Beverly Maguire, RDH
Recently, I visited the National Museum of Dentistry in Baltimore, and I couldn`t help but notice the strides we have made in our profession during the past 100 years. Looking into the coming century, I`ve pondered the areas holding the most opportunity for growth and development for the general practitioner - the areas of cosmetic dentistry and diagnosis-driven hygiene. On these wings we are catapulting into the 21st century.
As profound as the positive changes have been, we continue to place beautiful esthetic dentistry on patients with periodontal disease. We can no longer afford to not know the status of the foundation, its stability over time, or the impact of patient noncompliance in home-care habits. Successful cosmetic dentistry must have as its foundation healthy gums and bone.
First and foremost, the periodontal status of every cosmetic patient should be evaluated accurately, as well as diagnosed and treated appropriately. The general dentist must address behavior modification, which directly affects not only the periodontal condition, but also the success of the case over the years.
Managing the esthetic dental case over time is similar to changing the behavior of a liposuction patient. A cosmetic physician can remove adipose tissue and recontour the body of an overweight individual to produce a pleasing result. However, if patients fail to alter their "home-care patterns" (nutrition and exercise), fat deposits return and failure of the cases is likely.
Likewise, periodontal disease is a chronic disease absolutely dependent on changing the daily behavior of patients to ensure a successful, stable outcome over time. Our patients must be able to understand and manage their disease by mastering daily plaque control, allowing for the disruption of deeper colonies of bacteria by the hygienist at three-month intervals, and by re-treating as needed with appropriate therapies, to keep the disease under control. Periodontists provide care when things progress beyond our ability to manage the case.
Providing ethical and esthetic service to patients in the coming century will be dependent on two things:
> Our continuing education regarding materials and techniques in the dispensing of cosmetic dentistry.
> Our hygiene diagnosis and proper periodontal care delivered prior to cosmetic services.
You`ll know if you are doing enough. Just open any chart and see if you find a complete, current periodontal chart, a hygiene diagnosis, and indications of hygiene treatment performed (designed to stabilize the periodontium). If these things are not present, there is a need to refine your approach.
Merely employing hygienists and having patients show up for "cleanings" will not ensure success or ethical treatment. Excellence demands routine full probing and charting, a hygiene diagnosis, appropriate periodontal care, and motivating patients to change home-care habits. This is a full-time and repetitive process.
Look at your daily schedule, your codes, and the X-rays for bone loss.
"Cleanings" are not the answer for most adult patients. Funny how doing the wrong thing is detrimental to everyone involved: the patient (who loses the bone and possibly teeth), the practice (consistently losing revenue), and the profession (being burned out, "cleaning" disease every six months).
Beverly Maguire, RDH, is a practicing periodontal therapist. She is president and founder of Perio Advocates, a hygiene consulting company based in Littleton, Colorado. She can be reached at (303) 730-8529 or by e-mail at [email protected].
