Liz Nies, RDH - A 'Dental Practice Hero' in the Fight Against Periodontal Disease
How do you speak to your patients about periodontal disease?
Let’s face it, every hygienist on the planet could talk about everything they know about periodontal disease 24/7. I like to keep it simple. The patient willingly comes into the office and most of the time confesses to not flossing when they sit down. Yet, they are in the office because they want to keep their teeth. Then they want them white, and they want to have fresh breath. I can work with that. I always incorporate what the patient wants and what they need to help them get healthy. One of the most valuable questions on a patient’s health questionnaire is, “When was your last physical or medical exam?” If it is 18 months or less, I always smile. It is a key indicator to me that the patient, on some level, is preventative minded. They will know their cholesterol, A1C, LDL blood pressure, weight, etc. Next, I look at their risk factors that periodontal disease may exacerbate, especially diabetes and cardiovascular disease. They have been schooled by their medical doctor on what they need to do to get these diseases under control or risk death! They know their numbers; I can work with that. My third health question, which is often overlooked, is the family history of disease. This is a vital piece of information, especially for a patient who is very healthy. Chances are that a close family member has had a heart attack, diabetes, dementia, cancer, etc. This adds a level of emotional buy-in when we are presenting our treatment. Back to the numbers.
Everyone knows that, if they bleed, it is not normal. Pink in the sink is not normal. I focus on bleeding points. When I am perio charting a patient, I say my pocket depths out loud, even if I am doing it alone. I say the word “bleeding.” I want them to hear it. My baseline is if it’s 10 bleeding sites or more, we need to do something different. When I am done, I sit the patient up and ask them, “I called out a lot of bleeding points, didn’t I?” They usually say yes. I continue, “It has been my experience that anyone who has 10 bleeding sites or more has inflammation of the gums or gingivitis.” I will tie in any risk factors or family history risk factors from the health questionnaire to assist them in making the connection between inflammation in their mouth connecting with inflammation in their body. What we have been doing in the past is just not working. We need to take action so that, not only can we prevent your inflammation in your mouth getting worse, but we can also free up your immune system to fight inflammation elsewhere in your body. Think of your immune system like the battery in your car. If you got into the car and did not turn the key to start the engine, but turned on the lights, the radio, air conditioner, etc, all those things will drain that battery. This may cause you to need a jump-start to get the car going. Think of your immune system as that battery. If your immune system must focus on the inflammation in your mouth, it has less power to focus on your medical disease.
What obstacles do you face in getting patients to agree to treatment and how do you overcome them?
Not covered by insurance is the big one, or money. This is a default statement. We all know what it is like to struggle financially. If you don’t have your health, you don’t have much. I focus on what is important. They came in the door because, on some level, they wanted to keep their teeth. Keep the focus there. I lay out a plan that will give them just that. Whether it is a prophy or SRP, I will tie treatment plan presentation into what that patient wants, which in this case is to keep their teeth. The truth is if we really want something, we can figure out how to pay for it. Third-party financing is always a great way to assist the patient in moving forward. Regarding a patient’s insurance and not covering the full cost to keep their teeth, I keep it real. I say, “Your insurance is a benefit that is offered through your employer. They purchased that plan for you. It is designed to assist you in keeping your teeth and not designed to cover all the cost.” I always focus on the positive as to what is covered and show them that the amount left is just a portion of the total cost. Most patients know their medical insurance does not cover everything, so why should dental insurance be any different?
How do you incorporate the Perio Protect Method in your treatment protocols?
I have been a fan of Perio Protect from the first moment I heard about it at a CareerFusion meeting. Tanya Dunlap was at that meeting and, once she explained it to me, I said, “Where have you been all my life!” As a clinician, I was frustrated that my patients could not maintain the level of health I wanted them to have. They were loyal. They had the electric toothbrush, oral irrigator, interdental cleaners and floss. They swore they were using them correctly, yet they still showed up to their appointments with bleeding, inflammation and pocketing. I liked the results I would get from localized antibiotics, but I did not like that I had to place in multiple pockets multiple times. This tray treated the entire arch! It was simple. Create an oxygen-rich environment deep under the gums everyday, allowing the aerobic bacteria to thrive! Only 10-15 minutes a day, and it can be done while you’re doing something else like a shower! Bonus: It whitens your teeth without sensitivity and gives you fresh breath. It was the trifecta! Healthier mouth, whiter teeth and fresher breath.
Our immune systems love oxygen. Our white blood cells (macrophages) just function better in an oxygen environment. Perio Protect creates an oxygen-rich environment in a pocket 3 to 9 mm deep. Now those macrophages can really get that infection under control. The trays hold oxygen under pressure. Periodontal disease is considered a chronic wound. If you got someone’s periodontal disease out of their mouth and gathered all their pockets together and it involves 10 to 20 sites or more, that chronic wound could be the size of the palm of your hand. If you had that size wound elsewhere on your body, your medical doctor would refer you to a chronic wound center. They chronic wound center would begin hyperbaric chamber therapy, which is 2 hours everyday for 6 weeks. They hold oxygen under pressure to kill the bacteria causing your infection. On a very small scale, the Perio Protect Method works very similarly. The trays hold peroxide-releasing oxygen under pressure to kill the bacteria causing your infection. It will also whiten your teeth and freshen your breath, which is what patients want. If you’re talking about what they want, they pay closer attention and ask questions which allows them to say yes to treatment.
We all have patients who just hate to have their teeth scaled. The more tenacious the deposit, the more lateral pressure we apply. Scraping the metal instrument along the root surface and dental tubules can be quite uncomfortable. For this patient, I know they want more comfortable and faster “cleanings.” That is another side effect of the perio trays. The perio gel will soften a deposit that has already formed on the teeth. It breaks apart the protein structure lattice of the calculus. It will make it softer, so it comes off the tooth much easier—more comfortable for the patient and less work for me! In addition, when they come in for their next preventative care visit, they will have less plaque and less calculus, thus easier cleaning appointments.
The easiest explanation I have for patients to understand the benefits of the Perio Protect Method is: “You have bacteria under your gums—you call it plaque, we call it biofilm, which is keeping your gums infected. Even if you had the best homecare technique and did everything right, there is not a homecare tool that gets all of it. Some of it is left behind, keeping your gums infected. We now have a prescription tray that is comfortable to wear, it will transform your plaque from unhealthy to healthy and you only wear it 15 minutes a day. It will also whiten your teeth and give you fresh breath, would you like to know more?” I have photos that help me for the visual learner.
Perio Protect just fits into my philosophy of treatment for my patients. It gives them what they want and what they need.
Liz Nies has 35 years of experience in dentistry, including 31 in clinical practice. She has served as a director of clinical hygiene for a large Dental Service Organization. She currently works as the DSO Liaison and Team Trainer for Perio Protect, LLC