6.29.12 Issue #538 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Carol Tekavec, RDH
Hygiene Consultant
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What Does a Hygienist Do? Part II
Carol Tekavec RDH

In my last article, we talked about the role of the hygienist in identifying and promoting necessary restorative treatment. Now we will focus on the identification, education, and performance of periodontal therapy, for both new and recall patients.

As hygienists we have all been faced with the new patient who presents with obvious periodontal needs. If the patient has been appointed with the dentist prior to seeing the hygienist, s/he may have already heard about these problems by the time s/he is in the hygiene chair. Some education has already occurred and the stage has been set for treatment - either a debridement or scaling and root planing. Even when the patient has accepted her/his condition, the situation is still fraught with potential stumbling blocks. Does the patient trust the diagnosis when s/he has not really had much of an opportunity for a relationship with the dentist and practice? Does the patient understand the time commitment that will be required for appropriate therapy to be performed? Does the patient understand that treatment today will not take care of the entire situation? Have fees been presented and is the patient “on board” with the additional cost of perio care? What brought the patient to the office in the first place - and if it was not perio symptoms, when will the patient’s primary concern be addressed? These are only a few common issues.

When a patient of record arrives for a “standard adult prophy” and “recall” exam and periodontal disease is identified, there can be even more problems. The patient is used to having a “cleaning” and may be resistant to accepting more in-depth care. S/he may be unhappy that “after coming in all these years, now I have periodontal disease!”

How might we handle these situations?

The New Patient
Ideally a patient should first meet the dentist in a non-threatening area (such as a clean private office), have a conversation where the primary concern is identified, and receive an order for radiographs, perio charting, or any other procedures. If this is not practical, the dentist can speak with the patient in a treatment room and then order any diagnostics. Keep in mind that a certain number of radiographs are not appropriate just because it is the office “routine” to take them. There needs to be a reason to take them, a reason provided to the patient, and a proper notation in the patient chart (For more information on radiographs go to ADA.org). The dentist’s exam follows, with the diagnosis including identification of periodontal disease. A Phase 1 treatment plan featuring scaling and root planing can be presented, along with possible fees, and then (time permitting) one quad of scaling and root planing, or a debridement, or whatever is appropriate, can be performed. If the patient has a restorative problem as his/her primary concern, even if it is not as pressing as the perio condition, this might need to be considered first. Nothing is more disillusioning for new patients than to have their main concern pushed aside in favor of what the dentist wants to address.

If the hygienist meets the patient first, the dentist should come to the hygiene room for a preliminary exam and the ordering of radiographs, but then may delegate to her the responsibility of identifying and explaining periodontal conditions and treatment as necessary. This should not be rushed, or the patient may become distrustful. Ample time must be provided to show the patient's photographs, perio charting, and provide other educational materials. The dentist and hygienist need to be on the same page about how the appointment needs to proceed.

The “Recall” Patient
When a patient of record develops periodontal disease, explanations are even more critical. A patient may ask how this might have happened when s/he has been coming for “cleanings” for years. One way to approach this is to use a comparison with a discovery of high blood pressure. A person may have had a healthy blood pressure all their life during regular exams, only to receive a less than healthy reading at their last check-up. A patient will likely understand that health is not static, but can change over time. Therefore, dental health is changeable as well. Just because someone has not had periodontal disease in the past does not mean that it will never happen. The hygienist might say:

“Periodontal disease is common, but does not always have distinct symptoms. It is an infection and inflammation of the gums, bone, ligaments, and root surfaces of the teeth. It is our job to be on the look-out for the condition, which is why we always examine your gums every time you come in. Here are the probing depths from the last two times you were here, and here are the probing depths today. Remember when I explained that 1-3mm with no bleeding is healthy? Today we see that you have several areas with 4mm and bleeding and several areas with 5mm and bleeding. We know that it is not appropriate to let these areas go. That is why we will need to do scaling and root planing of these inflamed sections, and then put you on a more frequent schedule of maintenance to keep the disease process under control.”

The next question is often: “Will my insurance pay for this?” A good response is: “Many plans cover this treatment, but may have limits on frequency. Most plans realize that periodontal treatment is a common need, so they are careful to restrict how often they will cover it. Let’s talk with Amy, our treatment coordinator, and see what your plan says. Even if your plan limits payments, it is important that we let you know what you really need. It is our job to try and keep you healthy - it is the insurance plan’s job to watch their bottom line.”

When perio scaling, root planing and subsequent periodontal maintenance is performed, the patient must be able to perceive a definite difference between these therapies and a standard “cleaning.” It goes without saying that the treatments are significantly different. Be sure your patients can see and understand these differences. Identification, education, and performance of periodontal therapy are important aspects of what hygienists do.

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 hygiene@mckenziemgmt.com.

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