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Perio Programs – Help!

Just took a new position after being in an office where almost all perio was referred out. I am now expected to be really getting those needing perio tx scheduled with my office for that tx as we are a half specialty office (owned by periodontist who is there 1 day a week – general dentist rest of the time). I am comfortable having these discussions with people, I just am curious to get some guidance on your process for perio care. When do you decide what areas need tx vs. Prophy only and how do you schedule it/bill it out. Good tips on getting people to comply! Thanks!

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At my office, the first appointment for a new patient is with the dentist first and all xrays, charting, perio probe charting, BOP, recession, furcation involement, MJDs, decay, and oral cancer screanings are done. At that appointment the doctor looks at radiographs and perio charting to determine the proper treatment for the patient. If SRP is recommended, we typically do the SRP at our office unless it is a severe perio case with significant pocket depths, and we will refer out. If we do the SRP in our office, we typically do half the mouth at each visit. We will typically do one side the the other. I don’t like to do all the mandibular teeth together due to their entire tongue being numb which makes the patient nervous and feel like they aren’t able to swallow. When we get the entire mouth done, we have them come back in about 6 weeks to re-eval and take probe measurements again to see if there is any improvement. After that appointment, I discus the best recall time for the patient(3,4 or 6 months). We then do perio maintenance appointments after that and take probe measurements at each appointment.

There are times when a patient may need SRP only on one arch, so we will do the SRP where needed and a regular prophy for the other arch. When we do this, we just bill out for the 2 quads (or however many quads you do). We don’t bill out for a prophy and an SRP. After that treatment, we will typically have them come back for a 6-8 week follow up then decide the treatment from there. The hygiene appointments in that case are still billed as perio maintenance appointments. For the re-eval appointments, we will for a perio 1. Patient education is very importance in any of these cases so the patient knows exactly what to expect. Luckily for me, the doctors I work for a very good about explaining everything to the patient before they even see me, so when I am talking to them about it, it is more of a reminder for them. That works out really well for our office and the patients love that they know exactly what to expect.

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