Caught in the Act: Part I

Last week I covered a day of hygiene for a friend and witnessed something horrible. 

My blood pressure rose. 

I perspired. 

I was afraid. 

In fact, I was so distraught by this heinous crime I had witnessed, it took nearly an hour that evening for me to settle myself to a point to discuss it with my other half

.And it's like a bad dream that repeats itself. This is not the first time I have witnessed this tragic occurrence.

When is our profession going to wake up? We are good people. Yet we allow ourselves to contribute to the demise of our patient's health on a daily basis. The incongruence of our ethical promises and the delivery of our care is mind boggling. How has it come to this?

My day was the result of years of bloody prophies. And reviewing the patient notes prior to beginning my day gave no clues to the scene that was unfolding before me. And it went something like this.

8:00 am prophy, BWX, exam patient 25 minutes late and office manager requests "Just do the cleaning. He is super healthy and usually out quickly"

Well all right. I've been at this for nearly 30 years and the perio chart says no pockets greater than 3mm with accompanying notes stating great home care and very light calculus.

Normally, I would reschedule the patient, but with a healthy guy like this, doing the prophy and rescheduling the exam and BWX to tomorrow? I'll make it work.

As soon as I picked up my probe I realized he was a victim. I entered this bloody crime scene shocked and dismayed. Moderate to advanced periodontal disease throughout the posterior. And he had no idea. "What do you mean?", he asks. "I come in every 6 months like she tells me to."

Needless to say, my schedule was on its way into the dumps and this man needed to a completely different course of treatment. And he was not happy. Up to the front he went, scheduled 4Q and left in a daze.

And me? Officially running 20 minutes late. Full of apologies, I bring my next patient back for his radiographs.

Obese, diabetic, statin meds, HBP and guess what? Advanced, bloody perio throughout. No insurance. Vet. And no idea.

Patient 3. Healthy appearing man in his early 60's. Groovy ponytail and self proclaimed "health freak". Had a heart bypass four years prior, a wife 18 years his junior, organic diet and a brushing routine like there's no tomorrow. I was happy to have him in my chair and looked forward to the opportunity to get back on schedule. He had requested to be on a 4 month recall, "because his teeth were important to him".

Extra oral exam, intra oral all looking good...and then I pick up my probe. Aghast, I am witness to another crime. I discover bloody, 7mm pockets in the maxillary molar region and more bloody 4-6mm pockets mandibularly.

Patient 4. Thirty five year old father of five children, yes, I said five. Mod Periodontal disease throughout. Heavy sub, bleeding and plaque. In, fact, there was so much inflammation the home care instructions caused hemorrhaging. He had no idea. But yes, his gums did bleed sometimes when he brushed (on the odd chance that he might actually hit the gum line with his brush)! Nobody had ever shown him how to brush. Needless to say, he was shocked by my findings, agreed to the 4Q and booked his treatment before leaving.

Patient 5. I complimented her beautiful whitened teeth. She said her father had dentures and she was planning to keep her teeth. Took photos of the moderate wear on facially tipped 24 & 25 and their 4mm lingual recession/abfraction. She said she could feel that with her tongue and wondered if it was a problem. Explained functional trauma and referred to orthodontist. She was so thankful that something might stop this progression.

And the afternoon was more of the same. 23-year old mother with an 11 month old son. Super excited to be moving to the City for her husband's new job. Generalized 2-3mm recession throughout posterior buccals and #23 and #26 presented 4mm and 5mm facial recession impinging on mucogingival junction. Mod bleeding throughout with mod decalcification and plaque posteriorly. Recommended increased frequency of prophies, remineralizing products, sensitive bristle power toothbrush with instruction and perio referral. She had no idea and was genuinely upset.*

40 year old school teacher with 5mm pocketing around molars. Again, discussed eitology and progressiveness of perio recommended 4Q 1-3 which she scheduled.

With the exception of ONE patient, each of these patients were on 6M recall's! What is going on out there? Hygienists, pick up your damn probes! Our profession is about to be busted! People are suffering. Their health is at risk and we are chatting and polishing and talking about our vacations?

Doctors. This has got to STOP! You must all hold your team accountable. You need to pick up your probes at your exams. Your patients are counting on you to be their advocates, yet they are walking out of your offices sick and infected.

The victims of whom I speak of are alive. And there is hope that they will heal and enjoy many years with their loved ones. But how many heart attacks, strokes and systemic infections are we responsible for?

We have been caught in the act! And yet we are fortunate. Our patients give us a second, third, tenth even twentieth chance. Please. Today. Insist that your patients are being properly assessed and provided the treatment they deserve when they visit your hygiene department. Our patients can "love their hygienists" because they talk about personal things while their gums and health go to hell in a hand basket or they can "love and appreciate their hygienist" because they give incredible comprehensive preventive care. What type of care do you want coming out of your hygiene department?

These victims are mothers, fathers, sisters and children. We must protect them as if they are our own.

* Incidentally, I ran into the young mother at dinner the next night. She and her husband came to me and thanked me for the care I had given her. They asked if I could help them find a dentist in their new city. "One with a hygienist like you". This broke my heart. Aren't we all hygienists like this?

Watch for Caught in the Act Part II, where we will break down the reasons why these crimes are being committed and best of all...how we can fix this broken model.

Your comments are appreciated!  What do you think is happening here?