Dentists do not work alone or in a vacuum. That would be tedious, and I believe I would miss out on a lot of fun and camaraderie. My hygienist is the leader of my dental team and, at times, an extension of my body. I wouldn’t practice without a hygienist for myself and my practice philosophy.
Does the hygienist, as a key member of the dentistry team, require malpractice insurance? No, is the simple answer. The employed dental hygienist is usually covered by the dentist’s professional liability or malpractice insurance. You’ll notice that I mentioned “in most cases,” which does not equal “always.” That suggests the hygienist was probably accountable at one point. As a result, there may be a time when the hygienist requires their own malpractice insurance.
Let’s have a look at an example. Assume your hygienist was applying sealants to a patient’s teeth. Regrettably, the etch tip was not properly secured on the tube. The tip popped off as they were transferring it from the patient tray to the patient, and etch was all over the patient’s face and eye. Did I mention that the patient was not wearing any eye protection? To make matters worse, the patient’s face was scarred as a result of a bad interaction between their face lotion and the phosphoric etch. The patient required not only emergency eye treatment, but also cosmetic facial and reconstructive surgery to conceal the scar left by the unsecured etch point. In this case, the civil law suit named both the dentist and the hygienist. The legal and medical fees exceeded the state’s minimum coverage requirements. Because both the dentist and the hygienist were mentioned on the case, they were equally accountable for the disparity in damages.
Is it possible for a civil suit to mention only a dental hygienist? Yes, they are capable. It would resemble the following example. As they left the operatory, an elderly patient gets up after a patient visit and uses the back of the patient chair to balance themselves. Unfortunately, instead of reaching for the chair’s headrest, they grip the headrest cover, which isn’t secure enough for the patient’s needs. The patient loses their balance and bangs their head on the counter. They end up needing sutures in their skull and sue the hygienist, not the dentist, claiming the operatory was their responsibility. The dentist’s malpractice insurance will not cover the hygienist because only the hygienist was listed in the lawsuit.
The hygienist who works independently is outside the scope of this blog. Without the direct supervision of a dentist, the hygienist is the sole giver of care and is responsible for their own professional liability insurance.
If your hygienist is concerned about the possibility of a lawsuit, he or she can get professional liability insurance, which will cover them if any of the aforementioned scenarios, or others similar to them, occur. The Colorado Dental Hygienist Association is a good place to start if you want to learn more.
Can dental hygienists diagnose?
Hygienists can, and do, make diagnoses. Don’t be afraid to use the “d” word; it’s a lot of fun. Merriam Webster’s Medical Desk Dictionary defines diagnosis as the “skill or act of recognizing a disease from its signs or symptoms.”
Is dental hygiene a regulated profession?
The College of Registered Dental Hygienists of Alberta (CRDHA or the College) was established in order for Albertans to obtain safe, high-quality dental hygiene care from a profession that is always evolving.
To safeguard Albertans, over 30 laws and over 100 schedules of regulations, rules, standards, codes, and bylaws governing healthcare have been enacted.
The College of Registered Dental Hygienists of Alberta was given responsibility for self-regulation of the dental hygienists profession by the Government of Alberta in 2006 under the Health Professions Act (HPA) and in conjunction with the Dental Hygienists Profession Regulation, which addresses profession-specific requirements.
The Health Professions Act (HPA) is a piece of legislation that governs all regulated health professions in Alberta. It establishes uniform registration, ongoing competency, and complaint and discipline procedures. It also calls for the creation of professional practice standards and codes of ethics.
The HPA assures that health professionals maintain high levels of competency, safety, and ethics, as well as providing Albertans with safe, high-quality care, through its processes.
What are your obligations to your patient as a dental hygienist?
Respect the rights of friends and family while supporting others’ efforts to develop and maintain healthy lifestyles. Using high levels of professional knowledge, judgment, and skill, provide oral health care. Maintain a safe working environment to reduce the chance of injury.
What are the 5 phases of dental hygiene care?
The Process of Care describes the many aspects of a single visit with your dental hygienist. The Assessment, Dental Hygiene Diagnosis, Planning, Implementation, and Evaluation steps make up the Dental Hygiene Process of Care. Each phase is an important part of the entire therapy plan.
Data is obtained during the Assessment Phase. A client’s medical history, for example, is documented or updated, and includes prescription and over-the-counter medications, dental history, recent surgeries, medical conditions, and vitals. In addition, a cancer screening (also known as an intra/extraoral examination) is performed. An odontogram records the position and shape of teeth (hard tissue). Plaque and calculus deposits are noticed, as well as the soft tissue’s overall health, which is verified both visually and quantitatively using a periodontal probe. Nutritional assessments, which link dietary consumption to the risk of caries, can also be included in the Assessment Phase (cavities).
After gathering all of the information from the Assessment Phase, the dental hygienist is ready to go on to the next phase of therapy, the Dental Hygiene Diagnosis. In this phase, customer needs and priorities are documented, and goals are set to address these needs in consultation with the client.
Keep an eye out for the next blog, which will describe the Dental Hygiene Diagnosis. It’s crucial to understand why dental hygienists perform what they do when you visit them on a regular basis; it’s not just about getting your teeth cleaned.
What is the purpose of a dental hygiene diagnosis?
Dental hygiene diagnosis, according to the American Dental Hygiene Association, is the assessment of an individual’s health habits, attitudes, and oral health care needs that a dental hygienist is educated and certified to offer. In order to draw conclusions regarding the patient’s dental hygiene treatment needs, the dental hygiene diagnosis necessitates evidence-based critical examination and interpretation of assessments. The dental hygiene diagnostic is used to create a dental hygiene treatment plan. Each patient or client may have multiple dental hygiene diagnoses. Only after recognizing the dental hygiene diagnosis can the dental hygienist create a treatment and evaluation plan that focuses on dental hygiene education, patient self-care practices, prevention strategies, and treatment and evaluation protocols to meet the oral health needs of the patient or community.
IV. Identify patient needs that can be met by providing dental hygiene services.
V. Determine which dental and other health-care fields require referrals based on dental hygiene diagnoses.
Can dental hygienist give local anesthesia?
Despite the fact that dental hygienists first began giving local anaesthetic 40 years ago in the state of Washington, there are currently six states that restrict them from doing so. Dental hygienists are well-qualified to administer local anaesthetic, ensuring that patients receive the degree of treatment they require without experiencing undue pain.
The state regulations governing the use of local anesthetic might be complicated. Deciphering state practice statutes requires a thorough awareness of the various types of local anesthetic injections used in dentistry. Table 1 lists the most widely used injections and their meanings. 1,2
Safety Considerations
In some states, dental hygienists are only allowed to administer infiltration injections. Infiltration injections, the theory goes, are easier to administer and provide a higher level of safety than nerve block anesthesia. Intraoral block injections, because they entail injection into key neurovascular bundles of bigger parts of the mouth, are significantly more involved operations, according to a recently published argument against dental hygienists performing nerve block anesthesia. As a result, major complications such hematoma, permanent or partial paresthesia, stroke, cardiac arrhythmia, and syncope are more likely to occur with this sort of injection. 3 However, there are no comparison studies that demonstrate infiltration injections are less likely than nerve block anesthesia to generate negative effects. In reality, data show that the complications that arise after nerve block anesthesia can also occur with infiltration injections. 4-6
The sort of injection used has less to do with safety than the administrator’s overall preparedness and competence. The safety of dental hygienists giving infiltration and nerve block anesthesia has been investigated in a number of studies. Complications resulting from the administration of local anesthetic by dental hygienists were described at minimal rates by Anderson7 and Lobene8. Only three cases out of 19,849 dental hygienist administrations led in negative outcomes, according to Lobene. According to Anderson’s poll, 88 percent of dental hygienists reported no difficulties when giving local anesthetic. The lack of disciplinary action has also supported the safety of local anesthetic administration by dental hygienists. Analyses conducted in 1990 and 2005 identified no complaints filed against dental hygienists for local anesthetic administration with state boards or the American Dental Hygienists’ Association (ADHA). 9
State Practice Acts
Local anesthetic is covered by dental hygiene practice acts in 44 states and the District of Columbia. Practice acts ban dental hygienists from delivering local anaesthetic in Alabama, Florida, Georgia, Mississippi, North Carolina, and Texas.
Although local anesthetic is used to provide pleasant patient care all around the world, there are no defined educational requirements, accreditation, or usage guidelines for dental hygienists. Despite having received their education and experience in one state, dental hygienists may find it difficult to transfer their knowledge to other states due to differing state regulations.
The type of supervision provided for dental hygiene practicedirect (a dentist must be present on site) or general (a dentist is not required to be present on site)varies by location. Furthermore, direct supervision usually implies that the dentist is not only present but also capable of responding in the event of an emergency. Currently, 38 states require dental hygienists giving local anaesthetic to be under direct supervision, while five states allow broad monitoring (Alaska, Colorado, Idaho, Minnesota, and Oregon). The state of Nevada’s dental hygiene statutes do not differentiate between direct and broad supervision. 10
Despite the widespread use of local anesthetic by dental hygienistsand the fact that it has been proven safe for more than 40 yearsfour states (Maryland, New York, South Carolina, and Virginia) prohibit dental hygienists from using nerve block anesthesia. Only patients aged 18 and over are eligible for nerve blocks administered by dental hygienists in Virginia.
Individual state credentialing policies are the largest impediment to the portability of local anesthetic skills and general practice licensure. 27 states require examination credentialing, but the basis for this examination varies across the 44 states and can include: successful completion of a written and clinical regional exam, a written-only regional exam, or documented completion of a course provided within a CODA-accredited dental hygiene program. Furthermore, each state licensing organizations must authorize these courses. In Maryland, for example, a dental hygienist must complete a course that includes at least 20 hours of lecture and 8 hours of lab/clinical practice in order to be accredited for local anesthetic. In Minnesota, the course must include at least 15 hours of lecture and 14 hours of lab/clinical practice, however in other states, such as Washington, the course hours are set by the educational programs.
Statute VS Rule
Generally, the authority that governs dental hygiene practice is a statute or regulation. Statutes and regulations are formally drafted pieces of legislation with governing authority that are published as law. By mandating or prohibiting something, statutes establish policy. State regulations may also apply to dental hygiene practices. In contrast to statutes, rules can be issued and produced by a government agency in response to an Administrative Procedure Act or to exercise and delegate authority to a board. These regulations have the force of law and impose additional obligations on the regulated parties, but they are not included into the professional practice act’s legislated definitions and may be amended more readily by a supervisory body.
Administration Patterns
Not only does legislation vary by region and state, but so does how dental hygienists administer local anaesthetic. Local anesthetic injections are most commonly used by dental hygienists in the Western United States, and they are most likely to administer for the entire dental office. 11,12 The data demonstrates a true West Coast to East Coast phenomena, in which the frequency with which dental hygienists provide local anesthetic reduces as one travels from west to east. Furthermore, dental hygienists in the western half of the country are more prone than their counterparts in the eastern half of the country to use nerve block injections. This pattern is most likely driven by the fact that Western states have allowed dental hygienists to inject local anaesthetic for the longest time; the earliest dates of introduction correspond to the highest utilizations. 11
According to a recent study conducted at the University of Pittsburgh, the type of practice in which a dental hygienist works influences the use of local anesthetics (Table 2).
12 According to the study, dental hygienists who worked in periodontal offices gave out more injections than those who worked in other types of practices. Academics injected more field block injections than the rest of the participants. Dental hygienists working in children dental practices were likewise found to be the least likely to use local anesthetic injections.
Additional studies revealed that anesthetic administration differs depending on the type of practice. Anderson discovered that 47.6% of dental hygienists working in periodontal offices administered local anesthesia for three to six patients per week, while 63 percent of dental hygienists working in general practice administered local anesthesia for one to two patients per week in a survey of Minnesota dental hygienists. 7 These findings are not surprising, given that periodontal experts’ procedures, as well as the degree of disease they encounter, necessitate more frequent pain control. It’s worth noting that dental hygienists in academic settings were the most likely to administer field block injections. This could be due to instructors’ need to offer students with a diverse injection portfolio or to help students understand the differences between field block injections and infiltration injections.
A new analysis was done using data obtained by researchers at the University of Pittsburgh to assess differences in practice style and the administration of local anesthesia to patients treated primarily by the dentist (Table 3).
11 In the initial survey, 58.4 percent of those who said they administered injections said they did so for procedures when the dentist was to provide entire care. 11 According to the current study, periodontal hygienists were the most likely to deliver local anesthesia to the dentist’s patients, followed by public health, general dentistry, academia, and pediatric dentistry. These findings are similar to injection type frequency and are most likely the effect of patient and practice demand.
Conclusions
Dental hygienists are restricted from administering local anesthetics by statutes or guidelines that apply specifically to individuals practicing in that state. Supervisory power and injection categories are often different between states and are included in these statutes and guidelines. Limitations on dental hygiene local anesthesia scope of practice may reflect concerns about potential injury in the hands of dental hygienists; however, regardless of the varying scope of practice in the United States, there is no published evidence of a higher incidence of adverse events.
References
- KB Bassett, AC DiMarco, and DK Naughton. Dental professionals can use local anesthesia. Pearson Education, Upper Saddle River, NJ, 2010.
- Senate Bill 1009: Allow dental hygienists to administer local anaesthetic, according to the Michigan House Legislative Analysis Section. Visit www.legislature.mi.gov/documents/2001-2002/billanalysis/House/htm/2001-HLA-1009-a.htm for more information. On the 28th of June, 2011, I checked my email.
- Articaine and lidocaine mandibular buccal infiltration anesthesia: prospective randomized double-blind cross-over study, Kanaa MD, Whitworth JM, Corbett JP, Meechan JG. 296â298 in J Endod. 2006;32:296â298 in J Endod.
- GA Gansto, AS Gaffen, HP Lawrence, HC Tenenbaum, DA Haas Paresthesia after dental local anesthetic injection in the United States. 2010;141:836â844. J Am Dent Assoc. 2010;141:836â844.
- M. Daublander, R. Muller, and M. Lipp. The frequency of issues in dentistry connected with local anesthetic. Anesth Prog., vol. 44, no. 2, 1997, pp. 132â141.
- Dental hygienists who completed a Minnesota CE course used local anesthetic. Anderson JM. 76:35â”46 in J Dent Hyg. 2002.
- SG Boynes, J Zovko, and RM Peskin. Dental hygienists administer local anesthetic. 2010;54:769-778 in Dent Clin North Am.
Do you have to go to uni to be a dental hygienist?
Obtain a dental hygiene, oral health science, or dental hygiene and therapy degree or diploma. You must complete a course certified by the General Dental Council before becoming a dental hygienist (GDC). Aspiring dental hygienists might choose from four different courses:
A dental hygiene, oral health science, or dental hygiene and treatment degree (three or four years) is required.
Choose the course that best meets your requirements and career goals. All of these programs cover topics such as dental anatomy, health education, and pathology that are relevant to becoming a dental hygienist.
Register with the GDC
Become a member of the GDC registry. Before a dental practice or another place of work may recruit you, you must first register with the GDC. A document certifying your identity, a character reference, and a passport photograph are included in the GDC registry application documents.
What is the ADAA code of ethics?
The profession’s aspirational goals are the Principles of Ethics. The Code of Professional Conduct and Advisory Opinions are guided by them, and they provide reason for them. Patient autonomy, nonmaleficence, beneficence, justice, and honesty are the five core principles that underpin the ADA Code. Principles can both overlap and compete for importance with one another. A given provision of the Code of Professional Conduct can be justified by more than one principle. Principles may need to be balanced against one another at times, but they are the profession’s steadfast guideposts otherwise.
Respect for Autonomy
Patients’ autonomy refers to their ability to make their own decisions. This means that nurses should ensure that patients have all of the information they need to make an informed decision about their medical care. The nurses have no say in the patient’s decision. Obtaining informed consent from the patient for treatment, accepting the circumstance when a patient declines a drug, and keeping confidentiality are all examples of nurses displaying this.
Non-maleficence
This means that nurses must not cause injury on purpose. In terms of medical competence, nurses must deliver a standard of care that avoids or minimizes danger. Nurses can demonstrate this value by not providing negligent treatment to a patient.
Beneficence
Beneficence is described as kindness and charity, and it necessitates the nurse’s activity to assist others. Holding the hand of a dying patient is an example of a nurse demonstrating this ethical concept.
Justice
Being impartial and fair is what justice entails. Nurses who make unbiased medical decisions, regardless of economic background, race, sexual orientation, or other factors, display this, whether it’s about limited resources or novel medicines.