February 12, 2018 -- Most dental practice owners have certain ideas about how periodontal services should be integrated into their office's everyday patient care. But how does your office compare with others in the U.S.?

Before we get into the numbers, let's take a step back and examine the issue of periodontal care more widely.

David Black, DDS
David Black, DDS.

First and foremost, I am not advocating overdiagnosis. However, when you consider that data from the Centers for Disease Control and Prevention show that nearly half of U.S. adults have some level of periodontal disease, there is little proof that we are at risk of overdiagnosing. The opposite is true.

We are underdiagnosing. We hold most of the blame for people not seeking treatment for periodontal disease. We must recognize that if the gums are bleeding, there is disease. If there are 4-mm pockets in several spots, there is disease.

I know there is a resistance from both patients and dentists to recognize and treat the disease. Until it is bad, it usually doesn't hurt. You have to have that hard discussion about the patient's home care. You have to actually sell the value of good periodontal health.

We also have some evidence that numerous health issues, including heart disease and high blood pressure, are linked to poor periodontal health, as periodontist Alvin Danenberg, DDS, has noted.

Periodontal appointments increasing

So how are U.S. practices responding to this challenge of improving their patient's periodontal health?

Using Sikka Software data, we are able to see that both periodontal maintenance and periodontal maintenance recall have gone up every year in a seven-year period since 2010.

Periodontal maintenance visits per month per U.S. practice
Year No. of visits
2010 8.25
2011 8.42
2012 8.92
2013 9.00
2014 9.33
2015 9.58
2016 9.83
Periodontal maintenance recall visits per month per U.S. practice
Year No. of visits
2010 26.75
2011 27.08
2012 28.33
2013 29.33
2014 30.83
2015 32.50

Scheduling issues

Now I would like to focus on one practice as an example. Using real numbers from this practice, the average hygiene visit was $153 for a recent month. The hygienist had 15% broken or missed appointments, and the practice had 49 new patient visits. In terms of total office production, the hygiene department accounted for 32% of production, but the periodontal services were only 12%, with the rest being prophylaxis- and recall-related. This is where this practice was leaving money on the table.

“A conservative, reasonable goal for diagnosis and treatment of periodontal disease in recall patients in a normal practice should be about 25%.”

Additionally, only 11% of this practice's patients who had previously had scaling and root planing (SRP) had at least two periodontal recalls following their initial treatment. With a fee of $231 for SRP, there is at least an $80 difference per visit on each missed opportunity.

A conservative, reasonable goal for diagnosis and treatment of periodontal disease in recall patients in a normal practice should be about 25%. The percentage of periodontal disease in new patients in a normal population should be even higher.

We need to do complete exams, including six-point periodontal probing and adequate imaging that shows bone levels, and take the time to discuss treatment with patients and educate them about the health risks of periodontal disease. To do this, you have to structure your hygiene schedule so that you have the flexibility to schedule patients with periodontal problems.

If you diagnose and schedule these patients correctly, you will have a huge financial gain. But, overall, the financial gain to your practice is minor compared with correctly diagnosing and treating your patients to tackle the epidemic called periodontal disease.

David Black, DDS, has more than 40 years of clinical experience along with serving on state and community dental boards. He focuses on speaking and coaching through in-office consultation.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.


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