Referrals by Dental Hygienists

May 5, 2020 Update: The CDHBC Interpretation Guidelines are under review. The content of these guidelines remains in place at this time; however, they need to be applied in the context of the new Dental Hygienists Regulation and CDHBC Bylaws. Readers are welcome to contact the CDHBC office if they have questions about the application of these guidelines in the interim time.
 

PURPOSE

To clarify the dental hygienist's role in initiating client referrals to dentists, dental specialists, and other health professionals.

BACKGROUND

The CDHBC Practice Standards indicate the registrant’s responsibility in initiating the referrals, when appropriate, throughout the process of dental hygiene care. Practice Standard 5.2 discusses referrals in relation to the planning phase of care: “when indicated, dental hygienists must consult with the client’s dentist, and may consult with other applicable health care providers, in order to integrate the plan for dental hygiene services into the client’s total health care plan.” Practice Standard 7.2 incorporates referrals based on the evaluation phase of dental hygiene care: “dental hygienists must, if indicated, recommend referral to dental and other applicable health professional(s).”
 
There are many situations in which a dental hygienist  needs to collaborate with other health professionals and initiate referrals for client care. These may include concerns about a client’s systemic health, for example:

  • referring to a dietician for nutritional counseling,

  • referring to a physician regarding high blood pressure or management of diabetes

  • referring indigenous clients to indigenous health service providers.

Other reasons for referral may relate to other medical-dental concerns (e.g. extra-oral or intra-oral pathologies, suspected caries, or progression of periodontal disease).

POLICY

In British Columbia, it is the responsibility of a dental hygienist to develop and implement a process for consultation and/or referral with other health professionals in order to ensure the provision of safe and ethical dental hygiene care to the public. Best practice is for any consultations or referrals initiated by dental hygienists to be conveyed to the client and/or the other health professional in writing. Additionally, any consultations or referrals initiated need to be documented in the client’s chart, as part of the legal record of care.
 
In order to act in the client’s best interest, the dental hygienist should establish a collaborative approach with the client’s dentist to mutually assess the need for further care from an appropriate dental specialist or other health care professional(s). Dental hygienists are encouraged to consider continuing competency courses on the identification of oral pathologies, so that they can communicate in a knowledgeable and collegial manner.
 
In addition, dental hygienists who are registered in the 365 Day Rule Exempt category of registration must recommend that a client have an examination by a dentist if it is evident that the client has not done so in the past 365 days, as outlined in section 6(3) of the Dental Hygienists Regulation. This must also be documented in the client’s chart.

REFERENCES

  • Scope of Practice Statement. Victoria: College of Dental Hygienists of British Columbia; 2013.

  • Darby M, Walsh M. Dental Hygiene Theory and Practice. 3rd ed. St. Louis: Saunders Elsevier; 2010.

  •  Dental Hygienists Regulation. Victoria: College of Dental Hygienists of British Columbia; 2013. 

    Added to Handbook: June 2005
    Updated: May 2019