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Getting it Right in the Operatory with Diagnostics

By Colleen Rutledge, RDH

In an exclusive Friends of Hu-Friedy Question-and-Answer, Colleen shares her take on the right components for long-term success in the hygiene operatory.


Q:           Colleen, there are so many approaches to team building and practice consulting. How do you manage your approach when it comes to the hygiene epicenter?

A:            Hands-on clinical hygiene consulting differs greatly from practice management consulting.  The primary focus of hygiene consulting is clinical procedures, current research, new technologies, products and techniques rather than office systems.  Having the right instruments is a critical component for long term success.


Q:           What do you consider key components to success?

A:            In the course of evaluating practices, there are key areas of focus common to most cases. These areas include:

  • Basic clinical skills:  Probing techniques, clinical attachment level, recession, implement periodontal charting on all adult patients
  • Communication:  Using "key words" and phrases for case presentation and enhanced patient compliance
  • Medical model of care:  Medical and dental history review; risk assessment; taking blood pressure on all adult patients, systemic link
  • Scheduling:  One hour recare and periodontal maintenance appointments: one to one and a half hours (sometimes longer) appointments for periodontal therapy (SRP)
  • Diagnostic skills:  Recognition of clinical signs of  disease; bleeding upon probing; tissue color, texture and contour, probing depths
  • Ultrasonics:  Increased usage of  both magnetostrictive and piezoelectric technology; importance of ultrasonics to enhance clinical results, tongue disinfection with ultrasonics
  • Bruxing/periodontal connection:  Identification of: abfractions, wear facets and recession and the role of occlusion in periodontal therapy, and occlusal guard diagnosis
  • Locally applied antimicrobials:  placement technique and rationale 
  • Host modulation: Discuss risk factors and the "two-pronged approach": host response,  as well as bacterial component of periodontal diseases
  • Options for enhanced patient comfort: Examine options available for achieving profound anesthesia

Q:           Share with us how antimicrobials can enhance the hygiene department in your practices. How can proper instrumentation choices enhance your results?

A:            Incorporating locally-applied antimicrobials is an integral part of a comprehensive hygiene program.  Effective retraction is a must when placing LAA.  Since most hygienists work without an assistant, the #5 double-sided mirror with #7 cone socket handle is an excellent choice.  The mirror size allows you to properly retract while gaining better visibility with the double-sided mirror. Additionally, the ergonomic handle helps reduce the symptoms of Carpal Tunnel Syndrome.


Q:           Clinical diagnosis and assessment is a key area of focus for you and your clients. How do you counsel your practices regarding assessment?

A:            My recommendation is a thorough 6 point periodontal evaluation should be performed at least once a year on every adult patient.   Even if no charge is assigned to this indispensible diagnostic tool, it should be entered as treatment rendered with no fee.  Patient can then see the added value to their recare visit.  Additionally, patients should be informed that without this critical screening, diagnosis of periodontal diseases can not be made. 


I highly recommended standardizing periodontal probes throughout the office.  I encourage the implementation of the ColorVue probe with the ergonomic handle and yellow/black 3-6-9-12 markings.  It can unscrew and be replaced when it becomes worn.  It is comfortable for the patients as well as reader friendly for clinicians. This will help tremendously in periodontal disease diagnostics.


Q:           What would you want to share as a final "pearl" with the audience?

A:            With the proper protocols and instruments, hygiene departments can transform into comprehensive centers of high-quality care and efficiency.



Here are additional recommendations from Colleen regarding popular products!

2.5 mg Chlorhexidine Gluconate (Periochip)

The orange-brown, non-antibiotic is a rectangular gelatin chip which is inserted directly into single site pockets.  The chip can be easily placed with 18L Locking pliers (aka: college/cotton/dressing pliers or 'pick-ups').  Due to the small size of the chip (4 x 5 mm), the locking feature is ideal for transporting from the bracket tray to the patient, as well as subgingival placement.

1 mg Minocycline (Arestin)

The handle / cartridge system expresses minocycline powder into single site pockets. Upon depressing the handle, the powder injects efficiently and comfortably when the first 1-2 mm of the plastic cartridge is 'flattened' by the blunt end of a #7 cone socket mirror handle.    This technique modifies the circular diameter of the cartridge conforming it to an oval shape.  This can also be accomplished with a Hartman Straight 10cm/4 hemostat.


10% Doxycycline Hyclate (Atridox)

This antibiotic gel treats multiple sites and is an excellent choice when as many as 10 -15 pockets are present.  About a minute after expressing the gel into the pocket, the product begins to solidify. To ensure it is at the base of the pocket, use a moistened Balshi gingival cord packer GCPBAL to tap the product lightly below the gingival margin.




Colleen Rutledge, RDH is a clinical hygiene consultant, national speaker, practicing hygienist and owner of Perio-Therapeutics & Beyond, a unique consulting firm based in the suburbs of Philadelphia, PA. Perio-Therapeutics & Beyond provides over-the-shoulder clinical training in contemporary periodontal therapeutics. Colleen is published in several dental publications, including Woman Dentist Journal, Doctor of Dentistry, Modern Hygienist and Access magazines.  Colleen's memberships include Speaking Consulting Network, American Dental Hygienists' Association, Christian Dental Society and several speakers' bureaus. For more information on Colleen, visit her Web site: