September 12, 2024
by Gabriele Maycher, CEO, GEM Dental Experts Inc. BSc, PID, dip DH, RDH: 


Challenge

As a senior hygienist on our team, I frequently find myself needing to retreat periodontal therapy due to calculus being left by previous hygienists. My goal is to reduce the need for uncomfortable conversations with clients about retreatment and improve the reliability of our services. How can we collaborate to tackle this challenge and implement a more dependable system that ensures our clients consistently receive thorough care?

Solution

Several key considerations could address this issue effectively:

Experience and Mentorship:

Assess the clinical experience levels within the team, particularly for recently graduated hygienists. Consider implementing a mentorship program during their first three years to support their confidence in managing nonsurgical periodontal therapy for clients with advanced disease. This initiative allows them to refer such cases to more experienced colleagues until they feel proficient. Ideally, recent graduates should have these conversations with clients during their initial appointments, explaining the benefits of scheduling with a senior hygienist.

Clinical Time and Treatment Goals: Clarify the time required to achieve the desired therapeutic endpoint. Whether targeting gingivitis (pocket depths ≤ 3mm, < 10% bleeding on probing) or periodontitis (pocket depths ≤ 4mm, < 10% bleeding with no bleeding at 4mm pockets), it’s crucial to understand and adhere to these health parameters. Achieving these standards may necessitate more than one appointment; the focus should be on comprehensive debridement to meet these endpoints effectively.

Continuity of Care: Assess how client care continuity is currently managed and ensure that each hygienist provides ongoing care to their assigned clients, rather than scheduling appointments based solely on availability. This approach not only fosters consistency in treatment but also strengthens client-provider relationships. It serves as a continuous learning process for understanding the therapeutic endpoint and determining if additional time is required. Over time, this approach enables new hygienists to develop a clearer understanding of the time needed to achieve optimal results for each client.

Regular Quality Assurance Checks: Implement regular quality assurance checks or peer reviews to evaluate the effectiveness of treatments and ensure adherence to clinical standards. This can help identify any recurring issues with incomplete calculus removal and provide opportunities for continuous improvement.

Standardized Protocols: Develop standardized protocols for initial therapy and recare appointments that detail precise steps and expectations for calculus removal and achieving therapeutic endpoints. This includes scheduling appropriate time based on oral deposit accumulation, addressing deep or old subgingival calculus seen on radiographs, and considering pocket depth as a scheduling reference. Establish guidelines for initiating local anesthesia and promotion of recommend gold standard oral self-care devices. These protocols promote consistency across the team and minimize variability in client outcomes.

Feedback Mechanism: Establish a structured feedback process that encourages hygienists to openly discuss challenges and share insights for improvement. Cultivate a culture of continuous learning and professional growth within the team. Monthly team chart audits play a crucial role in fostering collaboration and enhancing collective expertise. By actively utilizing these audits as proactive learning opportunities, you can create a supportive environment where valuable insights are shared and implemented to continually enhance client care practices. These sessions are particularly invaluable for recently graduated hygienists and new hires, ensuring alignment with your practice’s systems and processes.

Utilization of Technology: Consider integrating advanced dental technologies such as intraoral cameras, loupes, ultrasonic instrumentation, and digital radiographs during treatment when the endpoint is uncertain. These tools significantly enhance the precision and effectiveness of calculus detection and removal, providing clearer visibility and more accurate assessments. Ultimately, they improve treatment outcomes and enhance the quality of care delivered to your clients.”

By addressing these aspects, your team can enhance efficiency, improve client outcomes, and promote a more cohesive team approach to delivering high-quality dental care.

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