How to increase patient commitment to periodontal treatment

I believe we’ve all had this experience: after what we feel is a comprehensive presentation of a patient’s periodontal status and treatment recommendations, we’re met with objections and “I just want the regular cleaning that my insurance covers.” There is either a disconnect, a lack of understanding, a lack of perceived value, or some other barrier that causes a divide between patients and what we know as providers is in their best interest. What can we do?

Here are six strategies to add value to your periodontal assessment process and verbal skills to foster better patient understanding and increased commitment.

Set the stage

Before you begin the periodontal assessment (no matter how many times a patient has experienced it), concisely explain what you are doing and why. What I have found most effective is something I call "breadcrumbing" information: I explain as I go and do so without overexplaining.

For example, before you begin, say, “As part of your hygiene exam today, I’m going to do an evaluation to check the health of your gums and the bone that holds your teeth in place. I’ll tell you what I’m measuring as we go along, and we can discuss what it means at the end of the exam.”

At this point, I do not recommend going too deeply into the disease process and possible treatment. It’s usually best to wait until you complete the assessment because some information may not be necessary based on the patient’s findings. There is also the risk of overwhelming the patient. The more you attempt to share, the less someone will hear you because they’ve gotten lost or tuned out.

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The way I prefer to breadcrumb a periodontal assessment is to briefly explain each component of the exam as I go. For example, “First, I’m going to use this small ruler to measure the space where your gum attaches to the root of your tooth. You’ll hear me call out numbers. One indicator of a healthy space is one to three millimeters. I will also look back every so often to see where you have bleeding, and I’ll call that out as well. The tip of this instrument is blunt, so healthy gums will not be uncomfortable or bleed when probed correctly.”

A helpful tool to engage a patient before you start is to show them with a hand mirror as you gently insert the probe under the gum so they can see what you plan to measure. Also, I always chart aloud so the patient can listen. This technique can help foster interest, commitment, and patient engagement.

I follow a similar process when I evaluate gingival margin, tissue appearance, attached gingiva, furcation, and mobility. For example, “Now I’m going to look at the outside of your gums to measure areas where the gum has receded and is sitting higher on your tooth than it should. These are areas where I can see the roots, which should be hidden by your gums. Where gums go, the bone follows.”

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Combine and summarize

In cases of concern, proposed periodontal treatment, or referral, it is best to sit up the patient as you share the information. An engaged patient who was listening as you charted is likely already invested in the conversation. Another helpful patient engagement tool is visuals. For example, have the periodontal chart up so the patient can see areas of concern (which many software systems show in red). Show photos or models so they can compare their condition to healthy ones. Show them what you’re looking at in a mirror, and compare a previous chart or x-rays to what you see now. All of this can help patients understand the disease progression.

Communicate clearly and honestly

In the early years of my career, I carefully danced around the words I used when discussing disease because I felt like I was going to insult someone. One of the best things you can do is be honest and straightforward about what you’re seeing. You’re not insulting the patient. You did not cause the disease. As a licensed oral health-care provider, you have the obligation to perform thorough assessments, communicate your observations, and provide education so patients can make appropriate decisions. Minimizing what you see does not help someone understand the severity of their condition or give them the tools to make informed decisions, and it devalues necessary periodontal procedures.

 Explain treatment and next steps

“When we look at the charting, I see pocketing, bleeding, and loss of the attachments that hold your teeth in place. You have active periodontal infection. Disease-causing bacteria invaded these deeper areas, and the infection can progress, often silently and with no obvious signs to you. This leads to further complications, including tooth loss. Periodontal infection also compromises overall health.”

Before you discuss treatment, this is a good place to pause and see what the patient says. Sometimes just a brief pause can result in them asking about next steps. Conversations can be much more successful as the patient is navigating the process with you versus listening to what can feel like a lecture.

“Accessing these areas calls for a different treatment than a basic hygiene visit, which is geared toward prevention. We use periodontal therapy that includes specialized instruments to remove the bacteria. It is nonsurgical; we just go further under the gums. We use anesthetics and many patients say they’re more comfortable than they were for previous hygiene visits.”

At this point, I explain that periodontal maintenance visits and patient home care are part of successfully continuing care. We discuss how we regularly evaluate and address those deep areas with the goal of halting active disease and maintaining current bone levels.

I explain that coverage for these procedures is based on their individual plans. I introduce them to a business team member at the end of the visit for more information. I also remind patients that dental plans are meant to assist and are geared more toward preventive services. Committing only to what is covered will likely result in more costly treatment down the road.

Open the floor

Instead of asking a closed question that elicits simply a yes or no response, try an open-ended question. “What thoughts or questions do you have? How is all of this sitting with you?”

It's important to listen and understand the patient’s oral health goals and tie the information back to what is important to them. For example, a health-conscious patient may benefit from hearing more about the systemic links. A financially focused patient may benefit from hearing about how treatment now can prevent more costly treatment down the road. A patient concerned about aesthetics may benefit from seeing photos of progressing periodontal disease.

Coordinated handoff

This is like handing off the baton at a relay, only it’s handing off information to the dentist in front of the patient so he or she can pick up the ball from here and the patient hears a consistent message. It’s always best to be on the same page with periodontal treatment beforehand and have consistent office guidelines and protocols.

Increasing patient commitment does not happen overnight. Creating value in appointments and finding verbiage that fits you and benefits patient understanding takes time and practice. Helping patients connect the dots and commit to better oral health is rewarding for clinicians, the office as a whole, and most importantly, patients.

This article originally appeared in RDH Graduate newsletter. To subscribe, visit rdhmag.com/subscribe.