Systems = Success• Systems allow for better delegation• Provide for more production• Save Dr. TimeA system is defined as having 4 components• 1-Intent• 2-Flow Chart• 3-Scripts • 4-Follow upGoal = Serve offer all patients the highest level of service while increasing productivity & profitability = Everyone Wins!

Developing Hygiene Systems

IntentOptimal oral hygiene not only results in healthier gums and teeth, but also prevents serious systemic health conditions

Hygiene Flow Chart

Three key roles of a hygiene provider

1-Preventive -Optimizing Hygiene Therapist

2-Periodontal Therapist

3-Patient Treatment Advocate

Wendy Briggs, RDH & John Meis, DDS, FAGD,DICOL

Maximize Preventative Therapist Role

“The more we involve patients in their own care and making decisions, the higher acceptance rate we will have.”

Periodontal Probing is vitalExample Script

“I am going to check your tissues for infection. This helps us detect any problems or disease in your gums. You will hear me saying a series of

numbers for each tooth & recording them. A 1-3 means that the tissue is healthy, a 4 means infection is present, and 5 indicates that the infection has

already spread to the bone.”

Patient Education

Increase Adult Fluoride Acceptance

Example Script“New research shows that for patients who consistently have a professionally applied fluoride treatment, we can see up to 75% fewer new cavities. This is huge for patients…”

Here is why fluoride would be good for youCustomize to patient needsIf there are exposed root surfaces & dry mouth, they are at very high risk for decay.If they have crown margins, large fillings or multiple restorations, fluoride can help protect their investment.If they have made significant investments in rebuilding their mouth, fluoride will help prevent recurrent decay & failure of their dental work.Investing in fluoride makes good sense especially when compared to the cost of restorations.

8 fluoride varnish treatments a day at $45 = $5,040 a 14 day cycle & $60,480 per year

Increase Sealant Acceptance“Everyone has a 95% chance of experiencing caries in the pits and fissures

of their teeth if sealants aren’t used.” American Dental Association

After 15 yrs there is a 54% reduction in decay. If you place a sealant & monitor it & maintain it, it can reduce decay by 74% over that 15 yr period.

Simonsen Study

Stress the value of doing convenient same day sealants

4 sealants a day @ $50 = $2,800 a 14 day cycle and $33,600 a year

Increase De-Sensitizing Agent Acceptance

Over 80% of the adult population suffers from sensitive teeth

Example Script:“We have an exciting new service that can help immediately remove the pain & discomfort from your sensitive tooth. It also protects it over time. It’s actually

easier if I show you how it works rather than try to explain to you how it works. Let’s do this, we can try it & if it doesn’t work, you don’t pay. If it does work, its only $39. If you start to notice sensitivity creeping back, most likely you have

had more recession in that area.”

4 desensitizing agents a day @ $ 39 = $2,184 a 14 day cycle & $26,208 per yearFluoride, Sealants & de-sensitizing combined potential=$120,208 per year

The ADA Recommends we treat all patients with Caries Management Risk Assessment CAMBRA

Maximize the Periodontal Therapist Role

To clear up the infection 3 things are needed1-A deep, more aggressive cleaning. We have advanced technology that enables us to be incredibly effective in dealing with the bacteria without painExample Script“We need to do the cleaning to get the build up out and to clear the area of bacteria.”2-If we want a different result, we change what we are doing. Recommended home care: Prescription mouth wash, flossing & using a power toothbrushExample Script“With this level of infection in your mouth, a power toothbrush is a tool that will help eliminate it. We don’t care where you get it as long as you get one. We carry them, here in the office, because we know you are busy and we try to make everything as easy for you as possible, plus, we can provide them for you at a cost less than you would pay at Wal-Mart.”3-Bacteria has been proven to regenerate in just 21-60 days after scaling and root planningExample Script“We need to see you back more often.”4- Laser bacterial decontamination of unhealthy gingival tissue and pathogens in a periodontal sulcus $43 per treatment @ 4 treatments day = $2408 per 14 day cycle & $28,896 per year

Maximizing the Patient Treatment Advocate

65% of the production completed in the restorative department of the practice is referred from hygiene.

What tools are you using in your case presentation?3 emotions are behind case acceptance failure1-Confusion2-Overwhelm3-FrustrationRule 1-Simplify –Talk in terms your patients understand-Seeing is believing-use the intra oral camera so they see for themselves, then there is urgency without the provider having to create itRule 2-Build value-In lieu of explaining procedures, focus on the benefits for the patient.Example Script: “If this were my mouth, this is what I would want to have done and why.”

Type 1 1-3 mm pockets Gingivitis

6 month Prophylaxis Oral hygiene instruction

Type 2 2-4 mm pockets Bleeding Gingivitis Localized Pockets

6 month Prophylaxis Oral hygiene instruction

Type 3 3-5mm pockets Slight / Medium Sub. Gin Calululus Generalized Bleeding Horizontal Bone Loss / Recession No Mobility No Furcation Exposed root surfaces

Debridement 4-6 month Prophylaxis Scaling and Root Planing Arestin

Type 4 5+ mm pockets Severe chronic periodontitis Mobility Bleeding and/or pus Periodontal abscess Advanced/vertical bone loss Calculus Furcation Exposed root surfaces

Debridement 3-4 month Prophylaxis Scaling and Root Planing Arestin Peridex Referral to Periodontist for co-management after no

progress with above therapies

Type 5 6mm+ pockets Severe chronic periodontitis Mobility Bleeding and/or pus Periodontal abscess Advanced/vertical bone loss Calculus Furcation Exposed root surfaces

Debridement 3-4 month Prophylaxis Scaling and Root Planing Arestin Peridex Referral to Periodontist for co-management after no

progress with above therapies Implant consultation Bone grafting

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Periodontal Maintenance Program

Breakdown of NP Appointment

Arrival•NP Paperwork/online or electronic check in•Assistant Greets•NP Tour (build value)• x-rays/intra orals FMX or Pano –•Perio Probing (FMP)/ Charting•Risk Assessment Tool-CAMBRA•Exam•Tx Plan•Benefits of Tx•Cleaning•Fluoride Varnish•Sealants•Schedule next hygiene visit•Hand off to TC

 

Breakdown of Hygiene Appointment

• Medical History and questions about any problems with teeth, BP• Take any radiographs needed: Pa’s, Bwx, pano, fmx• Extra oral and intraoral exam• FMP, chart in computer once a year, evaluate any areas of recession• Take any intraoral photos that are needed• Clean teeth with ultrasonic, handscalers, polish, floss, fluoride varnish• Laser if needed• Exam• Tx plan• Make recall appointment• Hand off to TC• Perio Breakdown• FMP-• Pts with untreated perio, explain periodontal disease and need for further treatment.• Reiterate importance of homecare in maintaining periodontal disease• Explain that once they have periodontal disease, they will always have it, explain the importance of • periomaintance after scaling and root planning.• Schedule for treatment• Hand off to TC• Periodontal Therapy• Scaling and root planing appointments: usually broken into two appointments: • laser /Arestin• 4-6 week evaluation-laser/ Arestin• 3-4 month periomaintance: laser/Arestin