When health becomes disease

by Beverly Maguire, RDH

Just when does the patient regress from health into disease? If we're not routinely probing and evaluating the periodontal data, it may only be revealed when destruction becomes easily apparent. A more judicious use of our assessment protocols can assist us here. Changes in the numbers of bleeding points can indicate disease activity. Changes in levels of attachment, recession, mobility, and furcations indicate disease activity.

I look for changes.

On a very basic level, I know that a healthy mouth does not bleed. Healthy tissue is pink and stippled, and is tight around the tooth. Healthy teeth are not loose. The ADA standard of care is that patients be provided a periodontal examination on a yearly basis. In past years, I used to begin periodontal exams at the age of 18, but then I started to notice periodontal activity among older teens. The fact that many of them were leaving home to go away to college began to concern me.

I thought that examining them at the age of 16 would allow me time to educate these young people about periodontal disease and influence their behavior before they left home and had more infrequent visits to our office.

I have been both surprised and pleased with the results. I have found these young people to be quite receptive to the periodontal exam and education process. It has given me more time to help them improve their home-care habits and monitor their progress before they move on to the next phase of their lives.

Interestingly enough, a fair amount of periodontal disease has also been uncovered and treated in this group of younger patients. The treatment occurred before extensive damage to supporting bone, as well as before lifelong habits became ingrained and extremely challenging to change.

These young people eventually make the transition from college into the workforce, becoming totally independent of parental support (both financially and emotionally). Our investment in well-educated, young dental patients is a smart way to send them into their early years of adult independence. Sending them off with a clue and a good foundation makes perfect sense to me!

As for other groups of healthy patients, when does health commonly turn into disease? I probe and chart healthy patients once a year. To me, that means patients with minimal bleeding on probing (1-10 BOP) and no bone loss and/or pocket depth. It can be easy to become complacent with charting these patients yearly. Eventually a great percentage of them do, in fact, show changes in their periodontal status. The only way those changes can be detected is through the charting and evaluation process. Once changes show up, it is appropriate to offer treatment options that are based upon the findings of the exam.

In most cases, it is our assumptions that cause us the most trouble. Assuming a patient to be healthy without diagnostic evaluation is a sure path to problems for both patients and care providers. Instead, use critical thinking in the process of evaluating periodontal records from visit to visit. This is the pathway to providing excellent care for patients. Change in the periodontal status will be revealed as we evaluate the criteria.

Anything other than health should be cause for concern. Disease activity can be subtle. Don't let it happen under your supervision. In this 21st century, we have the capability of early detection and early treatment of periodontal disease.

Our goal is to help patients keep their teeth for a lifetime. The final outcome is often in our hands.

Can you be certain that your patients are healthy if you are not looking at a complete periodontal chart? How much disease is OK with you?

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.

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