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What Do We Say When a Routine Hygiene Patient Has Periodontal Disease Today? (Part Two)

By: Debbie Seidel-Bittke, RDH, BS

October 5, 2018

Part II

In Part I, we discussed what to say to this patient.

In Part II I will talk about what our American Academy of Periodontology and the research says about this. You will read about other publications and what the general public has access to regarding treatment of gingivitis and periodontal disease.

The intent of reading this information is to answer this question, “What Do We Say When a Routine Hygiene Patient Has Periodontal Disease Today?”

What Others Say:

The American Academy of Periodontology (AAP)addresses this situation on their website. As dental professionals we know to look at the AAP as the “gold standard” for treating and preventing periodontal disease.

You will see many of the messages about oral health and it’s role in total health in men and women’s magazines.

The National Institute of Health Library, has extensive research on the mouth body connection and how oral disease contributes to various systemic diseases and cancer.

Your Message

Many dental clinicians today still find it awkward to talk with routine prophy patients about a change in their oral health.

What we have discovered working with many dental offices around the world is that when clinicians have routine prophy patients return with bleeding gums and in many cases, undiagnosed periodontal disease (an ex-employee/clinician missed this diagnosis), the clinician feels uncomfortable delivering the message to their patient about gingivitis and/or periodontal disease.

Patient care in the dental office must be about the patients’ well-being, their total health. Patients are paying for your expertise and you must be open to sharing the true picture of their oral health and how it relates to their total health.

 

Not Only About the Tooth.

Before you begin assessing your patient, at the beginning of your hygiene appointment, it will be helpful if you tell your patient what you will be looking for. Begin by confirming the services you have planned to complete at the beginning of your appointment.

Before you pick up a probe to assess the health of the patients gums, explain about the “ruler” used to measure the space between their gum and tooth. Let your patient know what the numbers on this ruler mean.

It becomes very valuable to have another team member to chart your numbers in the perio chart or technology such as the “Florida probe” to call out the numbers and record. The hygienist or doctor will call out the numbers during a comprehensive periodontal exam and another person will chart the readings. If you have the Florida Probe (or another software to record the readings) you won’t need something to write the numbers.

In Part I, we shared how to inform your patient about the numbers. Examples of this will be, “ if you hear a 3 or less, your gums are healthy, a 4 means inflammation, 5 or higher means you have infection in your gums. If you hear a number 4 or higher, when I am finished with the exam, we will create a plan to get your gums healthy again.”

Ask your patient to listen for the numbers and at the end of the comprehensive perio exam ask them to tell you the highest and the lowest number they heard you call out.

After your patient hears the numbers, this is where you can begin the partnership and collaboration with your patient.

Engaging your patient in the exam process makes it easier for them to be a part of a treatment plan when you need to talk about something outside of healthy teeth and gums.

Use words that your patient will understand during each appointment and especially when you discover something abnormal such as gum disease.

When you say words like “Periodontal Disease,” you are more likely to see a glazed-over look in their eyes. People will tell you they understand but if you say words like “gum disease” your patients will be a lot more likely to understand what you are talking about.

Next Steps After You Assess

Once you are looking in your patients’ mouth, take pictures of what you see.

Once you have collected all of your information during your assessments, including your intra-oral pictures., sit the patient up-right in the chair to talk with them, knee-to-knee and eye-to-eye.

Now is the time to create a partnership with your patient and help them make the best decision to create a healthy body.

Once a patient has inflammation and infection in their mouth our role is to help the patient understand how this affects their overall health.

Showing your patient pictures about what is happening in their mouth paints a picture and is more descriptive than words can express.

Words You Want to Use:

-Preventive Care vs. Cleaning

-Hygiene Appointment vs. Cleaning

-Gum Treatment vs. Deep Cleaning

-Gum Therapy vs. Periodontal Therapy

-Gum Maintenance vs. Periodontal Maintenance

-Active Disease vs. Periodontal Disease

-Inflammation vs. Periodontal Disease

-Infection vs. Periodontal Disease

-Routine Care vs. Periodontal Maintenance or Cleaning

-Abnormalities vs. Cancer

-Ruler vs. Probe

Treatment Planning Phase

After your patient has heard the number’s you called out during the “assessment of their gums” when you do find abnormalities, inflammation, infection, active disease, etc., you need to seat your patient upright in the chair and show them what you see.

Since you have already explained what the numbers they will hear during the exam mean, they already understand if they have inflammation or infection and you won’t find yourself in a position of objections from your patient. They understood what to listen for and what the numbers mean, so a lot of your hard work explaining has been completed. You have also told your patient at the beginning that if they hear certain numbers you will create a plan for health.

This first conversation before you begin your assessment, ends up saving you time and a lot of effort explaining. Most patients , when they hear the 4, 5’s and higher, will tell you, “That did not sound too good!”

This type of communication makes it much easier to collaborate and create a treatment plan. It will get patients to want what they need, schedule and pay for treatment.

Our Responsibility

We have a legal and ethical responsibility to let our patients know when they need something different than what they are scheduled for.

If your patient is scheduled for a crown prep and the doctor discovers more decay than originally seen on radiographs or from a visual exam, that doctor will typically stop the planned treatment (Stop the drilling when they see the decay has gone too far into the nerve) and discuss with the patient what they see and how much more decay is in the area. The doctor will let the patient know the treatment plan is more extensive than originally planned.

When a patient comes to their prophy appointment and you discover this is going to be more than a prophy you must do the same thing. You will show the patient what you see and bring them into a partnership to own the disease in their mouth.

Our team runs into many objections from hygienists and dentists who are concerned about “what the patient will think if they are told something different (than planned) needs to be completed. Too many dental professionals are concerned about the patients having a negative response to knowing it is “more than a prophy appointment.”

We must tell our patients what is truly happening in their mouth and their body. The dental appointment must be patient centered and not about what “WE” the clinician thinks our patient can pay for or if they will be upset that we have discovered an abnormality and they need a different treatment plan.

How do you know if you are doing the proper treatment planning with your hygiene patients?

The American Academy of Periodontology estimtes (Back in 2012 was the last documentation) that 62 million American adults have periodontal disease. A typical percentage of adults we see being treated for periodontal disease is about 40% of their adult population over 30 years of age.

We have also noticed that if a hygienist sees eight patients a day they will have about one gingivitis patient each day.

What are your percentages of patients being treated for gingivitis and periodontitis?

We are happy to take a look and use our data collection formula to help you correctly assess and diagnose.

Is your office receiving payment for treating gingivitis patients? Please let us know how we can help you receive payment for treating gingivitis and periodontal patients. We enjoy helping offices like yours, understand how to correctly treatment plan, sequence treatment and then get patients to schedule, pay and return for preventative care.

We can help! Just give us a call or email us and we will share more with you.

About the Author: Debbie Seidel-Bittke, RDH, BS, is one of Dentistry Today’s top dental consultants.  She is an international coach, speaker and author. Debbie is the CEO of Dental Practice Solutions.

Debbie is a world-class leader in creating profitable hygiene departments. She is a well-known as a former clinical assistant professor at USC in Los Angeles and a former hygiene department program director. Dentistry Today recognizes Debbie as a Leader in Dental Consulting.