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11.4.05 Issue #191  
The Periodontal Examination

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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Is it possible you have undiagnosed treatment in your existing patients charts, because you do not have a ‘written’ interceptive periodontal therapy protocol established for your hygiene department? Establishing protocol will enable you to identify problems and treat your recall patients in the proper sequence to maximize their oral health.  This protocol, for example, could be an evaluation before the professional cleaning and having all necessary diagnostics available.  Think of it this way…the dentist wouldn’t place a crown before treating a periapical abscess associated with the tooth. In this same venue, why would a hygienist do a professional cleaning before correcting periodontal pockets?

Hygienists are skilled educated professionals trained to identify and conservatively treat periodontal disease. Therefore giving them the responsibility to help the dentist with the diagnosis of periodontal disease and communicate their findings to the patient is a positive step towards moving to a successful hygiene department. The hygienist, of course, is not responsible for the diagnosis of the disease, but the hygienist gathers much of the information. Although, in most states, the dentist makes the actual diagnosis, the hygienist can be held liable if these issues are not disclosed with the patient.

As a practicing hygienist, it is my responsibility to the patient to do everything I can to help treat and prevent periodontal disease.  Therefore, probings should be done on every patient using the six point probing method.

Part of your written protocol will be making decisions regarding what probe should be used by the hygienists. All of the providers need to be calibrated. Making sure that the doctor and all the hygienists agree on what a three-millimeter, four-millimeter, and five-millimeter pocket are. This protocol would also be done whenever a new hygienist is hired into the practice or a temporary hygienist is there for the day.

In a “multi-hygienist” office, standardize your documentation as much as possible. The periodontal chart should be easy to read and have a legend that is easily followed and that everyone in the office including the front office understands.

     The examination would include gathering information regarding:

  • A medical history
  • A dental history
  • Extra oral structures
  • Intraoral tissues and structures
  • The teeth
  • Radiographs as needed to diagnose
  • Presence and distribution of plaque and calculus
  • Periodontal soft tissue
  • Presence and type of exudate present
  • Probing depths (clinical attachment levels)
  • Bleeding sites
  • Furcation involvement
  • Color and contour of gingiva
  • Presence of inflammation
  • Areas of recession
  • Mobility

Note this information in the patient’s record with a standardization of symbols.
Once the evaluation information has been obtained, establishing a game plan of orderly sequence of treatment and appointments is next.  A well planned protocol will adapt to the needs of your patient’s condition. Not only will the patient actually receive a personalized approach, but also they are more responsive to treatment.

Explaining to the patient what pocket charting is, what all the numbers mean and why you are doing it before you start is recommended. Speak about the pocket charting in front of the patient will enable them to co-diagnose with you. Allow the patient to watch you as the probings are done. Show the probe to the patient. Explain that the measurements will tell whether there is disease or health. Explain that bleeding upon probing is not normal in healthy tissue. Point out any significant problems as the probing is being done. At this point, the patient will have an idea of their periodontal health and identify with the results obtained. Allow the patient to ask questions so you can ascertain if they understand the results of the test.
Scripts and verbiage can be gone over with the entire team in order to establish continuity when talking to the patient about periodontal disease and the commitment the office has made to help in the prevention and slowing the progression of the disease.

Establishing office protocol is essential in order to deliver optimum dental care thus, maximizing the health of your patients. It is important to properly diagnose acute and chronic problems before any treatment is initiated.

If you are interested in one-on-one instruction to enhance your hygiene skills Email

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