How you can change a patient’s mindset to improve overall outcomes.
Miranda, RDH, yawned as she opened her daily online schedule and started looking at charts to determine her patients’ needs, including radiographs. The coffee hadn’t yet kicked in, but she was awake enough to notice a note on the schedule next to the name of a 44-year-old male patient that read: “Patient wants to know if he can return from perio maintenance to six month prophy status.” Miranda’s first reaction was a defensive one, mostly because she knows that periodontitis needs to be effectively managed over a lifetime.
The above scenario is common in today’s dental practices. Many patients who are treated for periodontitis nonsurgically think they can return to a six-month “routine cleaning.” What causes a patient to stumble over these two codes and what can we do to change a patient’s mindset to improve overall patient outcomes?
Periodontitis is a chronic, progressive inflammatory disease that affects millions worldwide. Once diagnosed, patients with periodontitis remain a periodontitis patient for life.1 This includes patients who have completed successful therapy and those who are at risk for recurrence of disease. Clinical judgement must include assessment and treatment by a periodontist specialist in moderate-severe and complex cases.
Stumbling makes transformation tough
It’s only 7:30 a.m., and Miranda’s employer, Dr. Jay, is yawning in his operatory too. He’s about to see an adult patient of record in his 50s who has neglected his teeth over the last few years. Dr. Jay performs a comprehensive periodontal exam on this patient and recommends a “deep cleaning.” The patient has no idea what this diagnosis means, but he complies with the recommendation, assuming he’ll return to a six-month “regular cleaning” schedule afterward. No one in the dental practice educates him otherwise, and he insists on his two regular “cleanings” a year that are covered 100 percent in his benefits package.
Once a diagnosis of periodontitis is made, patients typically want to know the following: “What’s it going to cost to treat, and am I being ripped off?” Humans typically change at a very slow pace, even though life circumstances can change in the blink of an eye. Even motivated individuals aren’t able to change overnight, so what are we doing/not doing to coax them along and push them toward-and not away-from health?
Road blocks to acceptance
The “deep cleaning,” “regular cleaning” and “SRP” lingo in dentistry needs to go away for good. Many corporate practices use this jargon and include it in their website as part of the online question-and-answer dialogue, but it undervalues this important therapy. We “deep clean” with maids and a mop; dental hygienists don’t “deep clean” teeth. In medicine, I don’t recall any therapeutic procedure being called a “cleaning.” For example, certified wound care nurses provide wound “care,” which has many components. Patients aren’t told that they’re getting a wound “cleaning."
A softer, more professional tone is needed to describe what we do in dentistry as a nonsurgical component of periodontal care. Why not just call it “nonsurgical periodontal care or therapy” and make sure it’s presented as a therapeutic procedure.
General dentists and hygienists need to make a diagnosis and it needs to be based on the new 2018 periodontal classification system. How can you provide a recommended therapy if you don’t complete a comprehensive assessment and diagnose the condition?
Patients fell out of favor with some dental practices when the “for profit” motive trumped patient-centered care. Profit shouldn’t be an issue when patients are properly diagnosed and treatment planned because half of adult Americans have periodontal disease.2
Besides motivational interviewing for case acceptance, simple and fundamental changes can be made immediately to empower patients with periodontitis to manage the disease successfully and improve quality of life. If done in a simple manner with the hygienist as a coach after diagnosis, patients can make choices with their dental hygienist coach that promote improved self-care behaviors. This isn’t the same as a risk assessment tool; rather, its sole purpose is to promote ongoing, self-directed management of disease.
This idea comes from the American Association of Diabetes Educators, which developed a framework of self-care behaviors called AADE7 Self-Care Behaviors™.3
In creating a framework to self-manage periodontitis, I’d consider using the following categories/questions in setting priorities. Be creative and consider adding the framework to your practice website.
Dental hygienists have the educational background to work collaboratively with patients to self-manage periodontitis. Patients with periodontitis (or gingivitis or dental caries, for example) gain the knowledge and skills needed to modify behavior and self-manage the disease and its associated conditions such as xerostomia and oral malodor. Stumbling blocks can become stepping stones to successfully remove inappropriate terms such as “deep cleaning."
1. Caton JG. A new classification scheme for periodontal and peri-implant diseases and conditions- introductions and key changes from the 1999 classification. J Periodontol. 2018; 89 (Suppl 1):S1–S8.