Perio maintenance is one of those procedures that always brings up questions and differing opinions. Much of that is due to the conflict between the CDT definition of perio maintenance, that patients with periodontal disease should stay on periodontal maintenance for life, and the insurance industry's lack of support for this service.
There are a few challenges to overcome to get better results when enrolling patients into a perio maintenance program.
First, ask yourself a few questions.
• Are you alternating perio maintenance and prophies for patients that have periodontal disease?
• Do you have a hard time getting patients to "buy in" to perio maintenance every 3 months?
• Does your hygiene team see very few periodontal maintenance patients each week or each month?
• Do you ever feel that there is little or no difference between the services you provide during a prophy and those you provide at perio maintenance?
I bet you answered "yes" to at least one of these questions and you are not alone. There are thousands of hygienists and dentists that share your frustration. Here are a few strategies to help you increase the value of perio maintenance and keep your patients healthy. Isn't that our #1 job after all?
Strategies
#1-You must believe in what you do. I could write a book on this alone. It especially applies to periodontal therapy and maintenance. If you don't believe in your heart that the treatment you are recommending is the best treatment for that patient, they won't believe it either. Alternating perio maintenance with prophy creates confusion and degrades the value of your skills to help prevent perio disease flair ups. Although every patient may not need to remain on perio maintenance forever, it's for sure that patients with moderate to severe disease will benefit from 90 day maintenance for LIFE.
#2-Know the science. If you're not sure what you believe about perio, that's ok. It just means you need more information. Learn more about the mouth-body connection. Three months is not an arbitrary number made up by some periodontist. It is based on classic studies and the AAP's statement on the benefits of frequent maintenance intervals. Learn some of the new information about bacteria and biofilm. A great resource for new perio information is a FREE online CE course delivered by Dr. Richard Nagelberg through Hygiene Town's website. Here is the link.
#3-Educate early. When you first recommend perio therapy to a patient, include the fact that the long-term success of your treatment depends on maintenance and what they can do at home. Don't let perio maintenance or the additional cost be a surprise to your patients. Remind them as you proceed through therapy and even schedule their 1st perio maintenance before therapy is complete.
#4-Make it different. Always, always, always do a complete periodontal assessment and charting including bleeding, mobility, furcation and recession at every perio maintenance visit. You must believe that your perio maintenance therapy is different from a prophy and that your frequent clinical services are critical to preventing future perio breakdown and worth MORE than the fee you charge. If it's not different, make it different.
#5-Add extra services. Maybe you simply add irrigation with an anti-microbial rinse at the end of the perio maintenance appointment. Maybe you add fluoride to coat those root surfaces or create a special fee for Arestin placement at perio maintenance. The definition of perio maintenance includes the isolated treatment of recurrent perio infection. Set guidelines so you know when it's time to recommend active therapy again.
#6-Make sure your patients get what they pay for. When you know they're getting more than they paid for, you will feel great about the service you provide and you will have no trouble enrolling patients into a lifelong maintenance plan. This includes giving patients support with the right tools for homecare too.
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