Periodontal Pocketing
Educational Conversation
We are going to measure your gum and bone health with this instrument. Any number you hear higher than 3 means there are pockets developing in your mouth that you are not able to keep clean from home. The space between your gums and teeth is called the sulcus. It is the space where infection develops into gum disease which is the number one cause for tooth loss. It is kind of like the space between your finger nail and your finger, in that, you probably don't notice it until your finger nails grow long and there's a lot of dirt under there.
Action - Probe
When numbers are higher than 3: There are (#/many) areas that you can't reach with your tooth brush. Patients who cannot get their gum number down to a healthier level have to do surgery to reduce them. Shh...(stop talking and let them think about the problem; see if questions arise)
Solution
“The best way to manage this with non-surgical treatment is with prescription trays. The trays are a prescription because the lab will make them to the exact conditions of your mouth, pocket to pocket, all the way around. This will drive medicine directly to the source of the infection and keep it there until the bacteria are eliminated. This will allow you to protect your body on a day to day basis. Right now you are completely dependent on the 3-4 times a year we eliminate bacteria from under your gums because your toothbrush cannot reach it. Tooth brush bristles can only reach about 2mm below your gums and you have many areas where there are deeper spaces.
Bleeding on Probing
Educational Conversation
Every point that bleeds when we probe shows an area where there is enough inflammation for the infection and bacteria in your mouth to enter your blood stream. Once it is in your blood, your heart pumps it all over your body and we have no control over where it goes. This is very dangerous. This instrument [probe] should never cause gums to bleed. If your gums bleed when we use this instrument, that means bacteria are able to get into your blood all throughout the day. It is likely happening when you brush your teeth and even when you're chewing.
Action
Shhh.... (Stop talking and let the patient think about what you said; see if they have questions)
Solution
[See the solution in situation above.]
Restorative Work
[Note any areas of bleeding or pocketing, refer to above narrative.]
Educational Conversation
You have invested a lot of money into your mouth. (You can estimate this number). We want to help you to keep all of those investments. Every filling, crown and veneer has tiny little grooves and margins for bacteria to grow. Once the bacteria work their way underneath the fillings and crowns, it becomes loose and eventually painful. Fillings and crowns have to be replaced every day, in this office, for that exact reason.
Solution
The easiest way to keep your investments clean and protected - and all of your teeth, too - is prescription trays. The trays are made to push a bacteria-killing gel over every areas you missed with your toothbrush. Prescription trays don't miss anything because it is a customized and sealed design. This will protect your investments for years to come and minimize the likelihood that you will need more fillings or crowns.
Scripts for Specific Patients
Fearful Patient
The trays are comfortable to wear. They gently push the medication down into your pockets to fight chronic infection.
You won't need so much scraping on your teeth because the medication softens the deposits, making them come off very easily. There will also be significantly less bleeding while I am working which allows me to get more vision.
Our bodies make hydrogen peroxide every day in our liver and lungs. It is also in our white blood cells and mother’s breast milk. This is a gentle and natural way to treat your infection. Peroxide is an anti-microbial rather than an antibiotic.
Cost Barrier Patient
Remember, you will be wearing these trays 1 time per day for 365 days for 5 plus years. If you average the cost of the trays and the gel over a five-year period, it is pennies on the dollar a day (40-50 cents a dayill have fresher breath, whiter teeth and a healthy mouth and body.
Think of the trays as an insurance policy for your gums. You may never need to go through the deep cleaning/scaling again, instead you can simply enjoy and maintain the health you have achieved.
Whiter Teeth Patient
I know that you have always wanted to have whiter teeth. The traditional whitening products we had available to you just caused you too much sensitivity. We have this new prescription tray that delivers medication at a lower concentration of hydrogen peroxide that will comfortably and slowly whiten your teeth over 5-6 weeks. Plus, you will have healthier gums and fresher breath.
Fresher Breath Patient
I know that you have been struggling to keep your breath fresh. We now have a new prescription tray that delivers medication under the gums to kill the bacteria that are causing your bad breath. You will finally have the fresh breath you have always wanted.
New Patient Diagnosed with Periodontitis
What we now know about these bacteria is that we must keep their numbers down between visits to keep your teeth and gums stay healthy. Traditionally, we would just do a deep cleaning in several visits to remove the hard deposits, and have you return every 3 months to keep the infection under control. We have found that by giving you the tools you need to decrease the number of harmful bacteria at home daily, we can assist you in maintaining your health.
The newest proven technology that Dr. and I are using are Perio Trays®. They are form fitted to your gums to deliver a low dose of hydrogen peroxide to the base of your pockets. The peroxide will oxygenate the pockets, as well as soften any deposits underneath the gum line.
Patient of Record in Maintenance Therapy
Steve, we have been keeping your periodontal infection under control and you have done everything we have asked you to do at home to get as healthy as you are. I know that you are frustrated that we aren't getting the results we want. Dr. and I have found a technology that far surpasses other homecare tools and techniques...