What you should NEVER say to an existing patient with perio


Ever been faced with this scenario? You ‘now know’ that active periodontal infection is a risk factor for heart attack, stroke, some types of cancer, and the list goes on. You ‘now know’ that waiting to recommend treatment until you see multiple 5mm pockets with bleeding and moderate bone loss is waiting too long.

So Jane sits in your chair, you do her complete perio charting with bleeding points and recession and you see that she has multiple 4-5mm bleeding pockets with slight bone loss in 3 quadrants.

You look back at your notes and notice that this isn’t getting any better, you’ve made a note of this issue the last 3 times you’ve seen her. Today, it’s time to do something different. But how do you break it to her? You’ve been seeing her for 7 years. How do you break the prophy cycle?

Well first, I can tell you what NOT to say. What you don’t want to say is this… “Jane, your gums are bleeding and you have signs of active infection. I know we’ve just cleaned your teeth before but we’ve been working with this consultant and he said that we just haven’t been doing a very good job diagnosing periodontal disease. So we’re going to get started with the treatment today. We’ll file this with your insurance and so don’t worry about it.”

I know you’re cracking up right now but seriously, this happens a lot. It leads to doubt with patients and also a lot of upsets for your financial coordinator when the insurance doesn’t pay the 100% (do they ever?).

Here’s what you WOULD say “Jane, we’ve discussed the bleeding I’m seeing with your gums more than once. You know I’ve been keeping my eye on this and I know you’ve been working hard at home but here’s the thing, you’re body is just not responding the way I had hoped with the treatment we’ve done in the past. It’s time to do something different

“I know you take medication for your high cholesterol. We now know that an active infection in your gums and bone may put you at a greater risk for heart attack and stroke and you already have one risk factor with the high cholesterol. We have to do something different to stop this infection. So here’s what I recommend we do.”

I’m assuming you’ve already used the 3 P’s of Perio Enrollment and then you proceed with your treatment recommendation and financial options. Then of course, have the doctor confirm your diagnosis and treatment plan.

So you see it’s really not that hard. These simple key words that I’ve highlighted have worked over and over with overwhelming positive results.

Remember I told you last week not to beat yourself up? It’s not that you have been ignoring the bleeding and pocketing. But you must recognize when it’s time to do something different. Treating an active infection is easier, more successful and more cost effective when it’s done early.

Stay Inspired,


Don’t Beat Yourself Up


When talking about implementing a more consistent, proactive perio protocol in their practice, the #1 question I get from dentists, hygienists, assistants and the admin team is always the same…

How do I enroll existing patients that truly NEED active perio treatment into therapy when I’ve just been doing prophy after prophy with them for years?

The truth is it all starts with you. One thing that often comes up with hygienists when we define active perio disease is that they realize they have been treating a lot of perio with a prophy. This is extremely common. And then the hygienists feel bad about it. Have I been neglecting my patients? Have I done them a disservice? How do I make up for that? Will they see that we’ve been ‘watching’ this for years?

Here’s the deal…you can’t beat yourself up about this. And you must do something to change it. One Tony Robbins quote always stands out in my mind “We do the best we can with the resources we have”. In other words, if you don’t have current periodontal diagnosis and treatment information and you don’t have a clear protocol in place, you can’t very well apply it.  You simply may not have all the information you need to do things differently.

I can confidently say that in all my years as a coach and trainer, I have not encountered a team that has intentionally neglected a patients’ periodontal condition. Maybe they weren’t as proactive as they could have been but most of the time they scaled the heck out of those pockets during the prophy appointment and then checked them again the next time. And so they cycle continues.

The problem with this is:

1-the distinction hasn’t been made to the patient that there is active infection that requires a different treatment

2-the hygienist is working his/her knuckles to the bone through blood and calculus much too often in very little time

3-the practice isn’t being financially compensated for the service

4- the patient doesn’t realize the overall health implications of this infection and

5-the practice is vulnerable to the risk of serious disciplinary actions because of poor documentation and/or improper treatment

Without the needed resources and information, you may not feel the need to recommend or enroll any different treatment than what you’ve been doing. So if you have a sneaky feeling that your protocol could be more progressive and you see way too many bloody prophies, or if you’ve been resistant in the past to being more proactive with perio, the first step is to start reading, studying, attending online and live lectures to gain new information.  Then work with a coach and/or your team to develop a clear, written perio diagnosis and treatment protocol that you believe in.

Now you’ll have the confidence in your heart and mind that you must create new distinctions for yourself and your patients and recommend something other than a prophy when there is true, active infection.

Next week, I’ll give you a couple tips on how to speak to those existing patients that really need something other than the same old prophy…

Stay Inspired,