Dianne Glasscoe Watterson, MBA
Dear Dianne,
I am a solo practitioner and have two full-time hygienists. Our practice is very busy, and I don't have the luxury of spending copious amounts of time in the hygiene exam. But I wonder if my hygienists are missing periodontal problems, as they rarely identify anything that needs deep scaling. They typically get 45 minutes for a prophy patient and one hour for new patients. Periodontal probing seems to be hit or miss. How can I make sure that my hygienists are being thorough with regard to periodontal charting?
- Dr. Tom
Dear Dr. Tom,
The first question I would ask is this: Do the hygienists have assistance with recording periodontal readings? Are there auxiliary assistants who are available to help when needed? My experience is that many hygienists do not perform thorough probing/recording because they don't have any help or enough time. It will take anywhere from 10 to 15 minutes for a hygienist to perform a charting solo, but with an assistant, the task can be completed in five minutes or less. Some offices have implemented voice-charting systems, which do not require an assistant. A 45-minute appointment may be sufficient for a very easy patient, but more difficult patients (such as smokers) will need more time in order to complete the prophylaxis and periodontal chart.
Make sure your hygienists know that you expect them to perform a six-point probing/recording once per year on all adult patients. When you walk in the operatory, ask to see the latest periodontal charting if it is not provided for your inspection voluntarily.
Your hygienists may need help in understanding how to usher a patient into definitive periodontal care, especially if the patient is an established patient. Let's say that during the course of a probing, the hygienist identifies two 6 mm pockets that had not been identified before. The discovery of the pockets should lead to some questions: "Have you noticed this area bleed?" or "Has this area been sore?" Whatever the answer, the discovery leads into a discussion about the definitive care that is needed to resolve the problem. "There have obviously been some changes since we last checked your readings, but the good news is that the disease process is at a very treatable stage." Any disease activity is a sign that definitive care is needed, and the earlier periodontal problems are identified, the more likely a good outcome can be achieved.
In discussing needed treatment, I suggest that hygienists and dentists avoid the use of the phrase "deep cleaning." In the mind of the anxious patient, this phrase spells an unpleasant dental visit and pain, the very reason many people avoid dental visits. I suggest the use of "definitive periodontal treatment" as a better phrase to use. A description of the microbial activity associated with periodontal disease might go like this: "Periodontal diseases are chronic infections that require specific treatment aimed at controlling the microbes that cause bone loss around the teeth over time. So we will treat the problem and teach you how to maintain the problem areas better in the future." When there is lots of calculus, I like to use the coral reef analogy in order to help people understand the whole microenvironment under their gums.
Some consultants feel that at least one-third of hygiene codes should be periodontal codes, either definitive care or periodontal maintenance. However, the "one-third" stat is not applicable in some practices that have a very low number of new patients and a majority of well-maintained patients. All the same, there's always room for improvement, and it sounds like your hygienists need to ramp up their identification process. They can do that with your guidance.
All the best,
Dianne
Dianne Glasscoe Watterson, MBA, is a consultant, speaker, and author. She helps good practices become better through practical on-site consulting. Please visit Dianne's website at www.professionaldentalmgmt.com. For consulting or speaking inquiries, contact Dianne at [email protected] or call her at (301) 874-5240.
