Perio Charting

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APeriodontal Chart is also referred to as a gum chart. It is a graphic chart dental professionals use for organizing the information about your gums. Periodontal charting is the best way to uncover the difference between patients that are periodontally healthy and those with periodontal disease.

The initial periodontal examination and probing can be quite traumatic to patients in whom significant periodontal disease is present. Inflamed, swollen soft tissues and teeth with deep periodontal pockets will be extremely sensitive during this examination.

3-5mm with bleeding: Early stages of gum disease, the beginnings of Periodontitis. This may require additional treatment, better home care and three to four visits to the dentist per year.

5-7mm with bleeding: This means soft and hard tissue damage, as well as bone loss. Definitive treatment is required, over several visits, greatly improved home care and many more hygiene visits to prevent tooth loss.

Healthy gum tissue should fit snugly around each tooth. However, in gum disease, the gum tissue can start to pull away from the tooth, creating what we call periodontal pockets below the gum line. Periodontal charting is a way of checking for these pockets by measuring the space between a tooth and the gum tissue next to it.

A dentist or dental hygienist uses an instrument called a probe and gently inserts it into the space. This probe has markings like a tape measure that shows them how deep it can reach into the space.

Your dental hygienist or dentist may record the gum depth numbers in several ways. Sometimes they are typed directly into a computer program. Other times, an assistant may type the numbers in for whoever is taking measurements. Voice recognition technology can also be utilized, during which you will hear your dental professional calling the numbers out loud. If any areas of concern are discovered, your dental professional will notify you where they are as part of the evaluation process. You may even be given a copy of your periodontal chart to take home.

Your dental professional takes six measurements per tooth to ensure that all areas are accounted for. Along with the measurements, they also check for bleeding of the gum tissue and areas of gum recession.

Periodontal charting is an important step in the detection of gum disease. According to the Centers for Disease Control, this condition affects almost half of adults older than 30. It causes inflammation of the gumline, and can lead to loss of the bone that surrounds the teeth. Gum disease can be painless, so it may go undetected without preventative dental care, but symptoms commonly include:

Periodontal charting should be done at least once per year, and more often if problem areas are found, in an effort to identify periodontal disease early on. Many dental offices start perio charting once a patient has reached full dentition, or a complete set of adult teeth, according to Dimensions of Dental Hygiene. It can be done at a younger age if gum tissue is swollen or bleeding.

Oral care at home plays an important role in making sure that your periodontal charting is looking positive. Brushing and flossing properly at home is an essential first step, and starts with brushing two times a day for two minutes and flossing daily. Keep in mind that cleaning above the gum line is just as important as cleaning below the gum line. Gently brush your gums while you brush your teeth and swish with a mouthwash for healthier gums.

Scheduling dental cleanings on a regular basis is another essential part of keeping your teeth and gums healthy for life. Your dental professional may recommend advanced treatment such as scaling and root planing or suggest a more frequent exam schedule if they notice pocketing and bleeding gums in your mouth. Otherwise, keep on a six-month cleaning schedule for the healthiest smile and the best results.

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

The chart can be recorded via voice commands in English, using Universal Tooth Numbering. A microphone must be set up on the computer. Any microphone or headset recognized by Windows will work.

Note: Open Dental Cloud users are not able to utilize Voice Perio Charting.

When considering which headset to purchase, choose one with good noise cancellation built-in to filter out background noise. Keep in mind that a noisy environment or improper microphone setting on the computer will result in less reliable voice recognition.

Solution: No probing depth has been entered on the site you are attempting to chart Furcation, Gingival Margin, Mobility, or Mucogingival Junction. A probing depth must be entered before these can be charted when utilizing voice perio charting.

I attended one of your seminars a couple of months ago, and since then I started a new job with two young doctors. The previous hygienist only charted probe depths occasionally, and there were no periodontal diagnoses anywhere in past notes for any of the patients. Another shortcoming is that there are no FMX radiographs for any of the patients, only BWs. So I am also trying to get patients caught up on radiographs. Most of the patients in this practice are older, so there are a lot of periodontal disease problems.

My problem is that even though I have an hour with each patient, sometimes I run 10 minutes or more behind. Yesterday, before leaving, the doctors expressed their concern about my running late and asked if all the charting was really necessary. I said that each patient needs to have a periodontal diagnosis, which is only possible by performing a periodontal charting. Since many patients do not have any recent charting, it is impossible to show the full extent of their attachment loss. How else can I support a diagnosis of moderate to severe periodontitis, especially with only horizontal BWs that don't even show the crestal bone?

I want to do what the doctors want, and I need to keep my job in this jobless market. But I also want to protect my license and make sure that I have everything documented. Any suggestions would be greatly appreciated.

From your post, it sounds like you are trying to be more comprehensive than the previous hygienist. The doctors probably have no idea how not having updated periodontal evaluations raises their liability risk. Of the top 10 reasons dentists are sued, failure to diagnose periodontal problems is No. 5 on the list. You'd think they would be glad that you are "busting your buns" for the good of their patients.

I'm not making excuses for the previous hygienist, but in many situations hygienists do not perform regular periodontal chartings because they don't have any help to get it done. This is especially true in offices where the hygienist only gets 40-45 minutes with the adult patient. It will take from 10-15 minutes for a solo hygienist to perform a full-mouth, six-point periodontal charting and recording if it has to be done solo. However, with an assistant doing the recording, the hygienist can usually get the probing/recording finished in about five minutes or less. There are also some wonderful software programs that assist the hygienist with probing/recording, such as Dentrix VoicePro speech recognition tool that allows for hands-free charting.

There are lots of things that can cause hygienists to run behind schedule, including waiting for a doctor exam or being disorganized. I urge you to try to pinpoint what is causing you to run behind and then develop a solution. It's not easy for any clinician to change speeds, but take a look at your protocol. Is there a process that you can streamline? One great time-saver for me was using a tray system. I had 10 plastic bracket trays that I would preload with all my disposables each morning. By doing this, I didn't have to continually open drawers all through the day to reset my operatory. Saving even a couple of minutes on each patient throughout the day adds up.

Another great time-saving tip I recommend is to implement an "interrupted hygiene exam" system. What this means is that you do not wait until you are finished to summon the doctor. Seat your patient and perform any preliminary items, including radiographs, medical history update, tour of the mouth, and any necessary chartings. If the patient has a lot of soft debris, polish first. Then summon the doctor. He or she can come anytime during the next 20-30 minutes.

When the doctor steps in the doorway, you would say to your patient, "I'm going to stop long enough for Dr. Smith to examine your teeth. Then we'll finish." The compromise is that the doctor may not get to examine a totally debris-free mouth, but the interrupted exam helps keep you on time. If you wait until you are completely finished to summon the doctor, you are asking to be kept waiting. Remember, the goal of the exam is not to check your work. The goal is to identify any restorative or soft-tissue pathology in the patient's mouth.

I also recommend that you resist trying to conquer the periodontal charting neglect issue in this office quickly, but rather over time. What I mean is this: If everyone needs periodontal charting, then choose some to do on this trip, and make notes to do others on their next visit. If you see about nine patients per day, make a goal to perio chart four to five patients per day. Over the course of the next year, you will have brought most people up to speed.

The doctors may also be concerned about fielding complaints from patients who are kept waiting. Some doctors are very prompt and pride themselves on seeing patients right on time. So if you are running late consistently, they've noticed and it concerns them.

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