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Periodontal disease

Is it me or does it seem that a lot of patients out there aren’t aware that they have periodontal disease? When I see new patients with 5 mm pockets on most posteriors teeth, detecting radiographic bone loss, and I tell my patients they have periodontal disease, they become shocked or report never hearing such a thing from their previous dentist.



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9 Answers

I often hear from new patients they have never been told about their “numbers”. That being said I wonder how much our patients really hear what we are saying during their appointment. I try whenever possible to explain periodontal disease by comparing it with things most people can understand and relate to.
One example that makes sense to patients is comparing our mouths to a house with our periodontal health as the foundation and the teeth are the house. You cant fix the house if the foundation is bad. You will be amazed how that analogy turns on the light bulb! Especially for men! Another that really gets attention is explaining our teeth have 5 sides and brushing cleans 3 sides or 3/5 leaving 2/5 that can only be cleaned with floss or interdental brushes. This works well with kids too as they understand that brushing only cleans just over half of our teeth.
Patients get overwhelmed with too much info so feed them little bits and they will listen.

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I also see a lot of patients who have no idea what periodontal disease is at all or that they have it. Unfortunately I think part of this stems from the fact that many dental offices do not allow the hygienist to fully practice hygiene and inform patients fully. Many patients I believe are falling through the cracks with just a routine prophy at every visit. Some offices still do not have a hygienist and the doctor does a “prophy” in between treatment. Most of my patients usually say that I have been so thorough and they have never had a good cleaning like that:( It really boils down to patient education and the dental community ALL having the same standard of care!

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Periodontal disease today is still one of the highest undiagnosed conditions in the American Adult population. Over 60 million adults have periodontal disease. Quite often we have to educate our patients more than once because we give them a lot of information. What has helped me is to have the patient visually see the perio chart with bleeding &;bone loss on the X-rays. Patients are visual & the more we show them the better they grasp the information. Also I changed my verbage to “you have active infection & for me to treat you appropriately I will nee to implement root planing followed by more frequent recalls.

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I think perio is a really vague thing to most people, they don’t really understand the concept. I also find lots of people with 5 mm posterior pockets who don’t recall anyone ever telling them before that there was a problem. I’m thinking that there’s at least a chance that it was presented to them in the past but maybe in a less definitive way like, oh, you have some pocketing, you should floss more, or something along those lines and the patients don’t put two and two together the next time they go and hear they have the beginnings of periodontal disease.

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In my 28 years as a hygienist, I have worked with doctors who are ultra conservative, to ultra preventative. Some may jump right in and treat the 5mm pocket with Arestin and/or scaling and root planing, others feel it’s best to monitor the area unless it changes for the worse. Overall, I think many hygienists try to inform their patients of their periodontal conditions, however, may patients refuse treatment, and so we do the best we can. I just take really thorough notes and document verbatim when the patient refuses treatment.

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This is a frustrating phenomenon. I always show the patient radiographs and intra-oral pics to help them understand. I also always send them home with a perio info pamphlet so they can review what I have said.
As clinicians, we only have control of our care of our patient and I feel education and info is very important.

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It’s difficult with new patients who have been neglected but think you are just trying to rip them off! I was yelled at by a man who was going to lose his teeth because the previous DDS of 40 years never addressed his perio disease. I was so upset he would think I wanted to steal from him, when all I cared about was his health.

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I think some patients are not diagnosed correctly. Some patients probably has been told before and forgot.
Scenario 1:
Diagnosed Perio type III, gave three pamphlets [Stages of Perio disease, What is Scaling and Root Planing, What is Perio Maintenance], completed S/RP all four quads. 6-8 wk re-eval 4910. Then mailed letter explaining after srp’s we shift to maintenance phase and why it is important to maintain 3-4 month continued care intervals etc…. Comes back for 3 month maintenance therapy and when I was finished and was rescheduling they ask : I Don’t have that gum disease do I?

Scenario 2:
New patient.. Has 5-6mm posterior pockets, 23 years old, has history of regular 6 month hygiene appts. Heavy sub and mos supra calc, heavy hemo during probing. Handed out the above pamphlets. Schedule S/RP……she cancels because she went for a second opinion, but did not want to tell us what the second opinion was, but gave us a horrible online review that said we had told her she drank too much soda and had 5 cavities and had gum disease. Her second opinion told her she did not have any cavities and only one area that they will watch that has a little gingivitis.

Lesson learned: I take intraoral photos of all quadrants with the Perio probe inserted into the 5mm + pockets. I know I couldn’t respond to the online review, but a picture speaks volumes!
You never know what the previous dentist/hygienist discussed or diagnosed with patient. We are telling them what we see as of today. Still irks me that offices aren’t very consistent and the patients can and will find another office that will tell them what they want to hear and ultimately “Just clean their Teeth”

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I’ve worked in all types of offices…including offices where nobody picks up a probe, charts, or informs about perio…as hyg its our job to detect…Dr’s normally are just not probing…its what WE do…I’ve had patients completely unaware of any perio and now with mobility on first time seeing me…I’ve had healthy patients tell me “wow, never had a cleaning that thorough before”…listen we can only control what we can control and what our offices demand…some are super lax in this area and some micro manage everything we do…forme, I educate in a diplomatic fashion on the desease present…if im in a lax office I push that perio referral…and I treat to the best of my ability…sure some patients dont care and wont go to perio…I adjust my own tx to their wishes but never leave them anything but fully informed….I also have no problem suggesting a consult with a specialist and dish out all my recommendations etc before the Dr even comes in the room…its harder to poo-poo it if I’ve fully educated and prepared the patient…tx from there is up to Dr and client but I fully invest myself to their care…and they fully appreciate both the knowledge and the detailed care…

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