The Ultimate Hygiene Exam
We all aspire to provide ‘ideal’ treatment for our clients and feel we can’t because of restrictions placed on us outside our control. If it was your practice, what you your protocol look like?
Greet patient by name with a handshake
- “Hi, Ms. Jones. My name is Rachel and I will be taking care of you.”
Escort patient to treatment room
Ask patient for any questions/concerns they may have
- “Have you noticed any changes with anything in your mouth? Do you have any questions or concerns before we start today?”
- Address any specific concerns
Take blood pressure and record in chart
Review medical history
- “Are you taking any medication, supplements or over-the-counter drugs? Are you taking aspirin daily? Have you had any surgery or new diagnoses since your last visit?”
Take radiographs if necessary
- Observe bone level and compare to periodontal probe readings
- Observe decay visible on x-rays
- Observe margins of restorations
- Observe any lesions in the bone
Do extra-oral head/neck oral cancer screening
- “Ms. Jones, I am going to be my exam by feeling for any unusual lumps or bumps on your face and neck. Is that ok? Have you noticed any lumps or bumps?”
Do intra-oral cancer screening
- Complete a visual exam
- Utilize technology for oral cancer screening-Velscope or Vizilite
Complete general intra-oral exam
- Observe restorations, teeth and gums
- Calculus detection
- Decay examination
- Evaluation of existing restorations
- Cosmetic evaluation-shade guide analysis
- Breath Analysis
- Oral Hygiene Evaluation
- Occlusal Analysis
Complete 6-point periodontal examination
- “Ms. Jones, I am now going to do a very thorough exam of your gums. This exam looks for signs of gum disease. I will be taking several measurements on each tooth and you will hear me call out lots of numbers. If you hear numbers that are 1-3 with no bleeding, that indicates that your gums are healthy and normal. Any numbers you hear that are 4 or higher or if you hear me say there are many areas of bleeding, that is a sign of gum infection. I will review all the numbers when the exam is finished”
- Using a periodontal probe, measure the depth of each pocket.
- Start on the upper right facial moving around the arch taking 3 measurements on per tooth. Then move to the lingual and take 3 measurements per tooth. Repeat on the lower arch.
- Say all perio numbers aloud from the upper right to the upper left facial. Then look back at upper facial areas and say aloud any points of bleeding, pus. Repeat on lingual and on lower arch.
- Measure recession from the CEJ to the gingival margin. Say all numbers aloud with surfaces to be recorded on perio chart.
- Record mobility and furcation aloud and record on perio chart
- Read aloud the total number of bleeding sites and pockets over 4mm
- Print perio chart in color.
- Highlight infected areas on periodontal chart (4mm or greater).
Determine patient’s periodontal status: healthy, gingivitis, periodontal disease
Share your observations with the patient
- Share with patient their periodontal status-healthy or infected
- Share with patients any teeth you are concerned about
- This is a good time to discuss whitening, fresh breath solutions
Take intra-oral photographs
- If patient has periodontal disease, take photos of inflamed, bleeding tissues and/or visible calculus.
- If patient has healthy gums, it is now time to discuss their restorative needs. Take photos of next restorative priority (area of concern).
Create periodontal treatment plan or preliminary restorative plan for doctor approval
Call Doctor for exam (doctor may do exam any time after hygiene exam is complete)
- Doctor confirms all findings and makes final diagnosis
- Doctor reinforces need for perio therapy as first priority when there are no emergency restorative needs
- Doctor reinforces need for restorative treatment when patient’s periodontal status is healthy
- This may occur immediately following hygiene exam or closer to the end of the appointment depending on doctor’s schedule
Begin hygiene service
You may now begin scaling.[Reprinted with Permission. Original appeared as a blog post by Rachel Wall, at Inspired Hygiene April 26th, 2010 Step-by-Step System for the Ultimate Hygiene Exam. Rachel provides office consulting, online programs, books, CDs and host of other valuable practice managment supports for dental/hygiene practice, her specialty, Dental Hygiene Practice]
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