Clinical

“Dentistry is Not Expensive, Neglect is.” By Aqib Mudassar

We live in a society where there is no concept of routine health checkups. General public is not aware of the importance of gum health and its critical role in their overall health. Unfortunately, we as a dental community do not acknowledge the importance of oral health in our practices. We are working on the concept of “drill, fill and bill” and there is a need to change that approach. We are focused on pain management, which only generates a limited amount of revenue. Revenue generated by pain management at Ideal Smile constitutes only about 5% of the total revenue as compared to 17 % revenue generation just by preventive dentistry which mostly includes treating periodontal disease. There is plenty of untapped revenue which we haven’t even explored yet.

perio

Ironically, the importance of periodontal health is just as ignored as it is theoretically emphasized.  Periodontal disease is a silent disease and goes easily unchecked until it gets to a late stage. Constant inflammation of the gums has detrimental effects on the inflammatory diseases of the entire body for example high blood pressure, heart attacks, strokes, diabetes, rheumatoid arthritis, pregnancy issues, kidney diseases and even different type of cancers.  Due to the infected and inflamed gums, the body’s inflammatory burden is greatly increased and hence its ability to overcome any disease process in general is compromised. The total area of gums is the size of the palm of a hand. Imagine a wound that big, would you chose to ignore it? Definitely not! So by treating oral infections not only do we improve the overall health of our patients but also reduce the total health care cost. Studies show that the financial savings of those who were treated for their gum disease were of significant proportions in contrast to those who weren’t. Yet periodontal infection remains the most prevalent type of infection in human race and more so in our society with 90% of the population having periodontal disease of one sort or the other. The main difference between a standard dentist and a complete health care provider rests in their major area of concern with regard to the patient; which is ‘the complete health of an individual’ in case of the later.

We need to instill the importance of gum health in our patient’s mind. People are very skeptical towards getting their teeth cleaned as most of them are of the opinion that scaling will result into weakening of their teeth, creating gaps and causing sensitivity. They need to be educated on how poor oral hygiene and not getting routine scaling done has resulted into bone loss around the teeth thus creating gaps in the first place. Educating the patients on how their gum health can impact their overall health and how it will prolong the life of further dental treatment they get is of utmost importance because all restorative procedures are bound to fail, if the gum health is not achieved. If we place crowns on teeth with poor periodontal health then we are making sure that those crowns will fail over a short period of time. 

stages-of-periodontal-diseaseFaulty crowns and restorations with overhangs or open margins also contribute to plaque accumulation resulting in gum inflammation around the restoration.

Achieving gingival health is the foremost thing. The ultimate goal is to have no gingival inflammation and no bleeding on probing. Doing cleaning just for the sake of charging the patient and doing cleaning with an intention of getting gums healthy are two entirely different things; and the later demands for a different amount of time, effort and the thoroughness altogether.

Hygiene is the back bone of our clinical practice. We spend ample amount of time on educating our patients through intra-oral pictures & X-Rays about the severity of gum disease & its impact on our oral & general health. A hygiene appointment is not just a 15-20 minutes appointment of scaling. It needs to be an hour appointment comprising of:-

  1. Patient education.
  2. PERIO charting.
  3. Scaling/root planning (both ultrasonic and manual).
  4. Oral hygiene instructions.
  5. Importance of Re-Care.

It is recommended to perio chart all your patients in order to diagnose the extent of periodontal disease and then schedule for scaling or root planing accordingly.

Getting cleaning done once is not sufficient for good oral health. Routine re-care follow ups are of utmost importance in order to maintain gingival health. At Ideal Smile, after a hygiene appointment we immediately schedule the patient for their recare visit. This not only sets up the patient to maintain their oral health in the long run but also gives us the opportunity to diagnose further dental problems, if any. This process is a great source of revenue generation too.                                                                                                                                                                                                     

Many dentists think that new patients are the lifelines of their practice; they bring-in cash flow. Objectively, that is not true. New patients tend to take-up a lot more time & resources. Sometimes we put-in a lot of effort on a new patient yet they refuse to schedule for treatment. What needs to be done is to capitalize on existing patients, who can get their treatment done without putting in too much effort to educate them, for they already know the importance of good oral hygiene.

We can’t grow as a dental community unless we create awareness about healthy gums and instill in our patients the trend of follow ups, re-care and maintenance of good oral hygiene. This creates a solid foundation for any good dental practice and allows us greater sustenance. The net value of a practice is calculated on number of active patients which keep coming back for re-care.

“When your hygiene goes up; The whole practice goes-up”

Our ultimate goal really needs to be to eradicate all sources of infections from a patient’s mouth; be it gingivitis, periodontitis or even an asymptomatic failing root canal with a periapical abscess. This all can be done by routine checkups along with good hygiene at home. Hence, by practicing complete health dentistry and creating such awareness not only do we make our patients healthier but ultimately our entire nation too.

October 10, 2017

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Dental is part of the Medical News Group of publications which in 1968 became the pioneer of medical journalism in Pakistan. Medical News is the only periodical in Pakistan which has 3 simultaneous editions from Karachi, Islamabad and online.

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