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Tailoring periodontal maintenance appointments

Jan. 3, 2019
Periodontal maintenance appointments can be very fulfilling, but they can also be challenging if the patient hasn't kept up with home care. Here are one seasoned hygienist's tried-and-true methods for making these appointments great for both patients and clinicians.

Post–scaling and root planing (SRP) patients are always great visits. This is the time for you as a clinician to see how well your work paid off and how well patients are complying. These appointments can be challenging at times, especially if a patient wasn’t diligent when coming back for three-month maintenance. It’s often best to be prepared for the worst, which is the fact that the mouth might be not as clean and maintained as we would like it—meaning more time in the chair and more time needed for education.

What can we do to make these appointments smoother? There are a few tips and tricks I have found helpful, and I’m sharing in hopes this will help tailoring your appointment more effective and efficient. Here are my top five must-haves during periodontal maintenance.

  1. Pre-rinse
  2. Cavitron
  3. Intraoral camera
  4. Post-rinse and patient education
  5. Fluoride varnish and home-care products

Pre-rinse and Cavitron

Having a patient pre-rinse before your procedure will help remove food debris and help reduce bacteria while you are in there. During the periodontal maintenance, I will Cavitron and then hand scale. Using the Cavitron second is a great way to give the gingival tissue a lavish treatment and to see how the tissue has responded since you’ve seen the patient last. This will guide your oral hygiene instruction and give you an idea of their oral hygiene care at home. I will pay close attention to bleeding and patient’s faces or comments when cleaning so that I can utilize these points when providing education.

Intraoral camera

Then, I like to use the intraoral camera to take pictures of the patient’s overall health; this helps tremendously with patient compliance. Most patients are more inclined to hear what you have to say when you’re showing them pictures of their own mouths. It is also good for documentation purposes because you can track progress and look back on it for reference purposes.

Post-rinse and patient education

When the debridement of the patient’s mouth is complete, you record his or her periodontal charting finding. At this time, I usually have patients rinse with a post-rinse and then go into education with them based off of the information I have collected. I like to use Oracare rinse or chlorhexidine rinse for my patients. This depends on what the doctor is willing to stock as well.

Fluoride varnish and home-care products

MI Paste One is a great product for sensitivity, root exposure, and dry mouth. Fluoride varnish is great for high caries risk, sensitivity, and helps with remineralization of the enamel. So determining which product to use for your patient will depend on what they present with and what you think would be the best treatment option for your patient.

Many patients get sensitivity after SRP because of recession, and some just have sensitive teeth. Patient compliance is important, so consider if your patient will pay for the MI Paste One and use it as recommended, or if he or she is better off with an in-office fluoride treatment. Half of patient compliance is knowing your patients and what they will and won’t commit too. The other half is education and how effective or important it is to the patient.

Wrapping up the appointment

Because education is so important, I like to spend a good chunk of time on this part of the appointment because it will benefit the patient long after the cleaning. I usually show the patient his or her intraoral photos and periodontal charting and discuss the difference from the initial appointment assessment when SRP was determined.

There are some really great apps and websites that the patient can use to get more information. I find that if your patient is tech savvy and loves to be on the phone, this is effective. Using before-and-after photos and charting gives both patients and clinicians a visual of the mouth. It helps patients comprehend and understand that this is about them individually and that I’m not just talking about periodontal disease in general. When patients have a personal connection or attachment to something, it usually results in them having more of an interest and hearing about what you’re saying. I always ask them if they have questions or concerns about their teeth and about their daily regimens.

Then we discuss products and what can help them achieve a healthier mouth, especially when in pain or sensitive—this really hits home for patients. No one likes to be in pain. This is when patients usually ask about whitening. While I do tell them what they want to know, I express the importance of getting the mouth healthier before doing cosmetic work to help reduce discomfort or unnecessary pain.

I usually finish the conversation with their next recommended recall and asking one last time if they have any last thoughts or questions about today. Having a good routine and flow to your appointment will increase time management and make your feel less stressed with your schedule.

I hope this helps you with your appointment types and as always go out and tailor those appointments!

Katie Melko, MSDH, RDH, is a public health hygienist at Community Health Center Inc. She graduated from Fones School of Dental Hygiene at the University of Bridgeport in 2016 with an MSDH. She has practiced dental hygiene since 2009.