by Beverly Maguire, RDH
In general dentistry, we are focused on preventing, treating, and managing both caries and periodontal disease. Both the dentist and hygienist have a bias through which we see our patients' oral status. It's been my experience that dentists love the teeth and see all the possibilities of restoring and rebuilding both the beauty and function of the teeth. But just as important to their mission is that of maintaining the health of the supporting structures, the bone, and gums.
Without healthy periodontal support, the teeth will be lost. Most dentists are not uniquely prepared to focus on the huge need of the adult population for treatment of periodontal disease, and I can't imagine a good part of their day being spent dispensing hygiene services to patients. It seems to me that there exists a natural partnership within the system of general dentistry for excellent patient care while, at the same time, addressing both of the common oral diseases.
But how do you distinguish health from disease? Obviously, evidence leads us to a periodontal diagnosis. In the hygiene department, that means the hygienist collects periodontal data, evaluates the findings, and informs the doctor, who then will make a definitive diagnosis. The patient also must be informed and be presented options for care appropriate to his condition. This process leads us to an excellent outcome in most cases if the protocol is followed consistently.
We get into trouble when the clock precludes the priority of the hygiene diagnosis. When the urge to pick up instruments prevails and hygienists begin to "clean" before assessment occurs, our ability to distinguish between health and disease is indeed compromised.
I am not talking about blatant periodontal disease. All of us can recognize the rampage of advanced periodontal disease. But in its early stages, the signs are much more subtle. The AAP's Parameters of Care publication offers definitive guidelines on periodontal health and disease. If you don't have a copy in your office, I suggest that you order one from their Web site, www.perio.org. The various types of periodontal diseases are categorized, and guidelines for treatment protocols and expected outcomes are presented.
One of the first questions I ask myself as a hygienist after gathering the periodontal data and considering the contributing factors is, "Does this chart reflect periodontal health?" If the answer is not "yes," then I begin the process of critical thinking to formulate a hygiene assessment of the patient. I can inform the patient of my findings though the "I'm concerned" approach during the education process. The doctor must be informed of the findings in order to make a periodontal diagnosis for the patient. Once the patient hears the diagnosis from the doctor, the hygienist can present an appropriate treatment plan based upon office protocols previously determined by both doctor and hygienist.
So, what's considered "health" in your office? Do you and your hygienist see it the same way? It's worth some serious discussion with the AAP Parameters of Care in hand. Your standards for periodontal health will likely change as your experience and success with nonsurgical therapy evolve. Holding patients accountable to a different standard produces different results.
"Health" is the absence of disease, and it is definitely a realistic possibility for patients. Our job is to clarify our own standards and treatment protocols professionally. We must offer patients the highest level of care possible based upon our current research and knowledge. Does the chart reflect health, disease, or periodontal stability? The answer should lead us to the diagnosis and treatment plan.
Beverly Maguire, RDH, is a practicing dental hygienist. 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 email at PerioAdvocates@aol.com