Registered dental hygienist and clinical consultant, Amber Auger MPH, RDH, shares tips on how to improve your practice’s periodontal care plan.
When was the last time you carefully analyzed your practice’s soft tissue management program? Maybe you have a sense that your program is solid, but you haven’t gotten a chance to sit down and evaluate the data.
According to the CDC, almost half of the US adult population over 30 has some form of periodontal disease, which has been suggested to play a role in systemic diseases. Studies indicate that regular periodontal maintenance visits are important for preventing disease recurrence and tooth loss for patients with more severe periodontitis.
So how do you ensure that you’re offering your patients an optimal periodontitis prevention and management plan before further advancement of disease progression? In this interview, Amber Auger, MPH, RDH, discusses common mistakes to avoid when it comes to implementing an effective soft tissue management program.
Amber asserts that maintaining a well-thought-out program is especially important in today’s climate as “we’re seeing a reduction in preventative care because dental and medical providers are overloaded with their patient population.” She offers recommendations on how to set your practice apart by upgrading the caliber of your patient care.
Amber Auger, MPH, RDH is an accomplished dental professional and preventative dental therapy advocate. She is a sought-after international speaker, podcast host, dental marketing strategist, published author for several industry-leading publications, and the recipient of the 2019 Sunstar/RDH Award of Distinction. Amber is also the founder of Thrive in the OP and the Functional RDH.
This is the second blog post of a 6-part series where Amber shares helpful insights from a distinct viewpoint on how dentists can enhance their business success.
Strengthening Your Periodontal Maintenance Plan
Q: Please explain the importance of an effective soft tissue management program for overall dental health.
Clinical studies show that prior to the onset of COVID-19, about 60% of the population had some sort of gingival disease. That number has likely increased since then. We know there's a direct correlation between gum disease and systemic health issues. In fact, the American Academy for Oral Systemic Health (AAOSH) has stated that up to 50% of heart attacks and strokes are triggered by oral pathogens.
A fantastic nurse practitioner and owner of The Prevent Clinic, Dr. Gina Pritchard, specializes in linking heart disease and gum health. She likes to say that we are lined “tooth to tail” with endothelial tissue. Even in the mouth, the gum tissue is four to five endothelial cells thick. This allows for oral bacteria to be easily transferred to other areas of the body.
So if you have periodontal disease, it's not just that your gums are inflamed. You actually have TLR2 and TLR4 cells, which are inflammatory cells that initiate an immune response in the body. And because of that immune response, you end up having more white blood cells, more foam cells, and more overall inflammation in the body.
Over time, the red complex bacteria that cause periodontal disease trigger an immune response that creates more and more white blood cells, or macrophages. As those build, they build foam cells that can block the endothelial tissue in the vessels. The atrial wall can gradually stretch from the plaque burdens and eventually tear, and that’s how you get a heart attack or stroke.
4 in 10 Americans have three or more chronic diseases; periodontal disease is usually at the base of that. So the importance of an effective soft tissue management program is the key to overall systemic health.
The industry standard for the success of periodontal programs is usually 30%. Dental consultants will work to get a team from around 5-10% of their patient load to 30%, even though we know at least 60% of the population has some sort of periodontal disease. So even as our industry standard, we're still missing half of those patients.
Q: What are some of the most common mistakes that practices make in their soft tissue management program?
- The most common mistake practices make is waiting for the tissue to get worse. If a patient has a localized 5- millimeter pocket in the mouth, you can actually do a limited quad scale. Dental professionals often wait to treat until multiple teeth in a quadrant are affected by periodontal disease, and then they put that patient back on a traditional 6-month recare visit schedule.
The American Academy of Periodontology (AAP) classification states that you should be treating a patient who has previous bone loss at 3-month intervals. If the patient stabilizes, you can see them at a 4-month recare visit, but they should never return to a 6-month schedule.
2. Another mistake that many offices make is rotating billing codes to meet the needs of the patient's insurance instead of really looking at what each code means. For instance, if you have an office that's rotating between a prophylaxis code and a maintenance code, it's considered fraud. Some patients will ask their dentists to submit that way because that's what their insurance covers. Patients and dental professionals need to be educated on why practices can’t do that from an ethical and legal standpoint.
3. The other option that many offices don't take advantage of is being able to create a customized insurance plan for patients who want an alternative to their insurance. This is a great way not to compromise your ethics and to ensure that you still remain profitable. It’s also a good way of meeting your patients halfway because not every patient can pay out of pocket for services that should be conducted, especially if you are periodontally involved every three months.
4. When it comes to scheduling, if you’re not planning for growth on your schedule and pre-blocking those appointments for scaling, root planning, and perio maintenance, you might overbook your healthy patients and fail to make time for your diseased patients.
This is alarming for so many reasons. Firstly, undiagnosed periodontal disease is the number one risk for lawsuits. In addition, there’s an increasing number of law firms directly targeting medical providers for supervised neglect or poor clinical outcomes. Dental practices now have this greater awareness of why it's important, but they’re still not adjusting their clinical schedules to meet the needs for growth.
You should be pre-blocking. If you see eight patients a day, at least four should be in some sort of periodontal therapy that could include scaling and root planing or periodontal maintenance. You have to really communicate about your schedule as a team. This is a great opportunity to use your software to outline different color borders of pre-blocked appointments.
Q: How do those mistakes impact patient care and the overall success of the practice?
These mistakes impact patient outcomes because they indicate that the practice is not providing the standard of care that's been set, specifically when it comes to treating patients with periodontal disease. This means that the patient can be more at risk for systemic implications, as well as for the progression of their periodontal disease.
In terms of the success of the practice, it’s usually very low-hanging fruit. If you're seeing a patient that is periodontally involved, for instance, they're going to need a minimum of six appointment times: four for their periodontal maintenance and two for their quad scalings (if you're doing a right quad and left quad scaling).
You might also encounter some issues when you start actually trying to build up a periodontal program after not having an accurate one. Typically with my clients, we end up adding another hygienist to meet that overflow need.
Q: What strategies or steps can practices take to avoid these common challenges and mistakes?
A great strategy is having software that you can easily use to pre-block your appointment times for patients. Your software should allow team members to communicate effectively by providing a color coding option so team members can know which appointments are for periodontal maintenance, which are for recare visits, and so on.
It’s also important to have monthly meetings where you can analyze what's working well and what’s not working with the periodontal program. Going to CE and learning the latest techniques is also vital.
Are you implementing lasers? Do you have a periodontist who comes into the office weekly or biweekly to evaluate advanced periodontal disease in the practice? What is the practice’s philosophy on homecare products? And how will you determine that those homecare products are effective with the patient? Not every product is going to work the best for each patient. So sometimes you need to create a customized plan that's going to work well for them.
- A solid soft tissue management program is paramount to your patients' overall health.
- Periodontal disease increases the number of inflammatory cells in the body
- Studies have shown a link between gum disease and systemic health issues
There are 4 common mistakes you should avoid when treating patients with periodontitis:
- Waiting for the gum tissue to get worse
- Patients with periodontitis should be scheduled for a visit every three to four months
- Ensure that teams are selecting the correct code to align with the level of disease that is present.
- Rotating between a D1110 and a D4910 poses ethical and legal issues
- Not creating a customized insurance plan for your patients
- Offering a private plan will make treatment more affordable for periodontally-involved patients.
- Not pre-blocking for periodontal therapy or maintenance appointments
- If you don’t pre-block appointments, you might not see your diseased patients as frequently as necessary.