3.8.13 Issue #574 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter
 

Carol Tekavec, RDH
Hygiene Consultant
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Helping Patients Accept Scaling and Root Planing
By Carol Tekavec RDH

One of the most problematic and common issues facing hygienists and dentists is helping patients come to grips with their periodontal conditions. Many of our patients have become accustomed to the six-month cleaning and exam routine, regardless of what might really be happening in their mouths. As hygienists, we too can become accustomed to the “prophy routine” and may postpone our responsibility to inform and perform appropriate dental treatment for our patients with perio conditions. Patients don’t want to hear about needing further treatment, and we can become weary of trying to help them see what we see.

Every now and then it helps to re-invigorate ourselves by setting into place a definite plan (or reinstituting a previous plan if we had one), to approach patients with perio conditions.  What follows is one such plan based on information from the American Academy of Periodontology. Keep in mind that every office needs to decide when scaling and root planing is appropriate for their patients, and all team members need to be “on the same page” about what that means.

This simple format classifies patients and treatment to clarify what is happening or has happened to the patient’s health, and what we need to do.

Class I - Gingivitis

  • Bleeding on probing on 5 or more sites
  • Probing depths of no more than 3mm
  • No bone loss evident on radiographs

Treatment: Prophy with possible additional prophys (three or four per year) scheduled. Detailed home care instructions and tools. Be sure patients understand that most insurance plans will only cover two prophys annually, and any additional will be their financial responsibility.

Class II - Periodontitis - Slight

  • Bleeding on probing in many areas
  • Probing depths of at least 4mm in one to three teeth in a quadrant
  • Bone loss may or may not be seen on radiographs
  • No furcation involvement

Treatment: Localized scaling and root planing, detailed home care instructions and tools, 3 month periodontal maintenance. When filing insurance use the code for SRP 1-3 teeth per quadrant and indicate the tooth numbers on the claim form. It is recommended to have one fee whether there is one tooth or three teeth involved. Some carriers will cover subsequent periodontal maintenance.

Class II - Periodontitis - Moderate

  • Bleeding on probing in many areas
  • Probing depths of 4-5mm on four or more teeth in a quadrant
  • Bone loss likely seen on radiographs
  • Possible furcation involvement

Treatment: Scaling and root planing of complete quadrants, detailed home care instructions and tools. May utilize adjunctive laser and/or antibiotic therapy. Three month periodontal maintenance. When filing insurance use SRP of four or more teeth per quadrant. Perform only two quadrants per appointment or benefit may be reduced. Many carriers will cover subsequent periodontal maintenance.

Class II - Periodontitis - Severe

  • Bleeding on probing in many areas
  • Probing depths greater than 6mm
  • Bone loss visible on radiographs
  • Furcation involvement seen
  • Mobility likely on some teeth

Treatment: Scaling and root planing of complete quadrants, detailed home care instructions and tools. May utilize adjunctive laser and/or antibiotic therapy. Three month periodontal maintenance. If improvement is not seen, possible referral to a periodontist. When filing insurance use SRP of four or more teeth per quadrant. Perform only two quadrants per appointment or benefit may be reduced. Many carriers will cover subsequent periodontal maintenance.

While these possible guidelines provide a treatment format, explaining the need for treatment is often an obstacle. Patients who have been receiving prophys may balk at the idea of scaling and root planing. They may ask why their perio condition had not been mentioned previously. One way to address this is to use the example of high blood pressure.  A person may have never had high blood pressure before, but upon a routine exam with their physician, high blood pressure may be recognized. Our bodies are always undergoing changes, and periodontal disease is a common occurrence for many adults. Showing patients the periodontal probe descending into a pocket by using a hand mirror or on a photo can be very effective. Showing a radiograph with visible patient bone loss is instructive. Providing patients with a copy of their probing depths can also be helpful.

The hygienist can set the stage by giving information prior to the dentist’s exam, with the dentist reinforcing what the hygienist has explained. Often a patient’s primary concern is the cost of treatment.  Most insurance plans will cover scaling and root planing on teeth with 4mm or deeper probing depths. The hygienist and dentist can state that plans cover scaling and root planing because it is a treatment that patients need for their general oral health. Knowing that insurance will help with the fee can often provide the final encouragement patients need to go ahead with treatment.

Hygienists need to focus on what patients really need at each and every appointment. If patients decline treatment, we need to keep trying to help them understand! Periodontal disease is common and treatable, and we are in the front lines of the fight. It is important not to become complacent and let inadequate “prophys” become the norm, simply because it may be easier.

Carol Tekavec RDH is the Director of Hygiene for McKenzie Management.  Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department?  Email hygiene@mckenziemgmt.com.

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