The Implant Imperative:
Enrolling the Patient as a Partner in Infection Control

By Sheila Wolf, RDH

(This article appeared in a dental magazine called Implant News and Views)

To the average person, what is going on inside their mouth is as mysterious as what is going on under the hood of their car. It is a rare mechanic who offers the consumer anything more than a recommendation to bring in the car for an oil change every . well, however long it is. The average person coming in for an implant consultation has about the same amount of information on oral care as the driver who knows only that he should change the oil but not why. As dental professionals, if we wish to be effective, we have a responsibility not only to treat but also to educate the patient. It is up to us to teach patients their role in ensuring success with their implants; to encourage them in what to do, and to have them understand the reasons for doing it.

About ten years ago, I had an awakening that was to change my life as a hygienist. I was introduced to the phase contrast microscope. Learning that periodontal disease is a bacterial infection is one thing. Seeing it under a microscope is an altogether different experience. I saw, up close and personal, squirmy, squiggly spirochetes, fascinating, undulating eel like critters, gliding, spinning, and clock-arm rods, and sluggish amoebic parasites. I saw organisms called Trichomonads, which look surprisingly like foraging mice, that I learned, are sexually transmitted. I actually watched white blood cells cluster around a pathogen and make a stand for health. I discovered a tool that could show patients the "why" of the need to master their oral hygiene.

Whether the infection is around natural teeth or implants, the bacteria are basically the same, according to Dr. Dan Watt. It is important to get these microorganisms under control otherwise patients will continue to have breakdown in the underlying bone, and to host a disease that seriously impacts their whole body health.

Armed with the "why", I am out to enroll my patients as partners in a treatment process that requires them to participate as fully as I do. This is no mechanic shop. They are not bringing their mouths in for repair. They are learning to take control. Whether the patient comes in as an implant candidate or with failing implants makes no difference. Treatment needs to begin at whatever stage they are at present.

Trust

To establish a basis for relationship and trust, I create an environment where patients can freely express themselves. On our first visit, generally a two-hour appointment, we discuss their medical, social and dental history. I listen patiently to their concerns, let them express their frustrations and fears, and watch their body language, which tells me a lot about how to proceed with treatment.

Coaching

I explain the distinction between teacher (one who imparts information) and coach, (one who takes a stand for them to be as great as they can be). As their partner and coach, my commitment is for them to get rid of this chronic infection, the bad taste and smell in their mouths, their pain and self consciousness, and to enable them to reach a level of oral health, energy, and full body wellness that they may not even be aware they are missing.

Products

As in athletic coaching, at each visit we study, practice, and refine their use of equipment, their techniques, and their applications of specific chemicals. I generally suggest a sonic toothbrush (SonicareT), an irrigator (HydroflossT or WaterpikT), and I recommend certain solutions such as TherasolT (Oratec), Closys ll (Rowpar products), chlorhexidine, and a special "Magic Mix" of baking soda, salt, and peroxide used as a toothpaste. My focus lies as heavily on the "chemical" as on the "mechanical."

Vision

We create a vision and a mission. If we do not have a vision for health, we do not know what to strive for. Each patient is treated individually. There is no generic treatment except that each patient needs to feel loved, nurtured and pampered. I promise them they will not feel discomfort and I keep my word!

Treatment

Their first few visits are generally superficial (light supra gingival scaling and polishing,) and treatment progresses, on subsequent visits, to include 4 to 8 quadrants of root planning, with plenty of topical and local anesthesia, nitrous oxide sedation if they like, and music of their choice on a cassette player with great earphones. They are wrapped in a blanket, pillow under their knees, and are as comfortable and spoiled as they want to be.

Patients return every 2-4 weeks, depending on the severity of their infection. Our one to two-hour appointment is spent sampling and reassessing their plaque smear, reviewing their oral hygiene, looking at the healthy changes in their tissues, and addressing concerns and answering questions. The level of infection, (assessed from their plaque sample at each visit,) determines clinical treatment as well as their possible need for antibiotic therapy. I never do any sub-gingival scaling until they are clear of the risk of septicemia and trust is established. All visits include anti-microbial irrigations and patients are taught to master the home equivalent of that technique on a daily basis.

Goal Setting

Patients are encouraged to set their own goals with me. They tell me what is realistic for them and what they are willing to do between appointments. I write that in their chart and hold them accountable for what they said. When they keep their agreements, they are rewarded with a colorful star, words of encouragement, and perhaps a new dental "toy," (a more streamlined irrigation tip.?) which will help them to the next level of optimum health. Before long, they feel empowered, and have learned to take charge of their own mouths and health, a goal that is truly gratifying for both partners.

Success

The end point in treatment is three negative plaque smears in a row over a 3-month period. Tissues that are pink and tight, with reduced pocket depths and no bleeding or exudation present, are now ready and healthy enough to place implants. No longer is the patient naïve and unknowing. He still may not know anything more about what is under the hood of his car, but he certainly knows what his mouth is supposed to look like. And he is probably a lot happier, knowing that he has a healthy foundation onto which will be "implanted " the smile he has always dreamed of having.

Mama Gums