It’s not a cleaning. That three or six-month dental visit patients schedule and appreciate for their clean and polished teeth is so much more important than they realize. That visit is an integral part of their health and wellness. Let’s pause for a moment and recall that 47% of American adults (over age 30) have periodontitis – that’s 64.7 million Americans. [1] – which means they have chronic infected ulcerations. The situation is so pervasive that hygiene departments can legitimately be renamed “Chronic Oral Wound Care Centers.” [2]

Our unacceptably high rates of disease contrast with our conviction that treatment is essential. Periodontal (gum) disease is a leading cause of tooth loss in adults. Chronic gingival infections and inflammation also play a large enough role in chronic systemic inflammatory conditions that treating periodontal disease indicates positive effects on patient general health. [3] Diseased-induced halitosis, a quality-of-life issue, is alone important enough for treatment to be considered.

It can be hard to communicate the importance of periodontal health to patients, especially when they are relatively young (<65) and not in pain. The Gum Score is an easy way to communicate a spectrum of health to patients and to explain your goal for their optimal gingival health.

The Gum Score is based on the number of points that exhibit bleeding on probing (BOP) and active infection. Patients understand infection and will quickly understand the score:  The ideal Gum Score would be zero, but anything under 10 would be considered healthy. [4]

BOP is a good basis for the Gum Score because it is easy to understand, quick to assess, and readily available to the dental team. Most importantly, BOP has reliable negative predictive value, meaning that the continuous absence of bleeding on probing is a reliable predictor for the maintenance of periodontal health or, stated differently, for no further periodontal damage. [5] We want to treat the infection and stop the bleeding.

The Gum score raises patient awareness and sets easily identifiable goals for health. Patients already know the acceptable range for numbers relating to blood pressure, blood sugar, A1C, and cholesterol to name but a few. Why not a simple number to understand their periodontal condition is in real time? [6]

When you have a gum score, you and your entire team know when and why they are educating patients about Perio Protect: because it’s important to treat infected tissue. And you can use this 5-step case presentation model from Perio Protect:

1. I am concerned that you have a high Gum Score. Your score is XX. This means that there are XX areas of bleeding and infection in your gums.  
2. The ideal score is zero with less than 10 considered healthy. 
3. I know you are trying hard at home. The problem is that toothbrush, rinse, and floss don’t get deep enough to fight the infections. 
4. That’s why we prescribe Perio Protect. [7] This is a comfortable tray that you use at home. It’s made just for your mouth to gently deliver the medication deep below your gums and hold it there long enough – just 10-15 minutes – to be effective. 
5. Not only will you have healthier gums, but you will also have whiter teeth and super fresh breath.  

These simple factual statements focus on health without a sales pitch or pressure. They clearly alert patients to your concerns and give them a goal to get under 10. When treatment is delayed the next communication is also factual:

I understand your position and I’m glad you will continue to consider treatment because these infections are not healthy. What can you do differently now at home to improve your health? [8]

Patients are likely to say, “I’ll brush twice a day.” Or “I’ll start flossing again.” You reply “Great. I’ll note that and we’ll score you again at your next visit.” The score is unlikely to change but you have made your point: you have alerted them to an infectious disease and the need to address it. At the next office visit, you have the conversation again.

Periodontal disease is one of the most under-diagnosed diseases in North America. The Gum Score highlights the disease for your patients and draws attention to treatment. It also helps you have those conversations at the earliest stages of disease when the infection and inflammation are the easiest to treat.  

When you implement the Gum Score with Perio Protect, you will get better clinical results. The missing link for most patients is homecare. See the results at www.perioprotect.com/research.

Help your patients make the hygiene paradigm shift away from cleaning to health. Start using the Gum Score and start prescribing Perio Protect’s non-invasive Perio Tray™ Therapy.

References:

[1] https://www.nidcr.nih.gov/research/data-statistics/periodontal-disease/adults

[2] This idea originated with Dr. Duane Keller, the former Chief Scientific Officer at Perio Protect LLC, who described the treatment for periodontal disease as chronic wound care.

[3] Periodontal diseases and cardiovascular diseases, diabetes, and respiratory diseases: Summary of the consensus report by the European Federation of Periodontology and WONCA Europe, 21 March 2024 https://doi.org/10.1080/13814788.2024.2320120.

[4] Zero is indeed ideal but not realistic for every patient. You can set your office score at any number. 10 resulted when focus groups of >3000 dental professionals agreed on 10 BOP as a good threshold for patients. Unpublished focus group data collected in 2019-2024 by Perio Protect, LLC, St. Louis, MO USA. Clinicians were asked “What is an acceptable number of bleeding points for patients in your practice?” a) zero, b) less than 10 sites, c) 10-20 sites, d) up to 30% bop could be considered healthy.

[5] Joss A, Adler R, Lang NP. Bleeding on probing. A parameter for monitoring periodontal conditions in clinical practice. J Clin Periodontol. 1994;21(6):402-408. Lang NP, Adler R, Joss A, Nyman S. Absence of bleeding on probing. An indicator of periodontal stability. J Clin Periodontol. 1990;17(10):714-721.  

[6] A simple number will not determine severity or diagnosis, but it will be useful. Severity is best determined with the American Academy of Periodontology’s revised classifications for the staging and grading of periodontitis. Based on clinical attachment loss, bone loss, tooth loss and pocket probing depths, these revisions also don’t help diagnose disease but “clarify extent, severity, and complexity of the patient’s condition” as well as the need for surgery, “difficulty of treatment, prognosis for the dentition and expectations during maintenance therapy.” Perio.org/2017wwdc. Grading documents the rate of disease progression and risk for future progression. The classifications, however, are complex and difficult enough to understand that multiple FAQs have been published about them.

[7] Perio Tray™ therapy from Perio Protect gets medication deep below the gums to fight the infections that toothbrush, rinse or floss can’t reach. When this targeted delivery is combined with scaling or surgery, it effectively reduces bleeding, inflammation, pocket depths, and gram-negative bacterial loads more than scaling or surgery alone. See www.perioprotect.com/research.

[8] This idea and statement originated with Dr. Michelle Hucke of JAX Beaches Family Dentistry in Jacksonville, FL.