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Wellness Approach to Clinical Care - Jameson Mgmt

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Andrea Greer

on 15 March 2018

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Transcript of Wellness Approach to Clinical Care - Jameson Mgmt

The Wellness Approach to Clinical Care
Health Belief Model
1. 6 month "recall"

2. "we'll just watch it bleed....."

3. Spot probing and PSRs

4. SRP... and then what??
The ADA guidelines now mandate that general dentists take greater care in preventing, diagnosing, and treating periodontal disease
Responsibilities of oral healthcare professionals
Health Continuum
Our job as clinicians is to :
* Educate
* Demonstrate & Enable
* Encourage
* Empower
* Approach holistically
The patient must own their problem to make a difference. Long term success is the result of patient understanding and being involved in therapy.
We are selling health
care education!
ADA estimates that 80% of population has some form of periodontal disease
pg. 35
For behavior change to succeed, people must:
* feel threatened by current behavior

* believe specific change will benefit them

* trust that cost is acceptable for the
desired outcome
pg. 46
In long term, wet-gloved studies, the results are consistent: 80-85% of population has some level of perio
Increasing number of lawsuits due to perio neglect.
You may have possible problems if...

* Your patients bleed each time they are seen for a prophy

* You are not probing and recording each adult patient at least annually

* You do not have a current PA series on all patients that may have infection

* You are not diagnosing, classifying, treating or referring every patient
pg. 49
10. Realize your limitations.
1. Diagnose infection at ANY stage and classify appropriately.
2. Inform and educate patients about their periodontal classification.
3. Take appropriate radiographs showing lamina dura and crestal bone.
4. Recommend treatment or refer.
5. Provide treatment by removing biofilm toxins from infected sites.
6. Re-diagnose, monitor and inform patients of improvement or regression.
7. Maintain patients' oral health.
8. Provide industry standard of care.
9. Stay current with one's own continuing education.
Periodontal Disease is:

* Episodic in nature

*Site Specific

*Can be treated if diagnosed

biofilm exercise pg. 53
OK! Now what??
To properly treat and maintain a perio patient,
we must classify and treatment plan
appropriately. In order to do that, we need info!
1. Charting, including...
2. Radiographs
3. Diagnose & classify
4. Inform & educate
5. Present Tx Plan
6. Documentation
7. Re-evaluate, reclassify
8. Maintain
pg. 55
This thorough documentation leads to objective diagnosis, rather than subjective.
The Goal:
Perio classification
Old system was determined to be inadequate.
overlap between categories
lack of emphasis on gingival disease
inappropriate emphasis on age and rate
unclear classification criteria
New system (as of 1999)
descriptive terms
more emphasis on gingival disease
pg. 56
Radiographic Protocol
*What are we looking for?

*What's the difference?

*What will be our protocol?
pg. 97
pg. 100
pg. 102
Comprehensive Evaluation
1. Probing Depths
2. Furcation (classification)
3. Bone height
4. Attachment loss
5. Mucogingival defects (examples?)
6. Mobility (classification)
7. Bleeding and suppuration
8. Recession
9. Head & neck/OCS
10. Occlusion
11. TMJ
12. Caries/Pathology
13. Existing
14. HHx/BP
pg. 70
Treatment Planning
pg. 138-143

*Gingival Disease

Preventive Care Therapy = D1110
6 month interval
patient education
alternate perio chart and radiographs
follow radiographic protocol
Early Periodontal Therapy = D4346
ultrasonic to completion
Oral irrigation (optional)
patient education

1. Initial Periodontal Therapy = D1110.p/P1110 (60 min.)
Ultrasonic SUPRA-gingivally
Intense Patient Education
Oral irrigation (optional)
No Polish
- why? Must pre-heat the patient at the beginning
2. APT - Quad 1 = D4341 or 4342 (60 min)
Oral Irrigation
Patient Education
3. APT - Quad 2 = D4341 or 4342 (60 min)
Oral Irrigation
Patient Education
4. APT - Quad 3 = D4341 or 4342 (60 min)
Oral Irrigation
Patient Education
5. APT - Quad 4 = D4341 or 4342 (60 min)
Oral Irrigation
Patient Education
6. Supportive Periodontal Therapy = D4910
Periodontal Re-evaluation
Site SRP if necessary
Oral Irrigation
Patient Education/OHI
Periodic Evaluation
Andrea Greer, RDH

Preventive Periodontal Therapy = D1110.g/G1110
re-evaluating perio and bleeding points
follow radiographic protocol
once reclassified as healthy, return to PCT
Full transcript