Five Tips for Talking to Patients about Perio Scaling and Perio Maintenance
The need for perio scaling can be a difficult topic for dental hygienists to broach with patients. It is often more difficult for patients of record than for new patients, although both can be a challenge. People often think that by brushing their teeth and using a T.V. advertised mouthwash they are doing everything that needs to be done to maintain good oral health. It can come as a shock when they are told they have periodontal disease. Here are a few tips to set the stage for a successful conversation.
1. Explain and then perform full mouth perio charting. To get patients on board with the need for perio scaling, they must first understand how we discern a perio condition. This can be accomplished by using something as simple as a hand drawn diagram of a tooth including the root, bone and gum tissue, or a professionally prepared video shown in the treatment room. The important aspect is that there is a visual so they can see what we are talking about. The visual can be used to describe what we are looking for, how we are going to obtain data concerning their condition (showing them the perio probe and its millimeter divisions), and where on a tooth the readings will be taken.
An intraoral camera and monitor are great tools to show a probe disappearing into a pocket in their own mouths, or a simple hand mirror can be utilized. We then explain what the readings mean. According to the latest guidelines by the American Academy of Periodontology, any reading deeper than 4mm indicates a need for treatment. Full mouth charting can be accomplished by the hygienist alone, but a minimum of ten minutes must be allowed for this if going from the mouth to the computer. About five minutes is all it takes if working with an assistant or voice-activated system. It is important for the patient to hear what the readings are.
2. Sit the patient upright and go over all of the results. Leaving a patient lying down is not conducive to an effective conversation. Ideally the patient and hygienist should be just about eye-to-eye. The perio chart results can be shown on the monitor with the readings over 4mm highlighted.
3. Describe what perio disease is and what perio scaling accomplishes. Talking about perio disease as an infection is often a successful method of approaching this part of the discussion. People will typically ask how they got the disease, why no one ever talked to them about it before, and why didn’t their own brushing and flossing take care of it. If they are patients of record they may want to know why they are just finding out about this problem now.
Addressing perio disease as a condition somewhat like high blood pressure may be helpful. A person may have gone many years without high blood pressure, yet have this condition diagnosed at a recent check-up. The fact that high blood pressure can be managed, just as perio disease can often be managed, is also a good comparison. Brushing and flossing is important, but just as eating a healthy diet and exercising may not be enough to control blood pressure, their home care up until now has not been enough to control their perio condition. Perio scaling removes the source of the infection (bacteria and toxic bacterial by-products living in the areas around the teeth) so that their own immune systems can work successfully. It reduces the bacterial load so brushing and flossing can be effective.
4. Explain what tools will be used to perform the perio scaling. Patients do not want to be hurt! It is very important to stress they will be numb for the procedure, hand tools and ultrasonics will be used, and they will be comfortable throughout. Typically one side (top and bottom) will be done at a time, although an appointment for the entire mouth is not uncommon. Beware of insurance guidelines if performing a full mouth procedure, as some carriers reduce the amount they will pay if the entire service is done at one appointment.
5. Be sure patients understand that perio maintenance is a must! It is important for patients to know that from now on they will be coming for a different service than a standard “cleaning” when they come for their recall appointments. They also need to know they will be coming more frequently. They must understand that in the future they will be receiving a maintenance procedure, not a prophy, three or four times a year. It is usually a mistake to spring this on patients after they have already had the perio scaling.
Talking about maintenance further reinforces the fact that meticulous home care and professional treatment are all part of the “deal” in getting them to health and keeping them there. Fees and insurance limitations are also an important part of the discussion. Nothing makes patients more uneasy than not knowing or understanding what the cost of their treatment will be.
Perio procedures are an important service we can offer our patients. We can help to keep our patients healthy, but we need them to understand and “buy-in” to perio procedures in order to ensure a successful result.
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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