8.27.10 Issue #442 Forward This Newsletter To A Colleague

Carol Tekavec, RDH
Hygiene Consultant
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Converting Prophies to Periodontal Maintenance -
Not So Simple Is It?

By Carol Tekavec, RDH Hygiene Consultant

It is known that almost 80% of adults have some form of periodontal disease, yet 90% of our patients are coming in for prophies. We know that this doesn’t make sense, but finding our way toward proper diagnosis, accurate treatment plans, and most importantly, helping patients understand why they now need periodontal treatment after being patients of record for many years, is not so simple.

As a working hygienist and consultant, I know that there is a lot more to increasing our percentages of periodontal treatment to prophies than announcing at a staff meeting it will be done. If your answer is “no” to any of the below questions, converting prophies to periodontal maintenance in any meaningful way is going to be extremely difficult.

1. Is the practice committed to appropriate patient care and treatment?
Things are constantly changing in the world of dentistry. Doing something one way just because “that’s the way we always do it” is not a reasonable approach to taking care of patients. Dentists and staff must be willing to keep up-to-date on all aspects of patient care. Just because our patients have “always” come in for prophies every six months, does not mean that is necessarily appropriate for them. And where did the idea of six month recalls come from in the first place? Some credit old Pepsodent toothpaste commercials that said, “Brush your teeth twice a day and see your dentist twice a year.” Not exactly scientific! Recall time intervals need to be based on what the patient actually needs.

2. Are the hygienists open-minded about evidence supporting more identification and treatment of beginning stages of periodontal disease?
Hygienists need to be open-minded about new recommendations concerning identification and treatment of periodontal disease. Not long ago it was considered inappropriate for 4mm pockets to be treated with periodontal scaling. Now, under the guidance of the American Academy of Periodontology, we understand that beginning stages of periodontal disease need to be addressed! Arming ourselves with knowledge such as that which is available in the AAP Parameters of Care can help us overcome any reluctance to make necessary changes, as well as back up our suggestions to our patients. Remember that patients cannot be converted to periodontal maintenance without receiving scaling and root planing or periodontal surgery first.  Periodontal maintenance is not considered to be appropriate unless previous treatment has been performed to control the disease process. After initial therapy, periodontal maintenance is correct and according to the ADA Current Dental Terminology may be continued for the “life of the dentition or any implant replacements,” as ultimately determined by the dentist.

3. Can the staff work together to support a “new way of doing things?”
Once a different philosophy of treatment is identified, can the staff work together to support changes? If the office manager is the only person supporting the “new ways,” changes will never get off the ground. The assistants, hygienists and the dentist can sabotage making changes effective, even if this is done unconsciously. Patients will often ask a dental assistant, “Do I really need this treatment?” If she cannot answer “yes” confidently, the patients will know it.

4. Is there enough time during a typical hygiene “recall” for both identification of periodontal disease and discussion with a patient about treatment?
Appropriate time must be scheduled into the hygiene appointment to allow for identification of periodontal disease, and patient education about the situation. Rushed appointments do not lend themselves to patient comprehension and acceptance of periodontal treatment recommendations. Should hygiene appointments at the office be lengthened? Discussion of scheduling needs to be a part of a staff meeting prior to instituting changes in patient care. It is not possible to be successful if identification and education is just “crammed in” to an already overloaded appointment.

5. Can the clerical staff support the hygiene department in discussion of treatment, discussion of fees and insurance, and scheduling for patients who are being moved to the periodontal “track?”
Once a patient has been identified as requiring scaling and root planing, the clerical staff can further streamline patient acceptance by being well versed in office fees and possible insurance parameters for patients who are being scheduled for periodontal care. Many insurance contracts provide for a certain amount of benefits for periodontal treatment. However, patients will typically find themselves facing higher co-pays or responsibility for more of their bill (for example - most contracts provide for only two periodontal maintenance procedures annually rather than the four visits which are typically recommended). It is usually up to the business staff to help patients understand their financial obligations.

Offering more appropriate care for patients can be good for patients and good for office production. Careful consideration of how changes are implemented can be vital for success.

Carol Tekavec CDA 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

Carol is also a speaker on dental records, insurance coding and billing, patient communication and hygiene efficiency for McKenzie Management. Interested in having Carol speak to your dental society or study club?  Click here

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