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Howard Speaks

So You Think You Have a Perio Program?

Howard Farran, DDS
MBA, MAGD
Publisher,
Dentaltown Magazine
 The response I receive when asking dentists if they have a perio program in their office, is always, yes, of course I do! In reality you have a perio program, but how successful is that program? If your hygienist is doing bloody prophies, your perio program needs some work. All dentists want to provide the best care for their patients and know this is an important aspect in their practice. However, implementing a successful program is the difficult task.

If you feel your hygiene department is not as profitable as it should be and you are performing "undercover perio," make the decision to get your staff on board with a successful periodontal program. I know it is overwhelming to come to the realization that perhaps the majority of your patients might need some form of periodontal treatment. Which patients receive periodontal therapy first? New patients? Recare patients?

The first step is to get everyone on your team on board and make sure they have good periodontal health themselves and that they understand the benefits of a successful periodontal program for both the practice and the patient's health. Schedule a staff meeting specifically to train your front office, assistants, as well as hygienists, on the specific perio case types. You can download the case types we use at Today's Dental by clicking on this link.

However, you might choose to define your own specific case types that will work best in your practice. It is so important to have each department educated on your case types so they will be able to answer any questions patients may have.

The next step is to implement your program into your practice on a daily basis. Listed below is the patient process for our perio program at Today's Dental. You will notice that each department is included in the steps below, which reinforces the need for adequate training for the entire staff before implementing your program.
  1. We schedule our new patients with the doctor and have one of our hygienists come in during the appointment, introduce herself and take the probing scores. It makes sense for a hygienist to do the probing since she will be the person doing the work. I have lectured for years on the best way to communicate perio conditions to the patient. I insist the hygienists in my office read all probing scores out loud to the patient starting with brushing surfaces — facial and lingual. They tell the patient they are checking for gum infection on the brushing surfaces. The numbers should be 1 to 3 for health. Anything over 3 might be a sign of infection. Next, they tell the patient they are going to check for gum infection on the flossing surfaces — probing mesial and distal surfaces. Separating the numbers by brushing and flossing surfaces is a great educational tool. Based on the hygienist's findings she is able to recommend a case type to the dentist.

  2. Once the hygienist has identified the case type, the dentist makes the diagnosis to the patient and does a "hand-off" to the assistant who is trained to explain in detail the importance of the diagnosed case type and future perio appointments. They use models and/or flip charts to educate the patient. At this point the patient is brought up to check-out.

  3. The patient services coordinator at the front desk takes over and reviews with the patient their treatment planned perio program. Our office uses different forms for each case type, which presents the fees along with the patients' estimated insurance portion as well as the number of visits required for their treatment. You can download the Perio Program forms we use at Today's Dental by clicking on this link. The necessary time needed for each appointment is already outlined on this form, based on the type diagnosed. This form is presented to our patients and any questions they might have are answered before the appointments are scheduled. Once the form is signed and agreed upon by the patient, the appointments are made; we try to schedule with the same hygienist if at all possible. The patient leaves knowing exactly what to expect, i.e. number of visits, estimated payment portion, and most importantly why they need to have this treatment done.
"I began explaining, 'If you see bleeding when you brush, that means bacteria and toxins are entering your blood stream.' Now that gets people's attention!" Tips for diagnosing and communicating with your patients, whether they are new or existing patients:
  • Telling patients they have a bacterial infection gets results better than discussing inflammation. People often associate inflammation with something they can't influence — like arthritis or a bruise. We know that periodontitis can be influenced. If you're trying to get people to own their own disease and therefore take responsibility for controlling and preventing it, link infection to each bleeding point. Instead of gingivitis, tell patients they have infection at each bleeding point. It's much more impressive to have 23 areas of infection, rather than 23 bleeding points. Infection is perceived as a much more serious word that ties in the importance of the bacterial biofilm component.

  • Your existing patients might ask why they are now being diagnosed with periodontitis when they have always just had a cleaning in the past. Your answer can be this, "We used to wait until the infection was much further advanced and then recommend painful, expensive surgery. According to new research, if we do scaling and root planing (SRP) now, we can stop this infection earlier and hopefully avoid surgery in the future. This treatment approach requires three things: the SRP treatment we provide, your daily commitment to cleaning between your teeth and maintenance visits every three months to prevent further infection."

  • Do you use "fear of tooth loss" to motivate your patients? Periodontitis leads to tooth loss — eventually. It's the truth, but in reality, only for a small percentage of cases. I've found it frustrating to talk to people about the risk of tooth loss when in fact very few of my patients were actually losing any teeth. Sure, some did, but not very many. It took me a while, but I finally figured out that tooth loss didn't always happen to those with periodontal disease and therefore was not a very good motivator. Instead, I began explaining, "If you see bleeding when you brush, that means bacteria and toxins are entering your blood stream." Now that gets people's attention! I don't want bacteria and the toxic waste bacteria can produce floating around in my blood stream, and I didn't think others would either. The information about toxins in the blood stream taking the infection to other parts of the body have had a greater impact and have resulted in better compliance with periodontal therapy and oral health measures than merely talking about tooth loss. We now have research that confirms the obvious — a connection does exist between the mouth and the rest of the body. With this information, oral health education takes on a new dimension that patients understand. We still cannot say, "Gum disease causes heart problems, premature births, low birth weights, lung infections, or ulcers." But we can explain that allowing bacteria and toxins to enter the blood stream increases the risk of systemic disease.
Now you have the necessary tools you need to implement a perio program in your practice. Monitor the success of your program by watching the periodontal health of your practice increase and the number of bloody prophies decrease. Next time you're asked, you can truly say, "Yes, I have a successful perio program in my office," and you can feel really good about your answer!
Dentaltown Magazine
September 2025
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