Dental Hygienist Skills Checklist

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PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS:

Proficiency

I have never done the stated task.
I have performed the task/skill infrequently; I require more experience/practice to feel comfortable and proficient.
I have performed the task/skill several times and feel moderately comfortable functioning independently but would require a resource person nearby.
I have performed the task/skill frequently and would feel very comfortable and proficient performing it without supervision or practice.

Frequency

CORE RESPONSIBILITIES *

	SKILL		FREQUENCY
Professional code of ethics
Knowledge about federal laws and regulations in the provision of oral health care
Promote patient/client oral health and wellness
Effective communication is practiced with diverse individuals and groups
Individualized care plans
Facilitate consultations and referrals

COMMUNITY INVOLVEMENT *

	SKILL		FREQUENCY
Assess the quality and availability of the community's oral health needs
Provide screening, referral, and educational services
Evaluate community-based oral hygiene programs
Advocate for effective oral health care for underserved populations

PATIENT CARE: QUALITY, SAFE, AND COMFORTABLE DENTAL HYGIENE - PATIENT POPULATION *

	SKILL		FREQUENCY
Child
Adolescent
Adult
Geriatric
Medically compromised patient
Patients with special needs
Patients from diverse cultural backgrounds

PATIENT CARE: ASSESSMENT *

	SKILL		FREQUENCY
Patient's concerns
Identify patients at risk for medical emergencies
Collect, record, and interpret a medical/dental history and vital signs
Recognize conditions that require referral or special precautions
Perform extra-oral and intra-oral examinations of hard and soft tissues
Identify the need for radiograph diagnostic exam

PATIENT CARE: DIAGNOSIS *

	SKILL		FREQUENCY
Critical decision making skills
Formulate an accurate dental hygiene diagnosis
Collaborate with a supervising dentist, and/or other health professional

PATIENT CARE: PLANNING *

	SKILL		FREQUENCY
Comprehensive individualized dental hygiene care plan
Interpersonal and communication skills
Patient/client informed consent

PATIENT CARE: IMPLEMENTATION *

	SKILL		FREQUENCY
Provide education to maintain oral health
Provide specialized treatment

PATIENT CARE: EVALUATION *

	SKILL		FREQUENCY
Evaluate the effectiveness of the treatment
Modify care plans as needed

CLINICAL INFECTION CONTROL PROCEDURES *

	SKILL		FREQUENCY
Hand hygiene
Personal protective equipment (PPE)
Respiratory hygiene/cough etiquette
Sharps safety
Safe injection practices
Sterilization and disinfection of patient-care items and devices
Environmental infection prevention and control
Dental unit water quality

VITAL SIGNS *

PROCEDURES/SKILLS: CLINICAL *

	SKILL		FREQUENCY
Medical and dental histories: past and present
Intraoral inspection (including charting carious lesions, periodontal diseases, existing, and missing teeth)
Extraoral inspection
Dental hygiene assessment/ dental hygiene treatment planning
Evaluation of dental hygiene services
Radiographs: Digital-based
Radiographs: Film-based
Impressions for study casts
Oral health education including health promotion, disease prevention, and behavior modification
Intra-oral imaging
Desensitization
Care for removable appliances and prostheses
Dental-related nutritional counseling
Supragingival scaling
Subgingival scaling
Root planing
Coronal polishing
Application of chemotherapeutic agents
Application of anticariogenic agents
Polish restoration
Pit and fissure sealants
Application of topical/non-injectable anesthetic agents
Assessment using Caries diagnostic scan
Application of locally applied antibiotics
Pulp vitality testing
Administration of local anesthetic: Infiltration
Administration of local anesthetic: Mandibular block

PROCEDURES/SKILLS: LABORATORY *

	SKILL		FREQUENCY
Administration of Nitrous Oxide/Analgesia
Periodontal and surgical dressing: place
Suture: place
Suture: remove
Rubber Dam: place
Rubber Dam: remove
Matrix: place
Matrix: remove
Temporary restorations: place
Temporary restorations: remove
Temporary crown: fabrication
Temporary crown: placement
Temporary crown: removal
Amalgam restorations: place
Amalgam restorations: carve
Amalgam restorations: finish
Composite resin restorations: place
Composite resin restorations: finish
Application of cavity liners and bases
Removal of excess restorative materials
Fabrication of custom impression tray

ELECTRONIC DOCUMENTATION *

AGE SPECIFIC COMPETENCIES *

Attestation

ATTESTATION: *

I certify that the information provided above accurately reflects my experience in each of the clinical areas identified within the past three years.

If you agree with the Attestation above, please electronically sign your name. *