As dental professionals, we are constantly striving to provide the best care for our patients. One critical aspect of this care is ensuring the health of their periodontal tissues. Periodontal health plays a vital role in overall oral health, and its assessment is essential for both new and existing patients. In this article, we will explore the standard of care when it comes to periodontal screening and recording (PSR) versus full comprehensive periodontal charting and why the latter is crucial for maintaining high-quality dental care.

Understanding the Standard of Care

The concept of the “standard of care” in dentistry is multifaceted and not limited to a single document or guideline. It varies from state to state, is subject to change with evolving technology and practices, and is influenced by what is considered reasonable and competent care within the dental profession. The standard of care comprises several elements, including:

  1. A duty of care owed by the clinician to the patient.
  2. Adherence to accepted standards of care.
  3. The presence of a compensable injury in the patient.
  4. Proximate causation of the injury due to substandard care.

State dental boards are responsible for upholding and investigating claims related to the standards of care in dentistry and dental hygiene, aiming to protect the public from substandard care.

The Role of Guidelines

While there is no single, comprehensive standard of care document that applies to all dental professionals, organizations like the American Dental Hygienists’ Association (ADHA) have created guidelines to help define clinical practice standards. In their document titled “Standards for Clinical Dental Hygiene Practice,” they acknowledge the importance of periodontal probing as a standard under clinical assessment but do not specify how frequently periodontal charting should occur.

Understanding PSR and Its Limitations

Periodontal Screening and Recording (PSR) was designed as a tool to expedite the screening process for periodontal health, indicating when a comprehensive periodontal exam is necessary. It is essential to recognize that PSR was never intended to replace a full comprehensive periodontal assessment; it serves as a screening protocol. It can help identify the severity of periodontal issues and guide decisions regarding the appropriate level of care for the patient.

The Importance of Comprehensive Periodontal Charting

Dr. Frank DeLuca, DMD, JD, an expert in the field, asserts that the standard of care for periodontal charting in dentistry is a full-mouth, six-point probing with all measurements recorded at least once per year for all adult patients. This comprehensive approach ensures that all relevant data is captured, providing a complete picture of the patient’s periodontal health.

One crucial reason for recording all measurements is the legal aspect of patient care. In the eyes of the law, if it is not documented in the patient’s chart, it is as if it never happened. An incomplete chart can raise concerns, especially when it comes to potential malpractice claims.

Dr. J. Crystal Baxter, DDS, MDS, an expert witness in dental negligence cases, emphasizes the importance of routine periodontal records. Failure to diagnose or treat periodontal disease in a timely fashion is a common allegation in negligence cases, often involving general dentists. To avoid such situations, regular and routine periodontal charting is imperative, even for patients initially seeking emergency treatment.

Barriers to Periodontal Charting

In some cases, dental hygienists may face barriers to conducting regular periodontal charting, such as time constraints or a lack of support for recording. It is essential for dentists and employers to identify these barriers and implement solutions to ensure that regular periodontal charting becomes the standard of care in the dental office.

Ensuring Excellence in Periodontal Care

In conclusion, the standard of care in dentistry is not a rigid, one-size-fits-all guideline but rather a set of expectations based on competent and reasonable care within the dental profession. While some guidelines exist, the American Dental Hygienists’ Association’s “Standards for Clinical Dental Hygiene Practice” recognizes the importance of periodontal probing but does not specify the frequency of comprehensive charting.

It is clear that PSR is a valuable screening tool, but it should not replace full comprehensive periodontal charting, which provides a complete assessment of the patient’s periodontal health. Dental professionals should strive to adhere to the highest standards of care, including routine and thorough periodontal charting, to ensure the well-being of their patients and protect themselves legally.

As dental practitioners, our primary goal is to provide the best possible care for our patients. By following the practice of comprehensive periodontal charting, we can continue to deliver the highest standard of dental care and maintain the trust and confidence of our patients.