Beverly Maguire, RDH
We are simultaneously moving foward toward excellence and backwards towards substandard care. The shortage of dental personnel and hygiene professionals is widespread. On one hand, dental hygienists are transitioning into periodontal therapists. On the other hand, the threat of preceptorship (where unlicensed staff would "clean" teeth) looms.
As these issues emerge, new research indicates that periodontal disease strongly correlates to systemic health. The treatment of periodontal disease with "cleanings" needs to become a thing of the past.
The standard of care we currently deliver in hygiene operatories is variable at best. Unrecorded, inconsistent probing and charting are common. Most offices feel it is unrealistic to provide a staff member to record numbers for the patient`s periodontal records. But, with more than 168 sites to evaluate for pocket depth, recession, mobility, and furcation involvement, a single person is also unrealistic.
The lack of a hygiene diagnosis continues to encourage the practice towards "cleaning" far after the learning curve has suggested it is appropriate. Patients have a historical perspective when it comes to the hygiene visit, and that view is one of "cleaning." Any change in the hygiene protocol must be thoroughly understood and supported by the entire dental team.
Colleges and universities that train dentists and hygienists uphold excellent standards for periodontal education. The challenge lies in the transition from the educational setting into the private practice arena. I doubt that graduating hygienists or doctors feel they are "masters" of their profession upon graduation. We all must embark on the road of lifetime learning and professional mastery.
Just how we begin that process can be critical. Most hygienists will accommodate the dental practice and the historical approach that has been created within the hygiene department. Often, this means business continues as usual without adapting to meet the standards as they have evolved and progressed. Because most dentists are restoratively minded, periodontics has not been a major focus of continuing education. They falsely assume that all is well in their hygiene department.
Doctors must be aware of the changes in hygiene protocol involving probing and charting, determining the hygiene diagnosis, and offering patients options for care that correspond to that diagnosis. It`s highly probable that for 60 to 75 percent of your adult patients a "cleaning" is inappropriate care.
To be practicing to current standards, hygienists must be doing a full-mouth periodontal charting, assessing the hygiene status, and informing both the patient and the doctor of the findings. The doctor must then diagnose the periodontal status as being: "healthy," "actively diseased," or "periodontally stable."
These findings must be presented to the patient along with appropriate options for hygiene care. The findings also must be documented in the chart. This is a far cry from "cleaning" every patient - the best job possible in the minimal time allotted.
Doctors, don`t expect your hygienist to accommodate the standards created decades ago. Hygienists, don`t assume that whatever protocols you encounter in your next office are cut in stone. As a professional partner to the doctor, you must step up to the plate and ensure the proper standard of care is being offered to each and every patient. If the protocols haven`t changed for some time within your practice, it may indicate a need to re-evaluate the philosophy and procedures of the department. Hygiene services today are intended to treat preventive, therapeutic, and maintenance needs.
Beverly Maguire, RDH, is a practicing periodontal therapist. 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 e-mail at [email protected].
