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  07.15.05 Issue #175

Prophylaxis Based Hygiene---A Thing Of The Past

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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So, you are still just cleaning teeth. I am sorry to hear that. Is that because of insurance limitations? Is it because of undeveloped verbal skills and the working knowledge on how to convert your patients? With so much technology out there and so many different approaches to fighting periodontal disease I would hope you had fallen off of that bandwagon.

Where the problem comes in is if the insurance, patient, or operator limits the quality of care you can provide because of the payment that is expected. I am sure there are many of you that have patients you would love to charge more because of the poor quality of homecare they perform. However, because of insurance benefits, you think you are forced to keep them as a prophylaxis. Should they still get the benefit of a more expensive treatment at a lesser cost? You should be asking yourself, is this fair when it comes to the dental office? Is the insurance company, and the patient limiting the money dental offices should be making? Is it the dental office limiting the money the dental office should be making? Who is the health care provider, the insurance company, the patient, or the person performing the task, and diagnosing the treatment?

Now, the sad thing is most patients, no matter of financial wealth, will only do what the insurance covers even though they say they value their oral health. I will use a periodontal maintenance appointment as my example. This procedure is for patients who have completed periodontal therapy and includes removal of the bacterial flora from crevicular and pocket areas, scaling, and ultrasonic scaling with antimicrobial agent, of the pocket area and teeth, periodontal probing, and a review of the patient's plaque control efficiency. This appointment should cost more than a prophylaxis. A periodontal maintenance appointment is typically at an interval of three months. Unfortunately, some insurance companies will only pay for two prophylaxes in a calendar year. Therefore, a lot of patients will only have two appointments per year when they need four. Again, you have to ask yourself why should you work twice as hard on somebody that will only come in two times a year? Why should these people get more for less? The major question is, are you really even helping them by only doing the partial treatment they allow you to do because of insurance limitations?

What you may not know is that some insurance companies actually pay for four periodontal maintenance appointments in a calendar year. Where they will only pay for two prophylaxes a year. Some will alternate between a prophylaxis and a periodontal maintenance appointment. Now, you just need to convert all of those “prophylaxis patients” that should be receiving periodontal maintenance appointments into periodontal therapy patients.

This is done by taking the time to diagnose the treatment needed, treatment planning it, and educating the patient about periodontal disease. Good communication skills are very important. The verbiage used alone may make the difference of the patient accepting treatment or declining treatment. The patients value system and the way they think about insurance benefits will need to be changed.

Americans have become so accustomed to thinking they must have insurance coverage to have dental work done. This way of thinking is actually limiting the quality of care health care providers are able to provide. However, it is not only the insurance companies fault. The patient and operator are also responsible for the way they think about the use of dental insurance. This mode of thinking needs to be changed within the office staff, the patient, and the doctor.

It is a nice convenience that people have healthcare benefits in order to help with the cost. However, patients and dental offices need to look at dental insurance as a coupon in a grocery store . The insurance is there to help cover expenses. It is not provided to dictate the care needed or the quality of care the patient deserves.

If your hygiene department is a prophylaxis-based production wanting to become a periodontal therapy based production, we can help you with skills to enable you to be comfortable with converting your patients. Not only will you be providing quality of care, but you will be getting paid for the quality of care you provide.

Jean conducts 2 day Hygiene Performance Enrichment Programs for The Center for Dental Career Development and McKenzie Management in La Jolla/San Diego, CA. Contact her at or call 1-877-777-6151 for more information on her Advanced Hygiene Training Programs.

Interested in having Jean speak to your dental group? Email us at or call 1-877-777-6151

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