Charissa Wood has been a practicing hygienist in private practice for 24 years. She is passionate about the oral-systemic connection and educating both her patients and fellow hygienists on the links and innovative ways to approach it. She is the lead hygienist of a four location practice in Atlanta and runs a double-book, assisted hygiene schedule making her one of the top hygienists in the country.
Why do you believe it is important to proactively diagnose periodontal disease?
I believe that periodontal disease is one of the most under-assessed and under-diagnosed conditions we face in the dental industry. The CDC statistics released back in 2015 showed that 50% of adults ages 30+ and 70% of those over age 65 have some stage of periodontal disease. Those numbers came out 5 years ago, so I can only imagine that those are underestimations at this point. Considering that the mouth is the gateway to the body and research has pointed to direct correlations and, in some cases, causative relationships between oral pathogens and systemic conditions—such as diabetes, arthritis, heart attack/stroke risk, cancers, Alzheimer's disease, and pre-term, low birth weight babies—we as healthcare providers bear a great weight in diagnosing and treating active periodontal disease. Studies show that reducing oral inflammation and the presence of anaerobic, gram negative bacterium in the mouth through periodontal therapies can contribute to a significant reduction in A1c levels and inflammatory markers such as hs-CRP, Lp-PLA2, and IL-6. Considering that periodontal disease is a progressive disease that degrades the supporting structures of the periodontium and leads to total body inflammation and bacteremia, it is imperative that we as clinicians screen for, identify and treat periodontal disease at its earliest stages.
How do you speak to your patients about periodontal disease?
One of my favorite things about being a hygienist is getting to connect with my patients. I do not see myself as a tooth janitor, but as a wellness advocate who exists to help every patient be their healthiest selves. Educating my patients and helping them understand and own their conditions so that they can make the best choices for themselves is what makes me jump out of bed in the mornings! I involve my patients in every aspect of the examination and assessment process. I show them the bone loss on the x-rays; the red, bulbous, inflamed gums in the photos; I explain the periodontal examination process and they hear me calling out the pocket depth readings and bleeding points; I explain that the tenderness they feel when probing is due to the presence of inflammation and infection present; and I ask them lots of questions about their home-care practices and personal and family history when it comes to periodontal disease. My goal is to help the patient see and understand their condition for themselves. I believe that if a patient takes ownership of their current state (whether it be gingivitis, periodontal disease, occlusal disease, or decay) then they are ready to take the steps necessary to achieve and maintain health and be an integral part of that process.
Because periodontal disease can lead to serious systemic disease, I take into consideration every patient's medical history and family history, and help them put all the pieces together to assess their specific risk factors. Utilizing salivary testing has been a great way to show them the bacterial pathogen levels contributing to their disease as well as their genetic predisposition to said bacterium, which helps in creating individual customized treatment plans.
If assessment leads to findings of active infection and disease, my patient is already aware of the situation as they have gone through the process of co-discovery with me. I then explain how anaerobic oral pathogens are opportunistic, setting up communities below the gum line where it is dark, moist, warm, and not much oxygen is present—creating the perfect environment for bacterial infection. We discuss how, once organized, these bacterial colonies secrete toxins that initiate the inflammatory response, which is why they may feel tenderness or see redness and bleeding when brushing or flossing. We discuss that the nature of periodontal disease is progressive and the collaboration of the bacterial toxins and the chemicals released from the immune system will work together to increase inflammation and lead to bone loss. I educate my patient on the systemic ramifications that can come from periodontal disease and tie them to each patient's individual medical history risk factors and conditions. We discuss treatment options for how to treat their specific condition in light of their individual factors. I leave lots of room for questions and emotions as I realize that I am conveying a loss in their measure of health. Giving bad news is no fun for anyone, but stepping alongside my patients with empathy and commitment to walk with them through the journey as we decide the best strategy for them is what builds patient-provider trust and respect.
What obstacles do you face in getting patients to agree to treatment and how do you overcome them?
With the way I practice co-diagnosis, most patients understand the weight of their situation and are asking what they can do to get back to health. When I have a patient say no to treatment, I take a step back to make sure they are understanding their condition of disease and infection. Most "no's" for me are based out of fear, finances, and time. So, I ask lots of questions to determine what the road-blocks are and how to help them through it. If it's fear, we have lots of ways to keep patients comfortable, such as anesthetic, nitrous, and sedation. If it's financial, we work with several financing companies and have a fabulous treatment coordinator to help patients fit their needs into their lifestyle. If it's time, we work with the patient's schedule to make it convenient for them.
When I have a patient that says no or that they need more time to think, I send them an email with some articles about periodontal disease and any personal links or risk factors they have and follow up to make sure they don't have any other questions. Treating periodontal disease can be expensive and not everyone is prepared to make that investment immediately upon hearing they have a non-curable disease. It's a lot to take in and we as providers will see a lot more treatment acceptance when we practice empathy and support through the process, even if it takes a few weeks/months of follow-up.
How do you incorporate the Perio Protect Method in your treatment protocols?
I have been using Perio Protect for the last 8 years in our practice and might just be their biggest fan! If you can't tell already, I'm kind of a geeky science nerd, and the science behind Perio Protect is what draws me to it and helps me promote it for everyone! I wear the trays myself! I don't have periodontal disease, but I don't ever want to get it either. Because the trays allow for oxygenation of the sulcus to the base of the pocket, anaerobes are not able to set up camp and create community, meaning they aren't secreting toxins that lead to inflammation. I love them as prevention for patients who want to do what's best for their oral health. I love them for perio maintenance patients who want to prevent further bone loss and get them off the inflammation train. I love them for implant patients who want to keep their bone support healthy and stable, protecting their long-term health. Obviously, I love them for patients with active gingivitis or periodontal infection as initial therapy and future maintenance. I pretty much insist on them for patients with significant systemic illness—conditions like diabetes, arthritis, cancers, heart attack/stroke survivors, and pregnancy. For those patients, I always use the trays as initial therapy prior to any type of scaling and root planing because of the bacteremia that comes from the disruption of the biofilm, calculus, and granular tissues. I let the trays significantly reduce the bacterial levels first leading to decreased inflammation, bleeding, and tenderness as well as softening the deposits for easier removal.
Getting a patient set up in trays is easy and timely—a big issue for us hygienists! You can either submit digital scans or impressions to the lab for a 3-week turnaround. Tray delivery to the patient takes 10 minutes and tray wear duration and frequency is dependent on each patient's case and treatment objectives. Perio Protect is great at providing support in all stages of the process, from initial team setup and training to providing patient education and resources for enrollment and patient care. My advice is to dip your toe in the water and give it a try—a few patients in, and you will see for yourself the benefits Perio Protect brings to your patients’ health and your practice's bottom line! I mean, who doesn't want whiter teeth and healthy gums all at once?