8.26.11 Issue #494 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Carol Tekavec, CDA RDH
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Making Recommendations - Supporting Sources
Carol Tekavec RDH

Dentists and hygienists are called upon every day to make recommendations for patient care based on the best information and professional judgment they possess. Diagnosis and treatment planning are the dentist’s responsibility; however, hygienists shoulder a significant role in carrying out certain aspects of treatment as well as educating patients about their care. In the case of periodontal disease, we have many sources and opinions on which to base our recommendations. One extremely valuable resource is the American Academy of Periodontology. The AAP publishes reports and guidelines developed by experts and reviewed and approved by the AAP Board of Trustees which can be accessed by professionals on the AAP website or purchased in print form from their catalog. A July 2011 report addresses Comprehensive Periodontal Therapy; what it entails and what treatment might be expected to accomplish.  

Under “Treatment Procedures” the report includes (but is not limited to) the following:

  • Patient education, training in oral hygiene, and control of risk factors such as smoking should be performed.
  • Removal of supra and subgingival bacterial plaque/biofilm and calculus by comprehensive, meticulous periodontal scaling and root planing, sometimes incorporating these into surgical treatment, should be accomplished.
  • Chemotherapeutic agents may be used to reduce, eliminate, or change the quality of microbial pathogens, or to alter the host response through local or systemic delivery.

Under “Evaluation of Therapy” the report mentions:

  • The patient’s response to therapy should be evaluated (probing, bleeding points, elimination of swelling) and treatment objectives should have been met.
  • An appropriate periodontal maintenance program, specific to the individual, has been recommended.

Under “Periodontal Maintenance Therapy” the report lists:

  • Evaluation of tissues should be accomplished.
  • Assessment of oral hygiene status should be done.
  • Mechanical tooth cleaning to disrupt/remove plaque, biofilms, stains and calculus should be provided. Local delivery or systemic chemotherapeutic agents may be used as an adjunctive treatment for recurrent or refractory disease.
  • Appropriate intervals for maintenance should be established.

Incorporating information contained in the AAP Comprehensive Periodontal Therapy report into our own treatment planning can help us provide the best possible care for our patients. In addition, we can use this report as a supporting source when talking with our patients - providing credibility and trustworthiness for our treatment advice and encouraging patient acceptance.

While scholarly reports are important, articles written in laymen’s terms can also be helpful. One such article, titled: “Chronic Illness is Related to Mouth Germs! What You Need To Know” explains the relationship between tooth and gum infection, inflammation and a person’s general health. It also supports treatment acceptance in that root planing and scaling are discussed and recommended.

Here is an example of using the AAP report and the web article with a patient:

After a full mouth periodontal probing, Annie the hygienist notes that Mr. Patient has several areas of 4 and 5 mm loss of attachment, and numerous sites of redness, bleeding, and gingival swelling. Her assessment, along with the diagnosis of the dentist, confirms that Mr. Patient has chronic generalized moderate periodontitis, and they recommend periodontal scaling and root planing.  Mr. Patient knows very little about periodontal disease, so it falls to Annie to educate him concerning his condition, as well as to obtain his acceptance of treatment. She provides written formation for him, such as a print-out of the web article mentioned above, and explains:

“Mr. Patient, based on our examination, we have determined that you have periodontal disease. This condition is an inflammation and infection of the gums and bone that support your teeth.The American Academy of Periodontoloy is the most respected source of current information concerning periodontal disease, and their recommendations include removing bacteria, plaque, and hard deposits from around each tooth in a very comprehensive way. That is why we are recommending scaling and root planing of all of your teeth to accomplish just that. The AAP considers scaling tooth root surfaces to be a critical element in establishing periodontal health. Left untreated, the toxins produced by the bacteria living around your teeth can overwhelm the mouth’s defenses, resulting in loosening of teeth and the possible spread of infection to other parts of the body. The print-out I have given you talks about this in detail. The good news is that with our treatment and your own home care, this condition can be controlled. Working together we can help you keep your mouth and teeth healthy and strong for life.” 

In addition to providing patients with sources and handouts, it is good to be prepared with quick and simple explanations for common questions. For example:

No dentist has ever told me that I had gum disease.  Why is this happening now?

“Even if a dentist has never previously told you that you need gum and bone care, new conditions require new treatment. It is not uncommon for even “regular” patients to develop mouth infections from time to time and need more than just a “cleaning” such as they have had in the past. Just as a person may develop high blood pressure, having never had it before, so may a person develop gum and bone disease. Our bodies change and face challenges all the time.” (Excerpted from Chronic Illness is Related to Mouth Germs article)

I accept that I need periodontal treatment and subsequent periodontal maintenance.  How often will my insurance pay?

“Many insurance plans pay for periodontal maintenance twice a year, although most patients require appointments more frequently. Insurance plans limit the number of exams, cleanings, and periodontal maintenance appointments that they will cover because these are the types of treatments that many people need to have often. Insurance can help cover expenses, but it will probably not pay for everything you need. It is a mistake to let benefits be your sole consideration when you make decisions about your dental condition. People who have lost their teeth often say that they would pay any amount of money to get them back. The good news is that your insurance can reduce your expense. It helps!”

Helping patients make appropriate decisions concerning dental treatment is important for their health as well as the health of the practice. Resource material can provide valuable support.

Carol Tekavec RDH is the director of Hygiene for McKenzie Management.  Carol can improve your hygiene department in just one day of training “in your office”.  Interested in knowing more about how to improve your hygiene department?  Email hygiene@mckenziemgmt.com.

Carol is also a speaker on hygiene efficiency and profitability for McKenzie Management. Interested in having Carol speak to your dental society or study club?  Click here

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