Dismiss or Not to Dismiss - That is the Question
To quote myself in my last article: “It is recognized that I am treading on philosophical territory.” I was correct, as I welcomed the reception of emails from our readers expressing their concerns about my “treading.” I recognize that my article was not intended for all dentists and hygienists. Many of you do have a very structured, organized and well-thought-out approach to manage your periodontal patients and I thank you for that. At the same time, there are others that need some assistance.
Supervised Neglect and Periodontal Disease
One e-mail I received expressed concern about supervised neglect in the profession. I am also concerned and at the same time, do not feel that any dentist or hygienist intentionally treats a patient with the thought that they are “neglecting” that patient. Dentists and hygienists are in the profession to treat patients, not neglect them. I have never witnessed a dentist in my career that intentionally neglected his patients or watched his hygienists neglect theirs.
Here is what I do see:
Would you consider this “supervised neglect?”
Importance of Having a Periodontal Diagnosis and Treatment Plan in Place
Here is what I see
I also see no clinical notes in the patient’s record indicating whether the patient has Type I, II, III or IV. In some offices, I see no periodontal screenings or charting, even though a D0150 for a Comprehensive Exam was billed. According to the ADA, the D0150 includes periodontal screening and/or charting.
Take the time to sit down with your hygienists to map out your “plan of attack” and write down guidelines to follow so there are no grey areas. Write clinical scripts to include in the patients’ clinical records that are thorough and complete, indicating the patients’ periodontal health.
Hygienists - It is NOT your fault!
It is your responsibility to educate them, after your dentist has made the diagnosis, as well as educate them on how they can help to prevent periodontal disease. At the same time, there are situations that are beyond even the patient’s control that can lead to periodontal disease. With education and cooperation, you can help them.
The Dentist’s Fear of Rejection
Informing the patient that they have periodontal disease is even more difficult when there are no indications in the patient’s clinical record that it has ever been discussed and there has been no periodontal charting or screening. “My other dentist never told me that I had gum disease!”
If you feel that you can “turn them around” and become compliant with additional education, then do that - making sure that you have documented, documented, documented. Does that still protect you - I don’t know. However, your other option is to dismiss your patient. It is your decision.
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