Continuing Care – Recall, What’s the Word?

  • June 2013
  • Posted By Debbie Ellard

 Continuing Care or Periodontal Maintenance? The Choices Keep Coming!

Continuing Care - Recall, What’s the Word? What is YOUR word? Continuing care is the heartbeat of every practice and not knowing the health of this vital organ is exposing many dental practices to unnecessary risk. More about this in a moment.

Not all patients will understand why hygiene visits are important so it’s critical to take a few moments to explain the benefits as well as the risks associated with compliance. Allow some time in every hygiene visit to discuss the focus of the next appointment and when that appointment needs to be.

Does the staff understand why patients come back at three, four or six month intervals for their continuing care? The prescribed continuing care frequency is related to the growth/life cycle of damaging bacteria. This is important not only for the hygienists but also for the team member charged with managing the continuing care system. If this person does not have a strong understanding of the risks associated with failed appointments, they will not be able to impress upon the patient the importance of scheduling their continuing care visit.  We spend focused amounts of time in stressing the importance of having pictures of the progression of periodontal disease in each hygiene room. This helps with communicating the goal for each patient. This is a visual representation for what can sometimes be hard to understand verbally. The Risk Assessment Form is another visual tool that the patient can refer to after leaving your office. The risk assessment sheet is designed to be a take-home educational tool which is given at every continuing care visit and is taken home to serve as a visual reminder of the risk associated with not following through on recommended treatment. Statistics clearly and scientifically show the rate of periodontal disease among adult patients. When the practice ignores the responsibility of picking up the periodontal probe and charting the condition of the patient, the standard of care is below acceptable. Everyone wins with an accurate diagnosis. If the patient has other chronic health issues this diagnosis and treatment can directly affect successful progress. The hygienist needs no additional continuing education or certifications. They need no additional costly training. The hygienist just needs to take the time to chart the periodontal measurements at the patient’s continuing care appointment. What is your protocol? Do you have one? The dentist just needs to set the protocol and then inspect what he expects. Pick up a probe and check the accuracy of your hired professionals. Is your standard of care adequate? If not, this is an easy fix but it starts with you. This is really a leadership moment and these issues are always implemented from the top  down. What is expected of your hygiene providers ‘ALWAYS’? What are your barriers to implementing a periodontal protocol for your practice? Identify the barriers and then remove them. The continuing care visit is an opportunity on so many fronts.

Do you have the patient education at the beginning of the continuing care appointment or is it a ‘floss and brush’ commercial at the end as you are running out of time? It is very effective to hand the patient a mirror and let them see their own tissue response. If you depress tissue and the patient sees their tissue bleed or ooze, they have an indelible impression of why they need periodontal treatment on some level. These patients are more motivated to action. Most people are visual (85%) and this can be a powerful teaching moment that also builds value for the services that can sometimes seem like just a cleaning. Try to ensure that every patient understands why they are coming back for continuing care and is committed to his or her next hygiene visit.


Email. Try using a range of media, ideally based on the patient’s preference; this is particularly important for email. For patients that work in an office environment, email can be very effective, but some patients rarely check email. If you did use email for a patient’s continuing care reminder, make sure you check your system to see if the email was successfully delivered and read. If the patient has read the email but not confirmed, a phone call should be placed to personally confirm the continuing care appointment. If you are using Demand Force your patient can reply by clicking ‘Confirm’ and this will integrate with your appointment book and change the status of the appointment to ‘Confirmed’.

SMS (text messages delivered to mobile phones and tablets) delivers the highest continuing care success rates, and you will receive replies within minutes. It is also less expensive than letters or phone calls. The reason for this success is that most people carry a phone on them, and your number is placed directly on their handset; they just need to press dial to speak to you or press ‘C’ to confirm. If you are using Demand Force this will integrate with the appointment book and change the status of the continuing care appointment to ‘Confirmed’. It is vital when using SMS that you can easily see who did not get the SMS so you can use another media to contact them. SMS continuing care confirmations are ideal to fill your appointment book at short notice.

Example of SMS Message:

“Audrey, your next appointment with Scott Ellard Dentistry is Wed, Jun 12 at 10:00 AM. Reply with ‘C’ to confirm your appointment.”

Post Cards should be sent to those who opt out of email and SMS options. The semantics of the message are very important and should reflect the ‘tone’ of the practice expressing the importance of your standard of care for your patients. Demand Force can integrate with your patient base and assess those that need post cards. You can customize the cards with your office logo and information as well as the message to your patient. Demand Force sends these post cards. This too is done for the practice at a cost less than that incurred when done by a team member.

It is important to note that any system or program is only as good as the person or persons responsible for its success. Also, for a repetitive system (like continuing care) to be effective, it must be monitored constantly. Along with constant monitoring is the need for consistency.

The Business of Semantics

Continuing Care – Recall, what’s the word? The primary reason continuing care programs are not as effective as they should be is because of the lack of perceived importance and value on the part of the patient. To be able to attach the necessary importance to your system, my first recommendation is to avoid, at all costs, the word “recall.” Too many people believe that a “recall” appointment is not very important — “It’s only a cleaning.” Recall is a word that adults have used and heard throughout their lives and it is, too often, unimportant in many people’s minds. Or, it is negative. Cars and baby beds get recalled. The word suggests ‘faulty goods’.

The word ‘cleaning’ is another term that definitely does not communicate importance or establish value. How important is a ‘cleaning’? Therefore, like ‘recall’ the word ‘cleaning’ should be eliminated from everyone’s vocabulary. There is no CDA/ADA code for this procedure. If the patient has had scaling and root planning, use the term periodontal maintenance with the proper code. Periodontal Maintenance, continuing care, prophylaxis and oral health exam will create more value in the patient’s mind.

Conditioning Your Patient

I have found that pre-booking or pre-scheduling continuing care patients is the most successful protocol for patient compliance and retention. There is not a dental retention study or statistic that does not support this protocol. This protocol also establishes your practice as efficient with a high ‘standard of care’ for your patients. Although there can be some drawbacks to pre-scheduling, the advantages far outweigh the disadvantages. Once you have a patient in the schedule, as opposed to “the ” the chances are exponentially greater that they will not disappear from your practice. It is much more productive to keep them in your schedule and re-appoint them, if necessary, rather than send them a reminder card, hoping that they take the time or remember to call your office to schedule an appointment. If the patient does not call your office, the staff is calling the patient to try and get them scheduled. Generally, this is discouraging and fairly unproductive for the chosen team member.

“John, do you prefer this 8am appointment time?

“Yes, then I don’t have to leave work in the middle of the day”

“Let’s get your next visit scheduled now, then. This way I can guarantee the time you prefer. If we wait we will have a hard time finding one at the right time.”

“I don’t know my schedule that far in advance.”

“No problem, John. We’ll pick the day that you prefer that is six months from now. You will get an email 4 weeks prior as an advance reminder. At that time, it is very important that you check your schedule to see if this time works and call us right away if it doesn’t. We will then adjust the time to fit your schedule.”

If you allow the patient to leave without an appointment and do not express to them that it may be difficult to schedule the desired appointment time at a later date, you are suggesting that the practice is not that busy and you can just call and schedule whenever. Again, it is easier to move the appointment around four weeks prior than it is to find time to call all the patients due next month or past due from this month.

This consideration requires a strong policy on appointment commitments from the time a new patient calls your office. If it has not been the protocol in the past for existing patients, then a newsletter should be emailed to them letting them know about your new protocol. This newsletter would simply announce the intention of scheduling changes and why it is best for the patient. It might include tips for making the process more successful, like

• Please check your family schedule prior to your appointment.

• Consider bringing your class schedule with you.

• Please bring your schedule and we can work together to find a good time.

Know the holiday and vacation schedules for your local schools and colleges. You can send email campaigns to the patients that will be home on break from various schools. You can send advance notices to parents of school age children that need to be seen. All of these tips can help condition the existing patient and win them over.

After booking a new patient it is important to let them know you are looking forward to meeting them and end with a statement like:

“Joan, we view our appointments with our patients as a commitment of trust. We will be here to take care of your concerns and ask that you give us at least 48 hours notice if you will be unable to attend our time together.”

You are probably thinking, “this is going to be really hard for our existing patients because they are used to things being a certain way.” Maybe for some this is true. This is all about efficiency and your standard of care. If you understand that this is what is best for the patient and the risks associated with not getting them back at the prescribed time, it is much easier to be confident when delivering the message. This confidence translates to your patient who appreciates your efficiency and dedication to delivering top shelf service. It is also about keeping costs down, which is a benefit to the practice as well as the patient. You will not get 100% compliance, as some patients just won’t want to pre-schedule. This is to be expected but should not prevent the practice from moving forward or doing what is proven to be the best practices for efficiency in continuing care systems.

Having a system like Demand Force to automate your messages is more than worth the monthly investment. There are no missed patients in this system. The messages go out on a systematic schedule that you dictate. They are customized to reflect the ‘voice’ of the practice. The patient chooses their communication style and this further enhances appointment retention.

There are choices in your communication partner. I have a preference for Demand Force and that is what we use in our dental practice. While they all deliver a functional service, I have this preference for Demand Force and first hand knowledge of the reliability. Demand Force integrates with many practice management software platforms. To see if they integrate with yours go to 



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