The hygiene protocol was developed on the premise that the hygienist is not performing a service which included a series of tasks that would be completed and checked off at the end of an appointment, but rather on a problem-solving process that allows the hygienist to assess and collect data on each patient, in order for the dentist to formulate an individualized treatment plan.
The acronym for the hygiene protocol model is SAPIE or Screening, Assessing, Planning, Implementing, and Evaluating.
The first step, Screening, is done using the PSR system and takes about 3-5 minutes. From this screening we can derive two things. Is the patient at risk for breakdown of the supporting structure of their teeth? Do they need further data collection? This process can be incorporated into the existing recall appointment at no extra charge to the patient. Depending on what the results of the PSR indicate will determine whether or not they need to move to Assessing or the Comprehensive Oral Examination (COE). New patients already receive this kind of evaluation, but the PSR is a great way of involving existing patients in their own dentistry and allows them to participate in a part of the new patient experience.
The Assessing part of the COE has two main components. The procedural side is probably what we’re most familiar with, and includes medical/dental history, oral cancer screening, existing restorative conditions, periodontal data, radiographs and intra-oral pictures. The second component is often neglected yet is important in not only developing a relationship with a patient, but is necessary in order for the patient to accept a treatment plan that is proposed to them. The behavioral component includes the patient’s dental I. Q., their motivators and goals, their expectations, IOC, their personality style and the degree of “self-care” that they will perform. This part of the examination is challenging because it requires the dental hygienist to use all communication skills in order to determine the patient’s perspective of what dental care is.
Once we have collected all the necessary information we can move to treatment Planning. By prompting the dentist when they enter the operatory, we can refresh them as to who the patient is, and quickly summarize any changes that have occurred since their last visit, as well as inform them of the current clinical findings. By having necessary intra-oral pictures, radiographs, etc., available, the dentist can visualize the summary and begin to formulate a customized treatment plan.
The planning part of the model should focus on the perio component of the treatment plan first. Placing the patient in the perio part of the treatment plan will get the patient as close to optimum oral health as possible, in order to make the restorative part of the treatment plan possible. The course of action taken during the perio treatment plan is based on the level of infection in the patient’s mouth and is of course reflected in the fees and time scheduled for the patient.
By creating a healthy environment for the restorative work to be done, we have also fulfilled the office philosophy or the preventive philosophy in trying to achieve optimum oral health for each patient. The restorative treatment plan includes crisis work, work that is needed and elective work that the patient would like to have completed.
The Implementing part of the module includes making sure that the patient is aware of what is going to happen at the various types of appointments. It includes involving them in the different new techniques of debridement, making sure that they understand the role of “self-care,” and have the necessary tools to perform their home-care routine. It involves teaching our patients selfassessment techniques that will allow them to see their progress and thus motivate them to continue with their success.
The last stage, Evaluation, is ongoing. The patient’s oral health may change at any point in time due to a variety of reasons. Lifestyle changes, work and health changes may all affect the mouth. Monitoring and updating the patient’s oral health needs will allow us to continue to strive for optimum oral health and assist us in maintaining personalized continuing care. Evaluation also includes evaluating the actual success of the treatment plan itself. Was it successful in achieving what was prescribed for the patient or do we need to modify it?
Do we need to refer this patient to a specialist in order for them to progress to better oral health or has this patient’s needs been satisfactorily met within the scope of our practice?
Regardless of what information the evaluation tells you, by using the SAPIE hygiene protocol, you have an organized and systematic approach to hygiene for all of your patients based on only one criteria; the state of the patient’s own oral health.
Lisa Philp is the President of Transitions Group North America, a full service coaching company for dentistry. Lisa is a certified effectiveness trainer, certified facilitator in Integrity Selling, a Certified Management Consultant as designated by the Academy of Dental Management Consultants; has been recognized in the National Register’s Who’s Who in Canadian Dentistry; is a member of NSA (National Speaker’s Association) and CAPS (Canadian Association of Public Speakers). Lisa also teaches the dental students at the University of Toronto, Faculty of Dentistry.
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By having necessary intra-oral pictures, radiographs, etc., available, the dentist can visualize the summary and begin to formulate a customized treatment plan
