The last decade has been exciting for the practice of dental hygiene; the standard of care required by us as health professionals has changed. This change has left us with increased responsibility, challenges, rewards and ultimately, a more nourishing career. What's next? The philosophy that we have been working with and integrating into practices all over the country is, "beyond treating disease." This philosophy offers the concept of "perfect tissue" whenever possible! This is where we invite you to open your mind and be willing to go out of your comfort zone.

The concept of perfect tissue can be integrated comfortably into any practice. However, the practices that we find most interested and excited about perfect tissue are those that have an emphasis in cosmetic dentistry. Providing a healthy foundation for cosmetic and restorative dentistry is nothing new. However, keep in mind that this concept involves thinking beyond a healthy foundation.

The idea of perfect tissue actually came from a patient, many years ago, who was referred to our practice because she did not like the inflammation around her beautiful crowns. She had been seeing another dentist for the previous two years. After a complete periodontal evaluation, the doctor's diagnosis found the patient to have no periodontal involvement (she had healthy bone levels and no signs or symptoms of periodontal disease). Gingivitis was localized specifically around her anterior crowns. The patient reported that she was uncomfortable with her smile. She wanted firm pink healthy tissue. "The other dentist told me my gums were okay, but I'm not happy with the way they look! What can you do for me?" We proceeded to offer and provide a treatment plan. The patient complied with all the recommendations and we did achieve beautiful firm pink tissue around those anterior crowns!

Our definition of perfect tissue is no disease present whatsoever! The actual academic definition of the preventive prophylaxis is, "limited to scaling and polishing procedures performed on dental patients in normal or good periodontal health to remove coronal plaque, calculus, and stains to prevent caries and periodontal disease. Since pockets are absent in a completely normal periodontium, scaling and polishing are performed in the anatomic or clinical crown and into very shallow, healthy sulci. Therefore, a prophylaxis is provided for healthy patients when no active therapy is required to treat periodontal pockets
or gingival bleeding."¹

The definition provides a basis as to why patients would require some type of treatment to achieve "perfect tissue." When we asked hygienists throughout the country what percentage of their patients fall into the above definition, the average was between five and ten percent. Then when we asked if patients that have typical clinical scenarios (with chronic gingivitis) are provided with an opportunity for treatment beyond a reduction in their interval, the answer was usually NO. However, that NO was followed with, "What else can I do? The patient doesn't require root planing and there's no calculus to remove. Besides a closer interval and motivating them for plaque control, what else is there? I've never seen perfect tissue, other than maybe three patients, in my whole clinical career! That's really not feasible for the bulk of our patient base!"

We truly understand that thought process and belief. First and foremost, does your office have a current clinical philosophy and protocol to provide treatment for the gingivitis patient or the supportive therapy patient (periodontal maintenance) that is in the beginning stages of relapse? If not, then the only direction you can turn is for a closer interval and increased plaque control (which can be a perfect direction for some patients).

Evaluate your current protocol and use the
following as a checklist:

1. Do you offer your patients the possibility of "perfect tissue" whenever possible?

2. A main concern in discussing perfect tissue is to realize the limitations, but do not allow those limitation to keep you from trying. Limitations:

a. Systemic health variables

b. Anatomic

c. Refusal or inability to perform adequate plaque control

3. Implement new treatment strategies:

a. Extended treatment plans (beyond the four quadrants) and open-ended

b. Repetitive therapy - subgingival detoxification of one or more of the following: diseased cementum, necrotic tissue (incidental curettage), calculus, and soft plaque deposits

c. A very extensive behavior
modification program.

d. Nutritional analysis and systemic variable educational program.

e. Complete brochure and handout supplementation for more thorough patient understanding

The following co-therapy questionnaire is a great way to start working with patients that you feel your current treatment protocol is not achieving "perfect tissue." It is also an excellent tool for new patients.

Click for Co-Therapy Program Questionnaire


Beyond Soft Tissue Management
(Creating Perfect Tissue)

Since soft tissue management or non-surgical periodontal therapy is considered the current standard of care in the general practice, a focus and concern has been, "How do we implement more preventive periodontal treatment in our practice?" Many practices have seen a need for this transition and accomplished a successful ideal preventive program. What's next? Is there another level we can offer our patients? The concept and philosophy of creating perfect tissue whenever possible can be very challenging and rewarding for both the
clinicians and the patient.

We find that the dental teams who support the philosophy of perfect tissue whenever possible have created a new-found excitement for their personal career development. The health of the practice is affected as well. There is more commitment from patients to their preventive or supportive interval, which reduces the number of openings in the schedule and less stress on the office overall. There is more interaction with patients which creates additional internal marketing and more new patient referrals! What an exciting concept and philosophy to work toward in your practice -- perfect tissue whenever possible!
"You'll see it when you believe it!"