A new focus

July 1, 2005
When I graduated from our local dental hygiene program 22 years ago, I thought that I had a clear picture of what my career would entail.

When I graduated from our local dental hygiene program 22 years ago, I thought that I had a clear picture of what my career would entail. I quickly settled into my job with a progressive general dental office. My employer was generous, and my co-workers and I became fast friends.

I was excited about dental hygiene for the first few years, but, like many of us in this profession, I found that the job could be physically demanding and things began to feel very routine. Schedules back then were packed full of back-to-back prophys. After several years of doing the same thing day in and day out, I was becoming disillusioned, and I’m sure that it showed.

My employer brought a consultant into our practice to implement a perio program and we welcomed the change. I found that I truly did enjoy treating perio and had a knack for motivating my patients. And while that seemed to help for a few more years, eventually I found myself becoming somewhat apathetic again. I took only the minimum amount of continuing education required to maintain my license. I routinely tossed the publications relating to our profession into the trash each month without trying to glean any pearls of wisdom from them. I never perused the Internet for new research information relating to our field, despite the rapid changes occurring in the diagnosis and treatment of periodontal disease.

I had become part of the problem.

How did I move from such complete apathy to developing a true passion for my work?

I owe it all to “Dan.” I can still vividly remember this patient who inspired me to set my path on a different course. Dan came to our practice as a new patient, having relocated from a college town in southern Indiana. He was in his early 40s, well groomed, and very articulate. He brought his most recent radiographs with him that day, which, unfortunately, consisted of only four bitewing X-rays. His previous dentist had never taken a panoramic or full set of intraoral films.

After going over his medical history and taking a full set of radiographs, I explained that I would be performing a full periodontal charting. I gave him a brief description of what I would be doing, and what numbers he should be listening for. He was curious about the periodontal charting and informed me that he had never had one performed on him before.

Dan’s oral hygiene was fairly good, and nothing looked alarming visually when I started the exam. I was probing along smoothly, calling out numbers in the one to four millimeter range when it happened - my probe dropped into a deep pocket on the mesiofacial of tooth #10. I repositioned the probe several times to make sure that the reading was accurate. I reluctantly called out the number “nine” to the assistant recording for us. Dan’s eyebrows shot up, and I could see the look of concern on his face. I calmly finished the exam, finding no other areas of significant pocketing.

As I do with any patient who needs an explanation of periodontal disease, I sat Dan up so I could talk to him face to face. I showed him a typodont model depicting bone loss, explained my findings, and gave him some literature to read. By this time, the assistant had mounted the X-rays on my view box, and it was apparent that there was, for whatever reason, a deep bony defect in this area. I knew that the doctor would recommend a referral to a periodontist for a surgical evaluation of this area, so I began prepping Dan for that recommendation by explaining what the periodontist might recommend.

Throughout it all, Dan asked straightforward, intelligent questions, and seemed genuinely concerned and interested in the condition of his mouth. I left the room to go tell the doctor what had been discovered, and that we were ready for an exam. When I came back to my room, I began quietly making notes in Dan’s chart while he read through some brochures on periodontal disease.

And then he asked the question that forever changed my life and outlook on our profession.

“Can you answer something for me?” Dan asked quietly. I stopped writing and gave him my full attention.

“Can you explain to me how, in the nine years that I’ve been seeing my other dentist every six months, no one has ever performed that screening test or taken that sort of X-ray to find this problem?”

I considered trying to make excuses for his previous dentist and hygienist. After all, I had made up excuses to smooth that question over countless times with new patients to our practice who have never received a periodontal screening.

But this time, for some unknown reason, the question stopped me cold. This was my “light bulb” moment. I was tired of trying to come up with excuses. The truth is, with over 70 percent of general practices still not performing regular periodontal screening on their patients, there really isn’t a legitimate excuse that I could offer this man.

So I took a breath, looked Dan in the eyes, and very gently and sincerely answered, “Dan, I really can’t explain why.”

Was he angry? I’m sure he was. I know that I would have been. Faced with potentially thousands of dollars in treatment to try to save his anterior tooth, he had every right to be bitter about not being diagnosed at an earlier, less expensive stage of the disease. I remember thinking, “This is crazy. Something has to change.” And that thought has never, in all of the years since that day, left my mind. If anything, my conviction about this has only grown stronger with time. So I decided to somehow devote my career to trying to initiate a positive change for patients when it comes to learning about their periodontal condition. It has become my passion to try to help as many patients as possible find their way to having the true health of their mouth evaluated.

I relate this story because it left a deep impression on me. Our patients put their faith in us every time they take a seat in our chair. They trust us to do the right thing, and keep up on recent research as well as diagnostic and treatment recommendations in our field. They assume that if they had periodontal disease, they would have been told about it. Right? Not necessarily. I recently read an estimated 80 percent of people with periodontal disease in the United States today are completely unaware that they have it! I’d like to say that this is the case because all of these people aren’t visiting their dentists regularly. And while that is true for some of these people, just as many of them actually are seeing their dentist regularly.

And when they do, they invariably receive a “routine prophy” while never having their periodontal condition evaluated. They are told that everything looks fine, and are then scheduled for another “prophy” in six months. It’s an endless cycle of neglect.

Pick up a newspaper, or just type the phrase “periodontal disease and heart disease” into your Internet Web browser, and see what pops up. I sit back and marvel at the incredible body of research being conducted in this area.

Shifting our focus

So what does that mean to us as dental professionals? It means that our hygiene departments need to shift the focus from “cleaning teeth” to evaluating levels of disease. We are actually on the front line of diagnosing a problem that has a profound impact on a patient’s total health.

What a huge responsibility! It’s certainly much more than I envisioned when I decided to learn to “clean teeth for a while” 22 years ago. So are we, as a profession, stepping up to meet this challenge and shoulder this important new responsibility? If not, why not.

Can you imagine going to your physician for a checkup and never having anyone put a blood pressure cuff around your arm to screen for hypertension? Of course not! We expect our physicians to keep up with new research and treatment trends in health care. We should expect no less of ourselves in providing dental care for our patients.

I urge all of you to take a hard look at your hygiene department. Work together with your office team to find a way to make sure that patients have regular periodontal screenings performed. This may mean attending appropriate continuing education, tweaking your appointment schedule times, assigning team members, or investing in technology tools to help with periodontal chartings. Develop a written protocol for how your office will handle your patients’ periodontal screening and treatment. Work on coming up with consistent diagnosis dialogue and patient education tools when presenting your findings.

If you can’t accomplish this goal on your own, consider bringing in a consultant to facilitate the change. We most certainly are capable of pulling consistent programs together ourselves. However, we are often so busy just trying to keep up with our schedules that it is difficult to make these sweeping changes on our own. That is where having someone come in to ease your office through the transition can be valuable.

So I say, let’s all commit to not letting another day go by in which a patient’s periodontal disease diagnosis “slips through the cracks” while we’re focused on “cleaning teeth.” Pay attention to the red flags; have we become resigned to the bleeding that our patients exhibit during their “cleanings”? Are there no regular periodontal chartings in the patients’ records? Are there notations about “watching” inflammation or pockets in our patients’ mouths? If so, these are clear signals that we aren’t living up to our legal and ethical obligation.

A change is needed, and we can lead the way!

Diane Sharp, LDH, has more than 22 years experience in the dental profession. She is the founder of Perio Focus, Inc., a consulting firm that provides education and support for general practices wanting to establish nonsurgical periodontal therapy programs. In addition, she serves as a hygienist educator for OraPharma, Inc., the manufacturer and distributor of Arestin and Oraqix. She also provides training on the Florida Probe System, a computerized constant force probe for periodontal charting. She can be reached at (317) 313-5441, or at [email protected]