periodontist Archives - The Wealthy Dentist

Dentists Say Specialists Usually Refer Patients Back

Prosthodontists and Periodontists Suck; Oral Surgeons and Orthodontists Rule

Dental Survey ResultsThis survey asked dentists how frequently their patients are referred back after being sent out for treatment by specialists. The clear majority said they always or almost always got their patients back.

Dentists reported that prosthodontists were the worst offenders when it comes to not referring patients back. There were also complaints about pediatric dentists and periodontists. Dentists were happiest with oral surgeons, orthodontists, and endodontists.

Here are some comments from dentists about specialist referrals…

  • “Periodontists only have incoming phone lines. They never refer back.” (Arizona dentist)
  • “Building a good relationship with your specialists is critical. Specialist referrals are our second greatest source of new patients, after existing patient referrals.” (Pennsylvania cosmetic dentist)
  • “Endodontists love to do it all, endo and restorations. They’re too greedy.” (Arizona dentist)
  • “The endodontists to whom I send patients are tremendous.” (Illinois dentist)
  • “Oral surgeons and orthodontists are a great source of new patients, especially in a growing area.” (North Carolina dentist)
  • “Orthodontists will not share or help with easy cases, and refer existing patients to oral surgeons, not back to us.” (Arizona dentist)
  • “I enjoy the relationship with my periodontist. He does the perio and I do the restorative. I’m not afraid that when I refer the patient that they will get lost.” (California dentist)
  • “Periodontists attempt to take over patients’ care and regular hygiene visits.” (North Carolina dentist)
  • “Pedodontists never, ever refer back! They are by far the worst of all specialists.” (Arkansas dentist)

about specialist referrals or read the complete results

Deep Periodontal Cleaning Costs About $225 per Quadrant

Cost of periodontal treatmentWhen we asked dentists about their average fee for one quadrant of deep perio cleaning, the answer was about $225. Full-mouth debridement costs, on average, about $175.

“There is some abuse of this code, making it harder for our office to get reimbursement from third party providers,” said a periodontist.

Cost of periodontal cleaningNot surprisingly, a periodontal cleaning costs somewhat more from a periodontist than a general dentist.

Here are some comments from dentists and periodontists:

  • “Doing this in conjunction with a Laser gets better results.” (California dentist)
  • “It’s easy money done in conjunction with quadrant dentistry.” (District of Columbia dentist)
  • “There is room for adjusting that default fee – number of teeth, difficulty of patient compliance, etc.” (Oklahoma dentist)
  • “Full moth debridement is only rarely used the way the code is written and is (ab)used by dentists as a code for a ‘difficult prophy.’ It is a code that should be changed or deleted.” (Indiana periodontist)
  • “We need a code or severity grading of the ‘prophy’… There has to be some indication of conditions somewhat between relative health and full-blown disease.” (Maryland dentist)
  • “This may not be definitive care for a periodontal inflammatory periodontal response (acute or chronic) and is only of value in an overall treatment plan of reevaluation.” (Ohio periodontist)
  • “With completion of 4 quads of scaling and root planing we give a Sonicare toothbrush.” (Texas dentist)

Read more: Cost of Periodontal Cleaning for Gum Disease

One Dentist in Two Fights Gum Disease with Dental Lasers (video)

Dental lasers for gum diseaseHalf of dentists use dental lasers to fight gum disease, while the other 50% do not use lasers on soft tissue.

“Lasers enable early, effective and efficient Interceptive Treatment for periodontal disease!” raved one dentist. “They are priceless when used properly!”

“I am on my fifth laser and been using them for the last 17 years,” said a periodontist.

A dental implant dentist disagreed, saying, “The cost/benefit ratio seems unreasonable with lasers; my choice is the electro-surge.”

Read more: Dentists Use Dental Lasers To Treat Gum Disease

A Little Periodontitis Mistake That Cost a Dentist $200,000

periodontitis malpractice lawsuitA dental patient has sued his dentist for malpractice, claiming supervised neglect, which caused him periodontitis.

Former patient Harry Berkowitz asked for compensatory damages from his dentist Dr. Dennis Miller (D.D.S) for his failure in diagnosing the periodontal disease that was silently progressing for years and ultimately destroying his teeth.

WorldDental.org reports that Berkowitz, who was a steady patient of Dr. Miller, always maintained regular dental checkups. It was at just one of these regular check-ups in 2009 where Berkowtiz learned from his Physician that he would need extensive root canal therapy. Since this seemed out of the ordinary from his usual dental treatments, Berkowitz decided to obtain a second opinion with another dentist.

The second dentist told Harry Berkowitz that he was apparently suffering from a severe periodontal disease that was badly affecting all his upper teeth. He was referred to a periodontist who extracted all but two of his upper teeth and then replaced them with permanent bridges and dental implants.

In his legal claim against his regular dentist, Mr. Berkowitz stated he was never asked for an x-ray examination to diagnose the periodontal disease that claimed most of his upper teeth. Dr. Miller countered this allegation by stating that he had suggested several treatment options to Berkowitz over the 20 years he was his patient, but Berkowitz declined some of the doctor’s treatment suggestions by insisting that full dental care would be too expensive.

The malpractice case was settled in the amount of $200,000.

When I first started as a dental management consultant — over 20 years ago — attorneys were attending seminars on how to sue dentists for periodontal neglect. And of course I had one of my doctors sued for this. The case was dismissed when we presented the scheduling book (yes a real hard copy book) showing the patient had missed or no-showed for continuing care appointments eleven times in a two-year period.

The issue was documentation of the patients failure to accept and complete treatment. Your ultimate protection is to dismiss the patient!

How do you screen for periodontitis? What do you do when patients refuse your dental treatment suggestions?

For more on this story see: Matters of the Law: Patient Sues Dentist for Neglect.

Periodontal Examinations: Dentists Recommend More Than 1 a Year

periodontal disease Dentists perform periodontal examinations once a year, we found in our recent survey, with some dentists preferring to do this procedure twice a year or more.

In fact, 14 percent of the dentists we surveyed are likely to recommend periodontal exams every three months.

“It should be done every time the patient comes in even if they see the dentist,” advised one dentist, “Generally, the patient should be seen 4 times a year.”

The respondents to this survey tended to perform periodontal examinations at least once a year.

43% recommend periodontal examinations once a year
33% recommended periodontal examinations at least twice a year
14% recommend periodontal examinations four times a year
9% recommended periodontal exam frequency on the need of their patients

Here are some comments from dentists:

“For periodontal maintenance complete charting should be done every three months.” (Florida periodontist)

“We probe at each cleaning visit, so the frequency varies based on the needs of the patient, ie: either 4x, 3x, or 2x per year.” (Arizona dentist)

“I recommend 3 to 4 times per year depending on the patient that I have diagnosed with having a case type III or higher.” (Illinois dentist)

“For the average healthy patient – once a year. For the patient with active periodontitis – every appointment.- For the patient with perio who has been been controlled for at least a year – annual full probes, and spot probes at other appointments.” (General Dentist)

“This all depends on the patient’s periodontal health. We do periodontal probings at each new patient exam and all recall/recare appointments with the RDH.” (Kentucky dentist)

“A four-month recall for adults is best!” (Virginia dentist)

“If a patient has aggressive periodontitis, we probe more frequently, and have the periodontist check the patient annually as well.” (Texas dentist)

“My hygienists probe at each hygiene appointment –every 3-4 months for perio patients.” (General dentist)

Read more: Periodontal Exams Should Be Done Every Time A Patient Sees The Dentist.

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