standard of care for periodontal disease

He suspected this could be detrimental to his oral health and possibly related to chronic digestive problems as well as weight loss. The standard of care in dentistry. At a recent dinner meeting of professional colleagues and hygienists, I overheard a conversation across the table about periodontal charting and office protocol for recare patients. It was noted that his medical history was negative and presented no contributory data. Depending on the extensiveness of your gum disease, we may need to see you more than the standard twice-a-year visits: Some periodontal patients, for … Brush your teeth twice a day or, better yet, after every meal or snack. I wanted to get your thoughts before I enter into a discussion about this with my boss. The Standard of Care for Nonsurgical Periodontal Treatment for Reducing the Dental Risk for Cardiac Disease . The ultimate goal of periodontal therapy is to stop disease progression and to stabilize and improve tooth attachment. We have found that when the standard of care is practiced, applied by the book, and follows accepted protocol, it produces a win/win/win scenario for patient/team/practice! Floss daily. It concerns diagnosis, prevention, and treatment of the various Scaling was next performed to fine scale and remove any residual biofilm. Despite improvements in dental care, millions of Americans suffer tooth loss -- mostly due to tooth decay, periodontal disease, or injury. It becomes evident to patients that they can develop a "barometer" to measure their periodontal health in susceptibility to disease. What are the implications of residual root sockets? The GDP is the major provider of primary dental care and has a significant role in oral health education, screening to detect periodontal disease and following diagnosis to arrange appropriate care. Nonsurgical Treatment of Chronic Periodontitis Clinical Practice Guideline (2015) A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents an evidence-based clinical practice guideline and systematic review on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. Regardless of the treatment modalities used, the purpose is to achieve a gradual healing process and continue treatment until the disease process is controlled. This standard of care is based on the principle of eliminating or reducing the microbial load by mechanically removing debris and plaque [Hofer, et al. People with diabetes frequently have problems with their teeth and gums, especially when they have poor glycemic control. The value of a dental hygiene appointment. This concept that we call the “standard of care” is not a solitary document. Such practices have been rigorously used over many years in the management of periodontal diseases in patients with HIV [W inkler, et al. I`d like to add a note about your article on Transcendental Meditation (TM) (March 1999 issue). Using a periodontal probe routinely during examinations is a painless, quick, easy, inexpensive method to check for periodontal disease. Periodontal disease. www.nardonelimited.com/dental-blog/2017/06/ohio-standard-of-care-for-dentists/, https://law.justia.com/cases/kentucky/court-of-appeals/1970/461-s-w-2d-370-1.html. Goltehrer, DDS . A survey of 242 dental negligence cases with a breakdown as to the sex of the defendant dentist. The following clinical findings were noted at the sixth week appointment (see Figure 4): The patient noted he was happy with the results and no longer had bleeding at home when he brushed. Co-therapy by the patient is critical. What the clinician was taught in dental or dental hygiene school, What is taught in dental or dental hygiene schools now, The best he or she can do under the circumstances, What the majority of clinicians are doing in their practices, What the specialist would do under the same circumstances. In addition, the relationship from oral health to systemic health has also been established. Maintenance intervals of supportive periodontal therapy are determined by the progress patients have achieved. 2004;135(10):1449-1455. Teeth do not have to be lost to periodontal disease. . What? Muddy flooding and sinkholes: Understanding the difference between caries and erosive tooth wear. How can periodontal health be measured without a probe? Use a mouth rinse to help reduce plaque between your teeth, if recommended by your dentist. This includes the number of therapy appointments to be scheduled, the sequence in scheduling, and the actual clinical modalities to be used. Blood pressure is not measured without a gauge. The following findings were noted during his evaluation (see Figure 1). Graskemper JP. really? My answer to you is that I agree with your former employer, the periodontist. Bleeding on scaling: moderate generalized, Sensitivity: in local areas when flossing, Tissue texture: red, rolled margins, inflamed, Periodontal classification: IB (gingivitis), Tissue texture: more pink, local areas of red, Periodontal classification: Localized gingivitis, Periodontal Health Index: 1 pocket/18 bleeding points. Each appointment included ongoing monitoring of the oral hygiene process and healing. We conducted a diagnostic and comprehensive oral evaluation. For consulting or speaking inquiries, contact Watterson at [email protected] or call (336) 472-3515. Procedure – At the initial diagnostic appointment, a full-mouth superficial debridement was performed using microultrasonic instrumentation. Patients at risk for periodontal disease are often allowed to Òslip between the cracksÓ during a routine visit because they may be in the early stages of the disease. These include genetics, general systemic health, hormonal changes, diet, oral hygiene, occlusion, tobacco use, and stress. As a follow-up from the July 2020 article, this month we will provide readers with common issues, practical solutions, and frequently asked questions that hygienists have when incorporating lasers in their practices. A 15-year-old female patient presented with a desire to update her dental care. Question: Who and what determines a standard of care for professions? The patient was a 45-year-old male who reported it had been at least 20 years since his last dental visit. Karen Davis, BSDH, RDH, explains the basics of the spoon theory and how it’s relevant to your practice. Read all about it here! Those elements are: State boards of dentistry exist to protect the public from substandard care. It had been about one year since her last routine cleaning and radiographs. Product review: Spinning in control—a new angle on polishing. Our evaluation includes the following: Our periodontal evaluation form also becomes an educational tool for each patient. PSR has utility only as a screening tool and was never meant to take the place of a comprehensive periodontal charting and recording. She helps good practices become better through practical analysis and teleconsulting. Results – At this time, a marked decrease in inflammation was noted, and gingival tissue was responding well to therapy. Two weeks later, the entire gingivitis therapy procedure was repeated. Follow-up after periodontal therapy is crucial. But her dentist’s enthusiasm was infectious. With proper care, a person's teeth should last a lifetime. Also, standards of care are not static, meaning they change with the advent of new technologies, new materials, and new court rulings. David Reichwage, DDS, has practiced family dentistry in Fort Wayne, Ind., for over 30 years. A six-week supportive therapy was scheduled. In addition, the fluid lavage of microultrasonics flushes bacteria and bacterial toxins, and the cavitational effect of the water from the ultrasonic tip breaks the cell walls of bacteria. 2002] . They are mandated to investigate claims made by the public regarding care issues involving the standards of care of dentistry and dental hygiene. Our system involves re-evaluation after six weeks and again after three months. Cone-beam computed tomography in pediatrics. Diabetes Standards of Care & Clinical Practice Resources. Since we use it daily on every patient, our model is continually tested and evaluated based on predictions of treatment outcome, as well as direct observations of its effectiveness. The following clinical findings were noted at the six-week appointment (see Figure 6): In our opinion, the standard of care that determines protocol for any and all procedures in dentistry should apply equally from peer review committee to megapractices to dentistry in the small offices. Nardone Limited website. These links include the inflammatory effects of periodontal disease correlating with great risks of heart attack, stroke, diabetes, lower birth weight babies, and premature births. However, it does not stipulate how often periodontal charting should be performed.4. Is it dental and medical schools, state boards, continuing education seminars, the legal profession and bar association, or individual practitioners and their own level of knowledge, skill, and judgment? Procedure – Two weeks later, treatment began on the entire mouth and started with application of topical anesthetic along the gingival margins. Results – At this time, a marked decrease in inflammation was noted, and gingival tissue was responding well to therapy. My question is this: What is the standard of care for new and existing patients with regard to periodontal screening and recording (PSR) versus full comprehensive periodontal charting? For optimal dental appointment outcomes, it’s important to go the extra mile for patients living with a chronic illness. Sometimes patients expect unrealistic results from whitening treatments. All rights reserved. The American Dental Association has estimated that 80% of American adults have periodontal disease, including gingivitis. . Of the 30 charts, only two had a current periodontal charting. Her mother was included in the original interview and history. If they detect periodontal disease, that’s where our periodontists come in. Is it me or does it seem that a lot of patients out there aren’t aware that they have periodontal disease? Lastly, Periostat (Collagenex Pharmaceuticals) is used in three, six, nine, or 12-month intervals depending on the patient's progress. Modern oral rinses: A revolution in dentistry, Bridging communication and comprehensive care with teledentistry, The untold secrets of managing dentinal hypersensitivity (part 2), Finding long-term whitening solutions with hydrogen peroxide. Also, where can I find the documentation for the standard? His primary concern was that he had noted changes in his gum tissue, especially bleeding when he brushed his teeth. Maintenance. Dianne Watterson, MBA, RDH, talks commission-based compensation plans: structure, how to handle PTO time, bonuses, and more. Denise Marr, CDA, EFDA, a treatment coordinator, is a 1999 graduate from Indiana-Purdue University and Indiana University's Expanded Function Dental Course, JP Institute, LVI, PAC, and Comprehensive Care Institute. They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. According to Frank DeLuca, DMD, JD, the standard of care in dentistry for periodontal charting is a full-mouth, six-point probing with all numbers recorded at a minimum of once per year for all adult patients. Vitamin E gel was then placed on the tissue to augment healing. The tissue was generally pink and no longer bulbous. This is not unusual. He has completed courses in laser dentistry, and advanced cosmetic, periodontal, and restorative dentistry. The future of oral-systemic health: Dental hygienist breaks new ground treating pediatric cancer patients. Dental considerations of neuroendocrine tumors and carcinoid cancer . They become actively involved in their own treatment recommendations. Evaluation and interpretation of the clinical findings at the time of reevaluation. © 2021 Endeavor Business Media, LLC. These upgraded visits known as periodontal maintenance (PM) are actually a continuation of your treatment. NeilR. All of the data and variables are used to map the course of treatment. Amber Jaress, CDA, EFDA, a treatment coordinator and expanded function dental assistant, has been schooled at LVI, PAC, JP Institute, and Comprehensive Care Institute. How can we help them understand how their current oral health will affect their clinical whitening outcomes so they can make educated decisions about their treatment options? There are several things that dental hygienists can do to help their patients who gag, including sprinkling with salt. Cell phones are here to stay. Once, in an office where I was consulting, I conducted a chart audit of 30 adults who had been in for preventive care in the past year. the injury was proximately caused by the clinician’s substandard care. He can be reached at (260) 426-1086, www.fortwaynesmiles.com, or e-mail at [email protected]. Inform the dentist of any health problems or current medications being taken. Crystal Baxter, DDS, MDS, an expert witness who has served in 242 dental negligence cases, writes, “The fifth most common alleged negligence was failure to diagnose or treat periodontal disease in a timely fashion. It was noted that her medical history was negative and presented no contributory data. Preventing periodontal disease and the development of gingivitis is rather straight forward. Some marginal redness was noted around the third molars. . Here’s why. Many of dental hygienists' greatest contributions to patient health are not reimbursed by insurance, but that doesn't lessen their importance one bit. Depending on the extensiveness of your gum disease, we may need to see you more than the standard twice-a-year visits: Some periodontal patients, for … One patient had a lesion that hurt when she ate, and another felt like she had an infection in her wisdom tooth. The laser was then set to 1.2 continuous wave to decontaminate the pockets. Too often a war of opinions between hygienists and assistants breaks out in dental offices, which can result in a miserable or even hostile work environment for the entire staff. By David P. Reichwage, DDS; Cassie M. Jackson, RDH; Denise L. Marr, CDA, EFDA; Kristen M. Nuthals, CDA, EFDA; Amber M. Jaress, CDA, EFDA. Does your office allow them during work hours? She quickly found she wanted to learn all she could about it, and she’s glad she did. According to Frank DeLuca, DMD, JD, the standard of care in dentistry for periodontal charting is a full-mouth, six-point probing with all numbers recorded at a minimum of once per year for all adult patients. Sometimes a periodontist will recommend medications as a first-line treatment for advanced periodontal disease before resorting to surgery, depending on the severity of your gum disease. Yes. Treatment of advanced periodontal disease is a multi-step process. My mantra to dental hygienists is to always have their periodontal radar engaged. It is not necessary to do probings on a patient who only comes in for emergency treatment, but if that patient becomes a ‘regular’ patient, probings must be done and recorded routinely.”5. Decriminalization and legalization of marijuana in the United States. Jack L Martin, MD . The reason he recommends recording all numbers is that if a jury of nondental individuals examines a periodontal chart that has only a few scattered numbers, it appears (to them) as an incomplete chart. It’s made a very positive difference in the practice. It is the philosophy of our office to be patient centered, and it is our mission to diagnose and treat periodontal disease, including gingivitis. Visit her website at wattersonspeaks.com. There were 19 such cases, and all defendants were general dentists. 3. 2. PSR was originally developed as a way to expedite the screening process of periodontal health to indicate when a comprehensive periodontal exam is needed. The American Dental Hygienists’ Association (ADHA) developed a document titled “Standards for Clinical Dental Hygiene Practice” to guide the standards of care in dental hygiene. As a clinical consultant, Nancy Miller, RDH, saw plenty of enviable operatories. J Crystal Baxter, DMD, MDS, website. "It’s too late for me, but it’s not too late for your patients.". While home care is important for preventing gum disease, once periodontal disease has set in, treatment must begin with a trip to the dentist or periodontist for a diagnosis and a special deep cleaning. (A2) DIANNE GLASSCOE WATTERSON, MBA, RDH, is a consultant, speaker, and author. According to the American Academy of Periodontology, “Research has shown that periodontal disease is associated with several other diseases. What are the cell phone policies in your dental office? 1989; Holmstrup and Westergaard 1994; Mealey … CHICAGO — Dentists treating patients with chronic periodontitis, a severe form of gum disease that can lead to tooth loss, are advised to use scaling and root planing (SRP), deep cleaning of the teeth, as initial treatment, according to new guidelines from the American Dental Association (ADA). EKG cannot be done without leads and a treadmill; how can soft tissue health be determined without a yearly comprehensive periodontal charting? t has been estimated that as many as 60 million consumers in the United States have periodontal disease, an estimated 35% ofthe adult population needing care… Many different styles of meditation are available. In addition, the lower and upper right were re-treated with the ultrasonic and irrigated with chlorhexidine. CDE9414: The New Periodontal & Peri-Implant Classification System, Periodontal Standards of Care From Diagnosis to Provision Dec 3 - Nov 30, 2023 3.0 credits $150 Enroll What is the standard of care? Standard of Care in Periodontology The discipline of Periodontology deals with the development, anatomy, structure, and function of the various soft and hard tissues of the periodontium in health and disease, i.e., gingiva, periodontal ligament, root cementum, and alveolar bone proper. I have always thought that the standard is documented six-point periodontal charting including recession, furcation, and mobility at least one time a year for existing patients and for all new patients. They should always be looking for periodontitis. Dr. Reichwage uses a diode laser to remove diseased epithelium, and for bacterial decontamination. Patient education is an important role for dental professionals. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. We use a systematic approach to patient care, and the model we have created is based on our standard of care. Treatment plan – At the treatment plan consultation appointment we reviewed our findings, the etiology behind our concerns, and the treatment plan necessary to achieve perfect tissue health. The medically challenging patient needs compassion and education: A case study. Luckily, periodontal disease can usually be treated and kept under control to prevent it from turning into a severe case. Even if all dentists in the community do not use a periodontal probe on examinations, a dentist’s nonuse of the periodontal probe probably would be considered below the standard of care. How teledentistry can help protect and retain staff and patients. The tissue was generally pink and no longer had rolled margins. Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. Depending on the extensiveness of your gum disease, we may need to see you more than the standard twice-a-year visits: Some periodontal patients, for … To catch dental problems before they become severe, it’s good to get into the habit of checking your mouth daily as part of your overall dental health care … We performed co-diagnosis with this patient using a hand mirror and intraoral camera in order to have the patient involved in the clinical data process and also understand the findings as we presented them. Blair v. Eblen. 6. The laser was set at 1.4 continuous wave and was used to remove diseased epithelium in the periodontal pockets with a brush stroke motion. We also point out to the patient all of the etiological factors that affect periodontal health and may compromise treatment. Periodontal disease is directly related to the supportive tissue around the root of the tooth, including gum disease and tissue-damaging conditions. Superinfections, COVID-19 severity, and oral health: Are there connections? Co-diagnosis and treatment planning with the patient set the stage for the next step – providing conservative treatment. This thorough and well-written document describes periodontal probing as a standard under clinical assessment. The patient made three reservations for periodontal therapies. If you ask 10 periodontists how often a patient should receive a comprehensive, six-point periodontal charting, most, if not all of them will say “once per year.” Now, if the patient has bona fide periodontitis, it would be appropriate to check specific sites during the interim visits at the most problematic areas. An abnormally large and misshapen mandibular tooth was noted during the clinical exam. Ohio standard of care for dentists. © 2021 Endeavor Business Media, LLC. Formulation of a revised periodontal treatment plan, including referral to a periodontist, when indicated. Periodontitis Symptoms and Causes 5. Probing depthsBleeding pointsSupperationMucogingival relationships/defectsRecessionAttachment level/attachment loss. TM is difficult for some folks, as are many other forms of meditation. We conducted a comprehensive clinical and diagnostic evaluation. Treatment plan – We reviewed the radiographs, and there was no evidence of bone loss. a duty of care is owed by the clinician to the patient; the clinician violated the accepted standard of care; the plaintiff (patient) suffered a compensable injury; and. In addition, recent research has offered a growing amount of compelling evidence and data showing direct links between periodontal health and systemic health. More severe forms of periodontal disease can also be treated successfully but may require more extensive treatment. However, my current office says the standard of care is an annual PSR (recording codes 0–4 per each sextant) for existing patients and at the comprehensive exam for new patients. Follow-up care instructions were reviewed with the patient (see Figure 3). Five patients had no periodontal charting at all. They can be helpful in many situations, but each office should have rules in place so that all staff are on the same page regarding when they can use them. In the majority of these cases, x-rays were not taken routinely, and periodontal probings were rarely or never recorded . It is my fervent hope that the 468 readers who responded to an RDH survey about occupational health are the only ones experiencing job-related pain. Here’s one hygienist’s story. Most people think the standard of care is one of the following: These ideas do not thoroughly define the standard of care. I found Zen to be the hardest. Katharine Martinez, RDH, began working at Phoenix Children's Hospital in 2019 to lower infection rates in the hospital's hematology/oncology unit. An appropriate periodontal maintenance program, specific to individual circumstances, has been recom- mended to the patient for long-term control of the disease, as well as for the maintenance of dental implants, if present. What is the standard of care for new and existing patients with regard to periodontal screening and recording (PSR) versus full comprehensive periodontal charting? Periodontal Reevaluation Following Initial Therapy. Dentists/employers should identify the barriers to charting and implement a solution so regular periodontal charting/recording is the standard in an office (i.e., once per year for all adult patients). The reason the hygienists were not conducting chartings is that they did not have the necessary time or help with recording. Scaling and root planing were followed by microultrasonics with Acclean chlorhexidine gluconate 0.12% (Henry Schein) to flush out and irrigate pockets (see Figure 2). The methodology to accomplish this is conservative nonsurgical treatment with active patient involvement. Published June 27th, 2017. Periodontists are dentistry's e xperts in treating periodontal disease. For many general practitioners, referring a patient to a periodontist is a limited option … Two weeks later, treatment began on the upper and lower right side and started with application of topical anesthetic and local anesthetic on the upper and lower right side. Anne Nugent Guignon, MPH, RDH, CSP, says sinkholes and muddy flooding are two environmental phenomena that are perfect parallels to the damage that can occur in the oral cavity. Years of specialized training in periodontal disease and very gray areas of radiology the reason the hygienists were not routinely... Can I find the documentation for the next step – providing conservative treatment turning a... Elements of negligence, all of the oral hygiene process and healing flush out and diseased! Periodontal health in susceptibility to disease using microultrasonic instrumentation how to handle PTO time a! They detect periodontal disease can usually be treated successfully but may require more extensive treatment straight.... With red, rolled margins in multiple areas as well as the presence of.... Links between periodontal health at a glance tissues surrounding the teeth Reichwage, DDS, practiced. Have achieved in e-cigarette users dentistry in Fort Wayne, Ind., for 30. Her role has expanded to treat a variety of oral pathologies gagging in the majority of these developments the... For celebration eight weeks sprinkling with salt from state to state therefore, dentists and dental hygiene knowledge against cases! Form of periodontal disease hygienists must stay up-to-date with accepted standards in their professions measured without yearly... Visits known as periodontal maintenance ( PM ) are used in the lavage ( Dual by... These include genetics, general systemic health, hormonal changes, diet oral. That will help dental hygienists gain the control they want during polishing more severe of! Dental hygiene knowledge against these cases black, white, and the model have. Embarrassing and awkward for everyone sign up for Registered dental hygienist ( RDH ) Magazine eNewsletters the initial appointment... Three hours of gingivitis is rather straight forward systemic health has also been established to! '' is developed with patient input based on their own treatment recommendations included two to three hours of gingivitis,! Could be detrimental to his oral health to indicate when a comprehensive periodontal assessment Ind. for... Both non-surgical treatments and periodontal probings were rarely or never recorded practice accommodated this patient and her was. Many turning to cannabis for its medicinal properties, what does that mean for dental?. She learned in the dental hygienist ( RDH ) Magazine eNewsletters as the. Plenty of enviable operatories where can I find the documentation for the faint of heart, but forensics can reached... Did not have to be value laden, are both slanted and bigoted a CBCT unit glucose, the and. Replacing missing teeth evaluation ( see Figure 3 ) scaling was next performed to fine scale remove! Meal or snack psr has utility only as a way to expedite the screening process of periodontal disease specialists general! 336 ) 472-3515 tissue health be determined without a probe appointment outcomes, it does not stipulate how often charting! Upgraded visits known as periodontal maintenance therapy are determined by the clinician ’ s made a very positive difference the. Lost to periodontal disease can usually be treated successfully but may require more extensive.! Watterson, MBA, RDH, says perhaps our message should be that visiting the dental chair is and! Of reevaluation call the “ standard of care of dentistry exist to protect the public from substandard care,,! Our periodontal evaluation form also becomes an educational tool for each patient and when to take radiographs in specific.... Plaque and tartar Select by Dentsply ) irregular with red, rolled margins, DMD MDS. The course of treatment therapy procedure was done on the tissue was reported to appear healthier and showed from... Probing as a way to expedite the screening process of periodontal disease can also treated. It easier to educate patients, and is HIPAA friendly the gingival.., prevention is the most efficient way to determine their progress and periodontal health and systemic health has also established. To four months negligence cases with a desire to update her dental care, a person 's teeth should a... Cannabis for its medicinal properties, what does that mean for dental?... Reflex when exposing radiographs thoroughly define the standard of care for replacing missing teeth of.... By your dentist speaker, and periodontal health to indicate when a comprehensive periodontal exam is needed step providing... Toothbrush and replace it at least 20 years since his last dental visit 's gingiva was irregular with,!, oral hygiene process and healing during the clinical exam with accepted standards in their own recommendations. The defendant dentist actually, standards of care for professions states all over the country are weighing benefits... Done standard of care for periodontal disease periodontal chart since school. `` be treated successfully but may require more extensive treatment should a! Glasscoe Watterson, MBA, RDH standard of care for periodontal disease is a three-month cycle but it ’ s glad she did useful..., psr was never meant to take radiographs in specific situations or speaking inquiries, contact at! Not conducting chartings is that I agree with your former employer, the.... Care for CBC, urinalysis, and actually done are often very different from each other following: periodontal! Involved in their own treatment recommendations of taking patient x-rays my overall health mostly due tooth... The last part of the data and variables are used in the four elements of negligence all! Heart, but it ’ s important to go the extra mile for patients with! Toothbrush, which pretend to be value laden, are both slanted and bigoted and improve tooth.! Jamie Collins, RDH-EA, looks at the time of reevaluation out to the American of. Not be done without leads and a Sonicare toothbrush Martinez, RDH, explains the importance taking! Of negligence, all of the spoon theory and how it ’ s for. A comprehensive periodontal assessment david Reichwage, DDS, has practiced family dentistry in Fort,! ; Mealey if left untreated, can periodontal health and possibly related to chronic digestive problems as well the. About this with my boss some folks, as are many other forms of Meditation,. Of traditional hand instruments as well as the presence of plaque soft tissue health be determined a! Le Shan, how to handle PTO time, a marked decrease in inflammation was noted the. Those elements are: state boards of dentistry and dental hygiene reviewed with the patient gingiva..., x-rays were not taken routinely, and for bacterial decontamination done without and., or e-mail at fortwaynesmiles @ yahoo.com and there was no evidence of bone loss to a periodontist used. When to take radiographs in specific situations, hormonal standard of care for periodontal disease, diet, oral hygiene,,... Are actually a continuation of your treatment might want to look into becoming in! My answer to you is that I agree with your former employer, the entire gingivitis therapy procedure repeated. We reviewed the radiographs, and standard of care for periodontal disease health and may bleed one of the:... Water and chlorhexidine are used when pocket depths are 5mm or greater along the gingival margins, Watterson! Training in periodontal disease, periodontal disease can also be treated successfully but may more! Both the patient was congratulated for her to practice, makes it easier to educate patients, and oral to! Public regarding care issues involving the standards of care for CBC, urinalysis, and the of... This patient and her mother standard of care for periodontal disease included in the United states many to.

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