Talking points on addressing compliance in the periodontally involved patient

essica Raymond-Allbritten, CRDH, BASDH, serves up a recipe for periodontal compliance: One part patient relationship plus one part break down compliance barriers. Toss in some patient education and combine with follow-up. Sprinkle liberally with communication. Serve with a smile.

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Start with one part patient relationship plus one part break down compliance barriers. Toss in some patient education and combine with follow-up. Sprinkle liberally with communication. Serve with a smile.

By Jessica Raymond-Allbritten, BASDH, CRDH

Periodontal disease continues to be prevalent in the United States. In a recent report, the Centers for Disease Control and Prevention (CDC) found that 47.2% of adults ages 30 years and older have some form of periodontal disease.1 Every day dental hygienists try to help patients improve their oral health along with their systemic health. In November 2016, the American Heart Association stated that, based on recent research, periodontal disease is independently associated with arteriosclerotic vascular disease (ASVD).2 This was a breakthrough in the medical and dental communities. Before, we could only say there was a strong correlation between periodontal disease and heart disease, but now we can say it is a fact. Dental and medical professionals need to come together to help patients improve their oral and systemic health.

Dental hygienists face issues daily with patients regarding periodontal compliance for a multitude of reasons. Getting patients to comply with treatment recommendations is a multifaceted process. The importance of compliance must be communicated consistently by all dental team members, primary care physicians, specialists, and team members throughout the referral network.

Communication

To increase patient periodontal compliance, it may be helpful to contact your patients’ physicians and specialists to request assistance in supporting the cause for treatment of the patient’s periodontal disease. In my office, our doctor regularly seeks medical clearance and support for periodontal treatment from our patients’ physicians and our referral network. Unfortunately, most physicians and specialists outside our network respond with letters that leave much to be desired and contribute little to help improve our patients’ compliance. But within our referral network, we have found that patients will comply with the periodontal treatment that we recommend. Building rapport not only with our patients but with local physicians can help increase patient compliance.

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Barriers

Building rapport and a good relationship with patients starts from the day they enter the practice. Patients can have many reasons for being noncompliant with treatment recommendations. In the dental office, it is up to the hygienist to discover what the patients’ barriers are and break down the walls. Getting to know your patients’ backgrounds and how well they understand dental and medical care can help guide the conversation and help remove any barriers they may have.

The key to removing patients’ barriers is not being afraid to ask questions such as “Why?” and “What do you think?” Asking open-ended questions to find out what is holding patients back is one of the most important things to remember when trying to find out what the barriers are. With some patients it could be finances, lack of insurance coverage, fear, and/or a lack of dental/medical knowledge.

Finances can be addressed by offering cash discounts, payment plans, or third-party financing. For insurance-driven patients, we are left with the task of changing their mind-set and helping them see past insurance so that we can help them improve their oral and systemic health.

Find out why patients are fearful and assure them that their fears will not become a reality. Using the words “feel,” “felt,” “find” in breaking down patients’ fears can be helpful. For example, saying “I understand how you feel. A lot of other patients have felt that way and you will find that…” can help put the patient’s mind at ease.

Perhaps a patient simply doesn’t remember to brush or floss. Finding a method that works to help him or her remember to perform oral hygiene habits at home would be important to that patient. Often, we work with patients who have a lack of dental and medical knowledge. It is important not to automatically assume our patients understand what we are talking about. Find out how much a patient understands from prior dental experiences about his or her condition and help build on that knowledge. I like to describe periodontal disease as a sinkhole under a house. For example: “Periodontal health is the foundation to our teeth. Without a healthy foundation, the houses will crumble.” This type of description helps make periodontal disease understandable to my patients.

Value

After patients’ barriers are removed, it is important to create value for treatment. As dental professionals, we know periodontal diseases are often asymptomatic. Comparing periodontal disease to something patients understand, such as a cut on the hand, can be helpful. I ask patients if they would let a bleeding, infected cut on the hand go untreated. I explain to them that having a bleeding, infected cut on the hand is similar to periodontal disease.

Reviewing the patients’ medical and dental history at each visit and explaining how their medical conditions can affect their oral health, and vice versa, can help them see that the health of the mouth directly relates to the health of the body. It is also important to ask about family medical and dental history, because patients could be predisposed to some of the same conditions. Having periodontal disease can also increase patients’ risks of being diagnosed with the same diseases their family members have.

The oral-systemic link must be explained to patients as now there is a confirmed correlation between oral and systemic diseases. Making the correlation between family medical/dental history and patients’ medical/dental history can help create value for them. If no value is created, then patients will not comply. Customizing the value to fit patients’ periodontal status, medical history, and barriers may also help them agree to treatment.

Patient education

Many patients lack education about their oral health and how it is related to their systemic health. Patients come from all kinds of dental and medical backgrounds. When time is limited during an appointment, patient education is the first thing to be eliminated. Yet patient education is one of the most important aspects of a dental hygiene appointment. While educating your patients, it is so important that you don’t shame them. Showing your patients compassion is crucial to their compliance.

If patients have many restorative concerns, I explain that periodontal health is the first step. If patients don’t have a good foundation of periodontal health, I explain that they are wasting their time and money on procedures that will fail due to lack of periodontal health. It is important to treat periodontal disease first for this reason.

Before you try to educate your patients, though, you need to consider their learning style. Patients can be visual, auditory, verbal/linguistic, or kinesthetic learners. Knowing how your patients will best grasp the information is imperative to compliance. There are many patient education tools available to hygienists that can help us educate our patients. My favorite resource to use is Spear Education. They have animated videos that can be shown or emailed to patients to help them understand why they need a procedure and what that procedure entails.

Follow-up

Be sure to follow up when any patient misses or cancels a periodontal appointment and doesn’t reschedule. Having the hygienist call the patient instead of the person at the front desk helps maintain rapport and the patient relationship. Maintaining that relationship is essential to periodontal compliance. Having a follow-up protocol in place ensures that patients do not fall through the cracks. Keeping a notebook with patients to follow up on can be helpful. Services such as Dental Intel can help the whole practice follow up on all patients.

Conclusion

Having periodontal-compliant patients depends on proper communication, removal of any barriers, patient education, and follow-up. Without success in each area, patients will not value the necessary treatment and, consequently, will not comply with recommendations. Sometimes this requires going above and beyond for patients to show them that you really do care about their health. Building relationships with all of your patients is important in isolating patient barriers. Remember, there is more to dentistry than just teeth—it’s also about your patients’ overall health.

References

1. Eke PI, Dye BA, Wei L, et al. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012;91(10):914-920. doi: 10.1177/0022034512457373.

2. Bale BF, Doneen AL, Vigerust DJ. High-risk periodontal pathogens contribute to the pathogenesis of atherosclerosis [published online November 29, 2016]. Postgrad Med J. 2016;0:1-6. doi: 10.1136/postgradmedj-2016-134279.

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Jessica Raymond-Allbritten, BASDH, CRDH, practices dental hygiene with Ryan Lepore, DMD, at Lepore Comprehensive Dentistry in Dunedin, Florida. Jessica was a member of the 2015 Colgate Oral Health Advisory Board. She is also a contributing author for the Colgate Oral Health Advisor web page. You may contact her at jraymond0128@gmail.com.

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