Part 8: Overall care: Treatment planning for life!

March 1, 2002

by Tammy L. Carullo, RDH, PC, PS

Dental hygienists have always attempted to act in the best interests of patients; seldom do we operate without the patient's care and health being at the epicenter of our efforts. Unfortunately, we have fought what have seemed to be insurmountable obstacles such as time restraints, professional restrictions, and even prejudices within the dental community itself. With an unprecedented need for continuity in excellence of care, these issues need to be ancient history. We need to expand the hygienist's role to include treatment planning for life.

Professional restrictions are more lenient in some areas of the country than in others. Some members of the dental community experience trouble in understanding that hygienists do not want "independence" so much as we want mutual respect and the freedom to practice within our scope of expertise.

Time restraints, on the other hand, have always been a battle of opinions. Many practice owners still believe that a practice will profit more if more patients are seen on a daily basis. What they fail to realize is that patients are becoming much better consumers about dentistry; they are able to distinguish very easily between excellent and substandard care. Why would time limitations placed upon patient care even be considered as potentially substandard? After all, I do realize that there are limits to the amount of time dental professionals have at their disposal. Some dentists and hygienists truly believe, for example, that they are able to provide adequate care within a 30-minute appointment. The definition of "adequate" is key to this discussion. Do we mean adequate as in "mediocre" or the "very best" care?

As I've stated in previous articles in "The Clinical Edge" series, I firmly believe that it is very difficult to provide adequate care in 30 minutes. Treatment planning takes time.

We absolutely need to step up to the plate and understand that treatment planning begins with hygiene. A patient spends much more time — quality time — with a dental hygienist than any other member of the dental team. This allows for ample opportunity to develop a trusting and lasting relationship. It is for this reason that the hygienist is the ideal candidate for conducting the rather ominous-sounding task of treatment planning. Aside from the time spent with the patient, studies reveal that patients tend to feel as though they can truly trust a hygienist and believe that the hygienist would not recommend anything that was not necessary. This is not to say that dentists recommend unnecessary treatment. But purely from patients' viewpoints, 82 percent say they would and have accepted treatment more readily when presented or recommended by the hygienist.

The time issue plays an integral role in this equation. Spending time with your patients will nurture a more trusting relationship — one that will make treatment planning almost effortless. I hate the term "selling dentistry" as much as the next person, but, for all intents and purposes, that is precisely what we do on a daily basis. We must acknowledge that the dental practice is, first and foremost, a business. Without a solid business foundation supplied by the income earned through the treatment provided, there will be no business conducted nor income to support excellent patient care.

The main focus needs to be on building a lasting relationship so that hygiene can be the very lifeline to successful treatment planning.

Our services include extraoral examinations, intraoral examinations (including oral cancer screenings), gingival and periodontal classifications, charting, comprehensive medical histories, plaque index via disclosing, detailed patient education, nutritional counseling, full-mouth series of X-rays, rechecking our work, and, of course, actual clinical care.

How many of these hygiene services are necessary for the health of our patients? Perhaps we should ask the individuals who designed the curriculum necessary for a college to attain accreditation as a dental hygiene program. They obviously felt these services were important enough to be included in every dental hygiene program. So why are they no longer considered important enough to be included for every patient in every private practice? Well, they are important; it's just that we've spent so much time cutting corners in the way we practice on a daily basis, feeling a constant pressure to see more patients each day. The truth of the matter is that paying attention to the details about our patients' health should be the cornerstone of treatment planning. Without a baseline evaluation and proper assessment, we have nothing to measure subsequent changes in health. There is new information suggesting a link between oral health and systemic disease. This very crucial information calls for a more precise approach to treatment planning.

I once believed that patients needed to receive structured treatment planning, providing them with every inch of detail possible. I no longer agree with that approach. Instead, hygienists should concentrate on the long term rather than short gains. It is this slow and steady methodology that will yield the best result for all involved. Treatment planning for life begins with the one small step of developing lasting relationships.

Tammy L. Carullo, RDH, PC, PS, is CEO of Practice by Design, Inc. She is a practice-management consultant and continuing-education instructor. She may be contacted by e-mail at [email protected] or phone (717) 867-5325. For more information about her company, visit www.practiceby