Questions and Answers
We receive many questions from current and potential clients, and we enjoy helping whenever possible. This article covers a few of the questions I have recently been asked that I believe other offices can benefit from.
1. In our office, when a new patient is diagnosed with periodontal disease, if any sort of cleaning is done it is scaling and root planing. This is how it’s always been done – is this correct?
This is not necessarily correct. Many offices will go ahead and diagnose the root planing and move forward with the cleaning appointment. This allows the hygienist to concentrate on the areas that are healthy and reinforce the need for root planing. Then the treatment plan can be reviewed with the Treatment Coordinator and the patient can be scheduled for root planing.
Now, there are patients who are very motivated or on a time schedule when it comes to utilizing and maximizing their insurance benefits, and these patients may prefer to begin root planing that day. It is critical for hygienists to be good at reading patients’ verbal and non-verbal communication to determine what is best.
2. But when a new patient is diagnosed with periodontal disease, they are no longer eligible for a 1110 prophylaxis – right?
This is not true either. They are not considered a periodontal maintenance patient by the insurance until having root planing or periodontal therapy of some type.
3. A debridement aides in assistance of diagnosis, so that doesn't necessarily qualify either. Often we do not need to debride the teeth in order to establish probings and a diagnosis.
You are totally accurate with this. In my 25+ years as a full-time clinical hygienist, I have only seen two patients who are truly a full mouth debridement. The rest of them should have been quadrants of root planing.
4. If a cleaning is not completed at the new patient visit, the patient is often unhappy that they didn't get their teeth cleaned.
This is true. If the doctor is not performing the new patient exam and the patient is expecting to have a “cleaning”, it is recommended that the hygienist clean the healthy areas of the mouth, and depending on the difficulty they may want to work a little in the deeper areas also.
5. I think cleaning at the first visit is fine assuming you have the time to start SRP.
This is partially true. Cleaning at the first visit is fine. If you don't have time to begin the root planing and perform the quality of work needed, it is better to only start the cleaning.
6. My hygienist is recommending that we do a prophylaxis and charge it out at the first visit, then have the patient return for scaling and root planing. Is it true that this starts the healing process and shows more favorable results following scaling and root planing?
Working in the periodontal pocket can be very controversial. Some believe it is better to not enter the pocket at all, some hygienists believe it starts the healing process and it’s better to do what you can, while others believe it is best to go ahead and only clean the areas that are healthy – which is what the cleaning appointment is for.
7. I am concerned about submitting a prophylaxis to insurance only to turn around a few weeks later to submit scaling and root planing.
As we know, all insurance benefits are different and this may or may not be a problem. There is no guarantee of benefits no matter what. It has been my experience that most dental insurance companies are alright with this. The most important thing as health care providers is for us to perform quality of care and inform the patient of all of their options when it comes to treatment. It is ultimately up to the patient.
Hopefully these are some of the issues you have wanted recommendations for. Of course, once we have analyzed your practice we are able to clarify these areas even more.
Interested in improving your hygiene department? Email firstname.lastname@example.org and ask us about our 1-Day Hygiene Training Program or call 877-777-6151
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