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    The clinical procedure that can make or break your career

    Being able to recognize and diagnose periodontal disease is critical for hygienists.

    Periodontal disease is the Goliath of oral healthcare, and every hygienist knows the signs. But with the recent discoveries on the causal link between oral bacteria and heart disease, stroke and Type 2 diabetes, it’s more important than ever to detect active infections in the patient’s mouth. And that goes beyond what hygienists normally do with periodontal probing.

    Non-surgical periodontal therapy is the clinical procedure that can make or break a dental hygienist’s career. More specifically, it’s “the ability to recognize, diagnose and treatment plan periodontal disease accurately and with a proposed treatment plan that is in the best interest of the patient,” says Kim Miller, RDH.

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    Miller says that hygienists’ first inclination when it comes to diagnosing periodontal disease should be to pick up a periodontal probe. And while that’s the right inclination, many hygienists fall short of what they could be doing when they only use the probe to measure pocket depth. Bleeding upon probing is typically recorded on the perio chart, but recession and furcation involvement are often left out.

    “They’re not looking at vertical attachment loss, which is the combination of recession plus pocket depth,” she explains. “That tells us the total loss of attachment that the patient has had. If we’re only doing pocket measurements and we’re not looking at all of those other factors, they’re not going to have the correct case type applied to that patient.”

    Miller references the first comprehensive book on dental hygiene, Esther Wilkins’ “Clinical Practice of the Dental Hygienist,” as the go-to book for many RDHs.

    “Esther has something called a gingival index in that book, but the translation for me is tissue response,” Miller says. “Esther asks us to use our periodontal probe and do a circumferential stroke around the tooth, including accessing the gingival col, which is not keratinized.”

    The typical non-keratinized col is more susceptible to infection. Miller explains that even if a patient’s tissue doesn’t bleed upon probing, bleeding from the epithelial lining around the sulcus or in the gingival col would indicate an active infection in the mouth.

    Miller says clinicians must be able to tell the difference between bleeding upon probing and bleeding upon tissue response.

    “Bleeding upon probing means when I touch the attachment at the bottom of the pocket with my probe, it’s red,” she says. “Bleeding upon tissue response means that when I gently do a circumferential stroke around the tooth with my probe, the wall of sulcus or the gingival col bleeds when I stimulate that area.”

    It’s important to make the distinction because they are two completely different things, she adds. A bleeding response to either stimulus indicates an active infection in the patient’s mouth.

    While it’s obvious why recognizing and diagnosing periodontal disease is crucial to a hygienist’s career, there is a larger aspect of this disease. While attention on the oral-systemic link has been growing in recent years, it was only within the last year or two that the connection between oral bacteria and other diseases in the body was proven.

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    Dental hygienist“Those bacteria escape into the bloodstream and cause myriad of inflammatory conditions that will increase a patient’s overall inflammatory burden, increasing their risk for heart attack, stroke, Type 2 diabetes and the list goes on,” Miller says.

    This link is what makes Miller so passionate about diagnosing and treating periodontal disease. She encourages hygienists to accurately measure those pockets, record the data at least annually for each patient, and then evaluate the patient for bleeding in the sulcus and the gingival col area. That extra step ensures that clinicians aren’t missing any active infections in the patient’s mouth.

    “I find that, for the most part, hygienists are not doing as much as they need to be doing to accurately diagnose the periodontal infection,” she says. “And if we don’t accurately diagnose it, then we can’t create a treatment plan.”

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