The Art of Practice Management's Dental Pearls
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Hygiene Department
Achieving Your Goals
Marianne Harper

Is there a level of frustration in your business or personal life or maybe both? Do you feel like you are getting nowhere fast? These are very negative feelings that can make life unfulfilling and difficult. You may wonder what the answer is to reverse these feelings and the answer may startle you – YOU are the answer.
If you can identify with these negative feelings then it's time to have a major discussion with yourself. If you don't take action, now, then the actions that you have been taking that have resulted in that "I'm getting nowhere fast" feeling will only continue and you will keep on going nowhere. You need to ask yourself what it is that you want to happen in your life. Unless you identify specific goals for yourself, nothing will happen to change things.

Once you establish a clear picture of your goals, you must decide what you need to do to achieve them. Reading books such as "The 7 Steps of Highly Effective People", "Outliers", and "See You at the Top" can help you shape those goals and provide advice as to how to best achieve them. Then imitate these behaviors – how they work, how they communicate, and how they handle problems. Pay close attention to what is said about how to achieve balance in both personal and business lives.

Spend some time in this process of making clear the actions that you need to take to achieve your goals and then put them into action. Your re-defined actions will make things happen.

The Importance of Hygiene Appointment Sequence
Colleen Rutledge, RDH

The order in which things are done is very important. Take for instance; when you go to the hair stylist, your hair will be washed first. If the hair is cut when it's dry you get a choppy, jagged haircut. Things are done in a certain order for a reason. The same is true for a dental hygiene appointment.

First, you must gather all the diagnostics. Without doing this first, it's like driving a car blindfolded to an unknown location without a map. This critical step includes updating the medical history, doing a periodontal risk assessment, oral cancer screening (doctor will follow up during exam) and taking blood pressure. Taking appropriate radiographs (FMX, horizontal/vertical BW's) should be done at the beginning of the appointment as well, as the images are used not only to detect decay and pathology, but also to evaluate bone levels and supporting tooth structures. Lastly, a full (6 point) periodontal charting (manual or technologies like Florida Probe, Perio Pal or Dental RAT) should be recorded and used in conjunction with all other diagnostic and clinical observations in order to determine a treatment plan. The information gathered during this portion of the dental hygiene visit determines the difference between a prophy and periodontal therapy – in other words 'you have to probe first' before you pick up a scaler!

Once you have treatment plan, it's time for the actual treatment. Have the patient do a 30 second pre-procedural rinse and then use ultrasonics throughout the entire mouth (including the tongue) followed by hand scaling. Next is polishing, unless 'therapeutic' polishing is necessary for desensitization. If that's the case then polishing would come first. Patients may be more comfortable when polishing first with a desensitizing prophy paste (ProClude, Enamel Pro, Nova Min, etc). The later part of the clinical portion of the appointment includes flossing, irrigating, applying isolated locally-applied antimicrobials if necessary, post op instructions, and oral hygiene instruction.

Lastly, it's time to prepare for the doctors examination. Utilizing caries detection technology (Diagnodent, SoproLife), Dental Patient Education (Casey) and the intraoral camera will help to easily communicate restorative needs to the patient and increase patient compliance. Finish up by establishing a recare frequency and entering treatment into the computer (or write up your chart). Prepare oral cancer screening technology (remember, chemiluminescent light source is most effective during first ten minutes) and notify the doctor for an exam. While waiting for the doctor, schedule the patient's next appointment and prepare a 'take home" bag of oral hygiene supplies for your patient. The order in which you do things really does matter!

For a copy of a Dental Hygiene Appointment Sequence Protocol, contact me at
  Insurance Alert
Dental – More and more dental practices have contracted with third party payors. These contracts are legally enforceable contracts. As such, it is vital that all dentists who sign these contracts read the contract completely and stay in compliance with the contract. In addition, dentists need to communicate these rules and regulations with the staff who work with patients' insurance plans to ensure that the practice is truly in compliance with the rules and regulations of each contracted payor.
Medical – HHS Secretary Kathleen Sebelius has announced that the agency is delaying implementation of the ICD-10-CM code set for outpatient diagnosis coding from October 1, 2013 to October 1, 2014. This gives us one additional year to prepare for this major change.
  Time Line
Update your cross coding manual –
The 2012 update is now ready
For those practices that have purchased my cross coding manual, "CrossWalking – A Guide Through the CrossWalk of Dental to Medical Coding", please take note that it is now time to update your manual. Please order your updates ASAP by emailing Marianne at
Effective since 2011 – Medicare now requires that all physician and non-physician practitioners that submit Medicare claims must be enrolled in PECOS (Provider Enrollment, Chain and Ownership System) as well as all ordering and referring practitioners, or claims may not be paid. Practitioners can enroll online at
Effective since January 1, 2012 – All covered entities listed below are required to upgrade to HIPAA 5010 Standards which are new sets of standards that regulate the electronic transmission of specific healthcare transactions including eligibility, claim status, referrals, claims, and remittances. Covered entities may use a clearinghouse to assist them with complying with the rules.
Additionally, even though software vendors are not included in the list of covered entities, in order to support their customers they will need to upgrade their products to support HIPAA 5010 and NCDPD D.0 as a business imperative.
October 1, 2014 – The new date for ICD-10 implementation

Favorite Quotes:
The following quote reflects my message in this newsletter's article on achieving your goals.
"It is not what you know that counts, it is what you do with it that makes the difference."
Will Rogers

Your Senior Patients
Special considerations should be taken when treating seniors. Use the following tips:
Greet them by their last name unless they say otherwise
Schedule them in the mornings when they are sharper
Escort them to the treatment area and also to the check out area when treatment is finished
Check on them frequently during their visits

Points of Interest:
The first toothbrush with bristles was manufactured in China in 1498. Bristles from hogs, horses and badgers were used. The first commercial toothbrush was made in 1938.

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