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to Dental Practice Solutions

Welcome to dentistry’s largest dental hygiene practice management resource center! We are the leading dental hygiene consultant/coaching business.

We will increase your TOTAL dental practice profitability without working more hours or days each year.

- Debbie Seidel-Bittke, RDH, BS, Speaker, Author. Dental Hygiene Coach & Consultant

Dental Practice Solutions - Debbie Bittke

A Story of Thanksgiving

By: Debbie Seidel-Bittke, RDH, BS

November 25, 2013

CORNACOPIA

I wanted to share a story of Thanksgiving which I found quite touching. Living in Portland, Oregon, it is not atypical to see people standing on the streets with signs asking for food, money or even alcohol, but the story I am about to write is a bit different from any of these!

A blind boy stood in front of a building in downtown Portland, Oregon with a hat at the bottom of his feet. He held a sign that said “I am blind, please help.”

I only saw a few coins in his hat.

Next I saw a middle aged woman walk by. She took a couple of one dollar bills from her purse and dropped them into the hat. This woman then took the boys sign, turned it around, and wrote a few words. This woman gave the sign back to the boy with the new words on it.

Surprising as it may sound, the boys hat began to fill up! Many more people began to fill the boy’s hat with coins, dollar bills and bigger bills!

Later that day the middle aged woman came walking back and inquired how the boy was doing.

The boy who couldn’t see the woman did however, recognize her gait and asked “Were you the lady who changed my sign this morning? What did you write on my sign?”

The woman told the boy, “I only wrote the truth. I wrote what you said but in a different way.” I wrote: “Today is a beautiful day but I cannot see it.”

Both signs told people that the boy was blind. The first sign very simply said that the boy was blind. The second sign told people that they were so lucky that they were not blind. Should we be surprised that the second sign was more effective?

The Moral of This Story

Be thankful for what you have. Be creative. Be innovative. Think differently and positively. When life gives you 100 reasons to cry, show life that you have 1000 reasons to smile. Face your past without regret. Handle your present with confidence. Prepare for the future without fear. Keep the faith and drop the fear.

The most beautiful thing is to see a person smiling. And even more beautiful, is knowing that you are the reason behind it!

As dental professionals we are in the business of making people smile. I hope that if you are thinking this has not been a good year for your dental business (MANY of you have told me this is how you feel this year and even the past three years!), that you will plan to create your own economy!

As Dental Practice Management Consultants we are here to create a success plan for your dental practice. What are you thankful for this year?

I am so thankful that I have a great life and part of what makes it so great is the chance to serve all of you!

I am so thankful to all of you!

Happy Thanksgiving!

 

A Story of Thanksgiving

By: Debbie Seidel-Bittke, RDH, BS

I wanted to share a story of Thanksgiving which I found quite touching. Living in Portland, Oregon, it is not atypical to see people standing on the streets with signs asking for food, money or even alcohol, but the story I am about to write is a bit different from any of these!

A blind boy stood in front of a building in downtown Portland, Oregon with a hat at the bottom of his feet. He held a sign that said “I am blind, please help.”

I only saw a few coins in his hat.

Next I saw a middle aged woman walk by. She took a couple of one dollar bills from her purse and dropped them into the hat. This woman then took the boys sign, turned it around, and wrote a few words. This woman gave the sign back to the boy with the new words on it.

Surprising as it may sound, the boys hat began to fill up! Many more people began to fill the boy’s hat with coins, dollar bills and bigger bills!

Later that day the middle aged woman came walking back and inquired how the boy was doing.

The boy who couldn’t see the woman did however, recognize her gait and asked “Were you the lady who changed my sign this morning? What did you write on my sign?”

The woman told the boy, “I only wrote the truth. I wrote what you said but in a different way.” I wrote: “Today is a beautiful day but I cannot see it.”

Both signs told people that the boy was blind. The first sign very simply said that the boy was blind. The second sign told people that they were so lucky that they were not blind. Should we be surprised that the second sign was more effective?

The Moral of This Story

Be thankful for what you have. Be creative. Be innovative. Think differently and positively. When life gives you 100 reasons to cry, show life that you have 1000 reasons to smile. Face your past without regret. Handle your present with confidence. Prepare for the future without fear. Keep the faith and drop the fear.

The most beautiful thing is to see a person smiling. And even more beautiful, is knowing that you are the reason behind it!

As dental professionals we are in the business of making people smile. I hope that if you are thinking this has not been a good year for your dental business (MANY of you have told me this is how you feel this year and even the past three years!), that you will plan to create your own economy!

As Dental Practice Management Consultants we are here to create a success plan for your dental practice. What are you thankful for this year?

I am so thankful that I have a great life and part of what makes it so great is the chance to serve all of you!

I am so thankful to all of you!

Happy Thanksgiving!

CDT Code Changes For 2014: Take a Proactive Stand on The Success of Your Dental Practice

By: Debbie Seidel-Bittke, RDH, BS

November 19, 2013

The end of the year is almost upon us and with that we need to look at ending this year and preparing for the new!

The dental field has many things you need to know about to get ready for the New Year. A big change in 2014 will be the new CDT code updates. The ADA is giving us some time to digest and prepare for the 2014 CDT additions and changes.

In 2014 we will have 58 changes to the Current Dental CDT Codes.  Dental Practice Solutions works hard to keep dental offices informed of changes within dentistry.  We realize that you need to keep focused on providing excellent care for your patients. Thank you for relying us to keep you up to date and informed.  There will be 29 new codes, 18 revised codes, 4 deleted codes, and 7 changes to subcategories of the CDT code set.

You must take a proactive stand on the success of your dental practice. Read about the CDT Code changes for 2014!

HIPAA

HIPAA recognizes the CDT as the standard for reporting dental claims and the ADA is responsible to maintain the CDT codes.  Changes to codes are determined by insurance carriers on how and what is being processed so remember to submit all procedures and codes that are provided, even if you know you will not be paid this year; it may be next year!  Who ever thought sealants, implants, adult fluoride, oral cancer screenings or night guards would eventually be a covered benefit for our patients?

RECOMMENDATIONS BY DENTAL PRACTICE SOLUTIONS

Dental Practice Solutions recommends having one team member be “in charge “of and completely understand the CDT codes. This team member is ultimately responsible for learning the CDT codes, updating tyour dental software with the changes, and for training all team members.

We suggest training all dental team members on the correct dental terminology because this is your menu of services that you offer. A good analogy would be a waitress arriving at a table not knowing the menu and then placing a wrong order into the kitchen and the kitchen producing the wrong meal for the table.  Most offices do not realize they can be selling the side of mash potatoes with the steak a la carte, they assume the steak just comes with the meal.  A perfect example of this is separating the implant attachment from the implant fee.

Previously, dental offices combined implant attachments with the implant fee because insurance companies never paid for implants. Now more insurance companies are paying for this valuable service you provide your patients. The CDT has previously updated this code to accommodate these changes.

Have someone in your office to be accountable and on alert of these changes. This will mean extra income for your practice doing the same dentistry you have been doing but now you will get paid for it!  “Making more money, for the same effort?” Yes, that is what we are saying!

New Codes

  1. D0393 Treatment simulation using 3D image volume
  2. D0394 Digital subtraction of two or more images or image volumes of the same modality
  3. D0395 Fusion of two or more 3D image volumes of one or more modalitiesd0601 Caries risk assessment and documentation, with a finding of low risk
  4. D0601 Caries risk assessment and documentation, with a finding of low risk
  5. D0602 Caries risk assessment and documentation, with a finding of moderate risk
  6. D0603 Caries risk assessment and documentation, with a finding of high risk
  7. D1999 Unspecified preventive procedure, by report
  8. D2921 reattachment of tooth fragment, incisal edge, or cusp
  9. D2941 Interim therapeutic restoration-primary dentition
  10. D2949 Restorative foundation for an indirect restoration
  11. D3355 Pulpal regeneration-initial visit
  12. D3356 Pulpal regeneration-Interim medication replacement
  13. D3357 Pulpal regeneration-completion of treatment
  14. D3427 Periradicular surgery without apicoectomy
  15. D3428 Bone graft in conjunction with periradicular surgery- per tooth, single site
  16. D3429 Bone graft in conjunction with periradicular surgery-each additional contiguous tooth in the same surgical site
  17. D3431 Biologic material to aid in soft and osseous tissue regeneration in conjunction with periradicular surgery
  18. D3432 Guided tissue regeneration, resorbable barrier, per site, in conjunction with periradicular surgery
  19. D4921 Gingival irrigation- per quadrant
  20. D5863 Overdenture-complete maxillary
  21. D5865 Overdenture-complete mandibular
  22. D5864 Overdenture –partial maxillary
  23. D5866 Overdenture-partial mandibular
  24. D5994 periodontal medicament carrier with peripheral seal-laboratory processed
  25. D6011 Second stage implant surgery
  26. D6013 Surgical placement of mini implant
  27. D6052 Semi-precision attachment abutment
  28. D8694 Repair of fixed retainers, includes reattachment
  29. D9985 Sales tax

New sub categories

  1. Post processing of image or images sets
  2. Pulpal regeneration
  3. Carriers

a)     Radiation carrier (D5983)

b)     Fluoride gel carrier (D5986)

c)      Vesiculobullous disease medicament carrier (D5991)

d)     Periodontal medicament carrier with peripheral seal –laboratory processed (D5994)

Deleted Codes

  1. D0363 Cone beam- three dimensional image reconstruction using existing data, includes multiple images
  2. D3354 Pulpal regeneration-(completion of regenerative treatment in an immature permanent tooth with a necrotic pulp); does not include final restoration.
  3. D5860 Overdenture-complete, by report
  4. 5861 Overdenture-partial, by report

The CDT 2014 is now available to purchase on the ADA website http://www.ada.org we recommend supplementing by also purchasing Dental Coding Made Simple: Resource Guide and Training Manual, 2013-2014.  This resource guide is revised every two years, sections include 151 common questions/answers; more than 25 coding exercises; an illustrated implant section; and a continuing education exam with five CE credits.  We also suggest you look at this website for additional information: www.practicebooster.com . The 2014 edit of Coding with Confidence is now available and a great resource for you office!

Keep your office up to date on the CDT codes to maximize patient coverage to have higher acceptance rate of treatment, have better speed and accuracy of dental claims submitted to have faster payment of dental claims and utilize front office staff to engage more dentistry in your schedule and not be resubmitting or following up on poorly submitted claims.

A well-trained dental team is a happier and more productive team! Are you proactive with the health of your practice? Make resolutions to be preventative with your offices’ health. Train and be prepared for the New Year.

Dental Practice Solutions is available for office team training and practice health assessments to move you forward in the New Year. Call today to for a 15-minute assessment to a healthier economic and mental well being for you and your staff members.  The economy is up to you not our nation or what anyone else may be telling you!

CDT Code Changes For 2014: Take a Proactive Stand on The Success of Your Dental Practice

By: Debbie Seidel-Bittke, RDH, BS

 

CDT 2014

The end of the year is almost upon us and with that we need to look at ending this year and preparing for the new!

The dental field has many things you need to know about to get ready for the New Year. A big change in 2014 will be the new CDT code updates. The ADA is giving us some time to digest and prepare for the 2014 CDT additions and changes.

In 2014 we will have 58 changes to the Current Dental CDT Codes.  Dental Practice Solutions works hard to keep dental offices informed of changes within dentistry.  We realize that you need to keep focused on providing excellent care for your patients. Thank you for relying us to keep you up to date and informed.  There will be 29 new codes, 18 revised codes, 4 deleted codes, and 7 changes to subcategories of the CDT code set.

You must take a proactive stand on the success of your dental practice. Read about the CDT Code changes for 2014!

HIPAA

HIPAA recognizes the CDT as the standard for reporting dental claims and the ADA is responsible to maintain the CDT codes.  Changes to codes are determined by insurance carriers on how and what is being processed so remember to submit all procedures and codes that are provided, even if you know you will not be paid this year; it may be next year!  Who ever thought sealants, implants, adult fluoride, oral cancer screenings or night guards would eventually be a covered benefit for our patients?

RECOMMENDATIONS BY DENTAL PRACTICE SOLUTIONS

Dental Practice Solutions recommends having one team member be “in charge “of and completely understand the CDT codes. This team member is ultimately responsible for learning the CDT codes, updating tyour dental software with the changes, and for training all team members.

We suggest training all dental team members on the correct dental terminology because this is your menu of services that you offer. A good analogy would be a waitress arriving at a table not knowing the menu and then placing a wrong order into the kitchen and the kitchen producing the wrong meal for the table.  Most offices do not realize they can be selling the side of mash potatoes with the steak a la carte, they assume the steak just comes with the meal.  A perfect example of this is separating the implant attachment from the implant fee.

Previously, dental offices combined implant attachments with the implant fee because insurance companies never paid for implants. Now more insurance companies are paying for this valuable service you provide your patients. The CDT has previously updated this code to accommodate these changes.

Have someone in your office to be accountable and on alert of these changes. This will mean extra income for your practice doing the same dentistry you have been doing but now you will get paid for it!  “Making more money, for the same effort?” Yes, that is what we are saying!

New Codes

  1. D0393 Treatment simulation using 3D image volume
  2. D0394 Digital subtraction of two or more images or image volumes of the same modality
  3. D0395 Fusion of two or more 3D image volumes of one or more modalitiesd0601 Caries risk assessment and documentation, with a finding of low risk
  4. D0601 Caries risk assessment and documentation, with a finding of low risk
  5. D0602 Caries risk assessment and documentation, with a finding of moderate risk
  6. D0603 Caries risk assessment and documentation, with a finding of high risk
  7. D1999 Unspecified preventive procedure, by report
  8. D2921 reattachment of tooth fragment, incisal edge, or cusp
  9. D2941 Interim therapeutic restoration-primary dentition
  10. D2949 Restorative foundation for an indirect restoration
  11. D3355 Pulpal regeneration-initial visit
  12. D3356 Pulpal regeneration-Interim medication replacement
  13. D3357 Pulpal regeneration-completion of treatment
  14. D3427 Periradicular surgery without apicoectomy
  15. D3428 Bone graft in conjunction with periradicular surgery- per tooth, single site
  16. D3429 Bone graft in conjunction with periradicular surgery-each additional contiguous tooth in the same surgical site
  17. D3431 Biologic material to aid in soft and osseous tissue regeneration in conjunction with periradicular surgery
  18. D3432 Guided tissue regeneration, resorbable barrier, per site, in conjunction with periradicular surgery
  19. D4921 Gingival irrigation- per quadrant
  20. D5863 Overdenture-complete maxillary
  21. D5865 Overdenture-complete mandibular
  22. D5864 Overdenture –partial maxillary
  23. D5866 Overdenture-partial mandibular
  24. D5994 periodontal medicament carrier with peripheral seal-laboratory processed
  25. D6011 Second stage implant surgery
  26. D6013 Surgical placement of mini implant
  27. D6052 Semi-precision attachment abutment
  28. D8694 Repair of fixed retainers, includes reattachment
  29. D9985 Sales tax

New sub categories

  1. Post processing of image or images sets
  2. Pulpal regeneration
  3. Carriers

a)     Radiation carrier (D5983)

b)     Fluoride gel carrier (D5986)

c)      Vesiculobullous disease medicament carrier (D5991)

d)     Periodontal medicament carrier with peripheral seal –laboratory processed (D5994)

Deleted Codes

  1. D0363 Cone beam- three dimensional image reconstruction using existing data, includes multiple images
  2. D3354 Pulpal regeneration-(completion of regenerative treatment in an immature permanent tooth with a necrotic pulp); does not include final restoration.
  3. D5860 Overdenture-complete, by report
  4. 5861 Overdenture-partial, by report

The CDT 2014 is now available to purchase on the ADA website http://www.ada.org we recommend supplementing by also purchasing Dental Coding Made Simple: Resource Guide and Training Manual, 2013-2014.  This resource guide is revised every two years, sections include 151 common questions/answers; more than 25 coding exercises; an illustrated implant section; and a continuing education exam with five CE credits.  We also suggest you look at this website for additional information: www.practicebooster.com . The 2014 edit of Coding with Confidence is now available and a great resource for you office!

Keep your office up to date on the CDT codes to maximize patient coverage to have higher acceptance rate of treatment, have better speed and accuracy of dental claims submitted to have faster payment of dental claims and utilize front office staff to engage more dentistry in your schedule and not be resubmitting or following up on poorly submitted claims.

A well-trained dental team is a happier and more productive team! Are you proactive with the health of your practice? Make resolutions to be preventative with your offices’ health. Train and be prepared for the New Year.

Dental Practice Solutions is available for office team training and practice health assessments to move you forward in the New Year. Call today to for a 15-minute assessment to a healthier economic and mental well being for you and your staff members.  The economy is up to you not our nation or what anyone else may be telling you!

Older photoABOUT SUSAN KETTERER

Susan Ketterer is an expert advisor to Dental Practice Solutions. Susan brings a wealth of business and back office auxilary experience, with over 20 years of “in-the-trences” experience. Susan is asked by numerous dentists each week how to assist with front and back office efficiencies. Do you ever wonder how to get paid by those insurance companies a lot quicker? Do you want your phones answered at the highest level of customer service? Do you struggle with lab efficiencies from getting lab cases returned efficiently to sending office referrals? What systems do you wish to have improved? Susan is your GO TO person for working smoothly during your day at the office! Call our office or email Susan to discover how you can get to your NEXT LEVEL!

Contact Susan:  support@dentalpracticesolutions.com or call for a complimentary practice evaluation: 888-816-1511

Telling Your Dental Hygiene Patient The News: Does It Need to Be Bad News?

By: Debbie Seidel-Bittke, RDH, BS

November 12, 2013

A few months ago I decided that I would go back to work in a dental office near my home in Portland, Oregon. I would only be there as a temporary hygienist for the day.

I was really looking forward to providing optimal oral healthcare to patients again! I have always enjoying providing patient care but even more I enjoy sharing my knowledge as a consultant.

The office doesn’t have a morning team huddle and I needed to talk to the dentist about the office protocol for treatment of peridontal patients. I asked the doctor about how he wanted me to tell a dental hygiene patient that a patient on my schedule had periodontal disease. From the chart notes,  I could see this was never been communicated to the patient.

When you tell your dental hygiene patient the news (Their perio diagnosis): Does it really need to be bad news?

 

PERIO PATIENTS: WHAT DO YOU TELL THEM?

I was extremely concerned about this one patient.  He was 56 years old and I saw he had no perio charting completed in the past three years. He was scheduled for a prophy appointment only. As I looked at his latest perio chart I saw chart notes with 5 and 6mm pockets generalized. Nothing else was documented. Looking at his radiographs (No FMX), I could detect that this patient probably had mobility on various teeth. Last perio charting and x-rays were about three years ago.

I asked doctor “How would you like me to approach this situation?” You can probably understand that I was a bit confused, at best, because looking at this patient chart, I was about to see a patient with definite perio problems and the scheduled told me it would be a prophy patient.

When I asked doctor about his plan for this patient with the perio disease, he told me “Just do the prophy!” Doctor said “This man has been coming here for years and he will never do anything so just clean his teeth and let me tell him about the periodontal disease!”

I add the exclamation marks to let you know that is how he responded to me about this patient.

Well, the patient came in, end of the day, and I did only clean his teeth. I did my very best and yes, those teeth were mobile. Many of the posterior teeth had mobility of 1.

Doctor came at the end of the appointment to do an exam. No x-rays were taken (doctor didn’t want me to do those!). Remember, I was instructed to “only” clean his teeth as my schedule said to do. The doctor said nothing about periodontal disease  during the patient exam, but told him “It all looks good, (Insert Patient’s Name Here).”

The patient left my treatment room at precisely 5pm and as I cleaned up my room I could hear doctor talking to the patient. They were making plans to play a game of golf together. Sounded like something they do often.

WHAT IS A DENTISTS ETHICAL/LEGAL OBLIGATION?

Well, it’s been months later, and I am now with enough nerve to tell you about this incidence. I don’t want to come across like I am bashing another dentist and I don’t like to write negative stories on the internet.

And yes, I already decided I didn’t every want to go back there again AND I have yet to do another day in a dental office as the temp hygienist!

My question that I would like to ask this dentist is “Will Patient X be really angry when his tooth falls out on the golf course with you or will he be angry if you now decide to tell him that he has periodontal disease?! Which is worse?!

We do have an ethical and legal obligation to tell our patients the truth. There is so much science and research to back the health benefits of treating periodontal disease. AND treating periodontal disease in the early stages vs. wait and watch has many benefits – Financial and health to the patient.

SOLVE THE DISEASE PROBLEM

Here is how I believe a patient with periodontal disease needs to be treated: It begins with each and every patient at about thirteen years of age. You will begin at this age, completing a full mouth periodontal screening. You can look up on the AAP website to see all that is involved in this screening because it is more than just those six probing numbers.

STEPS TO INVOLVE YOUR DENTAL HYGIENE PATIENT

Step 1 Call out the Numbers and Have another Auxiliary Record These Numbers

The periodontal screening needs to be completed and documented once a year. This is the standard of care. If a patient has a periodontal pocket that is not within normal range you must recheck that pocket before you pick up your curette. Re-evaluate pockets before you scale is key here. Too many reasons so write about here so email or write in the comments below if you want more 411 on why probing comes before scaling.

Tell you patients that you will be taking some measurements of their teeth and gums and that you will call out some numbers. Tell them that 1-3 are good numbers and 4 means the start of disease. Anything above a 4 means disease.

Step 2 Include Your Patient in This Exam Process

Ask your patient to remember the lowest number and the highest number you call out. At the end of your screening, ask the patient to tell you the lowest and highest numbers. This really helps to bring the patient into active participation with their oral health – or lack of health.

When another auxiliary is there to document the numbers, this entire process should take approximately ten minutes.

Step 3 Use Intraoral Photos

If you see bleeding, suppuration, and heavy supra, etc., now is a great time to take photos with the intra oral camera.

Step 4 Initial Treatment Planning Process

You should be at approximately fifteen to twenty minutes into the hygiene appointment at this point.  Sit your patient upright in the chair. You will sit eye-to-eye and knee-to-knee, while you explain what you see in their mouth. Computer monitor in front of you both, will show the perio chart, x-rays and any photos you have taken.

I mention the word see because I have had patients say they don’t like the dental office because we always find something. I believe that when you say the word see the patient can also be looking with you and see what you see.

This is now your time to review the periodontal probings, bleeding points, furcations, etc., with your patient and show them what you see and the photos you took with the intra oral camera. Use brochures or posters, etc., to explain the treatment process and future preventive recommendations, etc.

This may take about ten minutes but you still have time left for the doctor exam and some treatment which also needs to include home care and post-op instructions. At Dental Practice Solutions, we educate our dental client team in a specific way for doctor to arrive in a timely manner, to complete the exam.

There is a strategy in place so doctor’s assistants understand when to direct doctor into the hygiene treatment room for the exam.

Step 5: Communication with Your Patients

It is important that you understand how to communicate with each individual patient. We use the DISC Profile and Meyer Briggs with clients. This can help us to understand the various personality types of your patients. You should know which patients want a lot of the details and the others who want you to get right to the point.

Always be sure to educate your patients about the oral health and systemic health link. If your patient has a risk factor that contributes to periodontal disease, emphasize the benefits of preventive care and treating their disease to keep their other risk factors under control. Some patients may need to read the science so be prepared with where they can read about this for themselves.

Step 6 Doctor Hygiene Exam Process

It is important to have a specific system so that when doctor begins the patient exam, the hygienist knows his or her role in communicating what was discovered during the hygiene appointment.

Practice this with the doctor, hygienist(s) and entire team at a monthly team meeting.

Step 7 Patient Dismissal

Usually the hygienist will dismiss the patient. This means walking them to the front desk, explaining future treatment, and necessary appointments. Repeating this a third time (1st time is with hygienist and patient. 2nd time is with hygienist and doctor during the exam.), can really be helpful when a patient is hearing about periodontal disease for the first time. Imagine that you are speaking Greek! These words may be new to a patient so the first or second time they hear these words, they may make no sense to them.

It is possible that your patient may need to speak to the financial coordinator or someone about the financial aspects. Be sure you do this in a private room and not a patient treatment room.

CONCLUSION

When you have a system for delivering information to your patients: good or bad, do you really think you are a BAD PERSON?

Treating periodontal disease is always going to improve your patient’s health. We must tell our patients the truth. If you create a system and do what is best for your patient, I do not believe that your patients will think you are doing something that is bad for them.

Involve your patient in their diagnosis. Remember, you will have the patient listen and participate with their perio screening exam, and they will look at the numbers, their teeth photos, etc., with you.

Optimal oral health means a longer life. Do you know a patient that doesn’t want to live a longer healthier life?

Neither do I!

How would you have handled that situation that I was in when I was the temp hygienist?

Do you agree with this recommendation for patient discovery?

What is the system in your office for diagnosing a perio patient fir the first time? What if this perio diagnosis is a long time patient of record? Do you handle this differently than a new patient?

Let me know in the comments below.

Telling Your Dental Hygiene Patient The News: Does It Need to Be Bad News?

By: Debbie Seidel-Bittke, RDH, BS

Doc enters to do exam

A few months ago I decided that I would go back to work in a dental office near my home in Portland, Oregon. I would only be there as a temporary hygienist for the day.

I was really looking forward to providing optimal oral healthcare to patients again! I have always enjoying providing patient care but even more I enjoy sharing my knowledge as a consultant.

The office doesn’t have a morning team huddle and I needed to talk to the dentist about the office protocol for treatment of peridontal patients. I asked the doctor about how he wanted me to tell a dental hygiene patient that a patient on my schedule had periodontal disease. From the chart notes,  I could see this was never been communicated to the patient.

When you tell your dental hygiene patient the news (Their perio diagnosis): Does it really need to be bad news?

 

PERIO PATIENTS: WHAT DO YOU TELL THEM?

I was extremely concerned about this one patient.  He was 56 years old and I saw he had no perio charting completed in the past three years. He was scheduled for a prophy appointment only. As I looked at his latest perio chart I saw chart notes with 5 and 6mm pockets generalized. Nothing else was documented. Looking at his radiographs (No FMX), I could detect that this patient probably had mobility on various teeth. Last perio charting and x-rays were about three years ago.

I asked doctor “How would you like me to approach this situation?” You can probably understand that I was a bit confused, at best, because looking at this patient chart, I was about to see a patient with definite perio problems and the scheduled told me it would be a prophy patient.

When I asked doctor about his plan for this patient with the perio disease, he told me “Just do the prophy!” Doctor said “This man has been coming here for years and he will never do anything so just clean his teeth and let me tell him about the periodontal disease!”

I add the exclamation marks to let you know that is how he responded to me about this patient.

Well, the patient came in, end of the day, and I did only clean his teeth. I did my very best and yes, those teeth were mobile. Many of the posterior teeth had mobility of 1.

Doctor came at the end of the appointment to do an exam. No x-rays were taken (doctor didn’t want me to do those!). Remember, I was instructed to “only” clean his teeth as my schedule said to do. The doctor said nothing about periodontal disease  during the patient exam, but told him “It all looks good, (Insert Patient’s Name Here).”

The patient left my treatment room at precisely 5pm and as I cleaned up my room I could hear doctor talking to the patient. They were making plans to play a game of golf together. Sounded like something they do often.

WHAT IS A DENTISTS ETHICAL/LEGAL OBLIGATION?

Well, it’s been months later, and I am now with enough nerve to tell you about this incidence. I don’t want to come across like I am bashing another dentist and I don’t like to write negative stories on the internet.

And yes, I already decided I didn’t every want to go back there again AND I have yet to do another day in a dental office as the temp hygienist!

My question that I would like to ask this dentist is “Will Patient X be really angry when his tooth falls out on the golf course with you or will he be angry if you now decide to tell him that he has periodontal disease?! Which is worse?!

We do have an ethical and legal obligation to tell our patients the truth. There is so much science and research to back the health benefits of treating periodontal disease. AND treating periodontal disease in the early stages vs. wait and watch has many benefits – Financial and health to the patient.

SOLVE THE DISEASE PROBLEM

Here is how I believe a patient with periodontal disease needs to be treated: It begins with each and every patient at about thirteen years of age. You will begin at this age, completing a full mouth periodontal screening. You can look up on the AAP website to see all that is involved in this screening because it is more than just those six probing numbers.

STEPS TO INVOLVE YOUR DENTAL HYGIENE PATIENT

Step 1 Call out the Numbers and Have another Auxiliary Record These Numbers

The periodontal screening needs to be completed and documented once a year. This is the standard of care. If a patient has a periodontal pocket that is not within normal range you must recheck that pocket before you pick up your curette. Re-evaluate pockets before you scale is key here. Too many reasons so write about here so email or write in the comments below if you want more 411 on why probing comes before scaling.

Tell you patients that you will be taking some measurements of their teeth and gums and that you will call out some numbers. Tell them that 1-3 are good numbers and 4 means the start of disease. Anything above a 4 means disease.

Step 2 Include Your Patient in This Exam Process

Ask your patient to remember the lowest number and the highest number you call out. At the end of your screening, ask the patient to tell you the lowest and highest numbers. This really helps to bring the patient into active participation with their oral health – or lack of health.

When another auxiliary is there to document the numbers, this entire process should take approximately ten minutes.

Step 3 Use Intraoral Photos

If you see bleeding, suppuration, and heavy supra, etc., now is a great time to take photos with the intra oral camera.

Step 4 Initial Treatment Planning Process

You should be at approximately fifteen to twenty minutes into the hygiene appointment at this point.  Sit your patient upright in the chair. You will sit eye-to-eye and knee-to-knee, while you explain what you see in their mouth. Computer monitor in front of you both, will show the perio chart, x-rays and any photos you have taken.

I mention the word see because I have had patients say they don’t like the dental office because we always find something. I believe that when you say the word see the patient can also be looking with you and see what you see.

This is now your time to review the periodontal probings, bleeding points, furcations, etc., with your patient and show them what you see and the photos you took with the intra oral camera. Use brochures or posters, etc., to explain the treatment process and future preventive recommendations, etc.

This may take about ten minutes but you still have time left for the doctor exam and some treatment which also needs to include home care and post-op instructions. At Dental Practice Solutions, we educate our dental client team in a specific way for doctor to arrive in a timely manner, to complete the exam.

There is a strategy in place so doctor’s assistants understand when to direct doctor into the hygiene treatment room for the exam.

Step 5: Communication with Your Patients

It is important that you understand how to communicate with each individual patient. We use the DISC Profile and Meyer Briggs with clients. This can help us to understand the various personality types of your patients. You should know which patients want a lot of the details and the others who want you to get right to the point.

Always be sure to educate your patients about the oral health and systemic health link. If your patient has a risk factor that contributes to periodontal disease, emphasize the benefits of preventive care and treating their disease to keep their other risk factors under control. Some patients may need to read the science so be prepared with where they can read about this for themselves.

Step 6 Doctor Hygiene Exam Process

It is important to have a specific system so that when doctor begins the patient exam, the hygienist knows his or her role in communicating what was discovered during the hygiene appointment.

Practice this with the doctor, hygienist(s) and entire team at a monthly team meeting.

Step 7 Patient Dismissal

Usually the hygienist will dismiss the patient. This means walking them to the front desk, explaining future treatment, and necessary appointments. Repeating this a third time (1st time is with hygienist and patient. 2nd time is with hygienist and doctor during the exam.), can really be helpful when a patient is hearing about periodontal disease for the first time. Imagine that you are speaking Greek! These words may be new to a patient so the first or second time they hear these words, they may make no sense to them.

It is possible that your patient may need to speak to the financial coordinator or someone about the financial aspects. Be sure you do this in a private room and not a patient treatment room.

CONCLUSION

When you have a system for delivering information to your patients: good or bad, do you really think you are a BAD PERSON?

Treating periodontal disease is always going to improve your patient’s health. We must tell our patients the truth. If you create a system and do what is best for your patient, I do not believe that your patients will think you are doing something that is bad for them.

Involve your patient in their diagnosis. Remember, you will have the patient listen and participate with their perio screening exam, and they will look at the numbers, their teeth photos, etc., with you.

Optimal oral health means a longer life. Do you know a patient that doesn’t want to live a longer healthier life?

Neither do I!

How would you have handled that situation that I was in when I was the temp hygienist?

Do you agree with this recommendation for patient discovery?

What is the system in your office for diagnosing a perio patient fir the first time? What if this perio diagnosis is a long time patient of record? Do you handle this differently than a new patient?

Let me know in the comments below.

ABOUT DEBBIE

ME not too high jpeg

Debbie Seidel-Bittke, RDH, BS, is founder of Dental Practice Solutions. She is one of Dentistry Today’s Top Consultants for the past eight years. She also has a background in academia, as a former assistant professor at the University of Southern California in Los Angeles, California. She also wrote the acreditation for a new dental hygiene program in Portland, Oregon and served as their first program director for the dental hygiene school.

Debbie works with clients all over the world. She has other expert advisors who work with her. Susan Ketterer is an expert consultant who assists dental practices with the business side and back office assistants in a dental office. Debbie is the go-to expert for improving your dental hygiene department efficiencies and consistently increasing profits. She has a 30 Day Dental Hygiene Program that is no cost and guides a dental practice to implement dental hygiene department services and systems to take the practice to that next level of success. Check out her webinar on the dental hygiene department and treatment of the perio patient. This will be held on Wednesday November 13, 2013 at 5pm Pacific.

Best Reasons to Pre-Schedule Dental Hygiene Appointments

By: Debbie Seidel-Bittke, RDH, BS

November 5, 2013

Schedule-Your-Appointment-SidebarThere is one system often overlooked in your dental practice and this is your dental hygiene preventive care system (also referred to as “continuing care” system). This system is most successful when the office doesn’t need to call patients to come in for a missed or overdue dental hygiene appointment.

If dental patients are the “heart” of your practice, then dental hygiene preventive care appointments are the “lifeline.” At least 80% of the dental diagnoses in your practice should be coming from dental hygiene continuing care appointments. When patients leave the hygiene appointment without pre-scheduling their future dental hygiene appointment, this dramatically decreases your practice profitability by at least 50%.

Many years ago it was the standard to have a patient complete a postcard at the end of their hygiene appointment and the office would mail these to the patient. The patient would then call the office to schedule their dental hygiene appointment.

This system has not proven to be successful and for many reasons. Read below for reasons WHY you need to Pre-Schedule Dental Hygiene Appointments

Top Reasons to Pre-Schedule Dental Hygiene Appointments

  1. Adult patients should/need to take responsibility for their appointments scheduled.
  2. With millions of people using android and iphones, they are able to easily mark their calendars and set reminders for appointments scheduled
  3. Adults can be responsible for their own appointments. No need for the office to “remind” them
  4. When you have a large and successful dental practice, if patients only call to schedule an appointment at the time they are due, when they do call, it is highly likely that the specific time a patient need to be seen, most likely won’t be available. Patients can’t be left to think they can schedule an appointment last minute or even two weeks before they want to see their hygienist. Create urgency!
  5. Patients may request a certain hygienist who works on specific days of the week.                                                                                                                                                                                                                                                                                                    a. Patients who pre-schedule will know they can see their favorite hygienist and should want to secure that date months in advance                                                                                                                                                                                                    b. People work well knowing they can count on a specific day and time for their dental appointments
  6. Pre-Scheduling patient dental hygiene appointments allows for a predictable schedule in your dental office.
  7. People today, prefer to not have to make unnecessary calls.                                                                                                                                                                                                                                                                                                                                                   a. Plan to use a service such as Solution Reach which allows you to email text or have someone else contact your patients (And contact them during hours that you may not have available for calling on the phone.)
  8. The front office auxiliaries can spend less time answering phones and scheduling appointments

The question that does prevent a patient from pre-scheduling their dental hygiene appointment, months in advance, is when a patient says “I don’t know what I will be doing in six (or even three) months from now.”

A simple answer to this statement can be “Now you know what you are doing in six (or whatever the date of the next appointment is) months!”

Smile when you say this. Usually patients will smile back and most ‘get it’.  Now let the patient know they will be spending that day and time with you. It really does work to use this method. Have fun with it!

Who is the best team member to schedule hygiene appointments?

The answer to this question is of course, the dental hygienist who is seeing this patient.

If your hygienist’s feel they do not have time to schedule a patients next hygiene appointment, then they need to understand the why and the value this adds to the patients dental hygiene appointment.

The hygienist, who just treated the patient, knows that patients balance point. When I speak of balance point, I am referring to the interval of time a patient can go between a prophylaxis or periodontal maintenance and remain healthy. If a patient comes in for a periodontal maintenance appointment at a four month interval but now they need to transition (maybe only temporarily) into three months, the hygienist knows exactly how to explain this change in their maintenance intervals. If you are not certain of this protocol you may want to contact our office and at the very least read about this at the website for the AmericanAcademy of Periodontology: www.perio.org

Today world of dentistry integrates computers in the treatment room and makes scheduling a patient’s next dental hygiene appointment an easy task to implement.

If you would like to know how to time this process please refer to our blog article “Using Down to a Science Doctor Hygiene Exams. There is a photo at the top of this blog which outlines where the scheduling needs to take place during the hygiene appointment.

If your hygienist is still waiting for the doctor to arrive and complete patient exams, this is a great time to schedule the patients’ next appointment. btw: Dental Practice Solutions does not advocate waiting for doctor exams until the end of the hygiene appointment.

  • Do you have open holes in your hygiene schedule?
  • Do you have patients missing dental hygiene appointments this year?

Don’t delay in calling and/or sending a letter to let patients know the importance oral health plays in their overall health.

Dental Practice Solutions has a Continuing Care System and ebook that explains how to easily bring in overdue patients. Many offices report that after they send the first of our overdue patient letters, approximately fifty patients will call within thirty days of receiving their letter to schedule their hygiene appointment.

This is a great time of the year to send out those letters to overdue patients. Many people will lose their benefits on December 31st and some will no longer have dental benefits when they change their insurance benefits due to the new healthcare reform. Don’t delay bringing in those overdue hygiene patients.

  • Do you pre-schedule at east 98% of all hygiene patient appointments?
  • Who is scheduling these appointments in your office?

If you like this information please share with your colleagues. We also invite you to use the comment section to answer the above questions about your office situation.

About Debbie

ME not too high jpeg

Debbie Seidel-Bittke, RDH, BS, is founder and CEO of Dental Practice Solutions. Dental Practice Solutions is the largest business for laser-focused hygiene department systems. Dental Practice Solutions has clients worldwide and a unique learning style for offices to implement systems from anywhere in the world. Debbie and her team are results oriented which is what makes their clients experience superior results!

Debbie has been in the world of academia for over twenty years. First as an assistant clinical professor at the University of Southern California in Los Angeles. She also taught the senior dental students at USC the practice management course. Most recently, in 2008, she wrote the accreditation and started a dental hygiene program in Portland, Oregon.

Debbie has been named one of Dentistry Today’s TOP Dental Consultants for eight years in a row! She founded Dental Practice Solutions in 2000 and has helped thousands of dental professionals capture passion for their profession, embrace MORE than just cleaning teeth and added millions of dollars to dental practices throughout the world!

You will find that Debbie has a no non-sense style which keeps team’s in-check and yet held accountable. Contact her for a no-fee assessment to find the hidden potential in your dental practice: 503-970-1122 or toll-free: 888-816-1511 Email: support@dentalpracticesolutions.com

 

 

Best Reasons to Pre-Schedule Dental Hygiene Appointments

By: Debbie Seidel-Bittke, RDH, BS

There is one system often overlooked in your dental practice and this is your dental hygiene preventive care system (also referred to as “continuing care” system). This system is most successful when the office doesn’t need to call patients to come in for a missed or overdue dental hygiene appointment.

If dental patients are the “heart” of your practice, then dental hygiene preventive care appointments are the “lifeline.” At least 80% of the dental diagnoses in your practice should be coming from dental hygiene continuing care appointments. When patients leave the hygiene appointment without pre-scheduling their future dental hygiene appointment, this dramatically decreases your practice profitability by at least 50%.

Many years ago it was the standard to have a patient complete a postcard at the end of their hygiene appointment and the office would mail these to the patient. The patient would then call the office to schedule their dental hygiene appointment.

This system has not proven to be successful and for many reasons. Read below for reasons WHY you need to Pre-Schedule Dental Hygiene Appointments

Top Reasons to Pre-Schedule Dental Hygiene Appointments

  1. Adult patients should/need to take responsibility for their appointments scheduled.
  2. With millions of people using android and iphones, they are able to easily mark their calendars and set reminders for appointments scheduled
  3. Adults can be responsible for their own appointments. No need for the office to “remind” them
  4. When you have a large and successful dental practice, if patients only call to schedule an appointment at the time they are due, when they do call, it is highly likely that the specific time a patient need to be seen, most likely won’t be available. Patients can’t be left to think they can schedule an appointment last minute or even two weeks before they want to see their hygienist. Create urgency!
  5. Patients may request a certain hygienist who works on specific days of the week.                                                                                                                                                                                                                                                                                                    a. Patients who pre-schedule will know they can see their favorite hygienist and should want to secure that date months in advance                                                                                                                                                                                                    b. People work well knowing they can count on a specific day and time for their dental appointments
  6. Pre-Scheduling patient dental hygiene appointments allows for a predictable schedule in your dental office.
  7. People today, prefer to not have to make unnecessary calls.                                                                                                                                                                                                                                                                                                                                                   a. Plan to use a service such as Solution Reach which allows you to email text or have someone else contact your patients (And contact them during hours that you may not have available for calling on the phone.)
  8. The front office auxiliaries can spend less time answering phones and scheduling appointments

The question that does prevent a patient from pre-scheduling their dental hygiene appointment, months in advance, is when a patient says “I don’t know what I will be doing in six (or even three) months from now.”

A simple answer to this statement can be “Now you know what you are doing in six (or whatever the date of the next appointment is) months!”

Smile when you say this. Usually patients will smile back and most ‘get it’.  Now let the patient know they will be spending that day and time with you. It really does work to use this method. Have fun with it!

Who is the best team member to schedule hygiene appointments?

The answer to this question is of course, the dental hygienist who is seeing this patient.

If your hygienist’s feel they do not have time to schedule a patients next hygiene appointment, then they need to understand the why and the value this adds to the patients dental hygiene appointment.

The hygienist, who just treated the patient, knows that patients balance point. When I speak of balance point, I am referring to the interval of time a patient can go between a prophylaxis or periodontal maintenance and remain healthy. If a patient comes in for a periodontal maintenance appointment at a four month interval but now they need to transition (maybe only temporarily) into three months, the hygienist knows exactly how to explain this change in their maintenance intervals. If you are not certain of this protocol you may want to contact our office and at the very least read about this at the website for the AmericanAcademy of Periodontology: www.perio.org

Today world of dentistry integrates computers in the treatment room and makes scheduling a patient’s next dental hygiene appointment an easy task to implement.

If you would like to know how to time this process please refer to our blog article “Using Down to a Science Doctor Hygiene Exams. There is a photo at the top of this blog which outlines where the scheduling needs to take place during the hygiene appointment.

If your hygienist is still waiting for the doctor to arrive and complete patient exams, this is a great time to schedule the patients’ next appointment. btw: Dental Practice Solutions does not advocate waiting for doctor exams until the end of the hygiene appointment.

  • Do you have open holes in your hygiene schedule?
  • Do you have patients missing dental hygiene appointments this year?

Don’t delay in calling and/or sending a letter to let patients know the importance oral health plays in their overall health.

Dental Practice Solutions has a Continuing Care System and ebook that explains how to easily bring in overdue patients. Many offices report that after they send the first of our overdue patient letters, approximately fifty patients will call within thirty days of receiving their letter to schedule their hygiene appointment.

This is a great time of the year to send out those letters to overdue patients. Many people will lose their benefits on December 31st and some will no longer have dental benefits when they change their insurance benefits due to the new healthcare reform. Don’t delay bringing in those overdue hygiene patients.

  • Do you pre-schedule at east 98% of all hygiene patient appointments?
  • Who is scheduling these appointments in your office?

If you like this information please share with your colleagues. We also invite you to use the comment section to answer the above questions about your office situation.