Providing optimal treatment

In the last couple of months, every dental-related e-mail group, Internet blog, and career-related journal has addressed increasing production during these tough economic times.

Jun 1st, 2009
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by Lory Laughter, RDH, BS
momylaugh@aol.com

In the last couple of months, every dental-related e-mail group, Internet blog, and career-related journal has addressed increasing production during these tough economic times. While different approaches are suggested, the solution always revolves around delivering optimal treatment to every patient. The answer seems simple, but it actually raises a hard question. “What keeps us from providing optimal treatment for every patient?”

I posed that very question to about 5,000 of my friends in the dental industry. Most who replied shared not only the barriers to providing the ideal treatment, but also a few solutions. The dental community is filled with deep thinkers and problem solvers, but unfortunately not enough listeners.

The best way to answer this query is to define optimal treatment. For purposes of this discussion, optimal treatment is therapy that leaves the mouth free of lesions, infections, and decay. Many would include esthetic, cosmetic, and orthodontic therapies — others call such treatments important, but optional.

By far the most common barrier cited by hygienists to providing optimal treatment is their employer. Some respondents said their dentist employers would not allow new products or treatments to be implemented, even when they were presented with substantiating research or when the hygienist offered to purchase the products. This is especially true when more than one hygienist works in an office and everyone is not on the same page.

I understand the need for treatment protocols and the importance for each health-care provider to follow that protocol. That being said, there is no room in health-care delivery for stagnant protocols. Research happens, technologies evolve, and knowledge is constantly added to our understanding of oral health. A protocol developed just five or 10 years ago may have been cutting edge then, but today it's outdated.

One RDH noted lack of time as an obstacle to providing optimal care. Periodontal cases she is qualified to treat are referred out to a periodontist because there are no openings in her busy schedule. In these tough economic times, a full schedule is a patient coordinator's dream. Unfortunately, no time to deliver necessary health-care services can lead to frustration for providers and a decrease in office production. Block scheduling can be helpful in these situations. Adding another hygiene day is also an option.

Time is also a hindrance to providing care when someone other than the health-care provider decides how much time to devote to each patient. Ideally, scheduling (and fees) are based on each patient's individual needs, not some arbitrary block of time determined to be adequate by an outside person, or worse, a computer program.

Too often we attempt to explain disease to a horizontal client while providing care. Attention cannot be focused on education while we're trying to remove deposits, disrupt biofilm, irrigate periodontal pockets, and eradicate stain. An educated patient is more likely to understand the necessity of treating a disease, and therefore will be more inclined to accept treatment. Since talking with the patient is not often seen as “productive,” very little effort is made to include education in most scheduling decisions. Perhaps it would be wise to have hygiene consultations in much the same way that dentists have restorative consultations. I bet treatment acceptance would go through the roof.

Return next month to find suggestions and ideas to incorporate into your practice, as well as Dr. Gerald Fraser's interesting take on the health-care provider's role in failing to offer the ideal treatment plan to every person. It's easy to point fingers and place blame, but remember that fingers can also be aimed at you.

About the Author

Lory Laughter, RDH, BS, divides her full-time clinical practice between general and periodontics practice in Napa and Sonoma, Calif. She is co-owner of Dental IQ, a continuing education provider (www.dentaliq.net).

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