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11.21.08 Issue #350 Forward This Newsletter To A Colleague


Angie Stone RDH, BS
Consultant
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Periodontal Screening And Recording (PSR)

Although dental schools educate students about a screening system called Periodontal Screening and Recording (PSR), hygiene schools never give this education to their students. This is understandable because hygiene schools need to teach future hygiene clinicians the task of periodontal probing and recording of pocket depths, suppuration, clinical attachment loss, recession, furcation involvement, mobility, etc. In order to ensure that students are efficient in this task, it is a requirement to do a full periodontal assessment on all patients while in school. This is the gold standard in the world of dentistry, but it becomes difficult to take the time to assess and record all the information necessary for a full periodontal assessment. This is where the PSR Screening tool is helpful.

PSR was developed by the American Dental Association and the American Academy of Periodontology to provide a simple, standardized system to effectively screen and provide for detection of periodontal disease. Not only is it effective, it is quick and easy and can be easily incorporated into recall appointments. It is a tool that determines the need or absence of the necessity for a complete periodontal assessment. If the patient fails the screening, they can be brought back to look further into what their needs may be.

The medical community does such screenings on a routine basis with patients. For instance, let’s say I go to my MD for an annual physical and at that appointment he recommends a mammogram because of what he discovered during my breast screening. I schedule the mammogram and have the mammogram completed. The report from the radiologist states there is an area that is suspicious. I am encouraged to now have an ultrasound done of the suspicious area. I schedule an appointment. The ultrasound determines that the suspicious area needs surgical attention. I schedule surgery. The process is clearly defined: screen for the possibility of disease, further assess if there is evidence of disease, diagnose the disease if it is there and treat the disease as necessary. This is standard of care. Why then is this process so different in dentistry?

The scenario in dental hygiene schools is something like this: The patient arrives and is seated. Medical and dental histories are reviewed, necessary x-rays are taken, a complete periodontal assessment is done including (but not limited to) documentation of pocket depths, clinical attachment loss, bleeding points, drawing of the gingival margin, furcation involvements, etc. By the time students graduate, they may be able to complete the periodontal assessment in thirty to sixty minutes. An experienced hygienist documenting all the necessary parts of a periodontal assessment and educating the patient about the results will take at least thirty minutes. If this in-depth process is added to each recall appointment, every recall appointment is likely to top sixty minutes. Would it not be smarter and more time-efficient to perform this extensive screening on the patients who need it and not those that don’t?

Periodontal Screening and Recording. The periodontal screening procedure involves concepts that are different from traditional periodontal examinations.

  • The mouth is divided into sextants.
  • For each sextant, only the highest screening score is recorded.
  • The probe that is utilized during PSR is different than a traditional probe. It has a rounded tip. The color-coded band extends from 3.5 to 5.5 on the shank of the probe. (PSR probes can be ordered from several manufacturers.)
  • Pocket depths are not measured. Only relationship of the gingival margin to the colored band is assessed.
  • The codes determine the need or lack of need for a comprehensive periodontal exam.

A periodontal screening and recording (PSR) should be performed at every oral exam. This procedure is designed primarily for use with patients aged 18 and over, but valuable information may be obtained when screening younger patients. It is important to remember that screening does not replace a complete periodontal evaluation, but indicates to the clinician when a partial or full mouth comprehensive exam is needed. The PSR can be quickly implemented into every adult recall visit. If the screening determines there is no need for a complete periodontal examination, the patient will be screened again at the next recall visit. If, however, the screening results say there is cause to look further into the patient’s periodontal condition, then the patient will be rescheduled for a complete periodontal assessment at a future date. This protocol mimics that of the medical community—Screen, Assess, Diagnose, Treat if necessary. There is no need to accomplish all of these steps in one visit.

Data gathered to determine how much periodontal disease is being diagnosed reveals a startlingly low percentage because the hygienist doesn’t have enough time to accomplish a comprehensive periodontal assessment at each recall visit. Therefore, it gets put on hold for a future appointment. Most the time such an appointment never materializes and periodontal disease is not diagnosed. The system isn’t working and PSR offers a valid way to drastically improve the system so patients are treated for periodontal disease.

For more complete information regarding PSR, visit the ADA Web site.

Need help with implementing new systems in your hygiene department to ensure patient acceptance and compliance? Email hygiene@mckenziemgmt.com.

Interested in having Angie speak to your study group or at your next seminar? Click here.

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