Proper Periodontal Planning Prevents Poor Performance

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On your first day at a new office, you are probably nervous, relieved, and hopeful − all in one. You are nervous about a new environment, relieved to be done with the job hunt (and to be paid!) and hopeful about the office situation and the future.

Starting a new dental hygiene job can sometimes be like buying a new car. It takes signing on the dotted line and driving it off the lot for the truth to come out. Even if you took it for a test drive (or in our case, a working interview), there will always be topics not covered.

Your first patient is a long-time patient and friend of the doctor. “Good,” you think, “If he is friends with the doctor, his hygiene can’t be too bad.” Wrong. During the intraoral exam, you notice heavy calculus and red, inflamed gingiva. His tissue could almost bleed just from looking at it. You pull up the patient’s periodontal chart and notice the date from several years ago. While checking the patient’s chart, you observe that the patient is religious about coming in for his six month recalls.

As you update his periodontal chart, your suspicions are correct. It is a situation that unfortunately happens more often than we would like to admit, entering a practice with a poor (or nonexistent) periodontal protocol. For a hygienist, it can be hard to know how to address the situation. With many states limiting a dental hygienist’s diagnostic capabilities for periodontal disease, it can sometimes feel like hygienists have all the knowledge and none of the power.

The establishment of a periodontal protocol is not only important for the financial stability of the practice, but it is a key area of dental care.

A Conversation

A first step to setting a periodontal protocol in a practice is having a conversation. This conversation should take place between the doctor and hygienist and should be removed from the patient care setting. It is important to respect your doctor’s knowledge and hear from him or her their initial feelings about their current protocol.

Perhaps the doctor feels periodontal data collection and patient education is the hygienist’s responsibility, or maybe he or she has never truly thought about what protocol his or her office should have. Layout the importance of correct diagnosis, treatment, and coding of periodontal care. Discuss with each other the legal ramifications of failure to diagnose and how courts may determine the current protocol to be neglect.

Express to the doctor how important ethical, quality hygiene care is to you. This conversation serves as a means to get on the same page, or it can be a sign you may need to move on.

A Protocol Based on Ethics

The next step is to design a periodontal protocol. Every office, doctor, and hygienist is different in the form of protocol they want to employ, and a protocol should be found that centers on your office ethics.

As the primary data collector, it is important for you to know what your doctor defines as periodontal disease. Using guidelines from the American Academy of Periodontology can help to ensure this definition is accurate.1 Consider taking a continuing education course together to assist the development of the protocol. This can ensure both of you feel confident in your data collection and interpretation skills.

Once the doctor has decided on a protocol with your help, write it out to be kept for reference and as a record of your doctor’s standard of care.

The Implementation Plan

After the written periodontal protocol, an implementation plan should be discussed. Rome was not built in a day, and neither will a good periodontal program be implemented. Agree on the process of periodontal diagnosis in your office, and the discussions you will have with patients receiving these diagnoses.

While this may be the most difficult step, remind yourselves that you are putting the patients’ best interest at heart. A medical doctor would never place a Band-Aid on a cut requiring stitches. Likewise, we must treat patients according to their needs.

When establishing a periodontal protocol, remember that it is a dental professional’s duty to serve our patient’s needs and not their financial wants. Having set periodontal guidelines and a doctor who backs you up will give you the courage and confidence to have the necessary conversations with patients. Starting a new periodontal protocol is not always easy, but when you have your patients best interest as your purpose, it is always worth it.

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  1. Caton, J.G., Armitage, G., Berglundh, T., et al. (2018, June 21). A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification. Journal of Periodontology, 89(S1), S1-S8. Retrieved from