opportunity for questions/concerns

To Give Informed Consent

A client must not only understand the information, but also appreciate the consequences of the decision.

Example:

A client could understand that periodontal disease may have an

effect on the stability of their teeth. However, the client may not

understand that at some point periodontal disease will make teeth

so unstable that they cannot eat certain foods, tooth loss will occur

and it will be difficult for clients to maintain proper nutrition.

Types of Consent

• Informed consent can be written, recorded, or verbal.

• Since informed consent is a process, it requires a verbal discussion regardless of whether there is a written form involved. Written consent forms are used for certain procedures, such as surgical or endodontic procedures, or aggressive periodontal treatment programs .

• If the practice is using digital records only, there are two ways to obtain the patient’s (or guardian’s) signature for the patient record:

• Use a signature pad, which is a device that allows the patient’s signature to be transferred digitally into the record.

• Hard copy document to be signed by the patient, and then that document is scanned into the patient record.

• Oral consents may be satisfactory for routine procedures that you expect the patient to know about, such as a dental examination.

• Recommendation to use written consent documents for all treatment procedures that are invasive or present a high risk.

• If a written consent document is not used, the patient’s verbal consent should be documented in the patient chart. Box on the chart

Example of documentation of verbal consent:

Discussed the diagnosis of periodontal disease; purpose, description, benefits, and risks of the proposed treatment; alternative treatment options; the prognosis of no treatment; and costs. The client asked questions and demonstrates that he understands all information presented during the discussion. Informed consent was obtained for the attached treatment plan.

Refusal

Should be documented in the dental record and signed/initialed by the client

• Radiographs

• Prophylactic Antibiotics

• Examination

• Fluoride

• Other…

Examples:

Which of the following is correct regarding documentation in the

client record?

1. Entries should outline the ADPIE process of care model that

took place in a given appointment

2. Entries made in pencil can be erased provided that the

correct entry is completed at the same time

3. Entries made in ink can be corrected with White-out

4. Entries made in the treatment notes must include the

client’s insurance information

Examples:

Which of the following would be considered an omission error in

a client’s record?

1. Failure to record periodontal assessment data and a dental

hygiene diagnosis

2. Failure to document a dental hygiene care plan

3. Failure to document informed consent

4. All of the above

Examples:

Which of the following would be considered an omission error in a client’s record?

1. Incorrect documentation of pre-procedural rinse

2. Failure to address chief complaint

3. The RDH initial is missing at the end of the entry

4. Incorrect documentation for pain management

Examples:

A client showing up for an initial dental hygiene appointment has given informed

consent?

1. True

2. False

Only implied

consent – not

informed

How long to keep records

• CDSS Document

• 6 years after the date of the last entry in the record

QUESTIONS

Before we move on…

Dental Hygiene Billing • Review standards relating to dental hygiene billing

• Dental Hygiene Billing Communication

• Appointment Examples

Message mailed to all dentists and dental hygienists

December

Joint Message

Often asked for advice and direction on how to correctly bill for dental hygiene treatment time.

Saskatchewan Oral Health Professions Conference Presentation

Frank Edwards September

• While the suggested fees are not obligatory, the use of correct procedure codes is.

• The dentist and dental hygienist must use the code that describes the actual service provided.

Fee Guide

Inappropriate billing could be considered fraudulent by third parties, dental regulators, bylaw enforcement agencies, or the courts.

• Intended to serve as a reference: a structure of fees which is fair and reasonable to the patient and to the dental practice.

• The suggested fees are not obligatory and each dentist is expected to determine independently the fees which will be charged for the services performed.

HOW ARE PER-UNIT-OF-TIME PROCEDURE CODES TO BE DETERMINED AND USED

In the case of per-unit-of-time procedures such as scaling and root planning, the code used must reflect the amount of time spent providing the service.

Time is measured in fifteen minute units. If a procedure takes a partial unit of time, (less than 8 minutes), the procedure code which corresponds to the half unit of time should be used. Where a half unit of time code does not exist, the code which corresponds to the next higher unit of time may be used and the dentist may adjust his/her usual and customary fee lower to reflect, in the billing, the actual time spent on the procedure.

HOW ARE PER-UNIT-OF-TIME PROCEDURE CODES TO BE DETERMINED AND USED

If multiple procedures are being performed in a fifteen minute time unit, the

procedure that should be billed is the predominant procedure in any unit (or half unit) of time.

Example: If you spend 4 minutes on OHI during a unit of scaling, this unit of time should be billed as scaling, because scaling is the predominant procedure. OHI would be the predominant procedure if it took more than 7½ minutes and thus this unit of time should then be billed as OHI, not scaling.

DENTAL HYGIENE TREATMENT TIME DEFINED

Procedure codes billed and time spent should be individualized to each patient. A standardized amount billed for all dental

hygiene appointments or to every patient is unacceptable and should be avoided.

Some offices have moved to a billing protocol where every client is charged the same thing to maximize billing per hygiene

hour. THIS SHOULD NOT BE DONE!!

Employer/practice protocols • Professional Responsibility • Ethics • Accountability


Dental hygiene treatment time is not just limited to "instrument on tooth time“

Treatment time is “all the time the caregiver attends

to the patient”.


The time billable as scaling or root planing would include the following:

Reviewing the chart and asking about the patient’s medical history; Assessing vital signs, which are necessary to prepare for the treatment; Intra-oral/extra-oral assessments; Oral cancer screenings; Probing, recording findings from periodontal assessments and other

dental hygiene treatment notes; Providing post-operative instructions to the patient, when required; and Administering a local anaesthetic, when required. Local anaesthetic

performed as part of dental hygiene treatment is not billable as a separate procedure.


In any appointment, the maximum time billable on a per-unit-of-time basis is

the time the patient is seated, less the time taken to do any separately billable procedures.

Example: • If a recall exam is done in your chair and it takes 8 minutes • And you do 4 BWs (takes 7 minutes) • There are only 45 minutes that can be billed for dental hygiene

treatment time: • 1 hour appt:

• Recall Exam (8 minutes) • 4 BWs (7 minutes) • 2 ½ units scaling (36 minutes) • Prophy (9 minutes) = 60 minutes


Examples of procedures that are not included in scaling or root planing time would be: Separately billable procedures such as examinations or radiographs (if

done in the hygiene chair), prophy, fluoride, OHI, desensitization or sealants;

Breakdown, disinfection and set up of the operatory; Idle time while the dental hygienist is waiting for the doctor to arrive to

perform an examination (i.e., when not performing any procedure or procedure related activity); or

Any remaining appointment time after the patient has been discharged and the time for administrative functions such as billing and reappointing the patient.


Operatory ‘prep’ time, like other administrative functions, is considered

part of general overhead and the recovery of these costs is built into all procedure fees.

Example: • Sharpening • Infection Control • Documentation

NOT billable time!!


Time spent measuring and/or recording oral/dental findings other than periodontal conditions would not be included in hygiene treatment time; this is part of the dentist’s exam and this time is billed to the patient in the exam fee, regardless of whether that exam is done at this appointment or at a subsequent appointment.

Examples: • Occlusion • Hard Tissue Charting • Possible caries

DO DENTAL HYGIENISTS NEED TO RECORD THE START AND STOP TIME FOR ALL PATIENT APPOINTMENTS?

The dental hygienist should record the time spent providing services that are based upon units of time; specifically the time spent scaling and root planning, polishing and/or desensitizing must be recorded. This time should include all the treatment time (excluding the time taken to perform procedures that are billed on a per-procedure basis such as fluoride, pit and fissure sealants, radiographs and the dentist’s recall exam).

Best practice is to record the number of minutes providing each of these services. Recording only as units may be confusing particularly when the office books in 10 minute units because procedure codes are always based on 15 minute units.

DO DENTAL HYGIENISTS NEED TO RECORD THE START AND STOP TIME FOR ALL PATIENT APPOINTMENTS?

The total time recorded for procedures that are billed as per-unit-of-time plus the actual time taken to perform procedures billed on a per-procedure basis should not exceed the total time the patient is in the chair.

Nor is it appropriate to round up several procedures so that the total time billed exceeds the time the patient is seated.

Acceptable 1 Hour appointment examples:

3 units scaling 40 minutes

Prophy 9 minutes

Fluoride 5 minutes

Total 54 minutes

3 ½ units scaling 53 minutes

½ Prophy 6 minutes

Total 59 minutes

Recall Exam 6 minutes

4 BWs 7 minutes

2 ½ units scaling

34 minutes

Prophy 8 minutes

Fluoride 5 minutes

Total 60 minutes

Unacceptable 1 Hour appointment examples:

3 ½ units scaling

53 minutes

Prophy 8 minutes

Fluoride 5 minutes

Total 66 minutes

3 ½ units scaling 53 minutes

Prophy 8 minutes

Total 61 minutes

Recall Exam 8 minutes

2 BWs 5 minutes

3 units scaling 38 minutes

Prophy 8 minutes

Fluoride 5 minutes

Total 64 minutes

Time in units:

½ unit Less than 8 minutes

1 unit 8 to 15 minutes

1 ½ units 15 to 23 minutes

2 units 23 to 30 minutes





QUESTIONS

Before we move on…

Continuing Competency Program Guidelines

• All regulated professionals are required to maintain some form of Continuing Competency or Quality Assurance requirements:

• Continuing Education

• Portfolios

• Examination/Assessment

• Mandated by Government/Regulatory responsibility

• Means to ensure that professionals are remaining current in new technology, skills, knowledge

• Review of accomplishments (audits) demonstrate that regulatory body is ensuring safe, competent professionals

– Members require a minimum of 45 Continuing Competency

credits in a 3-year period • 5 credits provided in the 3rd year for completion of PL Tools

– Required for full, conditional or non-practising members

– A minimum of 30 credits to be obtained in the Dental Hygiene Practice Category

– Credit hours in excess of those required in a 3-year cycle cannot be carried forward to a subsequent period.

SDHA Credit Requirements

All continuing competency programs, courses or equivalent must have significant intellectual or practical content related

to the practice of dental hygiene or to the professional responsibility or ethical obligations of the member.


• Members are responsible for keeping track of their own continuing competency hours and for reporting those hours to the SDHA.

• If the activities/courses are put on by the CDSS, SDHA, SDAA or SDTA there will most often be a sign-in/sign-out sheet at the door that is automatically forwarded to the SDHA. If it is not sponsored by one of these organizations, but is largely attended, confirm with the facilitator that the sign-in/sign-out sheet will be forwarded.

• Members may be granted credits for courses or activities not sponsored by SDHA, however, will be asked to provide further information to the registrar. If members are unsure if courses will qualify for credit, prior approval should be obtained.

Reporting of Credits

Reporting of Credits

ALL FORMS ONLINE AT www.sdha.ca

Please Note:

ONLINE AT www.sdha.ca


Personal Learning Tool Forms (PL Tool) • It is a Saskatchewan registrants’ professional responsibility to determine

their specific continuing competency needs and to pursue activities that enable them to maintain competency in their dental hygiene practice.

• The PL Tool was developed to assist the SDHA membership in their self-determination of learning at continuing education opportunities and to aid application of the knowledge to Practice Standards.

• The CDHA/SDHA Practice Standards and SDHA Competencies apply to all aspects of our day-to-day practice. The Practice Standards are to be used by dental hygienists to assess dental hygiene practices and to identify learning goals that will direct continuing quality improvement activities.


Personal Learning Tool Forms (PL Tool)

• The function of the Personal Learning Tool (PL Tool) is to serve as

evidence that dental hygienists in Saskatchewan are following the Practice Standards of the profession. Each dental hygienist should maintain his/her own evidence of his/her own professional development.

• Each member will RETAIN COPIES of their completed Personal Learning Tool Forms for each three-year reporting period.


Personal Learning Tool Forms (PL Tool) • The Continuing Competency Committee will randomly audit

approximately 10% of dental hygienists’ PL Tool forms annually.

• The audits will be performed on a random selection of those members who are at the end of their three-year reporting periods.

• Those selected will have 2-3 months notice to submit their completed forms. The auditors will review the forms to ensure all the required evidence of continuing professional development has been included.

• Should any forms be incomplete, the dental hygienist will be given an opportunity to correct the deficiency.

PL Tool Changes

• 5 credits each 3 year reporting period for completion of forms, granted in 3rd year.

• Forms changed: – Question 1

– List a minimum of 3 Practice Standards/Competencies

– If audited, submit PL Tools for only 45 credits

http://www.sdha.ca/

Jurisprudence

Outline

• The SDHA • History • Dental Hygiene Self-Regulation • Jurisprudence • Legislation • The Dental Disciplines Act, 1997

• The SDHA Regulatory Bylaws

• The SDHA Administrative Bylaws

• National and SDHA Competencies & Practice Standards

• The SDHA Continuing Competency Program Guidelines

• The Code of Ethics

Serves as both the professional association and the regulatory body

Same as Alberta (CRDHA) and Nova Scotia (NSDHA)

All other provinces have two separate organizations

BCDHA and College of Dental Hygienists of BC

MDHA and College of Dental Hygienists of MB

ODHA and College of Dental Hygienists of ON

Sask

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Ass

oci

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Saskatchewan Dental Hygienists’ Association

Regulatory Body:

Advocates on behalf of public interest

Public members are part of decision making process

Registration is mandatory to practice

Develops regulations and guidelines for practice

Enforces standards of practice and conduct and monitors quality assurance

Association:

Advocates on behalf of RDHs

Concerned with the

professional profile

Addresses employment concerns of RDHs

Provides professional

development programs

Lobbies government on behalf of its members


Council: made up of 6 elected dental hygienists and 3 public reps

Committees:

Professional Conduct

Discipline

Continuing Competency

Others as needed

Council President: Kaylen Wiens

Council Vice-President: Leanne Huvenaars

Registrar–Executive Director: Kellie Watson

SK Polytechnic Rep to Council: Lynn Johnson

Sask

atch

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De

nta

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ien

ists’

Ass

oci

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History

• In 1951, Canada's first dental hygienist, Mary (Brett) Geddes, was registered by the College of Dental Surgeons in SK

• Prior to 1997, dental hygienists were licensed by the College of Dental Surgeons of SK (CDSS) through The Act Respecting the Dental Profession in Saskatchewan

• Dental hygienists had one non-voting member on the CDSS Council.

• In 1997, The Dental Disciplines Act was proclaimed and recognized each dental profession as autonomous entities

Self-Regulation:

• Privilege of a profession, not a right

• Contract with society and the profession to regulate its own members in order to protect the public from harm that could be caused by registered dental hygienists in the course of their practice

What is Self-Regulation?

Regulation, governance, or licensure by one’s own peers in

the public interest.

Self-regulation means that appointed and elected dental hygienists along with representatives from the public will register dental hygienists, implement a continuing competency program and handle any complaints or disciplinary action.

What is Self-Regulation?

• Being recognized and accountable as a distinct profession

• Governing board/council composed primarily of RDHs

• Having a voice in the governance of the profession

• Primary role of protecting the public

• Defining educational qualifications and other requirements for entry to practice

• Restricted use of the title “Dental Hygienist” and “RDH”

• Recognition of DH profession as equal but different than dentistry, dental assisting & dental therapy; equal in value but different in scope of practice.

99% of RDHs are self-regulated

• BC – 3578 – Self-regulation since 1995

• AB – 3213 – Self-regulation since 1990

• SK –630 – Self-regulation since 1997

• MB – 762 – Self-regulation since 2008

• Ontario – 13,328 – Self-regulation since 1994

• Quebec – 5401 – Self-regulation since 1975

• NFLD – 190 - Self-Regulation in 2013

• NB – 486 – Self-Regulation since 2010

• NS – 696 – Self-Regulation since 2009

• PEI – 100 – Not Self-regulating

• Yukon – 13 - Not Self-regulating

• Nunavut – 5 - Not Self-regulating

• NWT – 16 - Not Self-regulating

TOTAL ~ 30,000 across Canada

How Do We Self-Regulate?

Ensuring that registered dental hygienists practice in a safe, competent and ethical manner. To that end, self-regulation involves three over-all principles:

▫promoting good practice ▫preventing undesirable practice ▫intervening when necessary

Promoting Good Practice

▫ Establishing and monitoring practice standards

▫ Promoting evidence-based practice that is safe, competent and ethical

▫ Establishing and monitoring continuing competence requirements

▫ Influencing healthy public policy by raising government’s awareness of the dental hygienists’ ability to contribute meaningfully to solutions to important oral/health care issues.

Preventing Undesirable Practice • Setting and monitoring requirements for registration

• Approving a code of ethics to guide practice

• Requiring individuals to write the National Dental Hygiene Certification Examination (NDHCE) to demonstrate a beginning level of knowledge on which to base their practice

Intervening in Instances of

Unacceptable Practice

• Receiving formal complaints and administering appropriate disciplinary and corrective remedial action when necessary

Jurisprudence

• Definition: “knowledge of the law”

• It is not expected to memorize the information, but to have a general knowledge of, know where to find relevant information when needed, and be able to apply this information to situations that arise in practice

• Practising legally and ethically are crucial components of a professional’s ability to provide quality care to the public

Legislation

The Dental Disciplines Act, 1997

The SDHA Regulatory Bylaws

The SDHA Administrative Bylaws

Code of Ethics

Competencies & Standards (National & SDHA)

The SDHA Continuing Competency Program Guidelines

The Dental Disciplines Act, 1997 (DDA)

Governs all self-regulating oral health professions in SK, recognising the autonomous nature of each

Establishes the professions of dentistry, dental hygiene, dental therapy, dental technicians, denturists and dental assistants and gives them the power to licence and regulate their own members

Establishes the SDHA Council and the Association

Gives the Council the power to make regulations/bylaws to register and licence members as well as determine fees, collect fees, hold property, employ people and delegate some powers

Also outlines a standard method of investigation of complaints and discipline for members found guilty of professional misconduct or professional incompetence (uniform for all dental disciplines that fall under the Act)

The DDA - Highlights

Protection of titles: 22(5)

No person other than a dental hygienist shall use the title “dental hygienist” or any word, title or designation, abbreviated or otherwise, to imply that the person is a member of the Saskatchewan Dental Hygienists’ Association.

The DDA - Highlights

Authorized Practices: 23(5) A dental hygienist is authorized, subject to the terms, conditions and limitations of that person’s licence:

a) To communicate an assessment and treatment plan regarding periodontal health

b) To perform supragingival and subgingival debridement

c) To perform orthodontic and restorative procedures consistent with an approved education program in dental hygiene

d) To administer local anaesthesia in the provision of dental treatment; and

e) To expose, process and mount dental radiographs in accordance with The Radiation Health and Safety Act, 1985

The DDA – Authorized Practices Authorized practices

23(5) A dental hygienist is authorized, subject to the terms, conditions and limitations of that person’s licence:

(a) to communicate an assessment and treatment plan regarding periodontal health;

The diagnosis and treatment of periodontal disease - self initiation Primary health care providers as RDH’s can see clients “first”



(b) to perform supragingival and subgingival debridement; (c) to perform orthodontic and restorative procedures consistent with an approved education program in dental hygiene;

The DDA – Authorized Practices

Authorized practices


(d) to administer local anaesthesia in the provision of dental treatment; LA has no supervision restrictions. Discuss with the dentist you collaborate with as to the terms for LA within their practice setting. It is recommended that this be documented in your Practice Contract.



(e) to expose, process and mount dental radiographs in accordance with The Radiation Health and Safety Act, 1985.

RDH’s can determine the need for radiographs in order to provide the diagnosis and treatment they are “authorized to provide”.

It is recommended that this be documented in your Practice Contract.

The DDA – Authorized Practices for Colleagues

23(4) A dental assistant is authorized, subject to the terms, conditions and limitations of that person’s license, to assist and to perform intraoral assisting services that include:

(a) the introduction and manipulation of dental materials and devices in the mouth;

(b) orthodontic and restorative procedures consistent with an approved education program in dental assisting; and

(c) the exposure, processing and mounting of dental radiographs in accordance with The Radiation Health and Safety Act, 1985.

The DDA – Authorized Practices for Colleagues

23(6) A dental therapist is authorized, subject to the terms, conditions and limitations of that person’s licence:

(a) to communicate a conclusion identifying dental caries or dental abscesses as the cause of a person’s symptoms;

(b) to perform a procedure in or below the surface of the teeth, conduct simple extractions of primary and permanent teeth and perform space maintenance on teeth;

(c) to administer local anaesthesia in the provision of dental treatment; and

(d) to expose, process and mount dental radiographs in accordance with The Radiation Health and Safety Act, 1985.

The DDA – Employers Limitations on certain authorized practices

25(1) For the purposes of this section, “employer” means:

(a) the Government of Saskatchewan;

(b) the Government of Canada;

(c) a district health board or an affiliate within the meaning of The Health Districts Act;

(d) an association incorporated pursuant to The Mutual Medical and Hospital Benefit Associations Act;

(e) a municipality;

(f) an Indian band within the meaning of the Indian Act (Canada);

(g) an operator of a personal care home within the meaning of The Personal Care Homes Act, a non-profit corporation or a co-operative, that is approved by the minister;

(h) a board of education, conseil scolaire or the conseil general within the meaning of The Education Act, 1995;

(i) The University of Regina, the University of Saskatchewan, the Saskatchewan Indian Federated College and the Saskatchewan Institute of Applied Science and Technology.

Limitations on certain authorized practices

25(3) A dental hygienist may only perform the practices that he or she is authorized by subsection 23(5) to perform where he or she is employed by or practices under contract with:

(a) an employer that employs or has established a formal referral or consultation process with a dentist; or

(b) a dentist

An employment or practice contract should detail the scope of practice within the practice setting or settings, such as a satellite practice.

25(2) A dental assistant may only perform the practices that he or she is authorized by subsection 23(4) to perform where he or she is employed by or practices under a contract with:

(a) an employer that employs or has established a formal referral or consultation process with a dentist; or

(b) a dentist.

25(4) A dental therapist may only perform the practices that he or she is authorized by subsection 23(6) to perform where he or she is employed by or practices under a contract with:

(a) an employer that employs or has established a formal referral or

consultation process with a dentist; or

(b) a dentist.

The SDHA Regulatory Bylaws

Further describes the duties of the Professional Conduct

and Discipline Committees

Policies and protocols relating to registration and licensure

Continuing education

Code of Professional Ethics and Standards of Practice

The SDHA Administrative Bylaws

• Describes the SDHA Council

• Nominations and elections

• Meetings

• Fees

Code of Ethics

Every registrant must comply with the Code of Ethics set out by the CDHA

The CDHA Code of Ethics sets down the ethical principles and practice standards of the dental hygiene profession.

The Ethical Principles express the broad ideals to which dental hygienists aspire and which guide them in their practice.

Code of Professional Ethics

The fundamental principle underlying this Code is that the dental hygienist’s primary responsibility is to the client.

Client refers to a person or persons or a community with whom dental hygienists are engaged in a professional relationship. These relationships occur in all areas of dental hygiene practice including:

• Clinical services (private offices, schools, LTC, community clinics)

• Education

• Research

• Regulatory & policy roles

• Administration/employment


• Principle I: Beneficence

• Principle II: Autonomy

• Principle III: Integrity

• Principle IV: Accountability

• Principle V: Confidentiality

Effective 2012


Principle I: Beneficence

Beneficence involves caring about and acting to promote the good of another.

Dental hygienists use their knowledge and skills to assist clients to achieve and maintain optimal oral health and to promote fair and reasonable access to quality oral health services.


Principle II: Autonomy

Autonomy pertains to the right to make one’s own

choices. By communicating relevant information openly and truthfully, dental hygienists assist clients to make informed choices and to participate actively in achieving and maintaining their optimal oral health.


Principle III: Integrity

• Integrity relates to consistency of actions, values,

methods, expectations, and outcomes.

• It includes the promotion of fairness and social justice, with consideration for those clients more vulnerable.

• It conveys a sense of wholeness and strength, and doing what is right with honesty and truthfulness.

Code of Professional Ethics Principle IV: Accountability • Accountability pertains to taking responsibility for one’s

actions and omissions in light of relevant principles, standards, laws, and regulations.

• It includes the potential to self-evaluate and to be evaluated accordingly.

• It involves practising competently and accepting

responsibility for behaviours and decisions in the professional context.


Principle V: Confidentiality

Confidentiality is the duty to hold secret any information acquired in the professional relationship.

Dental hygienists respect a client’s privacy and hold in confidence information disclosed to them, subject to certain narrowly defined exceptions.

Competencies

• National Competencies

• SDHA Competencies

www.sdha.ca

http://www.sdha.ca/

SDHA Competencies & Standards

• Assessment

• Planning

• Implementation

• Evaluation

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http://www.sdha.ca/


Assessment:

• The dental hygienist determines data requirements and then

collects and records the subjective and objective data on the health status of clients using professional judgment and methods consistent with medico-legal-ethical principles in order to complete the client profile.

• The dental hygienist analyses and interprets data using problem solving and decision-making skills in order to synthesize information and formulate a dental hygiene diagnosis within the dental hygienist’s scope of practice.


Planning:

• The dental hygienist, in partnership with the client and/or agent

and, if needed, in collaboration with other professionals, uses the assessment data and the dental hygiene diagnosis to formulate goals and objectives, select dental hygiene interventions or services, and determine evaluation methods in order to formulate a dental hygiene care plan.

• The dental hygienist uses relevant information to develop plans related to practice management and ongoing professional competence.


Implementation:

• The dental hygienist activates and/or revises the dental hygiene care

plan in collaboration with the client and/or agent, and, if needed, in collaboration with other professionals. The dental hygiene care plan may include educational, consultative, preventive, aesthetic and therapeutic services, in order to achieve the planned oral and other health goals.


Evaluation:

• The dental hygienist appraises the effectiveness of the implemented

care plan, objectively comparing actual outcomes to expected outcomes, in order to determine the extent to which oral health and wellness goals have been attained, to provide recommendations in regard to clients’ ongoing care, and to evaluate the dental hygienist’s own professional competence.

Establishing a SK Dental Hygiene Practice

A dental hygienist may only perform the practices that he or she is authorized by subsection 23(5) to perform where he or she is employed by or practices under contract with:

(a) an employer that employs or has established a formal referral or consultation process with a dentist;

or

(b) a dentist.

SDHA has a “Verification of Contract Status” Form to be completed by the dental hygienist and dentist.

1. REQUIRED:

“Verification of Contract Status” Form to be completed by the dental hygienist and dentist.

Acquired by and submitted to the SDHA

2. RECOMMENDED:

“Employment/Contract Agreement” between the dental hygienist and dentist that outlines the details of the practice.

Established and kept by contracted parties

Establishing a SK Dental Hygiene Practice

• Increasing number of insurance companies reimburse dental hygienists for dental hygiene services.

• CDHA keeps a current list of these insurance companies on our web-site.

• To apply to submit directly for reimbursement a “Unique Number” must be obtained from CDHA. The application is on the CDHA website.

Ann Wright CDHA

Dental Examinations:

• There are no examination restrictions (i.e. - 365 day Rule).

• The CDSS has in policy, that dental professionals “shall endeavour to ensure that all clients have a complete examination conducted by a dentist every two years”, but this is a recommendation and accurate documentation of this recommendation should be made in the client’s record.

• Dental Screening: Assessment, identification and referral to the appropriate oral health professional

• Fissure sealants: Need for sealants can be determined by RDH’s as well as providing the sealants

• Bleaching/tooth whitening: Taking intra-oral impressions is an RDH service, and the act of providing bleaching material is an unregulated activity – anyone can do it (even non-dental professionals)

• Mouthguards: Can be provided by RDHs

College of Dental Surgeons of Saskatchewan

• Have regulations that pertain to their members which can affect the employment of other dental professions.

• Need to be discussed with you employer / contracting dentist.

SDHA Q & A

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