Poking is not enough

The probe is now a standard part of the tray setup in most hygiene operatories in this country. The question remains: Are we gathering complete data that serves as a scientific basis for a periodontal diagnosis? Given the busyness of our appointment time, it is not uncommon for many hygienists to "poke and check" the pockets, partially recording the information, and then to move directly into the perceived priority of the visit - the "cleaning."

Beverly Maguire, RDH

The probe is now a standard part of the tray setup in most hygiene operatories in this country. The question remains: Are we gathering complete data that serves as a scientific basis for a periodontal diagnosis? Given the busyness of our appointment time, it is not uncommon for many hygienists to "poke and check" the pockets, partially recording the information, and then to move directly into the perceived priority of the visit - the "cleaning."

That`s exactly the misconception that has led to substandard and unproductive hygiene care in today`s dental practices. It`s not that hygienists aren`t very caring, thorough, and excellent. They are! Treating perio without the patient`s consent and without proper compensation is hardly where we need to be as a profession. We must learn to gather complete periodontal records including: pocket depth, bleeding points, recession, mobility, and furcations.

The hygienist must then determine appropriate treatment based upon these findings. If the chart reveals health and stability, a prophylaxis would be the appropriate treatment. However, if an active periodontal infection is revealed, the doctor must be informed of findings and be prepared to make a periodontal diagnosis. Working together with a common philosophy and organized systems in place, the patient legally must receive a periodontal diagnosis and be offered appropriate care. This process alone would preclude about 75 percent of the "cleanings" now done in the normal course of a hygiene schedule.

All too often, we are gathering perio information but not taking the next step of evaluating the data by asking ourselves, "What does this information mean? Am I looking at health or disease?" If dentistry is tired of providing hygiene services as a "loss leader" and is ready to be productive, as well as providing excellent care for patients, complete periodontal charting and diagnosis is the beginning point.

To gather complete and accurate information, the hygienist must have a staff member or a voice-activated charting system to record the data. Numbers must be called out loud so that the patient can also hear the findings. With a proper introduction of the process, the case presentation actually begins with the charting. A typical patient then will ask us, "What can be done about this problem?" If there`s any fear on the part of dental professionals, it`s that of telling our long-standing patients of recorded information that they may not like or want to hear. What better way than to let them ask us!

To effectively diagnose and treat hygiene patients, we must have complete perio records and evaluate these findings, looking for changes each visit. Invest in this process with good systems for gathering the information. OSHA standards always will preclude the hygienist from going "mouth to paper" in an effort to record the data by herself.

Look into your own charts tomorrow morning. When was the last complete periodontal chart done? What was the hygiene diagnosis? Was appropriate therapy offered? Or are you "cleaning disease," seeing the patient more often, every three months rather than each six months? Prophylaxis will never treat or stabilize periodontal disease.

Doctors, when did you personally last diagnose periodontal therapy in the hygiene operatories - last month, or yesterday? Remember, eight out of 10 patients are affected!

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 perioadv@aol.com.

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