I am fortunate to work within a team of like-minded individuals who embrace change and enjoy the new challenges that dentistry brings. Over the last decade the role of the hygienist has moved from a traditional, segmented department to the life-blood of the practice. That’s not to say that hygiene was not considered vital to the patients. In fact quite the opposite is true; periodontal treatment, support and prevention have always been a priority. The difference now is how we deliver that care and how we communicate it.
Traditionally we may have created invisible lines between departments: hygiene department, restorative department, administrative and assisting. Not only have we created separations between departments but we have probably also created segmented or separate delivery of care.
If the hygienist department looks at the gums and bone, the restorative department focuses on the teeth, while the administrative team will look at scheduling and finances. With such segmentation the bigger picture can often be lost.
Comprehensive dentistry can often be understood as offering a broad range of treatments: crown and bridge, aesthetics, endodontics, paedodontics and many more services. However, another way to envision comprehensive care would be to consider the dental apparatus as a system consisting of teeth, bone, gums, joints and muscles.
Comprehensive care is our understanding of the system components, their relationship and how they can affect each other. It is also our ability to communicate this information to our patients and provide solutions to treat the root cause rather than the symptom.
Take a moment to add up how many minutes are spent in the dentist’s surgery performing dental examinations. Consider if this is profitable and ask yourself if this creates interruption in longer appointment procedure times. Are you being as productive as you would like? Could you work smarter instead of harder? It takes time and costs money each time the surgery is turned around.
As most patients will visit the hygienist frequently, we can think of this as a gateway to a more comprehensive level of care for our existing patients. Hygienists can screen and educate patients, leaving the diagnosis and treatment planning for the dentist. The hygiene room thus frees up the dentist’s time to run a more productive restorative schedule.
What the appointment entails
I would say it’s crucial to consider communication at each point of the appointment. Perhaps using an opening statement will help the patient clearly see the value and importance of the procedure. I would say something like: ‘Before I begin your maintenance today I will start with three screenings – an oral cancer screening, a restorative screening and a periodontal screening. That’s a screening of your gums that tells me if they are healthy or not.’
Communication time is always with the patient upright and referring to radiographs and charting as a visual aid. For data collection, communication and initial debridement, I suggest an hour for each appointment would suffice.
It is important to perform a comprehensive evaluation, assess the patient’s periodontal condition and flag up any pertinent risk factors. Discuss periodontal procedures and quote the fees to the patient, giving them time to consider and ask questions. As I mentioned in my recent article, reflective questioning is the best course here as it is proactive.
During screening time co-diagnose with the patient so that she or he can feel and see the disease in their own mouth. I like to use disclosing solution, demonstrate how the periodontal probe works and show bleeding with a mirror.
Plaque retentive margins, wear facets, caries etc are all demonstrated with the intra-oral camera and the findings communicated to the patient. Advise the patients what treatment the dentist would usually recommend.
The dentist time commences with a short synopsis by the hygienist followed by a clinical examination and a diagnosis and treatment plan.
The hygienist completes treatment, documentation and hands the patient over to administration.
There are two further areas in which we can screen patients, not diagnostically but rather so that they can bring the results to the attention of their GP if appropriate.
About half of Irish adults over 50 years of age have high blood pressure. The higher the blood pressure, the greater the risk of stroke, heart attack and heart failure. Many people visit their dentist far more frequently than their GP. This gives us the opportunity to perform a simple blood pressure check to ensure the patient is not at increased risk and is safe to proceed with treatment.
Over 200,000 people in Ireland have been diagnosed as diabetic. Another 200,000 are unaware that they have the condition. Type 2 diabetes displays very few symptoms and it is likely that many people remain undiagnosed. With more and more links between systemics and periodontal disease, a blood glucose check could aid in early diagnosis.
The whole relationship
If each member of the team can understand and communicate the relationship between all aspects of dental health, as well as their relationships to the patients’ overall systemic health and well-being, we could then consider that as comprehensive care. We can build bridges between departments and create continuity of care. If, as a team, we can understand the business of dentistry, we can together create a viable business that not only treats patients optimally but also rewards its team for their efforts.
Bressman JK (1993) Risk management for the 90s. JADA 124(33): 63-67
Hodson K, Anthony B, Martineau M (2002) High tech hygiene. The Journal of Cosmetic Dentistry 18(2): 37-42
Anthony B (2006) Team advantage: the purpose driven practice. The Journal of Cosmetic Dentistry 22(1): 40-43
Diabetes Federation of Ireland: www.diabetesireland.ie
Irish Heart Foundation: www.irishheart.ie
The author would like to extend special thanks to Bobbi Anthony Comprehensive Care Consulting for her continued professional development.