by Nancy Dukes, RDH
Jameson Management Consultant
Historically, we kept patients healthy by appointing them every six months, recording limited periodontal data, following insurance guidelines for treatment, and waiting for definitive evidence of bone loss and disease. We did not feel justified in treatment planning any other way because of time limitations, lack of supporting research, patient financial concerns, and a general lack of understanding by dental teams regarding how to make necessary changes to treat more comprehensively.
We now have research that enables us to diagnose, treat, educate, and maintain periodontal patients much earlier and much more successfully. As a result of the research and experience with nonsurgical periodontal therapy protocols in the last 10 to 15 years, we understand that early diagnosis and treatment are our best defenses against a disease that is more prevalent among adults than the common cold. With the development and introduction of the new periodontal classification system by the AAP and International Workshop for a Classification of Periodontal Diseases and Conditions in 1999, we have a system that encourages early diagnosis and treatment. The classification system was revised in an attempt to be more descriptive and comprehensive. This welcome change has given us direction for comprehensive care.
Criteria to classify patients periodontally should include comprehensive periodontal charting, bleeding, severity of bleeding, suppuration, furcation and its classification, recession, mobility and its classification, bone loss, attachment loss, and mucogingival health. The patient with chronic or aggressive periodontitis should be further classified as to quantity or extent of the disease (localized or generalized) and classified as to the quality or severity of the disease (slight, moderate, severe).
In the past, dental professionals have relied strongly on probing depths, which can increase or decrease with inflammation, surgery, etc. Today, a much more comprehensive evaluation of the entire patient must be done to determine contributing factors that may affect the therapy. One must consider health history and/or systemic diseases, oral hygiene habits, limitations, and results, as well as previous therapy and results.
According to the ADA, 80 to 85 percent of the American adult population is in some stage of periodontal disease. If this is indeed true, what percentage of your daily patients should have received some periodontal treatment or need treatment? Expanding and developing the services within a general practice to care for these patients with disease requires elevating the skills of the entire team. It is no longer just the responsibility of the doctor and/or the hygienist. It must become a team effort.
To truly elevate your hygiene department, every patient must be comprehensively:
• Evaluated and assessed
• Diagnosed and classified
• Informed and educated
This is no small task. It requires the entire team to accomplish this, enrolling and maintaining patients in care as a priority. As a team, everyone must thoroughly understand periodontal disease and treatment, and be prepared to support one another.
If we are to gain treatment acceptance and keep those patients enrolled in the maintenance they need, we must be comprehensive not only in our evaluation and diagnosis, but in patient education as well. We must become partners with a patient who thoroughly understands his/her state of wellness.
You or your patients may be journeying down the wrong road if any of these conditions exist:
• Patients bleed each time they are seen for a prophy
• Each patient does not have a written comprehensive periodontal charting yearly
• Each patient does not have a current full-mouth series of radiographs
• Patients have not been diagnosed, classified, treated, or referred
We are responsible for the following in comprehensive periodontal care:
• Taking radiographs and gathering comprehensive data
• Classifying
• Informing and educating
• Recommending and providing treatment or referring
• Rediagnosing
• Maintaining the patient according to industry standards
• Staying current with our own education
As health-care professionals, we are responsible for diagnosing disease at any stage. Earlier diagnosis, delivery of treatment equal to current standards, and patient education gives dental professionals and the patient the best chance for great results. We owe this to our patients who trust us.
As a result of research since 1985, the American Academy of Periodontology concluded that periodontal disease is episodic in nature, site-specific, and very capable of being treated and maintained when diagnosed and treated early. With proper team involvement, general dentists have the earliest opportunity to achieve this.
Team involvement includes not only all of the dental professionals within the practice, but the patient as well. The patient must become an integral part of the diagnosis, treatment plan, and maintenance. Patients must be thoroughly educated to understand that they have periodontal disease or they are at risk. This is the first vital step to engaging them on the journey to wellness. How do we, as dental professionals, do this successfully?
Engaging patients in a lifelong journey to wellness has always been a challenge. We need to check these lists, pack the right skill set and systems, commit, and communicate every step of the journey to hygiene excellence. Today, success begins with careful, intricate patient education on the part of the entire dental team. The dentist, dental hygienist, clinical assistants, and business team must work together to achieve patient commitment to what is in the patient's best interest. This is the goal for success.
Jameson Management, Inc.'s Nancy Dukes, BA, RDH, invites you to expand your horizons in the area of patient motivation by joining in a series of articles to discover the keys that will enable you to book more passengers than ever imagined on the journey to wellness. The Journey to Hygiene Excellence will not only offer this wellness approach to clinical care article, but features on comprehensive health evaluation, systemizing your data collection and documentation, treatment planning and ADA coding, building relationships of trust through effective patient education, case presentation and treatment acceptance, and building retention and referrals while offering a healthy new-patient flow. Dukes is director of clinical consulting for Jameson Management, Inc., an international dental practice-management consulting firm. Visit www.jamesonmanagement.com or call (877) 369-5558 for more information.
