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The Keys to a Successful Hygiene Patient Appointment: A Team Approach

By: Debbie Seidel-Bittke, RDH, BS

October 9, 2023

Dental Team. It takes team collaboration to create success in a dental practice.

A successful dental hygiene appointment is more than just a routine check-up; it’s the result of a well-coordinated effort that includes the patient, the dental hygienist, the dentist, and the entire team.

Each clinician plays a unique role, in ensuring that oral health concerns, such as gingivitis and periodontitis, etc, are effectively addressed.

This blog delves into the distinct contributions of each dental professional in your dental office, emphasizing the importance of their collaboration in fostering patient acceptance of care and maintaining optimal oral health.

Let’s make dental hygiene appointments patient-centered, enjoyable for the patients and the entire team.

Read on!

Dental Hygiene Time Management. Explains when to complete important patient assessments.

The Role of the Dental Hygienist:

The dental hygienist, often the first point of contact for patients, holds a crucial role in setting the tone for the hygiene appointment. We must begin by creating a comfortable environment, easing patient anxieties, and taking various oral and systemic health assessments. Initial rapport, at the beginning of dental appointments helps build trust between the patient and the dental team.

During the hygiene appointment, dental hygienists’ complete various assessments to identify the patient’s total health, identify areas of concern and any abnormalities.

Dental hygienists are preventive care specialists and not just a tooth cleaner! The main goal during dental hygiene appointments is to assess oral conditions and educate patients about the risks for oral inflammation. Our goal is to halt oral inflammation.

Our overarching message to patients should be, “Optimal oral health is key to helping you live a longer, healthier life.”

Dental hygienists must strive to provide a partnership with their patients. When we collaborate with patients rather than tell them what we find, we are more likely to have patients who “Take ownership of their disease” and “want what they need.”

Collaboration is key to case acceptance.

The Dentist’s Role:

Dentists play a pivotal role in the success of the hygiene patient appointment. During the hygiene patient exam, dental hygienists have a perfect opportunity to bring the doctor into the loop on exactly what has been discussed and what they have identified with the patient up to this point.

It’s helpful to provide positive feedback to the dentist during the hygiene exam; not always talking about “what’s wrong with the patient’s oral condition.” Remember to compliment patients when they have improved their oral health, positive outcomes, great oral health, etc.

When hygienists become a partner with the dentist during the hygiene patient exam, it’s much easier for the patient to accept all necessary dental care. The partnership between hygienist and dentist combined with patient collaboration, will create a higher level of case acceptance.

Since the hygienist has been looking around the patient’s mouth for the past thirty plus minutes, they have a great opportunity to support the patient in making the best decisions after dentist has made a diagnosis.

When the dentist arrives to complete the hygiene patient exam it is beneficial to have x-rays and intra-oral images available for the doctor to quickly review and confirm any diagnosis.

During the treatment planning phase of the hygiene appointment (See above image), hygienists must take time to review with their patient what they see happening in the patient’s oral cavity. This is where the patient and hygienist collaboration begin. This makes case acceptance much easier for the patient.

“Seeing is believing!”

This treatment planning phase is vital for creating a positive response for patients to accept proper care. Refer to the above diagram for timing of the various phases during the hygiene preventive care appointment.

Dental Assistants Role:

Dental Assistants play an important role in supporting the hygiene appointment. Imagine the dental assistants as the air-traffic controllers in a dental office.

There is no need for a dentist to wait until the end of a hygiene appointment to complete the hygiene patient exam. About half-way through a dental hygiene appointment, the hygienist should have completed the assessments and taken time to discuss treatment with the patient.

The dental assistants must be aware of which hygiene patients need an exam. While the dental assistants are with the dentist, and when they know the dentist can take a break from working on their patient, the dental assistant will request the dentist goes to the hygiene room and complete the hygiene patient exam.

*See the above Time Management image to support this process during hygiene preventive care appointments.

Examples of opportunities for doctor to complete a hygiene patient exam:

  1. Waiting for local anesthesia
  2. Waiting for an impression
  3. Dental Assistants can scan the patient while doctor completes the hygiene patient exam
  4. What else can you add to this list?

Since the hygienist has taken time to review any abnormal oral conditions (gingivitis, periodontitis, cracked or worn out fillings, crowns, abfractions, occlusal wear, etc, etc) and/or discussed unscheduled restorative care, the hygiene patient exam should not take longer than seven minutes.

Waiting until the end of a hygiene appointment can mean waiting for the dentist to take time away from their patient to complete the hygiene patient exam. Waiting for the doctor leaves the hygiene patient waiting and hygienists will run behind for their next patient.

Collaboration is key during the hygiene patient exam and therefore, hygienists play a valuable role in sharing with their doctor what has been discussed with the patient during the hygiene appointment.

Effective Communication:

During the hygiene patient exam, the hygienist will report on the following:

  1. Personal updates, rapport
  2. Medical history update
  3. Oral abnormality (Soft and hard tissue screening)
  4. Comprehensive Periodontal Evaluation (Annual). 1
  5. TMD: Occlusal wear, abractions, etc.
  6. Sleep Apena (report on tonsils, tongue, lack of sleep, snoring, etc)
  7. Restorative Unscheduled and any new cracks, leaky fillings, crowns and/or open margins
  8. Gingival health, BOP, gingivitis, periodontitis, localized inflammation, etc.
  9. What you have completed today: preventive care, polish, gingivitis, gross debridement, LBR (soft-tissue laser), fluoride treatment, etc.
  10. When will the patient return? Example: 4-6 weeks re-evaluation for gingivitis or starting gum treatment ASAP, etc.

Every clinician must use the same words and phrases when speaking with the patient. Break down the words and phrases into words the patient can easily understand.

Use words that are descriptive such as: bleeding, infection, inflammation, hole in the tooth or discoloration, etc. Stop telling patients they will have their teeth cleaned. Dental hygiene appointments are about the prevention of disease not about cleaning teeth. 2

Collaboration Between Clinicians:

The synergy between the dental hygienist, the assistants, and the dentist, are vital in providing the patient with a well-rounded and effective treatment plan. Their collaboration allows for a thorough assessment and diagnosis, ensuring that no oral health issues are overlooked.

This teamwork fosters trust and confidence in the patient, knowing that their dental care is in capable hands. When the dental assistants guide the dentist through their day, it makes the day run more smoothly.

Consider a ten-minute team huddle before your day begins so all the clinicians know where they must be and when they must be there. The front office team should also know this information to prevent bottlenecks at the front office as well as who will need to make payment and other valuable information for a successful day.

The front office is also part of this collaboration.

Once the patient has completed their hygiene appointment it’s imperative for the patient to be personally walked up to the front desk.

If there is a hygiene assistant they can schedule the patients next hygiene appointment and walk them to the front desk where the hygiene assistant will share the important information about what occured during the patients appointment, if they have a next hygiene appointment and what they must be scheduled for if there is restorative treatment needed.

When there is a financial arrangement to be made the front office must have a private area to discuss flexible financial options, personal information.

Case Acceptance:

Clinicians must present a united front when discussing treatment and future appointments. Enthusiasm and expressing urgency when there is necessary care are very important pieces to case acceptance. When patients understand how well the team works together for their well-being, and how much their healthcare providers care about their total health, patients are more likely to comply with recommended treatment and maintain consistent preventive care.

Hygienists should know what type of care the dentist will most likely recommend for the patient and be able to discuss the various types of treatment; risks and benefits. If hygienists are not able to properly speak with patients about the type of treatment doctor completes such as implants, veneers, etc., it’s time to schedule an in-service with doctor and the hygienist(s) so everyone is on the same page.

You may want to consider bringing in an expert to help train the hygienists and the doctor so everyone can speak about optimal oral care options with patients. It is imperative that the entire team understands how to effectively communicate the types of dental services available.

There are experts who can guide doctors, hygienists, and the entire team so your dental practice achieves 75% or higher case acceptance each month.

Conclusion:

During a successful hygiene patient appointment, each clinician’s role is distinct and equally crucial. The dental hygienist’s skill treating disease, utilizing preventive care modalities and technology, communicating restorative and cosmetic care options, educating patients about optimal oral health benefits, coupled with the dentist’s expertise in diagnosis and treatment planning, creates a harmonious hygiene team.

This collaboration promotes higher case acceptance and contributes to maintaining the patient’s oral health. Optimal oral health will lead to a longer, healthier life.

By understanding the unique contributions of each clinician and working together as a cohesive unit, dental professionals can ensure that patients receive the highest level of care and support. This approach not only addresses immediate oral health concerns but also promotes a lifelong commitment to prevention of disease and overall well-being.

Do you want to learn about the un-tapped potential in your dental hygiene department?

I have a few open spots for a quick overview of your hygiene department.

Book your complimentary hygiene productivity call here.

References.

  1. Comprehensive Periodontal Evaluation. https://tinyurl.com/23atrxm2 Accessed October 1, 2023.
  2. Motivational Interviewing. https://tinyurl.com/yappeexh Accessed October 9, 2023.
Posted in Business of Dentistry, Dental Hygiene Appointment, Dental Hygiene Coaching, Dental Hygiene Department, Dental Hygiene Department Services, Dental Hygiene Patient Exams, Dental Hygiene Patients, Dental Hygiene Services, Dental Hygiene Treatment, Uncategorized

A Dental Hygienists Guide to Treating Oral Inflammation

By: Debbie Seidel-Bittke, RDH, BS

September 26, 2023

Dental Hygienists and Soft Tissue Diode Laser

Periodontal disease is a prevalent oral health issue that affects millions of people worldwide. If left untreated, it can lead to tooth loss and other systemic health problems. 

In the battle to conquer this disease process, dental professionals employ various techniques and tools to provide effective treatment. One service that has revolutionized treatment of oral inflammation and one that has a significant result in our total health and well being is use of the soft tissue diode laser. 

In this blog, we will explore how diode lasers are used in the treatment of periodontal disease, their effectiveness in targeting aerobic cells, and the ability to boost cellular mitochondria. 

This blog will also explain the hygienist’s responsibility to determine health or disease in the oral cavity, how to sequence  appointments when a patient has various levels of gingival inflammation and you will learn about the benefits of using soft tissue diode lasers. 

At the end of reading this blog you will have information to help your patients better understand the importance of optimal oral health and how this will help them live a longer, healthier life!

Diagnosis of Gingivitis and Periodontitis:

The journey towards treating periodontal disease begins with a comprehensive examination of the oral cavity and a diagnosis. When your patient is seated in the chair for a dental hygiene preventive care appointment it’s imperative for the dental hygienist to evaluate for any abnormalities.

An annual comprehensive periodontal examination (CPE) must be performed at the beginning of a dental hygiene appointment to determine if the patient has active periodontal (“gum”) disease: Gingivitis or Periodontitis. Our goal is to determine optimal oral health.

When the dental hygienist recognizes generalized moderate to severe gingival inflammation, with or without radiographic bone loss, the hygienist and dentist will make a diagnosis for treatment of gingivitis or periodontitis.

When there is a diagnosis of generalized moderate to severe gingivitis or periodontitis, the clinician will properly plan a sequence of appointments to treat the disease which will also include scheduling a 4-6 week re-evaluation, to determine an end-point of the disease.

At the time of a diagnosis and when the patient has active gum disease, a sequence of appointments to treat the disease will be scheduled.

Periodontal Disease Etiology:

Bacterial plaque is the primary etiologic factor associated with periodontitis, yet there are several other variables that may place an individual at risk for developing disease. Two of these variables are clearly defined risk factors: tobacco smoking and diabetes.

Periodontitis is considered the sixth complication of diabetes. Periodontitis and diabetes (DM) have a two-way relationship. DM increases the risk of periodontitis, and severe periodontitis coexists with severe DM. 

It’s mandatory for diabetic patients to receive adequate treatment for periodontitis.

The basic treatment modality for periodontitis is scaling and root planing. The conventional periodontal procedure includes scaling and root planing (SRP), which consists of debridement of contaminated root surfaces as well as the elimination of bacteria and their endotoxins from the cementum and from the adjacent periodontal tissues. 

Scaling, root planing and curettage procedure creates a long junctional epithelium with no connective tissue attachment.

During the InitialAppointment, the Dental Hygienist Will:

  • Conduct a comprehensive oral health assessment with comprehensive periodontal evaluation (CPE). CPE includes measuring pocket depths, assessing bleeding upon probing, recording recession, mucogingival involvement, furcation, occlusal disease, etc. 
  • Recent full mouth  x-rays are used to determine the extent of disease.
  • Identify any contributing factors such as tobacco use, medical conditions such as diabetes, high blood pressure, RA, Crohn’s disease, etc, and/or poor oral hygiene habits.
  • Formulate an individualized treatment plan tailored to the patients specific needs.

The Role of Soft Tissue Diode Laser

Soft tissue diode lasers have become indispensable in modern dentistry, particularly in treating gingivitis and periodontal disease. Diode lasers emit specific wavelengths of light that are absorbed by pigmented bacteria and inflamed tissues, making them highly effective in eradicating bad cells and promoting healing.

Soft Tissue Diode Laser Therapy 

Let’s delve into how the soft tissue diode laser becomes a crucial component in the treatment of oral inflammation. Use of the diode laser targets the bacteria and inflamed tissues in the periodontal pockets.

  • Reduction of Inflammation: Diode lasers also promote the reduction of inflamed tissues, creating a more conducive environment for healing.
  • Stimulation of Mitochondria: Research suggests that diode laser therapy may stimulate the mitochondria of cells, enhancing their energy production and overall cellular health.

Practice Management/Communication Tip: “What happens inside the mouth transfers through the saliva and blood stream and eventually happens inside the body. Year after year of bleeding gums year after year, can create various systemic diseases such as: heart attack, stroke, high cholesterol, Crohn’s Disease, Parkinson’s Disease, Low Birth Weight Babies, and even Alzheimer’s Disease, etc.”

The enhanced reduction of inflammation induced by laser therapy is also due to the effective bacterial reduction property of diode lasers. In previous research it was demonstrated that diode laser light at 805 nm eliminated Aggregatibacter actinomycetumcomitans and Porphyromonas gingivalis in periodontal pockets. 

Lin et al, demonstrated that subgingival treatment with the diode laser effectively inhibited recolonization of A. actinomycetumcomitans for up to 28 days than in root planing. 

Note. Read below about the end-point and re-evaluation appointment for more information on the importance of this 4-6 weeks re-evaluation appointment.

Pick et al. showed that diode laser light not only eliminates bacteria but also inactivates bacterial toxins diffused within root cementum. A study by Moritz et al. showed that Gram-negative species showed immediate structural damage when exposed to the laser. Diode laser at 810 nm causes bacterial damage without injury to periodontal tissues.

Soft Tissue Diode Laser Therapy Advantages:

  • Minimally invasive: It requires no incisions, minimizing patient discomfort and reducing the need for sutures.
  • Precision: The laser can precisely target infected areas, leaving healthy tissues unaffected.
  • Reduced healing time: Patients typically experience faster recovery compared to traditional methods.
  • Improved outcomes: Laser therapy can lead to better results and long-term periodontal health.

Re-Evaluation, Periodontal Maintenance, and  End-Point

The final phase of Phase I therapy involves 4-6 weeks re-evaluation. This is also known as (in the case of using a CDT code) the patient’s 1st periodontal maintenance appointment. 

This appointment is essential for long-term success in managing periodontal disease. The 4-6 week re-evaluation is very important because we must identify an end-point of the disease process.

When we see a physician for treatment of a disease there is always a re-evaluation appointment to be certain the disease process has ended.

In terms of treating dental patients, we will have the same sequence of appointments: re-evaluate to determine an end to the disease process. Only when you have a patient return after treatment of active disease can you can clearly determine the next interval for preventive care (Periodontal Maintenance).

Never do we treat disease and hope for a positive outcome. We must always have patients return for an evaluation to determine the state of the disease.

Our goal is to halt bleeding gums and gingival inflammation. Only when we know there is an end point to active gingival disease can we truly help our patients live a longer, healthier life!

The Dental Hygienist Will:

1. Complete the CPE

2. Determine if there is a halt of the disease process or if the patients will need referral to a periodontist, etc, 

3. If periodontal disease is no longer in an active stage the hygienist will:

  • Complete LBR full mouth
  • Scale any new calculus
  • Polish
  • Re-cap mouth-body connection, perio process (episodic and cyclic, etc.), review homecare and
  • schedule regular follow-up preventive care appointments, typically every 3-4 months, to monitor periodontal (“gum”) health.

Conclusion

Periodontal disease is a chronic gingival disease in populations around the world. Treatment of this disease requires meticulous care and attention. 

Soft tissue diode lasers have emerged as powerful tools in the battle against gingivitis and periodontal disease, offering precision, reduced invasiveness, and the potential to stimulate cellular mitochondria. 

By following a comprehensive treatment plan that includes diagnosis, gross debridement, soft tissue diode laser therapy, scaling and root planing, end-point re-evaluation and ongoing maintenance, patients can achieve optimal total health. 

Our overarching message to patients is that optimal oral health will help us live a longer, healthier life.

Do you have questions about this? 

Would you like to learn more about treating gingivitis and periodontitis patients?

I have opened my calendar for 30 minute complimentary coaching sessions. Book yours today. Doctors and hygienists must be present for this un-interrupted 30 minutes!

BOOK HERE

Resources.

  1. Löe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993;16:329–34. Accessed September 21, 2023.
  2. Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, et al. Periodontitis and diabetes: A two-way relationship. Diabetologia. 2012;55:21–31. Accessed September 21, 2023.
  3. Adriaens PA, Edwards CA, De Boever JA, Loesche WJ. Ultrastructural observations on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth. J Periodontol. 1988;59:493–503. Accessed September 21, 2023. 
  4. J Pharm Bioallied Sci2015 Aug; 7(Suppl 2): S636–S642. doi https://tinyurl.com/LBRPTRDIODE . Accessed September 21, 2023.
  5.  Laser curettage as adjunct to SRP, compared to SRP alone, in patients with periodontitis and controlled type 2 diabetes mellitus: A comparative clinical study. Accessed September 21, 2023.
Posted in Dental Hygiene Adjunctive Serivices, Dental Hygiene Appointment, Dental Hygiene Department, Dental Hygiene Department Services, Dental Hygiene Patients, Dental Hygiene Services, Dental Hygiene Services, Dental Hygiene Training, Dental Hygiene Treatment

To Charge or Not to Charge. Oral Cancer Screenings

By: admin

March 13, 2017

Oral Cancer Screening

Video: Oral Cancer Screenings. To Charge or Not to Charge

CLICK THIS LINK TO VIEW VIDEO

Years ago, the dilemma that most dental professionals faced was regarding whether to use advanced technology to screen for oral cancer.

Today’s Facts: The occurrence of oral cancer has continued to rise and has begun affecting a younger demographic, due to a staggering increase in the prevalence of human papillomavirus (HPV). Fluorescent technology for early discovery of this growing epidemic has continued to evolve. Adjunctive devices have been simplified and very cost-efficient. My preference is the OralID because of the light weight and small size of the device. This technology makes oral cancer screening a no-brainer.

The questions that continue to repeat in the dental clinicians mind is:  “Should we charge for this or not charge?”

Once the dental team has decided to charge the next questions are:
“How much do we charge our patients for this enhanced oral cancer screening?”
“Do we only bill insurance, or do we screen for free as a service to our patients?”

The great news is: With the latest device having zero cost per patient use, you can incorporate the technology with whichever answer to the question fits your practice best.

Below, I will outline a few examples on ways to incorporate enhanced oral cancer screening into your practice.
To Charge
Charging for services performed is standard in health care. As you invest in your practice, in terms of both time and money, it is natural to assume compensation will allow you to make a return on your investments. Enhanced oral cancer screening is a service you provide, and it is perfectly acceptable to expect an increase in revenue in return for the service.
How to charge for enhanced oral cancer screening can vary from office to office. Here are a few options for charging:
Charge an annual fee: You can simply charge a flat fee for your enhanced oral cancer screening. Set a fee of around $20 (or within a range of $10 to $35) per patient, per year. If you educate your patients properly, you should see fairly high acceptance rates in your office. But if you just hand a patient a consent form and ask for a $65 fee, you will not have any success. So, if you decide to incorporate this method, make sure that the fee is reasonable and that you have educated your patients about the importance of what you are doing. Explain that you have invested in the technology because it could potentially save their lives. OralID offers Lifetime Team Training by our in-house hygienist, so you can get help with ideas on how to best educate your patients and maximize screening acceptance.
Charge one fee for life: In the spirit of the “whitening for life” campaigns that some offices offer, you can charge up-front for participation in an “oral cancer screening for life” program. Charge $35 to $100 at the first visit and then screen the patient at no additional charge during future visits (as long as he or she does not miss any hygiene appointments, of course).
Raise your fees: Increase your exam and/or prophy fees to include the service and do not charge the patient directly for it. This allows you the freedom to screen every patient and compensates you for your time and for your investment.
Not To Charge
Dental practices are always looking for ways to differentiate themselves from competitors. Offering advanced oral cancer screenings is a proven method for increasing marketability and gaining new patients. Performing free oral cancer screenings for every patient is a service that will be appreciated by patients and that will not only get you more loyalty from current patients but also motivate them to refer friends and family-and this is the ultimate marketing goal.
You can hand a card to each patient that reads, “Has your loved one been screened for oral cancer?” or a coupon for a free oral cancer screening. Doing so will certainly differentiate your practice from the others, building value in the practice by maintaining and growing the patient base. The days of “whitening for life” are unfortunately over, but offices can now incorporate “oral cancer screening for life” for their patients due to the latest technology finally being affordable enough to make it possible.

CDT Code to Bill: D0431
A change in thinking
Patient care should be the focus for all offices. Given that, you may eventually change the method you choose in regard to charging or not charging. It’s not uncommon for offices to begin screening by charging for the service, only to decide not to charge after finding a lesion that might not have been discovered without the device. For many practices, a situation like this one is a practice changer that leads to the realization that enhanced oral cancer screening is important for every patient.
So, when you are thinking about the new screening decision, whether “to charge or not to charge,” remember that there is no right or wrong. By making the simple choice to incorporate this technology into your practice, you could be making a life-changing decision for your patients.

For more information on the OralID go to: ORALID MORE INFORMATION

Posted in CDT Dental Insurance Codes, Dental Hygiene Adjunctive Serivices

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