Professional harmony

Oct. 1, 2004
Help! My doctor won't diagnose perio. Does this sound familiar? If you sometimes feel a lack of doctor support in the periodontal department, consider a new strategy.

by Janet Hagerman

Help! My doctor won't diagnose perio. Does this sound familiar? If you sometimes feel a lack of doctor support in the periodontal department, consider a new strategy.

As the health-care professional for your office, the periodontal therapist for your patients, and the business partner with your doctor, it is your responsibility to create a rapport with your doctor and establish systems for congruency. What do I mean by congruency? I mean that your philosophies are similar, matching, compatible, and harmonious. Is this something that happens spontaneously, magically, or with good luck? No. Creating a congruent philosophical relationship, particularly in the area of periodontal co-diagnosis, calls for thought, planning, and focus.

It may surprise you to learn that most dentists get little periodontal training in school. They graduate immersed in restorative dentistry, which usually remains their focus. In my years of coaching I often hear dentists lament, "I hate perio! I don't want to deal with it. Teach my hygienist what to do about it!" It's clear that these dentists may not comprehend the clear implications of the mouth-body connection, or the importance of healthy, sound periodontium as a basis upon which to place their restorative work.

Add to this the often confusing, frequently changing ADA codes, the fact that we still do not have a clear code for the treatment of gingivitis, and the changing standards of the American Academy of Periodontology (AAP), and you have a recipe for frustration. This will continue to change as research delves more deeply into periodontal disease to reveal the mysteries of biofilm and bacteria. It is no wonder that our dentists are often overwhelmed and may under-diagnose due to misunderstandings about the distinctions of this disease, as we now know it.

Establishing philosophical congruence starts with you, the hygienist and periodontal therapist, and your standards of care. As I interview countless hygienists for our company, Coast Dental, I am often surprised at the lack of conviction about practice philosophy. These hygienists typically fall into the regimen of the office in which they work, with little thought about their true support of that regimen. I'm not saying that hygienists should be deliberately noncompliant with the doctor. I'm saying that it is up to you to establish a relationship of philosophical harmony with your doctor. How do you do that?

Get a clear picture of your own periodontal protocol and back it up with scientific support. Check out the AAP Web site at Stay current by reading professional hygiene journals. Join professional organizations such as the American Dental Hygienists' Association ( Attend continuing education courses available at RDH Under One Roof, ADA, ADHA, and AAP.

Start at your job interview. Ask the doctor about the office periodontal protocol, and share yours. This is an excellent opportunity to determine if you are even in the same ballpark when it comes to your periodontal approach. If you do not feel comfortable with the practice's periodontal protocol, or you do not feel that the doctor will be open to your professional contributions for increasing patient standard of care, keep looking.

Schedule monthly (or bi-monthly) meetings with your doctor. Conduct patient case reviews over lunch. Examine together the radiographs and periodontal charts of several patients. Take a look, together, to determine bone loss and number of perio pockets and bleeding points. Evaluate the level of patient health or disease and treatment options. Determine antibiotic needs based on patients' periodontal chart readings. Discuss differences of opinion calmly, clarifying support for your position with AAP guidelines and periodontal case type distinctions.

Study your department production reports to determine if you are treating the periodontal disease of the patients in your practice. According to the ADA and the AAP, 75 percent of the American population has some form of periodontal disease. Do your production reports reflect this statistic? Do 25 percent of your adult patients get a prophy while the remaining 75 percent get some sort of periodontal therapy? If not, why?

Some locations may vary from these demographics. A college town practice, for example, may have more prophys based on a younger patient population, while a retirement area practice may indicate the need for more perio. In general, however, in the many practices I've coached, these demographics exist. Share these numbers and forecasts with your doctor.

Read hygiene journals and share periodontal articles with your doctor. Also, read the same journals as your doctor in order to share information. Save articles from mainstream magazines and newspapers (current examples abound) that describe the perio-whole body connection, informing the average citizen - your patient - about the connection between heart disease, diabetes, etc., and periodontal disease. Share the article you're reading right now with your doctor.

Most doctors are not deliberately noncompliant when it comes to periodontal diagnosis. They appreciate your help with understanding the parameters of the disease, and how you, as the periodontal therapist, can treat it nonsurgically, or sometimes as a precursor to surgery. However, it is imperative that you approach this in a supportive manner that does not lay blame, but rather seeks to concur, professional to professional.

As you request your doctor's support to accurately diagnose periodontal disease, are you doing your part to support your doctor in enrolling restorative treatment? Do you know what kind of dental work your doctor likes to do, and do you actively enroll that kind of treatment? Do you encourage complete treatment planning and assist your patients with continuing and completing their treatment plans? Your doctor will be much more inclined to support you with your perio goals when you reciprocate with his/her restorative goals.

Will you always agree on a co-diagnosis? Probably not. However, in successful practices, the hygienist and doctor develop a mutual respect for each other's opinions. This comes as a result of many months of continual monthly case review meetings, continuing education, and keeping up with professional journals and books.

Janet Hagerman, RDH, BS, is a speaker, writer, and the director of dental hygiene for Coast Dental. She can be reached at [email protected].