Hi and welcome, or welcome back. You are listening to the Perio Hygienist Podcast, a podcast for my professional colleagues and anyone else who cares to listen. My name is Dr. Ben Young and I am a periodontist in private practice in San Antonio, Texas. This is episode 63 and the title is Improving the Patient Experience.
If you were to metaphorically open my head up and look inside, I think you would find I am a creative. I enjoy creating and improving things, and my medium, what I work with most are words. I love to write. Speaking is OK but the activity of sitting and writing I find personally even more enjoyable.
There are many topics within my specialty that I enjoy thinking and writing about, and one of these has to do with working off the question: How do we improve the patient experience?
Note first of all that I spoke in the first person pleural. How do we improve patient care and experience – not how do I improve it. And this is because it is a “We” activity, not an “I” activity.
So it involves communication and cooperation – and the process is a series of steps – which means we can break the process down into small elements and then analyze each one.
Of course, my interest has to do with the health of the supporting structures that surround the teeth and dental implants. How can we improve the health of the soft and hard tissues around the teeth? If we can’t do this then we will ultimately lose the teeth.
So the treatment of periodontal disease, primarily in the adult population, is early on the to do list when someone comes in and needs dental care. Often those with this condition have missed a few years and now things are beginning to become noticeable to themselves, and sometimes to others as well.
So here we have a new patient with periodontal disease. What are some of the best ways we might improve their patient experience?
This is where the team approach becomes both helpful and complicated.
As a specialist in this area I know what I can do to improve patient health and compliance, because this area of treatment not only involves initial therapeutic procedures but also the necessity for the patient to change his or her ways with regards to continuing routine care at an interval that maintains health and intercepts any problems as soon as possible.
The potential downside is losing the new patient to another office early in the forming relationship between you this patient.
One possible solution for this is to send the patient for treatment with the dental hygienist. For early disease situations this is a good option. For more advanced conditions, when there is the risk of tooth loss, it may be setting the office up for an unhappy patient. Best to get this one to a specialist who can then assess treatment options and therapeutic risks – but then we are back to the first problem – that this patient is new to the practice and has little reason to remain loyal should they be referred out.
So now, how to improve this patient’s experience?
What if, the periodontist came to your office to specifically perform the LANAP procedure? LANAP stands for Laser Assisted New Attachment Procedure. It uses a particular NdYAG laser. It is also known as LAR – laser assisted regeneration. I have other podcasts about this you can check out. Go to my website to find them – or go to lanap.com.
What might this look like in practical terms?
I know this will not be useful to every practice. Corporate run offices usually have their own periodontists. But this is what I am willing to do if our two offices are within reasonable driving distance.
Here is how it would work.
First, you identify the patient has need for periodontal treatment. In essence, they need to be cleaned up, and quickly. It is more than dental hygienists enjoy doing for many possible reasons. For one thing, this individual may need a lot of instruction. Compliance is a potential problem. I will come meet the patient in your office using your periodontal charting, dental radiographs, and medical history.
If they elect to have me treat them in your office, they will pay my office a flat fee to be scheduled. Currently I am offering this procedure at $2,200. This allows you and the patient to study this fee and compare it around. Let me know if you find anything that comes close.
When I come to your office I will bring my own equipment and assistant. All I need is a treatment room with suction.
Now let’s break this offer down further.
LANAP is a procedure that dramatically improves periodontal health over scaling and root planing alone. In fact studies show that many sites at the base of their pockets will regenerate tissues. The standard optimum expectation in pocket reduction from scaling and root planing is 2 mm. The pocket reductions from LANAP are similar to patients who have been treated through the scaling and root planing as well as the periodontal surgical phase. It is not uncommon for deep pockets to resolve to maintainable ones after one LANAP procedure and a few supportive care visits when the pockets are remeasured after six months.
So what is the cost savings to the patient? Take the cost of scaling and root planing, the reevaluation examination one month later, and then the periodontal surgical procedures, followed by a final reevaluation, and what is usually the case is the insurance will have maxed out early on. Plus this is less insurance the patient will have for other dental treatment they need.
Because dental insurance does not cover the LANAP procedure, I provide it at a discount for patients. This discount reflects the reduction in time it takes me to provide equivalent treatment outcomes but at less discomfort and numbers of appointment for the patient.
So here is what it can look like for new or recurrent periodontal disease patients in your practice.
The patient stays in your office.
He or she obtains a consultation with me as a courtesy to you. No charge to me. You worked up the case. Hopefully, eventually, these come at times when I am in your office treating someone else.
At a time when you have a treatment room available, I come in and treat your patient. Everyone in your office is welcome to watch. I’m a teacher at heart. Plus the more you see the more you learn the more confident you are when discussing this treatment with patients. Also, you always have more resources on my website and I do podcasts for periodontal patients where they can listen and get to know me better. This lowers anxiety. Their podcast is called The Perio Patient Podcast. I encourage you to listen to a few of these podcasts yourself, just to get a feeling for them.
Once the patient has been treated they will be on a liquid diet for three days followed by a soft-food diet for another seven days – and I will put them on an antibiotic and dispense a mouthwash (included in the fee).
Three weeks after the procedure the patient will return to your office and be seen by the dental hygienist. If there are problems or concerns, I am available to see them at my office at no charge to them.
Also, after this third week check, the patient may proceed with all other dental treatment. Orthodontics can also usually be started. This should be addressed on a case-by-case basis, however.
The only thing I recommend we not do for six months is to make measurements. The pockets are continuing to heal. We are still expecting the laser effect to be in place and do not want to damage areas in their earliest stages of healing. After six months, measure the pockets again. Should there be concerns the patient can come see me in my office. Usually, what they will need at that point is a reasonable maintenance interval. All of this can be discussed for each particular patient as they are going through care.
So let’s review. I have structured my practice around the idea that patients are best managed in one office. I do not have a dental hygienist in my practice because I see this as competition with your office team. Rather I produce podcasts like this one to provide you with ongoing information to equip you to manage the routine care that comes with having patients with a history of periodontal disease. This is what I call a Supportive Periodontal Therapy Program. I like this term over Periodontal Maintenance because we are supporting the patient in caring for themselves and there is no such thing as a steady state when it comes to chronic illness. We need to monitor oral health which can change due to changes at times in physical health. This is the preventive side of dentistry.
Now, I am offering the full mouth LANAP procedure to be performed in your office under a single fee proposition to simplify patient acceptance. When I come to your office to treat the patient, I will obtain my own charting, as I am required to do, and I will provide them with the LANAP experience, which is much easier on patients compared with classic periodontal therapy. I am a board-certified periodontist with decades of surgical experience and I can tell you personally that this procedure is tremendous in returning patients quickly and easily to a good level of periodontal health. Is it perfect? Nothing is. But is makes no sense to me to have patients lingering in disease when they can be out of the problem quickly.
What if someone only has a single area that needs treatment? Then refer them to my office. The patients who will benefit from me coming to your office essentially need to be recovered quickly from a full mouth of problems. A by a full mouth of problems, this means as little as a few deep pockets in every quadrant, or periodontal problems involving every tooth. This is because the LANAP protocol will be used for every tooth to irradicate by laser all nests of bacteria that may be hiding in the periodontal tissues regardless of a particular tooth’s pocket depth. Certainly more laser energy will be deployed when pockets are deeper but the protocol generally requires a particular amount of time (at least for me) regardless the pocket depths.
I am happy to discuss this treatment idea further with any dentist or office team. Just call my office at (210) 615-1995 and ask them to schedule either an in-your-office meeting or a zoom call.
Finally, just so you know, I am covered under my own malpractice for the services I perform.
Well that’s it for today. Thank you, as always for listening. If you have questions please call me. I have already started this service in other offices and would be happy to discuss how this might work in your practice as well.
You have been listening to the Perio Hygienist Podcast. I am still Dr. Ben Young. Bye for now.