Beverly Maguire, RDH
The standard of hygiene care is inconsistent throughout the country. Apparently, there is quite a discrepancy between what we know, and what we do. We know, for example, that 75-85 percent of all adults have some degree of periodontal disease. We also know that there are successful ways to treat and stabilize this disease if diagnosed early. And we also know that established standards require every adult age 16 years and older receive a complete evaluation. "Com-plete" means gathering information, evaluating the clinical signs, and formulating a diagnosis and treatment plan. We should then inform patients of our findings and offer them appropriate options for care.
But what do we do? The "best we can in the time allotted" is too often our answer. Most dental professionals believe they are treating the disease within the acceptable parameters of their hygiene protocols. However, marking a few random numbers on the perio chart, followed by a "cleaning" has become the minimal - and customary - standard. Busy schedules, confusion regarding timeliness of treatment, and a lack of confidence when presenting the diagnosis are big factors contributing to this reduced standard. Poor communication can also contribute due to the often inefficient transition of patients between hygienists and doctors.
Patients also complicate the message. They make the routine assumption that hygiene visits are merely for cleaning or cosmetic purposes. In turn, we fear their dismay when we inform them that the results of their "cosmetic" visit is a less than perfect diagnosis. Our concerns for patient retention supersede those of maintaining the highest standard of care.
Will it take a 20/20 expose on periodontal disease to force us into consistent standards for periodontal exams? Patients deserve to know their periodontal status in terms they can understand, and be presented with options for care. The steps are simple and straightforward: complete a perio chart, assess, diagnose, and inform. Then, devise a treatment plan, treat, and maintain. This is the minimal standard we all should adopt.
Resolve poor communication by formulating a concise model for "handing off" perio information between hygienist and dentist. Take the necessary time as a team to discuss and establish your own periodontal philosophy. When all providers reflect the same standard of care, the result will be increased trust within the team. This leads to better efficiency, allowing a hygiene diagnosis to be completed within the specified time.
Dentists should also take the lead in establishing a line of open communication during exams. Try asking, "How does the patient`s perio- dontal evaluation look today? Did you complete the charting?" Your hygienists can then share their concerns with confidence.
Patients also appreciate consistency. When doctor and hygienist agree on the necessity and scope of treatment, patients are more likely to accept a problem diagnosis with composure.
Invest in the staff time needed to come to a consensus on these issues, and to implement systems designed to treat your hygiene patients appropriately. I also recommend reviewing your computer reports for 1999 to evaluate your own hygiene codes. Your codes will indicate whether your practice has a high (more than 40 percent) rate of adult prophys. Conversely, they may also reflect (by the amount of services rendered) a profitable and excellent standard of care.
Excellent cosmetic dentistry depends first on the basics. That is - or should be - your ideal foundation for care.
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 firstname.lastname@example.org.