by Dianne Glasscoe Watterson, RDH, BS
OK, I'll admit it – I hate probing! It is the only part of my job that I truly hate. There are several reasons why I hate probing. First, I don't have enough time. It takes me anywhere from 10 to 15 minutes to chart a full dentition by myself, yet I'm only given 40 minutes for the average prophy patient. Second, there's no one to help me get all the numbers written down, and I have to contaminate the patient chart to get everything recorded. Third, I don't like making my patients uncomfortable, and probing hurts. Fourth, there are areas of the mouth where I can't see the probe, such as linguals of posterior teeth. Fifth, it seems like such a pointless exercise, since the doctor never looks at the chart anyway.
With all of these objections, it is easy to see why I hate probing. I know I should be perio charting my patients, and I feel guilty that I'm not doing something I know I should do. Help!
I like your honesty, and I'm glad you are feeling guilty about not probing. Recognition of a problem is the first step in finding solutions for the obstacles you expressed so succinctly. Let's examine each issue, starting with a lack of time.
It sounds like you work in a high-volume office if you are given only 40 minutes on average with your patients. You have to prioritize and use every minute wisely. Hygienists who work in these situations often do just what I used to do when I was pressed for time, which was perform a "drive-by" probing. I'd probe here and there and write in the chart notes "Probing WNL," which was supposed to mean "within normal limits" but could easily mean "We never looked." Those drive-by probing charts that only have a number here and there appear – to a jury of nondental people – to be incomplete. Remember this: In a court of law, if it's not written in the chart, it never happened.
I distinctly remember a patient who expressed discomfort near a mandibular second molar when the doctor did the hygiene exam. The doctor discovered an 8 mm pocket at the DL that I completely missed. I felt terrible! The reason I missed it was because I wasn't looking for it. I had not performed a thorough periodontal assessment of my patient. That was a wake-up call for me.
I accepted the blame for missing the pocket, but the doctor had to accept blame for not giving me sufficient time to perform that all-important charting. When the office hired an assistant to help all five hygienists in our office perform comprehensive probings, we discovered many periodontal problems on our patients that we had previously missed. The discovery led to more definitive periodontal treatment, which led to higher production overall.
For your time issue, here's what I recommend. Try to be proactive with scheduling. What I mean is to think ahead and determine what will be needed at the next appointment. If you know the patient will need a full-mouth periodontal charting at the next recall visit, schedule accordingly by allowing an extra 10 minutes. Use the exam code D0180 and charge a higher fee than you charge for a D0120 periodic exam. This will cover the expense of the additional time required to do what is necessary.
The second problem you mentioned was not having assistance. There's nothing better than having an additional person present to record what you find either in the computer or in the paper chart. If the doctor has only one chairside assistant, it is doubtful she would be available when you need her. However, there are several alternatives that you should explore.
The first one I want you to check out is something called PerioPal™ (periopal.com). Basically, this is a voice command program that allows you to speak what you see through the use of a headset that is plugged into your computer. It was invented by a practicing hygienist who saw the need for a viable option for assistance while probing. This program is like a super assistant! Basically, all you have to do is learn the commands, and the program does all the work. PerioPal is miles beyond the old voice recognition systems, in that this program responds to commands. The commands are logical and easy to learn. It allows the hygienist to keep eyes focused on the oral cavity and complete probing without having to interrupt the sequence.
Another option is called the Dental R.A.T., which stands for "remote access terminal." It is, in essence, a foot-controlled mouse. Also invented by a hygienist, this device allows the hygienist to probe and record the readings with the foot. It is an ingenious invention that allows periodontal charting solo without having to break sequence by stopping to record. The learning curve is not difficult. It's a matter of learning to depress the appropriate position on the mouse (dentalrat.com).
Periodontal probing should not be an unpleasant experience for your patient unless the tissue is inflamed or your technique is heavy-handed. If the tissue is inflamed and sore, using a small amount of topical anesthetic in the sulcus will help to alleviate discomfort. Two good topicals that can be squirted in the sulcus are Ultracare (Ultradent Products) or Cetacaine (Cetylite Industries). I also believe that plastic-tipped probes are generally more comfortable than metal probes, especially if there are hypersensitive root surfaces. Now if you are applying too much pressure, you need to be intentional about lessening your pressure so you don't punch through the crest of the attachment into the connective tissue.
Your inability to see the probe is strong evidence that you need magnification. In fact, I will emphatically state that every practicing hygienist should be wearing magnification. Hygienists who do not wear magnification are not aware of what they are missing. Magnification also helps the hygienist's posture by negating the need to bend and crane the neck and back.
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Periodontal charting is a part of your professional obligation in providing high-quality care. Doctors depend on hygienists to keep them informed about the patient's periodontal status. You should have a full-mouth, six-point periodontal charting for every adult patient once per year and spot probings of problem areas at interim visits. Every time you chart, you should show the charting to the doctor before he or she examines the patient and point out any areas of concern. Omission of the periodontal charting leaves the doctor open to liability for failure to diagnose periodontal disease. If you implement the recommendations I've shared with you, I think you will overcome your distaste for periodontal charting.
Dianne Glasscoe Watterson, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe Watterson for speaking or consulting, call (301) 874-5240 or e-mail [email protected]. Visit her Web site at www.professionaldentalmgmt.com.
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