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5.26.06 Issue #220

The Referred Patient...Has Undiagnosed Treatment

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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When a new patient comes into your office and is identified as having a dental problem, the patient may have doubts about the validity of the diagnosis. Particularly, if the patient has been going to another dentist regularly for a long time and nothing has been mentioned in the past.
Therefore, you want to be prepared when that patient sits in your chair for the first time. It is recommended that the provider look at the current x-rays that were sent to your office prior to the patient’s appointment. This will allow the provider to note any areas of concern before that patient even sits in her/his chair. When the patient is in the chair, the health care provider will do a visual exam and probe the entire mouth in order to determine periodontal health. Make sure to explain the probings, and periodontal disease to the patient before you start. This will allow the patient to co-diagnose their disease status. It is also best if you ask the patient an open-ended question before you actually start probing, “Mr. Jones, What questions do you have before I begin?”   

The operator has finished probing and the patient now has:

  • Pocketing in all four quadrants
  • Bleeding upon probing 
  • Taking medications for diabetes and heart disease
  • The x-rays show bone loss
  • The tissue is red and inflamed

This patient really needs to be root planed. What do you do? This patient has never been told they have periodontal disease by their former doctor, and the patient thinks they are only in need for a cleaning. Or, let’s say the patient was diagnosed with periodontal disease years ago and had root planing, but has not been told recently that their disease has progressed further. You don’t want to loose their trust immediately, and ethically you cannot slight the other doctor. Here is a sample of what the doctor may say to the patient. “Mr. Jones, now that I have been able to examine your mouth along with the x-rays that Dr. Black’s office provided to us. I am observing a lot of infection in the gums. I am seeing that you have active periodontal disease and will need further treatment. We want to get your gums in good health. To accomplish this in a conservative manner, we would use a non-surgical approach. The interceptive therapy will take approximately four visits, at no more than a week to ten days between appointments.  It is best to start with root planing, and then we will evaluate your gums again to determine if even further treatment is needed by a Periodontist.”

This is the perfect time to allow for silence. There are many times that a patient may be encouraged to talk and by providing silence this gives them that perfect time. Working with silence is a talent that takes time to acquire. The provider must learn when to talk and when to allow the patient time to gather their thoughts and wait for an answer. Being patient lets the patient know that what they have to say or question is important.

What if the patient replies “Did this just happen since my last cleaning? I have been having my teeth cleaned every three months, why do I need periodontal treatment now? Why didn’t my old dentist tell me about this?” The provider may then reply, “I cannot answer for Dr. Black, but as you can see from our examination there are pockets present today that are not normal in a healthy mouth. The advancement in periodontal diagnosis and treatment in the last few years enables us to treat this disease earlier and with less surgery. Fortunately, we discovered the gum disease and we may possibly be able to improve your condition without surgery. By having your teeth cleaned every three months at Dr. Black’s office they were trying to prevent the progression of the pockets in your mouth. We will be using a method that may reduce the pockets without surgery. Not all pockets will totally improve with root planing treatment, but there is evidence that the procedure has great success! If you do not have any further questions, it’s best if we get started as soon as possible.”

At this time the Financial Coordinator will come in and go over the treatment plan and the cost to the patient. It is always nice when there is time in between the two appointments to go over financials with the patient. However, if there is not time in between, it is imperative that time be made at the chair. We all deserve to be paid for any services rendered. Going over financials before treatment is started will help with educating the patient on office protocol and policy. This may help increase patient acceptance, because they are more informed.

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2006 Location Sponsor Information Topic Speaker
June 8-9 Santa Barbara,CA The Art of Endodontics 800-528-1590 Max. Prod.

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July 20 Del Mar, CA Ortho Symposium 619-656-4646 Top Issues

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July 26 San Diego, CA San Diego Womens Dental 858-755-1590 Leadership

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Aug. 2-6 Denver, CO Academy of General Dentistry* 877-777-6151 Peak Per./Systems

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Aug 10-11 Santa Barbara, CA The Art of Endodontics 800-528-1590 Max. Prod.

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Sept. 29-30 Oviedo, Spain Clinica Sicilia 877-777-6151 Over/Top Issue

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Oct. 7-8 Krakow, Poland UNO Dental 877-777-6151 TBA

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Nov. 8 San Diego, CA San Diego Women's Dental 858-755-9990 Top Issues

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Nov. 17 Concord, NH New Hampshire Dental Society 312-440-2908 Breakdown

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Dec. 7-8 Santa Barbara,CA The Art of Endodontics 800-528-1590 Max. Prod.

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* McKenzie Management will be exhibiting at this location

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