The practice of dental hygiene is composed of five parts: assessment, dental hygiene diagnosis, planning, implementation, and evaluation. Dental hygienist usually uses a computer program that makes her work easier.

It is the first phase of the dental hygiene process. It represents collecting data: patient histories (personal, dental, and medical), vital signs, extraoral and intraoral examination, X-ray investigation, study casts, examination of the gingival and periodontal tissues, and examination of the teeth.

Diagnosis identifies the patient´s problem. Dental hygienist determines problems that can be prevented, minimized, or resolved by interventions.

Dental hygienist uses strategies which can help or improve patient´s condition. She offers therapies or educational activities that eliminate or prevent the problem.

It is the phase when the care plan is applied to the patient. Before any specific procedures are performed, the patient must sign informed consent.

Evaluation

DH (dental hygienist) compares the patient´s current status with basic data, and progress or lack toward the goal is assessed. Dental hygienist either continues in treatment or modifies the care plan.

All relevant data (patient´s histories, status, hygienic indices, anamnesis, dental charts, medicaments, X-ray pictures, photos, etc.) is written to a computer program. There can be simply found, compared and used when needed.

If we talk about technology in a surgery, we must not forget the computer and computer programs developed for dental hygienists. These are e. g. Hobosoft, Stomatolog, PCdent, or Xdent. These programmes can do electronic medical records management, online ordering patients through the web, the patient will receive a SMS reminder of the meeting, allow the creation of a treatment plan with a budget, sending of benefits to insurance companies, ePrescription, website for clients, GDPR contract, digital connection with laboratory.

A two-digit system proposed by FDI (Fédération Dentaire Internationale) for both the primary and permanent dentitions has been adopted by the World Health Organization. The FDI system of tooth notation is as follows:

Number 5 indicates the maxillary right side, and 6 indicates left side, 8 is for mandibular right side, 7 is for the mandibular left side. The second number is the tooth position number.

The quadrants are counted from upper right, upper left to lower left and finished in lower right. The second number is the tooth number. Dental hygienist records the status of all teeth. Missing teeth are usually recorded I or X, dental caries are marked with red colour, different characters are for restorations, carious lesions, inadequate contact areas, etc. It depends on computer programme or system of dental hygienist.

The care for baby teeth starts with parents´ education. They should understand that small babies can have dental caries and infections of the oral mucosa. Dental hygienist can prepare a leaflet about breast feeding, using bottles and pacifiers and their influence on teeth position development. Some information about diet is beneficial as well. Parents need a routine for cleaning the infant´s mouth. They start with damp cloth over finger and wipe over gums after each feeding. After first tooth eruption, small, soft toothbrush with water should be used. Parents must continue to care for the mouth until the child develops fine motor coordination, usually around 7 years of age.

The first appointment should be done with the eruption of the first tooth. It is around 6 months of age. It is important to work with parents´ oral health because their behaviour will equally affect their children, and parents are dental hygienists´ co-workers. They can prepare their toddlers, children for first meeting. They can help them to avoid fear.

Dental hygienist should welcome a child with a wide smile. First impression is the most important! She can invite a mom or dad to surgery as well and start communication, with child not with parents. The topic should be funny, probably not about teeth. She can ask about siblings, or about pets, hobbies. Then dental hygienist shows the tools she will use. It is fine to let the children touch them and check them out. DH should avoid dental terminology, children cannot understand them, and fear can grow up. Saliva ejector can be a vacuum cleaner, prophylactic paste – sparkle dust. It is good to have enough time for examination, let the child understand, cooperate, try, let them ask and discuss. Colourful aids, toothpaste with different colours, flavours, the educational toys are very useful. It is a kind of motivation a child can select another flavour next appointment. DH should communicate and instruct only child and praise him/ her all the time. In the end some kind of reward is very fine. Treasure box can contain small toys, pictures, toothpastes, toothbrushes, discounts.

Puberty is a sign of growing up. Chronologic age is an unreliable indicator, because puberty can start in either sex between 9 and 17 years of age. Adolescents are no longer children. Great emphasis should be placed on the composition of the diet and its influence not only on the state of the body but on oral health. The incidence of dental caries is higher during adolescence than in other age groups. It is related to dietary and eating habits of the adolescent. On one side are demands of rapid growth, on the other side we can find eating disorders like anorexia nervosa or bulimia. DH can create a diet chart and study the patient´s diet and recommend changes according nutrition and non-cariogenic food. Another chapter can be traumatic injury to teeth and oral structures from sport, contact sport and other dangerous activities, especially roller blading, skateboarding, cycling, etc.

Working with adolescents offers a challenge. Each of them needs their own approach. Dental hygienist should treat them as adults, encourage them to communicate. DH should be very patient and respect them when they choose to make their own decisions. Adolescents need to take increasing responsibility for their own health. They are usually interested in detail about their physical condition. Attractiveness is important to most teenage patients.

The adult person is responsible for his / her health as well as the state of his / her teeth. Patient should have fixed cleaning habits from childhood, and know brushing methods, brushing instruments and aids. DH checks, cleans, improves the patient´s dexterity, helps with product orientation in the market, and whitening the teeth. Many adult patients appreciate the possibility of complex dental treatment and dental care provided by the dentist and dental hygienist. Many of them value that they are treated as a person not as a patient.

Biologic age is not synonymous with chronologic age. Changes with aging vary among individuals. There is influence of many factors: genetic predisposition, specific diseases, environment, and definitely lifestyle. Effects of aging can be seen on many parts of human body. We notice changes in the cardiovascular system, musculoskeletal system, gastrointestinal system, on the skin. Pulmonary disorders are very common. There are changes in the oral cavity too. Lips, oral mucosa are dry. It is result from dehydration. The tongue appears smooth, shiny and bald. It is related to anaemia because of nutritional factors. The teeth show colour changes, dark stain from restorations, signs of wear, abrasion at the neck (probably aftereffects of extend hard toothbrush in a horizontal direction). Root caries are increased with roots exposed by periodontal infections.

Dental hygienist should show respect for age, shouldn´t call the patient by his/ her first name. She shall sit facing the patient, because hearing can be problem. If it is, she shouldn´t shout, just speak slowly and increase volume, eliminate background music or other sounds. DH should know all the diseases or disorders and used medicaments of the patient, do dietary schedule because of nutritional deficiencies, and complete it with oral examination. In patient instruction, DH shouldn´t try to change lifelong habits because doing so may create frustration and unhappiness. She can present one idea at a time and have enough time; older people do not like to be hurried.

Pregnancy lasts approximately 40 weeks and is divided into three trimesters. Dental and periodontal examination is strongly recommended, in the Czech Republic is compulsory. Nearly every pregnant woman is bothered by one or more complaints at some time of her pregnancy. DH should provide the patient with comfort. It can be the position on the dental chair. Patient lies on the left side with a pillow roll to elevate right hip, or appointment time around noon to avoid time of sickness in the morning and tiredness later in the afternoon.

Morning sickness with vomiting, or emesis, can lead to demineralization and acid enamel erosion primarily of the palatal surfaces. Woman should rinse her mouth with sodium bicarbonate to neutralize acid on the teeth and wait with brushing at least 30 minutes. Dental hygienist instructs and supervised mum-to-be in brushing technique to avoid bacterial plaque, because there can be exaggerated response of the tissues to plaque and gingival inflammation develops. The gingiva can show a reaction to the physiologic changes of pregnancy, and there is influence of increased circulating levels of female sex hormones too. The gingival reaction is usually seen in the first trimester. It must be treated if not, gingivitis develops to maximum severity by the end of pregnancy. Restorations, replacement of restorations should be completed before delivery the baby. Mother may be too busy after giving birth and have no time for early appointment.

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycaemia. Type I – an absolute insulin deficiency, Type II – pancreatic insulin secretion is low, but the patient exhibits an insulin resistance. The oral cavity of a patient with diabetes may show unusual reactions to injury, infections and local irritations, delayed healing.

Dental hygienist must accept patient´s insulin chart. Patient should be treated in the morning after breakfast and medication, or after lunch and will not be waiting a long time in the waiting room. DH will not do long and stressful procedures, there is limit number of teeth treated at each visit. DH must be very careful during scaling and root planning to avoid trauma to tissues, pay attention to areas of irritation related to fixed or removable prostheses. Sometimes GP, or dentist can prescribe antibiotic premedication, usually in case of reduced ability to resist infection.

AIDS (Acquired ImmunoDeficiency Syndrome) is a condition caused by infection with HIV1, HIV2 (Human Immunodeficiency Virus). Both are slow, progressive, often lethal diseases. Many HIV positive patients have persistent oral candidiasis, parotiditis (swelling of the parotid glands), herpetic gingivostomatitis, aphthous ulcers, herpes simplex, hairy lekoplakia, ulcerative gingivitis. The other problems are lymphadenopathy, enlarged lymph nodes, and skin lesions can be found during extraoral examination.

The dental hygienist must strictly follow all precautions against infection. She must protect her HIV positive client from infections but also other patients and of herself. She teaches her patient for postponing an appointment when a herpes lesion is present, keeping medical history up-to-date, and come to the surgery with mouth cleaning with toothbrush and floss to lower the bacterial count and thus lessen contamination in treatment room. The HIV patient is usually ordered as last, so that thorough sterilization can be performed.

Dental hygiene treatment is not carried out during an acute period. Treatment is undertaken when the patient´s symptoms are reasonably controlled by medications. Beside bad treatment of the oral health, there are very common side effects of medications – xerostomia, dry mouth resulting from reduced or absent saliva flow, which leads to risk of enamel and root caries. The loss of enamel and the exposure of dentine results in sensitivity.

Appointments are best scheduled in the morning, patient shouldn´t wait long time. Patients can be overactive, restless, and in constant motion, can behave aggressive. DH must simplify the surroundings, keep the voice firm and low-pitched, must avoid long description because patient has a short attention. She mustn´t rush the patient, it can lead to anger. Due to poor oral hygiene, DH should recommend reduction of cariogenic food, fluoride therapy, she can advise sugar-free chewing gum to stimulate saliva.

In all these cases, DH usually cooperates with family members, therapist and nursing staff.