Courageous conversations: Talking to patients about perio without fear

Perio conversations can feel intimidating, especially when the patient has been coming to the practice for years, trusts their providers, and says, “No one has ever told me this before.” Many new hygienists worry about upsetting long-term patients, contradicting previous care, damaging trust, or facing pushback from the doctor. 

But diagnosing periodontal disease is not confrontation. It is advocacy. 

Courage in the operatory is not about eliminating fear. It is about doing the right thing, even when your heart is racing a little. 

From fearful to “challenge accepted” 

Early in my career, perio conversations scared me too. But once I began grounding my decisions in the data, including radiographs, charting trends, bleeding points, tissue changes, calculus patterns, and bone loss, something shifted. 

It stopped feeling like conflict and started feeling like a challenge: 

Here is what the body is showing us. How do I help the patient understand the truth and take action? 

That does not mean the barriers disappear. They are real, and naming them helps us prepare rather than avoid: 

• The patient’s understanding of the seriousness and urgency 

• The level of doctor collaboration 

• The patient’s financial or emotional readiness 

• The foundation of trust in the provider-patient relationship 
   

Awareness allows us to lead with clarity instead of hesitation. 

A real-life case that strengthened my confidence 

Several years ago, I treated a long-time patient who typically saw another hygienist, someone I deeply admired as a mentor early in my career. During the appointment, the full picture became clear: inflammation, bleeding, unresolved pocketing, and radiographic evidence. The clinical signs indicated the need for periodontal therapy, and treatment was likely overdue. 

I educated the patient, presented the findings, and brought in the doctor. Together, we recommended treatment. But I will be honest. I felt nervous. 

What if my mentor had already seen this and did not diagnose it? Would she be upset? Was I overstepping? 

I reminded myself of my responsibility to provide ethical, evidence-based care, and I moved forward. 

After the visit, I went to speak with her. Instead of frustration, she exhaled in relief and thanked me. She shared that during a previous appointment; the patient had opened up about a deeply painful personal experience. In that emotional space, it felt difficult to shift back into a strong clinical advocacy conversation in that moment. 

She was not careless. She was human. And I am still grateful for the many lessons she taught me. 

The patient still needed treatment, and that experience reinforced a profound truth: 

Compassion and courage must coexist. Loving our patients includes honesty, even when it feels uncomfortable. (Patient details have been respectfully protected). 

A common mistake: Being as “surprised” as the patient 

A frequent mistake, especially among newer clinicians, is reacting to findings with the same surprise as the patient by saying something like: “Oh wow, I did not expect to see this.” 

In that moment, confidence collapses, and the patient senses uncertainty before the explanation even begins. 

If you are new to an office or still building your perio confidence, review charts ahead of time. Look for patterns. Anticipate conversations. Preparation creates calm clarity. 

Confidence in the operatory is a skill, and it can be practiced. 

Language matters: Provider mindset vs. apologetic tone 

We can be warm, kind, and approachable without shrinking our professional authority. 

Words to avoid:

“Only”—"It is only $888"
 “Just”—"It is just a little deeper of a cleaning.” 

If it is “just a little deeper,” why does it cost significantly more? 

Those words minimize the seriousness of infection and undermine patient acceptance before the conversation even begins. 

You are not selling a service. You are identifying and treating disease, so speak as a healthcare provider. 

Do not “drop the perio bomb” 

One of the biggest communication mistakes is remaining silent during data collection and then presenting the entire diagnosis at the end. Patients feel blindsided. 

Skilled clinicians build the narrative gradually throughout the appointment. 

During radiographs: 

“I am also assessing your bone levels today. If I see anything concerning, I will show you so we can talk through it together.” 

During perio charting: 

“Last time you had several 5 millimeter areas here. If those pockets have not healed, that tells us the tissue needs more support and may require a different type of cleaning.” 

When bleeding is present:

“Bleeding is a sign of active inflammation. Healthy gums do not bleed, so this helps us understand how your body is responding.” 

By the time you present the diagnosis, the patient has already seen key pieces of the picture, and the conversation feels logical instead of shocking. 

Tools for courageous perio conversations 

Confidence Script:

“Based on your charting, bleeding points, and the bone changes we reviewed on your X-rays, what we are seeing is consistent with periodontal disease. That means bacteria have moved deeper under the gums where a standard cleaning cannot reach. The good news is that we have a treatment designed for this, and addressing it now helps protect your teeth, gums, and overall health.” 

Boundary script for long-term patients:

“Even though this has not been discussed before, today’s findings reflect what your body is showing us right now. My role is to advocate for your health, and I want to make sure we treat this before it progresses.” 

Collaboration script with the doctor:

“I have identified areas consistent with periodontal disease and would appreciate your support confirming the diagnosis so we can present a treatment plan together.” 

Courage does not mean fearless, it means honest

Perio conversations are not about confrontation or boldness. They are about compassion, clarity, and unwavering commitment to patient health, even when emotions, history, or uncertainty are present. 

You do not need to be fearless. You simply need to be brave enough to tell the truth, with empathy, confidence, and integrity, in service of your patient’s well-being. 

Courage grows with every honest conversation. And that is the heart of courageous hygiene. 

Author's note: This piece is written in gratitude for the mentors who have shaped my growth as a clinician and leader. A mentor early in my career taught me the power of compassion in patient care, and my current mentor continues to inspire me through her example of courageous leadership and her commitment to building a culture of honesty and support.