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Debbie Seidel Bittke

What Do We Say When a Routine Hygiene Patient Has Periodontal Disease Today? (PART 1)

What Do We Say When a Routine Hygiene Patient Has Periodontal Disease Today? (PART 1)

11/16/2018 6:09:03 AM   |   Comments: 0   |   Views: 75

Part I:

Most hygienists see approximately eight patients in an eight-hour day.

Not all of those patients will be healthy.

Most hygienists will report daily one patient (Some days more) with gingivitis and at least one patient will be diagnosed with periodontal disease or they are returning for scaling and root planing.

The question and challenge many dental practices face is when a routine hygiene patient returns six months later and now they have gingivitis or worse, periodontitis.

What do we say when a routine patient has periodontal disease?

In Part I, we will discuss what to say to this patient.

What we must tell our patients whenever they have an abnormal condition in their mouth is…the truth.

How we say this is a different story.

This is where clinicians feel challenged.

What will make this challenge much easier is bringing the patient into a partnership to help make the diagnosis.

How you will bring your patient into the partnership:

Step 1: Rapport

The first 90 seconds of your patient appointment must focus ON your patient.

Get to know your patient and if you do know your patient get re-acquainted.

Ask about their weekend or what they are going to be doing this summer, Christmas, etc., etc.

The purpose is to make your patient feel like a valued human not a mouth.

Your appointment is not about making money it is about helping your patient live a longer and healthier life.

“We are in the business of saving lives.”

Step 2: Inform

Before you put a bib on your patient or lay them back in the chair, inform your patient about what services you will complete.

Explain what you will be looking for and what they can expect to see, feel and/or hear you say.

What will you say to your patient?

Here is a short example:

“Mr. Smith, today you are here for your routine preventive care appointment. Doctor has also asked me to take x-rays of your teeth. After I take a few x-rays I will look for any abnormalities. I will check your tongue, cheeks, floor of your mouth (continue explaining about the oral exams you check at hygiene appointments) and I will use this ruler with millimeter markings to check the health of your gums. If you hear me call out 1,2 or 3, this means your gums are healthy. If you hear me call out a 4 or higher that means you have inflammation and infection in your gums. If you hear these higher numbers, we will create a plan to get your gums healthy. I want you to listen to these numbers closely because when I am finished measuring I will ask you, what is the highest and what is the lowest number I called out?”

I have been hearing clinicians say, “I will poke your gums.” True story. And I also hear, “This may hurt a little.

”Of course, it will hurt if you tell them they may feel pain!

The message here is; don’t set your patient up to feel pain.

After you explain what you will be doing during the hygiene appointment, now you put the patient bib on and lay them back in the chair to begin your exam and assessments.

Step 3: Create a partnership with your patient

Once you are finished with your assessments and you have gathered all of your information, sit your patient up in the chair.

Have your periodontal chart, x-rays and digital photos in front of the patient so you can show them what you saw in their mouth during your exam.

With pictures in front of the patient, ask them about the numbers you heard you call out. Remember, you asked your patient to tell you the lowest and highest number you called out?

Usually when patients hear numbers that they know are not good, they will let you know they the numbers did not sound good.

Once your patient is able to tell you what they heard, your job becomes much easier when you need to tell them what you saw in their mouth.

This is where it takes away any negative challenges you may have with telling your patient they have periodontal disease.

Why is it that if we have a mammogram, the doctor will tell the patient if they see an abnormal area on the x-ray?

What does a doctor tell their patient they have a polyp during a colonoscopy?

Does a dentist tell patients when they have a cavity?

I believe you said “Yes,” to all of the above questions so my question now is this, “Why are you uncomfortable telling your patient they have periodontal disease or maybe you don’t want your patient to know they have gingivitis today?”

Let’s reverse these above scenarios.

You have a mammogram and the doctor is concerned you won’t return because they told you about the abnormality on your x-ray.

You had a colonoscopy and the doctor found a polyp, so they left it there concerned you would not be happy if this is present inside your colon.

You see tooth decay and don’t want your patient to be concerned it will cost them a lot of money to fix this or you think their insurance benefits are maxed out and the patient would have to pay for the restoration.

How does this make you feel?

Are you cringing?

I think you are reading this and not in agreement that the doctor would not tell the patients about the abnormalities, the polyps and areas of decay.

It is the same exact thing with periodontal disease and gingivitis.

If we do see this for the first time or maybe it is not the first time, but we must tell our patients what we see.

We must create a partnership with our patients and bring them into the decision-making process.

Who are we as dental professionals to choose if our patients can afford treatment for gum disease?

Who are we to withhold this valuable information?!

Let’s remember, we are in the business to help our patients live a longer and healthier life.

It is not up to us to decide which treatment our patients may not want to schedule and pay for.

Let’s leave the final decision up to our patients.

Our role is to understand how to best deliver this message.

Step 4: What to say when you discover disease?

When you are completing the comprehensive periodontal exam (CPE) if you have told your patient what to listen for and if you ask your patient to tell you the numbers they heard you call out, it takes away a lot of the explaining what is needed.

Most patients will know what is happening in their mouth if you have prepared them.

When you are explaining what you see with your patient, make sure to sit near your patient.

Notice that I write the word, “sit.”

If you patient is lying back in the chair and you are talking to them, know that their brain is jumbled.

If the patient is seated upright in the chair, they are thinking clearly, and you can effectively communicate.

Use words your patient will understand for example, gums not periodontal.

Say words like “infection, inflammation, bleeding, pus, swelling, preventive care, gum therapy, gum treatment, routine maintenance of your gums, etc.


Today’s world of dentistry provides great knowledge about the mouth-body connection.

As we evolve and grow our dental practice understanding what will keep our patients returning to our office is key to our future success.

If you share the truth with your patients showing them what you see, it will most likely come across as “caring.”

Most patients will believe what they see.

Never be afraid to speak the truth.

If you don’t feel comfortable telling your patient what you see, when they do choose another dental office and find out that you did not tell them the truth about their oral disease, how will they feel about you?

Sure, you were not comfortable telling your patient they have infection and disease, etc., but how will you look if another dentist does tell them and your patient of the past ten years learns you never told them the truth about their oral condition?

What will your patient think now?

Return to our blog site next week for Part 2 when I share more of the research, the science and what the American Academy of Periodontology says about gum disease.

Do you or your team member(s) struggle with the “what to say when a routine hygiene patient has gum disease or gingivitis? Not sure how to sequence treatment for gingivitis? We are here to help! Just give our office a call or email to schedule a call so we can explain how we will help you with this bump in the road. We will also provide AGD CE Credits with your training (in-office or web-based). Just ask us how it’s done: email: admin@dentalpracticesolutions.com or Call our office: 949-351-8741. You can also schedule your session to find out more about this here.


Debbie Seidel-Bittke, RDH, BS, is one of Dentistry Today’s top dental consultants.  She is an international coach, speaker and author. Debbie is the CEO of Dental Practice Solutions. 

Debbie is a world-class leader in creating profitable hygiene departments. She is a well-known as a former clinical assistant professor at USC in Los Angeles and a former hygiene department program director. Dentistry Today recognizes Debbie as a Leader in Dental Consulting.

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