To Threshold or Not to Threshold

OralDNA® providers frequently comment that some patients will say “I am below those black lines so I must be okay.” To help overcome this obstacle, the MyPerioPath® results have an option to display the threshold lines (black lines) or have them removed. There are benefits to both versions. This blog will provide sample verbiage a clinician can use both when the thresholds are present and when the thresholds are removed.

To serve as a refresher and from a previous blog “What is the Therapeutic Threshold?” these lines represent the respective level of bacteria associated with moderate/severe chronic periodontitis calculated from an extensive sampling of clinically confirmed patients exhibiting bleeding 4-5 mm periodontal pockets.

If a clinician sees disease clinically but the quantity of bacteria doesn’t surpass the therapeutic threshold, the patient/clinician conversation could go as follows.

Threshold Reported

Patient: Whoa, I see a lot of colored bars, but if I am below those black lines, I should be okay right?

Clinician: Periodontal disease is very complicated. In your case, we can see bleeding, bone loss, and other signs of inflammation.  These are indicators of active disease.  Even though you are below the average, these levels are too much for you personally. If you didn’t have bleeding and bone loss, then I would agree with you as being okay. Let’s consider your personalized treatment plan to address these bacteria, get them to a lower level, and find the point where the bacteria are not producing inflammation and infection.

No Threshold Reported

Patient: Whoa, I see a lot of colored bars, am I okay?

Clinician: Periodontal disease is very complicated. This report indicates you have several different bacteria that are often the cause of bleeding gums and bone loss like you are experiencing. Our treatment plan is to personalize your therapy to target these specific bacteria and get them lower. Ultimately, the goal of therapy is to find a point where the bacteria are not causing inflammation leading to bleeding and bone loss.

As you can tell from the scripts, there are only a few words utilized differently. To threshold or not to threshold is an option for your team to consider. Please share what works for you. Do you use the thresholds? Or do you remove the thresholds?

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Diane Larson RDH, BSDH

Diane Larson, RDH, BSDH has over 20 years of dental experience. She is a member of the ADHA/ MnDHA. Although she is no longer providing patient care chair side, her passion is helping clinicians provide a higher quality of care for their patients by assisting in developing an evidence based treatment plan. She considers herself an extension of every team that utilizes OralDNA services. Her total health approach is complimented by her nutritional knowledge. She is from the Midwest and calls Minnesota home, where she lives with her husband.

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