According to the Research Trisha E. O’Hehir, RDH, BS
Editorial Director, Hygienetown Magazine

I’d like a dental board member (whose job it is to protect the public) to tell me how an RDH could “cause injury to a patient” by telling the patient he/she has gum disease or tooth decay. According to the more than 25 definitions that I checked, diagnosis is simply “recognizing the signs and symptoms of disease.” So what’s the big deal with hygienists using the word diagnosis?

After all, you’re dealing with basically two diseases––tooth decay and gum disease. (Oral cancer is usually confirmed with a biopsy, which leaves only two diseases.) It’s not nuclear science that needs to be protected and kept from college educated, licensed professionals with knowledge, skills, and critical thinking responsibilities. It’s just caries and periodontal disease.

When you stop to think about it, you just have to laugh. You’re already diagnosing. Some people just want to make you believe you can’t. I’ll bet patients say, “I have a cavity,” to you all the time. Should you start telling patients that by diagnosing their own cavity they are in violation of state law? Should you start reporting these patients to the State Board of Dental Examiners for practicing dentistry without a license? Of course not! The whole issue of who can use the word “diagnosis” is ridiculous.

To get your dental hygiene license you first needed to find a patient with the required level of disease. (Diagnosis!) How can diagnosis be required for boards and denied for practice?

Here’s a quick three-step process that will make your job easier, the dentist’s job easier, and involve the patient in the process. First, collect the data you need to make a diagnosis: gum disease, yes or no. If yes, is it chronic or aggressive? Mild, moderate or severe? Is it associated with a systemic disease? Are there abscesses? Is it a necrotizing infection? Is it associated with endo lesions? Are developmental or acquired factors involved?

Second, present your findings and treatment options to the patient. It might sound like this: “Mr./Ms. Patient, you have the following signs and symptoms of gum disease: 25, 4 mm pockets; 17, 5-7 mm pockets; and 96 bleeding points. That means you have 96 areas of infection in your mouth. I know that sounds bad, but the good news is that everything is treatable. To treat those areas of infection, we need to do three things: daily plaque removal from in between all your teeth, frequent hygiene visits, and non-surgical periodontal therapy.”

Third, when the dentist comes in, what’s the first thing he/she normally asks? That’s right, “What did you find?” The dentist is asking for your diagnosis! Why make him/her wait? Present the diagnosis and treatment options to him/her, getting additional input and clarification from the patient in the process. No need to beat around the bush pointing out “suspicious” areas, just identify the signs and symptoms of disease. That’s the three-step process that will take the “d” word out of the closet.

Imagine this situation: The patient, still in the chair, says, “That’s the most thorough dental hygiene exam I’ve ever had. It was a bit scary hearing all those 5s, 6s and a couple of 8s. Plus, all the bleeding points––oh my gosh! You know I haven’t been in for a couple of years. Tell me how bad it is and what we can do about it.”

Based on your findings, you’ve determined the patient has generalized, moderate periodontitis with localized areas of severe disease, complicated by Type II diabetes and medication-induced xerostomia, a broken filling with recurrent decay, and several root surface lesions.

If you’re avoiding the “d” word, you might say, “You have a few suspicious areas I need to have the doctor check.” What would you think if you were that patient? You’d probably say to yourself, “It must be so bad, she/he wants to have the doctor break the news to me.” Or, you might wonder why the hygienist just spent 20 minutes in your mouth, but can’t tell you what’s going on in there.

You as a hygienist are very good at diagnosing. Why avoid using the “d” word? Dentists and hygienists are a team when it comes to diagnosis and treatment planning. Dentists focus on hard tissue––the teeth, and hygienists focus on soft tissue––the periodontium. Four eyes are better than two, as the old saying goes. When the dentist and hygienist pool their expertise, it’s a win-win situation for all––especially the patient.