1.1.10 Issue #408 Forward This Newsletter To A Colleague

Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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Becoming More Periodontally Focused

In my last article we looked at why the hygiene department may not be producing to its full potential. Now let’s look at a couple of ways to fix what may have happened.

New patients are easy because they don’t know what the office has done in the past. The new patient that needs root planing will have a periodontal maintenance appointment in the time frame determined necessary by the clinician. The appointment will be included in the original treatment plan in the computer. It is the existing patients that will be the biggest challenge to convert over to the periodontal therapy program.

Let’s talk about probing first. Six point probings and recession needs to be charted on patients. It is recommended to do six point probings at every visit. Not only should both be done, but the practitioner should be telling and educating the patient about what the numbers mean before they are done. This will enable the patient to co-diagnose their periodontal health or disease.The hygienist or doctor will first tell the patient:

 “Sam, I am going to do what is called probing. This is where I will go around and measure the level of attachment to your tooth. You want to hear 2’s and 3’s. If the number is higher than that, you may need more advanced and aggressive treatment to slow down the periodontal disease in your mouth. This treatment is called root planing and it is where we concentrate in one particular area of your mouth for a specific amount of time. You will be numb so it will not be uncomfortable. We also do not want to have any bleeding upon probing or during the actual procedure.”  

It is also recommended that the probings be done out loud at least once a year so the patient can hear them. This is also the time to tell the existing patients that if there is bleeding upon probing, they may need to have root planning. This verbiage, or something similar, should be told to not only new patients but existing patients, especially if you have not been doing the probings out loud on your existing patients. You will be surprised at how many of them forget what the numbers mean and are not inclined to ask – particularly if you have not done the probings and recession out loud in the past or have not done them out loud in quite awhile.

Once you are done probing the pockets, recession should be charted. We all know that the pocket depth is not the only thing that needs to be documented in the patient’s record. The level of attachment is what really matters. If you have a patient with a 3 mm pocket and 6 mm’s of recession, this patient is going to be treated differently than the patient with a 3mm pocket and 1 mm of recession.

Again, a conversation something like this should happen before the recession is charted: “Sam, I am going to chart recession now. This time you want to hear zero. What happens is we take the first set of numbers and add it with the second set of numbers in order to come up with how much attachment you have lost. The lower the number is, the healthier your periodontal/gum health is.”

As you are probing the patient may actually start asking questions about what the numbers mean once they realize they have higher than 2’s and 3’s and zero. This is your time to talk to them about what root planing is and where the numbers are compared to the past. Even if the numbers are the same as they have been in the past, and there is no sign of the patient’s health improving, then it may be time to root plane. If the patient has not been referred to a periodontist this may be the time to refer the patient out. If the patient refuses to go to the periodontist or is non-compliant with home care, this may be the time to root plane again, as this may help slow the disease down.

Bleeding gums during instrumentation are not healthy gums. The patient should be treatment planed according to their individual needs. The treatment plan should be given to the front office and the three-month periodontal maintenance appointment should be included in the treatment plan. This way, the patient is aware they are no longer going to be receiving a prophylaxis, and they will be made aware of the difference between a periodontal maintenance appointment and a prophylaxis. This should be explained to the patient not only in the hygienist’s chair, but the person going over the treatment plan and the financials should explain the difference to the patient also. Before either staff person finishes with the patient, they should ask: “What questions do you have?”   

Some of you really know your patients and know that some of them are going to want a chance to try and improve the numbers. These are the people that you will inform at the end of the appointment that if their mouth does not look healthier at their next visit, they will need to be root planed. Document, document, document that they may need to have root planing done and make a note to treatment plan if the health of their mouth does not improve by the next visit. This way when they come in and their health has not improved like they were expecting and treatment needs to be done, it will not be a surprise to them. This will also help with patient acceptance.

Converting existing prophylaxis patients to the periodontal maintenance patient that they should be is not an overnight fix. This will take some time and effort on the entire practice. Becoming a periodontally focused office is a team effort.

Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

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