The changes occurring during the last two decades about the way we approach hygiene treatment are well documented. It's obvious that not every patient needs a "cleaning." Health and disease are treated differently in both the mouth and in the body. The protocols of the hygiene visit have shifted. We're distinguishing periodontal health from disease through the scientific process of data acquisition, assessment, and diagnosis.
There is power in the probe; it reveals the direction in which we must move. The current hygiene protocol involves assessing the information and then informing the doctor of findings to facilitate an accurate diagnosis. This is followed by a case presentation to the patient.
The transition flows effortlessly on paper. In the reality of the hectic, time-driven nature of a busy dental practice, it is, however, quite a different story. In my speaking and consulting contacts throughout the United States, I continually evaluate hygiene statistics. In 1996, the Journal of Dental Research reported that nine out of 10 patients in the country show evidence of periodontal problems. A 1999 issue of The Journal of Periodontology states that 94 percent of all adult patients received prophy services. This is consistent with my findings as well; our profession dispenses a disproportionate number of prophys considering the prevalence of periodontal disease.
We are, however, making progress in our movement toward diagnosis-driven hygiene; within the past year, I have seen more department evaluations that reflect 80 to 85 percent prophy services being dispensed. Progress? Yes. Adequate progress? Probably not. Ten percentage points in nearly 20 years is not exactly transforming the standard of care!
The trend will be transformed only through careful evaluation of each patient's periodontal chart, followed by a periodontal diagnosis by the doctor and appropriate treatment options offered to the patient. The key to success is not more information. Frankly, I feel that the information is well understood in dentistry. Success lies in actually implementing what we know.
In upcoming columns, I will address 10 essential steps involved in the hygiene transition process. Transition is a process, not an event. It doesn't occur because you went to a seminar or understand the concepts. It does take time to transition through the practice patient base, but it doesn't take forever. Assessing one periodontal chart at a time is the only way to move through the transition process. Education, communication skills, and team commitment are the keys to success. Our perception of the transition process must coincide with the reality of the department statistics.
Ralph Waldo Emerson said, "Not only in his goals but in his transitions, man is great." My desire is to witness an industry transformation bringing to reality the consistent implementation of diagnosis-driven hygiene protocols, which will allow patients everywhere to receive appropriate periodontal treatment options. When this happens, we will recognize it. The percentage of prophy services in this country will decline markedly.
10 steps of the hygiene transition process
- Department assessment
- Professional evaluation
- Commitment to philosophy
- Personal periodontal evaluation
- Developing periodontal treatment protocols
- Developing systems for implementation
- Mastering communication skills
- Coaching support
- Developing leadership skills
- Monitoring transition progress
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 [email protected].
