Hygiene Hot Spot: The 3-Letter Word in Dentistry

The 3-Letter Word in Dentistry: SRP Taking Patients from Compromised to Compliant

By: Mary Hamburg, DDS., MS

During my dental training, I was taught that there are certain words one must not say in front of the patient. Whether it was to prevent an outburst of fear from the patient or to quell my discomfort about discussing blood and pus, I was not sure. No doubt it takes skill and a certain degree of dental acumen to discuss a troubled disease status. But do we dentists take it too far? Suppuration instead of pus. RBCs instead of blood. Hiding calculus that is removed from teeth. Does hiding the negative aspects of the patient’s disease effect their acceptance of treatment? Are we making treatment into a 3-letter word, hindering patient’s care? I had the privilege to work with a wise, experienced dental hygienist during my first years of practice as a periodontist. We often had loud debates about almost every subject in dentistry, not because we disagreed, but simply because we enjoyed the subject matter. One of our discussions centered around a teaching technique she developed after years of cleaning compromised patients’ teeth. She placed all the calculus she removed on a 2X2 clipped to the patient’s napkin, and showed it to them after the cleaning. As someone who can drain an abscess with a straight face without gagging, this revelation was astonishing and disgusting! How dare we show the patient what we are doing in their mouth and prove why the treatment is necessary?! The audacity! This revelation changed the way I discussed periodontal disease with patients. If patients could see the problem, would they move forward with treatment? Could discussing the issues like pus and bleeding with the patient instigate a discussion? Would symptoms be harder to ignore just because it doesn’t hurt? After years of perfecting my consult routine, I have developed a list of three very important things I make sure patients hear while they are in my care. First, I explain what the periodontal probing measurements mean, “1, 2, 3 are normal and 4, 5, 6 are problem areas.” Simple, uncomplicated and without judgement. The next thing I discuss is the bleeding points or BOP. I mention that these areas with bleeding mean active bone loss is occurring and have the potential with worsen without intervention. If suppuration or pus is noted, then I mention an active infection is present in that area and show them intraorally. Last, I show the patient their radiographs. I demonstrate the normal bone levels at the CEJ and point out areas where the bone does not meet that mark. It can easily be done on a full mouth radiographic assessment. With these steps, patients are engaged by the time we get to the treatment plan. They want to know how we are going to stop the disease progression. Patients and clinicians have many hurdles to care. Insurance, finances, and time are just a few. Patients will make the financial and time investments if they understand what they are working toward, and they cannot do that if they do not understand the full picture. If we hide the signs of disease because we are worried about hurting the patient’s feelings, then we are ultimately hurting their overall health. We can no longer afford to think of periodontal disease as a process that does not have systemic implications, such as diabetes or heart disease. We need to give our patients the full picture so they can make the best decision for their health by discussing all aspects of their disease.

ABOUT THE AUTHOR: Dr. Mary A. Hamburg is a 2008 graduate of the OU College of Dentistry, where she also received her periodontal and implant specialty training. She has served the Oklahoma City metro area as a boardcertified periodontist for the last nine years. She is a member of the Oklahoma Dental Association Board of Trustees, currently serving as Editor of the ODA Journal. She has also served as an executive board member of the Oklahoma Association of Women Dentists for the last nine years. Hamburg currently practices in Midwest City Dental Implants and Endodontics of Oklahoma, and in Yukon at Rosewood Dental of Yukon. She is also a Clinical Assistant Professor in OUCOD’s Advanced Education in General Dentistry (AEGD) program. Hamburg and her husband Dustin live in Norman with their two boys, Daxton [8] and Caden [5].