Hygiene Protocols

Periodontal Philosophy – Meeting Agenda

The Doctor should review his/her hygiene philosophy of care with the entire team to ensure consistency. Clarify these four areas:


1. When to treat periodontal disease through SRP

  • This is generally defined as quadrants with 5mm in pocket depths, bone loss on the films, or signs of disease


2. When to refer to a specialist

  • This is unique for each staff and dependent on the skills and confidence of the hygiene team
  • It is generally discussed on a case-by-case basis


3. When to retreat

  • Periodontal disease is cyclic in nature and may need to be treated again when a further breakdown occurs
  • Often if an additional round of SRP is indicated within two years, it is referred to a specialist


4. When to dismiss the patient for non-compliance

  • While this is rare, it should be addressed that it would be inappropriate to continue a prophy treatment on a patient with advanced periodontal disease


Additional Exercises/Topics for the Hygiene Philosophy of Care Meeting

  • Select three or more patient charts to review among clinical providers. Examine radiographs and perio charting and reach a consensus on treatment plan and philosophy for your practice.
  • Discuss and determine medicaments, irrigation, anesthesia, etc., included in your standard of care for periodontal treatment.
  • Review proper CDT coding of periodontal treatment. These include:
    • D0180
    • D1110
    • D4346
    • D4910
    • D4342
    • D4341
    • D4355
  • Consider calibrating periodontal probe readings among your providers. Have each provider probe one quadrant on another team member and compare readings/technique.
  • Discuss how your patient will know the difference between a prophy and perio maintenance appointment.





Shorter time scaling

Perio Maintenance
Longer time scaling



Hand scale with limited ultrasonics
No anesthetic

Perio Maintenance
Full mouth ultrasonics
Possible anesthetic


Home Care

Generalized instruction

Perio Maintenance
Specialized instruction


Perio Charting

Alternate visits

Perio Maintenance
Each visit



Confirm the bone level is healthy and review the importance of continued care to prevent gum disease.

Perio Maintenance
Utilize the term “gum disease” and clarify the areas of greatest concern for the patient. At each visit, review these areas or new areas and keep patient well informed as to the stability of their condition.


Adjunctive Therapy

Limited indication for use – acute conditions

Perio Maintenance
More frequent application – chronic conditions


  • Discuss the parameters leading to a periodontist referral for a patient.
  • Adopt a standard chart note template (manual or electronic) for consistency among providers. The chart note template should include a “reason to return,” allowing the hygienist an opportunity to note areas of concern. This brings more value to the appointment, increases recare retention, and provides the front office information when calling overdue patients.
  • Define how to manage non-compliance with periodontal treatment recommendations.




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