Walk into enough dental practices and you hear the same reasoning: That 5-mm pocket has been there for years, the patient is doing fine, and the team knows them. Kelly Tanner, RDH, PhD -- DrBicuspid.com's hygiene editor -- has heard this many times. She has questions about it.
In this episode of The DrBicuspid.com Podcast, Editor-in-Chief Kevin Henry sits down with Tanner to work through what the 5-mm pocket actually represents, why the American Academy of Periodontology (AAP) staging and grading system draws a clear clinical line there, and what it means when a practice decides to watch and wait.
Tanner's argument is not that every 5-mm site demands the same response. It is that familiarity with a patient stopped being a clinical rationale some time ago. The AAP framework uses that depth as an indicator of disease -- not a suggestion or a guideline -- but a marker that something specific is happening biologically.
The question Tanner returns to is often skipped: Why is that pocket there in the first place? What about the patient's immune response, stress load, systemic health, and the composition of their subgingival microbiome? And if the site has been watched for years without changing, why has it not been addressed?
The conversation takes an unexpected turn when Henry asks about gut health -- a thread from Tanner's original article that she expands on here. She is direct: The answer to a nonhealing periodontal site is not always picking up the ultrasonic scaler again. Sometimes it is stepping back and asking what the body is trying to communicate. Research is strongly backing the gut-oral microbiome connection, and Tanner argues it belongs in the periodontal conversation even when it is inconvenient to raise.
The second half of the episode addresses communication strategies when the patient refuses treatment. "You're not doing that to me," is a sentence many hygienists know well.
Tanner explains the approach she uses -- framing the body as a source of information rather than a problem to be corrected. Tanner then raises the harder questions: What is the office protocol when a patient declines treatment? What does the dentist expect? What does the hygienist do at the next appointment? Those calibration conversations, she says, need to happen inside the practice before the patient is in the chair, not after.
Tanner's continuing education courses and coaching are available at nextleveldentalhygiene.com.
Listen to the full conversation below.
