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2.10.06 Issue #205  

Prophylaxis to Periodontal Based Hygiene Department

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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One of the many questions I have been asked is how do we take our prophylaxis based hygiene department to a periodontal based hygiene department? Hopefully you have been reading the past articles on how to monitor and progress aggressively with the treatment of periodontal disease.

I was recently asked this question by a dental office. “What do we say to our REGULAR patients when we charge more for their periodontal recall appointments- these are the "true" perio patients that have been seen previously by a periodontist and now we are charging MORE for the "SAME" treatment they have been receiving previously. We need help/scripting regarding this problem ASAP...

Part of the curriculum of the Advanced Hygiene Performance Enrichment Program that is taught is not only what the hygienist tells the patient, but even more importantly what the patient perceives. Therefore, the hygienists may want to do something different at the periodontal maintenance appointment (4910) than they did at the continuing care appointment (1110). As dental professionals we are well aware of the difference in the amount of work required when performing the treatment on a periodontal patient versus a continuing care patient.

However, the patient is going to have a hard time accepting that the treatment they are receiving is any different than any other prophylaxis. “After all, it feels like the hygienist is doing the same thing he/she has always done.Why should I pay more than I did in the past? I just want a cleaning.”   First words of advice, eliminate the words cleaning and deep cleaning from the entire staff. Educate the patient with the terminology prophylaxis, continuing care appointment, periodontal maintenance appointment and root planing. This starts at the initial phone call and the entire life of the patient in your office.
Now the question is, “How can I change the patient’s perception when it comes to a periodontal maintenance appointment versus a prophylaxis?”

The easiest and most beneficial to the patient is to really evaluate all of the patient’s periodontal condition. If you were not doing this in the past, now is a good time to start, it is never too late. If there is still bleeding while scaling and you have been doing periodontal maintenance appointments and billing out for prophylaxis for the last two or three years you may want to treatment plan the patient for root planing, 4341 or 4342 depending on what they need. This may be the time to refer the patient to the periodontist. This is one of the many protocols that the Advanced Hygiene Performance Enrichment Program will help your office establish.
Once you have determined that four quadrants of root planing are required, make sure you have the financial coordinator go over the treatment plan and that the periodontal maintenance fee is included in the treatment plan.

This is also when the hygienist and the financial coordinator would explain to the patient about the four quadrants of root planing that are needed and make sure to explain to the patient that "You will have periodontal maintenance appointments until the health of your gums stabilizes. If you continue to improve and your condition stabilizes, we may be able to extend the amount of time between visits. However, if your periodontal disease should relapse, further periodontal therapy may be necessary. We will continually evaluate the health of your tissue. "  This verbiage is designed that you may modify the above words and find the conversation that best suits you.

When the existing patient returns for their first periodontal maintenance appointment something different will need to be done. Of course this would be determined by the needs of the patient after the clinician has determined what would benefit the patient most. Any of the following treatments may be incorporated in a periodontal maintenance appointment.

  • Removal of subgingival and supragingival plaque and calculus
  • Utilization of an ultrasonic or piezoelectric scaler
  • Starting in the deeper pockets first with hand scaling, an ultrasonic cleaner, or piezoelectric scaler.
  • The use of chlorehexidine in the ultrasonic cleaner
  • Anesthetizing site specific areas
  • Placement of chemotherapeutic agents (this is an additional charge)
  • May or may not polish
  • Irrigate site specific areas with the product of your choice
  • Root desensitization

These are just a few things that may be incorporated in the periodontal maintenance appointment. Remember, it is quality of care and what the patient perceives that is most important. The patient will want to feel and notice a difference in the treatment being provided.

For existing patients, this is the best way to go when it comes to converting the patient over from a routine prophylaxis to the periodontal maintenance appointment they should have been charged for all along. The hygienist will be surprised at how many patients will benefit from having root planing.

The entire staff has to be on the same page when it comes to converting all of the existing patients. It is difficult to just start billing the patients for a periodontal maintenance appointment when they have only been billed for a prophylaxis in the past without communication, protocol and a plan.

For more information on The Advanced Hygiene Performance Enrichment Program in La Jolla CA or YOUR OFFICE, email

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