7.12.13 Issue #592 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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New Patients in Hygiene
By Jean Gallienne, RDH BS

There are some patients who insist on scheduling an appointment for a cleaning, even though they are new to the practice. In some states, it is illegal for the hygienist to see the patient first, and the doctor has to do an exam in order to determine what the patient’s needs are. However, many offices will schedule the new patient in the hygiene chair first, because that is what the patient wants - a cleaning. I am not here to tell you if this is right or wrong. This article is to help you through some of the hurdles that hygienists may encounter when a new patient is scheduled in their operatory first.

“Mary” the hygienist seats “John” the patient and reviews his health history. Mary determines that according to the office protocol created by the doctor, the patient needs a full mouth series of x-rays. She takes the x-rays and sees visible calculus, or she glances at the x-rays and does not see visible calculus, but sees that the patient has vertical bone loss. This practice also has a protocol that every patient will have a 6-point probing done on every existing tooth, and recession will be entered into the chart as a baseline. Mary goes over probings with the patient.

“John, I am going to be doing a procedure on you today that is called probing. This is where I go around the gums and measure the level of the attachment of the gum to the tooth. Measurements of 1, 2 or 3 are all considered within normal limits. I would like it if you count all of the 4’s and above on your fingers as I am calling the measurements out. When you have 4’s and above, this usually indicates a more extensive and aggressive procedure than a cleaning, because you have gum disease.”

Reminding the patient to count all of the 4 millimeter and above probings on his fingers enables John to co-diagnose his periodontal disease. The probings are done, and Mary determines that the patient needs 4 quadrants of root planing. She now goes into even further description of root planing and what it involves with the patient. 

Up until now, the appointment has been all of the fact-finding and standard protocol that the office has put into policy. What happens next? The patient is expecting a cleaning and needs four quadrants of root planing. If the hygienist does not do the cleaning the patient is expecting, the patient may not return.

Financials need to be reviewed before the root planing is started. Some patients are compliant and will be ready to go ahead with the root planing immediately, and some patients will only want the cleaning they were told they would get. How this is handled is crucial, as it is a huge part of the trust relationship you are building with the patient. It becomes very important for the hygienist to read the non-verbal clues and communicate what is going on before mobbing forward. Once the financial coordinator has gone over the details, the hygienist will then be told if the patient is prepared to move forward. If the patient is not ready and is still asking about the cleaning they came in for, then the hygienist had better do the cleaning. This may involve doing all of the healthy teeth and leaving everything else that needs to be root planed for future appointments. This gives the hygienist time to talk to the patient some more about periodontal disease.

The patient may try to appoint again in six months without having the root planing done. If this happens, go ahead and make the appointment, and the hygienist can continue to educate the patient about periodontal disease and the need for more advanced treatment. To dismiss the patient immediately without having another time scheduled for further education would be a loss of a potentially good patient. However, at a certain point if the patient is non-compliant about everything you recommend doing, you may have to dismiss them from the practice. Sometimes this is a wake-up call to the patient, and they start getting work done. The doctor has to determine protocol for when it is appropriate to dismiss a patient, as it may be based on the individual patent and the patient’s needs.

It is important for the doctor and hygienist’s time to be as productive as possible. However, with some patients it is more productive to step back, pay attention to their wants and needs, and make sure treatment is presented in a non-confrontational, safe, and compassionate environment. It is always very important for the entire team to be tuned-in to what type of personality the patient has, and be observant of ALL non-verbal and verbal communication the patient shares. We want to keep the patients that walk in the front door and not chase them out the back door because of a hard sale attitude.

Interested in improving your hygiene department? Email hygiene@mckenziemgmt.com and ask us about our 1-Day Hygiene Training Program or call 877-777-6151

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