Periodontal Disease Preventation
In dental school we are taught to take periodontal disease seriously. From day one we learn that failure to diagnose periodontal disease is one of the top reasons dentists are sued, thus we probe every patient and every pocket. We spend unrealistic amounts of time on oral hygiene instructions (OHI), trying to help our patients fully understand how to manage their disease. We are taught to provide perio treatment before restorative, unless a specific tooth needs acute phase treatment. We are prevented from moving onto any prosthodontic treatment until our patient’s periodontal disease is improved and under control. This is so important that it would be unethical to proceed any other way.
There are only so many hours in a day. How can I ensure successful perio treatment and follow up for my patient once I enter private practice?
- Make it clear that OHI is a part of your hygienist’s job and allow time for it. Educating the patient is just as important as cleaning their teeth. Have the patient demonstrate what they have learned to make sure the appointment was effective. Some patients may need extra tools, such as interdental brushes or a Reach® flosser, depending on their manual dexterity level. OHI is also when you get the patient on the same page as you about their care.
- Check your hygienist’s work. Include this in your contract upon hiring. Let her know up front that for the first month of employment you will be checking her SRPs and prophies. Get out the ODU 11/12. In dental school one full quadrant of scaling and root planing (SRP) takes one hour.
- Make sure your charting is thorough and give the patient a periodontal diagnosis at the comprehensive oral exam. Make use of diagrams and other patient educational tools at this appointment.
- Use an efficient recall system.
According to a 2010 study by the Center for Disease Control, half of American adults have periodontal disease. This equals, “64.7 million adults 30 years and older.” DentalEconomics.com states that the most common “goal for hygiene is 33 percent of total practice production.” The strong emphasis placed on periodontal care in dental schools and the prevalence of the disease makes me wonder why it’s not even higher.
Four to six weeks after initial SRPs the patient needs to be brought back for re-evaluation. At this time you re-probe all pockets and see where healing has taken place. Address remaining pockets of four millimeters and greater at this time. Determine maintenance frequency at this appointment and whether or not referral to a periodontist is necessary.
The responsibilities of a general practitioner (GP) can end at SRPs, maintenance care, and/or referral. GPs can perform surgical periodontal treatment but will be held to the same standards as that of a periodontist.
If you don’t do these things in your practice, then start today. It’s never too late to get your perio protocol back on track. Share your tips below on how you make periodontal disease, prevention and maintenance a priority in your patient care.