Annette Ashley Linder, BS, RDH
Why do some hygiene departments produce more than others? After consulting with hundreds of dental teams throughout the country, here are some of the perio benchmarks in these clinically excellent and highly productive hygiene departments.
Treatment is offered based on the patient’s clinical requirements (including risk factors) rather than what the hygienist thinks the patient wants or what insurance will cover. There are no “Loss Leaders” or “Blue Light Specials” (low-fee prophys) to bring patients into the practice. Current research regarding periodontal health and systemic health mandate the need for ongoing periodontal evaluation, treatment, and maintenance. An estimated 75 percent of the adult population will, at some time, have some form of periodontal disease. Given this data, it is the norm to see the periodontal hygiene department generate from 30 to 40 percent of its services from periodontal procedures. Track this data each month with the computer reporting for procedures analysis (by provider) for Codes 4341, 4342, 4355, 4910, and 4381. If you come up short, meet with your hygiene team and discuss your current periodontal protocols. Make sure you are up-to-date on the following:
1) Site-specific treatment - Patients with isolated active periodontal disease (5 and 6 mm bleeding) receive appropriate periodontal mechanical and chemical therapies as needed. Code 4342 is used when one to three teeth are involved as described in CDT 4/5. Code 4341 is utilized for quadrants (four or more teeth). Some offices report success when they attach a perio chart and an intraoral photo of bleeding, swollen, pus-oozing gums and radiographs. Periodontal scaling and root planing is not a once-in-a-lifetime procedure. Many insurance companies reimburse for Code 4341, if necessary, after 36 months have elapsed.
2) Chemical antimicrobial agents - Localized delivery of antimicrobials and antibiotics such as Arestinand Perio Chipare placed when tissue healing does not occur. The code for this is 4381, and it is always adjunctive to scaling and root planing. The progressive, state-of-the-art hygiene department stays current on research and new technologies, including anti-infective agents.
3) Treatment-plan for the generalized gingivitis patient - When a patient presents with inflamed tissue, generalized bleeding, plaque and calculus wall-to-wall, but no pocket depth or bone loss, the patient requires more than a routine prophylaxis. The dentist and periodontal hygienist have clearly defined protocols for treating this patient. Rather than running the risk (“waiting and watching”) that the patient will progress to periodontitis, an early interventive treatment protocol is presented. This includes a full-mouth, ultrasonic debridement with medicament followed by a second appointment to assure healing and elimination of the inflammation. The second appointment includes an examination and fine scaling and polishing. The patient is placed on a closer (not six-month) interval of care. Typically, the hygienist will see the patient every three to four months to assure health and stability. The interval of care for all patients should be determined by the clinical requirements and risk factors the patient presents and not by what insurance will pay for.
Proper utilization of Supportive Periodontal Maintenance Code 4910, used following active therapy (Code 4341) is also very important. It is not used for three-month prophy recare patients. A full-mouth periodontal examination is performed and any active sites are retreated. Many offices struggle with patient compliance (“insurance won’t pay”) regarding maintenance. This is why it is so important to have perio patients accept treatment because they want to be healthy and not because you badgered them into treatment. Success occurs when the hygienist educates the patient at each appointment during periodontal therapy, so that by the end of the treatment regime, the patient knows as much about the disease process as the dental professional.
Annette Ashley Linder, BS, RDH, is a recognized leader in the field and an award-winning speaker and consultant. 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.