DSO Hygiene: Making Quality Tangible

I recently attended the ADSO conference in Las Vegas and had the opportunity to sit in on the Chief Dental Officers (CDO) panel discussion.  One of the main discussion points was pertaining to quality assurance initiatives in the group practice setting. Demonstrating quality care is a hot topic, especially since it seems to be one of the most common attacks against dental group practice. The CDO’s from various dental groups came together and shared what they are doing to make quality tangible within their organizations.

The questions are: How do you measure quality for your providers? And, how do you make quality tangible? Each participant on the panel presented some of the areas they have focused on in their groups and the efforts they make to ensure quality patient care.

For those groups that have not created a quality measurement for their hygiene providers, now may be the time to implement a quality initiative that is not just doctor focused, but focused on your dental hygiene team, as well.

When measuring the quality of your dental hygiene team, the team at Enhanced Hygiene suggests starting with these three basic measurements. These key measurements will help you start making dental hygiene quality tangible in your group.

Periodontal Services

Non-surgical periodontal treatment is the number one key procedures your dental hygiene team provides to your patients.

Recently the Academy of Periodontology and the Center of Disease Control identified Periodontal Disease to be a significant health concern and is more prevalent than once estimated. (www.perio.org – 2015)

In order to understand how well your dental hygiene team is caring for your patients, dental practices should track their periodontal percentage as a way to address how well they are addressing periodontal disease in your group. The periodontal percentage is calculated using the following procedures:

D1110 – Adult Prophy
D4910 – Periodontal Maintenance
D4341 – Scaling/Root Planing – Quadrant
D4342 – Scaling/Root Planing – Localized

The periodontal percentage measures the number of periodontal related procedures as a percentage of the number of overall definitive dental hygiene procedures completed (D1110, D4910, D4342, D4341)

D4910 +D4341 + D4342 / (D1110 + D4910 +D4341 + D4342) = Periodontal Percentage

At least 60-80% of your procedures should be periodontal related. Based on the statistics released from the American Dental Association (ADA), American Academy of Periodontology (AAP), the Center of Disease Control (CDC); As they have stated: 1 in 2 U.S. adults have some level of periodontal disease. This rate goes up to 75% with patient over the age of 65.

Caries Prevention

Caries prevention is the second key patient care focus your dental hygiene team provides to your patients.

In 2007, the America Dental Association (ADA) and the California Dental Association (CDA) released the Caries Risk Assessment (CRA) and Caries Management by Risk Assessment (CaMBRA); which is a method for identifying the cause of disease (caries) through the assessment of risk factors for each individual patient and then managing those risk factors through behavioral, chemical and minimally invasive procedures. Understanding of the patient risk factors during the dental hygiene assessment will lead the dental provider to incorporate fluorides, sealants, xylitol, and antimicrobials into a treatment regimen for their patients; in order to prevent further demineralization and halt the caries disease process.

The ADA and CDA estimated that over 80% of the population (all ages) are at risk for dental caries. So, the incorporation of preventive factors, such as fluoride and sealants is important in minimizing risk.

When looking at preventive therapies in your practice you will want to look at how many of your patients were treated with the following codes:

D1208 – Topical Application of Fluoride
D1206 – Topical Fluoride Varnish
D9630 – Other drugs and/or Medicaments, by report (take home fluoride)
D1351- Sealant (per tooth)

The ADA and CaMBRA recommend in-office topical fluoride treatments preferably varnish) are provided for moderate and high risk caries patients. Ideally, you should see that a minimum of 50-80% of your patients receiving in office fluoride treatments. While a minimum of 50% are receiving take home fluoride at their dental appointment.  The sealant calculation should show a minimum of 30- 50% of your patients are receiving sealants. This number may seem high to some, but consider this: If your office was at 50% sealants, this would mean that 50% of your patients received 1 sealant in their mouth. In most cases, sealants are placed in multiples. Especially with your pediatric patient base. Your dental hygiene team is trained at placing sealants, so sealants should be a standard service performed in the hygiene chair. The evolution of products has made it easier for the dental hygienist to place sealants without the help of an assistant.

Patient Satisfaction

Patients judge quality on terms of their experience and their satisfaction level with the care and service the received.

With the help of organizations such as Press Ganey you should create a hygiene specific patient satisfaction survey for your practice. This survey will ensure your hygiene team is providing the highest level of care possible, a system to monitor patient satisfaction and dissatisfaction. These surveys will give you foresight into what patients are saying, what their expectations are and what areas your hygiene team could advance in.

Dental Hygiene Quality Initiatives need to be a part of your groups structure. You can start measuring the quality of your hygiene team today by implementing the three simple starter measurements into your group today. If you are interested in implementing a full quality initiative that yields strong results, please contact Enhanced Hygiene today: hello@enhancedhygiene.com.

By: Heidi Arndt, RDH, BSDH|Founder, CEO @ Enhanced Hygiene