ADHA Standards for Clinical Dental Hygiene Practice

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STANDARDS FOR CLINICAL DENTAL HYGIENE PRACTICE REVISED 2016

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Access Supplement 2016 Standards.indd 1 11/10/16 11:47 AM TABLE OF CONTENTS

REVISED History ...... 3 JUNE 2016 Introduction...... 3

REPRINTED Definition of Dental Hygiene Practice ...... 4 SEPTEMBER 2014 WITH UPDATED Educational Preparation ...... 4 POLICIES AND REFERENCES Practice Settings ...... 4 ADOPTED Professional Responsibilities and Considerations ...... 5 MARCH 10, 2008 Dental Hygiene Process of Care ...... 5 ITEM STANDARDS FOR CLINICAL DENTAL Standards of Practice...... 6 HYGIENE PRACTICE Standard 1: Assessment ...... 6

ACTION Standard 2: Dental Hygiene Diagnosis ...... 8 ADOPTED BY ADHA BOARD OF Standard 3: Planning ...... 8 TRUSTEES Standard 4: Implementation ...... 8 Standard 5: Evaluation ...... 9 Standard 6: Documentation ...... 9 Summary ...... 10 Key Terms ...... 10 References ...... 11 Resources ...... 12 Appendix A ...... 13 Appendix B ...... 13 Appendix C ...... 14 Appendix D ...... 14 Development and Validation Process for the Standards ...... 15

Access Supplement 2016 Standards.indd 2 11/10/16 11:47 AM structure and operation of dental hygiene education programs.4 Dental hygienists are valued members of the health care workforce. They have the knowledge, STANDARDS skills, and professional responsibility to provide oral health promotion and health protection strategies for all individuals as well as groups. As li- FOR CLINICAL censed professionals, they are accountable for the care and services they provide. DENTAL HYGIENE These Standards promote the knowledge, values, practices, and behaviors that support and enhance oral health with the ultimate goal of im- PRACTICE proving overall health. The primary purpose of the REVISED 2016 Standards for Clinical Dental Hygiene Practice is to assist dental hygiene clinicians in the provider-patient relationship. In addition, dental hygienists in other professional roles such as educator, researcher, entrepreneur, public health professional, and administrator — as well as those employed in corporate settings — can use these Standards to facilitate the implementation of col- History laborative, patient-centered care in interprofessional teams of health professionals. This collab- ne hallmark of a true profession is its willing- oration can occur in a variety of practice settings ness to assume responsibility for the quality including community and public health centers, of care that its members provide. In 1985, hospitals, school-based programs, long-term care the American Dental Hygienists’ Association facilities, outreach, and home care programs. The O secondary purpose of these Standards is to edu- (ADHA) took a major step toward fulfillment of that responsibility with the development of Applied Standards cate other health care providers, policymakers, of Clinical Dental Hygiene Practice.1 This document and the public about the clinical practice of den- is the third revision2 to build on those Standards and tal hygiene. The purpose of medical and dental promote dental hygiene practice based on current and science is to enhance the health of individuals as relevant scientific evidence. well as populations. Dental hygienists use scientific evidence in the decision-making process im- pacting their patient care. The dental hygienist is Introduction expected to respect the diverse values, beliefs, and cultures present in individuals and communities. The Standards for Clinical Dental Hygiene Prac- When providing dental hygiene care, dental hy- tice outlined in this document guide the individ- gienists must support the right of the individual ual dental hygienist’s practice. Dental hygienists to have access to the necessary information and remain individually accountable to the standards provide opportunities for dialogue to allow the in- set by the discipline and by applicable federal, dividual patient to make informed care decisions state, and local statutes and regulations that de- without coercion. Facilitating effective communi- fine and guide professional practice.3 These Stan- cation might require an interpreter and/or trans- dards should not be considered as a substitute lator based on the patient and practitioner’s need for professional clinical judgment. In addition, to communicate. Dental hygienists must realize they should not be confused with the Accredi- and establish their professional responsibility tation Standards for Dental Hygiene Education in accordance with the rights of individuals and Programs, which are chiefly concerned with the groups. In addition, when participating in activities where decisions are made that have an im-

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Access Supplement 2016 Standards.indd 3 11/10/16 11:47 AM pact on health, dental hygienists are obligated to to make clinical dental hygiene decisions; and assure that ethical and legal issues are addressed are expected to plan, implement, and evaluate as part of the decision-making process. Dental the dental hygiene component of the overall care hygienists are bound by the Code of Ethics of the plan.7-10 All states define their specific dental hy- American Dental Hygienists’ Association.3 giene practice scope and licensure requirements. The Standards for Clinical Dental Hygiene Prac- tice provide a framework for clinical practice that focuses on the provision of patient-centered com- Educational Preparation prehensive care. The Standards describe a competent level of dental hygiene care1,2,4-7 as demon- The registered dental hygienist (RDH) or licensed strated by the critical thinking model known as dental hygienist (LDH) is educationally prepared the dental hygiene process of care.7 As evidenced for practice upon graduation from an accredited by ADHA policy6 and various dental hygiene text- dental hygiene program (associate, post-degree books,8-10 the six components of the dental hy- certificate, or baccalaureate) within an institution giene process of care include assessment, dental of higher education and qualified by successful hygiene diagnosis, planning, implementation, completion of a national written board examina- evaluation, and documentation (Appendix A). The tion and state or regional clinical examination for dental hygiene process encompasses all signifi- licensure. In 1986, the ADHA declared its intent cant actions taken by dental hygienists and forms to establish the baccalaureate degree as the min- the foundation of clinical decision-making. imum entry level for dental hygiene practice (Ap- pendix C).7,13-14 Definition Of Dental Hygiene Practice Practice Settings Dental hygienists can apply their professional Dental hygiene is the science and practice of rec- knowledge and skills in a variety of work settings ognition, prevention and treatment of oral dis- as clinicians, educators, researchers, adminis- eases and conditions as an integral component trators, entrepreneurs, and public health profes- 11 of total health. The dental hygienist is a primary sionals, and as employees in corporate settings. care oral health professional who has graduated Working in a private dental office c ontinues t o from an accredited dental hygiene program in an be the primary place of employment for dental institution of higher education, licensed in den- hygienists. However, never before has there been tal hygiene to provide education, assessment, re- more opportunity for professional growth. Clinical search, administrative, diagnostic, preventive and dental hygienists may be employed in a variety of therapeutic services that support overall health health care settings including, but not limited to, 12 through the promotion of optimal oral health. private dental offices, schools, public health clinics, In practice, dental hygienists integrate multiple hospitals, managed care organizations, correction- roles to prevent oral diseases and promote health al institutions, or nursing homes.6 (Appendix B). One example of an innovative, interprofession- Dental hygienists work in partnership with all al practice model was tested by Patricia Braun, MD, members of the dental team. Dentists and dental MPH, Associate Professor, Pediatrics and Family hygienists practice together as colleagues, each Medicine at the University of Colorado Anschultz offering professional expertise for the goal of pro- School of Medicine. This project co-located a den- viding optimum oral health care to the public. The tal hygienist in the pediatrician’s office. Co-locat- distinct roles of the dental hygienist and dentist ing dental hygienists into medical practices is a complement and augment the effectiveness of feasible and innovative way to provide oral health each professional and contribute to a collabora- care, especially for those who have limited tive environment. Dental hygienists are viewed as access to preventive oral health services. 14 experts in their field; are consulted about appropriate dental hygiene interventions; are expected 4 2016

Access Supplement 2016 Standards.indd 4 11/10/16 11:47 AM pact on health, dental hygienists are obligated to to make clinical dental hygiene decisions; and Another innovative model exists in Oregon, • Maintain awareness of changing trends in assure that ethical and legal issues are addressed are expected to plan, implement, and evaluate where expanded practice dental hygienists (EP- dental hygiene, health, and society that im- as part of the decision-making process. Dental the dental hygiene component of the overall care DHs) do not need a collaborative agreement with pact dental hygiene care. hygienists are bound by the Code of Ethics of the plan.7-10 All states define their specific dental hy- a dentist to initiate dental hygiene care for pop- • Support the dental hygiene profession American Dental Hygienists’ Association.3 giene practice scope and licensure requirements. ulations that qualify as having limited access to through ADHA membership. The Standards for Clinical Dental Hygiene Prac- care; however, some aspects do require a collabo- • Interact with peers and colleagues to create tice provide a framework for clinical practice that rative agreement.15 an environment that supports collegiality focuses on the provision of patient-centered com- Educational Preparation EPDHs in Oregon are able to work in a variety and teamwork. prehensive care. The Standards describe a compe- of settings,16 such as nursing homes and schools, • Prevent situations where patient safety and tent level of dental hygiene care1,2,4-7 as demon- The registered dental hygienist (RDH) or licensed and many are employed as private business own- well-being could potentially be compromised. strated by the critical thinking model known as dental hygienist (LDH) is educationally prepared ers.14 • Contribute to a safe, supportive, and profes- the dental hygiene process of care.7 As evidenced for practice upon graduation from an accredited sional work environment. by ADHA policy6 and various dental hygiene text- dental hygiene program (associate, post-degree • Participate in activities to enhance and main- books,8-10 the six components of the dental hy- certificate, ro baccalaureate) within an institution Professional tain continued competence and address pro- giene process of care include assessment, dental of higher education and qualified by successful Responsibilities and fessional issues as determined by appropri- hygiene diagnosis, planning, implementation, completion of a national written board examina- ate self-assessment. evaluation, and documentation (Appendix A). The tion and state or regional clinical examination for Considerations • Commit to lifelong learning to maintain com- dental hygiene process encompasses all signifi- licensure. In 1986, the ADHA declared its intent petence in an evolving health care system. Dental hygienists are responsible and account- cant actions taken by dental hygienists and forms to establish the baccalaureate degree as the min- able for their dental hygiene practice, conduct, the foundation of clinical decision-making. imum entry level for dental hygiene practice (Ap- pendix C).7,13-14 and decision-making. Throughout their profes- Dental Hygiene Process sional career in any practice setting, a dental hy- of Care Definition Of Dental gienist is expected to: Practice Settings • Understand and adhere to the ADHA Code of The purpose of the dental hygiene process of Hygiene Practice Ethics. care is to provide a framework where the individ- Dental hygienists can apply their professional • Maintain a current license to practice, includ- Dental hygiene is the science and practice of rec- ualized needs of the patient can be met; and to knowledge and skills in a variety of work settings ing certifications as appropriate. ognition, prevention and treatment of oral dis- identify the causative or influencing factors of a as clinicians, educators, researchers, adminis- • Demonstrate respect for the knowledge, ex- eases and conditions as an integral component condition that can be reduced, eliminated, or pre- trators, entrepreneurs, and public health profes- pertise, and contributions of dentists, dental of total health.11 The dental hygienist is a primary vented by the dental hygienist.8-10 There are six sionals, and as employees in corporate settings. hygienists, dental assistants, dental office care oral health professional who has graduated components to the dental hygiene process of care Working in a private dental office c ontinues t o staff, and other health care professionals. from an accredited dental hygiene program in an (assessment, dental hygiene diagnosis, planning, be the primary place of employment for dental • Articulate the roles and responsibilities of institution of higher education, licensed in den- implementation and evaluation, and documenta- hygienists. However, never before has there been the dental hygienist to the patient, interpro- tal hygiene to provide education, assessment, re- tion; see Appendix A).7-10, 18 more opportunity for professional growth. Clinical fessional team members, referring providers, search, administrative, diagnostic, preventive and The dental hygiene diagnosis is a key compo- dental hygienists may be employed in a variety of and others. therapeutic services that support overall health nent of the process and involves assessment of health care settings including, but not limited to, • Apply problem-solving processes in deci- through the promotion of optimal oral health.12 the data collected, consultation with the dentist private dental offices, schools, public health clinics, sion-making and evaluate these processes. In practice, dental hygienists integrate multiple and other health care providers, and informed hospitals, managed care organizations, correction- • Demonstrate professional behavior. roles to prevent oral diseases and promote health 6 decision-making. The dental hygiene diagnosis al institutions, or nursing homes. • Maintain compliance with established in- (Appendix B). and care plan are incorporated into the compre- One example of an innovative, interprofession- fection control standards following the most Dental hygienists work in partnership with all hensive plan that includes restorative, cosmetic, al practice model was tested by Patricia Braun, MD, current guidelines to reduce the risks of members of the dental team. Dentists and dental and oral health needs that the patient values. All MPH, Associate Professor, Pediatrics and Family health-care-associated infections in patients, hygienists practice together as colleagues, each components of the process of care are interrelated Medicine at the University of Colorado Anschultz and illnesses and injuries in health care per- offering professional expertise for the goal of pro- and depend upon ongoing assessments and eval- School of Medicine. This project co-located a den- sonnel. viding optimum oral health care to the public. The uation of treatment outcomes to determine the tal hygienist in the pediatrician’s office. Co-locat- • Incorporate cultural competence17 in all pro- distinct roles of the dental hygienist and dentist need for change in the care plan. These Standards ing dental hygienists into medical practices is a fessional interactions. complement and augment the effectiveness of follow the dental hygiene process of care to pro- feasible and innovative way to provide oral health • Access and utilize current, valid, and reliable each professional and contribute to a collabora- vide a structure for clinical practice that focuses care, especially for those who have limited evidence in clinical decision-making through tive environment. Dental hygienists are viewed as on the provision of patient-centered comprehen- access to preventive oral health services. 14 analyzing and interpreting the literature and experts in their field; are consulted about appro- sive care. other resources. priate dental hygiene interventions; are expected 4 DECEMBER 2016 Access Supplement 5

Access Supplement 2016 Standards.indd 4 11/10/16 11:47 AM Access Supplement 2016 Standards.indd 5 11/10/16 11:47 AM and indicate risk for medical complications. Dis- proportionate height and weight also combine as a risk factor for diabetes and other systemic diseases that impact oral health and should prompt the practitioner to request glucose levels for health history documentation.

STANDARDS OF Social history information such as marital status, children, occupation, cultural practices, and other PRACTICE beliefs might affect health or influence treatment acceptance.

Medical history is the documentation of overall medical health. This information can identify the need for physician consultation or any contrain- Standard 1: Assessment dications for treatment. This would include any mental health diagnosis, cognitive impairments The ADHA definition of assessment: The collection (e.g., stages of dementia), behavioral challenges and analysis of systematic and oral health data in (e.g., autism spectrum), and functional capacity order to identify client needs.19 assessment. It would also include the patient’s level of ability to perform a specific activity such as withstanding a long dental appointment as well as I. HEALTH HISTORY whether the patient requires modified positioning for treatment. Laboratory tests such as A1C and A health history assessment includes multiple current glucose levels may need to be requested if data points that are collected through a written they are not checked regularly. document and an oral interview. The process helps build a rapport with the patient and verifies key el- Pharmacologic history includes the list of medi- ements of the health status. Information is collect- cations, including dose and frequency, which the ed and discussed in a location that ensures patient patient is currently taking. This includes but is privacy and complies with the Health Insurance not limited to any over-the-counter (OTC) drugs or Portability and Accountability Act (HIPAA). products such as herbs, vitamins, nutritional supplements, and probiotics. The practitioner should Demographic information is any information that confirm any past history of an allergic or adverse is necessary for conducting the business of den- reaction to any products. tistry. It includes but is not limited to address, date of birth, emergency contact information, phone numbers, and names and addresses of the refer- II. CLINICAL ASSESSMENT ring/previous dentist and physician of record. Planning and providing optimal care require a thorough and systematic overall observation and Vital Signs including temperature, pulse, respira- clinical assessment. Components of the clinical tion, and blood pressure provide a baseline or help assessment include an examination of the head identify potential or undiagnosed medical condi- and neck and oral cavity including an oral cancer tions. screening, documentation of normal or abnormal findings, and assessment of the temporomandib- Physical characteristics of height and weight pro- ular function. A current, complete, and diagnostic vide information for drug dosing and anesthesia 6 2016

Access Supplement 2016 Standards.indd 6 11/10/16 11:47 AM and indicate risk for medical complications. Dis- set of radiographs provides needed data for a com- for preventing or limiting disease and promoting proportionate height and weight also combine as a prehensive dental and periodontal assessment. health. Examples of factors that should be evalu- risk factor for diabetes and other systemic diseas- A comprehensive periodontal examination is ated to determine the level of risk (high, moderate, es that impact oral health and should prompt the part of clinical assessment. It includes low) include but are not limited to: practitioner to request glucose levels for health history documentation. A. Full-mouth periodontal charting including A. Fluoride exposure the following data points reported by loca- B. Tobacco exposure including smoking, smoke- STANDARDS OF Social history information such as marital status, tion, severity, quality, written description, or less/spit tobacco and second-hand smoke children, occupation, cultural practices, and other numerically: C. Nutrition history and dietary practices includ- PRACTICE beliefs might affect health or influence treatment 1. Probing depths ing consumption of sugar-sweetened bever- acceptance. 2. Bleeding points ages 3. Suppuration D. Systemic diseases/conditions (e.g., diabetes, Medical history is the documentation of overall 4. Mucogingival relationships/defects cardiovascular disease, autoimmune, etc.) medical health. This information can identify the 5. Recession E. Prescriptions and over-the-counter medi- need for physician consultation or any contrain- 6. Attachment level/attachment loss cations, and complementary therapies and Standard 1: Assessment dications for treatment. This would include any B. Presence, degree, and distribution of plaque practices (e.g., fluoride, herbal, vitamin and mental health diagnosis, cognitive impairments and calculus other supplements, daily aspirin, probiotics) The ADHA definition of assessment: The collection (e.g., stages of dementia), behavioral challenges C. Gingival health/disease F. Salivary function and xerostomia and analysis of systematic and oral health data in (e.g., autism spectrum), and functional capacity D. Bone height/bone loss G. Age and gender order to identify client needs.19 assessment. It would also include the patient’s lev- E. Mobility and fremitus H. Genetics and family history el of ability to perform a specific activity such as F. Presence, location, and extent of furcation in- I. Habit and lifestyle behaviors withstanding a long dental appointment as well as volvement 1. Cultural issues I. HEALTH HISTORY whether the patient requires modified positioning 2. Substance abuse (recreational drugs, pre- for treatment. Laboratory tests such as A1C and A comprehensive hard-tissue evaluation that in- scription medication, alcohol) A health history assessment includes multiple current glucose levels may need to be requested if cludes the charting of existing conditions and 3. Eating disorders/weight loss surgery data points that are collected through a written they are not checked regularly. oral habits, with intraoral photographs and radio- 4. Piercing and body modification document and an oral interview. The process helps graphs that supplement the data. 5. Oral habits build a rapport with the patient and verifies key el- Pharmacologic history includes the list of medi- 6. Sports and recreation (swimming, extreme ements of the health status. Information is collect- cations, including dose and frequency, which the A. Demineralization sports [marathon, triathlon], energy drinks/ ed and discussed in a location that ensures patient patient is currently taking. This includes but is B. Caries gels privacy and complies with the Health Insurance not limited to any over-the-counter (OTC) drugs or C. Defects J. Physical disability (morbid obesity, vision and/ Portability and Accountability Act (HIPAA). products such as herbs, vitamins, nutritional sup- D. Sealants or hearing loss, osteoarthritis, joint replace- plements, and probiotics. The practitioner should E. Existing restorations and potential needs ment) Demographic information is any information that confirm any past history of an allergic or adverse F. Implants K. Psychological, cognitive, and social consider- is necessary for conducting the business of den- reaction to any products. G. Anomalies ations tistry. It includes but is not limited to address, date H. Occlusion 1. Domestic violence of birth, emergency contact information, phone II. CLINICAL ASSESSMENT I. Fixed and removable prostheses retained by 2. Physical, emotional, or sexual abuse numbers, and names and addresses of the refer- natural teeth or implant abutments 3. Behavioral ring/previous dentist and physician of record. Planning and providing optimal care require a J. Missing teeth 4. Psychiatric thorough and systematic overall observation and 5. Special needs including temperature, pulse, respira- Vital Signs clinical assessment. Components of the clinical III. RISK ASSESSMENT20-21 6. Literacy tion, and blood pressure provide a baseline or help assessment include an examination of the head 7. Economic identify potential or undiagnosed medical condi- Risk assessment is a qualitative and quantitative and neck and oral cavity including an oral cancer 8. Stress tions. evaluation based on the health history and clini- screening, documentation of normal or abnormal 9. Neglect findings, and assessment of the temporomandib- cal assessment to identify any risks to general and Physical characteristics of height and weight pro- ular function. A current, complete, and diagnostic oral health. The data provide the clinician with vide information for drug dosing and anesthesia the information to develop and design strategies

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Access Supplement 2016 Standards.indd 6 11/10/16 11:47 AM Access Supplement 2016 Standards.indd 7 11/10/16 11:47 AM clinical decisions within the context of legal and Standard 2: Dental ethical principles. Hygiene Diagnosis The dental hygiene care plan should be a ve- hicle for care that is safe, evidence-based, clini- The ADHA defines dental hygiene diagnosis as the cally sound, high-quality, and equitable. The plan identification of an individual’s health behaviors, should be personalized according to the individ- attitudes, and oral health care needs for which a ual’s unique oral health needs, general health dental hygienist is educationally qualified and li- status, values, expectations, and abilities. When censed to provide. The dental hygiene diagnosis formulating the plan, dental hygienists should be requires evidence-based critical analysis and inter- sensitive and responsive to the patient’s culture, pretation of assessments in order to reach conclu- age, gender, language, and learning style. They sions about the patient’s dental hygiene treatment should demonstrate respect and compassion for needs. The dental hygiene diagnosis provides the individual patient choices and priorities. basis for the dental hygiene care plan.22 Multiple dental hygiene diagnoses may be made I. Identify all needed dental hygiene interven- for each patient or client. Only after recognizing tions including change management, preven- the dental hygiene diagnosis can the dental hy- tive services, treatment, and referrals. gienist formulate a care plan that focuses on den- II. In collaboration with the patient and/or care- tal hygiene education, patient self-care practices, giver, prioritize and sequence the interven- prevention strategies, and treatment and evalua- tions allowing for flexibility if necessary and tion protocols to focus on patient or community possible. oral health needs.23 III. Identify and coordinate resources needed to facilitate comprehensive quality care (e.g., I. Analyze and interpret all assessment data. current technologies, pain management, ad- II. Formulate the dental hygiene diagnosis or di- equate personnel, appropriate appointment agnoses. sequencing, and time management). III. Communicate the dental hygiene diagnosis IV. Collaborate and work effectively with the with patients or clients. dentist and other health care providers and IV. Determine patient needs that can be im- community-based oral health programs to proved through the delivery of dental hygiene provide high-level, patient-centered care. care. V. Present and document dental hygiene care V. Identify referrals needed within dentistry and plan to the patient/caregiver. other health care disciplines based on dental VI. Counsel and educate the patient and/or care- hygiene diagnoses. giver about the treatment rationale, risks, ben- efits, anticipated outcomes, evidence-based treatment alternatives, and prognosis. Standard 3: Planning VII. Obtain and document informed consent and/ or informed refusal. Planning is the establishment of realistic goals and the selection of dental hygiene interventions that can move the client closer to optimal oral health.24 Standard 4: The interventions should support overall patient Implementation goals and oral health outcomes. Depending upon the work setting and state law, the dental hygiene Implementation is the act of carrying out the den- care plan may be stand-alone or part of collabo- tal hygiene plan of care.24 Care should be deliv- rative agreement. The plan lays the foundation ered in a manner that minimizes risk; optimizes for documentation and may serve as a guide for oral health; and recognizes issues related to pa- Medicaid reimbursement. Dental hygienists tient comfort including pain, fear, and/or anxiety. make Through the presentation of the dental hygiene

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Access Supplement 2016 Standards.indd 8 11/10/16 11:47 AM care plan, the dental hygienist has the opportunity perception of care). Evaluation occurs throughout to create and sustain a therapeutic and ethically the process as well as at the completion of care. sound relationship with the patient. Depending upon the number of interventions, I. Use measurable assessment criteria to eval- the dental hygiene care plan may implemented in uate the tangible outcomes of dental hygiene one preventive/wellness visit or several therapeu- care (e.g., probing, plaque control, bleeding tic visits before a continuing or maintenance plan points, retention of sealants, etc.). is established. Health promotion and self-care are II. Communicate to the patient, dentist, and oth- integral aspects of the care plan that should be er health/dental care providers the outcomes customized and implemented according to patient of dental hygiene care. interest and ability. III. Evaluate patient satisfaction of the care provided through oral and written question- I. Review and confirm the dental hygiene care naires. plan with the patient/caregiver. IV. Collaborate to determine the need for addi- II. Modify the plan as necessary and obtain any tional diagnostics, treatment, referral, educa- additional consent. tion, and continuing care based on treatment III. Implement the plan beginning with the mu- outcomes and self-care behaviors. tually agreed upon first prioritized interven- V. Self-assess the effectiveness of the process of tion. providing care, identifying strengths and ar- IV. Monitor patient comfort. eas for improvement. Develop a plan to im- V. Provide any necessary post-treatment in- prove areas of weakness.26 struction. VI. Implement the appropriate self-care intervention; adapt as necessary throughout fu- Standard 6: ture interventions. Documentation VII. Confirm the plan for continuing care or maintenance. The primary goals of good documentation are to VIII. Maintain patient privacy and confidentiality. maintain continuity of care, provide a means of IX. Follow-up as necessary with the patient communication between/among treating pro- (post-treatment instruction, pain manage- viders, and to minimize the risk of exposure to ment, self-care). malpractice claims. Dental hygiene records are considered legal documents and as such should include the complete and accurate recording of all Standard 5: Evaluation collected data, treatment planned and provided, recommendations (both oral and written), refer- Evaluation is the measurement of the extent to rals, prescriptions, patient/client comments and which the client has achieved the goals specified related communication, treatment outcomes and in the dental hygiene care plan. The dental hy- patient satisfaction, and other information rele- gienist uses evidence-based decisions to continue, vant to patient care and treatment. discontinue, or modify the care plan based on the ongoing reassessments and subsequent diagno- I. Document all components of the dental hy- ses.25 The evaluation process includes reviewing giene process of care (assessment, dental hy- and interpreting the results of the dental hygiene giene diagnosis, planning, implementation, care provided and may include outcome measures and evaluation) including the purpose of the that are physiologic (improved health), functional, patient’s visit in the patient’s own words. and psychosocial (quality of life, improved patient Documentation should be detailed and comprehensive; e.g., thoroughness of assessment (soft-tissue examination, oral cancer screening, periodontal probing, tooth mobility) and

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Access Supplement 2016 Standards.indd 9 11/10/16 11:47 AM reasons for referrals (and to whom and fol- V. Ensure compliance with the federal Health In- low-up). Treatment plans should be consistent formation Portability and Accountability Act with the dental hygiene diagnosis and include (HIPAA). Electronic communications must meet no evidence that the patient is placed at inap- HIPAA standards in order to protect confiden- propriate risk by a diagnostic or therapeutic tiality and prevent changing entries at a later procedure.26 date. II. Objectively record all information and interac- VI. Respect and protect the confidentiality of pa- tions between the patient and the practice (e.g., tient information. telephone calls, emergencies, prescriptions) including patient failure to return for treatment or follow through with recommendations. Summary III. Record legible, concise, and accurate information. For example, include dates and signatures, The Standards for Clinical Dental Hygiene Prac- record clinical information so that subsequent tice are a resource for dental hygiene practi- providers can understand it, and ensure that tioners seeking to provide patient-centered and all components of the patient record are cur- evidence-based care. In addition, dental hygienists rent and accurately labeled and that common are encouraged to enhance their knowledge and terminology and abbreviations are standard or skill base to maintain continued competence.27-28 universal. These Standards will be modified based on emerg- IV. Recognize ethical and legal responsibilities of ing scientific evidence, ADHA policy development, recordkeeping including guidelines outlined in federal and state regulations, and changing disease state regulations and statutes. patterns as well as other factors to assure quality care and safety as needed.

KEY TERMS

Client: The concept of client refers to the potential or actual recipi- Intervention: dental hygiene services rendered to clients as iden- ents of dental hygiene care, and includes persons, families, groups tified in the dental hygiene care plan. These services may be clinical, and communities of all ages, genders, socio-cultural and economic educational, or health promotion related.29 states.29 Interprofessional Team: a group of health care professionals Cultural Competence: the awareness of cultural difference and their patients who work together to achieve shared goals. The among all populations, respect of those differences and application team can consist of the dental hygienist, dentist, physician, nutri- of that knowledge to professional practice.17 tionist, smoking cessation counselor, nurse practitioner, etc.31

Dental Hygiene Care Plan: an organized presentation or list Outcome: result derived from a specific intervention or treatment. of interventions to promote the health or prevent disease of the patient’s oral condition. The plan is designed by the dental hygienist Patient: the potential or actual recipient of dental hygiene care, and consists of services that the dental hygienist is educated and including persons, families, groups, and communities of all ages, licensed to provide.5, 7 genders, and socio-cultural and economic states.22

Evidence-Based Practice: the conscientious, explicit, and Patient-Centered: approaching services from the perspective judicious use of current best evidence in making decisions about that the client is the main focus of attention, interest, and activity the care of individual clients. The practice of evidence-based dental The client’s values, beliefs, and needs are of utmost importance in hygiene requires the integration of individual clinical expertise and providing evidence-based care.32 client preferences with the best available external clinical evidence from systematic research.30 Risk Assessment: an assessment based on characteristics, behaviors, or exposures that are associated with a particular disease; e.g., smoking, diabetes, or poor oral hygiene.21

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Access Supplement 2016 Standards.indd 10 11/10/16 11:47 AM reasons for referrals (and to whom and fol- V. Ensure compliance with the federal Health In- REFERENCES low-up). Treatment plans should be consistent formation Portability and Accountability Act with the dental hygiene diagnosis and include (HIPAA). Electronic communications must meet 1. Standard of Applied Dental Hygiene Practice. Chicago: Ameri- 19. ADHA Policy Manual [SCDHP/18-96]. American Dental Hygien- no evidence that the patient is placed at inap- HIPAA standards in order to protect confiden- can Dental Hygienists’ Association. 1985. ists’ Association [Internet]. 2016 [cited 2016 April 15]. Available from: https://www.adha.org/resources-docs/7614_Policy_Manual. propriate risk by a diagnostic or therapeutic tiality and prevent changing entries at a later 2. Standards for Clinical Dental Hygiene Practice. American Den- pdf procedure.26 date. tal Hygienists’ Association [Internet]. September 2014 [cited 2016 March 3]. Available from: http://www.adha.org/resourc- 20. ADHA Policy Manual [12-10]. American Dental Hygienists’ As- II. Objectively record all information and interac- VI. Respect and protect the confidentiality of pa- es-docs/7261_Standards_Clinical_Practice.pdf sociation [Internet]. 2016 [cited 2016 April 15]. Available from: tions between the patient and the practice (e.g., tient information. https://www.adha.org/resources-docs/7614_Policy_Manual.pdf 3. Code of Ethics. American Dental Hygienists’ Association [In- telephone calls, emergencies, prescriptions) internet]. 2-14 [cited 2016 March 24]. Available from: https://www. 21. ADHA Policy Manual [11-10/21-82]. American Dental Hygien- cluding patient failure to return for treatment adha.org/resources-docs/7611_Bylaws_and_Code_of_Ethics.pdf ists’ Association [Internet]. 2016 [cited 2016 April 15]. Available from: https://www.adha.org/resources-docs/7614_Policy_Manual. or follow through with recommendations. Summary 4. Accreditation Standards for Dental Hygiene Education Pro- pdf III. Record legible, concise, and accurate informa- grams. Chicago: American Dental Association. Commission on tion. For example, include dates and signatures, The Standards for Clinical Dental Hygiene Prac- Dental Accreditation. Revised January 2016. 22. ADHA Policy Manual [1-14/SCDHP/18-96]. American Den- tal Hygienists’ Association [Internet]. 2016 [cited 2016 April 15]. tice are a resource for dental hygiene practi- 5. ADEA Competencies for Entry into the Allied Dental Professions. record clinical information so that subsequent Available from: https://www.adha.org/resources-docs/7614_Poli- J Dent Educ. 2011; 75(7): 941-948. providers can understand it, and ensure that tioners seeking to provide patient-centered and cy_Manual.pdf evidence-based care. In addition, dental hygienists 6. ADHA Policy Manual. American Dental Hygienists’ Association all components of the patient record are cur- 23. Swigart DJ, Gurenlian JR. Implementing Dental Hygiene Diag- [Internet]. 2016 [cited 2016 March 3]. Available from: https://www. are encouraged to enhance their knowledge and nosis into Practice. Dimensions Dent Hyg. 2015; 13(9): 56-59. rent and accurately labeled and that common adha.org/resources-docs/7614_Policy_Manual.pdf skill base to maintain continued competence.27-28 24. ADHA Policy Manual [SCDHP/18-96]. American Dental Hygien- terminology and abbreviations are standard or 7. ADHA Policy Manual [4-10/SCDHP/18-96]. American Dental Hy- These Standards will be modified based on emerg- ists’ Association [Internet]. 2016 [cited 2016 April 15]. Available universal. gienists’ Association [Internet]. 2016 [cited 2016 April 15]. Avail- from: https://www.adha.org/resources-docs/7614_Policy_Manual. IV. Recognize ethical and legal responsibilities of ing scientific evidence, ADHA policy development, able from: https://www.adha.org/resources-docs/7614_Policy_ pdf recordkeeping including guidelines outlined in federal and state regulations, and changing disease Manual.pdf 25. ADHA Policy Manual [5-14/SCDHP/18-96]. American Den- patterns as well as other factors to assure quality 8. Darby ML, Walsh MM. Dental Hygiene Theory and Practice. 4th state regulations and statutes. tal Hygienists’ Association [Internet]. 2016 [cited 2016 April 15]. ed. St. Louis, MO: Saunders. 2015. pp. 2, 9, 314-217. care and safety as needed. Available from: https://www.adha.org/resources-docs/7614_Poli- 9. Wilkins EM. Clinical Practice of the Dental Hygienist. 12th ed. cy_Manual.pdf Philadelphia: Wolters Kluwer. 2017. pp. 12-14. 26. Guidelines for Medical Record Documentation. National Com- 10. Henry R, Goldie MP. Dental Hygiene: Applications to Clinical mittee for Quality Assurance [Internet]. [cited 2016 January 31]. Practice. Philadelphia: FA Davis. 2016. pp. 549-553. Available from: http://www.ncqa.org/portals/0/policyupdates/sup- 11. ADHA Policy Manual [3-14/14-83]. American Dental Hygienists’ plemental/guidelines_medical_record_review.pdf Association [Internet]. 2016 [cited 2016 April 15]. Available from: 27. ADHA Policy Manual [18-15]. American Dental Hygienists’ As- https://www.adha.org/resources-docs/7614_Policy_Manual.pdf sociation [Internet]. 2016 [cited 2016 April 15]. Available from: 12. ADHA Policy Manual [4-14/19-84]. American Dental Hygienists’ https://www.adha.org/resources-docs/7614_Policy_Manual.pdf Association [Internet]. 2016 [cited 2016 April 15]. Available from: 28. ADHA Policy Manual [17-15]. American Dental Hygienists’ As- KEY TERMS https://www.adha.org/resources-docs/7614_Policy_Manual.pdf sociation [Internet]. 2016 [cited 2016 April 15]. Available from: 13. Focus on Advancing the Profession. Chicago: American Dental https://www.adha.org/resources-docs/7614_Policy_Manual.pdf Client: The concept of client refers to the potential or actual recipi- Intervention: dental hygiene services rendered to clients as iden- Hygienists’ Association. 2005 29. ADHA Policy Manual [17-93]. American Dental Hygienists’ As- ents of dental hygiene care, and includes persons, families, groups tified in the dental hygiene care plan. These services may be clinical, sociation [Internet]. 2016 [cited 2016 April 15]. Available from: and communities of all ages, genders, socio-cultural and economic educational, or health promotion related.29 14. Transforming Dental Hygiene Education and the Profession for states.29 the 21st Century. Chicago: American Dental Hygienists’ Associa- https://www.adha.org/resources-docs/7614_Policy_Manual.pdf Interprofessional Team: a group of health care professionals tion. 2015. 30. ADHA Policy Manual [1-07]. American Dental Hygienists’ As- Cultural Competence: the awareness of cultural difference and their patients who work together to achieve shared goals. The among all populations, respect of those differences and application team can consist of the dental hygienist, dentist, physician, nutri- 15. State of Oregon Board of Dentistry. Dental Practice Act – ORS sociation [Internet]. 2016 [cited 2016 April 15]. Available from: of that knowledge to professional practice.17 tionist, smoking cessation counselor, nurse practitioner, etc.31 Chapter 679. Oregon.gov [Internet]. 2016 [cited 2016 May 17]. https://www.adha.org/resources-docs/7614_Policy_Manual.pdf Available from: https://www.oregon.gov/dentistry/docs/Rules/ Dental Hygiene Care Plan: an organized presentation or list Outcome: result derived from a specific intervention or treatment. 31. ADHA Policy Manual [18-14/16-85]. American Dental Hygien- of interventions to promote the health or prevent disease of the DPA2016Statutes01012016Color.pdf ists’ Association [Internet]. 2016 [cited 2016 April 15]. Available patient’s oral condition. The plan is designed by the dental hygienist Patient: the potential or actual recipient of dental hygiene care, 16. Oregon State Statute §679.010(2). Oregon State Legislature from: https://www.adha.org/resources-docs/7614_Policy_Manual. and consists of services that the dental hygienist is educated and including persons, families, groups, and communities of all ages, [Internet]. 2013 [cited 2015 July 20]. Available from: https://www. pdf licensed to provide.5, 7 genders, and socio-cultural and economic states.22 oregonlegislature.gov/bills_laws/lawsstatutes/2013orLaw0310.pdf 32. ADHA Policy Manual [6-97]. American Dental Hygienists’ As- Evidence-Based Practice: the conscientious, explicit, and Patient-Centered: approaching services from the perspective 17. ADHA Policy Manual [7-07]. American Dental Hygienists’ As- sociation [Internet]. 2016 [cited 2016 April 15]. Available from: judicious use of current best evidence in making decisions about that the client is the main focus of attention, interest, and activity https://www.adha.org/resources-docs/7614_Policy_Manual.pdf the care of individual clients. The practice of evidence-based dental The client’s values, beliefs, and needs are of utmost importance in sociation [Internet]. 2016 [cited 2016 April 15]. Available from: hygiene requires the integration of individual clinical expertise and providing evidence-based care.32 https://www.adha.org/resources-docs/7614_Policy_Manual.pdf 33. ADHA Policy Manual [12-05]. American Dental Hygienists’ As- client preferences with the best available external clinical evidence sociation [Internet]. 2016 [cited 2016 April 15]. Available from: from systematic research.30 Risk Assessment: an assessment based on characteristics, behav- 18. ADHA Policy Manual [16-93]. American Dental Hygienists’ As- iors, or exposures that are associated with a particular disease; e.g., sociation [Internet]. 2016 [cited 2016 April 15]. Available from: https://www.adha.org/resources-docs/7614_Policy_Manual.pdf smoking, diabetes, or poor oral hygiene.21 https://www.adha.org/resources-docs/7614_Policy_Manual.pdf

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Access Supplement 2016 Standards.indd 10 11/10/16 11:47 AM RESOURCES

The following websites can provide evidence upon which to base clinical decisions in compliance with the Commis- sion on Dental Accreditation (CODA) Accreditation Standards for Dental Hygiene Education Programs.

ADHA Policy Manual. Glossary, 18-96. American Dental Hygienists’ Association [Internet]. 2016 [cited 2016 March 28]. Available from: https://www.adha.org/resources-docs/7614_Policy_Manual.pdf

American Academy of Public Health Dentistry: http://www.aaphd.org/.

American Academy of Pediatric Dentistry: http://www.aapd.org/.

American Academy of Periodontology: http://perio.org/.

American Dental Association: http://www.ada.org/.

Commission on Dental Accreditation. Accreditation Standards for Dental Hygiene Education Programs. American Dental Association [Internet]. 2016 January [cited 2016 March 3]. Available http://www.ada.org/~/media/CODA/ Files/2016_dh.ashx

American Diabetes Association: http://www.diabetes.org/.

American Heart Association: http://www.americanheart.org/.

Association of State and Territorial Dental Directors: http://www.astdd.org/.

Canadian Dental Hygienists’ Association: www.cdha.org.

Centers for Disease Control and Prevention (caries, mineralization strategies, and health protection goals): http:// www.cdc.gov/ http://www.cdc.gov/osi/goals/goals.html http://www.cdc.gov/niosh/homepage.html

CDC Guidelines for Infection Control in Dental healthcare Settings. Centers for Disease Control and Preven- tion [Internet]. 2003. [cited 2016 March 28]. Available from; http://www.cdc.gov/OralHealth/infectioncontrol/ guidelines/index.htm

Center for Evidence-Based Dentistry: http://www.cebd.org/.

Clinical Trials: http://www.clinicaltrials.gov/.

The Cochrane Collaboration: http://www.cochrane.org/.

Forrest JL, Miller SA. An Evidence-Based Decision-Making Model for Dental Hygiene Education, Research and Practice. J Dent Hyg. 2001; 75(1): 50-63.

Health Insurance Portability and Accountability Act (HIPAA): http://www.hipaa.org/.

National Guideline Clearing House: http://www.guidelines.gov/.

Nunn ME. Understanding the Etiology of Periodontitis: An Overview of Periodontal Risk Factors. Periodontol 2000. 2003; 32:11-23.

Occupational Safety and Health Administration: http://www.osha.gov/SLTC/dentistry/index.html.

The Organization for Safety and Asepsis Procedures (OSAP):http://www.osap.org/.

Special Care Dentistry: http://www.scdonline.org/.

The Selection of Patients for Dental Radiograph Examinations. American Dental Association and the US Department of Health and Human Services [Internet] Revised 2012 [cited 2016 March 28]. Available from: http://www.fda.gov/downloads/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/ MedicalImaging/MedicalX-Rays/UCM329746.pdf

Comprehensive Periodontal Therapy: A Statement by the American Academy of Periodontology. J Periodontol. 2011; 82(7): 943-949.

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Access Supplement 2016 Standards.indd 12 11/10/16 11:47 AM ASSESS Data Collection Appendix A DIAGNOSE DENTAL HYGIENE Problem PROCESS OF CARE 7 Identification

There are six components to the dental hygiene process of care. These include assessment, dental hygiene diagnosis, planning, implementation, evaluation, PLAN and documentation. The six components DOCUMENTATION Selection of provide a framework for patient care Interventions activities.

Adapted from: Wilkins EM. Clinical Practice of the Dental Hygienist. 12th ed. Philadelphia, PA: Wolters Kluwer. 2017. pp. 12-14. IMPLEMENT Activating the EVALUATE Plan Feedback on Effectiveness

Appendix B PROFESSIONAL ROLE OF THE DENTAL HYGIENIST33

Overview The dental hygienist plays an integral role in assisting individuals and groups in achieving and maintaining optimal oral health. Dental hygienists provide educational, clinical and consultative services to individuals and populations of all ages in a variety of settings and capacities. The professional roles of the dental hygienist are outlined below .

Clinician Corporate Public Health Researcher Educator Administrator Entrepreneur

Dental hygienists in Corporate dental Community health Research conducted Dental hygiene ed- Dental hygienists By using imagina- a clinical role assess, hygienists are programs are by dental hygienists ucators are in great in administrative tion and creativity diagnose, plan, employed by com- typically funded by can be either quali- demand. Colleges positions apply to initiate or finance implement, evaluate panies that support government or non- tative or quantita- and universities organizational skills, new commercial and document the oral health profit organizations. tive. Quantitative throughout the communicate ob- enterprises, dental treatment for pre- industry through These positions research involves U.S. require dental jectives, identify and hygienists have vention, interven- the sale of products often offer an op- conducting surveys hygiene instructors manage resources, become successful tion and control and services. portunity to provide and analyzing who use education- and evaluate and entrepreneurs in a of oral diseases, Leaders throughout care to those who the results, while al theory and meth- modify programs of variety of business- while practicing in the dental industry otherwise would qualitative research odology to educate health, education es. Some examples collaboration with often employ not have access to may involve testing competent oral and health care. of business oppor- other health profes- dental hygienists dental care. Exam- a new procedure, health professionals. Examples of admin- tunities developed sionals. Examples of due to their clinical ples of positions for product or theory Corporations also istrative positions by dental hygienists clinical employment experience and dental hygienists for accuracy, effec- employ educators held by dental include: settings include: understanding of in public health tiveness, etc. Exam- who provide con- hygienists include: dental practice. Ex- settings include: ples of employment tinuing education • Practice manage- • Private dental amples of corporate settings for dental to licensed dental • Clinical director, ment company practices positions include: hygienist research- hygienists. Examples statewide school • Product develop- Clinician • Community clinics ers include: of dental hygiene sealant program ment and sales • Hospitals • Sales represen- educators include: • Program director, • Employment • Rural or inner city • University dental tatives • Colleges and dental hygiene edu- service community clinics clinics • Product research- universities • Clinical instructors cational program • CE provider or • Indian Health • Prison facilities ers • Corporations • Classroom • Executive director, meeting planner Service • Head Start • Nursing homes • Corporate edu- • Governmental instructors state association • Consulting programs • Schools cators agencies • Program directors staff business • School sealant • Corporate admin- • Nonprofit organi- • Corporate edu- • Research adminis- • Founder of a programs istrators zations cators trator, university nonprofit Administrator • Director, corpo- • Independent rate sales clinical practice • State public • Professional health officer speaker / writer • Community clinic administrator

Access Supplement 13

Access Supplement 2016 Standards.indd 13 11/10/16 11:47 AM Appendix C Four year academic Two+ years of college EDUCATIONAL PATH program in an (usually one year of pre- FOR ENTRY INTO THE undergraduate requisite course work PROFESSION educational followed by two years of Dental hygienists must complete an accredited educational program to qualify for licensure in a par- environment professsional courses) ticular state or region. Dental hygienists are licensed with the credential of Registered Dental Hygienist (RDH) or Licensed Dental Hygienist (LDH) following completion of an academic program that includes National Board Dental Hygiene Examination successfully didactic and clinical requirements. passed PROFESSIONAL SPECIALIZATION Clinical/written examination as required by region of state Dental hygienists can further their academic successfully passed credentials after earning a certificate, associate, and/ or baccalaureate degree. A dental hygienist can continue their educational advancement by enrolling in a variety of Master’s level programs which provides Licensure granted by state board of dentistry eligibility for a Doctoral level degree.

The American Dental Hygienists’ tain a provider-patient relationship Association (ADHA) defines direct (ADHA Policy Manual, 13-15). access as the ability of a dental hy- Appendix D gienist to initiate treatment based on their assessment of a patient’s needs States that permit direct access to DIRECT ACCESS 2016 without the specific authorization of dental hygienists a dentist, treat the patient without Revised April 2016 www.adha.org the presence of a dentist, and main-

D N H

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Access Supplement 2016 Standards.indd 14 11/10/16 11:47 AM Appendix C Development and Validation Process for the Four year academic Two+ years of college EDUCATIONAL PATH program in an (usually one year of pre- Standards for Clinical Dental Hygiene Practice FOR ENTRY INTO THE undergraduate requisite course work PROFESSION educational followed by two years of Dental hygienists must complete an accredited educational program to qualify for licensure in a par- environment professsional courses) n 2003, the ADHA Board of Trustees approved the 2006, the task force met and considered the com- ticular state or region. Dental hygienists are licensed establishment of a task force to define and develop ments from all respondents and made addition- with the credential of Registered Dental Hygienist (RDH) or Licensed Dental Hygienist (LDH) following standards of clinical dental hygiene practice. The al revisions to the document. The task force also completion of an academic program that includes National Board Dental Hygiene Examination successfully previous standards of practice document created by reviewed clinical standards of practice documents didactic and clinical requirements. passed I ADHA was published in 1985 and was no longer be- from other professions as a point of comparison. PROFESSIONAL ing distributed due to the significant changes in dental In 2007, the revised Standards were shared SPECIALIZATION Clinical/written examination as required by region of state hygiene practice; therefore the association did not have during the ADHA Annual Session with the draft Dental hygienists can further their academic successfully passed document posted online and open for comments credentials after earning a certificate, associate, and/ document accurately reflecting the nature of clinical or baccalaureate degree. A dental hygienist can con- dental hygiene practice. A series of task force meetings from the communities of interest. Following the tinue their educational advancement by enrolling in a variety of Master’s level programs which provides Licensure granted by state board of dentistry occurred by phone, electronically and in-person from annual meeting, the draft document was also eligibility for a Doctoral level degree. 2004-2008 in order to create and revise the draft stan- broadly distributed to the broad communities of dards document. interest, which included a pool of approximately 200 organizations. As part of the validation process, in November Following the collection of feedback from all in- 2005, a survey was distributed to all ADHA council terested parties, the task force considered all feed- members, 50 participants in the ADHA Constitu- The American Dental Hygienists’ tain a provider-patient relationship back and met by conference call in order to finalize ent Officers Workshop, and a 50-member random Association (ADHA) defines direct (ADHA Policy Manual, 13-15). the document. The final document was submitted access as the ability of a dental hy- selection of the ADHA membership to provide Appendix D gienist to initiate treatment based on to the ADHA Board of Trustees in March 2008 for their assessment of a patient’s needs States that permit direct access to feedback regarding the draft Standards of Practice DIRECT ACCESS 2016 without the specific authorization of dental hygienists their consideration and adoption. Revised April 2016 www.adha.org that had been created by the task force. The data a dentist, treat the patient without In September 2014, the Standards for Clinical the presence of a dentist, and main- collected from these audiences was collated, an- Dental Hygiene Practice policies and references alyzed and reviewed by the task force in making were updated and the document was reprinted. It subsequent modifications. was determined at the 2015 Annual Session that A During the 2006 ADHA Annual Session, the chair the Standards would need to be revised since at of the task force presented the draft Standards least three years had passed since the last full re- D document to the membership, responded to ques- vision of the document. A new task force was ap- N tions, and requested written and verbal feedback H pointed by ADHA President Jill Rethman, RDH, BA, regarding the direction of the document. The Stan- for the revision of the Standards. Y dards were also posted on the ADHA website prior to the annual meeting and for a period following E in order to solicit feedback from the membership and other communities of interest. In the fall of A S Y

C Z 2016 TASK FORCE MEMBERSHIP: ADHA STAFF: Christine Nathe, RDH, MS, New Mexico, Chair Pam Steinbach, RN, MS Carol Jahn, RDH, MS, Illinois Michelle Smith, RDH, MS

A Deborah Lyle, RDH, BS, MS, New Jersey ADHA Board of Trustee Advisor: JoAnn Gurenlian, RDH, MS, PhD, New Jersey Sharlee Burch, RDH, MPH, EdD, Kentucky Jane Forrest, RDH, EdD, California

14 DECEMBER 2016 Access Supplement 15

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