This is a continuation in a series. If you haven’t read the previous posts about SPT, there are links at the end of this one.
Eventually I do plan to come back around and put all of this information together as a single document.
If you want me to send it to you when it’s ready, just let me know.
But for now, knowing that brevity fits the time constraints of our busy lives, I will strive to keep each of these segments as short and useful as possible.
Foundational to effective SPT is the following statement. It is a modified repeat of what I stated last time.
If you want to take on the supportive care of periodontal patients – and I encourage general dentists and their dental hygiene teams to do this – then you need to be probing 6 sites around every tooth at every visit. From this activity you then can create a running record of pocket depths and bleeding points.
I’m not saying this to be a nag but because this is the key to managing a large population of periodontal patients without losing your mind.
Let me now break out how I see the fundamental steps of a Supportive Periodontal Therapy appointment.
Step #1: Prepare for the examination. Review previous entries, document changes to health or any dental problems the patient has experienced since the last visit. Take vital signs. (5 minutes)
Step #2: Full-mouth periodontal probing to record bleeding and pocket depth. Record any other important findings as a part of this examination. (5 minutes)
Step #3: Analyze the collected data including calculation of the bleeding index. Some dental software programs track all this information and this may be the moment where you print out copies for the patient. (5 minutes)
Step #4: Review the findings with the patient. This will include the current bleeding index and its relationship to previous times as well as changes in pocket depths beyond probing error (changes of 2mm or more). Also take note of the presence or development of advanced sites (6mm pockets and deeper) and compare these with earlier times as well. (10 minutes – take your time and connect with the patient. This should be a conversation, not a lecture).
Step #5: Create a treatment plan that involves at least two actions. (3 minutes)
- Action #1: Performing interceptive care today (more about this later).
- Action #2: Determining when, where (if alternating care) and what will be the next appointment. It’s smart to give patients heads up if you plan to take radiographs at the next appointment, for example.
Step 6: Perform the interceptive low-impact care. I will say a great deal more about this later but suffice it to say that the SPT appointment is not a cleaning appointment. Don’t call it this and don’t let anyone else in your office call it this either. It will confuse patients and diminish in their minds the importance of what you are really doing. Yes there is a cleaning step, but this is primarily focused on subgingival plaque disruption in pockets the patient is unable to reach during their daily plaque control routine. (5-10 minutes)
The general time needed for routine SPT is one hour – 40 minutes to perform the steps above and 20 minutes for documentation, consultations between dentist and hygienist and room turnover. This is unhurried and does not involve intensive cleaning activities. Anyone who has an SPT every hour through the day should not leave at the end exhausted. It should actually be a pleasant interesting day mixing examinations, conversations and low impact care. This is not the case with scaling and root planing or even performing prophylaxis care on patients with poor oral hygiene.
When SPT patients are managed as prophylaxis patients, they are over-treated supragingivally and possibly under-treated subgingivally. Heavy handed instrumentation and excessive coronal polishing to remove stains result in an accelerated loss of tooth structure and attachment in shallow sites over time. This results in increasing recession and tooth sensitivity.
Next time I will explain how I use the Bleeding Index with patients and why turning findings to numbers is a good idea.
Previous Posts On SPT:
Supportive Periodontal Therapy is the Endpoint
Moving Patients In and Out of Supportive Periodontal Therapy