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#20 – Determines interval between preventive appts.

More and more your recall appointments will develop into the major factor in our practice. The more you can develop a long-term caring attitude with a client, the greater the chance they will accept your advice and our best dentistry.

Effective determination of appropriate recalls for patients is essential for good preventive care. Every patient is not a 6-month recall. The recall interval is very specific for each client.

Importance of proper recall interval:
1. Ensure that dentistry already done is properly maintained
2. Diagnose new problems when they first start
3. Prevent future problems for the patient
4. To upgrade the quality of dentistry for your patients

You cannot fulfill these obligations, which satisfy the objectives of your recall system, unless the patients come in, and you do not motivate patients to come in unless they perceive the need to do so. The “See you in 6 months” makes each patient average and people don’t want to be “average”.

We have developed a unique system that categorizes varying levels of dental health. These structured levels are separated between decay and gum disease. Level I is our healthiest group, level II presents with mild risk for disease, level III presents with moderate risk of disease and level IV is our group that is a severe risk for disease.

It is important to let our patients know in what level they are, what risk factors they have and what interventions they need to move to the next level. The level that a patient is in helps determine their recommended interval for cleanings, decay X-rays, full set of X-rays, doctor exams, etc. It is important to motivate your patient to move to the next level. This is important for their health and can also show the patient how to lower dental costs.

To help motivate patients, we have created a Control Gum Disease brochure and a Stop Decay Now brochure to send home with each client so they have something to follow and help them with their goals.

Reinforcing the 3 W’s of Recall

Why: Give patients a specific reason other than having their teeth cleaned as to why they need to return for recall. Maybe you point out a perio pocket or a large filling that may need to be crowned.
Ex. Mrs. Jones has a 5 mm pocket on upper right side. If that area worsens, we may need to consider referring you to Dr. Hamal (a periodontist) because of this condition. It’s important to monitor the area closely. “I’d like to check this area in 3 months.”

When: Now give patient a specific when they are to return “I need to check that area at Christmas time.” Mentioning a holiday that falls in that month can further help the patient to remember when they should return.

What: Tell the patient what to expect when they return
Ex. “At your next visit, Mrs. Jones, we’ll be checking that pocket and cleaning your teeth.”

Determining Proper Recall

1. 12 month recall consistently healthy patients no gum problems, no joint or bite problems, very little calculus stain buildup.

2. 5 – 7 months recall largest # of our patients – a lot of old fillings to watch, moderate buildup of stains tartar gums slightly puffy some bleeding. Use 5 or 7 month intervals rather than 6 whenever possible. This will personalize the time with your client and help them feel more special and that you are custom designing their treatment.

3. 3- 4 month recall Patients with active periodontal problems

 

STM Recall

Many of our clients have completed our soft tissue management (STM) program. These clients require meticulous:

1. Root planing
2. Probing
3. Client communication

Flag these clients in your mind before you start the day. When you have your initial conference with them, be sure to mention their past program. Ask how their gums feel. Ask how they are doing on their home care program. Reinforce. Be positive.

When the appointment is completed, the clients gums will fit into one of four categories:

A. Controlled Periodontitis
1. Pocket readings are same or better
2. No increased tooth mobility
3. No bleeding
4. Good homecare

B. Advancing Periodontitis
1. Disease is progressing in one of 3 stages
a. Gradual
1. Some pocket depths increasing 1/2 mm
2. 1 3 teeth can be lost over a 5 7 year period
b. Slow
1. Several pockets of 2 mm increases
2. Lose 4 9 teeth over a 10 15 year period
c. Steady advanced
1. Pocket depth increase generally 2 4 mm
2. Loss of 10+ teeth over the next 10 years

C. Uncontrolled Periodontitis
1. Client doesn’t
a. Provide good home care
b. Show up for recall appointments on schedule
2. Pocket depths are increasing

D. Refractory Periodontitis
1. Client doing everything possible
2. Pockets are increasing

Although these categories are valuable diagnostically, we only have three categories that count:

A. Controlled Periodontitis
1. Pockets 5 mm or less
2. Extend from 3 month recalls to 4 month recalls. This will probably be their recall interval forever.

B. Advancing Periodontitis gradual
1. Definite warning that periodontal surgical intervention may be necessary.
2. Stay at 3 month intervals

C. All other diagnoses
1. Prepare client for an evaluation with Dr. ______________, our periodontist.
2. Alert your doctor.

Determining length of recall appointment

It is the hygienists responsibility to decide the length of the recall appointment. At this level, most will be one hour. However, within three months your average appointment will be 45 minutes. When you decide the length of your next appointment, here are factors to consider:
1. Need for anesthesia or nitrous oxide
2. X rays
3. Doctor’s exam
4. Oral hygiene review
5. Amount of stain and calculus
6. “Talkativeness”
7. More than 6 months past due for cleaning – add 1 unit

People are more apt to return for their reexaminations if they feel there is a valid reason to return.

People only hear what they want to hear in certain situations in the hospital emergency room, they repeat instructions 7 times and still the patient is not always aware of what they should be doing.

The doctor, the hygienist, the front desk person, and occasionally the assistant should all repeat the following information to the patient during reexam, during the doctor’s exam an during check out.

The client will be more apt to remember the month that we want them to return if we associate the month with an event

Jan After the New Year
Feb Around the Valentine’s Day
March – St. Patrick’s Day or hopefully when spring starts
April When winter’s over, Easter
May Just before school is out, Memorial Day
June Just after school is out. Flag Day
July After the 4th
Aug Before school starts
Sept After Labor Day
Oct Before Halloween
Nov Before Thanksgiving
Dec Before Christmas

Always say to the client “You will want to see the doctor again for a reexamination in February before Valentine’s Day because he is concerned about your gum tissue and wants to check it at that time”

Next give your clients a specific reason for them to return. Find the important “key” that is important enough to our clients to get them to return. Choose from the following list:

A – Repairs since last visit
B – Watching decay areas
C- Gum problems
D – Muscle/joint
E – Bite problems
F – Watching old fillings
G – Great appt.
H- 5 year review
I – High potential for decay
J – Tartar buildup
K – Stain buildup
L – Has braces
M – PC – No problems
N – PC – Ready for Ortho?
O – Client to take premedication
P – Keep Smile Bright

To put a recall in Dentrix, change the length of the appointment, or the number of months between appointments:
1. Enter the client’s treatment for that day
2. Click on the family file
3. Click twice on continue care box
4. Click on set box to change recall (months, length of appointment)
5. Press yes to confirm changes
6. Click on “x” to close that screen and return to schedule on tooth chart