3 Steps to Increasing Acceptance for Periodontal Services

Wendy Briggs;

3 Steps to Increasing Acceptance for Periodontal Services

January 19, 2015

Modern Hygienist, modernhygienist.com-2015-01-01, Issue 1

For the last several years, I have been fortunate to work with many of the top dental practices in the country. As I review their vital statistics and study procedures done, I am often alarmed at how often we struggle to provide periodontal services.

I often see that our challenges in providing periodontal care are not in performing the procedures themselves. Rather, it’s having patients ready and willing to have the services done.

Many dentists think they should be providing periodontal care to 25-40% of their patients. Yet, when we evaluate where they really are, it’s often far below that. Some are stunned to find out that less than 5% of their patients are currently enrolled in a periodontal maintenance program. Practices that have studied this extensively and worked diligently with their teams might be a bit higher than that, but the reality is we are often underperforming in this area.

Again, in my experience, the problem is not in our clinical abilities to scale and root plane when heavy calculus exists, but rather gaining acceptance from our patients on these procedures that are costlier than the “regular cleaning” and may or may not be covered by their insurance policy.

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Hygienists face real obstacles in discussing periodontal disease. We all know that periodontal disease is a complex, bacterial condition that presents a real threat to the patient’s oral health. In studying the oral-systemic link, it is widely accepted that having periodontal infection also represents a serious threat to the patient’s systemic health. So why is it so difficult to have the patient complete all four quadrants of therapy and return for recommended maintenance?

Here are some simple steps that we teach to hygienists that have proven to help improve acceptance for periodontal procedures.

Step #1: Probing correctly

This may seem basic but it’s an important step. I am not talking about proper insertion and angulation of the actual probe, but rather how we present what we are doing to our patients. If we do this correctly, we help patients understand why we are recommending they have the services done.

Setting the stage is critical. The moment you see warning signs of periodontal disease (even before you start probing), it’s important to tell patients that you are concerned about some warning signs of infection you see in their mouth. Then explain that you’re going to take some measurements in order to do a more thorough assessment. Tell the patient in advance what the numbers mean to help him or her understand what’s going on.

We have found success when we explain the numbers in the following way:

If you hear a three or under, it’s considered healthy.

Anything higher than a three means there is infection.

If you hear anything higher than a five, this means the infection has already spread to the bone.

Just by listening to us call out the numbers, the patient already knows there is a problem. It is not uncommon to have patients react immediately when they hear us calling out 6-5-6, 7-5-7. When you do it this way, you don’t have to tell the patient there is an issue. They often will look at you and say, “We have a problem!”

Step #2: Helping the patient see their disease for themselves

There are several ways we can do this. Some hygienists will have the patient watch a suitable educational module so that they understand the issues fully. Choose your module carefully as some give way too much information and actually turn patients away from treatment rather than educate them as to why they need treatment.

To introduce the module, you can say, “As you could tell from the numbers, we do have some infection in there. I am going to have you watch a short video that will help you know what we are talking about.”

The reason this is important is that it’s not enough just to talk about options and solutions. We need a format that presents the information visually. It is said that 87% of patients are visual learners and will not truly understand it until they see it. Patient understanding and retention is much greater with visual information. This also helps us with efficiency because while the patient is watching the video, the provider can step away and make notes on the chart or enter information on the computer.

Another exciting way to do this is with a Soprocare camera by Acteon. I love being a hygienist in today’s world! We have such incredible technology with which to work. The Soprocare camera utilizes varying wavelengths of light to help us educate our patients. This tool actually has a “Perio Mode” setting that is unlike anything else I have ever seen. With this setting, I am able to have my patients see for themselves the inflammation and deposits that we see. As trained dental professionals, we can easily see plaque and calculus in our patients’ mouths. Now with the Perio Mode setting, plaque and calculus become visible to our patients’ untrained eyes. They also can see areas of tissue inflammation and redness for themselves. When they see their mouth and can recognize these concerns, they are more likely to accept periodontal treatment. We have seen the visualization of their current conditions help to motivate and inspire patients to move forward with recommended periodontal treatment.

Step #3: Review findings with the patient utilizing simplified terminology

In the next step, it’s important to review the findings with the patient and review the health assessment form. Note: The health assessment form is available to our members in the resources area of our member-only website, but I have included a link to a free PDF of this tool at the end of this article.

When a practice has multiple providers and/or multiple locations, it can be a challenge to get all the hygiene providers and dentists on the same page. This tool is an example of a system that can help everyone get on the same page when it comes to determining the level of infection, and what should be done. This resource is especially helpful if we are dealing with a patient who is borderline.+

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The form is not a final diagnosis. Rather, it’s meant to be a guide to help providers make an assessment. The doctor always makes the final diagnosis.

After the patient has watched the educational module, the hygienist could say,

“Let’s review where you are. Do you have any questions about the video? Let’s talk about what level of infection is present and about how we can help control and maintain this infection that’s in your mouth.”

If we have used the camera to show the patient the obvious infection and calculus present, they often can see for themselves and will ask about solutions. We then go on to explain the three steps needed to clear up the infection, being careful to use simplified language that the patient can understand.

“The first step is to do a deep, more aggressive treatment than you’ve had in the past.” And then I stop. At this point, the patient is probably thinking this is going to involve pain and discomfort. We need to reassure patients we will do everything possible to keep them comfortable. If they have a fear of pain, they will not come back. We have a tremendous advantage with state-of-the-art technology and power scalers.

An analogy that we often use when talking about a deeper cleaning is making a comparison with a splinter. You can explain it’s like having a splinter under the skin.

If we don’t get rid of the splinter, the area is never going to heal. In the same way, we need to do the cleaning to get the buildup out and to clear the area of bacteria.

We often will utilize lasers with our periodontal therapy, and will introduce that concept here as a way to keep them comfortable while providing a thorough “detox” of their mouth.

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“The second thing we need to do is to change a few things that you are doing at home.” We have to be very careful here. Patients don’t appreciate the lecture on what they are not doing. We try to have a guilt-free, lecture-free discussion. We don’t focus on what they are NOT doing. Instead, we discuss getting them better tools.

When we have this level of infection present, it is time to focus on helping our patients be more effective in their daily battle against the bacteria. We often recommend using a power toothbrush. When it comes to recommending the power brush, we love the analogy of a screwdriver – a basic job can be done with a manual screwdriver but a big job will need a power screwdriver. With the level of infection they have in their mouth, it requires a tool that will do more for them.

We also may suggest that they get a prescription mouthwash and recommend they use something every day to keep the bacteria under control. They are open to this and people are willing to follow our recommendations … if that’s what gets the job done.

Whatever products you are recommending to help minimize infection can be introduced here.

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“The third step is to see you more frequently than we have in the past.”

We know how important it is for the patients to come in for three- or four-month recall visits but patients don’t realize how critical it is. In 2012, the Journal of Periodontology stated that after scaling and root planing alone, the bacteria returns to pre-treatment levels in just 21-60 days. We need to evaluate and attack the bacteria again within the first four to eight weeks. Patients need to understand that this is not a one-time fix. Just like any other bacterial infection, they can have re-infection and progression of the disease.

We need to explain that after the initial therapy, if they don’t come back for maintenance visits more often, they can end up back where they started. The disease will continue to progress and the infection can continue to cause damage.

We have overwhelming scientific proof that dental health affects overall health. Infection in the mouth often means the patient is at risk for other serious medical illnesses. In a 2012 consensus published by the AAP and the EFP, they stated that evidence exists that indicates a connection between periodontitis and other systemic diseases, such as chronic obstructive pulmonary disease, pneumonia, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome, and cancer.

We know this, but patients do not. We need to help them understand the serious nature of their diagnosis and what is required to keep them smiling for many years to come.

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