Donít Minimize Perio!
A common complaint I hear from hygienists is that dentists don’t always back them up concerning the seriousness of a patient’s periodontal disease. They tell me this can be very disappointing when they have taken pains to set the stage for moving a patient from “standard cleanings” to scaling and root planing. It often seems to go like this:
“Mr. Patient” arrives for his recall appointment. During his perio assessment, “Emily the Hygienist” notices that he has developed numerous pockets between 4 and 5 mm. Mr. Patient is 48 years old, in generally good health, and has been a patient of the office for five years. During that time, he has received only prophylaxis on a 6-month schedule.
Emily knows that Mr. Patient will likely be resistant to changing the schedule of his recall visits or the treatment he receives at those appointments. She also knows that Mr. Patient’s oral condition will likely respond well to an early intervention, preventing a periodontal situation from getting worse. She delicately explains her concerns to Mr. Patient during the course of his visit.
Emily: Mr. Patient, I know you have been our patient for years, but today I notice that conditions in your mouth are changing. Where you had healthy gum and bone around your teeth in the past, I am noticing that some inflammation and tissue infection is present.
Mr. Patient: Infection! You’re telling me I have an infection?
Emily: I don’t like being the bearer of bad news, but you do have an infection and inflammation around some of your teeth. I can tell by the appearance of your gums and also the readings from my periodontal probe. You remember that my probe is like a little ruler that can measure around your teeth.
Mr. Patient: How did this happen? I brush my teeth every day and I come in for cleanings every six months.
Emily: Well, just like a person can develop high blood pressure or high cholesterol when he previously did not have these conditions, a person can develop gum and bone disease, which we call periodontal disease, when he previously did not have that problem. We can control this disease, but we will need to approach your care differently than we have in the past.
Mr. Patient: What can you do?
Emily: It is really a combination of what we can do here and what you can do at home. I am going to recommend that you come back to see me for two more visits. During those appointments I will be getting your gums numb with anesthetic so you will be comfortable, and then using my ultrasonic and hand instruments to remove all hard and soft deposits under your gums. We call this procedure “scaling and root planing”.
Soft plaque, which is like super glue and provides an excellent medium for bacteria, will be removed. I will also remove the hard calculus called tartar, which is rough and encourages bacterial growth as well. When these bacteria, which are the sources of your infection, are taken away, the inflammation around the teeth will go away as well.
Inflammation is one of the ways our bodies fight infection. It is a tool of the immune system. If mouth bacteria are allowed to keep growing, the immune system can become overwhelmed. Inflammation persists, but the body cannot rid itself of the “germs”. My scaling and root planing gets the bacterial levels down to where your own home-care can keep them from getting out of control. The infection is removed, inflammation is reduced, and you are healthy again.
Mr. Patient: What happens after you are finished?
Emily: I am going to give you a few more tools to use at home when you clean around your teeth and I will see you three to four times a year for maintenance. You actually won’t be coming for “cleanings” anymore – you will be receiving periodontal maintenance. I have many patients on this type of schedule and the results are often very good.
Mr. Patient: Well, I am not too happy to have to do this, but let’s get started.
Dr. Dentist enters the treatment room. Emily tells her what she and Mr. Patient have been discussing. Dr. Dentist begins her exam, looks at the perio chart, and says: Well, 4 and 5 mm pockets are not so bad. Let’s just go ahead and have Mr. Patient come for cleanings a little more often.
Mr. Patient looks at Emily and says: Well, that sounds good to me.
While variations in recommendations for which conditions require perio scaling and root planing are not uncommon, it is imperative that the dentist and hygienist agree on when SRPs are needed. Perio conditions, caught early, may be resolved with early treatment. It is not helpful for patient care if the dentist and hygienist are not on the same page. It is also not good for the office image if one professional is saying one thing, while another is saying something different. In addition, perio treatment is diagnosed and treated in successful practices. A hygiene department should be diagnosing and treating at least one-fourth to one-third perio in its practice mix. The hygienist should not be providing only prophies.
Dentists, please don’t minimize perio treatment. Get with your hygienists to be sure that perio identified is perio treated.
Carol Tekavec RDH is the Director of Hygiene for McKenzie Management. Interested in knowing more about how to improve your hygiene department? Email firstname.lastname@example.org.
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