May 27, 2009 | ModernHygienist.com Exclusive
PATIENT | COMMUNICATION

You don't 'clean teeth'

Helping patients understand the differences between prophylaxis, periodontal maintenance and root planing. by Carol Tekavec CDA RDH

Patients with periodontal disease often have trouble understanding that a “regular cleaning” is not an appropriate treatment for their condition. If other dental hygienists provided “cleanings” year after year, the patient may be upset to learn that instead of the usual once over with a pumice cup, you are suggesting nonsurgical periodontal therapy (i.e., root planing). Patients who do not understand their treatment or its’ costs may break appointments, refuse to pay their bills, or even—in worst case scenarious—report the dental practice to the state board of dental examiners! Helping patients understand treatment is the key to patient compliance, payment plans, and predictable progress.

Revamped visits

Although it seems counterintuitive, it may be best to avoid scheduling new patients with a dental hygienist prior to seeing the dentist. Why? If the patient is expecting a prophylaxis (“cleaning”) and the hygienist determines that he or she needs root planing, the patient is probably going to be a little skeptical; remember, the patient does not have a relationship with the hygienist yet, and may prefer the doctor’s evaluation. In some states, in fact, the law requires that the dentist perform an examination before the dental hygienist commences treatment. Don’t let this tactic get you down! This can be a great opportunity for both you and the dentist to explain the importance of your role on the team and the value of your judgement—all before you ever pick up an explorer.

It also is important to remember that the time allotted for a prophylaxis is completely different than what is required for root planing. To top it off, the fee for root planing can be triple the fee for a prophylaxis; the patient may be shocked by the cost. If the patient does not trust the treatment recommendations, problems are inevitable.  Instead of bracing yourself for the potential hassle, have the dentist examine the patient and determine his or her periodontal status. Together, you and the dentist can have a “treament conference” and provide the patient with a written fee estimate—no surprises! You also can provide whatever informational brochures, videos, or other visual aids that may hep the patient understand their issues and the proposed

treatment

From this foundation, future appointments can be made with a much lower chance of misunderstandings. Instead of the dental hygienist being faced with a hostile, mistrusting patient for that first root planing appointment, the patient will have more understanding and will be ready to proceed.

Some offices will say that all of their patients demand a “cleaning” during a new patient exam, and that altering from that model won’t work. That’s only half true: It will never work if you never try.  Attempt to gently steer patients toward receiving an examination first.

word choice

Providing periodontal information to patients in a succinct, easy-to-understand manner can be a practice booster. Using words that are clear—not overly complicated or technical—and addressing a patient’s real questions is vital. Here are a few examples:

Q: What is a “standard” cleaning?

A: A “cleaning ,“ more appropriately refered to as a preventive prophylaxis, is a preventive treatment where plaque, calculus and stains are removed from the teeth. This is accomplished by hand instruments or ultrasonic devices. A prophylaxis is recommended for persons who do not have periodontal disease, meaning no bleeding, mobility of teeth, areas of recession, or exposed roots.

Q: What is a root planing procedure?

A: Root planing is a nonsurgical procedure that removes bacteria and their toxins as well as other deposits from tooth roots. Root planing is often one of the first steps in treating periodontal disease. Infection and inflammation of the gums can cause loose teeth, bad breath, teeth shifting, and may be implicated in several systemic conditions.

Q: What is periodontal maintenance?

A: If you have periodontal disease you may require root planing to remove diseased deposits from tooth roots; surgery also may be required. After the disease process is under control, a preventive prophylaxis is no longer appropriate. Instead you will require on-going care procedures, known as periodontal maintenance, to keep your mouth healthy.

Q: My insurance only pays for teeth cleaning twice a year. Will my insurance cover root planing and periodontal maintenance?

A: Dental plans are really not insurance, which means a payment to cover a loss. Dental plans are actually benefit strategies providing for a limited payment toward a limited number of services people might need. Benefit plans are a big help in paying for necessary treatment, but it is unlikely that your insurance will cover everything you require. Some insurance plans pay for root planing once every five years, and periodontal maintenance twice a year. However, periodontal maintenance procedures are typically needed four times or more per year. Therefore, not all maintenance appointments will be covered by your plan. It is a mistake to let benefits be your sole consideration when making decisions about your oral health. People who have lost their teeth often say they would give anything to have them back.

These few suggestions are among the many types of care you provide and it is worth spending the time, before beginning treatment, to make sure patients are on board.

Carol Tekavec, CDA, RDH, is president and owner of Stepping Stones to Success , as well as a well known author and lecturer. She has appeared at all the nation’s top dental meetings, and is a consultant for the ADA Council on Dental Practice. She has written over 200 magazine and journal articles as well as designing a “Patient Brochure” series.