When Perio Isn’t Perio

I recently received this private message from a Facebook friend who happens to be a retired dental hygienist:

“I need your advice! No matter where my adult daughter and some of her friends go for dental treatment in Southern California, they are inevitably told they need four quadrants of scaling and root planing. My daughter’s oral hygiene is impeccable, with no probing depths deeper than 3 mm and no bone loss revealed on her radiographs. We even had a close friend who is on faculty at a dental hygiene school perform a periodontal exam on her recently, and she found absolutely no problems. Is this a trend across the country?”

While I’m not sure how prevalent this practice is in the United States, it is not the first time I have heard of such a case. The purpose of this scheme is obvious: to increase revenue from “the dental hygiene department.” And while periodontal disease classifications change periodically, a criterion for early periodontitis (now known as Stage I periodontitis) is not 3 mm probing depths. If you haven’t reviewed the latest classification of periodontal diseases from the American Academy of Periodontology, please do.¹ Revised in 2017, the system not only includes staging of disease severity, but grading to help determine rate of progression.

WHILE PERIODONTAL DISEASE CLASSIFICATIONS CHANGE PERIODICALLY, A CRITERION FOR STAGE I PERIODONTITIS IS NOT 3 MM PROBING DEPTHS.

My immediate thought was that the dental hygienists involved in this scheme are not adhering to the Dental Hygiene Code of Ethics as developed by the American Dental Hygienists’ Association.² In particular, the code’s standards of professional responsibility to patients came to mind. These include:

• Provide oral health care using high levels of professional knowledge, judgment, and skill.
• Promote ethical behavior and high standards of care by all dental hygienists.
• Serve as an advocate for the welfare of patients.
• Provide patients with the information necessary to make informed decisions about their oral health and encourage their full participation in treatment decisions and goals.

Considering all this, I tried to imagine myself in this situation, especially as a new dental hygiene practitioner who did not want to rock the boat with the very real possibility of losing my job. And that’s a tough place to be, no matter how long someone has been in practice. However, I kept coming back to the Code of Ethics and my responsibilities to patients, colleagues, and, most of all, to myself. Because, ultimately, the treatment decisions we make don’t solely impact our patients. They determine the heart and soul of who we are as dental hygiene professionals. Frankly, I would not be able to work with an employer who pushed this (or any other) unnecessary treatment on patients.

Here is my reply to to my friend’s dilemma:

I suggest that your daughter seek a second opinion from a periodontist. She should look for a board-certified periodontist in her area. This may seem counter-intuitive at first, but periodontists are much more aware of the latest research-validated diagnosis and treatment options than the majority of general practitioners.  Periodontists are also privy to the type of work general dentists perform and how it compares to other general practitioners. They are familiar with the general dentist colleagues in their region and their reputations. As we all know, some dentists perform excellent work while others are mediocre at best. For that same reason, your daughter may want to use a periodontist as her primary care dental provider.  Once individuals reach adulthood, the main oral health concern is periodontitis. So what better place to be than in the office of a specialist who treats periodontal conditions?  As part of the periodontal exam, the dental hygienist team member can check for oral cancer and caries and refer to a general practitioner or other specialist if needed. I’ve long thought that this care protocol (periodontist as primary care provider) makes more sense for adult patients than what we’ve done traditionally over the years (general dentist as primary care provider).

I truly hope that any dental hygienist who is caught up in this type of situation can find her or his way out and rise #upward. Patients are relying on us to do the right thing.

Jill Rethman, RDH, BA

Editor in Chief

jrethman@belmontpublications.com

REFERENCES

1. American Academy of Periodontology. Staging and Grading Periodontitis. Available at: perio.org/​sites/​default/​files/​files/​Staging%20and%20Grading%20Periodontitis.pdf. Accessed February 19, 2020.
2. American Dental Hygienists’ Association. Bylaws and Code of Ethics. Available at: adha.org/​resources-docs/​7611_​Bylaws_​and_​Code_​of_​Ethics.pdf#page33. Accessed February 19, 2020.

From Dimensions of Dental Hygiene. March 2020;18(3):6.