This entire series of articles started with asking if, “Is it possible you have undiagnosed treatment in your existing patients charts, because you do not have a ‘written’ interceptive periodontal therapy protocol established for your hygiene department?”
We have briefly gone over how to establish an interceptive periodontal therapy protocol, and how to introduce it to new and existing patients. We have also mentioned that a protocol of when to refer to the periodontist, and when to treat in your own office would need to be established.
Now we are actually chair side and have to apply all of this information when treating our patients. We have reviewed our patient records at the morning meeting and are aware that Mr. Jones had root planing two years ago, has had adequate plaque control in the past, has been referred to the periodontist every time he enters the office, and has not gone. He has been coming in every three months for his periodontal maintenance appointment. The gingival tissue is still inflamed, pockets have not reduced, and there is lack of stability of clinical attachment. You are aware of all of this before the patient even sits in the chair because of the progress notes, and the multiple letters sent to the periodontist referring the patient out.
Now what? Upon arrival you greet the patient, seat them in your chair, make them comfortable, review their medical and dental history, take any necessary x-rays, (preferably periapicals or vertical bite wings) review past or current x-rays, complete an intraoral and extraoral soft tissue examination, including six point periodontal probing, and note all of this information in the patient’s record. Now, you may want to sit the patient up and explain to them the current status of their mouth. Confirm the need to go see the periodontist and make a notation in the chart if they tell you they will not go to a gum specialist. At this time you may want to recommend to the patient, “Mr. Jones, we have been attempting to control your periodontal disease for the last two years by having you come in every three months for a periodontal maintenance appointment, this has been found to be effective in maintaining gingival health. However, you have not obtained the desired outcome of periodontal therapy, you have refused to go to the periodontist, which is the optimal treatment you need at this time. Therefore we need to look at alternative treatment. I must inform you that this is only a limited therapeutic program, and that the outcome with limited treatment may be less favorable. At this time if you are still unwilling to have surgical treatment then non-surgical treatment is another consideration. This will not be as effective as surgical but it has been shown to slow the disease progression. I recommend we go ahead and start root planing today. I will have Sandy, the financial coordinator, go over the financials portion with you.” This verbiage is designed that you may modify the above words and find the conversation that best suites you.
No matter what, treatment plan the recommended treatment and have the financial coordinator go over the financial options with the patient, and have the patient sign that they have been informed about their periodontal condition. If the patient refuses to do the treatment today go ahead and treatment plan the recommended treatment, have the patient sign that they have been informed about their periodontal condition and the recommended treatment, and go ahead with the periodontal maintenance. During the appointment reiterate the need for treatment and that they can start it tomorrow or within the next week. Remember you want to answer their questions and help to relieve them of their questions involving the need for the treatment, any fear, or financial concerns they may have.
Once treatment is complete if the desired outcome has not been reached you may want to re-refer the patient to the periodontist. If they refuse again, you may want to inform them at this time, “Mr. Jones, as you know we are still recommending that you go to see the periodontist. However, since you have refused to go we may want to look at doing the root planing on a regular interval in order to continue to slow down the disease process. This is not the optimum care, but it may help you to keep your teeth a little longer. There is no guarantee on how long that may be. In the mean time if you change your mind about seeing the periodontist here is a referral card to the periodontist we recommend.” As the clinician, make sure you write or note the referral in the patient’s record.
Once you start utilizing your new interceptive periodontal therapy protocol chair side you will be amazed at the amount of treatment that you will be recommending to your existing patients. Constant evaluation and reevaluation of periodontal disease is required on all patients.
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