Sequence matters …

When assessing a patient, the hygienist plays an important role by aiding the dentist in proper diagnosis of disease. The hygienist gathers all information from the patient, including medical history, proper dental radiographs, a thorough intra- and extra-oral examination as well as periodontal charting.

Proper charting includes multiple factors. A straight probe is important, as is one without burs. Proper angulation of the probe gives the clinician the best idea of the amount of bone loss in a particular location. Finally, the appropriate pressure the clinician uses on the probe, 15 grams, is necessary if bleeding on probing is used as a disease indicator.

The Florida Probe is a “go-to” tool to assess and educate. It provides a computer voice verbalizing the readings of the periodontal probe. The patient’s attention is grabbed when “danger” is mentioned in pockets 4 mm and greater during an exam.

It’s important to get this third party endorsement of the disease process as patients become more cognitively aware. For clinicians hesitant to bring up a person’s periodontal condition, this uninvolved voice from the computer takes away that hesitation as well.

The Florida Probe sums up all the data professionally. The patient sees as well as hears the status of his or her condition. Keep in mind that today’s insurance world requires charting of periodontal recordings before treatment.

Periodontal charting and dental radiographs help provide the utmost care in treating disease. Radiographs should be current, based on the diagnostic needs of the patient and permit proper interpretation of the status of the periodontium.¹ Intra-oral camera photos before and after any procedure show the patient a before-and-after perspective. A picture is truly worth a thousand words.

If the oral condition is such that a diagnosis cannot be made due to calculus getting in the way, a debridement, using code (D4355), is necessary. This code is only used if calculus blocks visualization of hard and soft tissue.

To complete the periodontal diagnosis, the patient must return for a comprehensive exam (D0150) after the debridement.

This exam must be comprehensive and involve charting existing restorations and their condition, soft-tissue condition and areas of dental decay. The periodontal condition is also part of this comprehensive examination.

Once fully assessed, the patient’s treatment is developed according to the oral condition and his or her periodontal diagnosis.

If the patient does have a periodontal infection and non-surgical therapy is the recommended treatment, the treatment plan can be broken down into full-mouth treatment or quadrants/sextants of periodontal therapy.

Because periodontal disease is a biofilm disease, it may be isolated to certain teeth or parts of teeth.

For people with less than four teeth involved in the disease, the new code for one to three teeth, D4342, may be used. Full quadrant of four or more teeth involved may be coded using D4341.

Each of these appointments should take approximately one hour and should be adjusted to an appropriate amount of time depending on the case.

At the appointment time, before scaling or any other invasive treatment, pre-procedural rinsing with an acceptable antimicrobial mouth rinse is imperative to protect the clinician and the patient.

Patient comfort is critical to a good healthy outcome. There are different types of anesthetic given by the dentist or hygienist depending on the state in which they practice. Needle-free anesthetics, such as Cetacaine, are well received by patients.

Some people prefer a fast-acting topical to injections and find this liquid quite comfortable. One drop per site placed facial and lingual is all it takes to get the effects of this anesthetic.

Once the patient is comfortable, the clinician will begin the actual treatment. Modern day use of the ultrasonic instrument to provide the best standard of care is amazing.

Ultrasonic scaling, magnetostrictive or Piezo, provides the most adequate removal of hard deposits and toxins from the tooth structure.

The care for the periodontal patient may include irrigation with a chlorehexidine or povidone iodine post scaling and the placement of a locally delivered antibiotic such as Atridox or Arestin.

Personalized oral hygiene instruction is demonstrated to the patient before or after each treatment is completed. The patient’s daily removal of food and plaque greatly affects the management of this disease. The periodontal re-care appointments in three-month intervals have been found to be effective in maintaining the established gingival health.²

The Florida Probe can play an important part of the therapy with charting at a recare appointment. Patients listen and wait to hear the change in their numbers. It’s very gratifying to see, hear and involve the patient in his or her treatment.

The patient’s sequence of care is essential for a positive experience and outcome for controlling the disease.

The ability to practice as a hygienist by making a difference in my patients’ health has given me such pleasure. I look forward to each new day with a passion to continue in my career as a hygienist.

If you are truly dedicated to the hygiene profession and providing the best care possible, I encourage you to learn about CareerFusion.

CareerFusion offers much for dental and health-care professionals who want expand their career options. I encourage you to get informed, get in the game and enjoy your passion!

About the author

Catherine Stark, RDH, Orofacial Myologist, is a member of the ADHA and has been in private practice throughout central Florida. She is currently practicing in Ormond Beach and works with three dentists. You may contact her at catherinestark321@gmail.com.

This article was originally published in Hygiene Tribune Vol. 4 No. 2, February 2011. A complete list of references is available from the publisher.