Prophy or Perio Patient – What’s Your Why?

Debra Seidel-Bittke, RDH, BS


Not too long ago, I was in a client’s dental office for a day of observation and coaching. As the dental team’s consultant and coach, part of my assignment that day was to help them create partnerships with their patients. The team was role playing how they would create a partnership with the patient and how to show the patient what was happening in their mouth. It was the goal of the clinicians to help their patients “own their disease.” The purpose was to help more patients accept, schedule, and pay for their treatment needs.

One of the new patients on the schedule that day was a gentleman in his early 40s named John. He told the hygienist that his wife threw him out of the house and that he was now living in his car. While the hygienist examined his mouth, took radiographs, and completed various assessments, she discovered that he had generalized moderate-to-advanced periodontal disease. When I discussed the options and treatment opportunities with the doctor and hygienist, I was overruled regarding offering any discussion about gum disease or any oral conditions to the patient. Both the doctor and hygienist were adamant that they should not tell John about his oral conditions (periodontal disease and active caries). Both doctor and the hygienist were convinced that telling this patient—who was already suffering from such difficult personal problems—about these issues would make things even worse for him. After all, he had just lost his marriage, his job, and had no money to pay for any treatment. Their point in not wanting to tell him about his dental disease was that he had enough stress in his life and, in addition, he had no money to pay for treatment.

Many dental professionals do find it difficult to talk to patients about periodontal disease and other oral conditions. It can be especially difficult when a patient routinely comes in for prophylaxis appointments and then, one day, that individual is found to have active periodontal disease.

  • What do you say to patients in these situations?
  • How do you tell patients they have active disease without upsetting them?
  • How can you tell your patients they have treatment needs without making them feel like you are selling them on something that they do not really need?
  • How do you get away from patient dependency on insurance?

It is important that everyone on the dental team has answers to the following questions that are in line with the office’s philosophy of patient care.

  • Why am I a dental professional?
  • What is my goal for patients?
  • What is our office patient-care philosophy?
  • How do our treatment recommendations affect the patient’s overall health?

Understanding the answers to the above questions is helpful in treating your patients at the highest level of care. The answers provide valid reasons why you will tell your patients the truth about what is truly happening in their mouth and body. After all, this is most importantly about understanding why you do what you do.

As a consultant and coach, I am a huge advocate of team meetings. These include a short team meeting every morning, in addition to regular and longer monthly meetings. These meetings must include everyone so, yes, doctors are included!

The morning team meeting helps everyone evaluate individual patient care before patients arrive. The morning team meeting is the perfect time to map out how your day with patients should run. These short morning meetings will help your day go more smoothly. This is where you organize your day: verbal skills (who needs TLC, who has special needs, etc), outstanding treatment to be scheduled, who is available to help with hygiene patient periodontal evaluations, which patients require examinations by the doctor in the hygiene room(s) today, and so on.

Once you have your hygiene patient seated in your chair, ask how he or she would like his or her teeth to look and feel. Take time to explain what you are going to be doing. Examples of this may be:

  • “Mrs. Smith, if there is one thing we can do to make your smile better than ever before, what would that be?”

(Pause, allowing your patients to use their imagination. Then, actively listen to the response.)

  • “Mrs. Smith, today I will look around your mouth to make sure you do not have any abnormalities. I will use this ruler [show the periodontal probe], and our assistant Sue will write down the numbers I call out to her when I measure the space between your gum and tooth. When you hear me call out one, 2, or 3, this means your gums are healthy. If you hear me call out a 4, this means that you have inflammation. If you hear a 5 or higher, this means that you have active infection in your gums. When I am finished calling out these numbers, I will sit you back up in the chair and ask you what the highest and the lowest numbers are that you heard. I may even take some pictures of specific areas as I am looking around so that you and I can look at your teeth and gums together.”

Once the hygienist has collected all the patient data, the hygienist will sit the patient upright in the chair and show what has just been seen in the patient’s mouth. This is a great opportunity for the hygienist and the patient to look together and to start the process of creating the best plan for the patient’s health. We have all likely heard the phrases, “seeing is believing” or “a picture is worth a thousand words.” Allow your patients to see what is happening in their mouth. They are more likely to want to change something that looks unhealthy if they can see it for themselves rather than have someone tell them what they think they need.

This is also the best time to talk with patients about what is valuable to them, explaining the benefits of completing their treatment needs. At this point, you are building your partnership to create the best plan for your patient’s health. The partnership between the hygienist and patient is where the patient gains the biggest buy-in for accepting necessary treatment. This is the perfect time for discovery and partnership with your patient. It is where the magic happens. Creating this partnership is one piece of keeping your patients returning to your practice. Partnership is a relationship, and relationships are what help keep your back door closed.

Insurance is a benefit. It is not our responsibility to understand our patients’ employee/insurance benefits; however, we do want to understand and discuss the benefits found in the acceptance of any necessary treatment plan. These benefits are about how it will best serve the patient’s life: less money, no pain, less time off work, increased self-confidence from an improved smile, and so on.

Do you want to know what happened to John, the patient with all the problems who was talked about earlier in this article? Later that month, he ended up meeting a beautiful (and wealthy) woman and got a great job as an assistant manager at the local grocery store. The dental office called him later that that year and found out he was now going to his girlfriend’s dentist. He told the office that he was scheduled for periodontal therapy and a few crowns at the new dental office. He told the dentist there that he was quite surprised that his previous dentist never told him that he had gum disease and tooth decay. John’s personal situation was not good, but it was temporary. The time that this patient had spent in my client’s office was also temporary, probably because their team chose not to create that partnership with him that would lead to a long-lasting, doctor-patient relationship. Remember, we must understand why we do what we do. We have no idea what patients’ financial situations are unless we can look at their bank account. We cannot see into the future and know if our patients’ circumstances will change. All we can do is give our best efforts to our patients and not let our assumptions about their current financial or personal situation dictate what we tell them about their oral health.

Some reading this may believe that these steps outlined are too time-consuming in their already hectic office schedule. You may be thinking that there is not enough time to do all this. Well, this hygiene appointment system needs to be mapped out and an appropriate time management system must be created and implemented to make sure your patients do receive the services that they need. Dentistry in the 21st century offers great opportunities for us and our patients. Creating optimal oral health that in turn helps to support a longer and healthier life for our patients should always be our goal.

Ms. Seidel-Bittke is the founder of Dental Hygiene Solutions, powered by Dental Practice Solutions. She is a dental consultant, coach, speaker, author, and world-class leader in creating profitable hygiene departments. She is a former clinical assistant professor at University of Southern California in Los Angeles and a former hygiene department program director. Dentistry Today recognizes her as a Leader in Dental Consulting. She can be reached at (888) 816-1511, via email at, or through her website,

Disclosure: Ms. Seidel-Bittke reports no disclosures.

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