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Inside Dental Hygiene
February 2020
Volume 16, Issue 2

Keep Patients from Slipping Away

Home visits can keep less mobile patients connected with dental practices

Angie Stone, RDH, BS

One new patient can bring a dental practice an estimated $10,000 to $45,000 in revenue over the course of a lifetime.1 As a result, bringing new patients through the door is a goal for many practices; consultants often have specific numbers they recommend targeting to maintain or grow a practice. This can seem daunting  for the practice owner. In addition, focusing on new patients is not the only way to maintain a strong patient base. Another piece of the puzzle is knowing how many people are going out the back door. A practice needs more patients coming in the front than sneaking out the back. If the balance is consistently negative, eventually the patient base will be too small to keep the practice viable.

While consultants, social media organizations, and marketing groups help practices implement systems to attract new patients, retention depends on the team working within the practice. Patients want to feel welcome, important, and valued. If the dental team makes them feel that way, they are far less likely to leave. However, there are other reasons patients leave that are not dependent on the dental team. These reasons include changes in insurance coverage, relocation, or simply being unable to get to the office anymore. That last scenario is one that does not have to result in loss of patients. The reality is that the dental team can make a difference for those patients and, as a result, retain them in the practice.

Who Is Leaving?

Patients who cannot get to the dental office include those who become disabled or medically frail, or who develop dementia.  These patients likely have spent decades with the practice and provided considerable revenue. Yet, in likely the most vulnerable time of their lives, many offices let them slip out the back door.

Dental teams may not realize an elder patient is not visiting on a regular basis until a chart audit is done. If an attempt to contact the patient is not successful, the assumption typically is made that the person may have passed away, moved away, or transitioned into a care community. It is also typically assumed that any dental needs are still being met. The chart is made inactive and the practice moves on. However, these assumptions are often wrong. The inactive patient eventually may even resurface with a dental issue. The issue is addressed, often via an emergency visit, and the patient is sent away. Secretly, the team may be hoping not to see the patient again. These patients are slow, their medical history is complex, and their mouth is a mess. If they stay out of sight, they are out of mind.

Is this how dental professionals would want their own loved ones served? It likely is not, and there is a better way. Recognizing changes in older patients, putting a plan into place, and taking action not only serves them better, but is better for the dental practice as well.

What Can be Done?

There are signs a person is losing physical and/or cognitive abilities. Signs include:

• Not driving themselves to their appointments

• Not paying their own bills

• Not managing their own medication list

• Not making their own appointments

• Forgetting appointments

• A decline in oral cleanliness

When those signs become evident, addressing the dental needs is a must, as they soon may not be able to get to the office anymore. It is similar to preparing a patient for losing dental insurance benefits upon retirement.

Once patients cannot get to the office, how will they receive dental care? Most often, they don't. Dental health is basically forgotten until a problem arises. Problems often are solved with medical professionals prescribing antibiotics and/or pain medications, and the issues resurface in the future, creating a vicious cycle in which the patient is in pain, caregivers are stressed, and physicians can provide only temporary solutions.

Prevention is the best solution. Dentistry is necessary when prevention fails, and dentistry is difficult to accomplish for this group, due to lack of ambulation, cognitive abilities, and money. Dental disease is nearly 100% preventable, so why is it not being prevented? The answer is the prevention experts, dental hygienists, typically are not knowledgeable about addressing this issue outside the dental office. In fact, they usually are not even involved. What if they were?

Imagine having a dental hygienist maintaining the oral health of the elders who no longer can do so themselves. In order for the patient to remain healthy, oral bacterial load needs to remain low. During weekly visits from the hygienist, elder patients receive a thorough brushing and between-the-teeth plaque removal with floss or other over-the-counter interdental aids. The elder is also supplied with 100% xylitol-sweetened mints or gel, toothpaste, and a toothbrush to be used daily. (This system has been developed and successfully implemented by the author. Additionally, she provides consulting for offices interested in incorporating it into their practices.)

Hygienists are the perfect professionals to manage this task. Invasive dental hygiene procedures would not even be necessary; with routine bacterial control, gum tissues remain healthy and dental decay is kept at bay.

If a hygienist determines a patient requires a full dental hygiene visit, or sees something that should be examined by a dentist, intraoral images can be taken and sent securely to the patient's dentist of record. The dentist can provide an opinion and treatment recommendations. The hygienist then can share that information with the patient (or family members) and assess if the patient can get to the dental office, sit for treatment, and pay for services. If so, the hygienist can connect the patient with the dental office. If the patient cannot handle a visit, the dentist can be notified and alternative therapies such as silver diamine fluoride can be discussed.

This system offers many benefits. When bacteria can be controlled and the mouth kept clean, very few dental issues arise. Patients are kept dentally healthy and, as a result, are usually healthier overall. Dental hygienists providing oral care can have their eyes on the dental health of the patients and keep the office of record abreast of the patient's situation. Referrals can be made back to the office when appropriate. The office never loses track of the patient. Patients always have a dental home, even if they are not able to physically get there as frequently or at all. Implementing this system in the dental office today can keep elders from disappearing through the back door and keep revenue flowing.


1. Do You Know the Lifetime Value of Your Dental Patients? Firegang Dental Marketing website.
Accessed December 18, 2019.

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