Andrea Kowalczyk

	The latest statistics on the prevalence of periodontal disease in the United States are startling. The CDC states that 47.2% of adults aged 30 years and older have some form of periodontal disease. These findings are based on a comprehensive study conducted in 2009 and 2010, and published in the 

, the official publication of the International and American Associations for Dental Research.

According to the findings, periodontal disease increases with age, with 70.1% of adults 65 years and older having periodontal disease. The condition is more common in men than women (56.4% vs 38.4%), those living below the federal poverty level (65.4%), those with less than a high school education (66.9%), and current smokers (64.2%). The classification of disease used in this study does not include gingivitis.

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As eye-opening and indisputable as these figures are, I hear from many hygienists who insist that the majority of the patients whom they treat do not present with periodontal disease, other than gingivitis. A common refrain from these hygienists (and doctors) is, “There is just no perio in our office.” Most of these clinicians site the high socioeconomic status of their patient pool, coupled with the high dental IQ of their community, as being the reason so many of the clients are “healthy.”

However, upon closer inspection and record auditing, we often find that many patients do in fact present with disease. The disconnect is that disease is not being recognized and classified as such. Unfortunately, proper treatment planning to treat existing disease is not being done as a result.

HOT READ: How does your practice stack up with the Perio Percentage KPI?

Even the most talented and experienced clinician will often overlook disease if the proper assessments are not being performed. In the busyness of the day, we can skip the critical assessments that enable a correct diagnosis. Some clinicians consider X-rays and a tour of the mouth a “comprehensive assessment."

While I completely understand how stretched clinicians are for time, there is just no definitive way to know if periodontal conditions exist without periodontal charting that includes identification of bleeding points. Bleeding is the first sign of disease, with pockets forming in later stages. Once bone loss is present on radiographs, it is too late to reverse the course of the destruction.

New patient and recall exams should have enough time built in to allow a comprehensive periodontal assessment if we are to avert and arrest disease. Time to educate patients on their condition, the course of treatment, and the proper home care routine should be included as well. With the prevalence of disease being what it is, it is advised to schedule 90 minutes for a new patient exam, and at least one hour for recalls.

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In terms of “not having any perio” in the office, clinicians are advised to brush up on the risk factors for periodontal disease. In addition to comprehensive assessments, risk plays a prominent role in disease progression, but is often overlooked. Consider the risk factors:

		Underlying immuno-deficiencies-e.g., AIDS

		Taking medications that cause dry mouth

		Female hormonal changes, such as with pregnancy or the use of oral contraceptives

Many, if not the majority of our patients present with one or more of these risk factors.

When they begin to properly assess, many clinicians find their percentage of periodontal cases coming more in line with current statistics. Not only are patients being properly treated with the most conservative measures available, but practice revenue increases concurrently.

Author's Note: Are you ready to improve the periodontal care you provide in your office and increase hygiene revenue? Contact us today at hello@enhancedhygiene.com to learn about our onsite or virtual training programs. 

Articles

 The latest statistics on the prevalence of periodontal disease in the United States are startling. The CDC states that 47.2% of adults aged 30 years and older have some form of periodontal disease. These findings are based on a comprehensive study conducted in 2009 and 2010, and published in the Journal of Dental Research, the official publication of the International and American Associations for Dental Research.

The comprehensive assessment is critical in diagnosing periodontal disease

	If we described a team member who produced 30 percent of the practice revenue, was the reason more than 80 percent of new patients came into the office and from whose operatory 60 percent of restorative treatment was discovered, you may likely be thinking this is one heck of an associate and partner.

Actually, we have just described your hygienist!

As a provider of care, generator of revenue and a chief draw of new patient and recall traffic, the hygienist should be viewed as a 

 in the practice, and yet we often relegate them to subordinate, auxiliary employee status.

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There are various reasons why we overlook the value hygienists bring to a practice, chief among them the fact that hygienists do not view 

 as partners and often do not realize their own value and contributions.

We are not advocating that professionals who do not diagnose treatment be given equanimity with the doctor. We all know that treatment decisions ultimately fall on the doctor’s shoulders. For that reason, giving a hygienist that 

A partnership does not mean identical equality in decision making or having complete financial ownership and responsibility. “Partnering” can mean many things and take many forms. 

 defines a partner as “a person who takes part in an undertaking with another or others, especially in a business or company with 

Giving hygienists a collaborative role in the practice has more benefit than risk. Give them a stake in the success of the practice, and you increase their accountability to the group. Partnership fosters responsibility and discipline. It sparks an awareness of accountability that we don’t see with more subordinate team members.

It is a known fact that those who have a sense of ownership in an endeavor take more thoughtful actions, view their work as more meaningful, show up early, leave late and generally work harder. They are more apt to educate themselves and others.

In short, they are less likely to be self-focused and tend to be more team-centered.

Hygienists weigh in: The most helpful hygiene products

These are the things we want from our hygienists and are often frustrated when they do not seem to take ownership. We don’t understand why they do not demonstrate the leadership qualities we know they surely possess.

However, when we relegate them to the hygiene operatory, exclude them from having input in decisions that affect the team and have closed-door “leadership” meetings without them, we will continue to see more of the same “subordinate” behavior we want to discourage. In other words, if we view them as auxiliary, they will never rise to be 

In order to spark a sense of leadership and accountability in your hygiene team, you will need to take leadership yourself. It may not happen overnight, but with each step you take, you will likely begin to see those latent leadership qualities emerging.

Read on for some simple actions that will elevate your hygienist to partner status:

		Hire hygienists whom you want as a partner, and understand the importance of strong patient care and the business objectives. Just as you would not hire a doctor who would not be on board with practice goals, hire hygienists whom you can see yourselves collaborating with and whose judgment you respect.

		Clearly define goals and expectations for your hygiene team. Using key performance indicators is the best way to communicate this and track success.

		Give them a financial stake in the practice-whether through production based compensation or bonuses.

		Provide training and coaching to them so they can reach their full potential.

		Have an open- door policy, and let them know honesty is safe.
		 

Related reading: Wendy Briggs on the future role of the dental hygienist 

		Give them autonomy where it is warranted. Do not micromanage.

		Highlight their contributions. Have a great production month? Let them know their contribution in more detail than, “Great job!” Tell them instead how much revenue they produced-and what that means for the practice.

		Share practice financial reports and goals with them.  Knowledge is power!

		Hold them accountable to being solution-focused.

It’s lonely at the top. Having a partner ensures burdens are shared, and we have another advocate we can depend on. It means knowing that this person has the good of the whole in mind. It means folks will mostly manage themselves rather than having to be managed.

Hygienists are fundamental to the success of a practice. Making sure your hygienists know and feel that is fundamental as well.

Andrea Kowalczyk, RDH, BS, works as a senior hygiene performance coach with 

. She is a national speaker and author. She can be reached at 

Related reading: 4 characteristics dental hygienists need to become successful entrepreneurs

 If we described a team member who produced 30 percent of the practice revenue, was the reason more than 80 percent of new patients came into the office and from whose operatory 60 percent of restorative treatment was discovered, you may likely be thinking this is one heck of an associate and partner.

The importance of partnering with your hygienists

	Did you ever hear the axiom “you can’t be a little bit pregnant?” In other words, someone either is or is not expecting. There is no in between.The same is true for most dental disease. 

 or tooth decay that is very shallow or very deep. But the fact is, the disease is present, and it needs to be addressed and arrested regardless of the stage it is in when we find it.

Knowing this to be true, why do we frequently tell patients they have a “little bit” of perio, or “kind of” a cavity, or “just some” gingivitis?

It may seem as if I’m being overly critical of 

, but the fact is, those “little” words often make a difference in a patient decision to accept treatment.

When we use what are called “minimizing words” to describe treatment, our words work 

what we are trying to accomplish, which is to ensure the patient accepts treatment. We are downplaying our findings. We devalue our recommendations. Why do we use minimizing words if we know they are not in our patient’s best interest? Habit is part of it, but I believe it’s because our intentions are good. We want to soften the blow. We may even be afraid of a patient’s reaction to bad news.

“Mrs. Jones, you have a little cavity. It’s really no big deal. We can go ahead and schedule to fix it if you’d like. It’s kind of important to fix it early.”

“Mrs. Jones, you have a cavity. It is in the early stages, and still isolated to one part of the tooth. I recommend that we fix it now, so it does not grow larger, which it will.”

In the first example, the well-intentioned clinician has inadvertently all but talked Mrs. Jones out of having the cavity filled. I want to make the distinction between involving patients in their treatment decisions and putting what should be an expert opinion concerning treatment squarely on their shoulders.

We should educate our patients and allow them to make the choices that are comfortable for them. However, if we provide them minimal or downplayed information and then ask them to decide what is best, we are doing patients a disservice. State your recommendations clearly, and then allow the patient to make a decision when they are armed with the facts around their particular treatment need.

		Patients will like and respect you more if you are honest and confident.

		Patients come to you for your expertise. It’s OK to be the expert.

		Minimizing words may actually talk patients out of having treatment. “Why is this filling going to cost me over $200 if it is ‘just a little’ cavity?” “Why should I take time off of work to have a two visit cleaning if its ‘just some’ gingivitis?”

		You can make your diagnosis unnecessarily confusing for patients. “If I have just a little gum disease, should I wait a few months before I treat it, or treat it now?”

Practice avoiding minimizing words. Confidently stating the importance of timely treatment and prevention is 

caring for your patient. There is no minimizing that fact!

 Did you ever hear the axiom “you can’t be a little bit pregnant?” In other words, someone either is or is not expecting. There is no in between.The same is true for most dental disease. 

How 'little' words can make a big difference in dental patient treatment acceptance and understanding

One of the most common challenges faced in the dental practice is ensuring that patients accept treatment recommendations. It is an enormous area of opportunity for most practices. If you were to add up the amount of treatment that is recommended and declined in a month, you might be surprised at the amount of potential revenue missed.

Most clinicians have attended CE courses on improving case acceptance, and have had at least some training on the subject so why isn't it working? We think we are doing a good job and are frustrated when our conversational skills don't result in the patient accepting our recommendations. When this happens, many of us point to the price of the treatment as the reason the patient refused.

Fortunately, and maybe surprisingly, this is usually not the case. Each of us has the ability to gain treatment acceptance simply by changing the focus of our recommendations. The disconnect happens when we focus on the treatment, rather than the patient in our treatment presentation.

A common example is when a hygienist, in an effort to convince an adult patient to accept in office fluoride, says, "I recommend fluoride for everyone. It's very effective." At face value, that may not sound wrong. However, patients are not interested in the treatment; they are interested in themselves. The hygienist would do better to say, "Mr. Jones, you need fluoride to protect the areas of recession you have. You are using a soft toothbrush, which is a great start. You had some root cavities in the past, and fluoride can help prevent that from happening again." The verbiage difference is incredibly simple, yet profound. Mr. Jones is much more likely to accept the personalized recommendation.

Another example: "Mrs. Smith, periodontal disease can cause tooth loss. It is important we perform a scaling and root planing for you." To make the treatment relevant to Mrs. Smith, say instead, "Mrs. Smith, you have lost bone around the tooth that anchors your bridge. We would hate to see you lose that tooth and the investment of the bridge. Performing a scaling and root planing is the best way to prevent that."

Personalizing treatment does not take extra time. Rather, it saves time. We've all had those new patients with whom we spend a lot of time, and then they leave the practice and never return. When treatment recommendations are relevant to patients, they feel empowered rather than pinned down.

Most folks agree that their time and money are precious resources. We don't easily part with either unless we feel it is for something we need and want. As dental professionals, we know the care we are recommending is important and will improve our patients’ oral and overall health. Help people understand how treatment will benefit them personally, and your case acceptance will increase!