What about acceptability of periodontal treatment?
Periodontal disease is an inflammatory disease that affects the tissues that support the teeth. The accumulation of plaque on the surface of one of these or trauma (a poorly adjusted crown for example), leads to a marginal tissue inflammation, gingivitis. Gingivitis is relatively common: it affects between 80-90% of the general population. Untreated, gingivitis can lead to periodontitis, characterized by progressive loss of support, leading to mobility and loss of teeth.
No study allows us to clearly determine the proportion of patients who, after being informed by their practitioner, will engage in periodontal therapy. One can easily imagine that this rate is low. For those opting for treatment, only 11-45% will adequately follow the maintenance protocol, an important element of the standard approach.
The acceptability of periodontal treatment is therefore a real issue. In a paper signed in 2010, Shaddox and Walker identified three main issues. Let's summarize each of these issues and then see how the Bonner Method brings solutions.
1. Diagnose and treat as soon as possible
By tackling periodontal disease quickly, it becomes easier to avoid future complications. Because these diseases are often painless, patients rarely seek care. In addition, clinicians have few tools to diagnose a disease at its early stages and visually, even some advanced cases are difficult to detect. The disease remains undiagnosed until the progression reaches a certain severity, characterized by bone loss or tooth mobility.
By introducing the clinical microscope into a dental office and analyzing a plaque sample during routine examinations, it is simple and quick (3 minutes) to determine whether a patient has a health flora, gingivitis or periodontitis and, depending on the case, intervene. Once the sample is taken, motility is probably one of the first elements that would attract attention, and then the presence of white blood cells, which is systematic in cases of gingivitis. In periodontitis, the presence of protozoa, amoeba type (81% of sickly crevices) or genus Trichomonas is characteristic, surrounded by dead white blood cells that form the pus. In this way, prevention becomes easy.
2. Identify and control the factors that contribute to the disease
The main etiology of periodontal disease is the pathogenic flora, consisting of bacteria, fungi and protozoa that cause direct or indirect destruction of the supporting tissues. Since root planing or surgery does not completely eliminate the pathogenic flora, recurrences are inevitable. However, they allow relief of symptoms by repelling the disease. Risk factors such as smoking, diabetes or age are difficult to reverse, even impossible.
All our clinical observations allow to conclude, after the Bonner treatment, the complete disappearance of the bacteria of the Socransky orange and red group, demonstrated by PCR tests in the vast majority of cases. After a few months (usually 4), it is easy to observe the restoration of a normal flora under a microscope, composed of points and lines, weakly mobile. By going to the root of the cause, the infection, the patient is able to avoid any further recurrence.
3. Long-term commitment to the treatment of periodontal disease.
After the active phase, supportive periodontal therapy is a necessary step in the standard method. Without this, several studies show a rapid decline in the periodontal health of patients. In either case, it is difficult to completely eliminate the risk of losing teeth in the long term.
Following the complete elimination of the pathogenic flora with the Bonner Method, no maintenance treatment is necessary. Only routine examinations are boding. Time is our best ally. Without pathogens, the gum heals, and we will see the bone rebuild. It should be added that the objectives of the treatment are clear and fixed at the beginning of the therapy which greatly facilitates the communication with the patient: 0 pockets above 3 mm, 0 bleeding points at the survey and a healthy flora. The Parodex allows us to establish the number of mm of periodontal pockets that we wish to see disappear.
Increase patient engagement with the Bonner Method
The Bonner Method has several advantages over other types of treatments when it comes to commitment and acceptability: visually the patient is able to understand the nature of their illness and they have the power to act and avoid reinfection (elimination of sources of contamination). The Bonner Method generally avoids surgery, repetitive appointments and generates the feeling of truly being cured.
Like all other treatments, the acceptability is based on the patient-dentist exchange of course, but in the specific case of The Bonner Method, it’s also based on the visualization of images of the periodontal biofilm generated by the microscope. Visually, it is easy for a person to understand the importance of the disease and the need for treatment in the face of an ultra-mobile flora and the presence of animalcules. The breath test carried out with the dental floss by the patient themselves also brings part of commitment. This test has the advantage of being able to be done at home on a regular basis to track the progress of healing.
In order to increase the acceptability of treatment, here are some general elements to remember when discussing periodontal disease with a patient:
1. First, make sure you have enough time to present the treatment.
Patients will usually have many questions and will be more likely to say yes if they feel confident. If you do not have enough time to present the treatment plan effectively or clearly explain the periodontal disease and its potential effects, invite your patient to another consultation meeting of 20-30 minutes, ideally early in the morning. If you have a cancellation, the patient could agree to start treatment immediately.
2. Make sure the patient understands the treatment completely.
Typically, a patient will not remember more than half of what you explain. It is often natural for us, as dentists, to focus on the "how", that is, the stages of treatment or interventions that will need to be performed. Remember that the patient is more often than not interested in "why". "Why should the treatment be done now and if it’s not done, what will the consequences be? ".
The dentist is usually the best person to talk about treatment fees. Patients are often more likely to listen to you than listen to your staff. Once you have explained the treatment, do not hesitate to tell the patient how much it will cost them. If you have a manager, he can complete the financing plan.