Beverly Maguire, RDH
As we continue to explore the steps to a successful transition to Diagnosis- Driven Hygiene, probing and charting take on pivotal importance. Periodontal data must be evaluated to formulate a diagnosis and an appropriate treatment plan. In the past, we have allowed the schedule to determine the treatment for hygiene patients.
Today, appropriate hygiene care must be evidence-based, which requires probing and charting. Without it, we are simply assuming the patient is healthy. Furthermore, failure to adequately diagnose and discuss a patient's periodontal status could leave your practice vulnerable to litigation.
Most hygienists are doing the best they can with this situation. But it's not enough - they need help! Hygienists can't do a complete probing and charting alone; they need assistance from their doctors. OSHA does not allow for "mouth to paper" protocol. "Poking and checking" does not constitute a complete probing and charting. "Complete" means evaluating not only the pocket depths, but also recording bleeding on probing, recession, mobility, and furcations. (Please review last month's column on "Staff Commitment.") Support from the entire team is essential to accomplish adequate charting for your patients.
Two charting options exist today. Voice-activated perio charting systems, such as Dentrix, Practice Works, or the Victor systems, are revolutionary and will likely become standard equipment in the future.
Most offices, however, utilize existing staff members to assist with recording this essential data. To determine if your current protocols provide the necessary information for diagnosis, grab the nearest chart! Is the above-mentioned data recorded in your patient files? You may have a few numbers recorded in all posterior quads where anything 4mm or more is written. Are the records dated? Are bleeding points and recession recorded? If not, you are in jeopardy with such random records. You cannot legally diagnose the disease without complete documentation.
Another critical issue is charting frequency. The ADA standard is once a year. My personal standard of care for the last 15 years has been to chart healthy patients - those with 1-3mm pockets and 0-10 bleeding points - once per year. I chart other patients every time they sit in the hygiene chair. This may seem like overkill - but I never miss my patient's periodontal changes. Frequent charting is the best diagnostic and tracking tool we have.
The periodontal chart itself is another issue. I have seen a variety of charts in patient files. Most are copies of something developed 20 years ago. Invest in an up-to-date chart that allows you to record and evaluate all the needed data. You will then be able to quickly monitor the changes and intervene with appropriate treatment options - the key to excellence. One such example is the comprehensive chart I have recently developed. Readers can preview this chart in the "Pearls" column this month by Dr. Joe Blaes.
Diagnosis-Driven Hygiene is excellent, profitable, and civilized. Patients pay for health care based upon a diagnosis - not for cosmetic "cleanings" driven by the schedule. The difference is like night and day. A successful transition to a diagnosis-driven approach requires a commitment to a system of complete charting.
Your office charts will reveal how well you are doing. Believe them! Your standard of hygiene care and profitability directly correlates with your ability to diagnose and treat periodontal disease.
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@example.com.