How much bleeding is normal?
4 minute read
Have you ever been in that awkward spot where you're cleaning a long-time patient's teeth and suddenly it's like a bloodbath? I'm talking serious bleeding here – like you've hit an artery. For me this used to happen more often than I’d like to admit. But when my initial assessment had minimal or no BOP or localized inflammation, it seemed logical a prophy was the right course of action. But 20 minutes in, it was clear this was a familiar bloody prophy situation.
The tricky thing is that bleeding gums are common.
But common doesn't mean healthy. The truth is I'd gotten so used to seeing blood every day that it felt normal. I mean practically all my patients bled, even after SRP, who wouldn’t start to think that must be normal.
What we learned in school about periodontal disease has evolved a lot. We now know bacteria causes gum disease, not plaque or calculus😳. Seriously, calculus doesn’t cause it. These bacteria also live inside the gum tissue, not just on top of it. So that super awesome prophy you just did, it's not gonna treat the bacterial infection. And those patients with awesome home care, they're not safe either. So put away your floss, and let’s talk treatment.
Let me explain- Periodontal disease is caused by bacteria. Treatment should focus on targeting these bacteria, which often overwhelm the immune system causing the infection (aka periodontitis).
Revising gum treatment to heal infection.
Step 1: Disrupt the biofilm wall. Remember that "matrix" layer we learned about in school? The sticky slide layer that’s sometimes called plaque or biofilm? Yep, that's the stuff we need to attack. The key here is to penetrate the matrix, not just smear it around.
Step 2: Use your ultrasonic during gingivitis and SRP treatments. These devices create a tornado-like effect that will penetrate the matrix, disorganizing the periodontal disease-causing bacteria.
Verbal Scripts that work!
Alert your patient that she has a problem, and it’s not a home care issue. Here’s the script that I use, "Sally, I’m seeing changes in your gums today. You have redness, inflammation, and even bleeding. You must have come in contact with bacteria that caused you to get a gum infection."
Avoid using probe depths, bleeding points, or debris terms. Stick to infection language that your patient can easily understand.
Create a vivid image in our patient's mind
To ensure your patient gets their role in home care, I often say to my patients, “think of these bacteria like termites in the foundation of a house. They live deep inside the gums, not just on top of them, so you need to help me help you get healthy.”
Periodontal disease causing bacteria know they have prime real estate, so they want to rebuild. And if the mouth is inflamed, it’s like an all-you-can-eat buffet of their favorite foods. So why would they want to leave?!
Patient home care musts
The best way for a patient to get and keep their gums healthy in my experience is the use of a Waterpik pocket tip (this is also true for 2mm pockets ya’ll, remember we need to penetrate the matrix, not smear it around.) Alternatively, PerioProtect trays also work great!
And there you have it, folks! Patients don’t by solutions to problems they don’t think they have. So Keep It Super Simple, focus on the bacterial infection, and Don’t over explain!
By sharing my journey and insights into periodontal health, I hope to empower you to elevate the health of your patients. Remember, bleeding gums might be common, but they're not healthy. By making small tweaks to our approach, we can achieve healthier and happier patients.
Your friend,
Coach Tosha
Do you have your own methods for explaining dental health to your patients? What analogies or word pictures do you find most effective? Leave a comment and let me know!
