Annette Ashley Linder, BS, RDH
The hygienist was waiting for me when I arrived at my lecture room. "I signed up for your course today," she said, "because I am having big problems, and I hope you have some answers! I've been practicing dental hygiene for 10 years in the same dental practice. I love my doctor, I love my patients, and I love my work ... for the most part. But I am feeling very frustrated with my patients who continually present with bleeding pockets. Many of them will not even listen to my recommendations to come in every three months. The doctor and I are worried about overwhelming the patient with our recommendations. Many of these patients have been coming to the practice for years. "
These valid concerns are among the most frequently asked questions at lectures or when I am consulting with a dental practice. How do you get the patient to willingly enroll in perio treatment and continue with maintenance appointments?
Many dentists and hygienists are frustrated with the lack of patient motivation regarding their periodontal health. In some cases, clinicians become so tired of dealing with unresponsive patients that they scale back their communications about the significance of periodontal disease. Yet, numerous research reports suggest potential links between periodontal health and systemic health. Periodontal disease has been implicated as a risk factor in a number of systemic disorders, including cardiovascular disease, stroke, low birth-weight babies and diabetes.
It's a no-win situation when patients feel "forced" into perio treatment. A successful (initial stage) periodontal outcome and ongoing periodontal stability is very much dependent on patient participation. What patients do when they leave the dental chair is equally as important as what occurs during professional therapy appointments. Patients who are nagged into treatment frequently do not maintain optimum home care or professional care visits. These patients continue to complain about the three-month visit "not being reimbursed by insurance." Often, they slide back into a six- month interval of return care because that's what their insurance pays for, clinically placing them at increased risk for recurring active infection.
Here is a solution that I recommend because it works to increase positive patient involvement. In this approach, the patient becomes a co-diagnostician and co-therapist. Prior to beginning the periodontal examination, the hygienist invites the patient to participate. The dialogue may go something like:" Mrs. Smith, at each of your preventive dental-care appointments, we perform several very important oral-health examinations, including an oral cancer screening and an examination to check your periodontal health. We want to be sure that there are no early warning signs of gum disease. I find that patients really appreciate understanding exactly what we are doing, and so I would like to invite you to do this examination with me." At this point, if applicable, provide a brief mention/discussion of any mediating factors (such as existing health problems or smoking) that may place a patient at risk for periodontal infection.
I might continue the conversation with, "As we discussed at your last visit, healthy gum tissues do not bleed, so we would expect not to see any bleeding. I will be calling out a series of numbers as I measure the bone level and the space between the gum tissue and tooth surface. Numbers greater than three may be an indicator of bacteria invading the bone that holds the tooth in place." At the completion of the perio exam, review your findings with the patient, allowing him or her to see the results.
A new insurance code, 0180, defines this process in the January 2003 CDT-4. The definition of this code is worded as follows: "Comprehensive periodontal examination, new or established patient — This procedure is indicated for patients showing signs and symptoms of periodontal disease and for patients with risk factors such as smoking or diabetes. It includes: evaluation of periodontal conditions, probing and charting, evaluation and recording of the patient's medical and dental history, and a general health assessment."
In my last column, I discussed the importance of keeping patients updated about the latest information on systemic health, chronic infection, and oral health. Utilizing a patient participation, co-examination, and co-discovery model is a positive way to overcome the challenge of patient acceptance for necessary treatment.
Annette Ashley Linder, BS, RDH, is a recognized leader in the field and an award-winning speaker and consultant. Since 1989, she has presented more than 250 seminars and consulted in dental practices throughout the world. She is a featured speaker at dental meetings and provides in--office consulting services with her team of business and clinical consultants. She may be reached at her Web site at AnnetteLinder.com, via email at Annette@annettelinder.com, or by phone at (804) 745-6015.