New periodontal disease research

By Annette Ashley Linder

Every time I begin a lecture with, "The hygiene department of the 21st century does not clean teeth," I get excited. You might be thinking I have "flipped my lid" — perhaps being in the "tooth business" for over 30 years has affected my thinking! Rather, my thinking is very clear because this is the most exciting time to be in dentistry and dental hygiene. I have been part of and seen the transformation of dental hygiene from a "just clean my teeth" operation to a science-based understanding of the relationship between systemic health and periodontal health.

Today, we have a much greater understanding of the etiology, pathology, and mechanism of periodontal infections. Numerous research reports suggest periodontal health as a risk factor in a number of health issues including, but not limited to, cardiovascular diseases, diabetes, and low-birth-weight babies. Heart disease is the No. 1 cause of death in the U.S.

The issue is so important that the federal government continues to fund research to find some answers. The ADA Symposium in July 2001 focused on "Taking Oral Care to Heart." Experts in various disciplines gathered to explore the interrelationship between oral and cardiac disease. The U.S. Surgeon General's Report on Oral Health (May 2000) reported that 95 percent of people with diabetes also have periodontitis. According to the research, pregnant women with periodontitis have a seven times greater risk for delivering low-birth-weight babies. While researchers continue to work on the answers, it has become increasingly apparent that we are obligated to keep our patients abreast of current research. The hygienist, as educator and periodontal co-therapist, plays a major role in this important undertaking.

Now comes a landmark study published in the New England Journal of Medicine (Nov. 2002) and picked up by the AP Newswire. Dr. Paul Ridker began a research program in 1999 at Boston's Women's and Children's Hospital centering on the role of inflammation. Researchers discovered that patients with high levels of C-reactive protein, a chemical produced by the body when there is inflammation present, are twice as likely to develop heart attack and strokes than people with elevated cholesterol. While cholesterol is a major risk factor, the study goes on to state that "other possible triggers include high blood pressure, smoking, and lingering low level infections such as chronic gum disease." Wow — chronic gum disease mentioned in a medical journal! This is a wake–up call for every hygienist who thinks all he or she does is clean teeth.

Now is the time to review your periodontal protocols. Are you current with the latest research? Do you have information and patient education materials readily available to give to your patients? Are you routinely assessing patients' periodontal status with complete exams ( CDT-4, new Code 0180, Comprehensive Periodontal Examination, new and existing patient)? Are you treating periodontal infection appropriately ... or are you trying to manage it with routine prophys? Are you treating the site specifically (new Code 4342) and not just "watching" it?

According to the AAP, almost two-thirds of adults have some form of periodontal disease! With this in mind, a reliable benchmark for periodontal health in the practice is that a minimum of 30 percent of hygiene production be generated for perio services. In my consulting work with hundreds of practices throughout the country, typical ratios fall in the 8 to 15 percent bracket. This falls well below a healthy ratio, given the amount of perio in the population. To determine the health of your hygiene department, generate a computer report for Codes 4341, 4342, 4355, 4910, and 4381 for each hygienist in the practice. Analyze the data and determine the percentage of periodontal-procedures production. Call or email me if you need help with this.

Next, team with your hygienist/s to discover what barriers are preventing patients from achieving appropriate levels of treatment. Most importantly, what do you need to do to fix this?

The next time a patient says to the hygienist, "Just clean my teeth — I don't care if my gums are bleeding and the pus is oozing," be prepared to discuss the latest research regarding the link between chronic periodontal infection and systemic health. Help patients become informed health-care consumers by providing take-home, patient- education information. We would all agree that it is best for patients to receive accurate information about dental health from their dental health-care provider. After all, good oral health is good health!