The journey to hygiene excellence: Part Two

Oct. 27, 2006
Check the list and pack the right gear: Comprehensive periodontal health evaluation

By Nancy Dukes, RDH, Jameson Management Consultant

Dental teams have historically kept patients healthy by appointing them every six months, recording limited periodontal data, following insurance guidelines for treatment, and waiting for definitive evidence of bone loss and disease. We did not feel we could treatment plan any other way because of time limitations, lack of supporting research, patient financial concerns, and a general lack of understanding about how to make necessary changes to treat more comprehensively.

We now have research that enables us to diagnose, treat, educate and maintain periodontal patients much earlier and more successfully. As a result of this research and non-surgical periodontal therapy protocols in the last 10 to 15 years, we understand that early diagnosis and treatment are the best defense against a disease that is more prevalent among adults than the common cold. With the introduction of the new periodontal classification system by the AAP and International Workshop for a Classification of Periodontal Diseases and Conditions in 1999, we now have a system that encourages early diagnosis and treatment. The classification system was revised in an attempt to be more descriptive and comprehensive, a welcome change. It provides direction for comprehensive care.

The criteria to classify patients periodontally should include comprehensive periodontal charting, bleeding and severity of bleeding, suppuration, furcation and its classification, recession, mobility and its classification, bone loss, attachment loss, and mucogingival health. The patient with chronic or aggressive periodontitis should be further classified regarding quantity or extent of the disease (localized or generalized), and quality or severity of the disease (slight, moderate, severe).

In the past, dental professionals have relied strongly on probing depths, which can increase or decrease with inflammation, surgery, etc. Today, a much more comprehensive evaluation of the entire patient must be done to determine factors which may affect therapy. One must consider health history and/or systemic diseases, oral hygiene habits, limitations and results as well as previous therapy and results.

According to the ADA, 80 to 85 percent of the American adult population is in some stage of periodontal disease. If this is true, what percentage of your patients should have received some periodontal treatment? Developing the services within a general practice to care for these patients requires elevating the skills of the entire team. This is no longer the responsibility of just the doctor and the hygienist. It must become a team effort.

To truly elevate your hygiene department, every patient must be comprehensively evaluated and assessed, diagnosed and classified, and informed and educated. This is no small task, and requires the entire team to accomplish, and enrolling and maintaining patients in care should be a priority. As a team, everyone must thoroughly understand periodontal disease and treatment and be prepared to support one another.

If we are to gain treatment acceptance and keep patients enrolled in their necessary maintenance, we must be comprehensive not only in our evaluation and diagnosis, but in patient education as well. We must become partners with patients who thoroughly understand their state of wellness or lack of wellness.

You and your patients may be traveling the wrong road if:

• A patient bleeds each time he/she is seen for a prophy

• Each patient does not have a written comprehensive periodontal charting annually

• Each patient does not have a current Full Mouth Series of radiographs

• Each patient has not been diagnosed, classified, treated or referred.

We are responsible for the following in comprehensive periodontal care:

• Taking radiographs and gathering comprehensive data

• Classifying

• Informing and educating

• Recommending and providing treatment or referring

• Rediagnosing

• Maintaining the patient according to industry standards

• Staying current with our education

As health care professionals, we are responsible for diagnosing disease at any stage. Earlier diagnosis, delivery of treatment equal to current standards, and patient education gives dental professionals and patients the best chance for great results. We owe this to our patients.

The American Academy of Periodontology concluded as a result of research since 1985 that periodontal disease is episodic in nature, site specific, and very capable of being treated and maintained when diagnosed and treated early. With proper team involvement, general dentists have the opportunity to achieve this.

Team involvement includes not only all of the dental professionals within the practice, but the patient as well. Patients must become an integral part of the diagnosis, treatment plan and maintenance. They must thoroughly understand that they have periodontal disease or that they are at risk. This is the first vital step to engaging the patient on the journey to wellness. How do we, as dental professionals, successfully do this?

Engaging patients in a lifelong journey to wellness will always be a challenge. We need to check these lists, pack the right skill sets and systems, commit, and communicate every step of the journey to hygiene excellence. Success begins with careful, intricate patient education on the part of the entire dental team. The dentist, dental hygienist, clinical assistants and business team must work together to achieve patient commitment. This is the goal for success.

Nancy Dukes, BA, RDH, invites you to expand your horizons in the area of patient motivation by reading a series of articles to discover the keys that will enable you to book more passengers than ever imagined on the journey to wellness. "The Journey to Hygiene Excellence" not only explains this Wellness Approach to Clinical Care article, but has features on Comprehensive Health Evaluation; Systemizing Your Data Collection and Documentation; Treatment Planning and ADA Coding; Building Relationships of Trust through Effective Patient Education; Case Presentation and Treatment Acceptance; and Building Retention and Referrals while Offering a Healthy New Patient Flow. Dukes is director of clinical consulting for Jameson Management, Inc., an international dental practice management consulting firm. Visit or call (877) 369-5558 for more information.