Tapping into an untapped resource: Initiate comprehensive reevaluation of established patients

By Karen Davis, RDH, BSDH

As you read this column, periodic examinations and evaluations are happening all over the country. These existing patients joined dental practices years or decades ago, and were given an initial examination that was comprehensive and thorough. Since that time, they have seen their dental hygienists for ongoing care, returning for restorative or esthetic procedures as indicated.

The hundreds of existing patients who trust their dental professionals and refer friends and family, yet have significant outstanding or pending dental treatment that was diagnosed quite some time ago, are an untapped resource in dental practices. They may have joined the practice 10 years ago and received a full series of x-rays, a complete periodontal evaluation, and intraoral images and photos, but since that time may have only received bitewings and spot probing or occasional periodontal charting. Nothing hurts. There is no urgency to proceed with their pending treatment, and in fact, it is my observation that the average dental patient has been given a script that sounds something like this: “I think I’ll just wait until there’s a problem.”

If you are the patient who has pending treatment, it seems reasonable in light of the fact that you have no immediate discomfort to simply wait until there is a problem. But, dental professionals know that by the time the patient realizes there is a problem, or has discomfort, it is likely that treatment will be more extensive, and consequently, more expensive. There is a need to create value, even urgency, to proceed with treatment prior to symptoms in order for patients to receive the most conservative treatment options.

Additionally, many existing patients that received a comprehensive periodontal or oral evaluation years ago have experienced changes in lifestyle, careers, and even in what they value most. Patients with outstanding treatment who have not had an updated comprehensive oral assessment in several years are excellent candidates for a “comprehensive reevaluation” scheduled with the dentist. ADA coding that most appropriately corresponds with this type of assessment is D0150 Comprehensive Oral Evaluation - New or Established Patient. Should the established patient present with significant changes in periodontal health, you could use D0180 Comprehensive Periodontal Evaluation - New or Established Patient.

Let’s look at an example of the type of patient that could benefit from a comprehensive oral reevaluation. James is a 52-year-old man who joined the dental practice nine years ago. As a new patient, he received a full series of radiographs; comprehensive periodontal evaluation/consultation/diagnosis; study models; and digital photos. His initial treatment plan included the following: three full-coverage crowns to repair broken restorations on posterior teeth; localized scaling and root planing to treat early periodontitis; and periodontal maintenance at intervals to be determined based upon results to therapy.

James completed the treatment diagnosed during his initial evaluation nine years ago and has received ongoing periodontal maintenance every four months with a dental hygienist, and periodic evaluations with the dentist at least annually. In the past 12 months, a lot has changed for James. He was promoted to CFO of a new start-up company and is working 60-plus hours a week. He and his wife divorced seven months ago. During his annual physical 10 months ago he was diagnosed with prediabetes, high cholesterol, and hypertension. He is taking prescription medication for these conditions. He visited a chiropractor recently for pain in his neck and back and is pretty sure he has begun clenching his teeth at night. The outstanding or pending treatment for James is as follows:

• Nos. 3 and 29 were diagnosed for full-coverage crowns six months ago due to failing amalgam restorations and recurrent decay undermining both restorations. Teeth are asymptomatic.
• Nos. 4, 5, 11, 12, 20, and 29 have significant abfraction lesions at the cervical areas but are asymptomatic.
• No. 5 DO resin to repair fractured cusp
• No. 7 MI resin to replace discolored resin
• Zoom Whitening

Does James sound a bit familiar? This patient has had significant lifestyle and health changes, and it’s been nine years since he received a comprehensive oral evaluation. This, coupled with the fact that he has had outstanding treatment diagnosed but not scheduled, should alert the dental team that this patient could benefit from a fresh, comprehensive evaluation to assess his dental needs and desires, which are now very different than his last comprehensive assessment.

Today, when the dental hygienist assesses James, he or she could easily “prepare” the patient for a more comprehensive reevaluation with the dentist. It might sound something like this: “James, as our lifestyle and medical history changes, so do dental needs and priorities. I see that your last full series of x-rays and comprehensive assessment was nine years ago when you joined our practice. I am aware that none of your teeth today are sensitive or symptomatic, but I am concerned that we begin to prioritize treatment before anything actually becomes symptomatic. Once teeth become sensitive, treatment becomes more extensive and more expensive for repair. What the doctor generally recommends is to reserve time in both of your schedules to update your diagnostic information and begin to prioritize treatment to preserve the health of your smile.”

The procedures, performed in conjunction with comprehensive reevaluations for established patients, will be tailored specifically to his or her needs and may be somewhat different for each person, but carving out time to literally reevaluate patients as if they were new provides a fresh perspective that can significantly increase value and treatment acceptance.

I’ve never met any dentist or dental hygienist who strives to be less than comprehensive in their ongoing care of patients, but I have observed many dental practices that do not routinely perform comprehensive assessments or evaluations on patients who have been in the practice for decades or more. As patients’ needs and desires change, so should their evaluations to assess esthetic desires, TMJ dysfunction, occlusal disease, obstructive sleep apnea, gingival recession, restorative needs, periodontal health, the need for dietary counseling or tobacco cessation support, and so on.

It is unrealistic within the context of the periodic evaluation to pay adequate attention to a host of dental and health issues, but the return to comprehensive reevaluation is an untapped resource in most dental practices that you can begin tapping into right away to accomplish exactly that! RDH

Karen Davis, RDH, BSDH, is the founder of Cutting Edge Concepts, an international continuing education company, and practices dental hygiene in Dallas, Texas. She is an independent consultant to the Philips Corp., Periosciences, and Hu-Friedy/EMS. She can be reached at [email protected].