Fluoride: The Anti-Cavity Fighter and Practice Builder

A systematic approach to adult hygiene patient appointments

Ruchika Khetarpal, DDS

Fluoride's powers have always been apparent. That little ion is almost like a superhero with a cape, always ready when called upon to wrap its arms around exposed root structure, preventing bacterial growth and decay. But why do some not beckon its superpowers?

Several anxieties exist around recommending fluoride to patients, but there are ways to implement and build confidence around the procedure, leading to increased production in the hygiene department.

The author graduated from dental school in 2007 and bought a practice 2 years later at the age of 26 - as green as a young dentist could be. As her confidence increased and she focused her energy on process and systems, she decided it was essential that her hygiene department start recommending fluoride to high-caries-risk adults. Using evidence-based dentistry, the team now discusses fluoride varnish treatments with patients who have periodontal disease, exposed root structure, sensitivity, moderate-to-high caries risk, or previous major restorative work.

What if patients say no? What if they do not want to pay? Most dental professionals have experienced anxiety when recommending treatment. Dig deep within yourself and remember that you are a clinical scientist and these are researched facts that you are recommending to a patient. With a combination of patient education, intraoral photos, and building personal rapport, you will hear "yes" more often than "no." The dental hygienist's job is to recommend the best care, and the patient can decide to accept it or not.

The author's office took a systematic approach to including fluoride into adult hygiene patient appointments. Because the practice is highly dependent on insurance, a breakdown of every single patient's insurance information is kept readily available. That information is put into the "memo" section of the "Edit Patient" folder in the software, where it is accessible to all team members.

During the hygiene appointment, if fluoride varnish treatments are deemed necessary, the information is accessible, and the hygienist can tell the patient the cost and move forward with treatment without needing to consult the front desk. When the patient is walked to the front, the administrative team member is told that the patient will be paying for this treatment that day. Once the stage has been set, future treatments will be simpler.

The key for ensuring that treatment is recommended at future visits lies in a strong chart audit process. Each hygienist is responsible for looking ahead 1 week and noting in the appointment block if the patient needs any radiographs, patient images, periodontal chart, remaining dentist treatment plan, or dentist exam, or had a previous fluoride treatment.

This process requires some work, but it can be fruitful if implemented in a practice that needs to compensate for massive insurance write-offs in the hygiene department. In the author's practice, an increased fluoride-to-prophy ratio has correlated directly to increased production (see Table 1).

For a successful and profitable practice, all team members must build confidence in suggesting treatment that they know is right for patients. Suggesting fluoride varnish to high-risk caries and periodontal patients is just one small part but essential to a profitable hygiene department.