The comprehensive assessment is critical in diagnosing periodontal disease

The latest statistics on the prevalence of periodontal disease in the United States are startling. The CDC states that 47.2% of adults aged 30 years and older have some form of periodontal disease. These findings are based on a comprehensive study conducted in 2009 and 2010, and published in the Journal of Dental Research, the official publication of the International and American Associations for Dental Research.

According to the findings, periodontal disease increases with age, with 70.1% of adults 65 years and older having periodontal disease. The condition is more common in men than women (56.4% vs 38.4%), those living below the federal poverty level (65.4%), those with less than a high school education (66.9%), and current smokers (64.2%). The classification of disease used in this study does not include gingivitis.

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As eye-opening and indisputable as these figures are, I hear from many hygienists who insist that the majority of the patients whom they treat do not present with periodontal disease, other than gingivitis. A common refrain from these hygienists (and doctors) is, “There is just no perio in our office.” Most of these clinicians site the high socioeconomic status of their patient pool, coupled with the high dental IQ of their community, as being the reason so many of the clients are “healthy.”

However, upon closer inspection and record auditing, we often find that many patients do in fact present with disease. The disconnect is that disease is not being recognized and classified as such. Unfortunately, proper treatment planning to treat existing disease is not being done as a result.

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How does this happen?

Even the most talented and experienced clinician will often overlook disease if the proper assessments are not being performed. In the busyness of the day, we can skip the critical assessments that enable a correct diagnosis. Some clinicians consider X-rays and a tour of the mouth a “comprehensive assessment."

While I completely understand how stretched clinicians are for time, there is just no definitive way to know if periodontal conditions exist without periodontal charting that includes identification of bleeding points. Bleeding is the first sign of disease, with pockets forming in later stages. Once bone loss is present on radiographs, it is too late to reverse the course of the destruction.

New patient and recall exams should have enough time built in to allow a comprehensive periodontal assessment if we are to avert and arrest disease. Time to educate patients on their condition, the course of treatment, and the proper home care routine should be included as well. With the prevalence of disease being what it is, it is advised to schedule 90 minutes for a new patient exam, and at least one hour for recalls.

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In terms of “not having any perio” in the office, clinicians are advised to brush up on the risk factors for periodontal disease. In addition to comprehensive assessments, risk plays a prominent role in disease progression, but is often overlooked. Consider the risk factors:

• Smoking

• Diabetes

• Poor oral hygiene

• Stress

• Heredity

• Crooked teeth

• Underlying immuno-deficiencies-e.g., AIDS

• Fillings that have become defective

• Taking medications that cause dry mouth

• Bridges that no longer fit properly

• Female hormonal changes, such as with pregnancy or the use of oral contraceptives

Many, if not the majority of our patients present with one or more of these risk factors.

When they begin to properly assess, many clinicians find their percentage of periodontal cases coming more in line with current statistics. Not only are patients being properly treated with the most conservative measures available, but practice revenue increases concurrently.

Author's Note: Are you ready to improve the periodontal care you provide in your office and increase hygiene revenue? Contact us today at hello@enhancedhygiene.com to learn about our onsite or virtual training programs.