Transform Your Practice from a Prophy to a Periodontal Focused Practice

Transcription

1 Earn 2 CE credits This course was written for dentists, dental hygienists, and assistants. Transform Your Practice from a Prophy to a Periodontal Focused Practice A Peer-Reviewed Publication Written by Heidi Arndt RDH, BSDH Abstract Dental care providers are under-diagnosing and undertreating periodontal disease according to recent information shared from the American Academy of Periodontology and the Centers for Disease Control and Prevention. This article addresses the connection between periodontal disease and systemic disease; and the importance of practicing Oral Medicine This article demonstrates how the process of care can guide comprehensive care, and ensure gingivitis and periodontal disease are identified and treated at their earliest signs. A clear step-by-step guide is demonstrated on what is needed to transform your practice from being prophy focused to a periodontal focused practice. Regardless of the challenges that exist in the dental practice, the dental team must remove the obstacles and transition to a higher level of care. Periodontal treatment is a necessary and integral part of oral health; and the pay off for the patient, the practice and the provider are well worth any challenge. Learning Objectives: After reading this course, the reader should be able to: 1. Discuss the 6 steps in the Process of Care as outlined by the American Dental Hygienists Association 2. Explain the relationship between periodontal disease and systemic disease. 3. Define and describe periodontal treatment guidelines as defined by the American Academy of Periodontology. 4. Clearly describe and explain each component of the assessment phase. 5. Summarize our current understanding of why and when to treat patients for gingivitis and periodontitis. Author Profiles Heidi Arndt RDH, BSDH has been working in the dental field for over 18 years. Her experience stretches from working as a treatment coordinator, dental assistant, and practice manager before graduating from the University of Minnesota with a bachelor s degree in Dental Hygiene. Heidi spent the early part of her career working in private practice and at the Mayo Clinic (Department of Dental Specialties). In 2002, Heidi began working for American Dental Partners, where she was a dental hygiene mentor/coach and was later promoted to Director, Dental Hygiene Development. Heidi led all dental hygiene development activities for American Dental Partners affiliated dental groups (more than 250 practices and 1000 dental hygienists) across the entire United States, improving patient care, dental hygiene team development and increasing hygiene profits exponentially year after year. In 2011, Heidi launched Enhanced Hygiene. She is dedicated to helping dental groups support the development and enhance the value of their dental hygiene team. Heidi s coaching and training programs have helped hundreds of practices achieve their long sought after goals. Improving leadership, teamwork, organizational systems, patient care, patient service, verbal skills, and the bottom line. Author Disclosure The author of this course has no commercial ties with the sponsors or the providers of the unrestricted educational grant for this course. Publication date: July 2012 Expiration date: June 2015 PennWell designates this activity for 2 Continuing Educational Credits Go Green, Go Online to take your course This course has been made possible through an unrestricted educational grant. Supplement to PennWell Publications This course was written for dentists, dental hygienists and assistants, from novice to skilled. Educational Methods: This course is a self-instructional journal and web activity. Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or third party has had any input into the development of course content. Requirements for Successful Completion: To obtain 2 CE credits for this educational activity you must pay the required fee, review the material, complete the course evaluation and obtain a score of at least 70%. CE Planner Disclosure: Michelle Fox, CE Coordinator does not have a leadership or commercial interest with products or services discussed in this educational activity. Educational Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise. Registration: The cost of this CE course is $49.00 for 2 CE credits. Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

2 Educational Objectives After reading this course, the reader should be able to: 1. Discuss the 6 steps in the Process of Care as outlined by the American Dental Hygienists Association. 2. Explain the relationship between periodontal disease and systemic disease. 3. Define and describe periodontal treatment guidelines as defined by the American Academy of Periodontology. 4. Clearly describe and explain each component of the assessment phase. 5. Summarize our current understanding of why and when to treat patients for gingivitis and periodontitis. Abstract Dental care providers are under-diagnosing and under-treating periodontal disease according to recent information shared from the American Academy of Periodontology and the Centers for Disease Control and Prevention. This article addresses the connection between periodontal disease and systemic disease; and the importance of practicing Oral Medicine This article demonstrates how the process of care can guide comprehensive care, and ensure gingivitis and periodontal disease are identified and treated at their earliest signs. A clear step-by-step guide is demonstrated on what is needed to transform your practice from being prophy focused to a periodontal focused practice. Regardless of the challenges that exist in the dental practice, the dental team must remove the obstacles and transition to a higher level of care. Periodontal treatment is a necessary and integral part of oral health; and the pay off for the patient, the practice and the provider are well worth any challenge. Recent reports state the prevalence of periodontal disease in the United States may be significantly higher than originally estimated. This research was reported in the Journal of Dental Research from the Centers for Disease Control and Prevention. The American Academy of Periodontology goes on to state the prevalence of periodontal disease may have been underestimated by as much as 50%. 1 Periodontal Disease is a significant public health concern. Centers for Disease Control and Prevention Over the past several decades, research has expanded our understanding of the relationship between oral health and overall health. Evidence is strong supporting the interrelationships between periodontal disease and inflammatory driven disease states. The cause and effect has not been proven yet, but evidence does suggest that periodontal disease is a much more than a LOCALIZED or an ISOLATED infection. 2 The relationship between periodontal disease and systemic disease such as cardiovascular disease, diabetes and respiratory disease among others are being closely investigated. Further studies will shed light on the strength and causality of these relationships. Diabetes: Periodontal Disease is one of the major complications of diabetes. Did you know that approximately 95 percent of Americans who suffer from diabetes also have periodontal disease? Diabetic patients with periodontal disease have more difficulty controlling their blood sugar. 3 Diabetes affects 25.8 million people in the U.S million of these people are undiagnosed. 4 Diabetes is a major cause of death and disability in the United States.4 Heart Disease: Cardiovascular disease affects 57 million people in the United States, causing one million deaths per year. Patients with periodontal disease are twice as likely to develop heart disease. 5 Research indicates that periodontal pathogens (P. gingivalis) can enter the bloodstream and spread throughout the body, inflaming coronary arteries, causing increased blood pressure, heart rate and promote blood clots. This may lead to heart attack and stroke. 6 Heart disease is the leading cause of death in the United States; while stroke is the third leading cause of death. Heart disease and stroke continue to be major causes of disability and significant contributors to increases in health care costs in the United States. 7 Coronary heart disease (CHD) accounts for the largest proportion of heart disease. About 12 million people in the United States have CHD. 7 In April 2012, the American Heart Association released the following statement: [No proof that gum disease causes heart disease or stroke]. They go on to state there isn t adequate research to conclude that gum disease causes heart disease or stroke; however, research does demonstrate an association between gum disease and cardiovascular disease. The AHA study did conclude that periodontal disease is associated with cardiovascular disease independent of know confounders Respiratory Disease: Bronchitis, asthma, emphysema and pneumonia affect millions of Americans annually. The bacteria that are associated with periodontal disease can be aspirated and travel from the mouth to the respiratory system potentially causing respiratory disease. The Connection: Understanding the connection between oral health and systemic health provides the dental team with an opportunity to reframe our protocols, systems and the way we address our patients. We need to start practicing Oral Medicine, because our scope is far beyond caring for just the mouth; we must consider systemic health when caring for our patients. The picture is big, and our opportunity is even bigger! Dr. Maria Emanuel Ryan has stated; The treatment of periodontal disease should not be considered optional or elective but instead, it should be a necessary and integral part of the patient s overall health program. 2

3 The Gap With all of this information available to us, we still see most practices treating 5-20% of their patients with periodontal treatment. 8 What is happening with the other patients with periodontal disease? According to the American Dental Hygienists Association, nearly 75 percent of American adults suffer from some form of gum disease from simple inflammation to severe cases and many of these patients don t even know it. 8 The Academy of General Dentistry states that more than 90 percent of all systemic diseases have oral health symptoms. 3 A poll conducted by Harris Interactive of 1000 people over 35 revealed that 60 percent of adults knew little, if anything, about gum disease, the symptoms, available treatments and the consequences. 65 million adults suffer from periodontal disease. 8 Gingivitis affects 50-90% of adult population. 9 Periodontal disease is the most common dental condition among adults. 10 Where do we start? It is time to go back to the basics of dental hygiene care in order to provide quality, comprehensive care to our patients. The Process of Care as outlined by the American Dental Hygienists Association provides a protocol for addressing individualized needs, while addressing the factors that will reduce, eliminate or prevent disease in our patients. 11 There are 5 components to the process of care. 1. Assessment The assessment is the collection, documentation and analysis of the oral and systemic health of the patient. This is the #1 step in the dental hygiene appointment, and should be completed before any instrumentation is done. Without a comprehensive assessment, you will not have a diagnosis, or a strong foundation for why and how you will treat the patient. The dental hygiene assessment must include 6 key steps: 1. Medical/Dental History: The medical/dental history provides us with key information to understanding the past and current health of our patient, and how this may affect the diagnosis and treatment we provide to them. The dental team must interview the patient, asking questions that may lead to additional information that was not revealed in the medical history form. 2. Risk Assessment: The risk assessment is an evaluation of the information shared through a self-analysis and use of the medical/dental history forms while interviewing your patient. The assessment provides details on risks for general and oral health. The data collected helps the clinician design strategies for preventing and limiting disease progression and promoting patient health. Risk assessment includes salivary diagnostic tests to identify the specific bacteria causing each case of periodontal disease. Salivary diagnostics help eliminate any subjectivity, by confirming the concentration and bacteria load that are causing the inflammation and destruction. This information will guide the provider to a strong understanding of how to modify risk and develop a treatment plan that will support the needs of each patient. Our goal is to help modify risk, if possible and educate our patients on how these risks affect their oral health. Risk Assessment is a KEY component of the comprehensive periodontal care. Without risk assessment, the dental team may miss valuable information that will affect treatment outcomes for the patient. 3. Radiographs: Radiographs provide solid clinical information for the dentist to provide a sound diagnosis. According to several research articles; however, radiographs do not always show the true picture of bone levels. 12 In fact, radiographs typically show much less bone loss than what is actually happening in the mouth. 4. Oral Cancer Screening: Screening includes a thorough examination of the head and neck and oral cavity for signs of cancer, trauma or other abnormalities. Document any abnormalities and schedule a two week follow up with the patient to check for changes to the area of concern. 5. Oral Assessment: Oral assessment includes an evaluation for the presence and degree of plaque and calculus; as well as a thorough examination of the hard tissues in the mouth, demineralization, caries, defects, existing restorations, occlusion, and missing teeth. Document all findings in the patient record and, if possible, take intra-oral photos for the patient to see. Involving the patient in each step of the assessment is key for understanding their current oral health status. 6. Comprehensive Periodontal Assessment: The periodontal assessment is much more than a simple recording of pocket depths around the teeth. Today s evaluation must include a comprehensive evaluation of the patient s health status. Full mouth periodontal charting must be completed on each patient. The periodontal charting includes 6 point probing depths, bleeding points, suppuration, muco-gingival relationships, furcation, mobility, recession, and attachment levels/loss, among other parameters. 3

4 A comprehensive periodontal assessment is required on all adult patients and the documentation should be updated no less than every 12 months. This is the standard of care. You should involve your patient in the periodontal assessment. Taking time to discuss the periodontal assessment with a patient before the probe is placed in the mouth is key to patient understanding and co-discovering the importance of the periodontal assessment. Once the patient has been introduced to the periodontal assessment the dental hygienist should read the numbers and bleeding points out loud to the patient. This process will allow the patient to self assess and co-discover the health of their mouth. Mr. Jones, I am going to evaluate the health of your gums and bone around your teeth. I will be using this small rounded instrument with millimeter markings on it from I will gently measure the pockets around each of your teeth. I will be calling out several numbers, as well as areas of bleeding. Bleeding is a sign of active infection. When I call out the numbers, 1-2-3, these are considered good, healthy readings; but anything above that, such as or higher means there is a break down of the tissue and bone and you may have an active bacterial infection present. The co-discovery process can be a powerful element to the patient appointment. Because the patient is involved, they will likely land on the periodontal diagnosis themselves, since you prepped them before the evaluation started. 2. Diagnosis Analyze and interpret the assessment data collected and formulate the diagnosis for your patient. The diagnosis should focus on the needs of your patient and how their oral health can be improved through the delivery of care. Mr. Jones, as I was doing your assessment today, you probably heard me call out several 4s, 5s and 6s and many areas of bleeding. As I mentioned earlier these numbers and bleeding areas indicate you have an infection, better known as periodontal disease in your mouth. Periodontal disease is an active bacterial infection in your gum tissue and the bone supporting your teeth Planning Once the diagnosis has been established the dental team must create a treatment plan for the patient. The treatment plan must establish realistic goals that can move the patient closer to optimal health. Identify and prioritize the sequence of care and coordinate with other providers and medical professionals as needed. 4. Implementation Implementation is the actual delivery of care to the patient based on the treatment plan that was established. 5. Evaluation Evaluation is the process of reviewing and documenting the outcome of the care provided to your patient. The evaluation phase should be used throughout the entire process of care. In periodontal therapy, we use measurable data to assess the patient s response to therapy. (Probing depths, bleeding, and tissue health.) 6. Documentation Documentation is the recording of collected data throughout the care of the patient, and important for ongoing care. It also serves as a legal record for each and every patient. The provider must ensure the patient record reflects accurate information and recognizes ethical and legal responsibilities as outlined by the state regulations. The process of care is the key to improving care to the patients in your practice. Each step must be completed in order to provide comprehensive care to your patient. Dental Hygiene teams will often times skip one or two steps in order to save time in the dental hygiene appointment. However, these hasty shortcuts will result in patients not receiving optimal care and another bloody prophy. Periodontal Treatment Guidelines It is important that each dental practice establish therapeutic guidelines that will provide a system for organizing the treatment needs for their patients. It is necessary to understand that guidelines are not meant to replace clinical knowledge or skills; and it does not imply that there is a one-size-fits-all approach for periodontal disease. Guidelines are intended to be used in a way that meets the needs of each individual patient. The American Academy of Periodontology (AAP) released Parameters of Care guidelines for classification of periodontal disease, as well as several other resources for understanding the correct classification and care of periodontitis. 13,14,15 These guidelines create a system for the clinical team to develop a logical diagnosis for the patient. Health is characterized by firm, pink, healthy gingiva with 1-3mm pockets, and no CAL(Clinical Attachment Loss). No bleeding is present in a healthy patient. Gingivitis includes pocket depts. 1-4mm with bleeding and inflammation; however, there is no bone loss present. Slight Periodontitis is characterized by 4-5mm pockets, 1-2mm of CAL (Clinical Attachment Loss), and if there is furcation involvement it will be a Class I furcation. Moderate Periodontitis includes 5-6mm pockets, 3-4mm CAL, possible Class II furcation and mobility of Grade I. 4

5 Advanced Periodontitis include pockets greater than 6mm. Typical furcations are Class III and may include Grade III mobility. Periodontitis and gingivitis can be localized or generalized. The periodontal patient can have areas of health and areas of advanced disease occurring simultaneously. This is why a comprehensive assessment is always necessary to evaluate each tooth in the patient s mouth. When to Treat With the appropriate assessments completed, the dental team can establish the appropriate diagnosis and treatment plan for the patient. Gingivitis affects 50-90% of the adult population, and should be diagnosed and treated at it s earliest signs. 9 Gingivitis is a reversible precursor to periodontal disease. If left uncontrolled, gingivitis may progress to periodontitis. Treatment of gingivitis, modification of risk, and good home care will help the patient reverse gingivitis and reduce risk of disease progression. Periodontal disease is a chronic, non-curable bacterial infection. When periodontal disease is present, the removal of deposits from the teeth is no longer considered preventive. Non-surgical periodontal therapy is indicated, usually with use of local anesthetic for pain control. Non-surgical periodontal therapy, antimicrobials, as well as adjunctive antibiotics is a definitive treatment for periodontal disease. Non-surgical treatment may also be utilized as pre-surgical therapy for advanced stages of periodontal disease. Upon completion of periodontal therapy (surgical or non-surgical) periodontal maintenance should be implemented. Periodontal Maintenance is crucial to minimize the recurrence of disease and maintain a stable periodontium. Patients who received non-surgical periodontal therapy, but do not enroll in the periodontal maintenance program may show initial improvements in comparison to pretreatment conditions, but are likely to revert back to levels worse than initial treatment. 13 Eliminate Obstacles Transforming your office from providing prophys as your primary approach to periodontal treatment is not an easy process. In fact, patient communication during the appointment will need to focus on comprehensive care. What does this mean? It is imperative that you educate your patients throughout the entire appointment about Oral Medicine the interrelationship between periodontal disease and systemic health; and get your patient involved in the diagnostic process. Next, you will need to eliminate the limiting beliefs the dental team has about periodontal disease and how your patients will respond to the new diagnosis and treatment protocols. These beliefs may be tied to insurance assumptions, past experience with patients refusing treatment, or your team s concerns about dealing with patient objections. Take time to identify the limiting beliefs that hold your team back from diagnosing periodontal disease and discuss how you will overcome these beliefs in order to improve patient care in your practice. When you implement each step in the process of care, and communicate effectively throughout the course of the appointment; patient acceptance will improve. Patients will be better informed and educated on what is happening in their mouth and how treatment of the infection can affect their overall health. Suggestions for Implementation Schedule a meeting with the entire team to discuss philosophies of periodontal treatment. Once a common philosophy has been identified, develop a system or protocol for how you will address health, gingivitis and periodontitis in your practice. Using the process of care, outline how you will assess, diagnose, plan, implement, evaluate and document in your practice. The outline you develop will help create consistency within your team and ensure accurate diagnosis and comprehensive treatment for each and every patient. Make a Difference Over the past 30 years we have learned a lot about periodontal disease and how it affects systemic health. We have an extensive body of scientific evidence available to us to support the treatment of periodontal disease. Use the information available and make a difference in your practice today! References 1. Gum Disease found to be a significant public health concern Williams RC, Barnett AH, Claffey N, et al. The potential impact of periodontal disease on general health: a consensus view. Curr Med Res Opin. 2008;24: U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. National Institute of Dental and Craniofacial Research, Rockville, MD, National Institutes of Health 2000, p.2 4. Iacopino AM. Periodontitis and diabetes interrelationships: role of inflammation. Ann Periodontal. 2001;6: Stone, N.J. Primary prevention of coronary disease. Clinical Cornerstone 1(1):31-49, PubMed; PMID National Heart, Lung, and Blood Institute (NHLBI). Morbidity and Mortality: 1998 Chartbook on Cardiovascular, Lung, and Blood Diseases. Bethesda, MD: Public Health Service (PHS), National Institutes of Health (NIH), NHLBI, October Heart disease is the leading cause of death for all people in the United States. Stroke is the third leading cause of death. Heart disease and stroke continue to be major causes of disability and significant contributors to increases in health care costs in the United States. 8. Blair, C. The economic impact of the under diagnosis of periodontal disease in general practice. Triage 2005;1: Brennan RM, Genco RJ, Wilding GE, et al; Bacterial species in subgingival plaque and oral bone loss in postmenopausal women. Journal of Periodontal: 2007;78:6:

6 10. Cobb CM, Williams KB, Gerkovitch M. Is the prevalence of periodontitis in the United States in decline? Periodontal ; In press. 12. Albandar JM, Rams TE. Global epidemiology of periodontal diseases: an overview. Periodontal ;29: Lanning SK, Best AL, Temple, et al. Accuracy and consistency of radiographic interpretation among clinical instructors using two viewing systems. Journal of Dental Ed Slots J, Ting M. Systemic antibiotics in the treatment of periodontal disease. Periodontal 2000;28: , Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontal 1999;4: Parameters of Care: Parameters on chronic periodontitis with slight to moderate loss of periodontal support. J Periodontal 2000; 71: Parameters of Care: Parameters on Chronic periodontitis with advanced loss of periodontal support. J Periodontal 2000;71: Standards of clinical dental hygiene practice. Notes Author Profile Heidi Arndt RDH, BSDH has been working in the dental field for over 18+ years. Her experience stretches from working as a treatment coordinator, dental assistant, and practice manager before graduating from the University of Minnesota with a bachelor s degree in Dental Hygiene. Heidi spent the early part of her career working in private practice and at the Mayo Clinic (Department of Dental Specialties). In 2002, Heidi began working for American Dental Partners, where she was a dental hygiene mentor/coach and was later promoted to Director, Dental Hygiene Development. Heidi led all dental hygiene development activities for American Dental Partners affiliated dental groups (more than 250 practices and 1000 dental hygienists) across the entire United States, improving patient care, dental hygiene team development and increasing hygiene profits exponentially year after year. In 2011, Heidi launched Enhanced Hygiene. She is dedicated to helping dental groups support the development and enhance the value of their dental hygiene team. Heidi s coaching and training programs have helped hundreds of practices achieve their long sought after goals. Improving leadership, teamwork, organizational systems, patient care, patient service, verbal skills, and the bottom line. Disclaimer The author of this course has no commercial ties with the sponsors or the providers of the unrestricted educational grant for this course. Reader Feedback We encourage your comments on this or any PennWell course. For your convenience, an online feedback form is available at 6

7 Online Completion Use this page to review the questions and answers. Return to and sign in. If you have not previously purchased the program select it from the Online Courses listing and complete the online purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the Take Exam link, complete all the program questions and submit your answers. An immediate grade report will be provided and upon receiving a passing grade your Verification Form will be provided immediately for viewing and/or printing. Verification Forms can be viewed and/or printed anytime in the future by returning to the site, sign in and return to your Archives Page. Questions 1. As defined by the American Dental Hygienists Association, there how many components of the Process of Care? a. 10 b. 3 c. 7 d How often should the periodontal assessment be completed on each patient with full documentation? a. Every 12 months b. Every 24 months c. Every 6 months d. Every 18 months 3. Periodontal disease is a chronic, bacterial infection that is considered as which one of the following? a. Curable b. Reversible c. Non-curable d. None of the above 4. Periodontal disease is associated with the following: a. Diabetes b. Osteoporosis c. Heart Disease d. All the above 5. According to Dr. Maria Emanual Ryan: The treatment of periodontal disease should not be considered as which of the following: a. Optional or elective b. An absolute c. Neither a, or b d. Necessary 6. The first step of the process of care is: a. Diagnosis b. Treatment Plan c. Documentation d. Assessment 7. How many steps are in the dental hygiene assessment? a. 5 b. 4 c. 9 d The evaluation of the information shared through self analysis and medical/dental history forms while interviewing the patient is called: a. Risk Assessment b. Periodontal Assessment c. Chief complaint d. Dialogue million people in the U.S. are affected, and one million die each year from this: a. Periodontal Disease b. Obesity c. Cardiovascular Disease d. Cancer 10. According to the Academy of General Dentistry, what percentages of systemic diseases have oral health symptoms? a. 50 b. 25 c. 90 d Which of the following are correct concerning gingivitis and clinical attachment loss (CAL)? a. 5% attachment loss b. 4mm pockets with attachment loss c. No attachment loss d. CAL always occurs with gingivitis 12. According to the definitions from the American Academy of Periodontology, healthy tissue is best described as: a. Firm, pink gingiva, with no bleeding. b. Firm, pink gingiva with <10 sites of bleeding c. No inflammation, with <2mm CAL d. None of the above 13. Periodontal Maintenance is: a. Important to help maintain a stable periodontium b. Important to help minimize the recurrence of disease c. Just like a prophy d. Not needed if the patient has only had scaling/root planning e. Both a, b. 14. Periodontal disease is: a. A significant public health concern. b. Not as big a concern as once thought c. Completely curable. d. A little gingival inflammation 15. In April 2012, the American Heart Association released a statement saying which one of the following? a. No proof that gum disease causes heart disease or stroke. b. No proof that gum disease is caused by diabetes. c. No proof that gum disease is caused by atherosclerosis d. None of the above 16. Periodontal Assessments can be completed by doing the following: a. Spot probing b. PSR c. Review radiographs d. Comprehensive periodontal assessment. 17. Advanced periodontitis include pocket depths greater than: a. 5 b. 9 c. 6 d Periodontal disease affects how many million U.S. adults: a. 25 b. 65 c. 75 d Which of the following is the first step in the process of care? a. Assessment b. Diagnosis c. Evaluation d. Implementation 20. In 2010, the American Academy of Periodontology stated that the prevalence of periodontal disease was, which one of the following? a. Overestimated b. Underestimated c. Drastically reducing due to excellent care in the dental office. d. None of the above 21. Salivary diagnostics are used to measure the: a. Pocket depth b. Bacterial concentration and bacterial load c. Bleeding tendency d. Oral/systemic link 22. Any abnormalities during the Oral Cancer Screening should be documented and a follow up should be scheduled in: a. 2 weeks b. 6 months c. 3 months d. 12 months 23. The main goal with risk assessment is to: a. Classify level of risk b. Document risk c. Help modify risk d. None of the above. 24. Gingivitis affects 50-90% of the adult population. It should be treated at: a. Earliest signs b. With more than 5 bleeding sites c. >10 bleeding sites d. The next hygiene recall appointment. 25. The Academy of Periodontology recently stated that periodontal disease my have been: a. Underestimated by less than 20% b. Underestimated as much as 50% c. Overestimated by 50% d. Overestimated by more than 20% 7

8 ANSWER SHEET Transform Your Practice from a Prophy to a Periodontal Focused Practice Name: Title: Specialty: Address: City: State: ZIP: Country: Telephone: Home ( ) Office ( ) Lic. Renewal Date: Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all information above. 3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn you 2 CE credits. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp. For Questions Call Educational Objectives 1. Discuss the 6 steps in the Process of Care as outlined by the American Dental Hygienists Association. 2. Explain the relationship between periodontal disease and systemic disease. 3. Define and describe periodontal treatment guidelines as defined by the American Academy of Periodontology. 4. Clearly describe and explain each component of the assessment phase. 5. Summarize our current understanding of why and when to treat patients for gingivitis and periodontitis. Course Evaluation 1. Were the individual course objectives met? Objective #1: Yes No Objective #3: Yes No Objective #2: Yes No Objective #4: Yes No Objective #5: Yes No Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = To what extent were the course objectives accomplished overall? Please rate your personal mastery of the course objectives How would you rate the objectives and educational methods? How do you rate the author s grasp of the topic? Please rate the instructor s effectiveness Was the overall administration of the course effective? Please rate the usefulness and clinical applicability of this course Please rate the usefulness of the supplemental webliography Do you feel that the references were adequate? Yes No 11. Would you participate in a similar program on a different topic? Yes No 12. If any of the continuing education questions were unclear or ambiguous, please list them. 13. Was there any subject matter you found confusing? Please describe. 14. How long did it take you to complete this course? 15. What additional continuing dental education topics would you like to see? If not taking online, mail completed answer sheet to Academy of Dental Therapeutics and Stomatology, A Division of PennWell Corp. P.O. Box 116, Chesterland, OH or fax to: (440) For immediate results, go to and click on the button Take Tests Online. Answer sheets can be faxed with credit card payment to (440) , (216) , or (216) Payment of $49.00 is enclosed. (Checks and credit cards are accepted.) If paying by credit card, please complete the following: MC Visa AmEx Discover Acct. Number: Exp. Date: Charges on your statement will show up as PennWell AGD Code 557 PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS. COURSE EVALUATION and PARTICIPANT FEEDBACK We encourage participant feedback pertaining to all courses. Please be sure to complete the survey included with the course. Please all questions to: michellef@pennwell.com. INSTRUCTIONS All questions should have only one answer. Grading of this examination is done manually. Participants will receive confirmation of passing by receipt of a verification form. Verification of Participation forms will be mailed within two weeks after taking an examination. COURSE CREDITS/COST All participants scoring at least 70% on the examination will receive a verification form verifying 2 CE credits. The formal continuing education program of this sponsor is accepted by the AGD for Fellowship/ Mastership credit. Please contact PennWell for current term of acceptance. Participants are urged to contact their state dental boards for continuing education requirements. PennWell is a California Provider. The California Provider number is The cost for courses ranges from $29.00 to $ Provider Information PennWell is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE Provider may be directed to the provider or to ADA CERP at org/cotocerp/. The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. 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