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5 Ways to Build a Strong Periodontal Therapy Program
By Dru Halverson, RDH, BS
Developing this portion of the hygiene department, a strong periodontal therapy program, will give your practice three things:
  • Increase in case acceptance of restorative and esthetic treatment
  • Increase in production
  • Best of all, it will allow each patient to achieve the healthiest mouth possible
Research tells us that at least 80% of the adult population has some form of periodontal disease. Unfortunately, only 10% are being treated in the general practice today. There is a tremendous need to rectify and heal the oral health of the average American. Additionally, since 1985, research and the American Academy of Periodontology have shown that periodontal disease is:
  • Episodic in nature
  • Site specific
  • When treated early, has the best chance of reversal back to health, and the general dentist has the “early” opportunity
Let's look at five ways to develop the periodontal aspect of the hygiene department in the dental practice to make certain that periodontal disease is diagnosed, that treatment is accepted and performed, and that payment is received for that treatment.
#1 Work Toward the Same Vision
A dentist takes a big step hiring a dental hygienist. The dentist must look at better use of his or her time by delegating responsibilities to the hygienist. Be consistent and leave the hygiene procedures to the hygienist, and the higher production procedures to the dentist.  This will not be accomplished if a close relationship has not been built and a clear vision has not been chosen.
Together, build a program that will allow proper care of the patients. If the dentist feels confident about the hygienist's techniques, that dentist will be more willing to relinquish the hygiene procedures. Make certain that the hygiene team is dedicated to the practice and the patients. Include the hygiene team in the team meetings and continuing education courses.
#2 Diagnose Periodontal Disease Properly
The new guidelines that have been set are an excellent reason to update your periodontal program. Every patient, existing or new, must be thoroughly evaluated, classified, and informed. We are now responsible for informing the patient of their current periodontal health status and diagnosing the infection at any stage. Finally, we must recommend treatment for the infection, which can scaling, root planning, and curettaging all of the toxins from the infected sites, or referring the patient to a specialist.
The clinical criteria for classification are:
  • Probe readings or pocket depth
  • Bleeding upon probing and suppuration upon probing
  • These require the use of a periodontal probe. There are many different types on the market, and I am sure one of them will be just right for your practice. Remember, an effective probe is one that is actually used!
  • Severity of the bleeding
  • Furcation involvement
  • Recession from the CEJ
  • Mobility
  • Bone loss (recession + pocket depth)
  • Attachment loss
  • Mucogingival health
In addition, we must monitor and inform the patient of improvement or regression. Rediagnosing at each appointment is a must. Time must be allowed in each hygiene appointment for this to happen. If the hygienist is rushed, then the probing will be done poorly, improperly, or not at all.
Finally, take the radiographs that show the crestal bone and lamina dura. Probing is the primary diagnostic tool that is available to all clinicians. Radiographs are a close second. It is important to be able to refer to diagnostic radiographs throughout the treatment, including the initial diagnosis, the series of active therapy appointments, and the maintenance appointments.
#3 Communicate Effectively
In the dental profession, we are always striving to improve our communication skills. We want our patients to be happy, both during and after each appointment, and healthy throughout their lifetime. To accomplish this, we must communicate in terms that will enhance the conversation. Patients need to understand the need for treatment and want to come in for each and every necessary appointment.
Communication gurus tell us that 80% of communication is through body language, facial expressions, and tone of voice, and 20% is through the actual words that are said. It is very important for clinicians to use effective body language and facial expressions.
There are a few basic things to remember:
  • When the patient is in the dental chair, raise them to at least a 45-degree angle. If the patient is lying back, they are not in control and will have a difficult time listening to you when they do not feel that they are in control of the situation. Sit the patient up when you are able for more effective communication.
  • Get the patient eye-to-eye, knee-to-knee. In the clinical area, so many dental professionals talk to their patients from the “mystery zone”: Talking from somewhere behind the chair as they are mixing up materials or completing the paperwork. The patient will be trying to find you to get focused on what you are trying to communicate. By the time they do, you will have said what is important. Make certain that you are positioned in front of the patient and adjust the height of the chair to get eye level. This will allow you both to be in a comfortable, win-win situation for great communication. This body position holds true when the patient is outside the clinical area as well, such collecting money for services rendered, scheduling appointments, and reviewing treatment and financial responsibilities for needed treatment at a consultation.
  • Take off the mask and the glasses or visor. If the patient cannot see your mouth as you are talking, then the patient will not be able to focus in on what you are attempting to convey.
Also, at the end of each hygiene appointment, give written communication in the form of professional brochures and home-care instructions that are developed for your practice. Make certain that the information is placed together in a sack or bag.
Even though non-verbal communication is so important, that does not mean that we don’t have to worry about the words that we speak. For us in the dental field, it is a constant battle to educate the patients and to clear roadblocks due to words and phrases that have negative connotations. This list below will give you some words that dental professionals need to veer away from and the words that we must attempt to adopt in our everyday communication with patients:
  • Say “evaluation” instead of “examination” or “exam”
  • Say “continuous care” or “professional cleaning” instead of “cleaning,” “prophy,” or “prophylaxis”
  • Say “treatment room” instead of “operatory”
  • Say “reception area” instead of “waiting room”
  • Say “embedded toxins” instead of “calculus” and “tartar”
  • Say “bleeding” instead of “hemorrhage”
  • Say “pus” instead of “purulent exudate” or “suppuration”
  • Say “infection” and “disease” instead of “just a little puffiness and redness”
  • Say “necessary radiographs” instead of “X-rays”
  • Say “active periodontal therapy” instead of “scaling” and “root planing”
When reviewing treatment, or when financial arrangements are being made for any type of treatment plan, a private consultation room is a great benefit. Some patients will need more time to ask questions concerning the treatment that is being recommended for them. Some patients prefer to have a support person with them prior to saying “yes” to a treatment plan. Some patients will need extensive financial arrangements. This will also take time, as well as a dental team member who is comfortable reviewing the patient's responsibility financially. Use the consultation areas as much as possible to achieve maximum case acceptance.
#4 Use the Correct Terminology for Treatment Performed
Many practices provide nonsurgical periodontal therapy and call these procedures "adult prophys." Do not short change yourself. You are providing care that will help a patient move from a diseased state to a healthy state. Call the treatment what it is and schedule the necessary number of appointments, charging the appropriate fee. The treatment for patients with periodontal disease is entirely different than for the patients who are healthy and coming in for preventive appointments.
#5 Set Production Goals for the Hygienists
Quite a few doctors have told me they know they need a hygiene department, but they feel the department costs more than it earns for the practice. Expenses for salaries, equipment, and supplies are high enough for these doctors to consider doing the hygiene themselves. That's a big mistake in my book. Doctors should not move from restorative dentistry to hygiene just to make the hygiene department profitable.
At the same time, I see many hygiene practices that may be good but not profitable. The department's challenge is to help patients get and maintain healthy mouths and to generate a healthy profit margin for the practice.
The hygienist should be producing at least three times their salary. The schedule should be pre-blocked for approximately half of the production goal. Those "pre-blocks" should be held for primary procedures. Pre-block the hygienist for at least six months or preferably one year if you are advance. Primary procedures for a hygienist include any periodontal appointments, sealants, and appointments that include a full-mouth series of radiographs or a panoramic radiograph.
In conclusion, spend the time and money necessary to become current with the latest in nonsurgical periodontal therapy. If you let your hygienist maximize the incredible talent and expertise that he/she has developed, your patients will benefit by becoming and staying healthier than ever before.
About the Author:
Dru Halverson, RDH, BS, graduated with honors from Oklahoma University College of Dentistry, Hygiene Department, in 1985. She also has received a bachelor's degree in Community Health Education from Oklahoma State University. Currently, she practices part-time in Dr. John Jameson's dental practice and is senior consultant and director of consulting for Jameson Management Inc. Dru can be reached at (580) 369-5555 or at jameson@brightok.net.