Inside the Guidelines
Michael P. Rethman, DDS, MS, a member of the task force that created the Guidelines for the Management of Patients With Periodontal Diseases, discusses how they relate to the dental hygiene practitioner.
Q. What do the newly released Guidelines mean for dental hygiene and dentistry?
A. Modern periodontists typically perform diagnoses and treatments in three related areas: advanced care for periodontal and other oral mucosal diseases, oral/periodontal plastic surgery, and the surgical placement of osseointegrated implants. Just like the rest of dentistry, these three areas of modern periodontal practice support the following patient-centered goals: to better achieve aesthetics, comfort, and good oral function, and to improve patients’ likelihood of avoiding various systemic problems in which chronic infection has recently been implicated, such as serious cardiovascular, respiratory, endocrine, and reproductive maladies. Once widely adopted, the Guidelines will improve the quality and quantity of appropriate periodontal care provided to needful patients—patients who trust us to act in their best interests. They are not treatment guidelines; they are patient management guidelines for chronic oral diseases that sometimes necessitate decades of care. The Guidelines will help patients and practitioners by providing suggestions regarding when it’s appropriate to make a periodontist part of the care team. They will lower the frequency of delayed referrals. They will dovetail with the growing use of validated risk assessment systems and therapy choices that are based on outcomes data, which has been the mantra in medicine for more than a decade and I believe to be critical to dentistry’s future as a health care profession.
Q. How did the Guidelines come about?
A. I have seen the need for guidelines since I was a resident in the early 1980s. In that era, many dentists confronted a slow business environment that sometimes contributed to a problematic competition between general dentists and periodontists. Remnants of this persist, even today. Yet, despite ever-improving evidence-based knowledge regarding diagnosis and treatment, periodontitis management criteria remained ambiguous over the years. When I was elected to the American Academy of Periodontology’s (AAP) Board of Trustees in the early 1990s, I felt that it was time to work toward developing a single document that would prescribe disease management guidelines to help mitigate the confusion. It took a decade to slowly build consensus among my colleagues, and even as I ended my term as president of the AAP in late 2004, I wasn’t sure these efforts would bear fruit. Indeed, I pointedly addressed the need for better management guidelines for patients with periodontal diseases in my President’s Address at the 2004 AAP annual meeting in Orlando. My speech seemed to hit a nerve. The go-ahead was given shortly afterward and an AAP task force led by Donald S. Clem III, DDS, drafted the Guidelines that were later approved by the board. The American Dental Association, the Academy of General Dentistry, and American Dental Hygienist’s Association also provided helpful input.
Q. Will the Guidelines be updated over time?
A. Yes, it is impossible to create an all-encompassing and timeless document in an age where scientific discovery and practitioner knowledge grow so quickly. But remember that the Guidelines advise on what is appropriate for most, but not all, patients. There will always be exceptions to any set of guidelines. Therefore, I believe that the Guidelines should not be capriciously criticized or altered on the basis of the occasional exception to their applicability. I want to re-emphasize that the Guidelines are aimed at improving our patients’ health by facilitating better teamwork between dental hygienists, general dentists, and periodontists.
Q. Where can dental hygienists obtain a copy of the Guidelines?
A. Dimensions has reprinted the Guidelines with permission from the AAP on a pull-out card for your use. You can also download the document via AAP’s website: www.perio.org/resources-products/posppr3-1.html#2. Dental hygienists were recognized as a key audience for this document, which has since been confirmed as I have received many questions from dental hygienists.
Editor’s Note: The views expressed are those of Michael P. Rethman DDS, MS, and are not necessarily those of the American Academy of Periodontology.
From Dimensions of Dental Hygiene. October 2006;4(10): 17.