July 27, 2023
by Gabriele Maycher, CEO, GEM Dental Experts Inc. BSc, PID, dip DH, RDH

    1. Are flawed processes holding your team back from experiencing better efficiency, healthier clients, happier employees, and continued practice growth?

      The challenge: “In my practice, new clients are scheduled for a 90-minute comprehensive oral exam and cleaning appointment. They typically see the dentist for the first half hour and then are scheduled for an hour with the hygienist for all the periodontal assessments and a cleaning. However, there is never enough time to do both, so in most cases, the cleaning is the priority and only some of the assessments are completed. We as a group try to get the balance of assessments done at recall, but that doesn’t always happen. I am feeling ethically challenged.”

      The solution: I certainly understand feeling challenged. There are so many things wrong with this appointment scenario that need to be addressed, so let’s get started.

      Commit to the process of care. What happened to ADPIE: assess, diagnose, plan, implement, and evaluate  in that order? Splitting appointments in the manner you described always results in a time crunch. Unless the dentist is prepared to review the medical dental history and vitals, expose and interpret radiographs and digital scans (for both a dental and dental hygiene diagnosis), conduct the intra and extra oral examination, chart the periodontal assessments and hard tissue (both current and existing), treatment plan, discuss insurance support and costs with the client, and document all the above, this schedule won’t work.

      I’ve actually never met a dentist who agreed to do all of the above; they typically only expose the radiographs and do a hard tissue exam for a dental diagnosis, never a dental hygiene diagnosis. Thankfully they inevitably acquiesce and give the entire 90-minutes to the hygienist, which is what needs to happen here. I recommend you start the conversation with the dentist and practice owner.

      Reset your own expectations. Ninety-five percent of your clients have some form of periodontal disease, so in most cases, you will not be doing a “cleaning” on healthy tissues during the first appointment. Instead, you’ll likely be scheduling a client for nonsurgical periodontal therapy, which could be anywhere from one to six more appointments to get him or her to the parameters of health. Perhaps you can get one arch done, but in most cases, you will not be picking up your scaler. The entire first appointment will be needed for assessments, diagnosis, treatment planning, client education, and getting consent for treatment.

      Set client expectations. Why is your client expecting a cleaning the same day as the comprehensive oral exam? Your college requires too many assessments to also fit in a cleaning. Have this conversation with your clients and if they have different expectations of care, you can educate them and get them on board. If the client doesn’t consent to your proposed recommended treatment, you will proceed with what the client agrees to, but at least you have received informed refusal. These situations should be few and far between.

      Let’s talk liability. You put your license at risk when you do not complete your college’s recommended assessments. And the practice becomes liable if you’re billing for comprehensive oral exam and not doing all the requirements as per fee guidelines.

      Client liability issues arise from not providing the standard of care to treat periodontal disease and its effects not only on oral health but on overall health. Can you imagine a client being diagnosed with oral cancer never having had a head or neck examination done? Or imagine the doctor mentions that the client’s heart condition is related to his or her periodontitis. Although Canada is not a litigious society, as clients get more educated on the link between oral and systemic health, these conversations will become more common. It is already happening down in the states. In fact, the No. 1 cause of lawsuits in the U.S. is not diagnosing gum disease.

      The bottom line: It’s time for clients to spend the entire 90-minutes with the hygienist. Get back to the process of care (ADPIE), and most important, slow down. Rome wasn’t built in a day. Achieving oral and systemic health is a process that takes more than one appointment.

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