Keeping periodontal maintenance relevant and positive

April 1, 2013
Do your patients tire of returning for their periodontal maintenance visits? Unless they are extraordinary, most eventually will.


Do your patients tire of returning for their periodontal maintenance visits? Unless they are extraordinary, most eventually will. After all, according to the American Academy of Periodontology and the American Dental Association, periodontal maintenance lasts for the lifetime of the dentition or its implant replacements. Patients requiring periodontal maintenance to prevent disease progression make room in their schedules approximately every three months to visit their dental hygienists. What if we could make this appointment a positive visit, and make it relevant to the patient's health? I'd like to offer some suggestions for dental hygienists to take a different tack than perhaps we've been taking.

As dental professionals, we understand the importance of bleeding upon probing, increased pocket depths, and daily plaque control. In fact, we often spend tedious amounts of time reviewing the facts with our patients, pointing out where there is still evidence of inadequate plaque control and subsequent disease activity. In an effort to put the focus on health and not disease, inform your patients of the number of sites that are healthy instead of the number of sites that are bleeding. For example: "John, based upon evaluation of your tissue response today, approximately 89% of the sites in your mouth represent health. That is great news, but if 11% of your heart or lungs were diseased, it would be valuable to discover ways to improve the health. Wouldn't you agree?" That type of statement opens the door to discuss how patients can improve the health of their mouths and move toward 100% health. Or, how about this approach? "Cindy, based upon evaluation of your tissue response today, approximately 89% of the sites in your mouth represent health. That is great news, except that the 11% of sites not in a state of health produce bacteria that often leads to bad breath and, ultimately, bone destruction. Would you like to know more about how to get 100% of your mouth healthy?" Granted, not all patients will be motivated to have a greater number of healthy sites in their mouths, but putting the focus on health and healthy-smelling mouths will resonate with many patients.

I'd like to also suggest the same approach in motivating patients toward excellent daily disease control. Do you often use a disclosing solution with your periodontal maintenance patients? Hopefully so, as it is a valuable tool. If so, give this a try: Instead of disclosing them and handing them the mirror to see what a failure they have been, why not tell them you are going to use this disclosing solution so you can both see where their plaque control has been effective? Let them know that the color represents plaque biofilm left behind, but put the focus on health by identifying the sites that do not have any color or visible plaque. Put it in a percentage. For example: "James, good news. Based upon use of this disclosing solution that enables us to see how effective you are with plaque control, you can see with me that you are very effective in about 70% of the sites." Make that type of a statement and then pause. Most patients don't like seeing 30% of their teeth with visible disclosing solution present, and will ask something like "Well, what can I do about the other areas?" Great opportunity to discuss use of the Philips Sonicare with a hands-on demonstration, or use of the Waterpik Water Flosser, or whatever is appropriate. We want patients to inquire about methods to improve their own oral health, don't we? Sometimes it is as simple as changing the way we communicate our message. Try putting the emphasis on health and how to achieve improved health instead of disease control.

I learned this lesson the hard way several years ago with a periodontal maintenance patient. At the beginning of the appointment she said, "Hey, Karen, why don't you try saying ‘Marsha, everything looks really great inside your mouth today'? Can you agree to tell me that before I sit down?" What was she really saying? I think she was voicing the sentiments of hundreds of other periodontal maintenance patients who faithfully trek in to see their dental hygienists every three months: "Could you please just give me some good news?" What if we put the emphasis on health and what's working and voice appreciation for their commitment to keeping their appointments? That could be a refreshing way to begin periodontal maintenance visits.

According to the AAP, it is our duty to inform patients of persistent or recurrent disease sites, but let's not forget that patients love good news too. Staying healthy, preventing tooth loss, and preventing bad breath are relevant issues to most patients, so let's emphasize the positive and encourage patients to achieve 100% oral health. RDH

Perio Team Take-Aways

1. Intentionally seek ways to give patients good news at each periodontal maintenance visit.
2. Inform patients of recurrent disease sites only after emphasizing the percentage of healthy sites.
3. Use disclosing solutions to identify ways patients are effective in plaque control.

KAREN DAVIS, RDH, BSDH, is the founder of Cutting Edge Concepts, an international continuing education company, and practices dental hygiene in Dallas, Texas. She is an independent consultant to the Philips Corp. and serves on the review board for She can be reached at [email protected].

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