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FAQ Practice Advice

Practice Advice FAQs

How often should dental hygienist renew their CPR training?

If a dental hygienist has taken a CPR course and the certificate is valid for three years, then provided the dental hygienist feels competent throughout the three-year period, the CPR would remain current until the noted three-year expiry date.

If the CPR certificate has no expiry date, then the certificate is valid for one year from the date that the CPR course was taken. The CPR certificate expiry date combined with the dental hygienist’s assessment of their competency determines how often CPR must be renewed.

Is practising Orofacial Myofunctional Therapy (OMT) within an RDH’s scope of practice?

To learn more, please see the article in the Milestones | March 2016 Issue 1.

What items are we required to have in a medical emergency kit?

  • Epinephrine (epi-pen)
    • Diphenhydramine (injectable)
    • Salbutamol (inhaler)
    • Nitro-Glycerine (sublingual tablets or sublingual spray)
    • ASA Tablets (chewable)
    • Fruit Juice or Glucose
    • Portable Oxygen Unit.

Is taking a blood pressure reading on my clients mandatory?

For clients whose medical history is clear, the CDHO encourages dental hygienists to take a blood pressure reading as part of their baseline assessment. If the client’s blood pressure is within the normal range, it may not be necessary to take that client’s blood pressure at every appointment. However, in the interest of being proactive, it would be prudent to periodically monitor the client’s blood pressure to ensure that there have been no significant changes since it is well known that hypertension can be asymptomatic.

Taking blood pressure is required for clients whose medical history indicates a need (i.e., clients with diagnosed hypertension, cardiovascular disease, diabetes, chronic kidney disease, and this list is not exhaustive). Treating a client with an elevated blood pressure can increase the client’s risk of experiencing a hypertensive crisis (where a severe increase in blood pressure can create an emergency) and possibly lead to a cerebrovascular accident (stroke) or myocardial infarction in the dental chair. If the presence of hypertension is suspected, the dental hygienist should make an appropriate referral to the client’s primary care provider and should proceed only after medical consultation with the primary care provider establishes that it is safe to do so.

All dental hygienists want to ensure that they are not putting their clients at risk while providing dental hygiene treatment. The monitoring of clients’ blood pressure is an important step that dental hygienists can take to ensure safe client care.

Can I treat a client who is receiving nitrous oxide and oxygen conscious sedation?

Dental hygienists may treat clients receiving nitrous oxide and oxygen, if certain conditions are met before initiating treatment. In Ontario, dental hygienists are not authorized to administer nitrous oxide and oxygen by inhalation (as this is a controlled act), or monitor clients receiving nitrous oxide and oxygen for conscious sedation as per the Regulated Health Professions Act, 1991 (RHPA).

Dental hygienists who wish to treat clients receiving nitrous oxide and oxygen must ensure that: 

  • They obtain any informed consent required before the client is sedated. 
    • Nitrous oxide and oxygen has been administered and is being monitored by an appropriately trained dentist who is a member of the Royal College of Dental Surgeons of Ontario (RCDSO) or an appropriately trained registered nurse or respiratory therapist under the order of a member of the RCDSO.
    • The individual who is monitoring the client must be present in the treatment room/operatory at all times and the dental hygienist is never left alone with the client while the client is receiving nitrous oxide and oxygen.
    • If a registered nurse or respiratory therapist is administering or monitoring the nitrous oxide and oxygen delivery, the dentist does not need to be in the operatory but must still be present in the office suite and immediately available for emergency.
    • Clients must be monitored by the appropriate professional described above by direct and continuous clinical observation for level of conscious sedation and assessment of vital signs.

In the case where any of the above criteria is not met, dental hygienists must refuse to provide dental hygiene services to clients who are receiving nitrous oxide and oxygen conscious sedation.

Does my client require prophylactic antibiotics before treatment to prevent infective endocarditis or hematogenous joint infection?

The need for antibiotic prophylaxis for the prevention of infective endocarditis and hematogenous joint infection should be considered on an individual basis in conjunction with the health care provider most familiar with the client’s specific condition. Treatment decisions should be made in light of all circumstances presented by the client. Treatments and procedures applicable to the individual client rely on mutual communication between client, dental hygienist, physician, dentist, and other health care practitioners. The dental hygienist is ultimately responsible for making the decision whether or not to proceed with dental hygiene services.

Can I use a laser while providing dental hygiene treatment?

The CDHO has no written protocol for use of lasers. This is because the laser is not controlled under our health legislation. It is what is done with the laser that becomes important. So a dental hygienist can use any laser within scope in Ontario as long as they do not enter into a procedure (act) that is not authorized to them. For example, they could not use the laser for gingival recontouring. They can use it for dental hygiene procedures such as debridement, sanitizing pockets, whitening, treating aphthous ulcers and cold sores.

As with any intervention, dental hygienists must ensure that the treatment is evidence based and must ensure their competency before performing the intervention. Competency in using the laser because of its wide capabilities should be gained through participation in a formal course/training that has a hands-on component. 

What are the CPR and First Aid requirements for dental hygienists?

The CDHO Standards of Practice state that a dental hygienist shows competence when providing dental hygiene services and programs by maintaining certification in CPR and basic first aid.

Each dental hygienist involved in clinical practice must hold current a CPR certificate at the basic life support level, which includes training in cardiopulmonary resuscitation (CPR) at the basic support level, including one-rescuer and two-rescuer CPR for adults, children, and infants; the relief of foreign body airway obstructions for adults, children, and infants; the use of an automatic external defibrillator (AED); and the use of ambu-bags resulting in certification or recertification by the Heart and Stroke Foundation of Canada, the Canadian Red Cross or an entity with equivalent requirements. All CPR certification or recertification courses must include a hands-on component. A blended delivery method would also be suitable, where the theory may be completed online in advance, as long as it also includes an in-person component. Online-only courses are not acceptable by the College.

The College requires that dental hygienists be competent should they have to administer first aid in an emergency situation. While taking a stand-alone first aid course may be necessary for some to obtain competence in first aid, the College is aware that many CPR courses cover many components of first aid, and as such, do not require registrants to have a separate first aid certificate. The dental hygienists’ self-assessment of their first aid competency determines whether or not they should take additional first aid training. Maintaining a current valid CPR certificate on the other hand, is mandatory and the College may request to see the CPR certificate.

Is a dental hygienist HARP certified?

The Healing Arts Radiation Protection (HARP) Act, and the X-ray Safety Code (Regulation 543) cover the use of x-rays for the irradiation of human beings in the province of Ontario. These regulations govern radiographic equipment, their operation, and the qualifications of individuals operating them. Section 5(2) of the HARP Act lists members of the College of Dental Hygienists of Ontario (CDHO) as persons deemed to meet the qualifications prescribed by the regulations. This means that even though dental hygienists complete radiography training in a dental hygiene program, they are not considered HARP certified until they are registered with the CDHO. The HARP Act does not approve or certify dental hygiene radiography programs. Only the CDHO has the authority to grant HARP certification to dental hygienists in Ontario. Dental hygienists who currently hold a general or specialty certificate of registration are deemed to be HARP certified. Those who have resigned, are suspended or revoked from the College are not considered HARP certified.

The Act also states that an inspector may enter and inspect the premises and require the production of proof that any person who operates an x-ray machine meets the qualifications and requirements. A ministry inspector will accept a dental hygienist’s certificate of registration (or CDHO wallet card) as proof that they meet the requirements.

Are dosimeters mandatory for dental hygienists?

A dosimeter is a device used to measure an accumulative amount of ionizing radiation the wearer has been exposed to. In Health Canada’s Radiation Protection in Dentistry: Recommended Safety Procedures for the Use of Dental X-Ray Equipment (Safety Code 30), it is very strongly recommended that all operators of dental x-ray equipment wear personnel dosimeters. However, in Ontario, the HARP Act does not require this, and the use of dosimeters while advised is not mandatory.

When can a dental hygienist take impressions?

The College of Dental Hygienists of Ontario (CDHO) does not consider the taking of an impression (for any reason ‒ e.g., whitening trays, mouth guards, permanent crowns, orthodontic appliances, etc.) as a controlled act. Therefore, all dental hygienists can take impressions if they are competent. 

What is included in each billing code?

The CDHO cannot interpret or make recommendations regarding the ODA or the ODHA Suggested Fee Guides. The CDHO is not the author of the fee guides so any questions regarding their use should be directed to the authors, specifically, the ODA or ODHA practice advisory services as they have the ultimate authority on the interpretation of these documents.

Can a dental hygienist fit and dispense an appliance?

NO. In the Regulated Health Professions Act, 1991 (RHPA), the fitting or dispensing of a dental prosthesis, orthodontic or periodontal appliance or a device used inside the mouth to protect teeth from abnormal functioning is listed as a controlled act #11. This controlled act is not in the scope of practice for dental hygienists as there are implications for the occlusion and the temporomandibular joint.

However, there is an exception in the RHPA, which states that dental hygienists who practise with a dentist may be involved in the fitting and dispensing of a bruxism appliance in conjunction with the dentist. Thus, an RDH can perform this function as long as they meet the criteria (a) and (b) in the RHPA exception to the controlled act #11 (see below).

Additionally, it is up to the dentist to determine the level of supervision and the dental hygienist must be confident and competent to perform the procedure. Ultimately, it would be wise to let the dentist have the final look before the client is dismissed.

RHPA exception to the controlled act #11

32(1) No person shall design, construct, repair or alter a dental prosthetic, restorative or orthodontic device unless,

(a)   the technical aspects of the design, construction, repair or alteration are supervised by a member of the College of Dental Technologists of Ontario or the Royal College of Dental Surgeons of Ontario; or

(b)   the person is a member of a College mentioned in clause (a).

Can I take x-rays when the dentist is not in the office?

Yes, however, all radiographs must be prescribed by a dentist.  The prescription can be verbal but must be documented in the client chart. Standing orders cannot be issued for radiographs.  It is not acceptable to take radiographs on a time-dependent basis (e.g. every six-months or once/year) or to take radiographs for every new client (e.g. two bitewings and a PAN).