Hey there, I am Dr. Richard Madow back again with Module #3 in the Madow Brothers MegaBundle. I am coming to you from my home studio today, as you can see. I've got my piano, see I can record music here, record MegaBundles here, it’s nice I love having a little home recording studio. It's actually called a Mac Book Air, but I can call it a home recording studio, got a little keyboard up here, but we are going to forget about all that stuff today and concentrate on something fantastic for you and your dental practice.
Now this module is for the entire team, definitely for the doctor and the hygienist but I highly recommend the entire team watch it, because it's going to change your mindset and, as you probably already know, this module, Module # 3 is called "Triple Your Hygiene Production Now" and it can be done.
Let’s talk about why this is so important because the information that you are going to learn in this module will help so many things in your practice. It will help increase your income of course, that's important, but more importantly, it will help increase the health of your patients; it will help you deliver the best care possible. It will help you differentiate your practice from every other practice in your area; hopefully get some more referrals of high quality patients through the back end.
It will make the entire team happier, not just the hygienist but the entire team because everybody loves to be associated with a practice that is doing the best treatment for their patients, really concerned about their patients’ health and getting a better income at the same time; how can you beat that. So I know that after these few minutes we spend together if you take this advice seriously, if you don't just shut off your computer and neglect this, but if you take this seriously, go back to your office and actually put this into practice, the value will be so great. Because not only will your income increase significantly, your practice income and everyone's income increase significantly, but your patients’ health will increase significantly. Your referrals will increase, especially of high quality patients, everything will be better; it’s the cure for everything. Well I'm not so sure about that but certainly the cure for a lot of what is ailing most dental practices in the US today in North America, maybe all over the world today. May be you are watching this in Istanbul, Turkey or may be Melbourne, Australia may be Osaka, Japan I don't know where you are watching this. I know this has gone all over the world, so wherever you are: welcome. I was going to say hello in many languages but decided not to.
This information, again as with many of these modules is based on things that we've learned by visiting hundreds of practices across the country and speaking to so many dentists and dental team members. And it's one of those things where everybody we see let's just say it again, as you probably know we don't do very many in office consults any more, but we use to do them quite a bit. And the process will start with an interview, and practically every single dentist would say they have a fantastic hygiene department working at full capacity, providing the best treatment possible for their patients, generating a great amount of income; doing all these things right. And I've got to say, unfortunately when we went into the practice and observed and looked through the charts and looked through the computer reports, and looked through the actual figures and these insurance quoting reports and all those things. We learned practically every single dental practice in North America is severely lacking when it comes to having a robust periodepartment, one that is providing optimum treatment for their patients and generating optimum income.
So this is not just theory, it's not just some B.S., it's not some practice management person writing an article, this is based on actual experience both in my practice and Dave's practice and more importantly, in all the practices that we've visited over the years. So let’s start with somestatistics. Depending on who you want to believe, there are many studies that are, you know, as all studies variance of the curve, whatever you want to call it. But I think it is pretty safe to say when you read a bunch of studies and statistics, you will agree that more than half of all adults in North America have some form of periodontal disease. Now I've seen studies that say 33 %, I've seen studies that say 80%, but I think it's pretty safe to say more than half of all the adults in North America, and probably your South America, Asia, Australia, Antarctica, not sure about Antarctica, a lot of penguins have perio disease there. But wherever you are, more than half of the adults have some form of perio disease and when you get to adults 65 years old and above, over 70% of them have some form of perio disease.
So what does this mean! Well it means a lot, but let's talk about one thing that it means. It means, depending on your patient population, if you are not either treating or referring a majority of adults in your practice for some form of perio therapy, you are practicing what we call "Supervised Neglect." Let's repeat that because it is so important. Depending on your patient population, if you are not treating or referring over 50% of your adult patients for some kind of perio disease, you are committing Supervised Neglect. Supervised Neglect means a patient comes in for their cleaning on a somewhat regular basis, you diagnose or you know there is some kind of perio disease, a 5mm pocket, a bleeding point, some demedisor ugly tissue,whatever it is, some areas of bone loss,whatever it is, the majority of dental practices, do what we call Supervised Neglect. They look at it, they tell the patient a little bit about it, they pat them on the shoulder, they say here floss better, brush better, see you in six months.
You are letting a disease, an inflammatory process and infection, go untreated and leaving it up to the patient's devices to make that better. They don't floss, they don't brush well, you know what, you see when they come in six months later, it's Supervised Neglect. So one thing you can do is to run a code report to see how much perio treatment you are doing in your practice. Let’s call typically scaling and rootplaning, so run a report, use the codes for scaling and root planning, and see how frequently you are doing this procedure in your practice; probably not very often. So referring is great, periodontists obviously do a fantastic job of treating our patients, hopefully they do; if they are not you need to find another periodontist, they should be. But so many times we can treat perio disease in the general practice, doing the series of scaling and root planing. Now we are not going to go through the mechanics, the clinical aspect of treating patients for perio disease today, that's not what we do; we are not clinical teachers, there are many great courses you can take on that. But suffice it to say, cleaning, a checkup, the old polishing you give them, the flossing instructions, that's not treating the perio disease, that's Supervised Neglect.
So let’s talk about maybe why, why so many practices aren't treating perio disease. I think the reason is we are almost afraid to do the complete examination and discuss perio disease with the patients. Why are we afraid to do this? Well, I think one of the main reasons we are afraid is because we are afraid of backlash from our patients. Let's face it, patients been coming for a few years, they've had a pocket here, a pocket there, bleeding point here, bleeding point there, inflammation here and there, but we just keep patting them on the back, telling them that everything is ok, you need to brush better, floss better, see you in six months, four months, whatever it is.
We are afraid of the backlash that we will get when all of a sudden we tell this patient that they have periodontal disease and it needs to be treated, and the treatment is going to be 4 appointments and cost well over $1,000, whatever, it is we are nervous about that. Or we get a patient that is a new patient, they've come in from another dental practice or from out of town and we are afraid of the question! Why didn't my last dentist tell me that? I honestly think these are the big reasons we are not treating so much perio disease in our practices; you know a lot of us just, we are too busy, the patient is here to do a cleaning, whatever. But I think deep inside we are afraid to look a patient in the eye and say, "You've got an infection in your gums, it's called periodontal disease this is how its treated: it's going to be 4 appointments, the fee is over $1,000, insurance only covers half, and have them look at you and say, "I've been coming here for 5 years! Why didn't you tell me this before?” Or, "Why didn't my last dentist tell me that? I want a second opinion." We are really afraid of those.
So! How do we get over that? Well one thing we can do is preempt it. Preempt these questions by doing an incredibly through examination of the soft tissues and let the patient know why you are doing it." We are going to spend a lot of time examining your gum tissue today because recently studies have come out that show gum disease in adults has actually been linked to heart disease, diabetes, general ill health, in some cases even cancer. We are paying more attention to gum disease now than we have ever before because there is something called the oral systemic link. Which means your mouth is link to your entire body’s health, and gum disease is one of the windows to your whole body health. So we feel in this practice it’s really, really important to properly diagnose and treat gum disease. But also, you may not know this, but you probably know some people with tooth loss: adults with dentures, partial dentures, and implants, whatever. In adults most of the time tooth loss is cause by gum disease, not cavities, not accidents. Tooth loss is usually caused in adults by gum disease. So it’s our dedication to really, really pay close attention to this; we want you to keep your teeth for the rest of your life, and we want you to have whole body health for the rest of your life," something like that.
Now those were my words and when you watch the module on clinical calibration, you'll know that we really don't believe in scripting, where every team member is told to memorize the script and then vomit it back to the patients. But we do believe that every team member should have a consistent accurate answer to patient’s questions including, "Why did my last dentist never tell me this? I've been coming here for 5 years you never said I had gum disease;what's going on?" In their own words but consistent and accurate. So when you get to the module on clinical calibration, you'll definitely understand what that is all about, so preempt it.
“New studies have shown most adults tooth loss is from gum disease,” all these great reasons, and then go ahead and do the most through periodontal exam that patient has ever had. Now that includes full mouth x-rays of course, you cannot diagnose periodontal disease without full mouth x-rays. Now if you have recent ones, that's great, most practices don't; they've got the old bitewing and panocombo or not even that. They've been doing bitewings every year for the last 10 years. You really need full mouth x-rays to diagnose periodontal disease, so full mouth x-rays, full mouth probing with recording, whether you have an assistant in there orhygienistrecording, you've got one of those new (not sure of word) contraptions, you're using the dental rack, you are talking on the IPhone, whatever it is, do it, but again when you watch the module on treatment plan acceptance, we will go more into this. But don't just do the exam, let the patient know exactly what you are examining. I mean let’s face it, what are most patients hearing doing a hygiene exam: 3 2 3, 3 2 3, it’s like a robot 323, 323; let them know what is going on.
So before you do the examination, explain to the patient in plain English, and again this is more covered in the treatment plan acceptance module. But it’s really important, so I am going to say it here too. And as you watch all 15 modules, you'll notice that there will be some repetition, some overlapping, that's fine, it’s for a good reason, some of these points are so important that they fall in many different categories, Dave and I want to stress them and also, look let’s face it, we know that everybody is not going to watch all 15 modules. So some of these important points will be repeated, will be overlapped, whatever, and this is one of them.
When you are doing this gum examination, make sure the patients knows in plain English what you are doing, no 323, 323; make sure they know that you are checking their gums for infection. And the way that you check is you use this little instrument that measures how tightly the gums are attached to the teeth. Again these are my words and you can put this in your words, but please don't use dental language, use regular language (Sneeze) excuse me, (sneeze), you know what, we are not going to edit that out; we all sneeze so what the heck we will leave it in there, hopefully you are saying “bless you” when you are watching this or whatever, whatever you believe in. I am not so sure I'm being blessed, whatever, ok that's a different thing altogether. But make sure (just cracking myself up here) in plain English, the patient fully understands what you are doing. “We are checking your gums for infection and one of the things we would like to see is how tightly your gums are attached to your teeth. So we use a small instrument, this little instrument, to see how tightly your gums are attached to your teeth. It’s kind of like a sleeve or a pocket that's forming between the gum and tooth, and if this little instrument measures that, if there is 3mm of space before the gum attaches to the tooth, that's great, we consider that generally healthy: 3mm, 2mm. If there is 4mm or 5mm or 6mm of space, that's a sign that there is a little bit of gum infection in there, so listen for those numbers when we are doing the exam. If you hear us say the letter B, that means that when the instrument touches your gums there is a tiny bit of bleeding; now there is nothing that's going to cause you to lose blood in mass quantity or anything, but chances areyou won't even feel it. But that's also another sure sign of infection because healthy gums do not bleed. If you ever notice your gums bleeding when you brush or floss, that's a sure sign of infection, remember, healthy gums, despite what many people think, healthy gums do not bleed. So we are going to do this little examination on your gums, so pay close attention, kind of follow along.”