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FMD

I had a dilemma at work today: a patient reported that their last cleaning was about 30 years ago. There was radiographic calculus and also moderate-heavy scattered sub detected while exploring. I went about educating the patient about etiology of periodontal disease and the need for a “deep cleaning.” Before I started, I asked the office manager to give the patient an estimate of the cost for treatment. The office manager comes in the room and goes over the cost, but the patient says he cannot afford it. Then the office manager turns to me and says, “just do a full mouth debridement.”

At this point, I didn’t know what to do. First off I felt that the office manger, who has no clinical experience, was dictating how I should go about performing dental hygiene treatment when I just spent 20 or so minutes discussing the need for full mouth S/RP. So of course the patient asks me, “what is a FMD?” And I explain that that procedure removes deposit above the gum line only….. The patient ended up denying any treatment due to financial issues/ no insurance (the office manager quoted $110 for FMD).

I felt relieved that unfortunately that was the outcome, because I knew the patient would not return anytime soon to complete S/RP even if I did do the FMD. How would you have handled the situation?



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Author Note:
Assuming the patient DID accept FMD proposal, should I have done it? There was not a lot of supra, mostly sub deposits.

4 Answers

Wow! It is so frustrating when non-clinical staff gets involved like this. Personally, I would have explained to the patient the clinical ramifications of doing an FMD and discouraged it.
Next, I think I would be having a chat with the front office about how insurance and what the patients can afford, does not dictate treatment. We have a standard of care to follow and need to encourage our patients to accept the treatment with the most favorable outcome and the least harmful effects.

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Assuming the patient DID accept FMD proposal, should I have done it? There was not a lot of supra, mostly sub deposits.

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I completely understand your frustration! Especially after all the time you spent discussing and explaining to the patient the need for full mouth SRPs. It would’ve been a better option for the office manager to ease the patient’s financial burden by offering Carecredit or another form of payment option, while still stressing your clinical recommendation.

If the patient did accept the FMD, I would’ve made it clear that it is the start of the perio tx you recommended, as opposed to being a substitute for it. Possible problem with FMD with such a patient is that the patient might not bother with the SRPs once they feel that the FMD removed enough of the buildup.

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If truly was just a pocket book/money issue I sometimes refer pts to dental schools for cleanings. You’ve educated them over and over again, they know they need the cleaning but can afford it. In the pts best interest I tell them about the closest dental school or Clinic. Probably not the best response but it’s something.

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