by Karen Davis, RDH, BSDH
For a patient who just walked in the door to have their teeth cleaned, wouldn’t you agree that there is a vast difference in the term "periodontal infection" vs. "gum inflammation"? One phrase generates a sense of urgency and the other implies "no big deal." I have found that the selection of certain words by dental team members is critically important to convey a clear message to the "unsuspecting" periodontal patient.
Patients with varying degrees of periodontal infection in their mouths simply dismiss bleeding gums as being commonplace, or are simply unaware of it due to a lack of noticeable symptoms. What we say, and how we say it holds a lot of weight in opening a patient’s eyes about the potential seriousness of periodontal infection. Without continuity in how team members discuss periodontal care, patients can end up confused or simply apathetic. The following are power words or phrases intended to create continuity among team members and increase our patients’ understanding.
Active periodontal infection is a more accurate description of the periodontal disease process than "gum inflammation" and should be used to describe generalized gingivitis, and local or generalized periodontitis. A patient may develop "gum inflammation" as a result of biting down on a hard bagel and causing temporary injury to the tissue. You will find that when you refer to disease in the mouth as "active periodontal infection," few patients are willing to just ignore it, especially if they are shown areas in the mouth where tissue hemorrhages easily upon gentle stimulation. Healthy tissue does not bleed, and that is a message team members must repeat to patients on a regular basis.
Periodontal therapy is preferable semantics to use when talking to patients rather than "deep cleanings," "scaling and root planing," or "quad scales." What takes place is a therapeutic treatment and all other semantics used to describe the procedure either sound really unpleasant, or are somewhat inaccurate.
During periodontal therapy, removal of the pathogenic biofilm often comprises more of the actual treatment than root planing itself, and the broader description encompasses all that is required to create an opportunity for healing to occur in the diseased periodontal pocket.
Permanent bone damage, as opposed to the common description of "bone loss" when viewing patients’ X-rays will almost always elicit raised eyebrows. The term, by the way, is accurate. It is the jawbone, and the damage is permanent. Even though bone density and sometimes lamina dura can improve dramatically following meticulous periodontal therapy, varying degrees of bone damage are permanent.
Daily disease control to describe the patient’s role in preventing and managing disease is preferable to the words "home care," which has the connotation of dreaded homework. We want our patients to take ownership in their role every day to control disease in their mouths, so referring to it as "daily disease control" communicates clearly that the patient has an ongoing role in their disease management.
Closely-monitored interval, or customized interval are powerful phrases to remind patients that management of periodontal diseases requires careful assessment and monitoring throughout their lifetime. The recommended interval should be based upon the patient’s risk factors and clinical condition, and it may be extended or shortened based upon assessments done each visit, even though the majority of periodontal patients will require a "closely-monitored interval" of periodontal maintenance every three months to prevent disease recurrence.
Achieving optimal clinical results, as opposed to "reduced pocket depths," should be the goal of active therapy. Even though reducing pockets from 6 mm to 3 mm is certainly desirable, if pathogenic biofilm is still above a threshold level and tissue is bleeding in a 3 mm pocket, optimal results have not been achieved and the risk of re-infection is high.
The goal of achieving "optimal clinical results" encompasses a reduction and or elimination of risk factors, patient compliance in daily disease control, and establishment of clinical signs of tissue health as evidenced by a lack of bleeding, decreased pocket depths, and healthy tone and color of the tissue. Obviously, the earlier in the disease process the patient is diagnosed and treated, the more realistic it is to achieve this goal.
Disease remission is a phrase many are familiar with to describe the goal of treating cancer, but establishment of disease remission should also be the desired outcome of treating active periodontal infection. One definition of remission states that it is "the absence of disease activity in patients with a chronic illness, with the possibility of return of disease activity." Doesn’t that describe our periodontal patients?
Administrators have opportunities to use these power words when patients attempt to cancel a scheduled periodontal maintenance visit. They should simply say to the patient, "John, I know Cindy recommended this closely-monitored interval to keep disease in remission. Extending your appointment out another month or two might put you at risk of reinfection. Is there any way you would be able to rearrange your schedule and keep this appointment?" Even if the patient cannot keep the appointment, the deliberate use of power words reinforces the ongoing purpose of the periodontal maintenance visit.
"Insurance assistance" or "insurance benefits" are power words that convey what dental insurance really is. The word "coverage" implies complete. Period. It has the connotation that insurance pays all and the patient pays nothing! When dental teams commit to effectively treating periodontal diseases, it is quickly apparent that dental insurance plans are not written with disease remission in mind. They are more similar to what you might see for "catastrophic care." The greater the amount of permanent bone damage; the more likely the patient will receive insurance assistance. For patients with generalized gingivitis – absent of bone damage – or patients with very localized areas of active periodontal infection, they often find that it becomes an out-of-pocket expense to treat their disease. The sooner we can eliminate the words "insurance coverage" and replace them with the words "insurance assistance" or "benefits" which are much more accurate, the sooner patients begin to feel freedom to make health decisions independent of dental insurance.
Effective communication is a process that needs to be enhanced, modified, and rehearsed with regularity. As science and technology change, so should the way in which we educate and motivate our patients through the spoken word.
- Establish team continuity in the deliberate choice of words or phrases (such as the examples in the article) that give added clarity in periodontal communication.
- Decide as a team which words to avoid or eliminate from your communication – words that fail to enhance the patient’s understanding and may even add to the confusion about oral health.
- As information changes, continue to identify power words and phrases that create a sense of urgency for the patient to take ownership in their health.
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. and serves on the review board for Dentalantioxidants.com. She can be reached at [email protected].
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