05.08.09 Issue #374 Forward This Newsletter To A Colleague
Angie Stone
Angie Stone RDH, BS
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Is There Life without a Chart

Recently I heard a shocking statistic. On average, seventy percent of adult dental records do not contain a full periodontal charting. With all the knowledge the world of dentistry has, how can this be the case?  Are offices still, “spot” charting?  Are they probing but not recording findings? Is the hygienist replacing the periodontal chart with “perio- WNL” in the treatment notes?  I have been told “WNL” means, “We never looked”. 

Without proper periodontal documentation, the health of patients and the livelihood of the office are potentially threatened. Current periodontal standard of care indicates all adult patients should have full periodontal probing and charting accomplished once a year. There are many reasons for this.  The two biggest reasons for this recommendation is to ensure patients are either disease free or receiving the treatment necessary to bring them to a healthy state and to prevent litigation against the dental office for not diagnosing periodontal disease.  Having a complete, up to date periodontal charting on file is the only way to protect the office against a claim that the office is not screening for and treating periodontal disease.  Why then is there not a complete periodontal chart in every adult dental record?

 Many reasons for this come to mind.  1. Periodontal probing and charting takes time.  If the appointment length is not appropriate, probing and charting may get delayed to the next appointment. While intentions are good, probing/charting never really get accomplished. 2. The hygienist needs to bother another staff member to help chart the findings.  If there is no one available, again, it gets pushed off to the next appointment and quite possibly there is no one available the next time either.  Again, the charting never gets accomplished. Measures need to be taken to remedy these situations.

Florida Probe Corporation recently launched the, “GoProbe System” to remove barriers to periodontal charting. GoProbe utilizes Florida Probe’s FP32 Software and new Wireless Keypad Input Device.   The GoProbe wireless key pad allows the clinician to input periodontal probing data without the assistance of a second team member.  Keypad entry is so effortless the patient can enter the data for the clinician if needed.  Pushing the button that corresponds to pocket readings is faster than writing numbers manually thus precious time is saved.  In addition the GoProbe is economically priced for general practice offices, is easy to use and can be used with ANY periodontal probe.  It is a more reliable alternative to voice activation, installation and training is easy, and it bridges with over 40+ practice management systems.

Can a hygiene department survive financially without periodontal probing and charting?  No, it cannot.  When periodontal data is not gathered and recorded, the hygiene department is inevitably prophy-based.  The billing of prophy procedures cannot sustain the department at a healthy level.  Fees for cleanings, x-rays and fluoride are not high enough for hygiene to produce 1/3 of practice production, or to reach the industry standard of 1/3 of hygiene production coming from periodontal procedures. 

Production in prophy based hygiene departments is usually not enough to ensure hygiene salaries are within recommended ranges either.  In this situation, production/revenue from the dentist is used to subsidize the hygiene department.  This does not need to be the case if periodontal probing and charting is accomplished. Research reveals the need for some sort of periodontal therapy in at least 30% of adults.  Based upon this knowledge, if a hygienist is seeing ten patients per day, at least three of them should be periodontal patients.   Periodontal maintenance appointments bring in more production than prophies and are typically charged out 4 times a year instead of 2 prophies. 

If an office has 500 patients, the production for prophies annually would be $75,000 (500 patients x 2 prophies /year = 1, 000 prophies x $75= $75,000). If 30% of the patients were receiving periodontal maintenance 4 times a year at a cost of $150 the production from these procedures would be $90,000 (4 visits at $150= $600/yr per perio patient x 150 patients =$90,000). When production of $52,500 is added for the other 350 patients receiving 2 prophies /year at $75 (2 visits at $75 each= $150/yr per patient x 350 patients= $52,500) the production for prophies and periodontal maintenance is $142,500. Doing the math makes it obvious having patients in periodontal maintenance after active therapy is a must, not only for the patient, but for the practice as well.

Once the need for periodontal therapy has been discovered, GoProbe assists the office in gaining acceptance of active periodontal treatment.  This is accomplished through the use of Florida Probe’s FP32 software that is part of the GoProbe system.  Software contains:

  • Pre-exam educational videos and risk assessment screening
  • Superior charting and printouts
  • Talking software involves patient in memorable, co-diagnosis experience
  • Picture-oriented charts for greater patient understanding

If periodontal therapy is accepted and one quadrant of scaling and root planing is done each day, hygiene production increases a great deal.  If a quadrant is charged out at $250 every day based upon a four day work week, for 50 weeks a year, production from scale and root planing would be $50,000.

There can be no life without a chart, as periodontal probing and charting is the lifeline to patient health, hygiene department productivity and safeguarding the office against potential litigation. 

Need help with implementing new systems and products in you hygiene department? Email hygiene@mckenziemgmt.com.

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