Beverly Maguire, RDH
Creating specific and organized systems for periodontal treatment will smooth the transition to a diagnosis-driven hygiene approach. The key systems should address probing and charting, case presentation, and scheduling and financing.
Systems help offices maintain consistency; they also create order from chaos. As we all know, knowledge alone is not enough to produce change. Knowledge must be put into action. A hectic day of clinical dentistry is challenge enough for most of us without the added stress of uncertainty and disorganization.
Periodontal charting is the heart of diagnosis-driven hygiene care, and provides the essential data needed to formulate a diagnosis. You must first decide what perio chart to use for documentation. You also need a place to document pockets, bleeding, recession, mobility, and furcations. (Check out the Perio Advocates' periodontal chart marketed by Omnii Oral Pharmaceuticals at (800) 445-3386.)
Once you have a good chart, the next issue is to record the data. This is a critical element. A hygienist can't chart the needed data alone; there is too much of it! Think OSHA, think time, think patient understanding, think proper diagnosis, and think getting paid for dispensing proper care! It's worth the time to resolve this issue. Technology offers a few options, but most offices still opt for the assistance of a staff member to accomplish the five to seven minute task. Creating a charting system involves choosing a chart, assigning staff to record numbers, training, determining frequency of charting, and agreeing upon the findings.
Next, create a system that allows your hygienist to report findings to both the doctor and the patient. Organized verbal feedback provides the doctor with quality information to formulate an accurate diagnosis and treatment plan. Patients can be categorized as healthy, actively diseased, or periodontally stable. With a system for case presentation in place, doctors can be assured of the follow-up once they leave the room.
Treatment plans and referral parameters should be established prior to the hygiene appointment. An organized presentation of perio findings that is supported with good scientific data leads to patient confidence in the hygiene protocol, and, ultimately, to case acceptance.
The final area to systemize is that of scheduling and financial arrangements. Appointments should be preblocked to ensure timely treatment. Appointments should be blocked each day for both perio therapy and perio maintenance. New research on full-mouth disinfection points to the value of treating nonsurgical cases within a 24 hours vs. a series of appointments over six to eight weeks. Many patients now prefer to visit the office fewer times to minimize travel and time away from work. These issues should be discussed and planned for within your office protocol. Half-hour re-evaluation appointments are critical for case management. Timely referral to the periodontist is our responsibility and will occur mainly through consistent evaluation and re-evaluation of periodontal data.
Financial arrangements become important when patients are facing a $1,000-plus periodontal treatment plan vs. their familiar and insurance-covered prophy. Being prepared to communicate the long-term value of treatment, as well as offering payment options such as credit cards, Care Credit, Dental Fee Plan & HELPcard, will ensure success with financial issues.
Once you empower your team with the systems needed to implement periodontal protocols, the transition to diagnosis-driven hygiene services will flow seamlessly. You can then relax into the day, assured that patients will be properly assessed, diagnosed, and treated according to their periodontal needs. Set yourself up to succeed!
Beverly Maguire, RDH, is a practicing dental hygienist. She is president and founder of Perio Advocates, a hygiene consulting company based in Littleton, Colo. She can be reached at (303) 730-8529 or by email at PerioAdvocates@aol.com.