Phase six: Treatment

The preliminaries are over. Probing and charting have been completed. You've reached a diagnosis, informed the patient, and offered treatment options.

by Beverly Maguire, RDH

The preliminaries are over. Probing and charting have been completed. You've reached a diagnosis, informed the patient, and offered treatment options. The next step is actually treating the disease. Hygienists are well-equipped to provide care far beyond the scope of the traditional cleaning. As Esther Wilkins says, "Hygienists don't clean teeth any longer — they provide periodontal therapy to patients. Patients clean their own teeth." I couldn't agree more!

As our knowledge and research have evolved, so have our treatment protocols. We no longer scale aggressively with the intention of removing cementum. Debridement is a gentler procedure intended to remove calculus and loosely attached toxic plaque from the pocket. Gone are the days of the glassy- smooth root surface. Today, our goal is to reduce the bacterial load to a level compatible with periodontal health and stability.

A well-planned protocol for nonsurgical periodontal treatment includes the use of ultrasonic instrumentation. Over the past 10 years, research has shifted our focus toward ultrasonic debridement. Ultrasonic root planing and scaling provide ergonomic relief for the hygienist as well as efficiency. Most hygienists today use a combination of instrumentation for the most effective nonsurgical treatment.

Anesthesia is an important component to quality treatment and patient comfort. Hygienists are licensed in over 33 states to administer anesthesia. Empowering hygienists to completely treat patients nonsurgically means giving them full responsibility, including administering anesthesia. This allows a seamless treatment flow that increases efficiency. No doctor looks forward to disruptions to the treatment focus. Fewer interruptions for the doctor are better for everyone!

Thoroughly debriding pockets is arduous and time consuming. Nonsurgical periodontal therapy consists of a group of services including root planing, scaling, and debridement. Subgingival irrigation, desensitizing fluorides and varnishes, and adjunct products such as Perio Chip, Atridox, and Arestin have been developed to aid in the treatment and stabilization of periodontal disease. Gone are the days of a random approach to scaling and root planing. Treating a few teeth here and there or occasionally root planing a quadrant without an organized treatment plan is an outdated approach.

The most recent development in nonsurgical care involves full-mouth disinfection. With this approach, patients are treated within a 24-hour period. Full-mouth root planing and scaling can be completed in one visit. It is more effective to treat an oral infection completely rather than to spread treatment over weekly visits of a month or longer. Mouth infections can spread to untreated areas; therefore, treating only the "worst" pockets in a quadrant is of little value. Root planing combined with debridement of the remainder of the mouth effectively reduces the bacterial load; it also promotes healing of the entire mouth and reduces the chance of reinfection.

A sound clinical approach to nonsurgical periodontal therapy is complimented by good criticals-thinking skills. Use current data and research to evaluate each case and implement new procedures and products. Treating the periodontal patient nonsurgically is a challenge that will bring variety and productivity to the hygiene department. It's what hygienists are trained to do.

Glance at today's hygiene schedule. Do you see a mix of prophy and periodontal treatment scheduled? If not, it's time to focus on your hygiene department. Both your patients and your practice will benefit.

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

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