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11.18.05 Issue #193  
Establishing Periodontal Protocol

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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In my last article I discussed establishing a game plan and an orderly sequence of treatment and appointments in relation to establishing or enhancing an interceptive periodontal therapy program. Protocol, ideally, would include those procedures that predictably determine the results most often expected. The goal of your periodontal therapy program is to reach optimum results for the patient in a minimal amount of time.

The amount of time required for the first therapy visit after the diagnosis is determined based on the diagnosis. Every assessed and diagnosed periodontal type would have its own protocol to follow. One must consider what the appointments will consist of at each visit.

An example of a first appointment treatment plan for case type III, might consist of: updating the medical history, having the patient pre-rinse with an antimicrobial oral rinse, performing one or two quadrants of scaling and root planing with or without anesthesia, irrigation, and possible local delivery of a chemotherapy agent as per manufacturer’s recommendations. This appointment time may be 90-120 minutes for two quadrants of scaling and root planing or 60 minutes for one quadrant of scaling and root planing.

Each subsequent visit to treat the remaining quadrants of scaling and root planing should be identical to the first visit until all treatment is completed, unless the patient’s needs are different for each quadrant. This would be determined at the time of diagnosis and treatment planning.

The last visit prior to placing the patient on periodontal maintenance is an evaluation appointment with a prophylaxis. Thereafter, the patient will continue their care with a periodontal maintenance appointment  (4910) every three months. This may vary depending upon patient compliance, as well as the clinical knowledge and judgment of the licensed clinician. When new or recurring periodontal disease appears, an additional diagnosis and treatment may need to be implemented. This is just one example of an interceptive periodontal therapy program protocol. The practice’s hygiene department should also consider establishing protocol for prophylaxis and periodontal maintenance appointments too.
Now that you have established a new office protocol for your interceptive periodontal therapy program, decisions regarding how to educate your patients about your new commitment can start immediately. Informing the patients of new procedures incorporated in the office usually starts at the front desk when the patient is appointed.  For example, the front desk may explain to the patient about the new commitment the office has made to screen all patients for periodontal disease. For example, “Ms. Jones, we have recently been to a seminar and are very excited about our new commitment to screen all of our patients for periodontal disease. We are sure you will benefit from our Periodontal Therapy Program protocol that we will be incorporating into our office.”
The Business Coordinator can mention the periodontal therapy program when she greets the patient. This could take place as she is asking the patient to fill out initial information, for example: “Ms. Jones, welcome to our practice. Jean, our dental 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 ADA’s Gum Disease Are You at Risk? could be introduced at this time. The patients would simply check any symptoms they have experienced and read through the brochure they were given. This will lead to a conversation in the treatment area regarding their periodontal condition.

The patient will have an indication as to whether they have signs of gum disease. Here is a sample presentation to use with a new patient. “Ms. Jones, as the screening process that we just completed, has indicated you have several areas of infection or periodontal disease. Before we can start your restorative dentistry, we want to get your gum tissues in good health. To accomplish this in a conservative manner, we would use a non-surgical approach. It’s the most effective way to get your gums healthy and keep them that way. Working together, we can establish a home care regimen that is most effective for you and your life style. The periodontal therapy will take approximately four visits, at a week to ten days between appointments. If you do not have any further questions, it’s best if we get started as soon as possible.”

This sample dialogue along with many others can be found in our new book,
 “Enhance Your Hygiene Department, How to Take Your Hygiene Department to the Next Level,” and during McKenzie Management’s “Advanced Hygiene Performance Program” that we provide at our location or yours. The dialogues are designed to give the presenter a foundation on which to build their conversation with the patient. McKenzie Management can help you with designing an interceptive periodontal therapy protocol for your hygiene department or to help enhance the performance of an already existing program.

For more information, or 1-877-777-6151

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