Episode 569: You Need to Establish Perio Protocol

This is an episode all about perio and why it’s so important to establish protocol for it in your practice. Dana joins Kiera to touch on the following:

• Why establishing perio protocol will benefit your hygiene team

• How to get calibration

• How to implement more perio conversations

No two perio philosophies are identical, so providing guidelines for your practice will help with continuity between patients.

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Transcript:

0:00:05.6 Kiera Dent: Hey everyone, welcome to The Dental A Team Podcast, I'm your host, Kiera Dent, and I have this crazy idea that maybe I could combine a doctor and a team member's perspective because let's face it, dentistry can be a challenging profession with those two perspectives. I've been a dental assistant, treatment coordinator, scheduler, filler, office manager, regional manager, practice owner, and I have a team of travelling consultants where we have travelled over 165 different offices, coaching teams. Yep, we don't just understand you, we are you. Our mission is to positively impact the world of dental, and I believe that this podcast is the greatest way I can help elevate teams, grow VIP experiences, reduce stress and create A teams. Welcome to The Dental A Team podcast.

0:00:51.6 KD: Hello, Dental A Team listeners, this is Kiera, and you guys, I'm super jazzed, I have our incredible consultant, Dana. If you don't know Dana, you should get to know her, her clients absolutely love her, and Dana is not only an incredible consultant, she also was a practising hygienist prior to being an office manager, treatment coordinator, all the things. So Dana, I'm super jazzed to have you. How are you doing today?

0:01:12.5 Dana: Good, thanks. Thanks for having me on today, I'm super excited.

0:01:15.6 KD: Of course. Dana, it's pretty fun to see you morph and grow in the company, I remember when you very first started to today. How do you feel like you've changed in this consulting world? This is totally rogue and off-script, but how do you feel your journey has been becoming a consultant? What were... From like when you started thinking about what a consultant would be, to today of actually being a consultant, how has your journey shifted and morphed?

0:01:41.0 Dana: I would say really what I would describe it as just so much learning and growing, which was why I pursued consulting to begin with, is just I wanted that personal and professional growth, and so I can hands down say I have gotten it.

[laughter]

0:02:00.0 KD: It is funny because with consulting, we hire people who are top-notch amazing, and their job is to be great regional managers and great office managers who have grown amazing practices, but consulting is a lot different, it's such a different skill set than even office manager is, and so I do agree, it's almost like I feel like I went back to first grade and I'm like, 'I don't even know how to read, write and spell', and yet I thought I knew what I was doing. Does that relate with you, Dana? 'Cause that's how I felt.

0:02:28.4 Dana: Absolutely.

0:02:31.2 KD: Yeah. So I think it's one of those things where I don't think people who wanna become consultants realise how much personal growth and development of just even like how to communicate with people and how to send effective emails and how to coach teams virtually and in person, like that whole world, you know what you're doing, you know how to get practices to grow, but then it's almost like to be a puppeteer behind the scenes and get other people to be able to do it just as good, if not better than you can do it, to me, I feel like that is the fun and hard part of being a consultant. Would you agree? How is it for you? That's at least how I feel, I feel like I'm a puppeteer behind the scenes.

0:03:06.0 Dana: Yes. 100%, I feel like that is where I have grown the most, is figuring out how to do it behind the scenes, not be the active implementer.

0:03:20.3 KD: So frustrating sometimes, huh? I imagine this is what it'll be like... You don't have kids that drive yet, do you, Dana?

0:03:25.6 Dana: No, not yet.

0:03:28.2 KD: This is what I imagine it will be like to be that person who's trying to teach someone to drive, like those driver ed teachers, they get in cars with students, hats off to them, I can't even imagine sitting there and be like, 'Okay, now turn left', like really turn left, and you're the only person doing it. That's how I almost feel like it would be... That's at the least how I feel with consulting, I'm like, 'Okay, no, you gotta click in the middle of the screen, the office manager', and I think I've just developed a lot more patience and also a lot more ease of protocols to help people really be able to do it easier for sure, as a tip, right?

0:04:01.5 Dana: Yes, absolutely.

0:04:03.5 KD: Well, fun. Well, on that note, I wanted to bring Dana on the podcast today obviously 'cause I love podcasting with her, but also she's a hygienist, guys, and I thought today would be a topic to dive into all things perio, I think with where the world's going, I feel like perio oftentimes gets overlooked in a lot of dental practices, I feel like it's one of those... People don't wanna talk about it, they don't wanna tell you, there's an embarrassment around it, all these... Whatever people wanna feel, and I just really feel like perio is such a good service for our patients that some people don't do. So, Dana, let's dive into all things perio, I know you've coached a lot of hygiene teams, you are and have been a hygienist but let's start taking off on all things perio today.

0:04:49.3 Dana: Sure, absolutely. This is definitely something that is important to me professionally. So I think the number-one thing you can do for your hygiene team as far as creating and supporting an environment that allows them to talk about perio comfortably is having a perio protocol, I think it helps continuity across your hygiene department, and I think it's just an important set of guidelines for your team to really dig into perio.

0:05:21.0 KD: I agree with you, and I'm gonna actually give the question I know a lot of doctors will say, and they say, 'Kiera, do I really need to have a perio protocol?' Hygienists are experts and they have licences and they have degrees. Who am I as a dentist to tell them what we should be doing for perio? They should all know perio. Right? So, Dana, how do you respond to that? 'Cause I have my very strong opinions on that but I am no hygienist. So what's your take on that from a doctor's perspective?

0:05:49.6 Dana: I think, right, yes, hygiene, it is kind of... They are the perio experts but every expert can certainly use guidelines to follow as a department. So putting all of these experts together, it's guaranteed that their philosophy on perio isn't identical, and so I think having a protocol that they follow helps just, again, that continuity across your department, which then allows that if a patient comes and sees one hygienist and they're scheduled with a different one the next time, the course of action will be the same regardless of who they see within your hygiene department, so that's why I think a perio protocol is really important, and to you as the dentist or business owner, it gives you a protocol to fall back on when maybe you're seeing things that don't align.

0:06:44.4 KD: Which I love that, and I am right in the same boat as you are, Dana, because I feel like I have seen so many hygienists, just like I've seen so many dentists, if I give you an FMX, if I give you intraorals, y'all diagnose different things, like every one of you, every person, which is great, but it's not great when it comes to patient care and also within that practice, and Dana, I don't know... Again, I've never been a hygienist. Is it true that in every practice, the perio protocol is a little bit per dentist? I feel like I've seen them be just like varying shades, like some will say, 'Do SRP when it's 4 millimetres above with bleeding', others will say, 'Nope, 5 millimetres and above with bleeding.' Have you just seen it's a variation, and by having a protocol in play per practice, it just helps you as a hygienist also know like, 'Okay, what is this practice? What is this doctor gonna back me on?' Of course, if I disagree, I'm gonna go talk to them, but at least it gives you the baseline of where to start at every different practice you've worked in.

0:07:40.1 Dana: Yeah, for sure, it will vary usually in a millimetre or so as far as pocket depth, and then number of bleeding points will vary by office, and then really where it varies by office and by hygienist is when we refer out because referred out oftentimes comes down to hygiene comfortability with pocket depths. So it can vary, and that way right when we transition in new hygienists, we bring on new team members, again, it's just that consistency.

0:08:12.4 KD: Which I think is that... I'm so glad you highlighted because it doesn't mean that one hygienist is right or wrong, it doesn't mean one way of doing it is right or wrong. At the end of the day, perio is perio, there are going to be varying shades, just like a composite is a composite, there are different techniques and methods that each dentist is gonna feel comfortable with. Some dentists are totally comfortable with an MODBL, others are like, 'Hard pass, no, I would never do that, I would crown it.' At the end of the day, I feel like if you're doing what's in the best interest of the patient, fantastic, but like you said, Dana, in your practice, it does need to be consistent, that way the patient experience is [0:08:47.4] ____ across the board and it's not... I mean my husband, we go to a pretty big practice here in Reno. Every hygienist does a different thing. So guess what? If I don't wanna have to deal with massive pocket depths and them probing me, I know there are quite a few hygienists that I could schedule with that won't perio chart on me, and I know they won't even do hardly any scaling.

0:09:09.2 KD: Others are gonna go like sub-G on me when I have no calculus down there and I'm gonna walk out with a bleeding mess when I have zero bleeding, but they're freaking animals on my gums and it's the same practice. So Dana, is that what you're trying to figure out of like how to get it to where the experience is pretty consistent amongst each identity rather than having what I just described at the practice I currently go to?

0:09:30.1 Dana: Yeah, absolutely, and having that protocol helps set them up for success, it also helps make those hard conversations that are often linked with perio easier, because if it's consistent across the team, we don't have where we have one and we have seen a patient and they've had prophys their entire time they've been at your office, then they switch to a new hygienist, and now all of a sudden they have periodontal disease and need a different type of cleaning. So to that patient, it's like, 'Well, why have I been able to have a prophy all this time with Susan, but now I'm seeing Carrie, and all of a sudden I have this disease?' So it creates distrust when they're not consistent.

0:10:10.3 KD: I totally agree, and I also think that that's hard when we're bringing a new hygienist, which right now, guys, I don't know if anyone noticed the hygiene drought that we've been in where there are hygienists not to be found, and now what we're trying to do is get hygienists that are fresh outta school. I know I've got an office and they are like, 'Shoot, Kiera, we're just waiting for the hygienists to graduate and we are recruiting them like crazy.' But they've had OG hygienists for years and years and years. How do you think that new hygienist is going to be? They're coming in, strong perio, they're coming right outta school, and then the OGs that were never doing perio, those patients lose trust in that new hygienist for sure. So I also think having a perio protocol sets it up for the practice to be able to hire a new hygienist straight outta school, gives that new hygienist more confidence of, 'How do I diagnose perio in this practice?' And also helps the OGs ensure that they are diagnosing perio, which I know was not as relevant or prevalent in years past, it doesn't mean perio didn't exist.

0:11:05.3 KD: I just don't think it was talked about nearly as much as it is today, like an awareness thing, like, let's go back, sunscreen wasn't worn back in the day, it doesn't mean the sun didn't give us skin cancer, but it wasn't as well-known or talked about as I think perio is today. Okay, so Dana, we gotta get a perio protocol put into play. What are some of the things like within perio that you found really can set up a hygiene department for success?

0:11:28.8 Dana: I think the first thing as far as perio is just doing that yearly full-mouth perio charting, it helps have those numbers that we look at for our protocol. So I'd say it's super important to make sure each hygienist is doing full-mouth perio charting yearly.

0:11:47.6 KD: And I always suggest that you do those full-mouth perio charts on the opposite visit of your X-rays. So you're doing your FMP, and then you do your X-rays, FMP X-rays, that way it has that circle, but I do agree, get those FMPs in because from a biller's standpoint, that's also helpful in case I ever have to go back, I have record of it year over year over year as well.

0:12:10.0 Dana: Absolutely, yep, and I think it just gives you your baseline data then to make your decisions about your patients' care.

0:12:16.2 KD: It's valid. Okay, so once we get the FMP, we know that that should be annually. Guys, it's not a billable code, I definitely love to put it in patient charts as the appointment, because hygienists, when you're making those re-appointments, if you will tag FMP on there, you know you need to perio chart that patient the next time and it's not even something that you're wondering, 'Do I need to do it? Do I not?' You just attach it in. So I'm a huge proponent of adding that to appointments, that way you don't have to go back and look what you did last time at your six-month visit.

0:12:45.8 Dana: Yeah, perfect.

0:12:48.4 KD: Okay, so after FMP, what else, Dana? What else do you recommend for perio?

0:12:52.3 Dana: The other thing I recommend is once you have your perio protocol in place, calibrating as a department, because now we have the guidelines, but are we seeing the same things as a hygiene department? So pulling FMX is pulling those FMPs and then talking about how with each of these patients, what type of cleaning would you deem appropriate for them?

0:13:13.0 KD: How often do you recommend doing that, Dana? Because so many offices talk about calibration, we've talked about, 'What would doctor do?' All that jazz, but really, how often should you do this as a team?

0:13:23.7 Dana: So I think when you first roll out your perio protocol... So if you've designed your perio protocol and it's a new thing for your practice, I'd say do it monthly for a quarter. So first, do it for three months monthly in a row. Then when we feel like we've gotten more calibrated as a team, I think quarterly for hygiene.

0:13:44.6 KD: Okay. So monthly, and it's like pull out an FMX, pull out patient information, and it's really just like today, we're actually gonna do it in our consultant calibration. Like truthfully, Dana and I, as soon as we get off the podcast, we're headed over to that meeting but I'm gonna pull out offices and we're gonna do an office autopsy and I'm gonna give them their numbers, so basically like an FMX, and as a consultant team, we're gonna say, 'What would we actually recommend for this practice to consult them on?' It's the same thing for perio and for hygiene of like, 'What would you say should be their next course of action?' And Dana, how do you get... Because in these meetings, you are always gonna have your outspoken people speak up a lot more than your maybe quieter personalities. How do you recommend getting full calibration? Because I think sometimes those quieter personalities are the ones that are more timid, they're not as confident explaining SRPs compared to your louder personalities. What do you suggest could happen, so that way all the hygienists really do have an equal speaking and they also get equal practice? Any thoughts on how you can get the hygienists to speak up?

0:14:52.1 KD: How many of you would just love to DIY and get the secrets of people who have been there, done that on your own time? Because I know for me, I love to learn from the best of the best, the people who have been there, done that, and can give me the shortcuts. That's why we have created our Dental A Team Virtual Academy, where it's the on-demand courses for you at your fingertips, where you literally can learn the secrets from all of my experience, all of Tiffany's experience, of Britney, Dana, our entire team's experience at your fingertips. So stop taking the hard route, guys, there's a shortcut sitting there waiting for you, and it's also CE. Head on over to thedentalateam.com and click on our Virtual Academy. Be sure to use coupon code 'podcast' and get started on that DIY and become the practice of your dreams.

0:15:38.7 Dana: Yeah, so I have everybody look at them, and then everybody write down really what course of action would they take with this patient, then it's just roundtable round robin, you go around and everybody talks about which they chose and why, and then I would then too take it one step further and roleplay, if this is the patient that we look at their history, and we've done prophys, but we've looked now and see that we probably should have done localised SRP once we have a protocol to follow. We should have done localised SRP. So what are we gonna say to the patient the next time they're in the chair? And then roleplay that. And make sure everybody has the opportunity to be the hygienist speaking to the patient.

0:16:15.7 KD: Yeah, and I think an easy way to do that that I've found is, I just pair people up, I will pair rather than letting them pair because people will choose their best friends, and I like to put them with people that they're maybe not as comfortable with, and then I usually say, 'The person with the shortest hair starts.' So it's just a quick easy one, and that person is gonna be the hygienist, the other person's the patient. And then once we're done, it's, 'All, let's share.' And I have everybody pick out one thing that that person did really, really well, and then also one area that they can improve. The reason I set the stage at the beginning when I'm doing any type of calibration is because we're very hesitant as a group, and I think especially colleague-to-colleague, to want to give feedback. You might hear it and you might think they could say it better, but it's like, 'Who am I? I'm a hygienist just like you're a hygienist.' So by almost forcing this feedback, I think it helps each person really look for and then have that become a collaboration of, what was some of the feedback that was really positive? If you heard that Dana explains SRPs really well, truthfully, guys, as a consultant, this is how I pick up my best verbiage, is I have people roleplay like this, I have them do a group share, I'm like, 'Dang, that was a really, really good way that you described that, I'm gonna snag that and go share it with other practices.'

0:17:32.6 KD: So I think same thing in your practice, you can do this, and then if there were areas of like, 'Hey, we caught this, like Dana, she was explaining SRPs to the patient really well, but then she didn't tell them about the six-week follow-up. This is the way we were able to come up with a way for us to do a six-week follow-up', or whatever your protocol is, I think it's just paramount that you give feedback like that because also, again, I'm not a hygienist, so Dana, I'm super curious, what I've heard from other hygienists though is hygiene can feel a lot like being a dentist, where you're isolated in your room all day long, you don't get to hear what other hygienists are saying to their patients, and you're just on your own lone island trying to figure out how to talk to patients. Is that fair? Is that accurate? Did this help to have collaboration of other hygienists? How do you feel as a hygienist working in your own room?

0:18:21.3 Dana: Yeah, I 100% agree with that, I can tell you, working side-by-side with somebody in operatories, you really are on an island by yourself, even though you're probably six feet away from the next hygienist, you don't hear the conversations that they have with patients, you don't see the radiographs that they took. You don't interact like that on a day-to-day basis. So that's why I think that having the calibration is super important, and I always tell my teams, 'When you do these calibrations, always, always come from a learning standpoint, you're doing them to learn and grow. No one is right, wrong. It's just, "Hey, tell me why," right? Dig in. "Tell me why you chose this." Point things out, and then learn and grow as a practitioner.'

0:19:06.2 KD: Totally, and I actually like it. Why we don't we call it like hygiene training, I actually notice, and Dana doesn't know this, like spoiler alert, Dana's learning all the things today on the podcast live, but Tiff and I were actually talking, and we have it called 'consultant collaboration', and we have, when new hires are hired, that it's a check-in, and we actually decided we're going to shift it to when new hires are hired, it's called 'consultant training', and then we're also going to change it to once a month, instead of always being 'collaboration', it's going to be 'consultant training'. So when they come to the table once a month, this is the time where we're actually training, and Dana, the reason I actually did this, it's an intentional move on my part, is I want our consultants to feel comfortable that they knew this was training for them. Something of... Feedback that we got in our company was, people didn't feel like they got enough training, and so I just thought, 'If we even just change that, and again, we'll try it for a quarter, we'll see what happens and who knows? Maybe we will change it back.' But my thought was, providing an environment that was literally called 'training' allows people to feel safe, it allows them to feel like they can make mistakes because all it is is training. They don't have to be an expert, they don't have to know it all, it's literally training to make us better.

0:20:17.3 KD: So I don't know, Dana, I think you had a really good point on calling it training and having it be that safe space where this is where we come to train, and then the next one we're gonna call 'collaboration.' So you guys are welcome to follow ours. Who knows? We'll try it out for a quarter and see, but I really love that you said like, 'This is training. No one's here to be perfect, no one's here to be wrong. We are all here to train and become better clinicians, that way we can be better for our patients.'

0:20:40.0 Dana: Yeah, absolutely, you summed it up perfectly.

0:20:45.6 KD: Dana, any last thoughts? We've got the FMP. We've got having calibration consistently, I love the monthly idea, I also loved the quarterly idea, making sure people are there. Any other thoughts you got around perio that can really help practices grow in this perio department? 'Cause I personally think so many practices are really low on perio, and I think it's just a lack of awareness and actually a lack of execution on perio.

0:21:12.2 Dana: It is, and I think too, when it comes to... As a hygienist and a hygiene team, a lot of what holds back perio is those hard conversations. Because honestly, the science supports the percentage. We know that people over a certain age, 50 over, 60-some percent of patients have active perio. People in their 30s tend to show signs of perio progression. So the science is there, and so as long as we... And I say this to all my hygiene departments when we're struggling with perio, is, if we are doing for the patient with what they present with, hitting those perio goals should be easy. Right? If we have the protocol in place, and we know what numbers fall where, it should just be something that comes easy, but what holds hygiene departments back are those difficult conversations, are those talking to patients about disease, talking to patients about the progression, showing them the signs and symptoms, and then doing something that the patient isn't used to having that.

0:22:23.8 KD: That's a really, really, really good point, Dana, of, 'Those goals should be easy if we're having those conversations.' So as a hygienist, Dana, how do you get more comfortable having that conversation? It's a real question 'cause I'm like, 'Gosh, it seems easy', but then I'm like, no, you gotta sit there with that patient for an hour, just you and them, you've gotta floss, clean their teeth, and then talk to them, but it's like, how do you get more comfortable as a hygienist to actually talk about perio to a patient?

0:22:52.4 Dana: So for me, I think it is just practising, roleplaying those conversations. The second part is just doing it, and one thing I always give as far as tips when it comes to just doing it, because as easy as that sounds, I know that it's not, is talk about it throughout the visit. When you are doing the numbers and you're saying... Say them out loud, explain to the patient which one is a symptom of which one is a sign of disease and which one is a healthy number. Point things out in the radiographs. If you see bone loss, show it to the patient. That way then at the end, when we have to have this conversation, we have pointed things out along the way to set us up to make that conversation successful.

0:23:34.3 KD: That's a really good point 'cause then it makes it not feel like it's like a, 'Surprise, you've got perio.' You've been teeing it up the entire time. And I am a big goal fan, I like to set goals, but I like people to set their own, and so I would say as a hygiene department, as a hygienist, I think that this podcast is a good way for you to just set up of like how many perio conversations are you actually gonna have in a day. And if you're right now not having a single one, I think at least having one a week... Notice I didn't even put you on the daily. One a week and track this over the next 12 weeks, that'd be a total of 12 conversations you have, I think is a good goal for you to start with. If you're a hygienist who's having them, maybe you set yourself up to have at least two perio conversations a day. Now, of course, I'm not saying you have to have these with patients who don't have perio, but guess what? If my goal is to have two perio conversations in a day and I only have one patient who has actually perio, then what I'm gonna do is I'm gonna go have that conversation with my front desk. I'm gonna go have a perio conversation with another hygienist, I'm gonna have a perio conversation with my dentist. That way I can just get into the habit of having these perio conversations.

0:24:43.0 KD: And so I think it could be a really good goal, and I would say, as a team, set it up, track it on a whiteboard in your break room so we can all keep each other accountable, but I agree with you, Dana, I think the number-one key piece to all of this... Like get your perio protocol in play so people have that confidence, but the number one, biggest problem I see with perio is the lack of execution on having the conversations. That is the bottomline nuts and bolts of what to do with perio. And so I think it's like you said, setting those goals, having people actually do it, I love your tips, Dana, on like, 'Set it up, tee it up for yourself', but I think really just having everybody set a goal of what they can do. And I'm a big believer, I don't go a 100% full bore. If I'm zero, let's not go to 100%. Let's just start with one, one per week, one per day, something that's doable that you are a 1,000% committed to over the next three weeks, 12 weeks, however long you wanna go, I would suggest let's go in the middle at six weeks. I think six weeks is a fair amount of time for us to get into those habits but I think that really could be a great way for you guys to take this podcast and make it tangible.

0:25:45.3 KD: So Dana, any last tips you got on perio? I think that that was great, I think we had a great summary of it, and I think you really hit on a lot of points on how to make perio a reality in practices.

0:25:55.5 Dana: Yeah, I just think, dig in, set yourselves up for success, and don't be afraid to have those conversations.

0:26:02.5 KD: That's coming from a hygienist, guys, and that's why I want Dana to have this 'cause I'm like, 'I can sit here all day long and tell you, but if I can bring Dana on, who is you, she's a hygienist, she's just like you, she struggles with that same thing, the fear of having to tell patients, and yet, she's overcome it, been very successful and coaches other hygiene teams. So guys, if you want her help, email us, [email protected]. Dana, it was super fun today. Thanks for your time, it was a great time chatting perio with you.

0:26:27.6 Dana: Always a great time. Thanks for having me.

0:26:28.1 KD: Of course. Alright, guys, as always, thank you for listening and we'll catch you next time on The Dental A Team Podcast.

0:26:37.4 KD: And that wraps it up for another episode of The Dental A Team Podcast. Thank you so much for listening and we'll talk to you next time.