Ask the right questions before you say yes
- How long are adult hygiene appointments, and how are new patients and periodontal patients scheduled?
- Does the office have a written periodontal protocol? Who diagnoses, and how is it charted?
- Will you have an assistant, or help with turnover?
- Which practice software does the office use, and who will train you on it?
- Who can you ask when you're unsure in your first weeks?
Learn to run a 1-hour appointment
In school you had hours per patient. Now you have about 1. Break the hour into parts (medical history and vitals, assessment and charting, radiographs if due, treatment, home care, notes and the next visit) and notice where your time goes.
A 60-minute bar split into the parts of a hygiene appointment, in order: medical history and vitals, assessment and charting, radiographs if due, treatment, home care, and notes and the next visit. Treatment takes the largest share.
Set up the room and review tomorrow's charts the day before. Most new grads lose time at the start and the end of an appointment, not in the middle.
Diagnose perio the same way every time
Use the 2017 classification of periodontal diseases, staging and grading, on every patient who needs it, and chart it the way your office does. A consistent diagnosis makes the treatment plan, the coding and the conversation with the patient much easier.
Get comfortable with the codes you'll use most
Ask your office manager to walk you through the CDT codes your office uses for hygiene, and how claims go out. The decisions new grads find hardest are usually:
- Prophylaxis (D1110) or periodontal maintenance (D4910), for a patient who's had periodontal therapy.
- Scaling and root planing by quadrant, for 4 or more teeth (D4341) or 1 to 3 teeth (D4342).
- Full mouth debridement (D4355), when heavy deposits stop you from doing a full evaluation.
Five CDT codes: D1110 prophylaxis, for preventive care without active periodontal disease; D4910 periodontal maintenance, after active periodontal therapy; D4341 scaling and root planing per quadrant, 4 or more teeth; D4342 scaling and root planing per quadrant, 1 to 3 teeth; D4355 full mouth debridement, when heavy deposits block a full evaluation.
Your notes have to support every code you choose.
Explain treatment so patients say yes
“Do I really need a deep cleaning?” is the question you'll hear most. Show the patient their own chart and radiographs, explain what the numbers mean in plain words, and ask what questions they have before you talk about cost. Practice the conversation until it feels natural.
Look after your body from day one
Adjust the chair and the patient before you start, keep your wrists neutral, and stretch between patients. Habits you build in the first year stay with you.
Keep learning
Find someone to ask, in your office or outside it, and keep a short list of what you want to get better at each month.