As a practicing dental hygienist for over 25 years, an educator, speaker and coach; I have had the privilege of observing and mentoring dental hygiene teams. Overall, hygienists have a strong desire to do what is ethically, morally, and more importantly, legally right for our patients. However, it became clear to me that the lack of a clear periodontal soft tissue protocol, rushed clinical time and ineffective communication skills led to patients being under-diagnosed or undiagnosed with periodontal disease. It’s been reported that 1 out of 10 dentists and dental hygienists will be sued sometime in their lifetime for undiagnosed or untreated periodontal conditions.

 A recent CDC report¹ provides the following data related to prevalence of periodontitis in the U.S.:

• 47.2% of adults aged 30 years and older have some form of periodontal disease.
• Periodontal disease increases with age, 70.1% of adults 65 years and older have periodontal disease.

My mission and core goal is to coach a comprehensive periodontal protocol that the whole hygiene team can feel comfortable with as they begin to co-diagnose and treat periodontal disease at the earliest of stages. By presenting a cohesive protocol within the hygiene team and a comprehensive dental health model to all patients, our goal is to bring forth positive contributions in the way of improved oral and systemic health, increased practice revenue, and most importantly do what is ethically, morally, and legally right.

Implementation: Each hygienist will be introduced to a cohesive and calibrated patient assessment and time management process.

• Fully utilizing a comprehensive periodontal charting protocol
• The new AAP Classification staging and grading system; documentation.
• Uncovering medical history data that supports an urgency to treat and maintain their disease.
• The use of technology to increase therapy acceptance and aide in the discovery of their own disease.
• Developing a partnership of communication trust between patient, dental hygienist, and the dentist to create a committed partnership as we begin to incorporate the “why now?” ,“what now?” of treating periodontal disease.
• Develop a perio-maintenance program that enhances the patients’ ability to stay in remission.

As you can see, after coaching this team on these core protocols, they were able to provide their patients with a higher level of care. When they began to incorporate the AAP classification guidelines, they uncovered many patients that were undiagnosed or misclassified as healthy prophies. The hygienists began to implement a comprehensive philosophy regarding full mouth x-rays. (taken only 10 in the previous year compared to 350 since coaching began)  In turn, this team uncovered and treated therapeutically, 242 more periodontal conditions that previously were either misclassified, under coded, or undiagnosed. (also, important to note that a full quarter (11 weeks) of reporting was during a shut down for COVID!)

The dental hygienist communication hand off with the dentist not only assists the dentist in discovering periodontal disease, but further supports the hygienist’s co-diagnosis. Including their patient in this discovery process further edifies the urgency and necessity for periodontal therapy. We have found that if the dental team embraces the protocols and is cohesive and confident, they will have fewer patient objections and accept periodontal treatment. This office is a shining example of what a hygiene team can achieve with support and mentorship from implementing a soft tissue management program.