Trisha E. O`Hehir, RDH, BS
We need an "oral health score." No matter what periodontal records are used, a bottom-line score for the patient could be a part of it. Why shouldn`t patients know their "score" at each dental hygiene visit? Well-informed patients know their visits to the dental hygienist are not simply a cleaning. The visits provide evaluation, prevention, and treatment of periodontal disease. When patients actually get a score based on their periodontal health, they realize we are not just "poking around in there," as I`ve been accused of on occasion.
Many people know their cholesterol level and their blood pressure scores. Why not their "Gum Disease Score" or, more positively, their "Oral Health Level?" Dental hygienists gather this information, using it to determine treatment and prevention decisions. Why not provide patients with a score they can remember and compare from visit to visit? You may already have a scoring system in place that works well in your practice. If so, let me know what it is. I`m always looking for new ideas. If you don`t have a scoring system, here are a few suggestions.
Whether we do a full-mouth periodontal charting or simply a screening index, we can calculate the score and discuss it with the patient. These scores tell the patient where they stand on a continuum from health to severe disease. It also provides a monitoring tool for both our therapy and the patient`s progress. Providing an oral health score could make communicating with patients a bit less difficult. Something new and different may catch their attention better than the same old story.
Screening tools. If you are using the Periodontal Screening and Recording (PSR) index to determine if full-mouth periodontal charting is necessary, you already have a built-in scoring system of 0 to 4. This index is a stepping stone to full-mouth charting and is of use in offices which have not yet established baseline probing for every patient.
A specifically designed color-coded probe is used with the PSR index. It has a color band from 3.5 mm to 5.5 mm. Pocket depth scores are not measured, but an index score is identified by the colored band, determining when a full-mouth periodontal charting is indicated.
- Scores of 0, 1, and 2 indicate health, gingivitis, and gingivitis with the presence of either or both calculus and defective restorations.
- A score of 3 indicates a pocket depth between 3.5 mm and 5.5 mm.
- A score of 3 in a single sextant indicates the need for periodontal charting in that sextant.
- A score of 3 in two or more sextants indicates the need for full-mouth periodontal charting.
- A score of 4 indicates pocketing beyond 5.5 mm and signals the need for full-mouth periodontal charting.
Simply using the deepest score will provide patients with an understanding of their screening score. Emphasizing that this is a screening score and more information is needed to determine the actual full-mouth, oral-health score will bridge the transition from screening to full-mouth evaluation.
If you do not have the special color-coded PSR probe, you can do your own Sextant Screening by simply probing six surfaces around each tooth and recording the deepest reading for each sextant as well as bleeding. Stickers for this screening are available from the Perio-Data? Company.
You can also simply sketch a small rectangle with six boxes representing the six sextants. Simply record the deepest pocket for each sextant. You can also record a red dot or circle the number in red if bleeding is present anywhere in that sextant.
Either the PSR or the Sextant Screening can be used for baseline screening or monitoring at successive dental hygiene visits. Use a scoring system of 1 to 8, even though you can at times have pocket depths deeper than 8 mm; 1 to 8 provides a broad span and reflects the diversity from health to disease.
Periodontal screenings are a good way to differentiate between gingivitis and periodontitis.
The Eastman Interdental Bleeding Index (EIBI) is a quick, easy bleeding index which provides interproximal information. This index can be performed in the office and also taught to the patients for their use at home. Scores range from 0 to 26, depending of course on the number of teeth present. Bleeding is measured after inserting a triangular-shaped stick into the interproximal area from the facial surface only. Excluding third molars, a full complement of teeth provides 13 interdental spaces in each arch, thus the range of scores from 0 to 26. A bleeding index is not recommended for tobacco users, since nicotine causes vasoconstriction, interfering with the bleeding normally associated with periodontal disease.
Full Baseline Probing. Full-mouth periodontal charting is indicated for those receiving a PSR score of 3 in more than one sextant or a score of 4 in a single sextant. Complete periodontal records are also good baseline documentation, with periodic updates, usually yearly for periodontal patients. A bottom-line score can be calculated by counting up the pockets by pocket depth and the number of bleeding points.
The only periodontal chart designed for this purpose is the Perio-Data chart. Cindy Chillock and I developed this chart 10 years ago to monitor the results of conservative periodontal therapy.
If you use another chart, you can total the pockets and bleeding points and simply note the score on the charting form or in the patient?s record. Rather than a few fours and some bleeding, it is more informative to tell the patient they have, for instance, a score of 45 areas of infection (representing the total number of 4 mm pockets) and 86 bleeding points. The total number of pockets and the total number of bleeding points provides both the patient and the clinician with a bottom-line baseline indication of oral health.
Another way to use full-mouth periodontal charting is to determine periodontal case type from I to IV. Case type I is gingivitis, case type II is early periodontitis, case type III is moderate gingivitis, and case type IV is advanced periodontitis. This scoring system will provide patients with a score from 0 to 4, indicating their position on a continuum from health to severe disease.
Identifying your patients? Oral Health Score will provide an easy way to communicate their level of health or disease. You?ll be surprised how many patients remember their scores and are anxious to see if their work at home has changed the score over time. Calculating and communicating an Oral Health Score will enhance the partnership between patient and dental hygienist focused on achieving optimal oral health.
Trisha E. O`Hehir, RDH, BS, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics. Her e-mail address is [email protected].