Inside Dentistry
May 2011
Volume 7, Issue 5

Third-Party Verification

Having an independent third-party identify a condition as a serious risk to health can raise the level of awareness for the patient.

By Neil Gottehrer, DDS

Dentists are constantly challenged to improve our treatment outcomes using new or updated technology. Likewise, we are challenged daily to use this new technology to improve patient outcome and treatment acceptance. Regardless of the economic climate, if patients recognize the immediate need for this treatment, and understand the risks of not accepting it, there will be a much higher level of acceptance for the dental care we want to provide. While marketing may be required to bring the desired patients to the practice, it is information and education that enables the patient to accept treatment.

The most common clinical problem that patients suffer from is periodontal disease. Statistics today have indicated that less than 10% of those patients with the disease are treated. Often dentists have told this author that the treatment for the disease, most commonly nonsurgical, is not predictable and often fails. They offer this as reason for not providing the treatment. Other dentists have told this author that patients are not interested in periodontal treatment when, in fact, the dentist has failed to create an interest in having the disease treated. With the recent advancements in nonsurgical periodontal treatment, allowing most patients to be treated successfully, with a predictable outcome, these excuses for not providing this treatment are not acceptable.

If patients were successfully educated regarding their condition, they almost routinely would accept the recommendations for care. One of the best ways to provide this education and increase acceptance for treatment is use of third-party verification. Having an independent third-party identify a condition as a serious risk to health, with periodontal disease being considered both a dental and physical risk, can raise the level of awareness of this condition for the patient. Seeing the condition described in print, from printed brochure to video prepared specifically for the patient, makes it easier for the patient to be examined and accept treatment.

Interactive patient education programs, where a patient can relate to a condition they have been told they suffer from or are at risk for, should be a major part of a treatment presentation. Programs such as Henry Schein's Guru™ (www.henryschein.com) or Patterson's CAESY (www.caesy.com) help a patient to both see and hear information describing a condition they may have. This is an excellent example of third-party verification which confirms the need for care and often the safety and predictability of treatment. Coming from an independent third party, this information most frequently gives the patient the incentive to accept treatment. Because this information has not been prepared by the dentist, and comes from an external source, there is more credibility. In today's world, we tend to rely on information from third parties to keep us informed. So it now becomes very easy to use information from these sources in our practice to educate and motivate patients.

In CAESY's program, there is a video presentation with a hygienist and the patient in the dental chair. Represented is the need for periodontal care to reduce the possible risks of cardiac disease. It illustrates so perfectly the oral–inflammatory connection and shows the patient how a heart attack or stroke may occur secondarily to periodontal disease. It has been the author's personal experience, as well as that of other dentists/hygienists who allow the patient to view this video as part of their treatment presentation, that very few patients will refuse this treatment after seeing the connection from the video. Third-party verification has the greatest impact here and confirms for the patient, who may have read about this connection, the validity of the need for treatment.

Video presentations have become, for many dental practices that use it for education, standard operating procedure in presenting a treatment plan. And it has even greater impact, as third-party verification, for existing patients of record, who have not been participatory in their own personal care. After viewing this video, it would be very difficult for patients to deny the need for routine brushing and flossing to maintain their periodontal health.

A more important issue, and the requirement for use of third-party verification in the dental practice, is presenting the need for periodontal treatment to patients who have had active treatment in the dental practice, require periodontal treatment, and have not been presented with this need, or who have not previously had the treatment provided for them. It is the perfect way to present need for care based upon “new” information about the oral–inflammatory connection. By explaining to the patient, after viewing this third-party verification video, that there is a risk and that this now suggests need for improved periodontal health, many existing patients of record will accept treatment. It is very hard to decline treatment when these third-party sources show the risks of chronic periodontal disease. The patient realizes that the dentist/hygienist is concerned not only about their periodontal condition but also about their physical health.

Because this information is still relatively new to the medical profession, the treating physicians rarely question the patient about their periodontal status, ie, “periodontal risk.” The author has created the STAT-CK Periodontal Risk Assessment form as a tool to make it simpler for the patient to understand their condition, and have a standard form to forward to the physician regarding the findings of a periodontal risk assessment and indicating treatment required (see Figure). In the author's experience, patients find it easy to understand a condition if it is graded A–F. They have been used to being graded in their education and this now becomes a way to give them an assessment of their condition using grades, as seen on the form.

Use of clinical forms, generated from a third party, again function as third-party verification, a useful tool in improving patient acceptance of treatment. Patients can now receive a take-home document, which describes their condition and the appropriate treatment for each stage of the disease. The A patient is healthy and requires minimal care. The B patient bleeds on probing. The C patient has calculus present. The D patient has deposits present below the gum with 5-mm pocket depths, and the F patient is failing with > 6-mm depths and the need for comprehensive care. The third-party verification form simplifies patient communication and allows the patient to take home a record of their condition, which is understandable to all concerned.

Another advantage of third-party verification forms is the simplification of communication with the family physician, who needs to know more about this connection as well as have a record of his or her patient's condition. An increasing trend, now and for the future, resulting from this third-party verification is new-patient or patient-of-record referral from the physician to the dentist for periodontal risk assessment. Physicians are becoming more aware of the oral–inflammatory condition. They realize that comprehensive care for their patients who suffer from cardiac disease is required to help stabilize their condition. This will require now, as well as in the future, periodontal risk assessment, and active treatment from the dentist for their condition.

Third-party verification helps to build patient/doctor relationships that previously may not have existed. Sitting next to a patient as they view a third-party educational video makes the experience more personal. Using standard documentation forms, derived from a third-party verification source, enables the patient to understand a diagnosis and treatment before actually going through the procedures. Taking the time to explain a condition, and the possible medical risk from not treating, makes a connection with the patient. This has now become an important part of patient treatment. The risk assessments, diagnostic technologies, and treatment have been seen by many dentists as an excellent way to build strong relationships with the patient. This experience and the possible positive attitude response from the patient, who can now recognize the physical benefit from nonsurgical care—the simplest form of periodontal treatment—can lead to the patient asking for and/or accepting recommendations for restorative/cosmetic treatment, which may have never been previously considered or accepted by the patient.

The message of third-party verification is improved health. Now is the time for all dental practices that want to provide quality treatment on a routine basis to implement these suggestions. A happier patient and a busier practice can easily be the result of using these sources.


The author developed the STAT-CK Periodontal Risk Assessment form shown in this article. Electronic copies of this assessment tool are available, at no charge, from the author. Contact him directly at dr.neilg@verizon.net.

About the Author

Neil Gottehrer, DDS
Private Practice
Havertown and Abington, Pennsylvania

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