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How do you explain to a patient that has had a prophy for years that they have gum disease?

I recently started at a new job that I love, but had a pt. that had CL I-II mobility on #23-26 and local 5-6mm pockets with generalized mod-heavy bleeding and calculus. She had never been told that her lower front teeth had mobility.



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12 Answers

I have been in this situation a number of times and it is always difficult. I always mention that the studies show more and more the correlations between gum disease and other systemic diseases. I advise them that because of what research is showing us, we have become more proactive than in years past. I always feel it is important that the patient not necessarily question their previous care, but rather feel really confident in their current care!

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I would just tell the patient she is due for a periodontal evaluation and let her hear the probing depths . Follow up with a full set of X-rays and consult with the doctor if she is due and explain what you are finding. I sometimes let the patient try some home care techniques for a few months and then recheck her periodontal health in a few months and then explain how you want to treat her problem. Most people are open to treatment just as they would be with a new area of decay.

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That I am not sure what she has been told or that she has done in the past that I can only tell her what I see today. That I am seeing that she has bone loss that may have been there for a while but that now there is active infection present. Then I go on to explain how periodontal disease works.

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I agree with hygenious. I would also recommend that pt to a periodontist. In my office my dds trust me to make the call on who and when I want someone to go to a periodontist

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I would definitely explain to the patient that she has periodontal disease and explain the process of how it starts. Show her the radiographic bone loss and visually in the mouth. Give her a pamphlet about gum disease that she can read about and definitely refer her to a periodontist asap.

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It is difficult to tell a patient that has been seeing a dentist regularly that they now have periodontal disease. When it is my first time seeing a patient that comes from another office and presents with disease, I let them know that I am looking at them with fresh eyes. That I have patients that have stabilized and maintained but someone with fresh eyes would want to treat. That today this is what I see and this is what I recommend. Hygenious’s response is good. Explain the process of disease.

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I would let her know that you are seeing changes in her oral health. Let her know about the pro’s and con’s of having tx or delaying tx I would inform her about perio and HER health risks. Personalize what you are saying toward each pt (no cookie cutting) but also don’t let them feel alone

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I would explain they have periodontal disease. The prophy appointments are not working for her based on their probing readings, radio graphic bone loss, mobility. When mobility is involved I agree a with a referral to a periodontist. Possible splinting is needed, and check for traumatic occlusion.
I like to explain that the bacteria that causes periodontal disease is never cured rather then managed through periodontal therapy. Also a brief description of a prophy vs periodontal therapy.

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You don’t ever throw another hygienist/DDS under the bus. You can explain that she has had perio. And that maybe it was stable for awhile before they saw you. But today you are noticing some changes to active perio w/ inf. that should be treated now. You cane cola in that is normal to have to have SRP every couple of years to help maintain their perio condition

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I explain as I go what I am doing…Head and neck exam, soft tissue exam etc..when I get to probing, I show the probe and what we are looking for , then I tell them where they are TODAY and the next step. To many this is new info, be gentle and explain that since this is the first time seeing them you can only go by what your findings are today.

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I sit the pt up to have the conversation about today’s findings. I explain that perio dz is the loss of the supporting structures of bone and gum around the teeth and then go on to say what today’s perio charting and/or radiographs reveal. Then I explain the next steps and procedures to stop the perio dz , the difference between types of cleanings, and allow pts to ask questions. If they ask why no one has told them this before, I honestly say that I can only speak for what I found today and if this was my mouth, what I would do. People respect honesty. It’s never gone this far, but I have told pts to feel free to get a second opinion. Your doc should back you up, especially with that amount of supervised neglect.

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Thanks to all that answered my question. Everyone of you helped and I will be taking this feedback and explaining to my pt. what is going on.

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