It`s fun to see patients getting excited about their improvement and taking an active part in their treatment.
Trisha E. O`Hehir, RDH, BS
It`s surprising to see how many people know their blood pressure and cholesterol levels. But do they also know their periodontal-health index score (PHI)? Can they tell you what it was the last time they visited a hygienist? Probably not! Do you know your perio score? Mine is 5/2.
In my experience, giving patients their "score" gets them more interested and involved in their periodontal health. The PHI or Periodontal Health Index is two numbers, similar to a blood pressure score of 120 over 80. The two numbers in the PHI are the total number of pockets measuring 4 millimeters or greater, followed by the total number of bleeding points. Perfect would be 0 over 0, but not very many mouths are perfect. Sometimes there are pseudo-pockets on the distal of the last molar, or alignment and tissue contours that produce a healthy sulcus deeper than 3 millimeters. Tissues are different for different people. Fair-skinned blondes have more delicate tissues than olive-skinned brunettes, generally leading to more bleeding points in fair-skinned patients. Our goal is to help patients achieve the lowest PHI possible for them.
The worst score in a mouth of 28 teeth would be 168 over 168. This means that six surfaces of each of the 28 teeth had a pocket depth of at least 4 and bleeding upon probing. Hopefully, you don`t have any patients like this in your practice!
Most pockets begin between the teeth, so the majority of pockets and bleeding occur in the interproximal areas. This focuses the bleeding and pocket-depth scores on four surfaces of each tooth. If the second number of the index - the bleeding score - is over 100, you can be sure that interproximal plaque control is being ignored or improper technique is being used. If all 28 teeth had interproximal bleeding associated with them, the potential bleeding score would be 112 (28 x 4 = 112).
Facial surfaces generally have fewer bleeding points or pockets than interproximal sites, because people are more likely to brush those surfaces and skip interproximal areas completely. Since the lingual surfaces receive the least attention during brushing, more bleeding points and pockets are seen on lingual than on facial surfaces.
In untreated periodontal patients, the first number (total number of pockets) is generally smaller than the second number (total number of bleeding points). Areas with both pocket depth and bleeding will require thorough debridement therapy. Areas of bleeding alone will require therapy to prevent attachment loss. Bleeding scores usually are higher, with the exception of smokers, whose bleeding is masked by vasoconstriction caused by nicotine.
To calculate the PHI for your patients, simply count up the number of pockets recorded and the number of bleeding points. Twenty-four pockets and 67 bleeding points would be a PHI score of 24 over 67 or 24/67.
You also can calculate the range of scores for any patient, as long as you know how many teeth they have. Simply multiply the number of teeth by four to calculate the number of interproximal surfaces they have, or by six for the total number of surfaces measured. Patients with periodontal disease often start out with scores of 25/100 to 85/140 or more.
After therapy, the numbers drop dramatically and incrementally. Patients always seem to be curious to see the numbers change. It?s also gratifying to see how effective your therapy is. Not all of the healing takes place in the first couple of months after nonsurgical therapy. Continued healing can be measured during the first year following treatment. A few areas may need more instrumentation ? perhaps a locally delivered antimicrobial ? and oral hygiene may need refining. By the second or third maintenance visit after therapy, scores often are below 10/10.
If someone in the office is writing down the numbers for you when you do your chart, the patient is aware of the range of numbers and where bleeding points are noted. This is especially true if you explain the process before you begin. Knowing the range of numbers and having a general idea where they occur in the mouth is quite different from being given the totals. Just try it and see!
A few 4s and some bleeding doesn?t sound too bad. A PHI score of 37/85 puts it into perspective. These figures reflect the number of infected areas in the mouth that need to be treated. This score provides the basis for your treatment plan and case presentation. Patients are very interested in finding out how this score changes after you?ve completed their periodontal therapy.
One of my patients, an engineer, actually calculated his expected rate of healing by comparing his baseline score with his first score after instrumentation. He mathematically calculated the next three scores. He was pleased when he achieved exactly what he expected at the next visit. The following visit he missed his predicted score by just a few numbers and was sure he hadn?t been doing enough interproximal cleaning.
I received a curious call from a dentist who wanted to know what kind of charting I was doing. It seems he was playing tennis with one of my patients who told him his perio score was 3/5 and asked the dentist what his score was! My patient was quite proud of his score, having reduced it from 86/122. The dentist didn?t know his own PHI ? and didn?t know how to calculate it ? so he phoned me. After our discussion, he changed his charting system. He now knows his own PHI and tells all of his patients their PHI.
Competition grows between family members. Rather than asking how the appointment went, the first question now is, OWhat was your score today?O It?s fun to see patients getting excited about their improvement and taking an active part in their treatment.
Your dentist-employer also will like the PHI scores, because it provides a snapshot picture of the periodontal charting. Dentists don?t have to look at all 168 probing scores you?ve just recorded. The PHI score gives them the bottom line. That score, along with your description of the case, provides a complete picture. It eliminates the problem of the dentist running in to do an exam, checking the patient for caries, ignoring your complete charting which indicates periodontal disease, and simply saying the tissues look just fine! Given this score, the dentist knows the periodontal condition of the patient before beginning the exam.
The Perio-Data? charting form is the only form available that provides a space for calculating the PHI. In addition to the total number of pockets, it provides a monitoring section where pocket depths are counted by sextant and by depths. One column is for 4-millimeter pockets, another is for 5-7 millimeter pockets, and a third is for pockets 8 millimeters and deeper. A fourth column is provided for bleeding points. The numbers are entered for each sextant and then totaled for the mouth. This provides a breakdown of the total number of pockets by depth and corresponds to case-type determination. Perhaps in the future, computer programs will include this unique Perio-Data? feature.
I predict that people will soon be keeping track of their PHI scores just as they do their blood pressure scores and cholesterol levels. That will make our work a lot more fun E and even more successful!
(For information about the Perio-Data? charting forms, call 800-411-7792.)
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. The Web site for Perio Reports is www.perioreports.com. She can be reached by phone at (800) 374-4290 and by e-mail at [email protected].