Prophylaxis Before or After Root Planing?
As hygienists, we have options of treating patients and are faced with decisions to do what is right for the patient but still get the production required to run a business.
“Jean, I saw a patient this morning who was perio involved. I did a full periodontal charting and found that he needed four quadrants of root planing. I spent a full appointment time with him, and I didn't feel it was fair to only gett paid for the periodic evaluation. My question is, what would have been a better way to approach this appointment?”
It would have been better to do the probings after you explained what probings are and what they mean to the patient, so the patient is able to co-diagnose and give the patient the cleaning he expected to have. While cleaning the patient’s teeth, explain to him why the cleaning is not enough and it is just a “band aid” until he is able to get in for the periodontal therapy treatment that is needed.
This is doing three things:
Many times, if the cleaning or service the patient originally anticipated having done is not done at that appointment, the patient may leave upset without anybody knowing differently. Thus, even if he understands and decides to have the periodontal therapy done he may go somewhere else.
The trust that was starting to be established the minute the appointment was made with the scheduling coordinator might have vanished. He expected a cleaning and should have received what he was scheduled for and in addition he would receive an education about his mouth and periodontal disease.
When it comes to doing the cleaning and then having the patient back the next day for root planning, most insurance companies usually pay for this. However, there will always be those insurance plans that the benefits are limited and they may not pay for it.
This is why, it is recommended that patients receive a written treatment plan by the financial coordinator and that the benefits are gone over with the patient and signed before treatment is started. Of course every treatment plan will have a notation that the amounts are estimated and that it is the patient’s responsibility to know their insurance benefits. This notation should also state that the patient is ultimately responsible for all cost accrued.
Now, the patient should have been given a treatment plan for four quadrants of root planing if that is what is needed and a periodontal maintenance in three months. There would not be the additional cleaning 2-4 weeks after the root planing because that was done before the root planning. Many offices see treatment plans like this on a regular basis because the new patient is scheduled into hygiene for a cleaning and more advanced therapy is needed.
In some offices, the patient sees the doctor prior to seeing the hygienist. An option for the treatment plan would be to do the four quadrants of root planing, a prophylaxis in 2-4 weeks, and then a periodontal maintenance three months after the prophylaxis.
Having a prophylaxis after the root planing in 2-4 weeks provides even higher quality of care for the patient. The hygienist will be able to concentrate all of her time during the root planing appointments on the 1-3 teeth or the four or more teeth that require root planing. Then at the prophylaxis appointment, the hygienist will now clean all of the healthy areas and polish if needed. If the patient has been on any antibacterial rinses that may have stained their teeth they will really appreciate being polished.
This appointment may also be used to determine the need for additional chemotherapeutic agents and placement of them where needed. If there is an area that has not quite responded the way it was anticipated, the hygienist may also want to retreat that area before placing a chemotherapeutic agent.
This is also a great time to describe the difference between a periodontal maintenance appointment and a cleaning. Seeing how a periodontal maintenance appointment falls between a cleaning and root planing and may be the next appointment they will have with the hygiene department.
Of course there is not one set treatment for all patients because all of our patients need to be treatment planned based on their individual needs. However, with the information provided this is one way that this patient may have been approached differently in order to be the most profitable for the office and beneficial for the patient.
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