Cheat sheet for periodontal protocol

July 8, 2014

Dental Hygienist’s Guide to Delivering an Effective Periodontal Program

by Karoline Biami, RDH

A recent hot topic in the Facebook forum Dental Hygienists Talk, which has more than 10,000 dental hygiene members, revealed that some new hygienists are feeling confused, insecure, or lost when it comes to implementing a periodontal program in their office. It’s no fault of their own. But getting a quick, yet comprehensive answer to how to implement a periodontal program seems to be quite a challenge.

This One Page Periodontal Protocol Cheat Sheet offers a great place to start.

3 Problems That Led To the Creation of This Document

Many hygienists leave school without a complete understanding of an effective periodontal program. So much time is spent mastering the technical skills of dental hygiene. In some dental hygiene programs, not much attention is focused on the other three areas of properly administering a periodontal program.

You must first develop a skill for identifying symptoms. Then you need to decide on a diagnosis. Then you administer an effective treatment. Finally, you support the continued oral health of the patient with an appropriate dental recall system. In school, students don’t have the time to develop this long-term relationship with their patients. When it is time to get their first job, new dental hygienists are left feeling confused and ultimately a bit insecure about really stepping up and guiding their patients to periodontal health.

Smart hygienists committed to giving the best patient care will likely end up searching for an answer to their questions. Some great resources are out there. The problem is that sometimes it is easy to get overloaded with information. There are multiple philosophies and approaches to treating periodontal disease, each with their own set of pros and cons. Hygienists may even find conflicting information about how to diagnose the symptoms. Trying to digest all the information out there without a proper foundation can lead to more confusion and make it even more difficult to have a confident understanding of implementing a periodontal program.

Hygienists sometimes find themselves owning the responsibility of implementing a periodontal protocol program and don’t have a lot of guidance from the dentist. Or they are practicing in an office that doesn’t have an official program, and they are quickly seeing the need for one. But they don’t know how to approach the dentist and navigate this conversation without feeling insecure about their level of understanding on exactly how to implement it. I gathered this from a post by a hygienist in the forum who said her doctor expected that hygienists “should just know.”

This One Page Periodontal Protocol Cheat Sheet is a quick overview of how to identify symptoms, diagnose, treat, and maintain various stages of periodontal disease. It is meant to be a synthesis of the information out there that is most consistent. It will give you an easy to understand foundation of how a periodontal program works.

How to Use This Guide

Use it as a conversation starter. Don’t just take this information and start treating your patients. Print this document out and bring it to your dentist to discuss.

Practice management consultant Kristine Hodsdon RDH, MSEC, was a participant in our Dental Hygienist Talk conversation and made a great point. She suggested the hygienist have a meeting seeking what the doctor’s philosophies are to learn about their hygiene vision, goals, and thoughts about periodontal treatment protocols. This is an opportunity to make sure you are all on the same page. Initiating this conversation demonstrates you are taking an active interest in the practice’s overall success and positions you as a team member focused on bringing value.

Keep it as a cheat sheet. After discussing with your dentist, print it out and keep it as quick reference guide in your operatory. The language is simplified so you can show to patients and explain the treatment. Providing the patient a quick overview helps them more readily accept treatment plans and commit to good oral health habits in between visits.

Use it as a study guide. If you are new to managing a periodontal program this one page guide gives you a great foundation to build on. Once you have an understanding of the basics you can make a list of questions or scenarios that you are still unclear about. Talk with your dentist or research on your own to expand your understanding.

Quick Tips In Implementing This Guide With Your Periodontal Program

Remember these are guidelines, not a set of hard and fast rules. It is a tool to help guide your focus. You want to look at all the information available such as X-rays, medical history, symptoms, and your doctor’s practice philosophy. Take a holistic approach when considering these then decide which diagnosis and treatment is best for the patient.

There is a lot of confusion about the diagnosis and treatment of gingivitis. There is no ADA CDT code specifically for its treatment. Gingivitis is typically diagnosed when there is bleeding upon probing but there is no attachment loss, no bone loss, and pockets measure 3 mm or less. Gingivitis is reversible but if not treated properly it can progress to periodontal disease.

So it is very important the dental hygienist and the doctor are on the same page regarding treatment protocol. Common practice for treatment is prophylaxis with additional biofilm control and more frequent recare of one to three months until the patient becomes healthy. If there are heavy deposits of calculus above the gum line, a full mouth debridement is commonly completed first, followed by prophylaxis with additional biofilm control. Patient education and proper home care are vital to success in reversing gingivitis.

Consideration of medical history is an important part of any diagnosis. Each patient is an individual whose body fights and controls disease in a different manner. Pay special attention to factors that can affect gingival bleeding such as diabetes, use of blood thinners, or other medication. Pregnancy, genetic predisposition, oral hygiene habits, smoking or drug use, stress, and eating habits should also be considered. Look for other medical conditions such as HIV or blood disorders. All of these impact periodontal health.

Make sure to complete a full periodontal charting on each visit. In my experience, probing is the most valuable diagnostic tool dental hygienists have to really understand what may be happening in the mouth. A full mouth periodontal charting allows us to track changes in problem areas and consider those in context within the whole mouth.

Understanding this guide can give you the knowledge you need to feel confident in administering a periodontal program in your office. After reading it, you’ll have the foundation you need to ask the right questions to continue your mastery of this very important part of dental hygiene practice.

Karoline Biami, RDH, is practicing dental hygienist in Fort Lauderdale Fla. She is also a foreign trained dentist and former dental assistant. She is dedicated to coaching and mentoring dental hygienists and dental hygiene teams. Karoline is available to help you deliver maximum value to your practice and answer any questions you may have. Visit her website at Karolinebiamirdh.com. Please email her at [email protected].