Tiff and Dana discuss how to achieve full team alignment on periodontal policies and protocols, even when it's the last thing you feel like doing. Their tips include which habits to build upon, which templates for conversation with the patient are most educational, maintaining team alignment, and more.

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The Dental A Team (00:00)

Hello Dental A Team listeners. We are back with you with us today I have Ms. Dana and I'm so excited to do these podcasts. I have podcasts all day I have podcasts with you Dana. I podcast with Britt today I never get Britt on these suckers anymore and then I think I'm Kristy later, too So it is a whirlwind of podcasting day. Thank you for letting me, you know Just bust it out and get all of you guys here today

I'm really excited. I'm really excited for the one we just did. We record these just kind of like back to back to back just so you guys know in case you were wondering how this actually happens. We're not live right now. I wish we were. That'd be super cool. But it'd be really time consuming at the same time. But we just did a really fun one. I'm excited for them to hear about it. Dana though, I haven't asked you lately just how's life. had, it sounds like a full weekend of kiddos sports.

Dana (00:54)

Mm-hmm.

The Dental A Team (00:54)

⁓

But you personally, you guys, talked about consistency in this last one. And you personally, you have some of the best consistency that I've ever seen anyone maintain. So number one, I think my big question that might be on everyone's mind is why? How do you maintain that consistency? You show up for everyone, but you still show up for yourself. You still do your workouts. You still make sure that your path

for your own health is one of the most important aspects of your life. So Dana, how do you maintain that?

Dana (01:29)

Yeah, I think that just I learned early on in life, right? Like, especially with my health, like I had a point in my life where my health cup was pretty much empty and I had nothing to pour from. And so I just promised myself when I made it through that, that like,

I would always prioritize keeping that like as a priority. And ⁓ it's just something that like, I've shown up for for myself. ⁓ And to like, because I've shown up, it just, I don't know, like it just keeps me

saying it makes me a better mom, it makes me a better friend, it makes me a better partner, it makes me like, just better in so many ways, because I do take that space. And I don't always like, there's guilt, for sure that I do it and that I take the time and that you know, like I put other things aside to do it. But I think what it like, reaps and benefits and rewards for me outweigh those things. And so I'm truly on to the point now where I have kept it so consistent that

when I fall off I feel terrible.

The Dental A Team (02:43)

Yeah, yeah, that's the real deal now.

Yeah, I love that. I think that the things you pointed out there just your why is big enough. And I think a massive reminder to everyone that typically for a human being to make a change in life, it has to be hard enough. Like, we don't change things that don't feel like they're not working, right? That haven't like sprung up as a quote unquote, like broken piece of life yet, right? Like however you want to word it.

If it's not hurting, we don't typically think, we're not thinking about it. If it's not hurting, we're just not thinking about it. So why are we addressing things we're not thinking about? So when it finally does get bad enough, I think I had a similar story, not the degree of health, but a similar instance where it was just like I hit the spot where it's like I actually don't have a choice. I either take care of myself or my health continues to deteriorate.

So was honestly, it was easy at that point. So it's interesting because it's so easy, I think for us from the outside, especially for you and I for fitness and health, like I think you and I have, I can imagine you're the same like my whole life. It's been in my, it's been in my being for as long as I can remember. So it was very easy to see that in myself and to see that in my life and to see where.

the consistencies or the inconsistencies are, but it's interesting to take a step back and see how relatable it is to just so many aspects of life. And if we applied those same steps and processes, the same thought to other aspects of life, how different things could look. And we narrow that focus because I think fitness and health just like, I don't know, I feel like it's like a box to check instead of like,

away and for you and I like it's a way especially for you and so it's just gives you the template for other areas which I think for us makes a lot of times consulting fun. I think it's more fun and it's a little bit easier for us to sometimes see the structure of what needs to happen because it's literally mimicking the results that we've seen in other areas of our life and first

So happy you're here, Dana, because had you not taken that initiative, things could look very different today. And I'm very happy that you did and that you dedicated to yourself and that you continue to. Second, you were teaching your kids the most important valuable lessons of their entire life. And it's so cool to watch you do that and to watch you show up for yourself, but for them too. I've always taken that stand with it. They're like, Brody's going to know that exercise is for health. It's not for the other.

ideas in there. So I never wanted him to, you know, have whatever complications with health and fitness in his life. So I made it a priority for me pretty early on in his life because of that. And then really had to about six years ago. So I applaud you for those pieces. And I just think it's really, really cool. And I think it kind of stems and spurs into a more fun version of today's podcast.

Because I really do think that that consistency and again that template that you have for like no I'm just going to do it and some days, you know I'm sure you wake up like I do or I'm like today's not the day and then it's like no just go just go it's 30 minutes It's an hour of my life. Like just go and you will always feel better afterwards So sometimes life comes in and this task or this duty comes in and it's like this feels like it's gonna be really hard I don't really want to talk to this person about this thing

I'll do it next time. And the I'll do it next time only slides us backwards. And we see that with the health and fitness very easily. If we don't go to the gym today, like we're sliding backwards to tomorrow. But in these conversations that we're talking about today with the perio, everyone's favorite word, perio, and being in alignment on the periodontal care kind of makes me think of those areas where we really do slide backwards because we're like.

I don't really want to have that hard conversation or, that kind of borderline or I don't know what we would classify this as. I'm just going to probe you today. Maybe they'll see somebody else next time. Like you're my, you're one of my favorites, Brits, my other favorite, ⁓ perio brain to pick when it comes to stuff like this, because really getting alignment on that can look like so many different things and consistency on the alignment I think is one of the key pieces. And Dana, there's so much to pick apart in there.

I'm obviously alluding to have the hard conversations with the patients when they need deep cleaning, even if they've been coming to your practice forever. I don't care, just do it. But how are the doctors important in your opinion and from a hygiene standpoint in gaining the alignment within the periodontal care, within the periodontal policies and protocols? Because we can tell a hygiene team to go do it, but I feel like without the doctor, we're like 90 % there.

Dana (07:22)

Mm-hmm. ⁓

Yeah,

and and I really and truly feel like the doctor is so crucial in to me. It's like, ⁓ we have to do in this situation is build a plan and then create habits stacking for our hygienists like to do it right. And I think that the doctor is so crucial in setting up the standard of care for perio like what are the expectations for the hygiene team for each specific perio service within the practice? What are our parameters? What are our guidelines?

That way, when a patient walks in, no matter which hygienist they see, the same thing is recommended. Also too, it gives a very clear roadmap for the doctor to back you up. You've built it together. So you know that if you follow the protocol, the doctor can confidently back you up. You know that you'll get that every time that they walk in the room. And then lastly, importantly, just as important, it allows you to ⁓

confidently have the discussions that maybe you haven't. And I've seen an office as to where we built the protocol and there are moments of maybe we disagree, right? Maybe we see something different on an x-ray or maybe we see, you know, we probe slightly different or our angles are a little bit different or I've got a doctor versus a hygienist that one presses a little bit harder when they probe, right? But it allows us to definitively be able to make a decision and say, we default to the protocol. This is what the protocol

The Dental A Team (09:08)

Yeah.

Dana (09:16)

says when we have this many millimeters in probing depth, this many, and this is how often we do those things. This is the cadence in which we bring them back. These are the results that we expect to get it. And so when you have that outline, whether you are so far from it when you start or whether you're like pretty close to it when you start, it's okay. It's just build your roadmap of what you want your

The Dental A Team (09:23)

Yeah.

Dana (09:41)

period to look like in your practice first. And doctors play such a key role in developing standards of care with hygienists.

The Dental A Team (09:50)

Yeah. my gosh, that was beautiful. something you said at the beginning was the habit stacking and then something in pieces, ⁓ kind of pulling those together, the habit stacking, mentioned, basically you mentioned templates, right? Templates of how to get there. So I think the first template that a doctor in that habit stacking, which is 101 of anything, accomplishing anything in life, it just generally gets put on the health and like fitness industry.

⁓ side of it, but anything is habit stacking to create any kind of habit you're going to have it stack. So what you're saying there and what it makes me think of is like realistically the initial template, like what do I do with my patient? So you mentioned probing. So I think that habit stacking is like probing how often that's your, that's your first habit. Like how do we implement the x-rays and the probing at a certain interval to get the result that we want. And if we want to be able to diagnose periodontal disease,

we've gotta have the x-rays and the perio charting. So then it's like, okay, our first habit is getting these things into the appointment. Our second habit is diagnosing accurately and having those three to four periodontal classifications, that's the word I want there, that we can choose from and making sure that we're in alignment on those. There's so many, you guys, you can get recommendations.

You can get 15 recommendations on anything anymore. So just be careful what you're looking at. That's a true space of alignment. What is a one to three periaprobe? One to three millimeters, what does that mean? What is three to five? What is five plus? And then what is, we're referring this out. So I think when you're talking habit stacking from an outsider's perspective, I am not a hygienist, I would imagine if I were to sit in your seat, these are the things I would need.

to get this started and the consistency on time, like how often are we periaprobing? How often are we taking these x-rays? Dana, I think those come from the doctor and I know I might've just made so many hygienists so angry because I know that I have this conversation so many times. You are a provider but at the end of the day, like it is the doctor's practice and the doctor's license and those types of recommendations have to come from

Dana (12:11)

you

The Dental A Team (12:15)

him or her where they're saying, I want bite wings once a year. I want bite wings every six months. I want perioprobes once a year. Dana, is that the kind of habit stacking and templates that you're looking for too?

Dana (12:27)

Yep, You're spot on in there. How do we gather the information that we need to make our period diagnosis or to make our cleaning recommendation with our patients and outlining and defining how often we do that, when we do that.

What it means to do that, like what are we doing ⁓ is your first and foremost foundation. And then it is like bridging into what we do end up diagnosing, right? So what treatments do we choose and when do we choose them? So that's your perioprotocol, right? That is when do we do localized SRP? When do we do generalized SRP? What is scaling in the presence of gingivitis in this office, right? Because that's a term that's very broad. So how many bleeding points?

do we have to have? it have to be in all four quadrants? Does it have to be 20 bleeding spots? What does that look like in your office? ⁓ What is a perio maintenance? What do we do? mean, even farther as far as, when do we refer out? If we...

aren't, that's one time that I see that hygienists maybe sometimes disagree because it's hygiene comfort. Then I always say default to who you recommend to. If you have a periodontist that you love in your area, call them and say, hey, at what point would you really like to see them in your office? And we start to kind of go back and forth with this patient. So that way it's a very, very cut and dry of what we follow.

Right? And then, you know, then it becomes then it's templates for the conversation. Right? So how do we get to the conversation to educate the patient? What do we say if this has been a long term patient? What do we do if a patient refuses? Right? If they just want the cleaning that insurance covers, what do we do once they've had each of these? Right? Is it are we a

yes please, perio for life, right? Like once perio, always perio. Do we have wiggle room in there, right? Like what is our, like what's our protocol for all of that?

The Dental A Team (14:27)

Mm-hmm.

Dana (14:28)

And I do feel like a lot ⁓ of doctors take the place that like, hey, my hygienists are my perio experts. And I think that like, that is a great stance to have, but I think doctors, need to be a part of building the standard in your practice. And then yes, trusting your hygienists to follow that standard for sure, and make the recommendations on the things that they see. Absolutely. But I do think it's crucial that the doctors are part of the standard setting within their own practice.

The Dental A Team (14:54)

Yeah.

Oh, you nailed it. I couldn't agree more. And that's coming from a non hygiene standpoint. And you just heard a hygienist word straight from her mouth. And I think even the most, I'm gonna say it stubborn and hard headed hygienist who are like, no, this is my world. It is your world. But I think even the most stubborn, hard headed or strong willed is probably a better word to use. Hygienist will agree that structure.

helps progress. And if there is a structure to be had, there's input to be had, I think anyone would prefer that input upfront and honestly than on the back end saying like something went wrong, right? I didn't do something correctly. Well, we've all said it like, well, you didn't tell me that I didn't know, right? Or

I didn't know you wanted it that way. This is the space to get all of that stuff out on the table first. And doctors, for you to be like, my standard of care is X, Y, Z. And a hygienist to be like, well, tell me more about that because I think this. You know, I think ABC. And a doctor's like, cool, this is why I think X, Y, Z. Why do you think ABC? This is a space to have conversation. it's not, Dana, what you're saying is everything you said was a conversation. So it's more about

Everyone being able to bring to the table their own knowledge, what you guys have learned, we've all gone, everyone likely has gone to a different school, right? Hygienists go to a different school, typically university, than the doctors do or trade school or wherever it's from. Doctors in most practices, it's rare that you have even associates that have gone to, everybody's gone to the same school. So there's different schools of thought depending on where your training was.

And there's different opinions. I walk into some practices that floss is floss. I walk into other practices that there's like, do not use glide, or do not use whatever on the wall, and it's coconut floss. And then there's other practices that are like, don't eat coconut. You just pick and choose. It's all just the best that you guys can come to terms with. And so I think that it's more of a sharing of ideas coming with the standards and protocols. Now, there are things that will be like,

There are things that will be a discussion and I think everything is a discussion. ⁓ There are things that will be flexible, there's things that won't be super flexible. Like x-rays are probably not a super flexible spot. How often are you periaproping? Because these are based off of standards, literally standards of care for their licenses, but it's still a discussion. And I know I've had hygienists that are like two years bite wings, but doctors are firm on one. Like, cool, just take the bite wings. That's the standard of care.

and come to an agreement. And Dana, think that based off what you're saying, like that alignment is not just a, this is the box you stay in, but it's a conversation. And what you said earlier kind of resonated with me too, because I do see sometimes, oftentimes where doctors are like, yeah, we'll do a perio alignment meeting and meeting Mondays, we'll do meeting Mondays and we'll do perio alignment meeting. And they've got a patient, they're doing a crown while hygienists are meeting. And then hygienists come out.

They're like, this is what we decided. And doctors are like, OK, I'll review it. I was like, come on, just be at the meeting. Right, Dana, do you think?

Dana (18:16)

yeah. Yeah, I see that a lot. And then, you know, then it sits on a doctor's desk or, or a doctor does review it and has notes, but like the notes don't get to the team or then it doesn't get even fully rolled out because we're still kind of waiting to see like, did we agree? Do we agree? Like, where is this? Where is this thing? And and I think the doctors being part of the meeting and part of the

The Dental A Team (18:33)

Mm-hmm.

Dana (18:42)

conversation, I just feel like you leave with alignment and you leave with buy-in. When a doctor is just is a part of that because I feel like,

As a hygienist, I never wanted to feel as if like I was doing something that was outside of what the doctor wanted as far as care for their patients. And so I think when they're part of the discussion, they're part of the building the standards, they're part of mapping out those habits stacking and the pieces that they want to see. I think then it makes sure that no matter what patient is in the chair, no matter who they see, right, everybody is aligned and everybody is doing

like what is desired for that specific office.

The Dental A Team (19:29)

Totally, I agree. think this was so cool. And I think we spun this in some fun directions today that were a little bit different than ⁓ areas we've spoken before where it was much more structured. This one is a little, slightly less structured. There's still structure to it, but it's more giving you guys the knowledge base to understand that you get to build the structure as a team together too. Our structure, our recommendations, your action items today. Schedule a perio.

alignment meeting. A lot of times these get put in the schedule as a hygiene team meeting or a hygiene department meeting and they're going to talk about perioprotocols and doctors don't think they have to attend or it's not on their schedule at all. But doctors who are listening, hygienists who are listening, office managers who are listening, schedule a full team alignment even if you're like, hey, we don't have issues, we diagnosed just fine. I just come together once, at least once a year, probably once every six months or so. Just make sure we're all on the same page, you guys. And I think Dana,

Something I've seen happen the most frequently is any kind of addition to the team, even Steril Tech, who's helping turnover rooms, any kind of addition to the team, those are the pieces that get lost first. That consistency becomes inconsistent and we lose the template. So first and foremost, make sure you guys have alignment meetings and then make sure you have some sort of a structure or a checklist on what are the things that these alignment meetings...

One, what are we trying to gain? Like what is the goal of the alignment meeting? And what are we going to cover? So templates A to Z, our x-rays, our perioprobing, our exams, how often do you have to have a doctor in the room for an exam? All of these pieces that might to some of you guys listening now be like, that's crazy that practices deal with this. But if you don't have it, there will come a day, there will be someone that it gets lost on. So just make sure it's there. So Dana.

Let me know if you have any more action items. My first one, schedule that alignment meeting. Second, make sure there's templates. Make sure you guys know what you're working towards and why. And then implement. And I think, Dana, when we're building out Perio protocols, I think it would be safe to say you should be able to implement those within a quarter. So if you've got the alignment meeting scheduled, you hashed out on the meetings, you should be, if you do it quarter one, you should quarter two, be able to roll out those Perio protocols. Do you agree, Dana?

Dana (21:51)

Yeah, I do. I agree with that for sure. And then I think the last action is if you already have a perio protocol in place, make sure that every hygienist on your team knows it and make sure it is updated. Right. I think that, you know, there are some things that in the perio world

have changed and will continue to change. And so I always say when you build these protocols or you build these templates and you have alignment, it's not just like set it and kind of forget it. Make sure it gets added to onboarding packets for new hygienists. Make sure that we, you know, continue to kind of check in and see what we're doing. Make sure that we've got tracking in place and make sure that we update those things as Perio changes because, you know, grading and staging is now here and pieces that if you've had a long term Perio protocol, we may need to

add or consider updating.

The Dental A Team (22:40)

Totally, beautiful, thank you. I am leaving it at that. Everybody, if you were listening in the car, go listen again, write these things down. If you were listening, I don't know, anywhere else, I hope that you were taking some awesome notes. If not, listen again. The recordings are here for just that. So, share this with a friend, you guys. Everyone needs to know these Prairie Protocols. This is massive. It is a huge space that is underdeveloped in a lot of practices, I would say most practices.

the perio space is underdeveloped. So these are some really quick, easy tools to get that ball rolling without having to take extra courses and laser certifications and all of these things. Those would be like step two or three. These are your first steps. So go do the things you guys drop us a review. We always like to see those five stars and know what you loved and any ideas that you have to add to what we talked about. And then [email protected]. That was a hard one to say today.

⁓ is where you'll reach us. If you have any questions or you want any templates or ideas, just shoot us an email, you guys. do, Dana and I do get a lot of those requests straight to us from our Hello team. So just let us know how we can best help you and we'll catch you guys next time. Thank you.