The connection between periodontal treatment and higher practice production

Over the past 40 years, I have analyzed many methods to increase practice production. In my research, I learned that some of the most effective production strategies are not based in new breakthroughs and innovative advancements; some of the best (and basic) production strategies have been available in dental practices for decades. Let's explore how one of those "basics"-the treatment of periodontal disease-can make a tremendous positive impact on overall practice performance while simultaneously enhancing clinical excellence and patient outcomes. Mistakes regarding periodontal disease

Periodontal disease is an epidemic-and it could be as simple as one infected tooth or pervading the entire mouth. So why hasn't periodontal disease treatment been more abundant?

1. Periodontal disease is not diagnosed more frequently because it is typically not painful until the later stages. There are patients who are losing gingiva and bone but do not experience discomfort, so they do not complain to their dentist. Even bleeding when brushing is not a worrisome sign to many people. Therefore, increased diagnosis of periodontal disease will not be driven by patients. They do not recognize that they have a problem.

2. In most practices, the identification of periodontal disease is a codiagnosis between the doctor and the hygienist. Dental hygienists are highly trained to diagnose periodontal disease. However, time constraints often prevent the hygienist from performing annual periodontal probing. Additionally, patients are not specifically asking about periodontal disease, which means that hygienists and dentists are not compelled to address a patient's question or complaint about a periodontal problem. There is a general lack of patient curiosity or awareness relative to periodontal disease.

3. Periodontal disease is not high on the priority treatment list for many practices. Despite being so widespread, it is still not viewed as a focus area for continual improvement relative to practice performance.

Periodontal disease and practice production

I would estimate that many existing patients in general practices are candidates for periodontal therapy, and that new patients are even more likely to require some type of periodontal or gingival treatment. Given this, we can immediately understand the potential impact that treating even a small percentage of those patients would have on practice production. The first step toward increasing production (and improving the periodontal health of your patients) is to probe every patient at least once annually. Each practice can determine the pocket depth guidelines for recommending treatment, but for many patients, their entire mouths need attention.

Full-mouth scaling and root planing as part of initial therapy provides higher levels of production (and reimbursements for patients with dental insurance) than a standard prophy. This is also in the patient's best interests. Hygienists can provide initial therapy over the course of four appointments. It is important to check the policies of the insurance carrier to ensure that all criteria are met to receive the appropriate reimbursements to which the practice is entitled.

Dentists and hygienists can increase production from periodontal treatment by working closely together in a "codiagnosis process" for periodontal disease. Since most patients do not know they have a disease, the news will come as a shock. Therefore, it is important that the hygienist and the dentist carefully explain the benefits of treating the disease before conditions worsen.

For example, explaining how scaling and root planing might eliminate the need for more complex procedures such as surgery, lost teeth, or expensive implants, would be very compelling to a patient.

Consider developing a script that focuses on the relationship between periodontal disease and overall medical health. Most patients are not aware that periodontal disease can increase the risk of heart disease, diabetes, respiratory infections, and neurological conditions such as Alzheimer's disease. Raising patient awareness about periodontal disease beyond the hygiene appointment will also help increase the total amount of periodontal treatment provided by the practice.

Levin Group recommends practices send out a monthly newsletter email containing a few paragraphs on periodontal disease, its signs, symptoms, and what patients might want to ask about during their next dental appointment. Remember that scheduling is critical. Allow your hygienists time to identify or diagnose periodontal disease along with everything else that is expected during a hygiene appointment. This may require elongating the current appointment time or simply becoming more sensitive to checking hygiene patients promptly and not making hygienists wait.

Other ancillary factors related to the treatment of periodontal disease can add to excellent patient care and increase practice production. Many patients will reject treatment when first told of their condition because they are not prepared to hear about it and need to process the information. It may take two, three, or more explanations of their periodontal condition, but it is worth it to persist. Not only will you be building production opportunities for the future but also helping patients to make the right decisions in their best interest for optimal health.

Summary

Treating periodontal disease can increase practice production considerably. It is one of those basic strategies that, for many practices, have lingered in the background but now need to be brought to the forefront and acted upon. And in an era of heightened competition and lower dental insurance reimbursements, it is more important than ever to identify top production strategies and implement them quickly. The key to success is to develop diagnosis protocols between the dentist and hygienist, excellent scripting, patient education, and ongoing periodontal diagnosis.

Editor's note: This article appeared in the July/August 2025 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.