1.29.10 Issue #412 Forward This Newsletter To A Colleague

Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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Perceptions of The Periodontal Maintenance Patient

Converting existing patients that have been on a three month recall and have been billed out as a prophylaxis instead of the periodontal maintenance patient that they should be, is not an overnight fix. This will take some time and effort on the entire practice. Becoming a periodontal focused practice is a team effort. Let’s take a look at two different patient scenarios that will be basically treatment planned the same way.

The first patient has been coming in for years as a three-month prophylaxis recall patient, and has had root planing in the past. When the hygienist does six point probings, there is 4 and 5 millimeter pocketing, with bleeding upon probing in the upper right and upper left quadrants in four or more areas.

The second patient has also been coming in for years as a three-month prophylaxis recall patient and has had root planing in the past. However, this patient does not have any bleeding upon probing. He does have four and five millimeter pocketing in the upper right and upper left quadrant. The measurements have not changed at all over the years, however, there is no sign of the patients health improving. During instrumentation the patient has heavy hemorrhaging in both the upper right and upper left quadrant. We all know that healthy gingiva doesn’t bleed.

Both patients have been referred to the periodontist and refuse to go. They are aware of all the risks, benefits and alternatives and have decided that they would like to approach their periodontal disease treatment in a non-surgical approach. The hygienist has treatment planned two quadrants of root planing at this time.

The treatment plan should be given to the front office and the three-month periodontal maintenance appointment should be included in the treatment plan. This way, the patient is aware they are no longer going to be receiving a prophylaxis, and will be billed at a higher amount at future appointments. They will be made aware of the difference between a periodontal maintenance appointment and a prophylaxis. This should be explained to the patient not only in the hygienist’s chair, but the person going over the treatment plan and the financials should explain the difference to the patient also.

Here is the clincher. With an existing patient, you and the entire staff can explain and educate the patient verbally as much as you want, but unless the patient perceives something different being done at the periodontal maintenance appointment, you are still going to end up with patients on the phone complaining and mad at the front office, hygienist, and the doctor. This may cause a lot of patients to seek treatment elsewhere.

The important goals are to keep our patients happy and healthy, provide quality of care, and be paid the appropriate amount for the services rendered. We as dental professionals know the difference when it comes to the amount of work a periodontal maintenance requires compared to a prophylaxis. The sad thing is that you have been doing the work, and not getting compensated fairly by the amount paid by the patient or insurances, mainly because of misuse of codes to procedures actually being performed. 

Again, the patient doesn’t want to hear it - they want to feel a difference at all future appointments. Here are some ways to accomplish this:

  • Concentrate on most infected areas first.
  • Use an ultrasonic scaler in deeper pockets, diamond files.
  • Offer intra pocket placement of an antibiotic for sustained and slow drug release. (additional charge)
  • Start in the deeper pockets first with the ultrasonic scaler and then go back and hand scale the entire mouth, even the areas you used the ultrasonic scaler on.
  • Use chlorhexidine in the ultrasonic scaler or irrigation after the hand scaling with chlorhexidine.
  • Anesthetize site-specific areas.
  • You may or may not want to polish irrigate site specific areas with the product of your choice
  • Offer root desensitization (extra charge)

Many patients will not only feel something additional is being done, but the health of the mouth will actually start to improve. Of course, patient compliance has a lot to do with the overall health changes. When these patients are communicating with the office to make their next appointment with the hygienist, everybody needs to call the appointment by the correct name: Periodontal Maintenance. And remember, the office deserves to be paid for the work being done.

Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

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