Navigating the Clinical Road Map

This is an exciting and challenging time to be involved in the treatment of periodontal diseases. Dental professionals now know more about periodontal diseases than ever before. We understand that the inflammatory response to bacteria leads to the destructive nature of periodontal diseases—not the bacteria themselves. We have a grasp on how an individual’s genetically predetermined inflammatory response may contribute to the progression of many chronic diseases associated with periodontal diseases. We are well versed in regenerative techniques and dental implant technology that make preserving our patient’s function and esthetics highly predictable.

Despite the clinical and scientific breakthroughs that have enhanced our understanding and ability to treat periodontal diseases, recent findings suggest that their prevalence is much higher than initially thought.¹ Preliminary data from research conducted by the United States Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) show that the prevalence of periodontal diseases in the United States may have been underestimated by as much as 50%.¹ These new data indicate that many people do not even know they have periodontal disease.

As the prevalence of periodontal diseases continues to grow, early screening, evaluation, and diagnosis are critical to improving the health of our patients. We must get back to basics, and ensure that all patients receive comprehensive periodontal therapy—treatment that works to maintain health, comfort, esthetics, and function.

AAP’s Statement on Comprehensive Periodontal Therapy

In July 2011, the AAP published “Comprehensive Periodontal Therapy: A Statement by the American Academy of Periodontology” to serve as a clinical road map for dental professionals who administer periodontal care. The academy is pleased to provide a reprinted version of the statement here.

The statement offers a basic overview of the components that constitute efficient and effective periodontal therapy, including:

• Scope of periodontal therapy
• Periodontal evaluation
• Establishing a diagnosis, prognosis, and treatment plan
• Informed consent and patient records
• Treatment procedures
• Evaluation of therapy
• Factors modifying results
• Periodontal maintenance therapy

Because the various elements of comprehensive periodontal therapy are often divided among members of the dental team, the statement aims to help dental professionals speak the same language when talking to patients about their periodontal health and corresponding treatment plans.

Comprehensive Periodontal Evaluation

A key component of comprehensive periodontal therapy is the periodontal evaluation. The academy’s statement sets the expectation that every patient should receive an annual comprehensive periodontal evaluation. Ensuring that this yearly exam takes place is the responsibility of the entire dental team—general dentist, dental hygienist, and periodontist.

The comprehensive periodontal evaluation should include:

• Extraoral and intraoral evaluation
• Thorough occlusal evaluation
• Assessment of the presence, degree, and distribution of plaque, calculus, and gingival inflammation
• Probing of six sites per tooth
• Assessment and documentation of recession and attachment loss around teeth
• Radiographic evaluation of bone loss and identification of vertical defects and furcation involvements
• Assessment of patient-associated risk factors such as age, smoking, and other chronic systemic conditions associated with development or progression of periodontal diseases or systemic inflammatory burden.

The entire dental team has a stake in reducing the prevalence of periodontal diseases, and we can do so by identifying those patients who require periodontal care—either from their general dental team or through specialized periodontal treatment.

Role of the Dental Hygienist

The publication of the Comprehensive Periodontal Therapy Statement helps elevate the role of the dental hygienist in periodontal care. As vital members of the dental team, dental hygienists are often responsible for several important elements of comprehensive periodontal therapy, including: evaluating the patient’s periodontal health; providing nonsurgical periodontal treatment; and offering guidance on follow-up treatment, as well as self-care and maintenance.

Dental hygienists play a key role in educating patients about the link between periodontal health and overall health. Patients need to understand they are not healthy unless they are periodontally healthy, and dental hygienists are critical to effectively communicating this message. Dental hygienists can help patients understand and comply with their treatment plans, including the need for and advantages of specialized periodontal therapy.

Moving Forward

Over the course of the past year, in my role as AAP president I have continuously stressed the importance of the “team approach” to periodontal care. Through my own experiences in clinical practice, I have seen the value of strong, collaborative partnerships between the general dentist, dental hygienist, and periodontist. Now, the AAP’s emphasis on comprehensive periodontal therapy provides even more rationale for the dental team to work together—especially in light of what we know about periodontal disease prevalence in the US.
The dental hygienist’s role in conducting comprehensive periodontal therapy, and ensuring that patients receive their yearly comprehensive periodontal evaluation, will require access to up-to-date resources and information in periodontics. Therefore, AAP is excited to continue our partnership with Dimensions of Dental Hygiene in 2012 to provide a series of quarterly inserts that will keep dental hygienists abreast of the latest innovations and scientific findings behind the diagnosis, treatment, and prevention of periodontal diseases.

As the specialty of periodontics continues to progress, it remains critical that we remember the basics of comprehensive periodontal therapy. In doing so, general dentists, dental hygienists, and periodontists can efficiently and effectively work together to benefit patients’ periodontal health.

REFERENCE

1. Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA. Accuracy of NHANES periodontal examination protocols. J Dent Res. 2010;89: 1208–1213.

From Dimensions of Dental Hygiene. November 2011; 9(11): 22, 25.