According to the Research: Periodontal Records Trisha E. O’Hehir, RDH, BS
Editorial Director, Hygienetown Magazine

Do “bloody prophies” ever show up in your schedule? Does this sound familiar––last patient of the day, arrives late, missed the last two appointments, hates to floss and thinks the toothpaste is more important than the brush. The patient has been in the practice for years, and the boss doesn’t want to upset the patient by telling him he has periodontal disease.

I understand the temptation to skip the periodontal charting and start blasting away with your power scaler. The appointment time is slipping away fast, but just this once, discard the idea you have to finish this “bloody prophy” today.

Your diagnostic skills are valuable. The information you gain from collecting six point probings, recession, mobility, furcations, bleeding points and occlusal screening can end this bloody battle. Let the periodontal records communicate your message to the patient and put an end to the “bloody prophy.” Three essential steps will provide you with valuable information and grab the patient’s attention: recognize, record, and monitor.

Recognizing disease is the first step and something the patient needs to discover himself/herself. Tell the patient you’re going to do a “new diagnostic test” for gum disease with measurements between the tooth and the gum. It is not new to you, but it may be new to him/her. And you will be doing something new with the data today––avoiding a “bloody prophy.” Explain in one sentence what the numbers mean: “Good scores are 3 or less; 4 or higher means infection.” Keep it as simple as possible.

Saying the numbers out loud, even if you have to write them down yourself, gives the patient the opportunity to connect it all with his/her own oral health. It is also a subtle and easy way to educate patients.

If you’re using a paper chart and not a preset computer program, try this approach. It’s Dr. Howard Farran’s idea, but I wish I had thought of it. Probe the facial and lingual surfaces first, and then probe the interproximals. Tell the patient you’re going to measure the “brushing surfaces” first, and then the “flossing surfaces.” This ties the numbers directly to the patient’s oral hygiene. You’ll be surprised at the patient’s interest, as he/she differentiates between brushing and flossing surfaces. It’s another way to let the periodontal records communicate for you.

The second step is recording all the data. Without written data, the periodontal exam has little value clinically or legally. The numbers are important to you, the patient, and the dentist. Record probe depths at every visit, and you’ll see the progress.

Monitoring is the third step. Tally up the total number of pockets and bleeding points. “A few 4s and some bleeding” takes on new meaning when you add them up. For example, 24 pockets of 4 mm and 35 bleeding points translates into “35 areas of infection and 24 places where the infection has increased the space between the tooth and gum.” This puts the “bloody prophy” into perspective for the patient. Now, you’ll get the questions: “What can I do about this? Can you fix this?” It’s easier and more effective to answer the patient’s questions than give him/her a prepared speech.

Monitor the periodontal records at each visit with the goal being no bleeding and no measurements over 3 mm. It’s no longer you battling through a “bloody prophy” on a patient who thinks it is normal. You, the patient and the dentist are now a team out to win the battle against periodontal disease.

There are many charts, charting systems, probes––manual and computerized, to assist you in collecting and recording periodontal information. Here are just a few of them.

Dental R.A.T.
The Dental R.A.T. (Remote Access Terminal) is a foot-operated mouse with numbers 1-8 to record probe readings. It also allows foot-operated access to any point-and-click mouse function. No assistant to record? Use your foot to enter the data. www.dentalrat.com

Florida Probe
The Florida Probe is a complete system using a constant force probe, computer voice call outs of the numbers and full color charting form and record. When connected to your personal computer, it provides a computerized probing station. www.floridaprobe.com

Perio-Data™ Charting Form
The Perio-Data paper charting form was designed by hygienists with space for four complete chartings and a unique Periodontal Health Index (PHI) Monitoring System to tally and monitor pocket totals and bleeding point totals for each visit. www.perio-data.com

PerioPal
PerioPal is a voice recognition software program, designed by a RDH, that allows hands-free periodontal charting. With this software, you can record, chart, store, and create a complete report of the periodontal exam as you do it. www.periopal.com

PDT Sensor Probe
The plastic PDT Sensor Probe makes it possible to maintain a consistent probing force of 20 grams or less. Various markings are available and the probe is safe for use on all surfaces, including implants. www.prodentec.com