A national study of periodontal assessment by dental hygienists

Periodontal examination is one of the most frequently performed dental hygiene diagnostic services. This examination is the basis for effective dental hygiene treatment throughout long-term care. The purpose of this investigation was to examine how dental hygienists across the United States assess the periodontal status of three patient types: patients new to the practice, periodontally healthy recall patients, and periodontally unhealthy recall patients.

A two-stage cluster sampling method was used to select a random sample of dental hygienists from each of two states randomly selected from four regions of the United States. Questionnaires were mailed in 1989 to 2,618 dental hygienists. Individual responses were scored according to criteria derived from dental literature for conducting seven components of a comprehensive periodontal examination. Results were calculated and analyzed for each state and region, and across regions for each patient type.

Responses were received from 1,429 subjects, resulting in a 57.5% response rate of deliverable questionnaires. Overall mean scores (possible 0-7) across all regions were 3.68-new patients, 3.22-healthy patients, and 2.67-unhealthy patients. Of the seven assessment components, three-gingival inflammation, furcation involvement, and radiographs-were performed according to the scoring criteria for all patient types by a majority of respondents. The criterion for periodontal pockets was met by a majority for new patients only. Three assessment component criteria were met by less than 40% of the sample for all patient types-attachment levels, mobility, and plaque control. Differences in the mean scores of certain states were found to be statistically significant.

Specific dental hygiene standards are recommended for initial diagnostic and recall monitoring periodontal examinations. Additionally, dental hygiene administration and management of long-term preventive and supportive periodontal therapy programs should assist in improving effectiveness of care and further delineate the profession of dental hygiene.