There are many offices that are not probing their patients, or they are only probing some of their patients. This article is not only for those offices that are wanting to start an interceptive periodontal therapy program and just do not know how, but for those offices that want to improve an already existing program.
One of the first decisions is regarding which probe should be used in the office. All the hygienist and doctors should be using the same probe. This will help with calibrating all of the operators in the office.
The office will also need to agree on a periodontal charting system that everybody can utilize. It should be easy to read and have a legend that is easily followed. In a “multi-hygienist” office, we need to standardize our documentation as much as possible.
It is imperative that every operator be calibrated when it comes to probing measurements. All operators will probe two people that have pocketing. They will all probe the same quadrant on each person, making sure they do not overhear or know the pocketed areas on the patient. Then the measurements will be compared. If there are not any discrepancies then the office is already calibrated. However, if one or two people are off on a few measurements then a consensus needs to be made using a probe as to what a three-millimeter pocket is compared to a four-millimeter pocket compared to a five-millimeter pocket. Once the consensus is made with all the operators, this will be the protocol utilized. This should be done whenever a new hygienist or dentist is hired.
An informed consent will need to be created or purchased. According to the position paper, “Guidelines for Periodontal Therapy” in J. Periodontal November 2001, the informed consent should include diagnosis, etiology, proposed therapy, possible alternate treatments, prognosis, recommendations for referral to other health care provider as necessary, reasonably foreseeable inherent risks, and potential complications associated with the proposed treatment, and the need to have periodontal maintenance therapy after active therapy due to the potential for disease recurrence.
There should be an orderly sequence of treatment and appointments. This will allow the doctor and hygienist to be more thorough for each procedure. Also, a more methodical approach will prevent duplication of treatment. This will allow for a multi-hygienist practice to have continuity of care between providers. A well-planned protocol will adapt to the needs of the patient’s condition. The protocol should include procedures that determine results most often expected.
The amount of time needed for each procedure will need to be determined. Of course there will always be exceptions to the protocol and time lengths needed. Some patients may require more time while others in the same periodontal classification may need less time. This may be altered when special circumstances apply to an individual patient. However, the majority of patients should fall in the time allotted in the office protocol. Otherwise, the office protocol may need to be re-evaluated.
Informing the patients of new procedures incorporated in the office, starts with the Patient Coordinator, when appointing the patient. This can be done a couple of different ways.
When a patient telephones to make an appointment, the business staff should be excited to tell the patient about the new commitment the office has made to screen all patients for periodontal disease.
“Ms. Jones, welcome to our practice. Debbie, our Hygienist, will be examining your gum tissues today during your professional cleaning. If you will fill out this questionnaire along with your new patient information, this will help both of you to more accurately evaluate the health of your gum tissues.”
Questionnaires and brochures addressing the signs and symptoms of gum disease, such as the American Dental Association’s, Gum Disease Are you at risk, could be introduced at this time.
Another suggestion is when you send the patient their invitation style notice in an envelope reminding them of the need for their next hygiene appointment, enclose a brochure having to do with periodontal disease.
This will lead to conversation in the treatment area regarding their periodontal condition. The questionnaires and brochures can be used on new or existing patients.
Once you are preparing to probe, explain to the patient that pocketing greater than three millimeters is a sign of disease, as well as areas of bleeding and or exudates. This co-discovery technique enables the examiner to create value for the patient.
Now, you are on your way to the beginning and/or improvement of your interceptive periodontal therapy program.
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