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Over-treating?

I work for a corporate dental practice that does have a wonderful perio program, but sometimes I question whether we over-treatment plan patients. For example, a patient comes in with gingivitis then the protocol would be: Oral B TB, 2 separate prophy appts, irrigation with CHX at the first appt, Fluoridex stannous rinse and Flouridex 1.1% NaF TP. And yeah, sometimes this is great for patients that have severe gingivitis w/calc b/u but that is not yet perio, but they want this tx plan for EVERY person with gingivitis, no matter what stage it is in. Sometimes I just think that the patient needs a good cleaning and some OHI/TBI to get back on track. For perio the treatment plan would be all of the above (substituting SRP for prophy of course) with Arestin on EVERY 5mm site. Honestly I usually pick and choose my Arestin sites based on what I think will honestly need it to become stable. They have a “hygiene coach” that comes around periodically and basically shames me for not doing it exactly as above. I just feel like I’m being pushed to sell and overdo it. What do you guys think? Is this treatment the best thing for the patients or is there such a thing as unnecessarily over doing it?



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6 Answers

I agree with you, not every gingivitis case requires that protocol. Sometimes a cleaning and OHI is enough and shows great outcomes. I think it’s a little overkill also with the Arestin. Unfortunately with a corporate office I think there is little you can do to change the protocol. Maybe at your staff meetings bring it up and offer ideas for change.

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I believe the key to reversing gingivitis is a good prophy and improvement of home care by the patient. It is tough enough to get patients to brush and clean interproximally daily, to ask them to do all these other things, I don’t see compliance happening. Time and effort might be better spent teaching the basics of OH.
As far as the arestin in all 5 mm. pockets…most of these pockets can be resolved with good scaling and home care by the patient. The pockets are not deep enough to cause the patient to not be able to keep them clean. Again, I think spending time on the basics and tricks and tips for thorough OH is the best course. If a pocket or two does not respond, then Arestin might be the answer.
I feel some corporate dental offices can go too far. Many are owned by non-dental professionals and are more concerned for their bottom line and not the patient. Just my opinion and what I have experienced. 🙂

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Sounds like the corp dental comp I use to work for. They often made me feel bad and question why I wasn’t using as much Arestin as I should be. One time the doc even diagnosed 25 Arestin sites on one pt to be done all in the same day along w 4q SRP’s. I quit that comp and I’ve never been happier :.)

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That sounds like a textbook description of a corporate dental office to me. I understand the need to standardize treatment in large offices, but I think they go too far. It takes treatment decisions out of the hands of the hygienist and puts all the decision making into the hands of people who see money more than patients. Not a good scenario in my opinion. But I also agree that there’s unfortunately probably not a whole lot you can do about it.

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Seeing as there are so many other factors that cause a patient to have gingivitis, I find this a bit ‘overkill’. Care cannot be uniform, it must be customized. For instance, a teen with ortho is dealing with hormones and difficulty with OHI – they should get education, not all mentioned above. Others, this might be necessary. Not one size fits all.

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Sounds like Aspen Dental to me!! I used to work there and I had a hard time over treating my patients just like you described. It was ridiculous. I don’t agree with their hygiene protocols because not everyone responds the same way, and the whole 2 cleaning system for someone with slight gingivitis is ridiculous. Corporate dental offices are NOT about patient care, they are all about making money. You should not have your “regional directors” or whatever (who by the way are not as educated nearly as the clinicians!!) telling us what to do and what is right for patient care. I could go on and on about these companies but I get so aggravated talking about it!!

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