Patients, colleagues and the public

A dental hygienist will be able to:

1.1 Provide patient-centred care by putting the patient’s needs first, and protect and promote patient and whānau or family wellbeing.

1.2 Understand the concept of professionalism and how to develop and maintain an effective practitioner-patient relationship.

1.3 Act with dignity and respect towards others by being open and honest, courteous, empathetic, and supportive in interactions, and acknowledging and respecting Tikanga Māori.

1.4 Treat others fairly and without discrimination, respecting cultural values, personal disabilities, and individual differences.

1.5 Respect patients’ autonomy and their right to make their own oral health decisions, aligned with kāwanatanga, tino rangatiratanga and ōritetanga.

1.6 Respect patients’ right to complain and enable them to seek redress by facilitating the fair, simple, speedy, and efficient resolution of complaints.

1.7 Respect and protect the confidentiality of patient information at all times, including situations outside the healthcare setting.

1.8 Behave in a professional manner that maintains public trust and confidence in them personally, and the profession.

1.9 Act to protect the interests of patients and colleagues from any risk posed by their own personal issues, health, competence, or conduct; or those of a colleague.

1.10 Act to protect the interests of tamariki, mokopuna, rangatahi in cases of suspected neglect or abuse by disclosing information to a relevant authority or person.

Laws and regulation

A dental hygienist will be able to:

1.11 Practise in accordance with legal and regulatory requirements that affect oral health practice in Aotearoa New Zealand.

1.12 Understand the relevance of Te Tiriti o Waitangi. Specifically, the concepts in relation to hauora Māori and Māori oral health outcomes; tino rangatiratanga, equity, active protection, options, and partnerships.

1.13 Understand and comply with the professional standards and practice standards of the Dental Council’s standards framework, and adhere to the ethical principles, in their interactions with patients and their communities.

Professional development and ongoing competence

A dental hygienist will be able to:

1.14 Critically self-reflect on their practice and apply this to their ongoing professional development; including reflecting on their decision-making, actions, performance, and whether culturally safe care has been achieved.

1.15 Recognise the importance of ongoing learning and professional interaction as means of maintaining and enhancing professional knowledge and skills.

Communication

A dental hygienist will be able to:

2.1 Communicate respectfully, effectively and in a culturally appropriate way with and about patients, their parents, whānau or family, carers, representatives, kaiāwhina, and the public.

2.2 Listen to their patients, recognise communication barriers, and take into account specific communication needs and preferences. This includes Te Reo Māori me ona Tikanga, communication needs and preferences.

2.3 Communicate honestly, factually and without exaggeration in all forms of communication.

2.4 Provide patients with the information they need and request, and facilitate their understanding of their oral health condition and options for care.

2.5 Communicate openly and respectfully with colleagues, other members of the oral health team, other health professionals, other hauora providers and social organisations.

Culturally competent

A dental hygienist will be able to:

3.1 Understand Te Tiriti o Waitangi and Treaty of Waitangi and the application of the principles to their practice.

3.2 Recognise and respect the cultural diversity of the Aotearoa New Zealand population.

3.3 Describe the Māori world view of hauora, tikanga and kawa and apply this knowledge to their practice.

3.4 Use knowledge of whanaungatanga and Te Tiriti o Waitangi as a basis for their practice, and to establish functional relationships with Māori patients.

3.5 Understand that a patient’s cultural beliefs, values and practices influence their perceptions of health, illness and disease; their health care practices; their interactions with health professionals and the health care system; and treatment preferences.

3.6 Recognise that the concept of culture extends beyond ethnicity and includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief; and disability. Patients may identify with several hapū, iwi and/or cultural identity.

3.7 Reflect on their own culture (including their own biases, attitudes, assumptions, stereotypes, prejudices and characteristics) and its impact on clinical interactions and the care they provide, including delivery of culturally appropriate care.

3.8 Understand the inherent power imbalance that exists in the practitioner-patient relationship and commit to work in partnership with their patients and whānau to enable culturally competent care.

Culturally safe care

A dental hygienist will be able to:

3.1 Understand Te Tiriti o Waitangi and their application of the articles, as described in Wai 2575, when providing care.

3.2 Recognise and respect the cultural diversity of the Aotearoa New Zealand population.

3.3 Describe the Māori world view of hauora, tikanga and kawa and apply this knowledge to their practice.

3.4 Use knowledge of Te Kawa Whakaruruhau and Te Tiriti o Waitangi as a basis for their practice, to achieve whanaungatanga-based relationships.

3.5 Understand the following concepts in relation to hauora Māori and Māori oral health outcomes:

• tino rangatiratanga which provides for self-determination and mana Motuhake
• equity³ which focusses on equitable health outcomes for Māori
• active protection to achieve equitable health outcomes
• options which focus on access to oral health care, and delivering the care in a culturally appropriate way that recognises hauora Māori models of care
• partner with Māori on delivery of oral health care to Māori to improve access, equity and oral health outcomes.

3.6 Understand that a patient’s cultural beliefs, values and practices influence their perceptions of health, illness and disease; their health care practices; their interactions with health professionals and the health care system; and treatment preferences.

3.7 Understand the impacts of racism, colonisation and power imbalance on Māori oral health, and the current state of inequitable access to care and hauora outcomes.

3.8 Provide culturally safe care - as determined by the patient, their whānau or family, hapū or community.

3.9 Recognise that the concept of culture extends beyond ethnicity and includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief; and disability. Patients may identify with several hapū, iwi and/or cultural identity.

3.10 Reflect on their own culture (including their own biases, attitudes, assumptions, stereotypes, prejudices and characteristics) and its impact on clinical interactions and the care they provide.

3.11 Understand the inherent power imbalance that exists in the practitioner-patient relationship and commit to work in partnership with their patients and whānau or family to enable culturally safe care.

Critical thinking

A dental hygienist will be able to:

4.1 Apply contemporary scientific knowledge to oral health practice appropriately.

4.2 Critically evaluate published clinical, scientific, Matāuranga Māori and health related research; and integrate this information, where appropriate, into their practice.

4.3 Understand and apply the principles of good rangahau and research practice. This includes scientific method, critical evaluation and referenced tohungatanga of research, evidence or information.

4.4 Recognise and evaluate the impact of new techniques, materials, and technologies in clinical practice.

4.5 Recognise and evaluate the impact of Matāuranga Māori and research on Māori oral health outcomes and equity, and how to use this information to improve hauora Māori and equity.

4.6 Critically reflect on their individual knowledge and skills throughout their professional career, to inform their ongoing professional development or identify their own limitations and how that may impact on their current practice.

Application of scientific and clinical knowledge

A dental hygienist will be able to apply scientific and clinical knowledge relating to:

5.1 General anatomy, with emphasis on head and neck, and physiology.

5.2 The aetiology, pathology, diagnosis, prevention and management of oral diseases and disorders.

5.3 General and systemic disease and disorders, including their relevance to oral health and potential impact on patient management.

5.4 Growth, development, and ageing, especially in the orofacial region; and orofacial developmental disorders.

5.5 Normal and abnormal tooth development, tooth eruption and occlusal development of the primary, mixed, and permanent dentition.

5.6 Social and behavioural sciences, and Te Ao Māori and, Tikanga Māori, to support patients and whānau or family in achieving oral health and wellbeing.

5.7 Understanding the causes of Māori inequity to access and improve hauora Māori outcomes.

5.8 The core principles of infection prevention and control, including standard precautions, reprocessing of reusable items, performance testing and validation. This includes consideration of Te Ao Māori and Tikanga Māori.

5.9 Pharmacology, with a focus on medicines, rongoā Māori and therapeutic agents relevant to oral health practice.

5.10 Ionising radiation and methods of imaging relevant to oral health practice, including appropriate selection and safe use of dental radiographic techniques.

Clinical information gathering

A dental hygienist will be able to effectively gather information relating to:

6.1 Patient’s presenting, complaint/s, concerns, ideas, wishes and expectations, including Te Reo Māori me ona Tikanga.

6.2 Medical, oral health, cultural, and whānau or family histories, and recognise the relationship between hauora Māori and oral health.

6.3 Extra-oral and intra-oral examination of the soft and hard tissues of the orofacial region, including intra and extra-oral radiographic imaging of adequate diagnostic quality and photographic imaging.

6.4 The following conditions:

1. dental and orofacial pain
2. dental and periodontal diseases and conditions
3. temporomandibular joint disorders
4. oral pathology
5. abnormalities of the occlusion, craniofacial disorders, dental and maxillofacial trauma.

6.5 Individual risk factors related to diseases of the dentition, periodontum, oral mucosa, jaws and the oro-facial region, and trauma.

Diagnosis and risk determination

A dental hygienist will be able to:

6.6 Perform or request relevant special investigations and diagnostic tests related to periodontal management.

6.7 Analyse the complete information gathered to:

1. Formulate an accurate diagnosis related to periodontal diseases or seek additional clinical opinion or refer as required.
2. Determine the individual patient’s risk of oral disease or injuries.

Oral health care planning

A dental hygienist will be able to analyse the information gathered and when developing a plan for care:

6.8 Understand and consider each patient’s individual preferences, needs and cultural values, their hinengaro/wairua and social situation.

This includes the specific needs of patients who are young, anxious, older adults and patients with special needs in their requirements to achieve oral health equity.

6.9 Identify oral health problems, and formulate an evidence-based, patient-centred plan for care that addresses the:

• aetiology of dental and oral diseases
• attainment and maintenance of oral health – including disease management and prevention appropriate for the patient’s oral disease risk
• priority of management
• options for care
• involvement of, and support for, whānau or family, and kaiāwhina, and
• anticipated outcomes and future needs.

6.10 Identify where the patient’s medical condition/s or rongoā Māori, medications may influence the oral health care plan and the anticipated outcomes.

A dental hygienist will be able to:

6.11 Determine whether they have the knowledge, skills and competence to provide for the patient’s complete health needs and wishes and refer appropriately to another oral health or health practitioner when they do not.

6.12 Gain informed consent, appropriate for the individual, and ensure informed consent remains valid throughout.

Establishing and maintaining oral health

A dental hygienist will be able to:

Guide behavioural change

6.13 Help patients understand the importance of their own tikanga/kawa and behaviours in establishing and maintaining oral health.

6.14 Apply their knowledge of behaviour change in relation to health to support and guide patients/whānau behaviours towards optimal hauora Māori and oral health.

6.15 Educate patients across the life course, sharing current concepts of hauora Māori, oral health, prevention, risk assessment and management of oral disease.

6.16 Work with patients and whānau to develop an oral health programme which employs strategies aimed at disease management and prevention appropriate for the patient’s disease status and risk, and their personal circumstances; and review and adjust strategies and goals as required.

Preventive care

6.17 Promote periodontal health by providing patients with preventive advice (including smoking cessation), and removal of supra-and subgingival hard and soft deposits from natural teeth and implants.

6.18 Provide dietary advice and perform procedures to prevent dental caries, including fissure sealants and applying fluoride.

6.19 Recommend or supply non-prescription preventive agents.

6.20 Promote the prevention of dental injuries by providing custom-made mouthguards where indicated.

Periodontal management

6.21 Manage conditions and diseases of the periodontium and perform appropriate periodontal therapy where indicated.

Dental management

6.22 Apply and supply topical agents for the treatment of tooth sensitivity and discolouration.

Pain management

6.23 Use local anaesthesia safely, appropriately and effectively; with the correct administration technique; and selecting the appropriate local anaesthetic solutions.

Young patients, anxious patients, older adults and patients with special needs

6.24 Manage care for tamariki, mokopuna, rangatahi or anxious patients, older adults and patients who have special needs; and advocate for and support individuals with these needs to achieve oral health equity.

Application, administering and supplying of prescription medicines

6.25 Apply, administer and/or supply prescription medicines, for example, antibiotics to manage infection or risk of infection, management of medical emergencies, or high concentration fluoride varnishes and toothpastes, in accordance with legal and regulatory requirements.

Monitoring

6.26 Evaluate and monitor the progress of treatment and oral health outcomes, in cooperation with the wider oral health team, whānau, family or kaiāwhina, where appropriate, and at regular intervals when treatment occurs over an extended period.

Orthodontics

6.27 Assist the dentist or dental specialist in implementing orthodontic treatment plans through performing the following procedures:

• tracing cephalometric radiographs
• fabricating retainers and undertaking other simple laboratory procedures of an orthodontic nature
• record occlusion relationships and make study models.

6.28 Assist the dentist or dental specialist in implementing orthodontic treatment plans, as directed by the dentist or dental specialist who is responsible for the patient’s clinical care outcomes and is on-site at the time, through performing the following orthodontic procedures:

• placing separators
• sizing and cementing metal bands including loose bands during treatment
• preparing teeth for bonding fixed attachments and fixed retainers
• indirect bonding of brackets as set up by the dentist or dental specialist
• placing archwires when necessary (as formed by the dentist or dental specialist) and replacing ligatures/closing self-ligating brackets
• trial fitting removable appliances – this does not include activation
• removing archwires after removing elastomeric or wire ligatures, or opening self-ligating brackets
• removing fixed orthodontic attachments and retainers
• removing adhesives after the removal of fixed attachments
• fitting passive removable retainers
• bonding preformed fixed retainers.

Safe practice

A dental hygienist will be able to:

6.29 Establish, manage, and maintain a safe working environment for patients, staff and colleagues; and to protect the public. This includes a culturally safe workplace, the routine and proper use of infection prevention and control measures, and following safe radiation practices.

6.30 Identify and appropriately manage potential hazards (including hazardous materials), and behavioural risks in the place of work.

6.31 Understand the principles and legal obligations of waste management and show awareness of practices used to limit unnecessary waste.

6.32 Produce and maintain accurate, time-bound, and up-to-date patient records which are secure.

6.33 Complete a comprehensive medical history: medical conditions, current rongoā Māori, medications (prescribed and non-prescribed) and allergies.

6.34 Manage a medical emergency appropriately and effectively in their workplace within their prescribed resuscitation training.

Teamwork

A dental hygienist will be able to:

6.35 Understand the value of interdisciplinary practice in providing patient-centred care, and work collaboratively with oral health and other health practitioners for enhanced patient outcomes.

6.36 Recognise the unique set of skills and competencies that each member of the oral health team contributes to patient care and the promotion of oral health in the whānau, hapū, iwi and community.

The practice environment

A dental hygienist will be able to:

6.37 Develop and comply with systems and processes in their workplace to support safe and effective patient care.

6.38 Describe the skills needed to lead and manage oral health team members.

6.39 Effectively manage their own time and resources.

6.40 Describe the basic principles of practice administration and management.

6.41 Be familiar with the use of contemporary information technology tools commonly used in practice to support safe and effective care.

Community oral health

A dental hygienist will be able to:

7.1 Understand the Aotearoa New Zealand oral health care system and the public health approach.

7.2 Understand the social determinants of health; the barriers to equitable access to health care and equity in hauora Māori outcomes; and their impact on oral health in Aotearoa New Zealand. In particular, on the oral health status of Māori.

7.3 Engage with Māori communities in the development and delivery of oral health promotion activities.

7.4 Promote oral health and its effect on general health and wellbeing.

7.5 Work with other health professionals, educational staff, whānau or family, hapū, iwi and health navigators to promote oral health.

Patient-centred care

Patient-centred care can be defined as providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions (Institute of Medicine 2011).

It represents an all-inclusive approach. The widely accepted dimensions of patient-centred care are:

• Fast access to reliable health advice
• Effective treatment delivered by trusted professionals
• Continuity of care and smooth transitions
• Patient involvement in decisions and respect for patient preferences
• Clear, comprehensible information and support for self-care
• Involvement of, and support for, family, whānau and kaiāwhina
• Emotional support, empathy, and respect
• Attention to physical and environmental needs.

Research findings show that patient-centred care improves patient experience, creates value for services and is increasingly recognised as a critical dimension of high-quality health care⁴.

Culturally safe care

The Health Practitioners Competence Assurance Act 2003 requires the Council to set standards of cultural competence for oral health practitioners⁵. This includes competencies that will enable effective and respectful interaction with Māori.

The Council’s Cultural competence practice standard defines cultural competence as “an awareness of cultural diversity and the ability to function effectively and respectfully when working with and treating people of different cultural backgrounds”.

Culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief; and disability.

Cultural safety extends beyond a practitioner’s cultural awareness or cultural sensitivity.

It requires the practitioner to examine themselves and the potential impact of their own culture on clinical interactions and the care they provide.

This means the practitioner needs to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, characteristics, and hold themselves accountable for providing culturally safe care.

Key to providing culturally safe care is that the practitioner understands the inherent power imbalance in the practitioner-patient relationship, recognises and respects each patient as an individual, and enables meaningful two-way communication to occur.

Cultural safety requires that all people receive oral health care that takes into account their uniqueness. It is the person and/or their community, whānau or family, hapū or iwi receiving the care who determine what culturally safe care means for them.

A well-referenced definition of cultural safety is:

an environment which is spiritually, socially and emotionally safe, as well as physically safe for people; where there is no assault, challenge or denial of their identity, of who they are and what they need. It is about shared respect, shared meaning, shared knowledge and experience, of learning together with dignity, and truly listening⁶.

This definition supports the understanding that the relationship between a practitioner and patient is a partnership based on trust and respect, where communication is key in meeting the patient’s needs and goals.

Evidence-based practice

Evidence-based practice is the integration of relevant scientific evidence with the practitioner’s expertise (clinical, technical, health protection and promotion) and the patient’s or community’s needs and preferences. Evidence-based practice promotes consistency and optimal outcomes of care.

In providing evidence-based practice it is fundamental that the practitioner has relevant scientific knowledge, understands scientific method, can evaluate evidence, and works to a robust and contemporary evidence base.

Equity

In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.

• mauri ora – healthy individuals
• whānau ora – healthy families
• wai ora – healthy environments.