I had quite a few questions asking me to expand more on the perio-focused approach that was mentioned in the previous article. Therefore, I thought I’d share a few tips that will support your hygiene team in being laser-focused on the periodontal status and health of each and every patient. I’m going to divide this into two parts in order to keep it in bite sizes and simple enough for you and your team to begin implementing right away.

Probe . . .

          every patient, every time and record at least once a year.

It is considered standard of care (minimally required) to have a complete and accurately documented periodontal evaluation once a year. One way I recommend setting the bar higher is to perform a complete recording every six-months with patients seen for supportive periodontal therapy and with those who are medically compromised or have contributing risk factors to periodontal disease. These patients are typically seen every two or three months and are at greater risk for recurrence of disease. With healthy patients (no history of periodontal disease or risk factors) who are seen every six-months, I recommend alternating radiographic images and periodontal charting. This allows for the collection and recording of these diagnostics to be performed once a year and without crowding the appointment time.

Challenges I know still exist today:

1 – Hygienists do not have enough time

2 – Hygienists do not have help recording

I’ll reserve the management of the appointment for another article. Specifically, what I’ll address now is that I still see and hear of practices with 45- and 50-minute adult hygiene appointments. I cannot stress it enough, there is NOT enough time in anything less than an hour to perform all the duties that are the responsibility of a hygienist. S/he cannot be your co-pilot with a 45-minute schedule — s/he is barely keeping pace, if not running behind every day, burned out and frustrated. That is, IF all those duties are being performed fully. I promise you.

In a non-assisted hygiene model, a hygienist needs one full hour.

Now, let’s address the help issue. I know dentists who won’t even administer anesthetic without their assistant helping them. Okay, I won’t pick on you, but it’s true. My point is, as the doctor, you have the power to make sure your hygienist has the help s/he needs. I’m encouraging you to take the lead here. Yes, it helps the hygienist and, more importantly, it supports the practice as a whole by getting necessary periodontal therapy diagnosed early and providing excellence in patient care. To get the ball rolling, I recommend incorporating this as a component in every morning huddle. By identifying in advance who needs periodontal charting recorded, an assistant can be designated to check in during the first 10-minute slot of the hygiene appointment to record measurements and be back to other duties in no time. It can take a hygienist 10 to 15 minutes when recording measurements solo versus 2 to 3 minutes with the aid of an assistant — saving precious time. In fact, it is an hour and four minutes in a day that can saved. There is a much greater impact on the practice when that time is dedicated to educating and treating patients. Documenting accurately and professionally is our duty in service to our patients. If you are still not sure it’s worth it, be aware, failure to diagnose periodontal disease is one of the most common malpractice actions brought against dentists.

Count Bleeding Sites . . .

          and give it a score.

Yes, part of a complete periodontal evaluation is recording bleeding sites. However, I recommend taking this a step further. After recording those, count in each quadrant the total number of bleeding sites and add all four for an overall score. Patient’s understand a score or a number and they certainly know how to gauge their progress when they know their goal is zero. Patients are very familiar with numbers in relationship to their health. They get a cholesterol score, they know their weight, we take their blood pressure. A number makes sense to them and it quantifies their state — based on the number of bleeding sites in this case. By enrolling patient’s in this way it supports the education process and empowers them to take control of their health.

One challenge in this area is:

Diminishing a condition with careful terminology

I often hear hygienists say, “BOP” when about to call out bleeding sites to the recorder. When I ask about it the reply is usually along the lines of, ‘I don’t want to say “bleeding” in front of the patient’. Why not? I encourage hygienists to say it and say it as often as they see it…bleeding, pus…whatever it is, call it as it is. When we refer to bleeding as “BOP” or pus as exudate, we disconnect our patient from the experience. Using terminology that is easily understood and that the patient can relate to is what helps them in getting a visual in their mind in order to fully understand what’s happening and take ownership of their condition. I believe in being straight with them. And, the payoff is, you now have a patient fully enrolled as a participant in achieving their oral health goals.

There is no greater reward.

If you enjoyed this article please like, share and comment below. For support in any of these areas and more reach out by calling or private message to connect with me at 866.809.4890 or Chris@hygienebydesign.com. And, be sure to follow us for Part II along with the latest strategies and tips for growing a hygiene department and practice you love…by design.