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Patti DiGangi, RDH, BS, believes dentistry is no longer just about fixing teeth. Dentistry is oral medÂicine. Her work helps dental professionals embrace the opportunities and understand the metrics that accurate insurance coding provides. The ADA recognized her expertise by inviting her to write a chapter in its CDT 2017 Companion book and again for its CDT 2018 Companion. She is the author of the DentalCodeology series of easy-to-read, bite-size books. Her latest book, "Teledentistry: Pathway to Pathology" was co-written with Cindy Purdy, RDH, BS. She can be reached at firstname.lastname@example.org.
Millennials balk at doing things the way we’ve always done it because they want freedom of choice in everything. They may not balk at the assignment itself but instead may challenge the methodology. A Modern Millennial Hygienist questions the same old way of charting and diagnosing periodontal disease. A Modern Millennial Hygienist knows that symptoms-disease-dysfunction does not make sense with science.
Millennials balk at doing things the way we’ve always done it because they want freedom of choice in everything. They may not balk at the assignment itself but instead may challenge the methodology. A Modern Millennial Hygienist questions the same old way of charting and diagnosing periodontal disease. A Modern Millennial Hygienist knows that symptoms-disease-dysfunction does not make sense with science. The symptoms are the last part to appear. Waiting until symptoms appear doesn’t make sense and creates unintended consequences. Why are we still so intent on perio charting? Why is this process a measuring stick of professional worth? What does charting really do?
Here are three reasons not to chart...
1. Moving biofilm around
The most significant unintended consequence, ignored by nearly everyone in our profession, is the iatrogenic vector type disease transference caused by the periodontal probe.
We have a good understanding that periodontal disease originates at a specific site so we blissfully go about periodontal charting as if moving mature biofilm from one site to others has no consequence. It does. Each biofilm is its own entity and life form. Host response notwithstanding, moving that biofilm around is disease promoting and should end immediately.
2. Measuring bone loss tells us little
Bone loss is detectable using X-rays. Only a few of us know what is considered normal. Measuring from the alveolar crest to the CEJ should be 1.5-2mm. Isn’t it important to understand what we mean by loss? Loss from where? Yet what does the presence of bone loss tell us anyway? Like a fever, bone loss tells us that something has happened, but there’s no way to tell when or how. The probe tells you there was damage in the past. That’s it.
3. Increasing hormone production
Breaking through the base of the sulcus/pocket is another unintended consequence of periodontal charting. Invading the pocket with a probe is not without consequence. It’s painful, and increases hormones like cortisol, or we’d see that it increases cortisol in our patients if we look. Damaging that intricate tissue may contribute to advancing a bacteremia, injecting pathogens right into the bloodstream. Studies have identified oral bacteria in nearly every body part, including amniotic fluid, cardiac veins and arteries, brain tissue and more.
Other options for testing diagnostics
A Modern Millennial Hygienist knows periodontal disease is a whole body disease and our diagnostics should do more than reflect a single consequence of active periodontal breakdown.
· PCR analysis: For starters, a saliva test for the pathogens known to be present in periodontal infections gives great information. PCR analysis of the bacteria present in the saliva shows whether periodontal pathogens are present. Knowing if the pathogens are present is a good starting point for treatment, and knowing they are no longer present is helpful as well.
· Inflammatory level lab tests: There are also tests available to determine inflammation levels that may be attributed to the presence of periodontal pathogens. As those values fluctuate with treatment, the clinician determines the treatments’ effectiveness.
As compared to periodontal charting where the pressure exerted, the angle of the probe, the person reading the probe and the tissue tightness all interfere with the readings; lab values do not. They give the best, most accurate and most easily repeatable information.
Our dental hygiene education taught to chart the periodontal condition using a periodontal probe, an instrument designed and perfected in the late 1800s. Today’s periodontal probes are not much different than those created more than 120 years ago. Was it ever really intended as the essential diagnostic tool we use it for today?
Get your critical thinking cap on and recommit yourself to ultimate patient health care that starts in the mouth. Regardless of your age, or what school or year you graduated, one message stands out above all else for the Modern Millennial Hygienist: Our goal is to help bring each patient to their individual highest level of health which is impossible to accomplish with a bent wire with or without markings.
Next time we will be looking at researching technology that will work for you in your office.
Editor's Note: Photo credit Gutkowski/Kinsell
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