Having the courage to identify perio

April 1, 2012
I grew up showing dogs in 4-H. When I was a young teen, I told my veterinarian of many years that I wanted to become a vet when I grew up.
A patients’ advocate persistently educates colleagues and patients about disease process

By Lori A. Fagundes, RDH

I grew up showing dogs in 4-H. When I was a young teen, I told my veterinarian of many years that I wanted to become a vet when I grew up. His reply was, “No, you don’t.” It wasn’t because he had mixed feelings about his career. His advice was based on the perception that I would end up being the “cat lady.” I was simply too emotionally involved with the well-being of all animals. Upon entering the dental profession, I would joke that I was certain I would not become emotionally involved with my patients’ teeth.

Yet here here I am, passionate about perio.

Being a dental hygienist involves so much more than I imagined when I decided to go back to school. As an assistant, I would look at the hygiene schedule and think, “They get at least an hour for every patient, an hour blocked for lunch, and make excellent money. Aside from being bored doing the same thing every day, what’s not to like?”

Bored is not a word I would use to describe my hygiene career. Stealing the title from the film series, The Fast and The Furious, would seem to be a better description. Constantly trying to fit more and more into a one-hour appointment, taking on job duties that originally were assigned to other staff members, and wondering why a new patient exam took 45 minutes in the doctor’s schedule but I should be able to do it as well as a perio chart and a cleaning with just 15 minutes more.

It is because of all of this that I feel the way I do about periodontal disease. Over the years, I have had to work to make sure that what was expected of me could be accomplished. One lesson I have learned is that I am not only fighting for a good work environment for myself but, just as importantly, I am fighting to give my patients the care that they deserve.

I am the patients’ advocate.

Our job is hard; our time is limited. Our patients have other things on their minds, and other places to go. How is it possible to initiate periodontal disease treatment on every patient who has the disease? Education.

How do we educate?

To be a patients’ advocate, hygienists must have the courage to continue to be educated about periodontal diseases, enlighten the dental team, and ultimately empower the patient. This is a three-step process.

• Self-educate. Study after study is starting to tie periodontal disease in some way to several systemic diseases. Studies show early detection and treatment equals better results. Early detection and treatment certainly is less expensive for our patients. How we treat periodontal disease is changing based on the multiple factors involved with the type of periodontal diseases, type(s) of bacteria, genetic components, health history, medical history, and the abilities and home care of each patient. There is simply too much information out there to be doing the same cookie cutter periodontal treatment on all patients.

• Educate our dentists and other staff members. Current literature and science-based studies regarding periodontal disease need to be shared with the entire dental team. This allows them to understand the reasons behind your dedication to identifying and treating all stages of periodontal disease. This may be your hardest job as most change is met with resistance. But remember that you are your patients’ advocate when it comes to their periodontal health. Create a periodontal program with your dentist. This way, everyone is on the same page and knows what to expect.

No one likes to talk about money, but remember that the dental office is also a business. Your dentist needs to understand that treating your patients’ periodontal disease will also improve the profitability of your hygiene department. I have never seen an office with a strong periodontal program that didn’t have a profitable hygiene department.

• Educate your patients. Until the patient tells me otherwise, I believe all patients want and deserve the whole truth about what is going on in their mouths. When I was an assistant, a perio consultant came into our office and asked us, “How much disease is OK with you?” Take a second to think about your own health or that of your children and family. How much disease is okay with you? My immediate gut answer is none. I am guessing the majority of our patients’ answers would be the same.

The only way for patients to make educated decisions is for them to be knowledgeable on what they are making decisions about. Be patient; once again, change is hard. Educate patients about the changes demonstrated in the current literature and studies. I like to use the phrases, “I want you to know why I care so much,” and “What we now know is ...” I print out articles and keep them in my operatory, so my patients can read the information. If you have CAESY, Guru, or another program in your operatory, take advantage of it. The videos are usually short and very informative, which also gives you time to do something else. Information coming from a third party helps to validate what you are teaching.

Educate your patients about what is going on in their own mouths. Print or copy your patients’ perio charts, and show them their deeper pockets, areas of recession, and bleeding areas. Let them take the charting home. I have found that this helps patients own their periodontal disease. You will be surprised just how many keep the information and start keeping track of their changes (or lack of changes). How different it is when your patient is asking you what you can do about that 6mm pocket that is still bleeding on probing. Don’t be surprised when you hear about family competitions breaking out.

I truly believe that we are privileged to be hygienists at this time in history, and I am passionate about perio. Our knowledge of the causes, symptoms, treatments, and consequences of periodontal disease is continually changing. We are medical professionals who must be our patients’ advocates. We must have the courage to learn, the foresight to enlighten our co-workers, and ability to share this information with our patients. There is just no time to be bored.

Lori Fagundes, RDH, is a national speaker, consultant, writer, and a registered dental hygienist. Her 20-plus years in the profession have made her a dynamic patient advocate. She has developed an in-office protocol based on the belief that everyone deserves the best information from their provider so that they may choose the best course of care. She can be contacted at [email protected].

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