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Is There An Acceptable Level Of Plaque Control?

What level of plaque control can we accept from our patients? The simple answer is – the best they are willing to perform. What is the minimal level of plaque control needed to control disease? The answer is – it depends. It depends on several factors none the least being the patient’s level of resistance. Another major factor is the frequency and quality of maintenance visits.

For years we would see our patients for their regular periodontal maintenance. At every visit we would evaluate their plaque control and invariably find some place that they missed. We would admonish them to do better. We set the bar and expected all to reach it. That was a mistake and can be demeaning to patients.

Several of my colleagues went farther. They would treat their patients through the hygienic phase but refused to do necessary surgery if their plaque indexes were not at a level to their liking. Is this even ethical?

We need to do a better job of taking what our patients give us and work within those parameters. If we don’t we lose patients and sacrifice optimal dental care. For years I thought the alarmingly high rate of attrition in our maintenance program was due to cost and a general lack of interest. I’m not so sure anymore. Maybe our patients just got tired of lack of progress.

It’s good to be the patient once in a while. I don’t mean jumping into one of our colleagues chair on a cancellation for a 20 minute prophy. I mean a full hour visit, the whole program that all your regular patients get. I did this recently and got scolded for missing a small area with my plaque control. I didn’t like it.

The solution to the above may lie in the frequency of maintenance visits. Several studies have shown that an interval of three months greatly improves long term stability over the traditional 6 month schedule. Most of the patients in my practice were seen every 3 to 4 months. Some came every 6 months while, at the other end of the spectrum, some came every 2 months.

My advice – tailor your patient’s maintenance program to their individual needs.

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