A dental hygienist's perspective of AAP's Comprehensive Periodontal Therapy document

Aug. 25, 2011
The July issue of the Journal of Periodontology contained a detailed statement from the American Academy of Periodontology (AAP) on comprehensive periodontal therapy. IIisa Wommack, a hygienist working in the Atlanta area , offered her perspective of the Comprehensive Periodontal Therapy Statement.

The July issue of the Journal of Periodontology contained a detailed statement from the American Academy of Periodontology (AAP) on comprehensive periodontal therapy. The Comprehensive Periodontal Therapy Statement provides a detailed overview of the following elements, which the AAP believes constitute efficient and effective periodontal treatment:

  • Scope of periodontal therapy
  • Periodontal evaluation
  • Establishing a diagnosis, prognosis, and treatment plan
  • Informed consent and patient records
  • Treatment procedures
  • Evaluation of therapy
  • Factors modifying results
  • Periodontal maintenance therapy
This statement is intended to serve as a clinical road map for any dental professional who supervises, administers, teaches, or regulates the provision of periodontal therapy. This includes dental hygienists who are generally on the front lines of treatment and patient education.

Ilisa Wommack, RDH

In an effort to get a hygienist’s insight into the day-to-day impact of the Comprehensive Periodontal Therapy Statement, IIisa Wommack, a hygienist working in the Atlanta area for periodontist Dr. Marie C. Schweinebraten, and general practitioner Richard A. Watkins, DDS, was interviewed. Because she works in two practices, Ilisa is exposed to a wider scope of patients and professionals and is better able to serve and educate patients with diverse needs.

Question: As a hygienist, why do you think this statement is helpful to you and your dental hygiene colleagues?

Wommack: It’s a great education tool that helps hygienists explain to their patients exactly where they stand in the oral health continuum and why they are receiving periodontal treatment. Even if the doctor already explained this to them, patients often come back to us with additional questions. In other words, the Comprehensive Periodontal Therapy Statement helps keep everyone on the dental team who speaks to the patient on the same page.

Question: Will the statement help manage patient expectations or increase treatment acceptance?

Wommack: I believe it will. First of all, it will help us explain why gingivitis must be treated before it progresses into periodontal disease, which is a chronic infection that is treatable, but not curable.

Question: And why it may not be covered under their insurance plan?

Wommack: This is never an easy subject, but it comes up more than ever in these economic times. Patients need to understand that periodontal maintenance may not be reimbursed when it falls outside of their allotted number of cleanings. The reason for this is that due to their chronic infection, they require more frequent and thorough treatment — the statement helps us justify this.

What’s more, periodontal disease maintenance should always be coded at 4910, not 1110, which is a prophy treatment. Once diagnosed with periodontal disease, a patient should never be coded as a healthy “1110” patient.

Question: In the past, you worked as a hygienist in a GP dentist’s office. Do you think your colleagues working in a general dentistry setting will find this statement useful?

Definitely. It will help the hygienist and the entire GP dental team to quantify what degree of attachment and bone loss corresponds to slight, moderate and severe levels of periodontal disease. This information, combined with their collective comfort level for treating various stages of periodontal disease, may help them decide which cases they will treat in-house and which cases they will refer to a specialist.

Question: Does the Comprehensive Periodontal Therapy Statement help you set short-term and long-term goals for patient care? If so, what are they?

Wommack: I would say yes to both. In the short term, I think our goals are to reduce bleeding, reduce pocket depth and stop the inflammation process. In the long term, we should be focused on preventing and reducing bone loss, ensuring tooth stability and reducing systemic risks. Although in the case of diabetes, systemic benefits can be derived in the short term, because reduction in blood sugar can occur rather quickly.

Question: Who will benefit most from this statement, hygiene school graduates or hygiene veterans?

Wommack: Both will benefit, but for different reasons. New graduates will have a useful roadmap to help them put their hygiene education into day-to-day practice. As hygiene veterans get further way from their original education, it becomes more and more important for them to revisit and reinforce these guidelines so they do not gradually drift away from a calibrated, standardized protocol for periodontal disease treatment. Graduates and veterans alike will benefit by being less prone to interpretation and more focused on evidence-based treatment.