Periodontal documentation: Stepping beyond 'ordinary' diagnosis
Karen Davis, RDH, admonishes dental hygienists to improve their periodontal documentation.
I remember like it was yesterday, even though it was more than 25 years ago. I was attending a dental meeting in Houston with hundreds of other people, but I felt like the speaker was talking directly to me. The periodontist from New Jersey captured my attention with this statement: “If you see bleeding gums in the majority of your patients while cleaning their teeth, the problem is you.”
Certainly, I knew bleeding gums were not okay. But honestly, they had become so “ordinary” in my patients that they had lost their urgency. Then, Van Stevens, DDS, from New Jersey stepped on my toes! Fast forward to today, and I now tell my audiences that I hope they wore close-toed shoes—in case I step on their toes, intentionally.
Let’s address this elephant in the room—periodontal documentation. Already some of you know you can move on to other articles in this publication because this topic won’t apply to you. However, since thankfully I had my toes stepped on and that got my attention, I feel as though I’ve earned the right to address the subject. To have the greatest impact in your practice, dentists and dental hygienists need to read this article and discuss this topic together.
Dentists can defer to the dental hygienists for collection of the periodontal data, but in order for that to become consistent there has to be value for the time required to collect the data thoroughly, as well as explaining the significance to patients. Surprisingly, given all we know about the oral-systemic connection, thorough periodontal assessment and documentation is still an overlooked procedure. Dentists and dental hygienists settle for spot probing, periodontal charts that are outdated, bitewings that don’t show bone levels, and in some cases, no periodontal assessments at all on patients. Right now, I bet some of your toes are becoming a bit twitchy after reading that last sentence.
I now tell my audiences that I hope they wore close-toed shoes—in case I step on their toes, intentionally.
A good friend of mine recently shared the nightmare that her sister endured after being treated by a reputable dentist. The visits included preventive visits with the dental hygienist twice a year for many years. Yet later she learned that she had extensive periodontal disease. There was no periodontal data on this patient despite the fact that she had undergone significant restorative treatment. The result? Loss of several teeth, extensive surgery, an unfortunate esthetic result for a lifetime, and an unwanted lawsuit. Was this an isolated incident? If it had been, I wouldn’t be devoting this column to stepping on toes.
Ensure that evaluations occur
So, let me go back several years to the time of the meeting. Even though we were performing periodontal assessments on our patients, we were guilty of providing a lot of bloody prophies because we weren’t diagnosing gingivitis and periodontitis in the earliest possible stages. In far too many practices today, patients aren’t even receiving routine periodontal assessments. This topic is worthy of time during your next team meeting to ensure everyone is on the same page in correcting the oversights.
Here are five concepts that will ensure that periodontal evaluations take place routinely.
• Dentists must be on board with periodontal evaluations performed on every patient. Dental hygienists can’t fly solo here. Patients visiting dental practices need to know that their dentist is concerned about their periodontal foundation prior to any restorative or esthetic treatment. Whether the dentist or dental hygienist collects periodontal data, keeping it current must become part of the culture of the practice.
• Annual updates are essential. According to the American Academy of Periodontology, comprehensive periodontal evaluations and the patient’s risk factors should be assessed at least annually. According to most legal experts, simply recording “WNL” in patients’ records might as well stand for “we never looked” rather than “within normal limits.” Assessments must be recorded and kept current to be of value.
• The periodontal evaluation can be included either with a patient’s preventive or maintenance treatment and doctor examination at no additional fee, or the patient can be billed separately for a comprehensive periodontal evaluation, as indicated.
• Patients need to “hear their numbers,” and they need know when their gums are bleeding during data collection. This fosters ownership of a condition that is most frequently asymptomatic. Patients need to see visuals to appreciate that bleeding gum tissue and deep pocket measurements can literally lead to the loss of their teeth, not to mention the spread of disease-promoting bacteria into other parts of their bodies.
• Periodontal data needs to be used to make an appropriate diagnosis and treatment or a referral. A patient is either periodontally healthy or has active disease. If disease is present, it is either localized or generalized. Current periodontal data uncovers evidence of gingivitis and periodontitis in the earliest stages, when interventions and treatment are most successful.
Dental professionals can collect periodontal data manually with voice-activated technology and constant-force probes (floridaprobe.com), or by using remote-access terminals (dentalrat.com). But if you’re not performing periodontal evaluations on all of your patients, I hope your toes are feeling mighty uncomfortable about now. I also hope you choose to make the periodontal health of your patients a priority.
Karen Davis, RDH, BSDH, is the founder of Cutting Edge Concepts, an international continuing education company, and practices dental hygiene in Dallas, Texas. She is an independent consultant to the Philips Corp., Periosciences, and Hu-Friedy/EMS. She can be reached at Karen@Karendavis.net.