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I am working in a new office that has purchased the practices of a few dentists that have practiced for many years in the field. The problem we are having is that majority of the patients are elderly and on fixed incomes. Lots of these patients have undiagnosed periodontal disease and decay. We are explaining perio and decay from step one again and having bad feedback from the pts. They are shocked when we tell them they have active infection and need teeth repaired or removed. And also they let us know financials are a concern. How much longer do we just “clean” their teeth and when is it supervised neglect? I can understand where these patients are coming from but the doctors should have not let it come to this point.



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5 Answers

Same situation here, with a father/daughter DDS office…I was brought in to take over all his recall patients, as he didn’t want to do prophys anymore…all, and I mean all had perio disease…the dad DDS did all his own prophys since the beginning, and rarely went subgingivally. I spoke to the daughter DDS to ask how to deal, she told me take it slow, do prophys, educate every patient about their perio condition , help them with OHI, be a cheerleader. for their improved hygiene… its my guess that new patients are your financial future, which are these patients’ kids and grandkids…create rapport and trust first.

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That’s a tricky situation to be in. At the same time I do believe that the patients should most defiantly be informed about their periodontal status. It is a shame but unfortunately there are dental practices that the dentist only permit the hygienist to do a “prophy.” Being that these patients have never been fully informed about their disease they think that you are trying to get whatever little money they have if you present SRP and the fee. I have encountered that from time to time and it saddens me. But you guys are doing the right thing by telling them and recommending the appropriate treatment. I think what’s important would be finding a gentle way to phrase it. That way you do not hurt your own reputation because of angry patients.

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I have been in a similar situation and it is not easy. You must inform the patients of your findings. Showing them boneless on x-rays and being very thorough in your perio explanation is vital. Ultimately it is the individual patients decision on tax or not. However, they cannot make an informed decision without all the information! Some will agree to tax and some will not. You will have to establish an office protocol for those decline tx.

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Another idea is to use one of the video programs to help you out. We have guru but Casey or another program that goes over the procedure can sometimes be helpful to back you up.

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I think all you can do is follow the standard of care. Explain thoroughly why you feel they need SRP and the consequences of not having said treatment. The patient can always decline, but you have done your ethical and legal part.

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