By Wendy Briggs, RDH
I have often said, there has never been a better time to practice Dentistry and be a hygienist than in our day. There are many reasons for this, but technology and access to an overwhelming flood of scientific advancements are at the top of my list. Another item at the top of my list is the exciting changes announced in November of 2017 in regards to a greater understanding of Periodontal Disease.
Maximizing the three roles in hygiene – Preventive Therapist, Periodontal Therapist and Patient Treatment Advocate – is critical to realizing World Class Hygiene effectiveness. These changes help improve our roles in all aspects of Periodontal Care.
New Classification of Periodontitis
In Chicago, there was a meeting of more than 100 experts from Europe, Asia, Australia, and the Americas who conducted literature reviews, established case definitions, and deliberated diagnostic considerations for the classification’s primary topic areas. The 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions resulted in a new classification of periodontitis. Involved in this effort were international researchers, educators, and clinicians, to create a global consensus to standardize and modernize patient care.
“The updated proceedings align with what scientific literature has revealed about disease progression in the last 20 years. As greater understanding emerges, the Academy is committed to revisiting and modifying the classification as evidence dictates,” says Steven R. Daniel, DDS, president of the AAP.
Change Can Be Overwhelming
Although exciting to have direction and updated resources that we can use when treating patients, I find that changes of this magnitude are often difficult to implement. Providers become overwhelmed with change in general, especially when it comes to services we have provided to patients for a long while. When overwhelmed, we often find hygienists and dentists unsure of what to do at all. This can result in less treatment of Periodontal disease, rather than the intended result of more clarity. To help with implementation, we have created several tools that should minimize paralysis, and help build confidence.
Staging and Grading Framework
The multi-dimensional staging and grading framework for periodontitis classification is among the 2017 Workshop’s major features. Staging levels indicate the severity of the disease and the complexity of disease management, while the grading structure considers supplemental biologic characteristics of the patient in estimating the rate and likelihood of periodontitis progression.
This framework is built upon an important change, in that forms of periodontal disease are now defined as one of three distinct forms which include periodontitis (formerly aggressive and chronic), necrotizing periodontitis, and periodontitis as a manifestation of systemic conditions.
Personalized Approach To Patient Care
This approach allows for a personalized approach to patient care and also takes into consideration more than pocket depth and bleeding points for classification. It also considers other factors in regards to complexity of each individual case, and provides a structure to evaluate risk for future progression of the disease be considered in initial assessment.
To simplify this process, we have created several tools to help hygienists and Dentists understand how to apply the new guidelines in the treatment planning process.
We find that having a system and having the capability to create a score for each patient helps minimize paralysis and facilitate patient acceptance.
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Wendy Briggs, RDH