Phase Three: Treatment plans

May 1, 2001
The clinical knowledge of an experienced hygienist can provide valuable guidance in the creation of office protocols.

By Beverly Maguire, RDH

The clinical knowledge of an experienced hygienist can provide valuable guidance in the creation of office protocols.

This month's focus involves creating treatment plans for the diseases we uncover through complete probing and charting. As in life, we tend to see what we are looking for. If we are looking at the schedule to guide patient treatment, we often see the need for a prophy. If we allow the probe to guide us, we often see a different picture!

Many patients need periodontal therapy. It is essential for the doctor and hygienist to collaborate on written guidelines for treating the most common types of chronic periodontitis, including gingivitis, early to moderate periodontitis, advanced periodontitis, and refractory periodontitis.

A prototype from which to format your treatment recommendations is the AAP document "Parameters of Care," updated in May of 2000. This document is easily obtained from the AAP Web site,

This document clearly defines each category of periodontal disease; it also gives guidelines for appropriate treatment protocols.

The referring periodontist is also a valuable source of education and support in this transition process. Most are willing to assist your team in probing techniques, treatment and referral guidelines, and with instruction in new product usage. Periodontists confirm the need for organized protocols for charting, diagnosis, and treatment of early periodontal disease within general practices. Timely patient referrals ensure surgical success.

Many professionals argue about the definition of disease, especially gingivitis and early periodontitis. The distinctions are clearly defined in the AAP document, as are appropriate protocols for treatment. The clinical knowledge of an experienced hygienist can provide valuable guidance in the creation of office protocols. Most cases we diagnose and treat nonsurgically are relatively straightforward, and require a simple approach. Three treatment plans - one for gingivitis, another for early to moderate perio, and another for advanced cases - are usually adequate for the general practice. Remember, the program is not set in stone. Our approach will change as our understanding and experience in treating this disease evolves. New products are constantly being developed that allow us to treat the disease with more success. It's our professional responsibility to stay informed and to modify our approach accordingly. Research, clinical experience, and your own patient case studies will provide guidance for growth and development. It's tempting to do the same old things we've always done and then gripe about low production and high hygiene salaries in the same breath. However, we know too much to sit complacently and provide patients with protocols more than 50 years old; the current research compels us to move forward.

We have the knowledge and research to provide a far more excellent standard of care to patients. The good news is that it's both productive for your practice and beneficial to the professional development of hygienists.

It's comforting when the doctor and hygienist agree about the assessment of disease and protocols for proper treatment. It takes the guesswork out of play, the treatment planning out of the hallway - and gets us off the fence!

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 [email protected].

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