Hygienists and periodontists have different roles in a practice. But that doesn't mean hygienists aren't as smart! In this episode of Clinical Edge Fridays, Kirk Behrendt shares their recent Master Class by Katrina Sanders, The Dental WINEgenist, to test your knowledge and skills in diagnosing various cases. Are you smarter than a periodontist? To find out, listen to Episode 879 of The Best Practices Show!
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More Helpful Links for a Better Practice & a Better Life:
Main Takeaways:
Quotes:
“The prevalence of [periodontal] disease that our perio specialists are actively treating daily and the disease process that, in general practices, you are actively screening for and subsequently actively treating in those mild and moderate cases is an extremely prevalent one. The American Dental Association, back in 2016, estimated that about 47.2% of U.S. adults — these are patients between the ages of 30 and 79 — have some form of periodontitis. It's important to know, in this population, 47.2% means that nearly one in two of your adult patients between the ages of 30 and 79 have some form of periodontitis — one in two. So, I want you to consider that. General practitioners, how often are you performing periodontal procedures in your clinical practice versus how often you are performing the “free cleaning” the patient's insurance will pay for?” (7:15—8:23) -Katrina
“It's important to know that the vast majority of this 47.2% of adults who have perio, about 89% of them are going to present with mild and moderate severities of the disease process. Only about 11% of patients who have periodontitis are considered severe. So, again, it's important for us to take a step back and recognize the critical role that a general practice should have in critically assessing and subsequently diagnosing this overt disease.” (10:01—10:43) -Katrina
“The current landscape of periodontitis really points to the overt concerns that periodontal disease is considered a massive contributor to the global burden of chronic disease. In fact, periodontal disease is considered the sixth most prevalent disease of mankind. It's no wonder we're so busy.” (10:55—11:21) -Katrina
“Prevalences of disease when it comes to periodontal conditions continues to increase. Despite the data, despite the research, despite how hard we're working to try to manage these diseases, the prevalence continues to increase. Concerningly, the prevalence of periodontitis has increased about 57% from the 1990s to about 2010. Now, that's really important because it means that although we are doing more to identify this disease earlier — we're pulling in tools from our tool belt to help eradicate this disease sooner — along the way, we are still continuing to see heavy prevalences of this disease.” (11:24—12:11) -Katrina
“Patients are living longer, and they are living longer with their natural teeth, which means that patients who, perhaps decades prior, would have had those teeth extracted due to hopeless prognosis and been wearing dentures by now, those same individuals today, instead, are managing their natural teeth with overt levels of attachment loss or, in many cases, we're seeing a resurrection of that inflammation that requires constant prudent evaluation and subsequent maintenance. What's more, patients are living longer through chronic diseases. And the sad reality of the existing health complications, particularly in the United States, directly point to the fact that although, yes, our life expectancies are longer — we are living longer than we ever have before, with the exception of the year 2020 . . . we are living longer with all of these comorbid complications showing up. Unfortunately, if you take a look at the quality of life of Americans who are living longer, we recognize that not only are we living longer, but we’re dying longer. The last several decades of our lives, in the United States, are oftentimes spent in chronic, catastrophic disease.” (12:16—13:46) -Katrina
“One of the biggest challenges that we run into is that we consistently see patients in a perceived state of health. Put simply, our patients who sit in our chairs — hygienists, you know exactly what I'm talking about. When our patients sit in our chairs, oftentimes, they lack awareness that bleeding from the mouth is not normal, nor is it a sign of health. Patients sitting in our chairs, although they will likely know and might even admit to us that they are poor with their oral hygiene habits, rarely understand that poor oral hygiene habits are linked to poor oral hygiene and subsequent poor oral health. So, part of our challenge early on in the process when we see these mild and moderate cases of disease is now to help educate our patients, to help them understand the sequelae of this disease process. And now, as research continues to unpack layers and layers of how oral disease is linked to systemic disease, now the burden, the responsibility, the opportunity, the pleasure we have in partnering with our patients and helping elevate their health becomes even more important than it ever has. Today, in dentistry, we have an opportunity to truly position ourselves as partners alongside the medical community in prevention and in subsequent inflammation management.” (15:48—17:32) -Katrina
“Just because a patient is put into the Dentrix appointment column as a prophy does not necessarily mean that patient is a prophy. Prophylaxis is in the implementation phase. So, while the patient may be scheduled for that, there is a plausibility, a probability, that that patient may not, in fact, qualify as a prophylaxis. While many of us want to start by sitting the patient down and going, ‘You're here for your cleaning. Let's get started,’ the reality is we really need to begin in that assessment phase to actively track what our patients look like today.” (21:04—21:44) -Katrina
“While we learned about assessments in dental and dental hygiene school, and while we know how important they are, I think we can all agree — and I'm going to share something quite provocative — the reality, or rather, the challenge inside of this is that oftentimes these assessments are not receiving the critical focus that they “should” in our dental practices.” (22:56—23:26) -Katrina
“Gathering a diagnosis does require us to take a step back and look at things like our patient's oral hygiene status, because we do know that indicators like the composition, location, duration, and presence of biofilm is going to be a critical driver. But unfortunately, for many providers, we have used the amount of debris as the beacon or benchmark for if we choose to do things like active periodontal treatment. And the reality is that while oral hygiene status and the presence of biofilm certainly is a piece or aspect of the puzzle, it is not the determining factor of how we diagnose our cases.” (42:30—43:15) -Katrina
“One of the things that may make our periodontists smarter than us is that they will pull out the evidence-based data and the evidence-based products that they know will help support their patients' healing.” (1:19:36—1:19:52) -Katrina
Snippets:
0:00 Introduction.
2:22 Katrina’s background and upcoming course.
6:47 The prevalence of periodontitis.
10:44 The current landscape of periodontitis.
15:50 Be a partner in prevention and inflammation management.
17:33 More about Katrina.
18:30 Course objectives.
20:39 ADPIE: The steps in the dental process of care.
22:47 The assessment phase.
25:59 Fear Factor: Perio charting.
33:49 Hands-free perio charting software.
38:36 How much pain are we causing for patients?
41:16 Early stages of disease are not seen radiographically.
42:25 Gathering an appropriate diagnosis.
44:33 Stages of periodontal disease.
50:33 Grades of periodontal disease.
56:27 Strategies for patient communication.
56:43 Family Feud: Why patients decline perio treatment.
1:00:08 The importance of patient communication.
1:01:45 Survivor: Implementation.
1:10:09 The Newlywed Game: How well do you know your patients?
1:17:06 Are you smarter than a periodontist: What do you know about Perio Tray therapy?
1:23:45 Why are periodontists opposed to Perio Protect?
1:24:56 Perio Protect, explained.
1:32:33 Are you smarter than a periodontist: Diagnosing case examples.
1:39:32 Are you REALLY smarter than a periodontist: Diagnosing case examples.
1:53:47 Perio Protect for diabetic cases.
1:55:03 Case example: Two months of Perio Protect therapy for a diabetic patient.
1:57:20 Case example: Type 2 diabetic.
2:00:53 Conclusion.
2:03:24 Q&A: If the grading can be modified, how about the staging?
Katrina M. Sanders RDH, BSDH, M.Ed, RF Bio:
In the ever-changing world of dental science where research, technology, and techniques for patient care are constantly evolving, dental professionals look to continuing education to provide insight, deliver actionable steps, empower, and create a dramatic impact within their clinical practice.
With wit, charm, and a dash of humor, Katrina Sanders enchants dental professionals with her course deliverables, insightful content, and delightful inspiration. Her message of empowerment rings mighty throughout her lectures and stirs a deep sense of motivation amongst course participants.
Katrina is the Clinical Liaison for AZPerio, the country's largest periodontal practice. She performs clinically, working alongside Diplomates to the American Board of Periodontology in the surgical operatory. Katrina perfected techniques during L.A.N.A.P. surgery, suture placement, IV therapy, and blood draws. She instructs on collaborative professionalism and standard-of-care protocols while delivering education through hygiene boot camps and study clubs.