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Jill Rethman, RDH, BA, is Dimensions' editorial director and has been involved in dental hygiene for more than 30 years - from clinical practice to speaking to publishing. She is an adjunct assistant professor at The Ohio State University, Department of Dental Hygiene, and visiting clinical instructor of Dental Hygiene at the University of Pittsburgh School of Dental Medicine. She also serves as vice president of the Hawaii Dental Hygienists' Association and is a board member of the Sunstar Foundation for Oral Health Promotion. 

Periodontal Probing Protocol 

QUESTION: I just started working for a new dentist whose periodontal protocol is lacking. I would like to implement a new system but I need evidence to back up my position. I am trying to find an article that specifically states the standard of care for full-mouth periodontal probing is once a year. I have found numerous articles that state this but none from professional sources such as the American Dental Association, American Dental Hygienists' Association, or American Academy of Periodontology (AAP). Where can I find this information?  

ANSWER: I understand why you haven't had any luck finding a "standard of care" regarding the frequency for periodontal probing. As part of a comprehensive periodontal evaluation, full-mouth probing is a key aspect of assessment. A newly published study also showed that the prevalence of periodontitis in the United States is underestimated by 50% when only partial-mouth probing is used to assess periodontal status.1 This tells us that so-called "spot-probing" is likely inadequate. 

Like you, I searched numerous sites to find a specific timeframe for full-mouth probing, but could not find anything definitive. In fact, the various Position Papers and Guidelines from the AAP seem to be purposely vague on this topic. I also sought the opinions of my husband, Mike Rethman, DDS, MS, and Gary Greenstein, DDS, a well-known periodontist who has written many literature review papers. They both stated that there is no standard and agreed there should not be, because full-mouth periodontal probing varies according to the needs of the patient. I know this isn't much help for you in trying to convince the new dentist you work with, but maybe a medical analogy would be helpful. Ask him or her if there is a standard of care for how often blood pressure should be monitored. There isn't—it depends on the individual. Some people should check their blood pressure daily, while others don't need such frequent monitoring. Yet even though there is no set standard, it behooves the patient (and the clinician) to be aware of blood pressure readings and check them regularly. The same can be said for periodontal parameters, such as probing depths, bleeding on probing, furcation involvements, mobility, etc. In fact, a comprehensive periodontal examination involves those measurements as well as medical and dental history updates, intraoral and extraoral tissue examinations, necessary radiographs, recording the presence of deposits on the teeth, and an evaluation of the teeth and their replacements (eg, the condition of restorations, notation of carious lesions, occlusal relationships, and more). As stated in the AAP's Parameter on Comprehensive Evaluation: "Based on the results of the examination, a diagnosis and proposed treatment plan should be presented to the patient. Patients should be informed of the disease process, therapeutic alternatives, potential complications, the expected results, and their responsibilities in treatment. Consequences of no treatment should be explained to the patient." Therefore, a comprehensive periodontal exam once a year seems not only reasonable but an important aspect of assessment. 

The AAP's Parameter on Comprehensive Evaluation is available at: www.perio.org/resources-products/pdf/847.pdf. Share this article with your dentist so he or she can unde rstand the various aspects of a complete periodontal examination and the importance of regular monitoring, including periodontal probing, based on the needs of the patient. 

Reference
1. Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS,Dye BA. Accuracy of NHANES periodontal examination protocols. J Dent Res. 2010;89:1208-1213.
 


From Dimensions of Dental Hygiene. November 2010; 8(11): 74-76.

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