12.24.10 Issue #459 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Nancy Caudill
Senior Consultant
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Dismiss or Not to Dismiss - That is the Question
By Nancy Caudill, Senior Consultant McKenzie Management

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
I am not an attorney, dentist or hygienist - but I am a consultant and I see 2-3 different practices a month. I have worked in the wonderful field of dentistry for over 30 years and have great respect and admiration for all that work in this field, especially the hygienists and doctors that are in the mouths every day.

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:

  • Long-time patients with periodontal disease that has never been addressed by the dentist.
  • Hygienists not having the support from the dentist to diagnose periodontal disease.
  • Hygienists not wanting to tell their long-time patients that they now have indications of periodontal disease because they feel “responsible” for their disease.
  • Young dentists not wanting to address periodontal concerns with a “new” patient in fear of being rejected or the patient not returning. This is especially true when the young dentist has purchased an existing practice where periodontal disease was never addressed.

Would you consider this “supervised neglect?”

Importance of Having a Periodontal Diagnosis and Treatment Plan in Place
It starts with communication between the dentist and the hygienist.  They MUST be on the same page. Dentists depend on their hygienists to “pre-assess” the patient’s periodontal condition, and in at least one state that I am aware of, the hygienist can “diagnose” periodontal disease.

Here is what I see
The dentist has no guidelines on when “periodontal disease” should be diagnosed. In other words, should the pockets be 4 or 5mm and how do you measure the pocket? Is there bleeding? Is there bone loss? What about pseudo-pockets? I am not here to make these determinations for you. What I am saying is that you must have a specific guideline that is followed by the dentist and the hygienists so everyone is on the same page. In some offices, even the hygienists are on different pages.

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!
When I speak with hygienists about their reluctance to talk with their long-time patients about their periodontal disease, they tell me that they feel “responsible” because they have been seeing those patients for years. Guess what? You only professionally clean their teeth 2-4 times a year, if you are lucky. They are cleaning their own teeth 361-363 days a year!

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
It is very difficult as a young dentist purchasing an existing practice to start treatment planning restorative needs, let alone periodontal disease. Without the opportunity to develop trust with patients, it is uncomfortable and difficult to tell the patient that the “old silver filling is leaking and needs to be replaced with a crown” because they don’t want to hear, “My other dentist never told me!”

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!”

Conduct a thorough periodontal evaluation, in conjunction with the guidelines that you and your hygienists establish together.  Make your diagnosis and turn the patient over to your competent hygienist to educate the patient about their disease. If you want to dismiss your patient because they elect NOT to accept the recommended treatment and you feel that you do not want to “just clean” their teeth, then dismiss them.

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.

If you would like more information on how McKenzie's Consulting Coaching Programs can help you IMPLEMENT proven strategies, email info@mckenziemgmt.com.

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