Redefining the Hygienist’s Role in Periodontal and Systemic Health

Katrina M. Sanders, RDH, BSDH, MEd, RF, is an internationally recognized dental hygienist, educator, and speaker specializing in periodontology and clinical innovation. She serves as clinical liaison for AZPerio, where she practices alongside Diplomates of the American Board of Periodontology in surgical settings. Sanders is widely known for her work in advancing periodontal care, interdisciplinary collaboration, and hygiene-driven diagnostics. A recipient of the Sunstar/RDH Award of Distinction, she is recognized for her leadership, education, and contributions to the profession. She has held faculty positions in dental hygiene education, contributed to curriculum development, and authored multiple editions of a board preparatory textbook. Sanders lectures nationally on clinical excellence, empowering dental professionals to elevate patient care through evidence-based protocols, critical thinking, and collaborative practice. Her website is katrinasanders.com.

Q&A

Inside Dentistry (ID): Can you share a bit about your journey into dental hygiene and what led you to focus so strongly on periodontal care?

Katrina M. Sanders, RDH, BSDH, MEd, RF: I fell in love with dental hygiene early on, and I recognize that my experience was somewhat unique. I had very positive experiences going to the dentist as a child, which I think can sometimes be rare. Many people describe dental visits as stressful or difficult, often because they had significant dental needs or challenging experiences with providers. That really wasn’t the case for me.

I didn’t have a lot of dental problems, so I genuinely enjoyed going to the dentist. It felt interesting and dynamic, even at a young age. What I didn’t fully appreciate at the time, though, was the scope of what dental hygienists actually do. My perception—like many patients—was that hygienists primarily polished teeth.

As I entered the profession and began my education, that perception changed dramatically. I started to understand how expansive the role really is, particularly in the context of periodontal therapy. What really drew me in was recognizing that periodontal care isn’t just about oral health—it has profound implications for systemic health as well.

I attended my dental hygiene program during a time when research around the perio-systemic link was gaining significant traction. My faculty were actively involved in studies, serving as examiners and contributing to research on topics like adverse pregnancy outcomes, cardiovascular disease, stroke, and even cognitive decline. Being immersed in that environment gave me a strong foundational understanding of how interconnected oral and systemic health truly are.

That combination—my early positive experiences and my exposure to emerging research—really positioned me to develop a deep appreciation for periodontology and the critical role hygienists play within it.

ID: You work closely alongside periodontists in a surgical setting. How has that experience shaped your perspective on the hygienist’s role in periodontal and peri-implant care?

Sanders: It has had a tremendous impact on how I view my role and the role of hygienists more broadly. In a surgical setting, you’re seeing things that you simply can’t fully appreciate when you’re practicing non-surgical periodontal therapy.

In general practice, we often refer to non-surgical care as a “blind” approach—we’re relying on tactile sensation, instrumentation, and our understanding of anatomy to navigate subgingival environments we can’t directly visualize. But in surgery the tissue is retracted, you see the true architecture of the bone, and you see the full extent of disease.

That includes the severity of bony defects and just how destructive furcation involvements can be for the supporting structures of the teeth. Seeing those realities firsthand really changes your perspective. It reinforces how significant periodontal disease progression can be—and, importantly, how critical early intervention is.

That experience has deepened my respect for the role hygienists play in both prevention and active periodontal therapy. It has also influenced my work as an educator. I feel a strong responsibility to share these insights with colleagues who may not have exposure to surgical settings, so they can better understand what’s at stake when treating earlier stages of disease.

ID: From your vantage point, what distinguishes a truly high-performing hygiene department when it comes to periodontal disease management?

Sanders: The answer is fairly straightforward, even if it’s not always easy to implement. It comes back to fully embracing the dental hygiene process of care—assessment, diagnosis, planning, implementation, and evaluation, or “ADPIE.” A high-performing hygiene department is one that prioritizes comprehensive assessments and accurate diagnoses. That may sound obvious, but in reality, it’s often where breakdowns occur. There’s a common assumption that a high-performing practice is defined primarily by financial production, and while that certainly matters, it shouldn’t come at the expense of clinical excellence.

What I’ve seen consistently is that when hygienists are given the time, tools, and support to properly assess and diagnose periodontal conditions in a calibrated environment, performance naturally follows.

We experienced this very clearly in our periodontal practice. During COVID, we initially extended appointment times to accommodate enhanced infection control protocols. As those protocols evolved, we realized we didn’t necessarily need all of that additional time for disinfection—but instead of reverting to shorter appointments, our periodontists made a deliberate decision to maintain longer visits for periodontal maintenance patients.

That meant going from 60-minute appointments to 70 minutes. On paper, that results in one fewer patient per day, which can feel counterintuitive from a productivity standpoint. But what we saw was the opposite effect over time.

With those additional 10 minutes, hygienists were able to spend more time educating patients, discussing findings, introducing appropriate home care tools, identifying periodontal abnormalities, and recommending adjunctive therapies such as locally delivered antimicrobials or soft tissue medicaments. They also had more time to identify patients who might benefit from surgical intervention.

As a result, we saw a significant increase in overall production and better patient outcomes. That growth was directly tied to improved assessment and diagnosis—not increased volume. It reinforced a principle I strongly believe in: when you do the right thing clinically, the production follows.

ID: You often speak about empowerment within the hygiene profession. What does that look like in a clinical setting, particularly in periodontal care?

Sanders: For me, empowerment goes well beyond simply being given permission to perform certain tasks. It’s really about partnership, collaboration, and shared responsibility for patient care.

In many states, hygienists are the primary providers delivering periodontal therapy in general practice settings. Yet, at the same time, we’re not legally permitted to diagnose periodontal disease independently, which creates an interesting dynamic.

Historically, I think there has been a tendency for doctors to view their role as granting permission rather than actively participating. But true empowerment looks very different. It involves doctors who are engaged—who calibrate with their hygienists, who take an active interest in periodontal therapy, and who support their hygienists’ clinical assessments in front of patients.

When I know that my doctor will come into the operatory, review my findings, and confidently reinforce what I’ve communicated to the patient, that creates a tremendous sense of confidence. It allows me to speak more clearly and assertively about what I’m seeing because I know that support is there.

Empowerment also extends to professional growth. It means having access to continuing education, being able to bring new ideas back to the practice, and engaging in peer-to-peer conversations about how to implement new tools, products, or protocols. It’s about being treated as a clinical partner, not just a provider working under supervision.

ID: What are the most important clinical skills or assessment protocols hygienists should master today to elevate their standard of care in periodontology?

Sanders: One of the most important—and often overlooked—skills is the ability to accurately identify what constitutes an active disease state. That includes both gingivitis and periodontitis.

There’s a surprising amount of confusion around this. With gingivitis in particular, many clinicians have become so accustomed to seeing it that it’s almost normalized. We sometimes fall into what’s been referred to as the “bloody-bib prophy” cycle—treating inflammation without fully acknowledging it as a disease state that requires intervention.

But gingivitis is the precursor to irreversible periodontal disease. Recognizing it as such—and treating it accordingly—is critical.

When it comes to periodontitis, the challenge is often even greater, particularly in mild to moderate cases. These patients can present with subtle findings that aren’t always clearly reflected in radiographs or even in obvious clinical attachment loss.

One of the biggest issues I see is clinicians relying on insurance coverage as a determining factor for diagnosis. If a procedure isn’t covered, the assumption may be that the disease isn’t present or isn’t severe enough to treat as periodontitis. That’s a problematic approach.

Developing strong diagnostic skills—independent of reimbursement frameworks—is essential for elevating the standard of care.

ID: What are the greatest opportunities for improving early identification and intervention of periodontal and peri-implant diseases?

Sanders: A significant opportunity lies in how we involve patients in the assessment process. Too often, periodontal charting is something we do silently, without engaging the patient in what we’re measuring or why it matters.

When we take the time to explain our assessment tools and narrate findings in real time, patients become much more engaged. For example, explaining that probing depths of 1 to 3 millimeters are generally healthy, 4 millimeters represents an early warning sign, and 5 millimeters and above may indicate active infection gives patients a framework for understanding their condition.

As we call out those numbers during charting, patients begin to connect the data to their own health. In many cases, they start to recognize patterns themselves, which can be incredibly powerful from a behavior-change perspective.

It’s also important to emphasize that clinical measurements are often more sensitive indicators of early disease than radiographs. Radiographic bone loss typically isn’t visible until a significant amount of destruction has already occurred, particularly given the limitations of two-dimensional imaging.

I often compare this to lab values in medicine. Patients are familiar with cholesterol levels or blood pressure readings and understand what constitutes a healthy range. We should be applying that same approach to periodontal measurements—helping patients understand what “healthy” and “concerning” look like in their own mouths.

ID: You emphasize continually asking “why.” How can clinicians cultivate that level of curiosity in a busy practice environment while still maintaining efficiency?

Sanders: The “why” is really central to patient motivation. As clinicians, we’re trained to focus on objective findings—probing depths, bleeding, attachment loss—but those metrics don’t necessarily resonate with patients on their own.

When we take the time to explain why those findings matter—particularly in the context of systemic health—we create a much stronger connection. Patients may not initially be concerned about a bleeding 5 mm pocket, but they will pay attention when they understand how periodontal inflammation may relate to conditions like cardiovascular disease, diabetes, or adverse pregnancy outcomes.

Incorporating that “why” doesn’t have to be time-consuming. It’s about being intentional in how we communicate and making those connections part of our routine conversations with patients. When patients understand the broader implications, they’re more likely to engage in their care and follow through with recommendations.

ID: Looking ahead, what are the most important frontiers in periodontal care from the hygienist’s perspective over the next 5 to 10 years?

Sanders: I believe hygienists are increasingly being recognized as key providers in managing inflammatory conditions. Periodontal disease is one aspect of that, but it’s part of a larger picture of systemic inflammation.

Looking forward, I think we’ll see significant advancements in diagnostics. Salivary and crevicular fluid testing will likely become more commonplace, allowing us to identify specific bacterial profiles and better understand the microbial and inflammatory drivers of disease.

We’re also beginning to move beyond viewing periodontal disease as purely bacterial. There’s growing interest in the roles of viruses, fungi, and host response in disease progression, which will further refine how we approach treatment.

In addition, we’re seeing expanded use of chairside screening tools, such as hemoglobin A1c testing. While we’re not diagnosing systemic conditions like diabetes, we are increasingly involved in screening and identifying risk factors.

I think the next frontier will involve incorporating broader inflammatory markers into clinical practice, allowing us to track outcomes in a more comprehensive way—not only through probing depths, but through systemic indicators of health.

ID: What are the most effective ways for dentists to foster a collaborative relationship with the hygiene team that truly advances periodontal outcomes?

Sanders: The most effective approach is active collaboration, not passive delegation. In some practices, periodontal care is essentially handed off to the hygiene department with minimal doctor involvement.

A more effective model is one where doctors and hygienists engage in ongoing dialogue. That includes attending continuing education together, discussing new concepts, and working collaboratively to implement changes in practice.

Something as simple as a doctor entering the operatory to review findings, confirm assessments, and reinforce the treatment plan can make a significant difference. It supports the hygienist, builds patient trust, and ensures consistency in messaging.

ID: What systems or protocols have you seen implemented successfully to create alignment around periodontal diagnosis and treatment planning?

Sanders: Calibration is the foundation of alignment. Teams need a shared understanding of what health looks like and how disease is defined and managed.

One approach we’ve found effective is regular case review. In our practice, we meet routinely to review patient cases in a blinded format—focusing on clinical findings rather than the provider who delivered care. We discuss staging, grading, contributing factors, and treatment options.

That process helps ensure consistency in diagnosis and treatment planning, and it creates opportunities for ongoing learning and discussion among team members.

ID: If you had to describe the perfect day in clinical hygiene, what would it include—and is there wine at the end?

Sanders [laughs]: There’s definitely wine at the end. But ahead of that, the perfect day starts with a team that is aligned and prepared to support one another. Dentistry is inherently unpredictable—schedules change, challenges arise—so having a team that can adapt and collaborate is essential.

It’s a day where providers feel comfortable asking for input, sharing challenges, and learning from each other. Periodontal care, in particular, is a team effort. It involves the general dentist, the hygienist, sometimes a periodontist, and often coordination with other healthcare providers.

When everyone is working together toward a common goal, that’s when you see the best outcomes—and that’s what defines a great day.