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Debbie Seidel-Bittke, RDH, BS is known as a top dental consultant by Dentistry Today.

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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.