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Thursday Troubleshooter: Dentist not happy with hygienist’s treatment choice

July 5, 2018
This dental hygienist wonders if she was in the wrong for her choice of treatment when it came to performing a prophy on a patient. She did not agree with the dentist, who disagreed with how she handled things.

Nearly everyone has problems and concerns on the job, and sometimes you're just too close to a situation to solve something yourself. Share your concerns with Team Troubleshooter, and the experts will examine the issues and provide guidance. Send questions to [email protected].

QUESTION: If a patient is being referred to a periodontist for 6-9 mm pockets, and the patient agrees that he needs a deep cleaning, should I do a prophy while he's in the chair because the doctor wants me to? I believe this is wrong. Please advise me on what to do in this situation. I chose not to do a prophy and the patient did not need a debridement as most of the calculus was subgingival. My decision was apparently a problem for the doctor. Was I wrong?

ANSWER FROM AMBER AUGER, owner of Millennial Mentor:
Thank you for your question. In my experience with coaching dental teams, I find this to be a common issue. If your patient had qualified for a full-mouth debridement, the doctor probably would not have been disappointed. As a business owner, the doctor was not able to bill for the time worked with the patient if services were not provided.

With that being said, it’s important that we’re always billing for the services that we provide. A prophy is defined as 1-3 mm of debridement, therefore, the appointment time can be used to provide debridement supragingivally and to discuss homecare. This is a perfect opportunity to ensure that all clinical documentation that’s needed to maximize insurance is collected. This includes a complete six-site periodontal chart, bleeding, recession, clinical attachment level, mobility, and furcation.

A full set of films and intraoral photos should also be taken to allow for a baseline of data and to document homecare progress. This will allow patients to take greater ownership of their disease and to promote meticulous homecare. Reviewing the systemic health of patients during this time is also helpful to allow patients to determine their specific risks, as well as perhaps to discuss additional services, such as laser treatment for advanced pocketing.

Implementing this protocol will allow you not to compromise the treatment recommendations of scaling and root planing with debriding below the gums and calling it a prophy. Remember to always be insurance-aware, but not to let insurance dictate what services you do or do not provide your patients.

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Don't be shy! If YOU have a tough issue in your dental office that you would like addressed, send it to [email protected] for the experts to answer. Remember, you'll be helping others who share the same issue. Responses will come from various dental consultants, as well as other experts in the areas of human resources, coding, front office management, and more. These folks will assist dental professionals with their various issues on DentistryIQ because they're very familiar with the tough challenges day-to-day practice can bring. All inquiries will be answered anonymously each Thursday here on DIQ.

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About the Author

Team Troubleshooter

This weekly column on DentistryIQ features questions from everyday people who work in dental practices, who have issues they would like addressed by the experts. Those who regularly take the time to answer questions include Rebecca Boartfield, Patti DiGangi, Dr. Chris Salierno, Laura Hatch, Karen Daw, Jill Townsend, Lisa Marie Spradley, Shelley Renee, Judy Kay Mausolf, Robin Morrison, Paul Edwards ... and the list is growing.

Send your question or issue for an expert to address to [email protected].. You'll be glad you did.