Developing treatment protocols

Oct. 1, 2002
Treatment protocols are an important step in the transition to diagnosis-driven hygiene. Practices must pay special attention to those patients whose needs go beyond mere cleaning, but do not require surgery.

Beverly Maguire, RDH

Treatment protocols are an important step in the transition to diagnosis-driven hygiene. Practices must pay special attention to those patients whose needs go beyond mere cleaning, but do not require surgery.

Too often, the hygiene treatment plan is developed at the last minute. The doctor may get the heads-up before the hygiene exam and then try to figure out with the hygienist and business staff how to approach treatment, its cost, and how many visits may be necessary. "Hallway treatment planning" is probably better than nothing, but it signals to patients that the office is unorganized. It also can send a conflicting message about whether the treatment is truly needed. We can do better by planning ahead on diagnosis, protocol, treatment costs, and scheduling. Patients will have more confidence in the diagnosis and treatment plan when offices are well-prepared to answer their concerns before they are voiced.

A productive, organized hygiene department that is prepared to treat the needs of all patients, both healthy and diseased, requires planning and preparation. Clinical decisions regarding therapeutic procedures, codes, and fees deserve careful thought and research. The American Academy of Periodontology is the best source for guidance in this area. The Parameters of Care is available for purchase from the AAP at (312) 573-3243. You also can down-

load it from the Web site at This document is a valuable resource for treatment protocols for nonsurgical periodontal care, as well as parameters for re-evaluation, retreatment, and referral guidelines for periodontal patients.

While root planing is certainly the mainstay of nonsurgical periodontal care, it is by no means the only needed element of treatment. Nonsurgical perio therapy involves proper diagnostic exams and ongoing re-evaluations, radiographic evaluation, therapeutic scaling and/or root planing, subgingival irrigation, desensitizing fluorides, home-care fluorides, oral hygiene instruction, behavior modification techniques and site-specific or systemic medicaments. Education and modifying the behavior that leads to disease activity matter most. Once the need for treatment has been identified, we must be ready to offer appropriate options for care. We must take a scientific approach to this very common dental disease that affects a large portion of our adult population.

After you research the available literature, try to work through these issues with pen in hand. Write down your treatment protocols and research, using the CDT-3 Manual, which are the broad range of periodontal codes available for your use.

Establish reasonable fees and communicate to your entire staff the value of periodontal treatment options for patients. Your team must understand the benefits to your patients, the practice, and the profession so that they can comfortably offer these options to patients. Treating periodontal disease isn't black and white. It is up to us as intelligent dental professionals to read the research, study the journals, and attend courses on periodontal therapy.

The dental hygienist certainly is a key factor in providing for the development and implementation of these protocols. I see great value in developing a close relationship with a periodontist to provide both clinical services to patients as well as guidance and education for you and your staff.

If your department still primarily dispenses services that are heavily weighted in prophys, you are talking the talk but not walking the path to periodontal stability, health, and a productive, high-quality hygiene department. Written, nonsurgical periodontal treatment plans should be a part of every general dental practice. Find out where things stand in your practice!

Beverly Maguire, RDH, is a practicing dental hygienist. She is president and founder of Perio Advocates, a hygiene consulting company based in Littleton, Colo. She can be reached at (303) 730-8529 or by email at [email protected].

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