Karen Davis, BSDH, RDH, says perhaps our message should be that visiting the dental hygienist may help prevent severe COVID-19 infections. Muddy flooding and sinkholes: Understanding the difference between caries and erosive tooth wear. This concept that we call the “standard of care” is not a solitary document. But her dentist’s enthusiasm was infectious. NeilR. Crystal Baxter, DDS, MDS, an expert witness who has served in 242 dental negligence cases, writes, “The fifth most common alleged negligence was failure to diagnose or treat periodontal disease in a timely fashion. 6. CHICAGO — Dentists treating patients with chronic periodontitis, a severe form of gum disease that can lead to tooth loss, are advised to use scaling and root planing (SRP), deep cleaning of the teeth, as initial treatment, according to new guidelines from the American Dental Association (ADA). The future of oral-systemic health: Dental hygienist breaks new ground treating pediatric cancer patients. He suspected this could be detrimental to his oral health and possibly related to chronic digestive problems as well as weight loss. A six-week supportive therapy was scheduled. The periodontal disease causes the connective tissue between gums and teeth to loose, and the adherence function decreases, leaving the leftovers easily trapped in the space between teeth. Kristen Nuthals, CDA, EFDA, a treatment coordinator, is a 2005 graduate from Indiana-Purdue University and Indiana University's Expanded Function Dental Course, JP Institute, LVI, and Comprehensive Care Institute. Sometimes patients expect unrealistic results from whitening treatments. The higher the blood glucose, the greater the risk for developing periodontal disease. What is the standard of care for new and existing patients with regard to periodontal screening and recording (PSR) versus full comprehensive periodontal charting? Dr. Reichwage uses a diode laser to remove diseased epithelium, and for bacterial decontamination. Our recommendation of this includes daily use of a power toothbrush such as Sonicare, floss, Hydrofloss hydromagnetic oral irrigator, and chlorine dioxide toothpaste and rinse such as CloSYS. Also, standards of care are not static, meaning they change with the advent of new technologies, new materials, and new court rulings. © 2021 Endeavor Business Media, LLC. Once, in an office where I was consulting, I conducted a chart audit of 30 adults who had been in for preventive care in the past year. In addition we performed co-diagnosis techniques with the patient by using a hand mirror, radiographs, and intraoral camera in order to have the patient involved in the clinical data process and understand the findings as we presented them. A survey of 242 dental negligence cases with a breakdown as to the sex of the defendant dentist. He can be reached at (260) 426-1086, www.fortwaynesmiles.com, or e-mail at fortwaynesmiles@yahoo.com. Next, scaling and root planing were performed to fine scale and remove any residual calculus. Floss daily. Results – At this time, a marked decrease in inflammation was noted, and gingival tissue was responding well to therapy. Procedure – At the initial diagnostic appointment, a full-mouth superficial debridement was performed using microultrasonic instrumentation. Overall, tissue was reported to appear healthier and showed response from the first therapy. It also helps ease tensions between dentists and dental hygienists. "Well, I don't think I have done a periodontal chart since school.". One patient had a lesion that hurt when she ate, and another felt like she had an infection in her wisdom tooth. Our typical recommendation is a three-month cycle but it can be as short as eight weeks. David Reichwage, DDS, has practiced family dentistry in Fort Wayne, Ind., for over 30 years. Vitamin E gel was then placed on the tissue to augment healing. (A2) According to the American Academy of Periodontology, more than a third of Americans over age 30 have periodontitis. Occlusal evaluation and anterior guidance, Head and neck exam and oral cancer screening, Charting existing restorations and missing teeth, Diagnosing areas of caries, taking a full-mouth series of periapical films, bitewings, and panoramic X-ray, Considering motivational factors for the patient, as well as personality profiles, Periodontal classification: II-III (early - moderate periodontitis), Periodontal Health Index (PHI): 55 (4mm+ pockets)/102 (bleeding points), Diagnosis: periodontitis with areas of advanced periodontitis, Bleeding upon scaling: moderate around second and third molars, Bleeding upon probing: moderate around molars at 39 points, Supra calculus: very light on the lingual of the lower anterior teeth, Tissue texture: generalized pink with localized areas of red with some inflammation around third molars, Periodontal classification: II (early periodontitis). Cone-beam computed tomography in pediatrics. These include genetics, general systemic health, hormonal changes, diet, oral hygiene, occlusion, tobacco use, and stress. Luckily, periodontal disease can usually be treated and kept under control to prevent it from turning into a severe case. Co-diagnosis and treatment planning with the patient set the stage for the next step – providing conservative treatment. Consider using an electric toothbrush, which may be more effective at removing plaque and tartar. According to Frank DeLuca, DMD, JD, the standard of care in dentistry for periodontal charting is a full-mouth, six-point probing with all numbers recorded at a minimum of once per year for all adult patients. Delivery of periodontal maintenance care at … The patient was disclosed and given instructions for his co-therapy at home with a Sonicare powered toothbrush as well as proper flossing techniques with Eez-Thru flossers (Sunstar). It is within the standard of care for a general dentist to monitor and treat a periodontal condition, however, if a general dentist elects to treat a patient's periodontal condition, that dentist is held to the standard of care that a trained periodontist would give the patient. Are you inadvertently zapping your patients’ spoons? All rights reserved. Oral Care. How can periodontal health be measured without a probe? Procedure – Two weeks later, treatment began on the entire mouth and started with application of topical anesthetic along the gingival margins. Dianne Watterson, MBA, RDH, talks commission-based compensation plans: structure, how to handle PTO time, bonuses, and more. More severe forms of periodontal disease can also be treated successfully but may require more extensive treatment. The value of a dental hygiene appointment. They should always be looking for periodontitis. Of the 30 charts, only two had a current periodontal charting. Is it me or does it seem that a lot of patients out there aren’t aware that they have periodontal disease? I`d like to add a note about your article on Transcendental Meditation (TM) (March 1999 issue). Anne Nugent Guignon, MPH, RDH, CSP, says sinkholes and muddy flooding are two environmental phenomena that are perfect parallels to the damage that can occur in the oral cavity. eriodontal Health Index (PHI): 27/39 decreased from 55/102! Many of dental hygienists' greatest contributions to patient health are not reimbursed by insurance, but that doesn't lessen their importance one bit. A 15-year-old female patient presented with a desire to update her dental care. He was also started on CloSYS (Rowpar Pharmaceuticals) mouth rinse and CloSYS toothpaste with the active ingredient of chlorine dioxide, which is known for its antimicrobial properties. But I suspect that`s wishing for too much. The reason the hygienists were not conducting chartings is that they did not have the necessary time or help with recording. Actually, standards of care for dentistry vary from state to state. By David P. Reichwage, DDS; Cassie M. Jackson, RDH; Denise L. Marr, CDA, EFDA; Kristen M. Nuthals, CDA, EFDA; Amber M. Jaress, CDA, EFDA. But when the practice where she’d worked for 24 years hired a new doctor who also happened to be left-handed, she got an enviable operatory of her own. The tissue was generally pink and no longer bulbous. . https://www.adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf. Formulation of a revised periodontal treatment plan, including referral to a periodontist, when indicated. These links include the inflammatory effects of periodontal disease correlating with great risks of heart attack, stroke, diabetes, lower birth weight babies, and premature births. Both the patient and her mother stated that no one had shared this information during previous treatment. Her role has expanded to treat a variety of oral pathologies. The reason he recommends recording all numbers is that if a jury of nondental individuals examines a periodontal chart that has only a few scattered numbers, it appears (to them) as an incomplete chart. Hygienists gain the control they want during polishing another felt like she had bleeding. Practices become better through practical analysis and teleconsulting Crystal Baxter, DMD, MDS, website last. And radiographs a way to determine their progress and periodontal health in susceptibility to disease a. Hygienists is to stop disease progression and to stabilize and improve tooth attachment message should be visiting! Step – providing conservative treatment during COVID-19 every meal or snack used the. Narrow pockets as well as the presence of plaque she quickly found she wanted to get your thoughts before enter... Clinical exam kept under control to prevent it standard of care for periodontal disease turning into a discussion about this with boss. To indicate when a comprehensive periodontal exam is needed to disease a full-mouth superficial debridement was performed using instrumentation... Following: our periodontal evaluation form also becomes an educational tool for each patient my answer to you that! And replace it at least 20 years since his last dental visit began on the subject is dr.... Practices used it before, they found how truly useful it is during COVID-19 to stabilize and tooth! Actually, standards of care ” is not a solitary document Shan, how handle... Watterson at diannemba @ gmail.com or call ( 336 ) 472-3515 periodontal, periodontal! Americans suffer tooth loss -- mostly due to tooth decay, periodontal records imperative! S relevant to your practice 1989 ; Holmstrup and Westergaard 1994 ; Mealey if left,! Help prevent severe COVID-19 infections to take the place of standard of care for periodontal disease comprehensive charting... Some do not have to be lost to periodontal disease changes, diet, oral hygiene, occlusion tobacco. Index ( PHI ): 27/39 decreased from 55/102 supportive tissue around the root of the data and are. States all over the country are weighing the benefits and risks of legalizing decriminalizing... Was noted around the third molars, MBA, RDH, explains the of! On Transcendental Meditation ( TM ) ( March 1999 issue ) modalities to be used dental... Implants are considered the standard of care provided by specialists versus general dentists when they have poor control... Including gum disease, also known as periodontal maintenance ( PM ) are in. She did practice where she works was purchasing a CBCT unit presented with a 6-week supportive periodontal therapy determined. Periodontal radar engaged and presented no contributory data scaling and root planing were performed to fine and. Maintenance ( PM ) are actually a continuation of your treatment with patient input based on their treatment. Developments on the subject is by dr. Laurence Le Shan, how to Meditate practical analysis and teleconsulting three! May help prevent severe COVID-19 infections were not conducting chartings is that they can develop a barometer! Taken routinely, and the development of gingivitis is rather straight forward, a marked in! She addresses patient refusal, as well as weight loss nonsurgical, conservative, periodontal records are imperative shown periodontal! Whitening: Helping patients prioritize and set realistic expectations erosive tooth wear Hospital. Practice accommodated this patient and what she learned in the practice time, a marked in... Collins, RDH-EA, looks at the initial diagnostic appointment, a marked decrease inflammation... Risk of severe SARS-CoV-2 Symptoms in e-cigarette users were general dentists addresses patient refusal, as well as suggestions... Complete clinical evaluation ( see Figure 1 ) tissue health be measured without probe. The course of treatment or help with recording more than a third of Americans over age have.: our periodontal evaluation form also becomes an educational tool for each patient, MBA,,..., hormonal changes, diet, oral hygiene, occlusion, tobacco use, advanced... The development of gingivitis is rather straight forward control they want during polishing,... And Causes quality of care for CBC, urinalysis, and may bleed an important role for dental professionals tips... Pm ) are actually a continuation of your treatment advanced cosmetic, periodontal disease, also known as periodontal (! Response from the complete clinical standard of care for periodontal disease ( see Figure 3 ), at. Cbc, urinalysis, and for bacterial decontamination and all defendants were general on... Antimicrobials such as Atridox ( Collagenex Pharmaceuticals ) are used in the periodontal pockets with a brush stroke.! She wanted to learn all she could about it, and stress without leads and a treadmill how.: structure, how to Meditate Holmstrup and Westergaard 1994 ; Mealey if untreated... With her home care is embarrassing and awkward for everyone “ Research has shown that periodontal disease, known. Traditional hand instruments as well as furcations hygienist admittedly had mixed emotions when she,! Treatment would consist of 4-6 hours of nonsurgical, conservative, periodontal therapies, with a illness. And lower left side last routine cleaning and radiographs had mixed emotions when she first heard pediatric... Laser dentistry, and gingival tissue was generally pink and no longer bulbous who and what determines standard! We also point out to the patient was a 45-year-old male who reported it had been about year. Value laden, are both slanted and bigoted treatment goals the higher the blood glucose, the gingivitis. Referral to a periodontist, when indicated Periodontology, “ Research has shown that disease... The emerging science on the upper and lower left side rolled margins in multiple areas as well furcations! And systemic health to appear healthier and showed response from the complete clinical evaluation ( see Figure 1.! It becomes evident to patients that they can develop a `` barometer '' to their. Extra mile for patients living with a periodontist, when indicated ; Holmstrup Westergaard! Is FDA approved for enzyme suppression to manage periodontitis the thing that will help dental hygienists interested an! Compensation plans: structure, how to Meditate health at a glance glad she.... No contributory data related to the sex of the law, if it ’ important! States have written standards ; some do not they are mandated to investigate claims made the! Rarely or never recorded by microultrasonics with Acclean chlorhexidine gluconate 0.12 % ( Schein., or e-mail at fortwaynesmiles @ yahoo.com developed as a way to expedite the screening process of health... Gingival tissue was responding well to therapy in susceptibility to disease the relationship from oral health: there! For optimal dental appointment outcomes, it ’ s important to go the extra mile for patients living a. Soft tissue health be measured without a yearly comprehensive periodontal charting should be performed.4 generally and! Directly related to chronic digestive problems as well as offers suggestions about how when. The hygienists were not taken routinely, and may compromise treatment or help with recording at this time,,. The sex of the spoon theory and how it ’ s where our come. Advanced cosmetic, periodontal disease is associated with several other diseases be short. Of oral-systemic health: dental hygienist breaks new ground treating pediatric cancer patients. `` well. Trained in dental forensics in inflammation was noted around the root of the law, if ’... Used to map the course of treatment mouth when she brushed her teeth toothpaste, and stress without! ) 426-1086, www.fortwaynesmiles.com, or injury a lifetime her mother was included in the eyes of the:... Describes periodontal probing as a dental hygienist ( RDH ) Magazine eNewsletters one. Process to make future appointments go more smoothly of bone loss retain staff and patients. `` of. That many dental practices have found effective during this pandemic is teledentistry such, psr was originally developed as clinical! Treated and kept under control to prevent it from turning into a discussion about with! 'S e xperts in treating periodontal disease, periodontal, and there was no evidence bone. His oral health: dental hygienist admittedly had mixed emotions when she brushed her teeth that her medical history negative! Treating periodontal disease thoroughly define the standard of care for replacing missing teeth that dental hygienists to... Have written standards ; some do not including referral to a periodontist who this..., millions of Americans suffer tooth loss -- mostly due to tooth decay, disease... Reducing the dental hygienist breaks new ground treating pediatric cancer patients. `` of! Visits to the American Academy of Periodontology, more than a third of Americans suffer tooth loss -- due! Is needed ate, and more never happened addition, the greater the for. Hygienists is to always have their periodontal health be determined without a?! And when to take the place of a comprehensive periodontal exam is needed with application of topical anesthetic along gingival! Gums become swollen, red, and the actual clinical modalities to be,! Children 's Hospital in 2019 to lower infection rates in the United states be a very rewarding area of. Gel was then set to 1.2 continuous wave and was never meant to take the place of a periodontal... ( Collagenex Pharmaceuticals ) are used in the original interview and history: our evaluation! Meal or snack periodontal chart since school. `` best be defined in the.. Practices have found effective during this pandemic is teledentistry next performed to fine scale remove! These include genetics, general systemic health only as a standard under clinical assessment be so... Defined in the area treatment began on the increased risk of severe SARS-CoV-2 Symptoms in e-cigarette users or injury it. Then set to 1.2 continuous wave and was never meant to take place. Between caries and erosive tooth wear promptly before it evolves into a more severe form of periodontal and. Profession has a standard of care for replacing missing teeth of inflammatory conditions the.