Is this the direction that dental hygiene is moving?
I work in a general dentist office and we are going through some changes, recommended by the marketing management company that our doctors have hired. We are no longer to do any subgingival scaling during a routine prophylaxis appointment. If there is any bleeding we are to stop the prophy and recommend limited periodontal treatment even though the pockets are 3mm and less. Medications are used and dispensed for home use. Bacteria culturing is also performed and antibiotic regime advised if necessary. There is generally no insurance help with these appointments because the pockets are normal. I am very comfortable recommending non-surgical periodontal therapy for those patients with pocketing greater than 4mm and inflammation. However, now I feel that I am no longer a prevention specialist but encouraging periodontal disease by not cleaning subgingivally. Is this the direction that dental hygiene is moving?
You bring up a very important concern regarding certain practice management consultants, assessing for periodontal conditions, and doing what’s right. It’s not appropriate to treat all patients the same, regardless of how they present to the practice. Treatment should be tailored to the individual’s needs based not only on clinical assessments but medical history as well. For example, is that patient with 3 mm probing depths and bleeding a new mother? If so, hormones might be the reason for the inflammation and chances are she could be free of bleeding the next appointment. So is it appropriate to start her on a “limited” (not sure what that means) periodontal treatment protocol even though your best clinical judgment tells you it’s best to re-assess her condition the next time?
What’s happening with a number of the practice management firms is that they are trying to highlight that periodontal conditions have been misdiagnosed and over-looked in general dental practices. Frankly, creating such awareness is good. However, they are causing practices to swing the other way and treat even the slightest sign of inflammation as a full-blown perio case. As we know, it’s much more complicated than that. I suggest you explore the American Academy of Periodontology’s website at: http://www.perio.org for resources on identifying and treating periodontal conditions. Click on the tab that says “Publications” and then “Clinical and Scientific Papers.” These are all evidence-based papers, guidelines and statements that every clinician can use.
Finally, to address your last question, “Is this the direction that dental hygiene is moving?” I emphatically say “no.” We are moving toward patient-centered care based on risk assessment and evidence-based principles. A “one-size-fits-all” concept of patient treatment is not only passe, it’s wrong.
Best of luck to you.