How many dental hygiene patients are currently overdue for a hygiene appointment?
Do you know if these patients have outstanding treatment?
What percentage of your adult patients have been treated for gum disease using one of the ADA CDT 4000 codes?
These are questions you need to ask yourself if you are a dentist and wish to see the highest productivity this year.
The Facts
Approximately 50% of American adults 30 years of age and older have some level of periodontal disease. In a recent study, 77% of adults reported they would see their dentist, but only 37% reported seeing their dentist.
The dental offices who work with us usually have a perio percentage of no more than 20% of their adult patients for periodontal disease. The problem lies in the discomfort and lack of knowledge to share with their patient what they see happening in their mouth.
This statistic means that dental hygienists are “Cleaning Teeth” and not sharing an important, life-altering disease with their patients. As the founder of Dental Practice Solutions and a dental hygiene clinician, it is my passion to share this important message that a healthy mouth leads to a longer, healthier life!
Solution To the Problem We Face
It’s essential to have a productive dental hygiene department that provides preventive care to patients and supports their overall well-being. It’s also important to track and monitor overdue hygiene patients to ensure they continue preventative care appointments versus treat disease.
The 21-Day Hygiene Dept Challenge will provide everything you need to share this important message, increase your perio patient percentage, and create a system/process to keep patients returning to your dental office. You now have a system and the tools to enroll more patients into gingivitis and perio treatment. This is a win for everyone!
STOP running on the dental treadmill and love more of what you do!
Soon it will be a new year and we are currently in deep contemplation. A lot going on in our world today!
Now is your time to consider what you will do differently next year and how you will accomplish your goals.
A new year, 2021, will be a breath of fresh air for many of us. What a year it’s been!
2021, is most likely going to be a year to reset. It will be a chance to accomplish things you were not able to do in 2020. Life got a little messy for all of us during 2020!
Let’s talk about where you may be today and then determine where you can be when 2021 arrives.
Do you feel like you are at a crossroads today?
Do you feel like the future is unknown?
Which side of the fence do you see yourself?
Right side or left side?
Are you focused on this past year or the great year ahead?
While you may not know what lies ahead in 2021, what you do have control over are the decisions you make today.
This is what you have control over today.
You get to choose which direction you wish your dental practice to go when 2021 arrives.
What plans are you creating right to have your best year in 2021?
Now is the time to create your success plan and your hygiene department is your biggest asset.
Once you decide to focus on your hygiene department, take a look at your number of hygiene patients who need to be reactivated. Doctor, do you think your team is reactivating all the overdue hygiene patients? I challenge you to take a look at how many patients are (or are not) being reactivated each day this week.
Do you know how many of your adult patients have been treated for gingivitis and periodontitis?
Do you understand that half-of our adult Americans (35 yrs of age and above) have some level of gum disease?
Most dental offices have less than 35% of their adult patients treated for gum disease. Lots of room for growth here!
The other area you must look at is, how many hygiene patients leave their appointment with a restorative diagnosis and actually schedule for treatment with doctor at the end of their hygiene appointment?
This is another HUGE opportunity to grow your dental practice productivity. You will never know what this real $ number is unless you look with an expert, who truly understands how to read these numbers and how you can tap into the opportunity to get them on your schedule ASAP.
If you have Dentrix, Eaglesoft or Open Dental, I can easily show you numerous, -thousands-of-dollars, in patient opportunities, that are waiting for you to tap into each daily in your schedule.
I can still show you these numbers (KPIs and opportunities for your future success) if you have a different practice management software (PMS) but need you to “pull” some numbers from your PMS. I am open to showing the opportunities no matter what PMS you have.
Our 21 Day Hygiene Department Challenge begins now and includes a customized strategy session to see where your untapped potential lies.
Once you have established your goals to achieve during the next 21 days, you and your team will view the daily challenge videos, implementation guides and receive 6 CE Credits once you review the training videos.
The winners of our challenge receive weekly prizes and a grand prize valued over $2,7000.
You will be challenged over 21 days to increase productivity in these three areas:
Increase the number of hygiene patients reactivated
Increase the number of adult patients who complete perio therapy (including gingivitis)
Increase the number of hygiene patients with a restorative diagnosis who schedule their restorative care at the end of their hygiene appointment
Register today for the 21 Day Hygiene Department Challenge.
As of March 23, 2020, the ADA Reported that 76% of Dental Offices Closed Due to COVID-19 Pandemic.
This has caused millions of dental professionals around the world serious sleepless nights!
Here’s the thing…….
When you applied to dental school, you were not thinking about being a business owner. You wanted to be a clinician.
You never intended to deal with a pandemic and the ADA telling you to NOT to care for your routine patients; who you consider friends and family.
What will you do to get these patients back on your schedule?
You don’t have to have a hemorrhage in your schedule AFTER COVID-19!
Check out this plan created for you IF….. you want to achieve and exceed your 2020 Goals.
SUCCESS ROADMAP w/ BLUEPRINT:
BOOST Your Hygiene Department After COVID-19
April 21-23, 2020 8-10AM PDT
6 CE Credits (PACE Approved)
Can you recover quickly after COVID-19?
Absolutely!
Who will join this training support?
Doctor and hygienists PLUS the entire team.
You walk away with a roadmap, a success plan to implement. You will have a plan to triage and schedule the back-log of patients who you rescheduled during COVID-19.
With all the COVID-19 PPE changes you will learn time management during the hygiene appointment to stay on time.
You walk away will a team approach to BOOST your hygiene department productivity and achieve/exceed your 2020 goals.
Learn what is included in treating the gingivitis patient: adjunctive services, appointment sequence(s), determine your fee and how to be reimbursed.
Learn how to get your patients to own their disease and want what they need.
Learn a team approach to reactive, retain and bring in more new patients after COVID-19.
You leave with the exact information to use and implement after COVID-19.
An integrated, team-approach, is your best way to BOOST your hygiene department production.
ABOUT DEBBIE SEIDEL-BITTKE, RDH, BS
Debbie Seidel-Bittke, RDH, BS is founder and CEO of Dental Practice Solutions. Debbie is also a former dental hygiene program director. Her expertise is optimizing the hygiene department by taking a total team approach; including the doctor as the leader.
Please check out the FREE RESOURCE on treating the gingivitis patient which also leads to a CE Course on Gingivitis (2 CE Credits). Grab a FREE RESOURCE here today because when you do, you will be one of the first to know about our FREE Training RE: Treating the Gingivitis Patient.
There is a common question asked by dental professionals and it’s also a question we get from our dental patients.
The question is, “Can we alternate periodontal maintenance with a prophy?”
Read this blog to know the truth and what you really need to do when your patient has completed periodontal therapy – Scaling and Root Planing.
The purpose of this information is to help dental professionals communicate the value of oral disease and inflammation which can contribute to other systemic diseases.
There has been an important paradigm shift in the last 20 yrs. Have you caught the wave? What’s new is that dental hygienists are no longer “cleaning teeth.”
Today’s most successful dental practices are treating the whole body not “just” the mouth. We can help our patients live a longer and healthier life.
Why Periodontal Maintenance?
According the American Dental Association, “Periodontal maintenance is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. It includes removal of bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planing where indicated, and polishing the teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.”
Notice these important phrases as you read this description of Periodontal Maintenance.
instituted following periodontal therapy.
for the life of the dentition.
If new or recurring periodontal disease appears, additional diagnostic and treatment must be considered.
Some insurance companies don’t cover periodontal maintenance. Are you in the business of providing your patients only what their insurance will pay for?
If you said “Yes,” think again.
What if your patient asked you, “Dental hygienist, is cleaning my teeth when you told me my gums are bleeding, the best service you have to offer me?”
What would you say?
Can you honestly answer that a “cleaning” will put a halt to periodontal disease?
Think again. Do your research. There are thousands of journal articles to support the mouth-body connection and how to put a halt to systemic disease and periodontitis. If you have not read this information, I assure you, putting a halt to inflammation does not include “cleaning teeth.”
Prophylaxis Does Not Address Inflammation and Halt Progression of Disease
According to the American Dental Association, Prophylaxis includes the following, “Removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.”
As you read the above two descriptions, Periodontal Maintenance and Prophylaxis, notice the clear distinctions between these two dental hygiene services.
Periodontal Maintenance is after periodontal therapy.
Prophylaxis is intended to control irritational factors.
Periodontal Maintenance includes site specific scaling where indicated and Prophylaxis is intended for irritational factors.
When a dental office offers adjunctive services such as localized antimicrobial antibiotics and/or soft-tissue diode laser, these can be included in the Periodontal Maintenance service however, Prophylaxis is indicated for a healthy patient and these adjunctive services are not a part of treating a healthy patient.
What Your Patients May Think
Your patients may only think that Periodontal Maintenance is more expensive, and they don’t want to return for this service when their insurance won’t pay for it.
Dental hygienists and all clinicians must show patients and help them understand what is happening in their mouth.
Super important that during the exam process to engage your patient. Before you lay your patient back in the chair, before you begin and services, explain to your patient what you will do during today’s appointment.
Ask them to listen and participate during the exam process. If you are completing a comprehensive periodontal exam (CPE), explain the numbers you will call and let your patient know what these numbers mean. For example, “4 mm’s means inflammation. If you hear a 5 or higher, that means active infection and we will put a plan together, so you don’t have infection in the near future. Let your patient know that you will ask them what the highest and lowest number they when you are completing your CPE. This is engaging your patient in their treatment.
When you have completed all of your wellness exams, with doctor and the patient, you can now make a diagnosis. It is super important that once you complete your wellness exams when you see anything abnormal, show your patient what you see. Include your patient by asking them what numbers they heard and ask them to look at what you see by showing them intra-oral pictures, x-rays and your CPE. Help your patient to take ownership of their disease.
Once patients truly understand the disease process and the cascade of events that can occur with their systemic health when active gum disease is left untreated, you will find it much easier for patients to pay and schedule treatment for preventive maintenance (AKA: Periodontal Maintenance).
As you are explaining “active gum disease” to your patient, sit with them knee-to-knee and eye-to-eye showing them what you see. Ask your patient questions as you look together at their x-rays, their comprehensive periodontal exam (CPE) and intra-oral pictures, etc.
An example of what you will explain to your patient:
“Mr. Patient, during your gum maintenance appointment (AKA: Periodontal maintenance) I will remove bacteria and plaque buildup below the gumline (AKA: hard and soft deposits).
Two years ago (Or say the last time they had SRP/Perio Therapy), we treated you for active infection and inflammation. As we have talked about before, inflammation and gum disease contribute to systemic diseases such as high blood pressure, diabetes, rheumatoid arthritis, Alzheimer’s, etc., etc.
I will be using these special instruments to remove bacteria, soft plaque and hard deposits below and above your gumline. (If you use a soft tissue laser you will explain the following) Each time you return for your gum maintenance I will re-treat these areas with my laser which we have previously treated for gum disease This will regenerate the fibers that hold your gums in place and our laser is FDA approved (If you have Millennium Laser) to regenerate bone that was lost during active gum disease.
Gum disease is episodic and at times we need to retreated these areas. At times the disease can become active disease, with infection and inflammation. Just like sometimes you may have the flu and other years you are perfectly healthy, it’s the same thing with gum disease.”
Once your patients understand the value of periodontal maintenance (“gum maintenance” or preventive care”) and when they know that putting a halt to inflammation, infection and active gum disease, will help them live a longer and healthier life, they will be more comfortable paying for the correct service.
I have yet to meet a patient who did not want to live a longer and healthier life, have you?
I sure hope not!
Let’s share this message about optimal oral health and how this relates to living a longer and healthier life!
Will you help me conquer this disease process?
ABOUT DEBBIE SEIDEL-BITTKE, RDH, BS
Debbie Seidel-Bittke, RDH, BS is founder and CEO of Dental Practice Solutions. Debbie is also a former dental hygiene program director. Her expertise is optimizing the hygiene department by taking a total team approach; including the doctor as the leader.
Please check out the FREE RESOURCE on treating the gingivitis patient which also leads to a CE Course on Gingivitis (2 CE Credits). Grab a FREE RESOURCE here today because when you do, you will be one of the first to know about our FREE Training RE: Treating the Gingivitis Patient.
The American Academy of Periodontology has not updated their guidelines for categorizing periodontitis since 1999.
This should be a big deal; right?!
Most clinicians: dentists, dental hygienists and even periodontists tell me they are confused with the new staging and grading for categorizing periodontitis.
What is a dental hygienist to do with the new AAP classifications?
Are you using the new AAP classifications?
Most clinicians I speak to are not using the new classifications.
We are currently working with our client hygienists to embrace this. We show them how to laminate the forms and refer to these when making patient clinical notes.
Let me shed some light on the topic here.
If the AAP has not re-classified periodontitis since 1999, there is a good chance it will be at least ten or twenty years before we have new guidelines.
Let’s embrace the “change!”
The American Academy of Periodontology Classifications are created to help dental hygienists diagnose and treat periodontitis. Follow these guidelines so consistent diagnosis can occur.
The first step is to assess your hygiene patients and of course, every new dental patient must have a comprehensive periodontal exam.
Steps to Use the American Academy of Periodontology Staging and Grading
Step 1: Assessment
Up-to-date full mouth radiographs
Up-to-date comprehensive periodontal exam (CPE)
Chart missing teeth
Step 2: Establish the Stage
As you know cancer is categorized by stages. Think stages of cancer only this is oral inflammation causing destruction of the supporting bone that results in tooth loss.
When you are assessing the stage of periodontitis, explain to your patient and show them what you “see.” Refer to the mouth/body connection as you explain inflammation in your patients mouth.
Now is your opportunity to speak with your patient about the connection between inflammation in your patients mouth and inflammation in the body.
Inflammation in the body year after year contributes to other inflammatory disease such as (and not limited to) heart attack, stroke, rheumatoid arthritis, Crones, Alzheimer’s, diabetes, etc.
Confirm clinical attachment loss (CAL)
Rule-out non-periodontitis causes of CAL (cervical restorations, caries of root fractures)
Determine CAL or radiographic bone loss (RBL)
Confirm RBL patterns (Ex: Vertical or horizontal RBL)
For moderate to severe periodontitis (think Stage III or Stage IV):
Determine CAL or RBL
Confirm RBL patterns
Assess tooth loss due to periodontitis
Evaluate complexity factors (Ex: severe CAL frequency, surgical challenges)
Based on your findings from step 2, determination of mild-moderate periodontitis can be made, and this is considered Stage I or Stage II. Severe or very severe periodontitis is considered Stage III or Stage IV.
Step 3: Establish the Grade
What I like best about this new system to categorize periodontitis is we now bring into the picture: inflammatory diseases, systemic considerations and outcomes of non-surgical periodontal therapy.
What’s a Dental Hygienist to Do with the New Classifications?
So glad you asked!
Your first step is to print out this article including the staging and grading charts.
Take the staging and grading charts, add them to a plastic sleeve or laminate them. Keep these in your operatory.
When you evaluate your patients, refer to your staging chart.
In your clinical notes write, “Stage I, II, III or IV”.
Write as indicated
When a patient has 15%-30% RBL definitely consider writing clinical notes a category for the stage and refer to your Grading chart printed and on the flip side of your staging chart.
If a patient has <15% CAL but smokes 10 or more cigarettes, you will write in your clinical notes: Stage I, < 15% localized horizontal BL (Ex: @ #19 & 30), Grade C (Pt smokes 10+ cigarettes daily).
That is all. If you have a positive outlook on this, it won’t be difficult to write these chart notes
If you have templates add staging, horizontal, vertical < or >, etc.
Now using your template mark or indicate the correct description
Use the staging and grading charts to add these notes in your practice management templates
For patients who have diabetes and/or a tobacco user with RBL you will grade them B or C and this is your time to talk about their “potential” for tooth loss if things do not improve.
Conclusion
Many clinicians I meet are fearful about scaring patients ‘if” and “when” they do tell patients “the facts.”
Imagine this, if you have a colonoscopy or mammogram and the doctor finds a suspicious lesion, will the doctor not tell their patient about this for fear of the patient never returning?
Does a physician feel concerned that their patient’s insurance may not pay for removal of an abnormality?
I have never heard of a physician not telling a patient they have an abnormality because of the above mentioned.
Why do us dental professionals fear telling patients what is truly happening in their mouth?
We have a legal and ethical responsibility to tell our patients what we “see” happening in their mouth and body.
In 2020, dental hygienists are doing more than cleaning teeth.
Dental professionals are in the business of helping people live a longer and healthier life.
Will you join me and help conquer the disease process?
This…….is our JOB!
ABOUT THE AUTHOR
Debbie Seidel-Bittke, RDH, BS
is founder and CEO of Dental Practice Solutions. Debbie is also a former dental hygiene program director. Her expertise is optimizing the hygiene department by taking a total team approach; including the doctor as the leader.
Check out this FREE RESOURCE to treat the gingivitis patient which also includes a new patient appointment sequence of treatment here.
I want to talk about the elephant in the room. Let’s take for example Ronda who is a twenty-year patient of Dr. Curry. Susan is her hygienist of ten years, but Ronda is out sick today. On this particular day the dental hygienists’ patient is schedule for a Prophy but Ronda, the patient, is NOT a Prophy!
To set the stage for the first challenge, Sally is the temp hygienist.
Sally is an amazing clinician. She is good with patient’s; knows how to build rapport and she definitely has excellent clinical skills.
Sally completes all the necessary clinical exams and discovers that Ronda is more than a prophy patient.
The next thing Sally does is talk to Ronda about the change in her oral condition and explains she needs more than a “cleaning” at today’s dental hygiene appointment.
Sally begins treating Ronda for gingivitis and Dr. Curry enters to complete the hygiene patient exam and everything seems fine with Rona.
Everything seemed fine until Ronda got to the front desk and was asked to make a 2nd hygiene appointment in two weeks PLUS, Ronda was told that only one of these two hygiene appointment would be covered by her insurance.
WOW! Now we have a problem!
Ronda complained about all this to the lady at the front desk!
Ronda was NOT happy! She says, “No one ever told me I have gum problems until today!”
I do NOT like this hygienist I just saw!”
Ronda continues, “That hygienist does not know what she is doing!”
Oh my!
The lady at the front desk is rather new and she did not know what to say.
Ronda left without a next appointment.
OVERCOMING OVERWHELM AND CONFUSION
How can this situation which turned sour become like lemonade at your next party?
Well, a dental hygiene appointment (to most) doesn’t feel like a party but how can we overcome this overwhelm and confusion.
Let me outline a few steps that can make a positive change:
When possible, for the long-term patients of your hygienist, let the know you have a temp hygienist
This may take out some of the shock of a different hygienist
Always explain what your patient is there for
Ex: Routine preventive care, x-rays, “abnormality exams (oral cancer and “gum exam”., Comprehensive perio exam), doctor exam, etc.
Before you complete the Comprehensive Periodontal Exam (CPE. To the patient it is called “Gum exam), let your patient know you will check the health of their gums with a ruler. Explain what the numbers mean. Ex: 1 through 3 is healthy. If you hear a 4, that means there is inflammation and if you hear a 5 or higher, that most likely means you have infection and active gum disease.
Ask your patient to listen for the numbers because at the end of your exam you will ask them, “What was the highest and what was the lowest number you heard me call out?”
The purpose of having your patient listen is because when they do hear a number that is more than 3, they will TELL YOU. Rarely, does the hygienist need to ask the patient, “What was the highest number your heard and what was the lowest number you heard?”
I can almost guarantee you that when your patient hears a 4 or 5, they WILL be letting their hygienist know, “that did not sound good!”
If your patient hears you call out “Bleeding on Tooth #3, etc.,” your patient will also be very likely to let you know, that did not sound good!”
Whenever you see something that is abnormal, always take this opportunity to “show” your patient.
Use the intra-oral camera
Take pictures of heavy supra build-up on lower lingual of lower anterior, take pictures of BOP and holes, discolored teeth in your patients mouth. When you see areas of papillary and marginal inflammation, take a picture of the area with your intra-oral camera. Use the intra-oral camera for stains on their teeth and old composite stains and discoloration.
When showing your patient, the intra-oral pictures, ask your patients to tell you what “they see.”
Interestingly, many patients will not be able to tell you they see anything out of the ordinary so at this point in the conversation, you will want to compare health to the disease in their mouth.
Be sure to show them the heavy supra calculus especially if they don’t recognize anything abnormal on the picture you will show them.
Be sure you sit your patient up-right in the chair as you discuss what you “see.”
Explain what you see, using words your patient will understand and yet, use words that add value to the hygiene service.
For ex: Deep cleaning is not going to be value enough to return and pay more money.
Use words like Gingivitis, gum disease, inflammation, infection, bleeding, disease.
Explain the change in today’s appointment after your initial exam of abnormalities.
Explain what future appointments are necessary to treat the abnormality today and what is necessary to prevent disease in the future.
Always follow the system and process of each dental practice.
Many offices find it valuable to quote a fee to the patient when there is a change in the service.
Be aware that it is not “best-practice” to have a patient lying or sitting in a dental chair and then give financial estimates.
Patients should always be in a place that feels “Safe” and “confidential” when discussing private matters such as “finances, etc.”
What do you do when a patient is angry like Ronda became?
This is where a written office- hygiene department system is super important!
When you have a new hygienist and especially when you have a temp hygienist, you should have a guide, a blueprint written for when you treat a prophy and when it is not a prophy.
When does a prophy patient receive treatment for gingivitis?
When does a gingivitis patient return for their next hygiene appointment?
When does a prophy patient become a perio patient?
What happens after scaling and root planing is completed? When does that patient return for a hygiene appointment?
The list of processes for the hygiene appointment is long. It must be written out so everyone on your team knows what is expected……and especially when you have a new or temp hygienist.
HYGIENE-DOCTOR-PATIENT EXAM
Not every dental office has a system where the doctor will complete a hygiene-patient exam in the hygiene room.
It is very helpful to have doctor and hygienist together for the hygiene patient exam. This provides effective communication, and nothing should be missed.
When doctor and hygienist complete the patient exam together, the hygienist can bring doctor into the loop on what has transpired during the hygiene appointment, up-to-this point.
In the situation with Ronda being new to Sally the hygienist, Dr. Curry can also build up Ronda’s confidence about the temp hygienist and let her know how great Ronda is even though she is the temp hygienist today.
At the end of the doctor exam, instead of asking the patient, “Do you have any questions,” change this question and ask, “What questions do you have for me today?”
This is an open-ended question and gets the patient thinking.
When asked a yes or no type of question, patient will usually tell the doctor, “No, I don’t have any questions.”
But as you can see in this situation, Ronda had a lot of questions. She never felt comfortable asking.
I could provide a one-two hour course on this topic.
It’s a hot topic in today’s world of dental hygiene. It’s a big-reason, dentists have been calling our office for support.
Dentists and dental hygienists want to know, what to say to a patient who has always been a prophy but is now “more than a prophy patient.”
I recently wrote a course called, “What’s Blood Got to Do With it?” and I highly recommend you enroll because I will review in two video training modules how to handle patients who are more than a prophy patient.
In this training you will have numerous resources to support reimbursement and so much more. This is not only for the knowledge of the dental hygienist but will support the front office with patients who will pay for more than a prophy appointment.
Also remember, we are here to provide optimal oral health for our patients. It is not the standard-of-care to treat a patient with a specific service because you know a specific service is what their insurance will or will not pay for.
When you are able to help patients “own” their disease, they will be most likely to schedule and pay for treatment.
These patients will continue to return for their appointments at your office.
These are your patients who will tell their friends and family about your dental office!
ABOUT THE AUTHOR
Debbie Seidel-Bittke, RDH, BS is founder and CEO of Dental Practice Solutions. Debbie is also a former dental hygiene program director. Her expertise is optimizing the hygiene department by taking a total team approach; including the doctor as the leader.
Checkout our latest training about treating the gingivitis patient. Each paid registration will receive 2 CE Credits once the complete the course.
