A nonsurgical approach to tissue management: Education is key

March 13, 2013
Sarah Robinson, RDH, discusses the role of dental hygienists in gingival tissue management. Treatment first begins at the patient level, by educating the patient on the importance of arresting the infection and stopping the progression of the pathogens that cause periodontal disease.

When looking at gingival tissue management, treatment first begins at the patient level. Patients are independently responsible for their own day-to-day management and care of their tissue. By using an automated toothbrush, flossing, and rinsing, patients can effectively decrease bacterial load, maintaining a healthy oral environment. To help aid in this independent approach, a hygienist’s most important role is educating the patient. By providing oral hygiene instruction and specific home care techniques, the hygienist can help patients create a strong foundation of techniques for tissue management. If the initial approach to tissue management is unsuccessful, more aggressive treatment is needed.

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As a clinician, you have to implement a consistent tissue management protocol. Early detection and diagnosis of periodontal disease is a critical aspect of tissue management, since disease is easier to treat in its early stages. Case typing the periodontal disease of each patient helps to reinforce consistency when diagnosing and treating patients. Patients diagnosed as Case Type 1 can typically be treated by simple six-month maintenance protocols. Patients presenting with findings consistent with Case Type 2 have gingivitis. This is a patient who can benefit most from a tissue management program. Because gingivitis is reversible, the combination of education and treatment can reverse and prevent the disease process. Treatment can consist of a one- or two-visit scaling and root planing. In addition, modifying home care techniques and adding a prescription rinse can show tremendous gains.

While making the above changes to home care, we have to educate the patient on the importance of arresting the infection and stopping the progression of the pathogens that cause periodontal disease. These patients should come back for a one-month reevaluation after treatment to ensure that the gingivitis has resolved. Studies indicate that it takes 21 days to form a habit. A one-month reevaluation allows the patient just enough time to commit to the changes and implement the techniques daily to create a habit. We know that if we can change the habits of our patients at home, we can decrease the progression of the disease process.

Case Type 3 (periodontitis) and Case Type 4 (advanced periodontitis) patients are more than likely coming back for scaling and root planing, antibiotic therapy, and then a one-month reevaluation. Science shows that antibiotic therapy is effective in decreasing pocket depth to a certain degree. Patients in Case Type 3 will need a tailored maintenance program to maintain their health. Depending on the reevaluation, those in Case Type 3 could need a referral for evaluation by a periodontist. We know that those who are Case Type 4 have generalized loss of supporting structure. Our part as a hygienist is to remove the causative factor (calculus) and control the infection (antibiotic therapy). Co-therapy with the periodontist is necessary to decrease the pockets and stop further progression of the disease. Again, it is important to educate the patient on the multifactorial aspects of the development and progression of periodontal disease. By educating the patient, you are establishing a diagnosis-driven treatment plan. Treatment planning, implementation of therapy, and periodontal maintenance are the major components of a successful tissue-management program.

Hygienists have many roles. Our role as educators is the most important aspect of tissue management. All the data collection that we document will progressively get worse if we do not implement changes to our patients’ home care routine. Oral hygiene instruction is a vital aspect to the routine visit. Review with your patients all the charting, pictures, and radiographs that you have taken and/or collected. Discuss the areas of the mouth they need to focus on and what tools they need to access these areas. Implementing small changes will not only impact their oral health but their overall health as well.

Sarah Robinson, RDH, is a graduate of New Hampshire Technical Institute in Concord, N.H. She has been working as a dental hygienist in private practice for five years. As the lead hygienist, she has implemented a soft-tissue management program and educated the team on the standard of care for early detection and diagnosing periodontal disease. She is passionate about her profession and enjoys the many aspects of patient care that dentistry has to offer.