Doctor disagrees with healthy: Conservative approach derails the attempt to provide care

Dear Dian,

I have practiced dental hygiene for seven years and I have been working with another dentist who has six years of experience. We have a good assessment and treatment protocol in our office and both agree on how to diagnose and design the treatment plan the various seriousness of periodontal disease.

We know when to perform a complete goal and when to go straight to the escalation and design of the roots. We are diligent for performing a complete target of periodontal mapping and X -ray and we are confident that by telling patients what type of cleaning are needed before the doctor’s exams: the options range from a pre -promotion, selective escalation and design of the root,

The problem we face is with a partner physician in our practice. Often disagrees with our appreciation. After discussing the periodontal condition with the patient, the dentist will say that he got a different periodontal reading and sees no bone loss in the X -rays. Then he will say that definitive treatment is unnecessary. We only recommend the escalation and installation of roots for patients with 5 mm detection depths or larger and the majority of these patients had no care for several years and complain that their gums bleed and sensitive.

I tried to talk to her, but she says she’s worried about her permission. My partner and I are embarrassed that it would question our hygiene skills and even suggest to over -stimulate periodontal disease. Many people in the office had problems with this doctor. I have come to the conclusion that he may have to see patients first, as he always seems to have a different treatment from the other healthy and I have.

I have another question: there must be radiographic bone loss in order to properly diagnose the periodontal disease that justifies the escalation and design of the roots? Please help, as I just don’t understand!

Florida rdh

Dear Florida,

Yours is not the typical periodontal diagnosis problem I hear. Most of the time, my health writes to say that a doctor diagnoses periodontal problems where they do not exist. In your case, the problem is a doctor who is so conservative that it prefers to delay definitive treatment until the disease has progressed to a more important pocket-more than 6 mm. Come on!

When you say that the doctor is “worried about his permission”, I suppose the doctor is afraid to be accused of excessive periodontal problems. This is a problem in some offices. If you look at disciplinary actions on most of the sites of the State Council, excessive diagnosis of periodontal disease is one of the most common violations. Each profession has its share of dishonest people, including dentistry.

One of my colleagues is a consultant with an important insurance provider and tells me that fraudulent periodontal reporting is one of the top worker’s top concerns. That is why many benefits providers now require radiographic bone loss in order to approve the benefits. After all, you cannot root the plane covered by the bones. Due to the over -stimulation made by dishonest clinical doctors, benefits are more difficult for everyone. Periodontal mapping is not enough to satisfy insurance companies, as they know how easy it is to inflate readings.

I find that 5 mm bleeding is a sign of periodontal activity, as are most insurance companies. However, bone loss is not always evident in x -rays, especially in oral or linguistic. One way to “build your case” for the insurance company is to enter your periodontal research on the bone loss website and take a photo with your endoscopic camera. Then submit the image with the protrusion. The previous periodontal problems are obstructed and treated, the better the results of the treatment. Therefore, we should expect better clinical results in the treatment of a 5-6 mm pocket against a 7-8 mm pocket. It seems to me that your office needs calibration, since this doctor is not clinically on the same page as healthy. It would be beneficial to have a workout in which all doctors and hygiene meet to discuss the protocol for the evaluation and diagnosis of periodontitis and gingivitis.

I have learned a long time ago that the most conservative doctors prefer to make them make the decisions about treatment, so what I suggest is to change your protocol. Here is what I mean: you collect the data and when you find that the patient has some periodontal activity, you just say to the patient: “Mrs Jones, according to X -rays and what I see in your mouth seems to be some problems that I have to pay attention to.”

Don’t tell the patient that he has periodontal disease. Instead, bring it to the doctor’s attention and let the doctor make the call for definitive treatment. Present what you discovered in the evaluation. Make sure you have a six -point periodontal mapping with all the numbers recorded and show your findings to your doctor. Be sure to document everything in the patient’s narrative. If the doctor decides that the patient does not need a definitive periodontal exfoliation, he / she documents that in the diagram of patients. Never write your opinion-just stick to the facts.

Although I am sure you are conscientious and capable, I would advise you not to take it personally if the doctor disagrees with your assessment of the necessary care. All doctors develop therapy philosophies. Some are conservative about the design of treatment, and some are more energetic.

I once worked with a conservative doctor in addition to the conservative and I had to learn to accept the fact that he had the right to make diagnosis calls, even if I disagree with him sometimes. I clearly remember a patient with a huge cracked amalgam. I told the patient about the problem and showed him with a mirror. I also shared that the doctor would probably recommend a crown for this tooth. Not only did the doctor recommend a crown, but he also used one of his favorite words: “I think we can get another 100 miles out of this tooth without housing it”, which meant that he preferred to correct it. He was the boss and was his decision to heal his patients according to what he felt was in their interest. By the way, this supernatural doctor was the best boss I’ve ever had!

My latest comment is related to discussing your differences in diagnoses with colleagues, as you have said that “many people” in the office are sharing your frustration. Cut this doctor some relaxation and work to understand why it tends to be conservative in the design of treatment. Sometimes the conservative road is the best way to travel.

All the best,

Dain

Author’s note: This article was originally published in 2016 and has been informed by June 2025.