Putting Together a Perio Program By Trisha E. O’Hehir, RDH, BS, Editorial Director, Hygienetown Magazine

We’ve all been guilty of performing “undercover perio” at some point in our careers. You know what I’m talking about; those “bloody prophies” on recall patients who need full-mouth periodontal therapy. In the words of Dr. Phil, “How’s that working for you?”

If you don’t have a periodontal therapy program already, it’s time to talk to your dentist, educate your office and get your team members’ full support in order to put together a program that will work for your office.

Periodontal therapy is a hot button in many offices today. The Townies, members of Hygienetown.com, have been discussing what to do when patients come in for a cleaning with “a lot of sub-g calculus,” as mentioned by Michele Moore, RDH (Townie name NHSMILEMAKER) in the message board “Non-Acceptance of Treatment.” Townie Joanna Miller, known as “Jo” on Hygienetown.com, was absolutely amazed hygienists have left behind “LEDGES of calculus” in the “Argh! Advice Please!” message board (see page 9). Based on the many Hygienetown.com discussions on this topic, help is needed to avoid treating periodontal disease during a prophy and provide the needed periodontal care. You have the skills and the knowledge to recognize, treat, and when necessary, refer patients with periodontal disease; however, not every dental office has the perfect perio program in place when you take the position.

Where do you start when you want to implement a perio program in your current work setting or fine-tune your perio program? According to Townies Dr. John McAllister, Kathy Holland and AnnieB925, you start with the Pro-Dentec Soft Tissue Management (STM) program. STM was developed many years ago by Dr. Steve Gutter. Although Dr. Gutter’s STM program is trademark protected and owned by the Pro-Dentec company, “STM” has become to perio programs what “Kleenex” is to facial tissues.

You may have experience from a previous practice you can implement, such as Townie 668Whaley in the message board called “How is your perio program working?” 668Whaley worked in an office where JP Consultants (www.jpconsultants.com) implemented a perio program. When 668Whaley moved to another office, she was able to bring what she learned at the previous practice with her.

So, where to take the first step? The consultants agree – the place to start is talking with the dentist. In order to make a practice’s perio program successful, the hygienist and the dentist need to work in tandem with one another. There is no sense wasting time and effort if you don’t have the same goals and can’t agree on treatment philosophy. Questions to get you and your dentist started are in Table 1.

Developing your philosophy and sharing it with your dentist-employer is essential for success of the program. If you’re committed to providing effective periodontal treatment and the dentist doesn’t want to upset the patients with the bad news of gum disease, there is an impasse.

Starting the conversation is sometimes the hardest task. After all, it is the dentist’s practice, so you may feel the direction should come from him or her. However, you are the periodontal expert in the practice who can contribute knowledge and experience concerning periodontal therapy. Go to the dentist with a plan in mind. Have your answers for the following questions on paper as a starting point for the discussion with your dentist employer:

• What is your ideal periodontal program?
• What is your definition of periodontal disease?
• When does a patient cross the line from “prophy” to “periodontal therapy”?
• How much appointment time do you want to treat periodontal disease?
• What instruments, equipment and adjunctive products do you want?
• How can you make this profitable for the practice?
• How do you want to present it to the patients?
• Do you want to take some courses or work with a consultant?

Michele reported that she works in an office where most of the patients get a prophy, but they still have lots of subgingival calculus. “I want to get their mouths healthy and educate them at the same time. I will recommend SRP, but if the patient is not compliant, I will still do as much as possible to remove what I can as long as I have them in the chair.” Michele’s philosophy is all about helping patients, but she’s providing undercover periodontal therapy during a “cleaning” appointment. Now, she wonders if she should alter her approach.

“…why should they [the patients] get a regular prophy when you are in fact doing two to three times the work? Don’t let the patients dictate treatment. You are the professional and you are the educated one when it comes to your patients’ oral health.”

Hygienists and dentists need to be on the same page philosophically. Either you both agree on a periodontal philosophy or you look for an office that is more in line with your thinking. Townie, Geneane Stahl, RDH tells us: “In my new office, perio [treatment] acceptance is almost 100%. I have 100% support from the DMD who comes behind me and does the exam. He backs me up and I back him up when I see something that needs to be restored. Get the dentist that you work for on your team and things will go much easier.”

When you and the dentist are on the same page philosophically, it’s time to evaluate the health of the practice. To be successful, you have to determine patient and practice health today and the goals you want to set. Consultants Cynthia Chillock, CDA, RDH and Beverly Maguire, RDH both point to data collection. With the numbers, you’ll know where you are. How healthy are the patients and how healthy is the practice? With baseline data, you’ll be able to measure your success. Ms. Chillock owns the Perio-Data Company (www.perio-data.com), with the first charting form to provide monitoring boxes to track the total number of pockets and bleeding points, and thus the periodontal health of the patient. Beverly Maguire also designed a charting form now available from Omnii Pharmaceutical (www.omniipharma.com).

It’s overwhelming sometimes to realize that perhaps a majority of your patients may need periodontal treatment. What patients receive periodontal therapy first? New patients? Recare patients?

Consultant Annette Linder (www.annettelinder.com) suggests starting the periodontal program with your team members. In order to help them understand what you do as a periodontal therapist, it’s important to be sure the team has optimum periodontal health and is familiar with the difference between “picking and polishing” and periodontal therapy. When your team has optimal oral health, you’re ready to tackle the rest of the practice.

No matter how well organized your perio program is, or the synchronicity you have philosophically with your dentist-employer, you may still run into patients whose first response is, “No.” They will have their reasons: “I’ve only had cleaning in the past, that should be good enough now,” and “If the insurance doesn’t pay, I don’t think I need it.” And some will use money as the excuse. Here’s where your psychology skills will be needed before you get to the periodontal therapy.

Following are some ideas to help the patient understand periodontal disease. This is what Townie, Anneke Wagner, RDH, BS added to the “Non-acceptance to treatment” conversation online: “Some people are ‘listeners’ and others are more visual. Props, like our perio model, that show the calculus subgingivally are very helpful, as are our brochures. Heck, the very ‘intellectual’ people really understand the whole bio-film explanation, and they like that scientific approach. Try to find out what kind of patient you have in your chair, and explain accordingly. Other times all you need [to say] is: ‘you have an infection in your mouth and we need to stop it.’”

Another hygienist posted on Hygienetown,com that she explains to patients who just want a “cleaning” the following analogies: “I tell the women that it’s like rinsing a dirty dish not scrubbing it. The men, I tell them that it’s like rinsing their car rather than using a sponge or rag to clean it. When they return and we reprobe, they see the numbers getting deeper. More often than not they agree to SRP!”

What responses have you developed for patients who only want a cleaning? Join the discussion on Hygienetown.com and post your suggestions. It’s a chance to share experiences and learn from each other. When one approach doesn’t work, change your message until you get the answer you are looking for from the patient.

You are the periodontal therapist in your office. You know what to do when you encounter periodontal disease and you’ve seen the positive results of your efforts. With education, oral hygiene instructions and periodontal instrumentation; you’ve produced amazing results. Not only did you give patients back their oral health, you changed their lives. It’s not just about plaque and calculus, it’s about giving people the tools they need to maintain their own oral health. Don’t wait another day to provide your patients with the best possible care. Talk with your dentist-employer, get your team on your side and offer patients optimal oral health.

Periodontal Therapy in Action

Trisha O’Hehir, Editorial Director
Interview with Cori Gwilliam, RDH, Hygiene Supervisor and Sandy Wilkinson, Office Manager at Today’s Dental in Phoenix, Arizona.

HT: Cori, over the last four years, you have implemented a perio program in Dr. Howard Farran’s dental office. How did you get started?

CG: Two things happened together that triggered the change. Doing only cleanings, our hygiene department wasn’t profitable, so it was decided that appointment times would be shortened to 45 minutes to increase production. Right after that, I attended a course by Bev Maguire. She began her presentation by saying the biggest mistake offices make is to shorten the DH visit instead of treating perio. Making the clear distinction between a healthy 0110 and periodontal disease was essential for us to make the change. Being a recent grad, I hadn’t yet learned the fine line between health and disease. Talking with other hygienists and learning from others on Hygienetown.com helped us develop a perio program for our patients. Knowing that Dr. Farran is big on numbers, I took my spread sheets in to explain why a perio program would be better than shorter cleaning appointments. He agreed, our program is up and running and all three hygienists in the office are happy with it. It’s a work in progress and we are always fine tuning it. Now I couldn’t work in an office that didn’t have an established perio program.

HT: Sandy, what are your thoughts about other dental offices starting a perio program?

SW: Every office should absolutely implement a perio program. Ours is awesome on so many levels. The way it is broken down by “types” enables scheduling to be done correctly; it is also very easy for the patients to understand the treatment needed and the fees. Our hygiene production has increased since the perio therapy case types were started because the fees are directly related to the severity of the case type. More and more cases are being treated in our hygiene department.