How Do I Talk to My Patents When They Have Periodontal Disease? 4mm VS 8mm

[music] How do I assess and how do I talk to a patient about their periodontal disease? How to treat it, how to prevent it from getting worse, and even how to avoid it in the first place. So, my name is Andrea. I've been a dental professional now for 22 years, and I have my own dental hygiene business, my mobile dental hygiene practice, where I go into nursing homes and patients homes to clean their teeth. Plus, I'm a tutor for dental hygiene and dental assisting students for those of you who don't know me. But let's dive into it. Okay, so periodontal disease, the first thing you need to think about is the only way to assess and determine if somebody has periodontal disease is by doing a periodontal probing. So we need to take those measurements under the gum line to see how close the gum is to the tooth. Okay, without that we don't know if somebody has periodontal disease or not. But X-rays go hand in hand as well. Even if somebody has a 3mimeter pocket, well, I might think it's a 3mimeter a 3mimeter pocket, but the next hygienist might measure it as 3.5 mm. So, we round up and that's now 4 millime. 4 millimeter pockets, even if it's just the one tooth is periodontal disease. It's early periodontal disease, but it's still periodontal disease. And we need to nip things in the bud and talk to our patient about it. But remember how I said x-rays? So X-rays go hand inand because you need to be looking at the X-rays to determine if the patient has bone loss. The only way to check that is with the pocketing depths, but also X-rays. You could take a pocketing depth and it could be 7 millimeters. You're assuming the patient has bone loss. You take an X-ray and you can see exactly where and how the bone loss is. But then if you're probing and you notice the patient has a 4 millimeter pocket, again, that can be subjective. I might see a a four millimeter pocket. The next hygienist might see a five millimeter pocket. So, the X-rays will really narrow down how bad the bone loss is. But even if you see one four millimeter pocket, as a hygienist, you might be thinking, "That's not so bad. What's the big deal?" We need to show our patient. We need to talk to our patient. I'm a mobile dental hygienist, so I see patients in their home. When I perform the periodontal probing, I tell them what I'm doing because I'm calling out the tooth numbers because I'm recording the tooth numbers. I don't have an assistant with me. So, I need to call out the tooth numbers out loud and in order to record them. And then I do up their perio chart at home so I can see where all of the pockets are. If there's any bleeding on probing, I'm going to calculate gingerville recession to then determine the clinical attachment loss. So, I do all of that at home. If I did it in front of them, it's probably going to take me 20 minutes. So, I always do it at home. And then I make sure to talk to them at their next appointment and show them that exact perio chart. So, I can show them the red numbers of 4 mm or above. I can show them the bleeding points. I can show them gingerville recession. But at that first appointment, I just simply talk to them about it. So, I'm recording the numbers. They hear me call out the numbers. Afterwards, I'm going to tell them, do you remember the numbers four or above? Remember when I said, you know, 4 mm, 5 mm? That is bad. Any of those numbers we do not like, that is telling us you have gum disease, but it's now affecting the ligaments around the tooth and it could be affecting the bone. Gingivitis is gum disease too, but that's when the gum is inflamed, red, swollen, sore, bleeding. But once I say periodontal disease that is now progressed it's worse than just gum disease. It's the batter form of gum disease. You know that's basically what I tell my clients. I go it's not good. But the good news is you have one 4mm pocket. We can reduce that. If you start brushing very very well. You said you maybe floss once a week. You're going to have to start flossing every day to get rid of the periodontal disease. Notice how I keep mentioning periodontal disease. I'm not saying pererryio or I'm not saying bone loss or gum disease. I'm being very specific periodontal disease because to patients that sounds scary. It is scary. But when I hear the word disease, even as a patient, if I'm talking to my doctor, if I hear the words disease, I'm going to pay attention to them. If I hear pererryio, I don't know what perio is. I don't know what he's talking about. But if I hear those two terms together, I'm going to pay more attention. So don't let that 1 4 mm slide. Talk to your patient about it. Because what you don't want to happen is you're not really worried about it. But you don't say much to your patient. You just simply say, "Okay, you need to floss every day. Start brushing twice a day. Every day. Not just sometimes twice a day. It has to be every day. Um maybe even incorporate a mouthwash cuz the gums were bleeding a lot today." That all sounds very wishy-washy, but if you tell them why you're recommending something, that disease won't get worse. If I see one 4mm pocket, I'm going to tell that patient, "Okay, I saw one 4mm pocket, but 1, two, and three is healthy." So, imagine a turtleneck. You want the turtleneck close to your neck, right? Not just hanging off. You have a 4mm pocket, which means that turtleneck isn't as tight as it should be. We want the gum as tight to the tooth as possible because that's healthy. The good news is the four millimeters can get better, but you need to be brushing twice a day. You need to be flossing every day. And I'm going to give you a mouthwash as well to rinse every single night to limit the bacteria. If the bacteria isn't limited, I need to be seeing you every three months for teeth cleanings. That's more expensive. That's more time consuming for you. But that's what we have to do if you're not able to incorporate all of that at home. And that's really not so bad. A couple minutes toothbrushing, 30 seconds using the water pick or the floss picks or the string floss, 10 seconds of mouthwash at night. That's just a couple minutes every single day. Or you can come see me for a 1-hour appointment, pay such and such amount that may or may not be covered by insurance every 3 months. But we want your milk to be healthy. You have periodontal disease just in one spot. But that can spread and the worst case scenario is you lose your teeth. No joke. This is how I talk to my patient. I'm not trying to scare them, but I'm not just throwing it under the bus either. Because what you don't want to happen is throw it under the bus. They don't take you seriously. They come back in 6 months and that one 4mm pocket is now 5 mm in a couple spots. and then 4 mm all in quad 3. So because you didn't mention that to them, their disease has progressed. It's gotten worse. And now you have to say to them, "Your periodontal disease has gotten worse. I need to be seeing you now every 3 months. You need to brush twice a day, floss every day, use the mouthwash." They might say to you, "What are you talking about? Periodontal disease. I didn't know it was bad in the first place." So then you caught yourself and you're like, "Oh, shoot. Yeah, I guess I didn't mention that to you." So always talk to your patient. This is no different than if it was gingivitis. If one gum is bleeding during the cleaning, you need to talk to the patient about it. Healthy gums do not bleed. If there's one 4 millimeter pocket, you need to talk to your patient about it and be very specific. Even when a patient has perio, I mention gingivitis a little bit because I say things like, you know how the gums are bleeding? You know how I called out bleeding points when I was checking your periodontal probing measurement? Well, you have gingivitis on those areas as well. Gingivitis is reversible. It's much easier to stop the bleeding. But periodontal disease, once that bacteria reaches the bone, it starts to eat away at the bone and that's when you lose the tooth. Obviously, an extreme example, you have one four millimeter pocket. That's not going to happen tomorrow, but we need to nip this in the bud. And I don't want you to have to spend more money. So, why not brush twice a day, floss every day, use the mouthwash, come see me every 6 months. But if it doesn't improve the next time, it's going to be every three months. Okay? So, do you have any questions? And always ask them, too. Do you have any questions? I've heard all kinds of questions like, "Wait, you mentioned pererryio something. What's that?" And I'm going to be thinking, "Oh, well, I did say pererryio, and I thought I told them that was gum disease, but they obviously missed that part. I thought I told them that that's when it reaches the bone levels, and we don't want to lose the bone support, but maybe they didn't get that." or they might say to me, "You mentioned bone. What do you mean I'm going to lose my bone?" So, always ask them if they have questions. There's no such thing as a stupid question. In fact, questions tell me that I'm not explaining something properly to my patient and I need to do better. But also, we all hear things differently, right? Um, right? We all retain information differently. So, keep that in mind. So, speaking of which, does anybody have any questions? Comment below. Let me know. As a dental professional, talk to your patients. Don't be afraid to talk to your patients, but you need to let them know how serious things are before it gets worse because gum disease, periodontal disease, is no joke, right? It's no joke. So, thank you for watching. Let me know if you need anything and I'll see you guys in the next one.