Perio Chart

[Clinio Lofton]

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.

Dentrix Enterprise offers a great deal of flexibility when creating a perio exam. One such flexibility is the ability to use shortcut keys to help you enter the measurement information into Dentrix Enterprise. Each one can help you complete an exam quickly and efficiently. Below are a few different shortcuts and tips to help you:

Minus key

The Minus key on the keyboard allows for entry of probing depths of 10mm or greater. For example, pressing minus(-) then 0 will give you 10, pressing minus(-) then 1 will give you 11, and so forth. Note: This shortcut is only available with the 10-key numeric pad.

Current Direction: The direction the Advance Sequence is currently auto advancing. This updates automatically when the perio chart advances to a new section, but can be changed toggled to manually change the Auto Advance direction.

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.

In answer to the question posed by the doctors as to the necessity of "all that charting" I'd probably say, "I want to give your patients the very best care I can and having updated periodontal evaluations is an important part of that. Many-if not most-of the patients I've seen haven't been charted in a very long time, so it's a lot of work for me to try to get them up to speed. I'm sure you are aware that not having updated periodontal evaluations is a serious liability risk, and it's my job to inform you of any periodontal problems."

Once the doctors see that you are just trying to be thorough and conscientious, they will come to value your dedication to doing your job well. After all, it is part of the hygienist's responsibility to identify periodontal problems and bring that information to the dentist's attention.

It really makes me proud to find a hygienist that is aware of the importance of updated periodontal charting. So good of you, Shelby, RDH! Keep doing your best, but do try to stay on time as much as possible. And don't be shy about asking for help if you're not getting it.

DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is an award-winning speaker, author, and consultant. She has published hundreds of articles, numerous textbook chapters, an instructional video on instrument sharpening, and two books. For information about upcoming speaking engagements or products, visit her website at www.wattersonspeaks.com. Dianne may be contacted at (336)472-3515 or by email [email protected].

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Florida Probe Corporation has been the industry leader in computerized probing and charting for over 20 years. We are proud of our history, longevity and innovation in this field. The Florida Probe Handpiece (computerized probe) was invented at the University of Florida in 1985 in response to a request by the National Institutes of Health and received FDA approval in 1987. Soon after, a computer program was added to organize and track changes in patients' periodontal health. This was the beginning of the Florida Probe System. read more >

In 2009, we are pleased to announce a major upgrade to our FP32 perio charting software, Version 9, which features E-pad digital signature capture and storage for Patient Diagnosis Sheets/informed consent; Live Chat feature within the actual software; SQL database management and support for our new wireless keypad (part of the GoProbe System).

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