12.31.10 Issue #460 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Carol Tekavec, RDH
Hygiene Consultant
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Guiding Patients to Perio Treatment
By Carol Tekavec RDH

We know that many patients are not receiving the perio treatment that they need. Either they don’t understand or accept their oral condition, or they may simply want “just what insurance pays for.” We also know that many patients are receiving the perio treatment they need, at the expense of the practice. When patients don’t understand or accept their disease, hygienists can find themselves providing perio treatment at “prophy prices.” We don’t want our patients to receive less than optimum care, so the practice provides the care for less than optimum fees.

This situation is wrong. 

How can we guide our patients to accept perio care, particularly if we have been treating them as prophys for many years? What about the difference in fees? A system of disease identification and effective patient communication can help us achieve routine scheduling of appropriate treatment for our patients.

Disease Identification, Communication, and Scheduling Appointments
Dental practices can develop a method of disease identification that makes communicating with patients easier and the scheduling of appointments more predictable. For an approach, we can look to the way physicians identify and treat individuals with hypertension. The identification of the disease process in that system is simple. Blood pressure readings over a certain threshold trigger treatment. This may mean medication, lifestyle changes, and re-appointment in the near future to assess your condition. Similarly, in dentistry, bleeding and pocket depths can serve as the “readings” that trigger treatment.

While most hygienists record bleeding and pocket depths during a typical prophy appointment, these readings often do not translate into patient acceptance of disease and/or scheduling of patients for future perio treatment. Making the process easier for patients to understand, having everyone in the practice agree on treatment thresholds, and scheduling appointments  based on these thresholds can work.

Here are some examples of how an office might deal with disease identified at a regular “prophy/recall” appointment:

1. Patients with more than 10 bleeding points, but no pocket depths over 3 mm, as recorded at today’s prophy appointment, are considered to have gingivitis.  These patients receive their prophy today, along with home care instructions to help them reduce the bleeding points, and are appointed for one month in the future for a second prophy and re-evalutation. The hygienist can explain that gingivitis is often an alert for possible gum and bone disease, just as a high blood pressure reading can be an alert for possible cardiovascular disease. If the hygienist is asked, “Will my insurance cover this?” she can answer, “Insurance plans commonly cover two standard ‘cleanings’ a year. Sue at the front desk can let you know what your plan will do.” The business assistant can then inform the patient of possible insurance benefits for the second prophy when setting the appointment for next month. 

2. Patients with bleeding and pocket depths of 4mm or deeper in 1-3 teeth in a quadrant as recorded at today’s prophy appointment, are considered to have Class II Localized Periodontitis. These patients receive their prophy today, and are appointed as soon as possible for scaling and root planing for the teeth that need treatment. (This might be one appointment or two depending on how many teeth are to be treated.) The hygienist can explain that pocket depths over 4mm signal that periodontal disease, with its’ resulting bone loss, is beginning.

Using the blood pressure example, she can say, “If your physician found that you had high blood pressure, he would not want you to ignore what that might mean for your general health in the future. We know that bleeding and unhealthy pocket depths can signal bone loss and future consequences for your teeth and appearance, as well as general health problems and bad breath. We can help you control and prevent your problems from getting worse by reducing the bacterial load from around your teeth, which in turn will allow your home care efforts to be successful.” 

If the patient asks, “Did I just get this disease?” or “Why didn’t you tell me about this before?” the hygienist can answer, “You have had bleeding and pocketing before, but I had hoped that your own home care and regular professional cleanings might have worked to prevent it from getting worse. Unfortunately, that hasn’t happened, and we need to get control of things now. We can’t just let you get worse and worse while we stand by and watch.” 

The hygienist can give the patient information about perio disease as well as detailed home care instructions, and then the patient is taken to the business assistant to schedule the necessary future appointments.  If the patient asks, “Will my insurance cover this?” he can be told, “Scaling and root planing are often covered by insurance.  We will do all we can to help you receive the benefits you and your employer are paying for.”

3.  Patients with bleeding and pocket depths of 4mm or deeper in 4 or more teeth in a quadrant as recorded at today’s prophy appointment, are considered to have Class II Generalized Periodontitis. These patients receive their prophy today, and are appointed as soon as possible for four quadrants of scaling and root planning (typically two appointments). The hygienist and business assistant’s conversation can proceed as in example #2 above, as well as the hygienist providing detailed home care instructions.

Your office may have a different bleeding or pocket depth threshold for patients, but this method of guiding them to perio treatment may work for you. Your patients deserve the best care, and your office deserves proper remuneration.

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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