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Karen Davis, BSDH, RDH, says perhaps our message should be that visiting the dental hygienist may help prevent severe COVID-19 infections. Standard of Care in Periodontology The discipline of Periodontology deals with the development, anatomy, structure, and function of the various soft and hard tissues of the periodontium in health and disease, i.e., gingiva, periodontal ligament, root cementum, and alveolar bone proper. Oral Care. Developing a commission-based compensation plan for dental hygienists. What the clinician was taught in dental or dental hygiene school, What is taught in dental or dental hygiene schools now, The best he or she can do under the circumstances, What the majority of clinicians are doing in their practices, What the specialist would do under the same circumstances. Many of dental hygienists' greatest contributions to patient health are not reimbursed by insurance, but that doesn't lessen their importance one bit. Floss daily. She helps good practices become better through practical analysis and teleconsulting. 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. The last part of the procedure consisted of using the initiated diode soft tissue laser (Premier Aurora). Since we use it daily on every patient, our model is continually tested and evaluated based on predictions of treatment outcome, as well as direct observations of its effectiveness. Periodontists are dentistry's e xperts in treating periodontal disease. The value of a dental hygiene appointment. Denise Marr, CDA, EFDA, a treatment coordinator, is a 1999 graduate from Indiana-Purdue University and Indiana University's Expanded Function Dental Course, JP Institute, LVI, PAC, and Comprehensive Care Institute. Dentists/employers should identify the barriers to charting and implement a solution so regular periodontal charting/recording is the standard in an office (i.e., once per year for all adult patients). They become actively involved in their own treatment recommendations. The patient was congratulated for her work and progress with her home care. How can we help them understand how their current oral health will affect their clinical whitening outcomes so they can make educated decisions about their treatment options? What are the implications of residual root sockets? What is the standard of care? Question: Who and what determines a standard of care for professions? The patient made three reservations for periodontal therapies. Graskemper JP. PSR was originally developed as a way to expedite the screening process of periodontal health to indicate when a comprehensive periodontal exam is needed. The patient's gingiva was irregular with red, rolled margins in multiple areas as well as the presence of plaque. If your periodontal disease has caused a loss of bone or gum tissue, your dentist may recommend bone or tissue grafts in addition to surgical pocket reduction. For optimal dental appointment outcomes, it’s important to go the extra mile for patients living with a chronic illness. Brush your teeth twice a day or, better yet, after every meal or snack. 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. A 15-year-old female patient presented with a desire to update her dental care. This was followed by microultrasonics with Acclean chlorhexidine gluconate 0.12% (Henry Schein) to flush out and irrigate diseased tissue. Also, standards of care are not static, meaning they change with the advent of new technologies, new materials, and new court rulings. Too often a war of opinions between hygienists and assistants breaks out in dental offices, which can result in a miserable or even hostile work environment for the entire staff. These were people from a prominent established practice in the area. The standard of care can best be defined in the four elements of negligence, all of which must be met to prove malpractice. Does your office allow them during work hours? These upgraded visits known as periodontal maintenance (PM) are actually a continuation of your treatment. We performed co-diagnosis with this patient using a hand mirror and intraoral camera in order to have the patient involved in the clinical data process and also understand the findings as we presented them. For consulting or speaking inquiries, contact Watterson at or call (336) 472-3515. But I suspect that`s wishing for too much. All rights reserved. Preventing periodontal disease and the development of gingivitis is rather straight forward. Linda Meeuwenberg was a 17-year-old high school student when she took a job at a general dental practice in her hometown of Fruitport, Mich. She was hired to type, file, answer the phone, and pay the bills. What is taught, talked about, and actually done are often very different from each other. Oral health care providers should treat LGE promptly before it evolves into a more severe form of periodontal disease. We conducted a diagnostic and comprehensive oral evaluation. Results – At this time, a marked decrease in inflammation was noted, and gingival tissue was responding well to therapy. t has been estimated that as many as 60 million consumers in the United States have periodontal disease, an estimated 35% ofthe adult population needing care… Depending on the extensiveness of your gum disease, we may need to see you more than the standard twice-a-year visits: Some periodontal patients, for … I`d like to add a note about your article on Transcendental Meditation (TM) (March 1999 issue). The PetitePearl prophy angle by Kerr might be just the thing that will help dental hygienists gain the control they want during polishing. As such, PSR was never intended to take the place of a comprehensive periodontal assessment. Try these measures to reduce or prevent periodontitis: 1. Depending on the extensiveness of your gum disease, we may need to see you more than the standard twice-a-year visits: Some periodontal patients, for … This dental hygienist admittedly had mixed emotions when she first heard the pediatric practice where she works was purchasing a CBCT unit. If you ask 10 periodontists how often a patient should receive a comprehensive, six-point periodontal charting, most, if not all of them will say “once per year.” Now, if the patient has bona fide periodontitis, it would be appropriate to check specific sites during the interim visits at the most problematic areas. However, it does not stipulate how often periodontal charting should be performed.4. Scaling was next performed to fine scale and remove any residual biofilm. The laser was set at 1.4 continuous wave and was used to remove diseased epithelium in the periodontal pockets with a brush stroke motion. CDE9414: The New Periodontal & Peri-Implant Classification System, Periodontal Standards of Care From Diagnosis to Provision Dec 3 - Nov 30, 2023 3.0 credits $150 Enroll Dr. Reichwage uses a diode laser to remove diseased epithelium, and for bacterial decontamination. a duty of care is owed by the clinician to the patient; the clinician violated the accepted standard of care; the plaintiff (patient) suffered a compensable injury; and. Full-mouth periodontal charting including the following data points reported by location, severity, quality, written description, or numerically: Presence, degree, and distribution of plaque and calculus, Presence, location, and extent of furcation involvement. Product review: Spinning in control—a new angle on polishing. A 43-year-old male visited a dentist for an initial examination and checkup. The reason the hygienists were not conducting chartings is that they did not have the necessary time or help with recording. In addition, the fluid lavage of microultrasonics flushes bacteria and bacterial toxins, and the cavitational effect of the water from the ultrasonic tip breaks the cell walls of bacteria. Dental hygienists interested in an intriguing side job might want to look into becoming trained in dental forensics. Dianne Watterson, MBA, RDH, talks commission-based compensation plans: structure, how to handle PTO time, bonuses, and more. 2. Each appointment included ongoing monitoring of the oral hygiene process and healing. Periodontists are also experts in … He can be reached at (260) 426-1086,, or e-mail at We also point out to the patient all of the etiological factors that affect periodontal health and may compromise treatment. Sometimes a periodontist will recommend medications as a first-line treatment for advanced periodontal disease before resorting to surgery, depending on the severity of your gum disease. Refer Wisely. Periodontal Reevaluation Following Initial Therapy. This includes the number of therapy appointments to be scheduled, the sequence in scheduling, and the actual clinical modalities to be used. 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. 2004;135(10):1449-1455. Cell phones are here to stay. We explain to our patients that this is the most efficient way to determine their progress and periodontal health at a glance. The tissue was generally pink and no longer bulbous. Jamie explains how she and her practice accommodated this patient and what she learned in the process to make future appointments go more smoothly. It is merely a screening protocol. Delivery of periodontal maintenance care at … Microultrasonic tips give better access to deep, narrow pockets as well as furcations. Nardone Limited website. I have always thought that the standard is documented six-point periodontal charting including recession, furcation, and mobility at least one time a year for existing patients and for all new patients. Test your oral pathology and dental hygiene knowledge against these cases. Kristin Goodfellow, AS, RDH, explains the importance of taking patient x-rays. Treatment recommendations included two to three hours of gingivitis therapies, CloSYS mouth rinse and toothpaste, and a Sonicare toothbrush. Blood pressure is not measured without a gauge. According to the American Academy of Periodontology, more than a third of Americans over age 30 have periodontitis. 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. These include genetics, general systemic health, hormonal changes, diet, oral hygiene, occlusion, tobacco use, and stress. Use a soft toothbrush and replace it at least every three to four months. We see a dilemma. At a recent dinner meeting of professional colleagues and hygienists, I overheard a con… The following clinical findings were noted at the sixth week appointment (see Figure 4): The patient noted he was happy with the results and no longer had bleeding at home when he brushed. 2002] . Decriminalization and legalization of marijuana in the United States. Modern oral rinses: A revolution in dentistry, Bridging communication and comprehensive care with teledentistry, The untold secrets of managing dentinal hypersensitivity (part 2), Finding long-term whitening solutions with hydrogen peroxide. Here’s one hygienist’s story. Published June 27th, 2017. 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. Yes. An appropriate periodontal maintenance program, specific to individual circumstances, has been recom- mended to the patient for long-term control of the disease, as well as for the maintenance of dental implants, if present. DIANNE GLASSCOE WATTERSON, MBA, RDH, is a consultant, speaker, and author. eriodontal Health Index (PHI): 27/39 decreased from 55/102! "It’s too late for me, but it’s not too late for your patients.". Cone-beam computed tomography in pediatrics. Two weeks later, the entire gingivitis therapy procedure was repeated. Gingivitis can be controlled and treated with good oral hygiene and regular professional cleaning. In its early stage, called gingivitis, the gums become swollen, red, and may bleed. Muddy flooding and sinkholes: Understanding the difference between caries and erosive tooth wear. (A2) . . Sign up for Registered Dental Hygienist (RDH) Magazine eNewsletters. It is not necessary to do probings on a patient who only comes in for emergency treatment, but if that patient becomes a ‘regular’ patient, probings must be done and recorded routinely.”5. The book I find most useful on the subject is by Dr. Laurence Le Shan, How to Meditate. Cassie Jackson, RDH, is a 2004 graduate from Indiana University-Purdue University, JP Institute, LVI, and Comprehensive Care Institute, and holds a certificate from the Periodontal Laser Academy. While some practices used it before, they found how truly useful it is during COVID-19. According to the American Academy of Periodontology, “Research has shown that periodontal disease is associated with several other diseases. There are several things that dental hygienists can do to help their patients who gag, including sprinkling with salt. Such practices have been rigorously used over many years in the management of periodontal diseases in patients with HIV [W inkler, et al. Whitening: Helping patients prioritize and set realistic expectations. The black, white, and very gray areas of radiology. These upgraded visits known as periodontal maintenance (PM) are actually a continuation of your treatment. 5. © 2021 Endeavor Business Media, LLC. Actually, standards of care for dentistry vary from state to state. Procedure – At the initial diagnostic appointment, a full-mouth superficial debridement was performed using microultrasonic instrumentation. Use a mouth rinse to help reduce plaque between your teeth, if recommended by your dentist. Nonsurgical Treatment of Chronic Periodontitis Clinical Practice Guideline (2015) A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents an evidence-based clinical practice guideline and systematic review on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. The following clinical findings were noted at the six-week appointment (see Figure 6): In our opinion, the standard of care that determines protocol for any and all procedures in dentistry should apply equally from peer review committee to megapractices to dentistry in the small offices. Sometimes patients expect unrealistic results from whitening treatments. It is the philosophy of our office to be patient centered, and it is our mission to diagnose and treat periodontal disease, including gingivitis. Treatment of advanced periodontal disease is a multi-step process. This "map" is developed with patient input based on their own treatment goals. I formerly worked with a periodontist who used this protocol. In addition, the relationship from oral health to systemic health has also been established. Our typical recommendation is a three-month cycle but it can be as short as eight weeks. NeilR. Blair v. Eblen. Depending on the extensiveness of your gum disease, we may need to see you more than the standard twice-a-year visits: Some periodontal patients, for … They are mandated to investigate claims made by the public regarding care issues involving the standards of care of dentistry and dental hygiene. The effect of these developments on the Standard of Care remains unknown. Visit her website at Some marginal redness was noted around the third molars. Diabetes Standards of Care & Clinical Practice Resources. Dental considerations of neuroendocrine tumors and carcinoid cancer . Her new setup makes it more comfortable for her to practice, makes it easier to educate patients, and is HIPAA friendly. Many different styles of meditation are available. Vitamin E gel was then placed on the tissue to augment healing. This thorough and well-written document describes periodontal probing as a standard under clinical assessment. A six-week supportive therapy was scheduled. The American Dental Hygienists’ Association (ADHA) developed a document titled “Standards for Clinical Dental Hygiene Practice” to guide the standards of care in dental hygiene. The return of a topical anesthetic is cause for celebration. The tissue was generally pink and no longer had rolled margins. Most people think the standard of care is one of the following: These ideas do not thoroughly define the standard of care. Statements, which pretend to be value laden, are both slanted and bigoted. I wanted to get your thoughts before I enter into a discussion about this with my boss. 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. She addresses patient refusal, as well as offers suggestions about how and when to take radiographs in specific situations. Jamie Collins, RDH-EA, looks at the emerging science on the increased risk of severe SARS-CoV-2 symptoms in e-cigarette users. The laser was then set to 1.2 continuous wave to decontaminate the pockets. It was noted that his medical history was negative and presented no contributory data. Ohio standard of care for dentists. Also, where can I find the documentation for the standard? In addition, recent research has offered a growing amount of compelling evidence and data showing direct links between periodontal health and systemic health. Patient education is an important role for dental professionals. Inform the dentist of any health problems or current medications being taken. Teeth do not have to be lost to periodontal disease. American Dental Hygienists’ Association. The following findings were noted during his evaluation (see Figure 1). "Well, I don't think I have done a periodontal chart since school.". With proper care, a person's teeth should last a lifetime. 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. Actually, the standard of care refers more to a set of expectations, specifically that the dentist or dental hygienist will use a degree of care and skill that is expected of a reasonably competent clinician acting in the same or similar circumstances.1,2. Read all about it here! It becomes evident to patients that they can develop a "barometer" to measure their periodontal health in susceptibility to disease. The methodology to accomplish this is conservative nonsurgical treatment with active patient involvement. This subantimicrobial dose of doxycycline (20mg) used twice daily is FDA approved for enzyme suppression to manage periodontitis. Superinfections, COVID-19 severity, and oral health: Are there connections? Treatment includes the use of traditional hand instruments as well as microultrasonics for debridement and irrigation. We have found that when the standard of care is practiced, applied by the book, and follows accepted protocol, it produces a win/win/win scenario for patient/team/practice! 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. Maintenance. Here’s why. Treatment was initiated by using the microultrasonics to remove plaque and biofilm. TM is difficult for some folks, as are many other forms of meditation. Is it dental and medical schools, state boards, continuing education seminars, the legal profession and bar association, or individual practitioners and their own level of knowledge, skill, and judgment? It’s not for the faint of heart, but forensics can be a very rewarding area. Co-diagnosis and treatment planning with the patient set the stage for the next step – providing conservative treatment. Our office finds it disturbing that there is such a high prevalence of periodontal disease – almost to epidemic proportions – in a field that has experienced vast technological advances. It was noted that her medical history was negative and presented no contributory data. 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. Treatment would consist of 4-6 hours of nonsurgical, conservative, periodontal therapies, with a 6-week supportive periodontal maintenance. However, my current office says the standard of care is an annual PSR (recording codes 0–4 per each sextant) for existing patients and at the comprehensive exam for new patients. As a clinical consultant, Nancy Miller, RDH, saw plenty of enviable operatories. Amber Jaress, CDA, EFDA, a treatment coordinator and expanded function dental assistant, has been schooled at LVI, PAC, JP Institute, and Comprehensive Care Institute. I found Zen to be the hardest. If left untreated, can periodontal disease affect my overall health? An abnormally large and misshapen mandibular tooth was noted during the clinical exam. What is the standard of care for new and existing patients with regard to periodontal screening and recording (PSR) versus full comprehensive periodontal charting? . This concept that we call the “standard of care” is not a solitary document. It had been about one year since her last routine cleaning and radiographs. Next, scaling and root planing were performed to fine scale and remove any residual calculus. Learn more in this exclusive interview. Procedure – Two weeks later, treatment began on the entire mouth and started with application of topical anesthetic along the gingival margins. 6. How can such a wide range of clinical data be used so differently between offices on similar clinical procedures? All rights reserved. He has completed courses in laser dentistry, and advanced cosmetic, periodontal, and restorative dentistry. Amanda Hill, BSDH, RDH, explains why. Some states have written standards; some do not. Five patients had no periodontal charting at all. Standards for Clinical Dental Hygiene Practice. Formulation of a revised periodontal treatment plan, including referral to a periodontist, when indicated. This standard of care is based on the principle of eliminating or reducing the microbial load by mechanically removing debris and plaque [Hofer, et al. As a follow-up from the July 2020 article, this month we will provide readers with common issues, practical solutions, and frequently asked questions that hygienists have when incorporating lasers in their practices. Lastly, Periostat (Collagenex Pharmaceuticals) is used in three, six, nine, or 12-month intervals depending on the patient's progress. His primary concern was that he had noted changes in his gum tissue, especially bleeding when he brushed his teeth. Patients at risk for periodontal disease are often allowed to Òslip between the cracksÓ during a routine visit because they may be in the early stages of the disease. She quickly found she wanted to learn all she could about it, and she’s glad she did. The medically challenging patient needs compassion and education: A case study. The Standard of Care for Nonsurgical Periodontal Treatment for Reducing the Dental Risk for Cardiac Disease . Both the patient and her mother stated that no one had shared this information during previous treatment. He suspected this could be detrimental to his oral health and possibly related to chronic digestive problems as well as weight loss. J Am Dent Assoc. It concerns diagnosis, prevention, and treatment of the various Treatment plan – We reviewed the radiographs, and there was no evidence of bone loss. States all over the country are weighing the benefits and risks of legalizing and/or decriminalizing marijuana. Is it me or does it seem that a lot of patients out there aren’t aware that they have periodontal disease? Sign up for Registered Dental Hygienist (RDH) Magazine eNewsletters. 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). Our evaluation includes the following: Our periodontal evaluation form also becomes an educational tool for each patient. Are you inadvertently zapping your patients’ spoons? We use a systematic approach to patient care, and the model we have created is based on our standard of care. Dentistry has definitions of care for bleeding upon probing, bleeding upon scaling, pocket depth, tissue appearance, loss of lamina dura, etc. Overall, tissue was reported to appear healthier and showed response from the first therapy. 2014] . quality of care provided by specialists versus general dentists on teeth with complicated anatomy and morphology. By David P. Reichwage, DDS; Cassie M. Jackson, RDH; Denise L. Marr, CDA, EFDA; Kristen M. Nuthals, CDA, EFDA; Amber M. Jaress, CDA, EFDA. Published 2016. Question: How can the standard of care in dentistry be so arbitrary and unregulated and subject to the whims and prejudices of individual offices? 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. The following findings were noted from the complete clinical evaluation (see Figure 5). Local antimicrobials such as Atridox (Collagenex Pharmaceuticals) are used when pocket depths are 5mm or greater. Regardless of the treatment modalities used, the purpose is to achieve a gradual healing process and continue treatment until the disease process is controlled. Dianne Glasscoe Watterson, MBA, RDH, provides some tips for temping as a dental hygienist. With many turning to cannabis for its medicinal properties, what does that mean for dental professionals?,

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