Beverly Maguire, RDH
The incorporation of new protocols into the hygiene visit has been challenging, simply because none of us - patients and professionals alike - seem to like change! This has been one of the stumbling blocks in the transition of hygiene departments across the country to diagnosis-based care.
With education and rapport, our patients have come to accept the new format of the hygiene visit. Our focus has moved away from simply "cleaning" the teeth to diagnosing the periodontal status and offering options for care that fit their needs.
We have always thought of ourselves in these terms, but patients have not. Why else would they be calling for a "cleaning" appointment before family pictures or an important event such as a wedding? Not every patient needs a cleaning; many patients need periodontal therapy or surgery.
Now that we have changed our focus, let`s take a closer look at the actual way in which we deliver the information. Most patients now understand the process of periodontal charting. They are interested in the numbers and bleeding points. The process of taking the information down on paper is a start, but it will never be enough. It`s a beginning point, not the endpoint. The charting determines if the patient is healthy, actively diseased, or maintaining periodontal stability.
Many times, this assessment never occurs. A glance at the clock pushes many of us to pick up those instruments and begin to "clean" the teeth. Assessment requires critical thinking skills and detailed comparison to previous chartings and radiographs to determine if the status of the patient has changed.
The best question any hygienist can ask at this point is, "Does this chart indicate periodontal health?"
If we can`t answer yes, our critical thinking skills must come into play. At this point, the hygienist has the responsibility to review the findings with the patient. We all know that hygienists are not licensed to diagnose periodontal disease. However, they can:
- Review findings with patients
- Express concern about the changes they are seeing in patients` health
- Educate the patient on the disease process
- Answer questions the patient may have concerning appropriate care
- Provide a thorough report to the doctor enabling him/her to diagnose the situation accurately.
Patients must receive a review of findings after every periodontal exam if you want them to understand the disease process and be involved in its management. For any professional to do the exam only - write treatment notes indicating periodontal disease activity, poor home care, bleeding on instrumentation, and probing - but not to inform the patient is unethical. In many cases, patients are simply told they have too much bleeding, they need to floss more, and return more frequently for "cleaning."
Patients deserve to know their periodontal status. If they have active disease, we must inform them and offer them options for care that can stabilize the infection and halt the bone loss.
I have reviewed thousands of patient charts across the United States. The treatment notes and perio charts clearly indicate active disease. Patients have been uninformed of their true status. Let`s be ethical, honest, and compassionate when educating our patients.
We must somehow summon the courage to say the words, "You have periodontal disease." This is followed by, "The good news is that we can do a lot to help you get this under control." Patients can handle the truth. Let`s start telling it!
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].
