INFORMATIVE ARTICLES
A Patient-Centered Periodontal Program for the 1990's, Part 1
By Robert S. Levine, DDS
(Compend Contin Educ Dent, Vol. XI, No. 4, Pg 222)
There has been much debate as to the indications for and outcomes of nonsurgical dental therapy. This two part series will discuss questions regarding nonsurgical v surgical therapies, including how the dental team can best relate findings to patients.
Introduction
Nonsurgical therapy, ie, scaling and root planing, has been the backbone of periodontal therapy for decades. The first controlled studies from Scandinavia in the 1950's revealed the efficacy of subgingival root planing, and the importance of good plaque control and hygiene. In addition, frequent follow-up in the maintenance phase has been shown to be critical to long-term success.
New Concept of Periodontal Disease Activity
The belief that periodontal disease is a slowly progressing disease that continues to worsen in areas already affected has come under recent scrutiny. Untreated patients in the United States and Sweden that were followed from 1 to 6 years without any periodontal therapy demonstrated the inability of using previously recorded destruction to predict future periodontal breakdown. Over a 6-year period, a 5 mm pocket was shown to be no more than a nearby 3 mm sulcus. In addition, the clinical indices of bleeding upon probing, suppuration, pocket depth, and color were highly unpredictable indicators of future breakdown.
A Patient-Centered Periodontal Program for the 1990's, Part 2
Introduction
Verbal skills are especially important when discussing treatment with the patient who needs periodontal therapy, since periodontal disease can be characterized as a silent" disease, similar to hypertension. The author frequently compares compares the two diseases, telling patients that many people do not realize they have high blood pressure until they suffer a stroke and, in the same light, many of the author's patients do not realize they have gum disease until they start losing teeth.
Case Presentation
When discussing periodontal disease with patients, some dentists have found that providing printed materials for the patient to review at their convenience makes for more effective communication. The author's experience has shown that the American Dental Association (ADA) brochure "Don't Wait Till It Hurts" the ADA wall plaque "The progression of periodontal disease"(Figure 1), the Quintessence book "What Is Periodontal Disease," and a patient education book compiled from interesting perio-related articles and pictures of therapies are all effective. Information that the patient obtains while in the dentist's office, other than from the dentist personally, is invaluable, since Bob Barkley's statement, "telling ain't teaching and listening ain't lea ring," applies to dentistry in general and periodontics in general and periodontics in particular. Therefore, graphic and nonverbal communications is helpful to reinforce the practitioner's messages to his or her patients.
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