hi and welcome my name is tasy panni and I'm one of the two practice advisers at the cdho thank you for joining me today I am pleased to be with you to discuss what resending the standard for authorization to self-initiate profession specific acts means to you I will be providing with a brief background of the issue and discussing what the decision-making process related to scaling and root planning and its relationship to the contraindications regulation we will finish up with a few scenarios and I'll be directing you to some resources that you may find helpful on September 22nd 2023 the CD's Council rescinded the standard for authorization to self-initiate profession specific acts this means that all active registered dental hygienists can now perform the controlled Act of scaling in root planning on their own initiative without the requirement of a standing order client specific order or authorization from the cdho the contraindications regulation requires that you obtain medical clearance from a physician or dentist when a contraindication is identified this clearance is also required if you have any doubt as to the accuracy of a client's medical or oral history your training and experience have provided you with the knowledge skills and judgment needed to make this decision the cdho is committed to public protection and to ensuring that dental hygienists are confident in their decision- making as it relates to the contraindication regulation we have developed several resources to help you I will further provide information on these later in the presentation although the cdho no longer requires you to have any special authorization to initiate scaling and root planning on your own some employers may wish to implement some sort of approval process employers can place these additional obligations on employees in this case you should ensure you fully understand the terms of the directive you are required to work under a complete accurate and comprehensive medical dental and Drug history is a crucial first step in the dental hygiene process of care it provides Vital Information you need to provide safe and effective care and to ensure you have all the information you need to make decisions about your treatment recommendations including helping you to decide if you can safely proceed with scaling in root planning a thorough health history includes a discussion of any conditions a client may be dealing with this information will insist in determining whether any of the contraindications listed in the regulation are present or known if you can rule out all contraindications you can confidently initiate scaling and root planning procedures safely if a contraindication is identified and obtaining medical clearance is needed further discussion with the appropriate healthc care professional should occur you will need consent to engage in this discussion with other healthc Care Professionals in the next series of slides we'll look at individual Clauses and provide some examples on how they might apply in your practice these two contraindications are related to cardiac conditions contraindication one any cardiac condition for which antibiotic prophylaxis is recommended in the guidelines set by the American Heart Association as those guidelines are amended from time to time unless the dental hygienist has consulted with either the client's physician dentist or registered nurse in the extended class and determined that it is appropriate to proceed if the client has taken the prescribed medication as per the AHA guidelines contraindication number nine a client who has previously experienced an episode of infective endocarditis or whose physician has noted prophylactic antibiotics are required due to valve replacement surgery must have taken the recommended prophylactic medication as prescribed before the commencement of the dental hygiene care appointment contraindication two dental hygienist should consult the cdho guideline recommended antibiotic prophylactic regimes for the prevention of infective endocarditis and hematogenous joint infection which can be found on the cdho website for additional conditions requiring prophylactic antibiotics and if there are any concerns consult with the appropriate healthc care professional before the delivery of invasive dental hygiene procedures at L as listed in the guideline contraindication three should a client present with an unstable medal medical or oral health condition and in your professional judgment proceeding with scaling and root planning is not in the client's best interest you should consult with the client's physician or dentist to seek clearance for treatment for example if your client indicated that they were undergoing testing for their heart under the direction of their physician but they have not yet perceive received a diagnosis contraindication four if a client is in the process of receiving chemotherapy and or radiation therapy consult with the client's healthc care provider is essential before performing any dental hygiene intervention contraindication five when the client's health history indicates that they may be significantly immunosuppressed you should work collaboratively with the client's healthcare provider team to determine the severity of their immunosuppression and the optimum sequencing of dental hygiene therapies and interventions to ensure that all oral health needs are met safely and appropriately contraindication six blood disorders is a very broad term and you should investigate any identified conditions sufficiently to make a decision based on risks as to whether to proceed or not among others risk could include abnormal bleeding compromised immunity or increased risk of infection your investigation should involve confirming knowledge and evidence related to the condition and Consulting with the appropriate healthcare provider as indicated contraindication seven if a client presents with active tuberculosis the dental hygienist should postpone treatment until the client's physician has indic indicated that the disease is no longer in the active State contraindication 8 a client who appears to be under the influence of a substance that could impair their judgment should be rescheduled for a time when the client is aware and can participate safely in the dental hygiene care plan obtaining infirmed consent requires that your client be free from the influence of drugs or alcohol cont indication 10 when taking the medical and dental drug history if you become aware of any condition with which you're unfamiliar you should further investigate the condition using appropriate resources and evidence such as that provided in the CD's knowledge Network this may include Consulting with additional healthc care providers contraindication 11 if the client is taking a drug or a combination of drugs with which you are unfamiliar you should further interview the client as to the nature of the medication and its effects it would be appropriate to research the drugs in the current compendium of pharmaceuticals and Specialists the CPS Mosby's Dental drug reference or other suitable reference and note any contraindications to proceeding with treatment if you're still in doubt you should consult with the appropriate healthcare provider the last contraindication is not listed as a specific contraindication and is meant to capture that if you're ever in doubt about the status or accuracy of anything in the client's medical or oral history you should seek medical or dental clearance before proceeding with scaling and root planning for example if a client reports having tuberculosis but is not sure whether it's active or not the need to see clearance from a physician or dentist would be indicated whether you are a Neer dental hygienist or one who's been practicing for several years you're fully qualified to practice the full scope of dental hygiene in Ontario including initiating scaling and root planning as you gain confidence you will find that you will continuously build on your skill set through your professional interactions your pursuit of continuing education and the creation of a network of trusted peers and colleagues good communication skills contribute greatly to delivering Quality Care modern clinical practice relies on up-to-date knowledge and evidence-based procedures with the right knowledge you can demonstrate your abilities and build your confidence this understanding makes learning and developing new skills of priority for both new and experienced dental hygienists so let's have a look at a few scenarios and practice a little scenario one a client's medical history shows a sign and history of angina no medications listed for Angina treatment and the client was taking medication for Angina at one point but doesn't believe any of their current medications are for Angina the client reports taking two medications however they forget what they're for and don't know their names the client occasionally experiences chest pain should you proceed with scaling and root planing what are your thoughts here if you would like a few moments to think about the scenario or the ones following please feel free to pause the video at any time so we know the client has a history of angina they cannot provide the dental hygienist with sufficient information about the current medications they're taking and they State they currently experience chest pain from time to time there could be unstable angina here or chest pain attributable to heart disease so what should happen next some options include seeking more information about the client's medications maybe obtaining consent to discuss with the pharmacist if necessary you could discuss the matter with the dentist or consult with the appropriate health care provider if you were to go to the CD's knowledge Network you can access the advisory and fact sheet on angina you will see dental hygienist cannot Implement any procedures without prior consultation with the appropriate primary or specialist care provider if the client is experiencing unstable angina or is experiencing pain that could be attributable to heart disease in this scenario you should not proceed with scaling and root planning at this point and should consult with the appropriate care provider this is a screenshot of what you would see if you open the angina fact sheet on the knowledge Network you can see the condition on the top left corner this section will also include other names you may encounter related to this condition on the right hand side you can see the goto navigation section if for example you only want to see the oral manifestations of a condition you can click on the link and it'll take you directly to that section scenario two a client whom you saw six months ago reports that they were diagnosed with cancer since the last VIs it they report that they're currently receiving chemotherapy and their next chemotherapy appointment is in 3 days should you proceive the scaling in root planning what are your thoughts on this one the knowledge Network advisory on chemotherapy and radiation states with active chemotherapy and radiation dental hygiene procedures are contraindicated without prior consultation it also States you should not Implement any invasive procedure es without prior consultation with the appropriate primary or specialist care provider if the client's current treatment includes chemotherapy with or without radiation therapy or the client has undergone or is about to undergo chemotherapy with or without radiation therapy so in this scenario you should not proceed with scaling and root planning and should consult with the appropriate healthc care provider scenario three a new client reports they were recently diagnosed with poly cymia you are unfamiliar with the condition but vaguely remember that it's some sort of blood disorder you research Poly cymia on the knowledge Network you ask the client if they're currently taking any medications and they say that they're on hydroxy UA medication to manage their polycythemia is it safe for you to proceed with scaling in a root planning what are your thoughts on this one so unfamiliarity with a reported condition could affect the appropriateness safety efficacy of scaling and root planning this is a contraindication it is also an indication for the dental hygienist to inform themselves about the reported condition from the knowledge Network you will learn that poly cymia is a blood disorder and any invasive procedures are contraindicated in the presence of blood disorders so in this scenario no you should not proed with scaling and root planning until the client is medically cleared by the physician or primary care provider most closely associated with treating the client's condition scenario four while reviewing the client's chart you know that they have not been to the clinic for three years the client reports that they have had a hip replacement two years ago have had no infections related to the joint replacement and are not taking any medications other than the occasional tile anol or Advil for pain the client reported that they don't require any antibiotic prophylaxis before their dental treatment according to their surgeon and the client is also in great health with no other medical conditions is it safe for you to proceed with scaling and root planning what are your thoughts here well in this case the medical history has changed and they State they haded a hip replacement just over two years ago and take Advil and Tylenol on occasion if you were to consult the knowledge Network or the recommended guideline it states that all routine dental hygiene procedures should be delayed for several weeks after joint replacement or revision surgery or if in doubt until clearance is given by the client surgeon for a client with a history of other comorbidities complications or Associated conditions listed on the advisory you before performing any D dental hygiene procedures should normally see seek the advice of the orthopedic surgeon whether directly or through the family physician so in this case the initiation of invasive denal hygiene procedures is not contraindicated we would like to draw your attention to several resources available on our website we think that you'll find the CD's knowledge Network to be particularly valuable in your decision making it contains advisories and fact sheets on medical conditions that will assist you and your clients in making decisions about dental hygiene care especially about whether or not you should proed with care the advisories and fact sheets do have areas where they specifically State whether non-invasive or invasive procedures such as scaling and root planning are or are not contraindicated the advisories and fact sheets are regularly updated by cdho staff and medical experts we'd also like to encourage you to review the following guidelines that can be found on our website we highly recommend that you read and become familiar with these guidelines if you have not already these guidelines help to point out the importance of comprehensive and detailed medical history they will help guide you in asking probing questions where medical histories are not clear this will allow you to rule out and relate the client's medical history to the contraindications regulation and help you with the decision-making process in terms of deciding to proceed or not to proceed with dental hygiene care the CD's registrant handbook is also another resource that you may find useful it includes a discussion about controlled acts and the contraindication regulations and considerations surrounding providing treatment to your clients we are available five days a week by phone or email and our contact information is on this Slide the college enthus enthusiastically perfor promotes the safe and effective delivery of dental hygiene care by providing dental hygienists with resources that will guide them in practice we welcome the contribution you make to the oral health of ontarians and encourage you to use these resources and consult with the college when you need help with decisions involving client care if you have any question about the resources provided today please reach out we are very approachable and if we can be of any additional assistance please do not hesitate to reach out to Carol or myself at any time thank you once again for joining us and bye for now