Why Arenít We Doing More Perio?
Mr. Patient comes in today for his recall/prophy appointment. His insurance covers this type of treatment every six months and he has been a patient of the office for over four years. He has accepted restorative treatment in the form of two full coverage crowns and a few composite resins over this time. Ms. Hygienist has been taking care of him through the years and has recorded probing depths at a minimum of once annually. He routinely has scores of 4mm around many biscuspids and 5mm on molars. Her recommendation has been increased flossing and she has shown Mr. Patient his scores and reviewed flossing at each appointment. He is not showing improvement. In the past, when Dr. Dentist performed his exam he has mentioned the probing depths, but is more focused on necessary restorative issues. Restorative treatment is being addressed, but perio treatment for this patient is not going forward. What is happening and what might be done better?
What appears to be going on is a situation common in many offices. That is, the hygienist is scoring perio but not explaining what is happening or pressing the need for treatment. The dentist is rightfully addressing the patient’s restorative needs, but in doing so appears to be relegating perio to a back-burner. And the patient is complacent, believing that by coming in for the “cleanings” every six months that his insurance will cover, he is doing all he needs to be doing to ensure good oral health. All of this contributes to necessary perio treatment being neglected. We can do better.
When patients of record who have been receiving prophys have perio identified, it can be a balancing act to explain the situation and go forward. If the hygienist announces today that the patient has periodontal disease, the patient will wonder why he is just hearing about this now. He may be resistant to pursuing additional treatment. If the dentist appears to be putting restorative ahead of perio, it further complicates matters. Here are some ideas:
1. Many dentists trust their hygienists to identify perio issues and bring them to their attention. What may be lacking is a stronger focus on integrating necessary perio treatment with necessary restorative care. The hygienist can vocalize her findings to the dentist during his exam, and even provide her opinion on recommended treatment. When the dentist confirms what has been discovered and verifies the need for treatment, the patient has confidence in what is being proposed. It is easier for him to say yes.
2. It takes finesse to explain why a patient who has been coming in regularly needs perio treatment now. The hygienist might say, “As you can see, the past two periodontal charts I made for you have shown us that you have several areas around your teeth that appear to be declining in health. Your cleanings and home care have not taken care of the problem. I recommend that we address these problems with scaling and root planing right away. Simply taking the readings and doing nothing to attempt to stop the problem is not sensible. Most adults face this problem at some time in their lives. It is as common as developing high blood pressure when previously normal blood pressure was seen. The good news is we see positive results when we remove the deep source of gum and bone destruction, which is bacteria at the base of the pockets around your teeth, with root surface scaling. You can make the results more lasting with a renewed focus on daily removal of plaque from around and between the teeth.”
3. Scheduling restorative treatment in conjunction with perio is also helpful. For example - if the dentist has identified #3 as needing a crown, the patient can be anesthetized on the maxillary and mandibular right, scaling and root planing can be accomplished, and then the crown prep performed. The patient makes one appointment for both services.
4. Talking about insurance coverage is also important. The treatment coordinator can explain that most dental insurance covers scaling and root planing for pockets scoring 4mm or higher. There are codes available for one to three teeth per quadrant, and four teeth or more per quadrant. After root planing has been accomplished, most insurance contracts will also pay toward two to three periodontal maintenance appointments per year (more frequent maintenance appointments will be the patient’s responsibility and this should be explained to the patient prior to treatment). Knowing their insurance will help pay also encourages patients to say yes.
5. Root planing sounds scary, so emphasize that local anesthesia can be used. With this in mind, be sure to schedule enough time to accomplish this. Scaling and root planing appointments must not be rushed. At least 90 minutes per half of the mouth is a good rule of thumb.
Many patients in our practices need periodontal care. They rely upon us to identify and treat this common condition. We should be doing more perio! The dentist, hygienist, and treatment coordinator can streamline their messages to support one another in identification, confirmation, and insurance coordination, to help patients say yes. It’s a winning situation for everyone.
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 firstname.lastname@example.org.
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