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3 Steps for Increased Periodontal Case Acceptance

Posted On: Friday, November 7th 2014 by

(Wendy Briggs, RDH, is our guest blogger today at Sidekick Magazine)

Our biggest challenge in providing Dental Care is not delivering our services; it’s having patients ready and willing to have the services done.

dental-patient.jpg 3 Steps for Increased Periodontal Case Acceptance

In this training we cover the five steps you need to follow to have more patients moving forward with your periodontal services.

Step #1: Probing Correctly

This may seem basic but it’s an important step. 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 the patient they may have an infection in their mouth that’s concerning.

Then explain that you’re going to probe in order to do a more thorough assessment. Tell the patient in advance what the numbers mean to help them understand what’s going on.

You can explain the numbers in the following way:

  • If it’s 3 and under, it’s considered healthy
  • Anything higher than 3 means there is an infection
  • Higher than 5 is critical because 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.

When you do it this way, you don’t have to tell the patient there is an issue. They’ll say: “We have a problem!”

Use your software and technology to make the process easier – don’t waste time using paper charts to record probe depth.

Even if you are charting for yourself still call the numbers out loud.

Step #2: Have Patient Watch an Educational Module

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 the patient 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.”

Technology means it’s now quite easy to create your own educational videos – but make sure they are short, simple, to-the-point and sharing the same valuable information in the same effective way every time.

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.

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. Their understanding of what needs to be done is much greater with visual information.

While the patient is watching the video, the provider can step away and make notes on the chart or enter information on the computer.

#3: Review Findings with the Patient

In the next step, it’s important to review the findings with the patient and have them fill out a perio classification form.

(The Perio Classification form is available to our members in the resources area of our member-only website, and I have included a copy at the end of this training)

Sometimes when a practice has many providers or different locations, it’s a challenge to get all the hygiene providers and dentists on the same page.

This perio classification form gets everyone on the same page when it comes to classifying the level of infection.

It takes the judgment off of our shoulders – especially helpful if they are borderline. The numbers on the classification form speak for themselves.

The form is not a diagnostic tool, it’s meant to be a guide to help make an assessment.

The final diagnosis is always made by the doctor.

After the patient has watched the educational module, here is what I usually say;

“Let’s review where you are…Do you have any questions about the video? Let’s talk about what level you are; and how much bone you’ve lost and about how we can help control and maintain this infection that’s in your mouth.”

I follow that up with;

“To treat this infection we need to do 3 things. To clear up this infection we need to do these 3 things….

We then go on to explain the three steps needed to clear up the infection:

#1: “We need to do a deep, more aggressive cleaning 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 so we need to reassure them we will do everything possible to keep them comfortable.

If they have a fear of pain, they will not come back.

If you are using high-end lasers for example, you can even say something like: “We have amazing new laser technology that helps you be more comfortable and can actually help the bone grow back.”

Another example that I like to use when talking about a deeper cleaning than they have had in the past is making a comparison with a splinter. You can explain it’s like having a splinter under the skin.

If you don’t get rid of the splinter you’re 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.

If a patient has not been in for some time, this can be used to explain why more action is needed. They need to catch up.

“To clear up this infection, we are going to need to do a deep more aggressive cleaning than you have had in the

#2: “We need to change a few things that you are doing at home.”

You have to be very careful here – It’s been proven that nobody likes to get a lecture on what they are not doing. So we need to position this carefully. We don’t need to get into telling them that they need to floss more often for example. But, what we do need to let them know is that we may suggest that they get a prescription mouth wash or provide/recommend that they use something every day to keep the bacteria under control. They are open to this and people are willing to use our recommendations, that if that’s what gets the job done.

It can also help to recommend using a powerbrush. When it comes to recommending the powerbrush, you can use the analogy of a screwdriver – a basic job can be done with a manual screwdriver but a big job may need a power screwdriver. And with the level of infection that they have in their mouth, it requires a tool that will do more for them.

In the same way, the infection that has built up in your mouth means you need a power brush to get rid of it. We need something that can do more for you than a basic hand toothbrush.

When introducing the idea of a powerbrush, it can be useful to say:

“We don’t care where you get it as long as you get one.”

You can suggest that high-end brushes such as Sonicare have been found to be more effective and add:

“We have some here because we know you are busy and we want to make it easy for you. We can get them to you for less than you’d pay at Wal-Mart.”

The patient then understands we’re not just trying to push a sale; we’re trying to give them the tools they need to be more effective against the infection.

#3: “We need to see you back more often.”

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.

They don’t know the bacteria can go out of control again – that they can have re-infection and more bleeding.

Patients really appreciate when we simplify things for them so it often helps to use the ‘oil change’ analogy.

We explain that after the deep cleaning, they are starting with a clean slate and that – but, if they don’t come back more often – they will end up back where they started.

The disease can reoccur and the infection spirals out of control and we lose ground.

We explain that it’s like buying a brand new car – it won’t last very long if you don’t change the oil regularly it won’t last you long. So, to maximize the potential healing, we need to see them back more often than you have come in the past.

There’s compelling scientific proof that dental health affects overall health. Infection in the mouth often means the patient is at risk for other serious medical illnesses. We know this, but patients do not. We need to help them understand the serious nature of this diagnosis.



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