How Do I Assess Gingivitis? At Every Appointment AND Time Saving Tips

Duration: 15:22 2843 transcript words EN summary

Video summary

The video emphasizes that a comprehensive assessment of gum disease must go beyond simple periodontal probing to include a detailed visual inspection of the gums at every appointment. The speaker argues that while dental professionals often notice visual cues such as gum color, texture, and swelling, these observations are frequently not recorded in patient charts or discussed with the patient. Instead of treating visits as routine cleanings where minor plaque issues are dismissed with a quick recommendation to return in six months, practitioners should conduct a full evaluation that considers factors like plaque distribution, recession patterns, and whether redness is localized or generalized. This thorough approach ensures that patients understand the specific nature of their condition rather than receiving vague advice that fails to address the root causes or progression of the disease. To facilitate this detailed assessment, the speaker shares personal practices involving the use of intraoral cameras to record videos of all four quadrants before cleaning begins. These recordings serve two critical purposes: they allow for the detection of minute details like tiny black spots or subtle discolorations that might be missed by the naked eye, and they provide a visual record to compare against future visits. Since human memory is fallible, especially when seeing many patients daily, documenting findings with videos and notes ensures continuity of care. The speaker also demonstrates how to verbally communicate these findings in real-time during the cleaning process, calling out tooth numbers and specific conditions like heavy plaque or gingival recession so that patients can hear and understand their oral health status immediately, rather than waiting until after the procedure is complete. Effective communication with patients involves explaining the clinical diagnosis using both technical terms and simple language to ensure they grasp the severity and reversibility of their condition. The speaker illustrates how to differentiate between localized and generalized gingivitis, showing patients visual evidence via intraoral cameras to make abstract concepts concrete. For instance, if a patient has dry mouth due to medication or poor hygiene leading to red, shiny gums, the practitioner should explain that while some conditions may be manageable but not curable, active gingivitis is reversible with improved brushing habits and regular maintenance. By presenting solutions alongside the diagnosis—such as recommending salt water rinses, adjusting toothpaste types, or scheduling three-month recalls instead of six—the provider empowers patients to take action before the disease spreads and becomes painful. Ultimately, the video concludes that taking the extra time to perform a full assessment and engage in meaningful dialogue during every appointment is essential for providing high-quality dental care. Although working in a busy office setting may make it challenging to extend appointment times, practitioners should utilize their existing time efficiently by integrating education and explanation into the cleaning process rather than reserving it for a post-procedure chat. This method not only prevents wasted time but also significantly enhances patient trust and satisfaction, as patients appreciate feeling cared for and informed about their specific oral health needs. By consistently documenting changes, explaining diagnoses clearly, and offering tailored treatment plans, dental professionals can effectively manage gum disease and foster long-term oral health for their patients.

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[music] Let's go over all about gum disease today. What we're looking for in our patients mouth, how do we talk to our patients about what type of gum disease they have, how are we going to treat it, and the importance of the assessment. So, I'm not just talking about the periodontal probing here and how important it is to check the pockets because otherwise, how do we know if there's bone loss? How do we know if there's periodontal disease? But I'm talking about all the different assessments. Quite often I find dental professionals aren't just going back to square one. They're not going back to stage one. And that's looking at the gums. What color are they? Are they pink, red? Are the gums bulbous? Are they shiny? Is the inter dental pill stippled? Is it going to be swollen? So all of that I find dental professionals are seeing that. We know it's there, but nobody's writing it in the chart. So when we're talking to our patients, it needs to be so much more than you're in for a teeth cleaning today. Um, let's get started. And then after the teeth cleaning, say there was a little more plaque than usual. Okay, here's a new toothbrush. We'll see you in 6 months or we'll see you in 3 months. It needs to be so much more than that. what I do personally in my own practice. So, I'm a mobile dental hygienist that goes into nursing homes, but I also see all types of patients in their own homes. They don't have to have a mobility issue, but it could be a family with four kids that likes to be seen in their home, so they don't have to go into a dental office and wait one by one for everybody to finish. So, I see all kinds of people, young, old, middle-ag, I see everybody. And what I personally do is I do the full assessment at every single appointment. And I explain everything to the patient at every single appointment. My teeth cleaning appointments aren't 30 minutes. They're going to be at least an hour, if not two hours, depending if it's a new patient or not. And that's not including my setup time and cleanup time. Being a mobile dental hygienist, we do have to set up everything in the patient's home. So, what I want you all to do when you're looking at gum disease, first and foremost, we can't tell the patient what type of gum disease they have until we look inside the mouth and we do the assessment. The first thing that I notice are the plaque and calculus levels. Do they have a lot of plaque? Do they have just a little bit of plaque? I'm going to make a note of that. Is it a little bit of plaque everywhere or is it more localized to the right hand side because maybe they're not brushing the right hand side as best as they could because they're right-handed and you tend to brush better on the left hand side, right? So, I'm going to be looking at all of that. But then after I look at the buildup, I'm going to look at how do the gums look. Are they a nice healthy pink color or a nice healthy pigmented color? or are the gums red along the margins only where there's plaque? Is it red everywhere? Does the patient suffer from dry mouth that's making the gums red and shiny? Not a nice healthy color, not a nice stippled inter dental pill. Is the inter dental pill missing because the patient has generalized severe recession? So notice how all of these things are different and all of these things I make note of. So what I do first when I see a patient is I take out my intraoral camera and I'm going to do a full video inside the mouth. I start with quad one, quad 2, quad 3, quad 4 and then I check along the buckles again. Quad 1, quad 2, quad 3, quad 4. And then I check along the along the linguals. I do this for two reasons. Number one, because there's a magnifier at the end of my intraoral camera, so I can see things really well. Even before I just look inside the mouth, I can see that tiniest black spot that might be on the distal of the of the wisdom tooth there that I might not have noticed right away just looking inside the mouth with my own eyes. But then another reason is I take a video so I can look at that again after the appointment because maybe once I'm writing down the notes I think, oh yeah, that upper left moler, let me look at that again. I don't really remember what I was looking at there. I thought there was a little spot, but maybe it was a tooth in front of it. I go back and look at the video every single time. I save the video so I can compare them at the next visit. If I'm watching a little suspected cavity there, well, I'm going to take another video at the next appointment and see if it's getting worse. We like to think we can remember everything, but we can't. And I'm the first one to say, "My memor is horrible. I need to write things down because I see so many patients there's no way I'd be able to remember everything. So I take the intraoral video first. I take some pictures and then I just simply look inside the mouth. This is well before I'm even starting the cleaning. So I look inside the mo um mouth and I take notes. I don't have an assistant. I have my own practice but as I mentioned I go mobile. So I I don't have my own assistant. So, what I do is I'm going to record my notes and I let the patient know I'm going to record some notes. I'm not going to make any sense. I'm talking in a dental language, but I will explain things afterwards. I explain things afterwards while I'm cleaning the teeth. So, see how I'm doing two things at once. I'm not wasting time. But I call out the tooth numbers. I call out everything that I see on every single tooth, whether that be heavy plaque, light plaque. Um, the gums probably aren't bleeding yet, so that's not something I'm going to count out yet. But I'm going to mark down if there's a little black spot, if there's gingerville recession. I mark everything down for every single tooth. If a tooth is more stained than another one, if the tooth is tipped lingually or buckly, I mark it down. I do this at every single appointment, not just the new patient exam, every single appointment. Because how do you know if things have changed unless you take notes and then compare the notes from last time? You don't. You might think you do, but you're not going to remember. We are doing a disservice to our patients if we're not doing everything we can at every single appointment. I wish doctors did this. We would all be so much healthier if doctors had the time to pay attention and not just ask us one little problem per appointment, but they go over everything in general. quickly, of course, but going over everything. Diet, exercise, this hurts, that hurts. You get the idea, right? So, I'm going to call out the notes and then this way too, the patient can hear me. The patient can hear me say light plaque, generalized, there's been an improvement since last time, or moderate generalized plaque, there's food debris, the lower left hand side, lingual. Um, there's gingerville, there's severe gingerville recession from quad to this, quad to that. There's attrition, there's abrasion. They can hear me say this. They might be like, "Oh my goodness, I have a lot of stuff in my mouth." But they hear you and they see you're paying attention. They can see you're working hard to look inside the mouth. There's nothing worse than a dental professional coming in saying hello, cleaning the teeth, and then giving you a toothbrush, and saying goodbye, and you have no idea how the mouth looked. Everybody kind of has an idea because as we're cleaning the teeth, of course, if we're spending more time on this side, well, there's more plaque there. So, everybody does have an idea, but it's better to explain these things to patients. So, after I take my notes, I call out the tooth numbers. Um, I record all of this and then I listen to it again when I go home and I make sure to write everything down. But then I pick up my scalers and I'm going to scale and then polish oral irrigation if needed. You know, anything that's needed, that's what I start to do. And while I'm doing the hand scaling, I'm going to talk to my patient about what I saw inside the mouth. So, as I'm cleaning the teeth, I can be saying, "Okay, so checking your notes from last time, you do have more plaque on the left hand side, but you have less plaque the upper preolar there, which is what we were focusing on last time." Um, plus you have this, you have gingerville recession. Remember that happens when and I explain everything as I'm cleaning the teeth. If I'm using a paso scaler, it's kind of loud with my compressor. So, I might wait to do the explaining for me to pick up the hand scalers afterwards, but that's easy. They can hear me and I'm still getting work done. But what I'm also letting them know is, but the gums are quite red, especially the bottom teeth. They are very shiny and that's not a normal appearance for healthy gums. But I might say, but due to the medications you are on, you are on a lot of medications that cause dry mouth. But how does the mouth feel? Does it feel okay to you? Okay. So, I let them know their gingervel condition. I might even throw out some big words like you have gingivitis. You have periodontal disease because of your four and 5 millimeter pockets. So, I'm going to explain it in easy terms, but then I'm also going to use the big words because big words make people pay attention. It's true. If you say, "The gums are kind of red. I'm not really worried about it." Or if you say you have localized gingivitis, that is a gum disease inside the mouth. Both mean the same thing. Localized means they have gingivitis to only certain areas of the mouth. A little bit of gingivitis. The gums are a little bit red. But doesn't the gingivitis term sound so much like, wait, what do I have? They'll pay attention. They'll listen. But you can't just tell them or you can't just lecture them. You have to offer them solutions. So, this happened to me today where I do have a patient with very dry mouth. I would say severe dry mouth, but it doesn't bother her. She's a she's an older lady. She's in a nursing home, but it doesn't bother her. Um, unfortunately, I've tried to give her um biotin mouthwash, biotin toothpaste, but it literally goes missing. So, the nursing home has said not to bring it because they don't know if the residents are swallowing the mouthwash or whatever. So they just unfortunately we can only do so much and we can't take her off of the medication. So I do let her know this is your condition. Drink lots of water. That will help. Let me know if anything starts to feel uncomfortable. Okay? So you kind of work with what you got at the same time. Right? But for another patient, let's say the gums are red all along the margins here because for whatever reason on the bottom there's more plaque, there's more calculus. Take a picture. Show them with your intraoral camera. Show them the difference between healthier up here and not so healthy down here. And then explain the process to them. Say you have moderate gum disease. Generalized. Cuz it's all along the bottom. That is generalized. If the gum disease gets worse, it can spread and it can get worse making things uncomfortable, making things painful. We need to nip this in the bud. Now, um, look at the red gums here. See? See how it's red along the margins? Look at all the plaque that I'm taking off with my instrument. But the good news is gum disease, um, gingivitis means the same thing. It is reversible. If you start brushing, not even just twice a day, three times a day, that will help to get the plaque out of there. I also would like to start seeing you every three months because of the gingivitis, because the gums are red, because the gums are bleeding. I want to see you every three months because that's how long it takes for that nasty bacteria causing the disease to get worse. So, let's say I see you in 6 months and that bacteria is getting worse and worse and worse. By the time I see you, the gingivitis, the gum disease has already spread. So, we want to stop it from spreading. So, see how I'm making things sounds sound very serious, but then I'm throwing in there, but don't worry, it's reversible. We can fix this for you. This is how we're going to help. You're going to brush three times a day for me cuz I can't do that for you. But I can make sure to come in every 3 months and give those teeth a good cleaning. When I come in 3 months, I will let you know if things are improving or not improving. Let's say things for some reason are getting worse because you weren't able to brush three times a day like I'm suggesting. I'm going to give you even a different toothpaste, a different mouthwash to really get in there and cleanse the gums and start to heal them up. Even today, I'm going to recommend a salt water rinsing because I want you to get in there after every meal. Brush after every meal with the salt water. You don't have to do this forever. But the gums are not in good shape. It is reversible. They can get better. You don't have to do all of this forever, but if it can get better. When I see you in 3 months, we're back to normal again. Brushing twice a day, seeing you every 6 months. So you guys, you see what I did there? I'm explaining everything. I'm showing them everything. I'm showing them with the intraoral camera. I'm explaining how I can help, what they need to do to make things better. I'm not just cleaning the teeth and then saying to them, "Okay, you have more plaque than usual. You have moderate gingivitis. Not good. You need to brush more. Okay, I'll see you in 3 months cuz let's do the 3 months. Bye for now." See how those are so different, right? And trust me, the patient will appreciate you. You will leave that appointment and they will say, "Wow, she or he was very thorough. That was amazing. I've never had somebody care so much. I've never had somebody pay so much attention. This is fantastic." So, this is you being that better dental professional. You are doing what you can. You're using your skills. What's the point of learning about gum disease and perio if we're not taking those assessments and then talking to our patients? So, start tomorrow. Start doing everything a little bit more. It's going to take you longer. Especially if you work in a dental office. I get it. You don't have two hours per appointment like I can, but utilize your time well. Okay? When you're inside the mouth, this is when you're talking to the patient. Like when you're cleaning the teeth or doing whatever, this is when you're talking to the patient about their plaque, about their calculus, about their gingivitis, about them needing to see you every 3 months. That is while you're doing the cleaning, not after the cleaning. and then you sit back and talk to them for 10 minutes. That's just wasting time. Think about it and do it all during the cleaning. Okay, so let me know if you need any help and I am always here for you. Comment, let me know. Thank you for watching and I'll see you guys in the next one. [music]