The window of opportunity

Treating periodontal disease in today`s general practice is becoming standard procedure. Our profession has undergone a transition from the "cleaning" approach to an organized periodontal therapy and maintenance approach. The struggle remains, however, to get another set of hands to record the large amounts of detailed information that periodontal evaluations require. This is no simple proposition.

Beverly Maguire, RDH

Treating periodontal disease in today`s general practice is becoming standard procedure. Our profession has undergone a transition from the "cleaning" approach to an organized periodontal therapy and maintenance approach. The struggle remains, however, to get another set of hands to record the large amounts of detailed information that periodontal evaluations require. This is no simple proposition.

Once the basic data has been gathered and recorded, we must next determine what to do with it. Many dental hygienists simply proceed with the cleaning, regardless of findings! Perhaps their thoughts are focused on accomplishing the task at hand, posted under the patients` name on the schedule.

But rather than proceeding mindlessly with an approach that is outdated and reflects substandard care, we must determine the best course of action for the patient based upon the data gathered. This is the paradigm shift required to move from schedule-driven hygiene to the diagnosis-driven approach.

Current research supports the systemic relationship of untreated periodontal disease to other health problems in other areas of the body. Fourteen factors must be evaluated to determine the proper course of action during the diagnosis process with the doctor. These factors are listed in the table at right. Evaluating this information is no easy task. No wonder so many of us long for those simple days of the "cleaning" appointment!

Early intervention, before irreversible damage has been done to the bone, is the real value of nonsurgical periodontal therapy. The window of opportunity for nonsurgical intervention is between 4 and 6 mm of pocket depth. Research has shown that beyond 6 mm, our root planing efforts are only 30 percent effective! Yet, how many of us struggle with the philosophy of treating periodontal disease?

We seem to be afraid of overtreating our patients. But turn the tables for a moment. If you were in the chair, would you want to be told, " Your gums are bleeding, and you need to floss more," and then be rescheduled for another visit in six months, knowing that your history as an adult dental patient indicates you will not be compliant? Of course, we can always offer periodontal surgery when the disease progresses out of control to 7 or 8 mm and beyond. This type of evasive action is the slow road to bone loss and possible systemic complications as well.

We can do better than this by offering patients early and conservative periodontal care. Waiting until we feel certain that bone loss has occurred is equivalent to supervised neglect. We owe it to our patients to take action when our efforts can be met with a good rate of success.

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 perioadv@aol.com.

Factors affecting the periodontal diagnosis

- Pocket depth

- Bleeding on probing

- Recession

- Bleeding on provocation

- Homecare effectiveness

- History of compliance

- Health history i.e. heart disease, diabetes, respiratory disease, pregnancy, medications, smoking

- Heredity factors for periodontal disease

- Occlusal factors; bruxism, clenching and trauma

- Restorative factors; overhangs, crown margins

- Amount of previous bone loss and periodontal related tooth loss

- Stress levels

- Immune system health

- Frequency of care

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