Question for Private Practice Dentists

[Halcion]

If any of you have followed my previous threads, you know that I work for a dental corporation.

The corporation I work for has recently implemented a "Gingivitis Treatment" as a periodontal procedure charged out to patients. I have never come across this before, not in school, or in my short time in private practice before switching to corporate because to be quite honest... it was the only opportunity available to me that was going to pay the bills, loans, etc.

Anyways, our hygienists, managers, etc want gingivitis treatment to be done on pretty much every patient who doesn't need SRP. I have a hard time justifying this, for obvious reasons.

What gingivitis treatment entails is subgingival irrigation with Peridex. Hygienists want this to be done on patients as young as 10 years old because they have inflamed gingivae. They also want it to be done on every kid in braces, because, you guessed it, inflamed gums. The fact of the matter is (in my opinion) that improved oral hygiene measures will reverse gingivitis. To me, it seems just another way to increase production in corporate dentistry, charge an out-of-pocket expense that insurance companies do not cover, etc.

What do those of you in private practice think about "gingivitis treatment?" Have you ever heard of it? Do you implement it in your practice? If so, what types of patients? Also, what do you think about Peridex use in patients under the age of 18? What about patients as young as 10-12 years old? What is your recommendation?

Also, on another note... how many patients have you come across that truly need SRP at the age of 16?

The reason I ask is a recent patient came in and reported he/she had a history of SRP (10 years ago) and hasn't returned to a dentist since. His/her probing depths were generalized 2-3 with localized 4 mm (likely pseudo pockets), light calculus, BOP, alveolar bone WNL. But my hygienist was adamant about SRP because the patient had a history of it. My feeling is the patient more than likely did not need SRP 10 years ago. What are your thoughts?

---

Members don't see this ad.

 

[helpfuldoc]

If any of you have followed my previous threads, you know that I work for a dental corporation.

The corporation I work for has recently implemented a "Gingivitis Treatment" as a periodontal procedure charged out to patients. I have never come across this before, not in school, or in my short time in private practice before switching to corporate because to be quite honest... it was the only opportunity available to me that was going to pay the bills, loans, etc.

Anyways, our hygienists, managers, etc want gingivitis treatment to be done on pretty much every patient who doesn't need SRP. I have a hard time justifying this, for obvious reasons.

What gingivitis treatment entails is subgingival irrigation with Peridex. Hygienists want this to be done on patients as young as 10 years old because they have inflamed gingivae. They also want it to be done on every kid in braces, because, you guessed it, inflamed gums. The fact of the matter is (in my opinion) that improved oral hygiene measures will reverse gingivitis. To me, it seems just another way to increase production in corporate dentistry, charge an out-of-pocket expense that insurance companies do not cover, etc.

What do those of you in private practice think about "gingivitis treatment?" Have you ever heard of it? Do you implement it in your practice? If so, what types of patients? Also, what do you think about Peridex use in patients under the age of 18? What about patients as young as 10-12 years old? What is your recommendation?

Also, on another note... how many patients have you come across that truly need SRP at the age of 16?

The reason I ask is a recent patient came in and reported he/she had a history of SRP (10 years ago) and hasn't returned to a dentist since. His/her probing depths were generalized 2-3 with localized 4 mm (likely pseudo pockets), light calculus, BOP, alveolar bone WNL. But my hygienist was adamant about SRP because the patient had a history of it. My feeling is the patient more than likely did not need SRP 10 years ago. What are your thoughts?

It is called corporate greed !! i have friends who work in corporations and have told me about the same thing that you are mentioning. They do not question it because after a while your job starts depending upon whether you are a "producing dentist" or not. Infact the chief dentist comes up with "treatment Plans" and bascially they have to follow it even if it involves some shady practices ( read production).I worked one day at a corporation 9 working interview) and was appaled by what was expected of me...ended up buying my own practice that same month !! ofcourse i had the good fortune of having the means and the opportunity which not everybody does. i would never implement what you are mentioning. Gingivitis is totally reversible with good oral hygiene. Kids in that age group just arent good with it and if given proper instruction and follow up and possibly electric toothbrush like rotadent it is reversible. A one time irrigation does nothing except make money for the corporation. So far i have never had to do SRP's on a young teenager...there ofcourse may be justifiable cases out there that require it .
I hope one day there is a collective way to fight this ! May the force be with you

 

[Halcion]

Thanks! I am on the same page 100%. I was just curious what others thought!

 

[gryffindor]

To me, it seems just another way to increase production in corporate dentistry, charge an out-of-pocket expense that insurance companies do not cover, etc.

Yup, you've figured it out. I see ortho patients all day long. There is no way squirting Peridex under the gums at a single office visit is going to improve their gingivitis in any appreciable way. Even if they rinsed with Peridex every night it wouldn't matter. I would not prescribe them Peridex for anything routine in ortho except maybe a surgical TAD placement. Most of these kids need to pick up a toothbrush to remove the plaque on a regular basis which they don't do. I have however seen some kids with good oral hygiene yet they have hyperplastic gums for the duration of their treatment. I suspect with these kids that it is a mild nickel sensitivity to the stainless steel brackets and wires in their mouth for ortho treatment. With these kids, the gingiva usually shrinks right after the braces come off. Sometimes they shrink so much that their clear vacuform retainers we make with alginates on the day of debond become loose. In those cases, we take a new alginate when the gums have settled and make a more accurate retainer to the new gingival architecture. Again, squirting Peridex isn't going to help in this case either.

I have not seen a 16 year old who truly needed SRP, but that doesn't mean it can't happen. I'm sure whatever rate SRP is "diagnosed" at your chain is not the true rate of 16 year olds with advanced gingivitis/mild periodontists who actually need SRP treatment to remove subgingival calculus on 5+ mm pockets.

Do the hygienists get some kind of bonus if they successfully push a certain number of these treatments? Why else are they so gung ho about this?

 

[Halcion]

Yes. The hygienist do get some sort of bonus, but I don't really know the details. I, however, do not push these treatments. I really emphasize oral hygiene. I take out the mirror with majority of my patients and show them how to brush. Something else I have seen, which is really unfortunate-- kids in ortho will see me while they are undergoing treatment, and their gums look awful. When I show them and their parents a floss threader, they look at me like I'm crazy because the orthodontist/ortho assistants didn't take the time to educate the child on how to floss with braces. Granted, many children are not going to be compliant with flossing while in braces, but they hadn't even been shown. And I didn't even consider a nickel allergy. It makes perfect sense in some of the cases I have seen.

 

[djeffreyt]

It's just off the top of my head, but I can only think of three kids in the last year, out of maybe 1000+ kids under 16 who I thought needed ScRP. There might have been a couple more that I could have justified it in order to get insurance to pay me, but I just did them as cleanings and did it just as well.

If you want to rock the corporate boat, you could ask your head dentists in the corporation for the clinical evidence to back up this new procedure, but I doubt that will help. Chances are they will have some articles about peridex rinses in situations completely different than what you are talking about and use it as justification.

They are making this an out of pocket charge because they know they can't justify it to dental insurances. They'll argue that insurances don't know what's best for patients, but what they probably mean, is dental insurances are more skeptical and dental patients can be more gullible. In the end, remember to inform your hygienist that the work that is done on the patients is billed under your license. If they try to force you to do something that you don't want to do, remind them that you are the one who is liable. If on the other hand they'd like to sign a document stating that any liability for these procedures shall be shared between both of you and if in 5 years when a group of patients gets wise to what is being done and decides to sue, that both you and the hygienist shall share liability for these procedures and have to each pay an equal share should the lawsuit succeed, then sure, shoot unnecessary rinses away. See what they say. And if they say yeah, they'll sign, tell them to learn how sarcasm works.

Then if your dental director gets on you, ask him to have these procedures billed out under his license instead of yours. Tell him you'll happily not take production for a procedure you do not believe in, but since it's the hygienists who do the work and the corporation that has pre-determined this diagnosis for its dentists, that you are fine with letting the corporation and the dental director take the money and liability.

In a corporation, you can be a dentist or you can be a number that they use in order to make money. Try not to just be a number that they use to make money. Not all corporations do this kind of thing. I work for a corporation...I have never been told how to treatment plan or what to do for my patients. While this particular procedure is non-harmful, like putting sealants on the lingual of lower anterior teeth, it is still wrong. If you decide to stand up to it, great. If not, it's not going to kill anyone, it'll just rob people of a little money for something really unnecessary. But then, the world is full of that. I can't tell you how many times I've been told to change an air filter or have my fuel injection system flushed 3 months after having it replaced by another shop down the street or had a dental rep tell me that their $25 carpule of microhybrid composite is vastly superior to the $10 carpule of their competitors.

 

[Lethstang]

D2 here. We learned in perio just last week that you injecting anti septic subgingivally doesnt work because it wont stay there long enough to be effective, and you cant compress two different liquids.

Soooooo either my dental school is teaching incorrectness or your company has implemented a protocol which flies in the face of science.

 

[Halcion]

D2 here. We learned in perio just last week that you injecting anti septic subgingivally doesnt work because it wont stay there long enough to be effective, and you cant compress two different liquids.

Soooooo either my dental school is teaching incorrectness or your company has implemented a protocol which flies in the face of science.

Do you have a recent study that your faculty referred to during your lecture? I'd be interested in recent evidence. Thanks.

 

[dmacgolf70]

If any of you have followed my previous threads, you know that I work for a dental corporation.

The corporation I work for has recently implemented a "Gingivitis Treatment" as a periodontal procedure charged out to patients. I have never come across this before, not in school, or in my short time in private practice before switching to corporate because to be quite honest... it was the only opportunity available to me that was going to pay the bills, loans, etc.

Anyways, our hygienists, managers, etc want gingivitis treatment to be done on pretty much every patient who doesn't need SRP. I have a hard time justifying this, for obvious reasons.

What gingivitis treatment entails is subgingival irrigation with Peridex. Hygienists want this to be done on patients as young as 10 years old because they have inflamed gingivae. They also want it to be done on every kid in braces, because, you guessed it, inflamed gums. The fact of the matter is (in my opinion) that improved oral hygiene measures will reverse gingivitis. To me, it seems just another way to increase production in corporate dentistry, charge an out-of-pocket expense that insurance companies do not cover, etc.

What do those of you in private practice think about "gingivitis treatment?" Have you ever heard of it? Do you implement it in your practice? If so, what types of patients? Also, what do you think about Peridex use in patients under the age of 18? What about patients as young as 10-12 years old? What is your recommendation?

Also, on another note... how many patients have you come across that truly need SRP at the age of 16?

The reason I ask is a recent patient came in and reported he/she had a history of SRP (10 years ago) and hasn't returned to a dentist since. His/her probing depths were generalized 2-3 with localized 4 mm (likely pseudo pockets), light calculus, BOP, alveolar bone WNL. But my hygienist was adamant about SRP because the patient had a history of it. My feeling is the patient more than likely did not need SRP 10 years ago. What are your thoughts?

In this era of decreasing caries, over supply of dentists in all areas and lack of supervision of dentist by dental boards it is another example of creative billing that increases the cost of dental care. Gingivitis treatment is doing a patient a disservice and results in the public losing TRUST in the dental profession.

 

[sed8nyank4u]

When my patients present with gingivitis, I give them a toothbrush.