Current Clinical and Practice Management Issues in Periodontics

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. Today we'll be discussing an innovative system that allows GPs to perform pocket reduction and periodontal maintenance easily and cost-effectively, and while doing so, achieving excellent clinical results. By keeping these procedures in-house, the GP saves the patient thousands of dollars and keeps the revenue in their office. Our guests are Dr. Bennett Jacoby and Dr. Garrett Oka. Dr. Jacoby is a clinical periodontist and the inventor and president of Bentips. Dr. Oka is a general dentist working in a practice with two full-time hygienists. Before we get started, I would like to mention that Dr. Jacoby's webinar titled Advanced Perio Treatment Made Easy and Profitable for the Hygienist and GP is now available as an on-demand webinar on VivaLearning.com. Simply type in the search field, Jacoby, J-A-C-O-B-Y, and you'll see the webinar. It's an excellent webinar for every dental team member to watch. And it's especially interesting for those that are referring out a lot to the periodontist or those that don't have a periodontist around that need to be able to streamline their perio procedures in-house in a very cost-effective and easy way. And depending on the state, even their hygienists could use this device to do these procedures. Dr. Jacoby and Dr. Oka, it's a pleasure to have you both on Dental Talk. Hi, Phil. It's a pleasure to be here. Hi, Phil. Thanks for having me. Before we get into this podcast, I would like to say that, as obvious as it sounds, that all GPs are not alike, especially when it comes to their comfort level with performing various periodontal procedures in their office. However, having said that, it will still be interesting to hear the opinion of both of you, Dr. Jacoby being a periodontist and Dr. Oka being a GP, regarding the process of referring a general practice patient to the perio specialist. And we're going to be talking about that today. So to begin, let's start with Dr. Jacoby. From the perspective of a periodontist, what are your thoughts about the GP referring his or her patients to a periodontist? Well, other than the fact that I really appreciate it, what I see a lot of is very severe disease. And over the years in visiting with my colleagues that are restorative dentists that refer to us, It seems like sometimes they get referred a little bit later than we'd like. And it's even told to me by the general dentists. So you're saying that they should have been sent earlier? That would be preferable, yes. So the disease process has progressed to a point where it's more difficult for you as a specialist to treat it. So you're saying they should look out for this and get it out to your office as soon as possible. Absolutely. And I think part of the problem is with the participation with insurance companies that it seems like we're kind of forced into these days, that then we get financial pressures from the insurance companies as far as profis go and the ability to do full mouth probing. So it feels like my colleagues are getting asked to do full mouth charting for free. which then makes it more difficult and it may not get done because of the financial constraints. Just my guess. Is the GP, and I'll ask Dr. Oka this separately, but while I still have you answering the questions, what is your thoughts about what the general dentist is doing in their practice to help with period disease? How far should they go and how do they know when to say it's time to go to a specialist? That's a good question. I think, again, Dr. Oka could probably address that better. But from my perspective, being outside my idea that I'm trying to introduce to the... the docs that refer to me, is to actually bill out for something like 0120 periodic exam, which would then allow them to get reimbursed for that extra time that would be needed for the charting. And then they could start doing things like scaling and replaning, reevaluating. And if there's still disease after that sort of treatment, then it would be appropriate for a referral unless they want to do advanced treatment. So let me ask this question to Dr. Oka. What is the GP perspective on the clinical limitations of perio treatment provided in the general practice? In other words, how far should the GP go with in-office perio treatment before it's time to say we need to send it out? My personal opinion on that one is your comfort level, like you kind of brought up earlier. I mean, if you've got procedures that you've been trained in school, that you've done in private practice, that you feel highly comfortable with. I see no problem with doing it. Like for me and working with Dr. Jacoby, he's introduced us to the procedure called BenTips, which has opened up our practice immensely for period treatment on the general side versus having to send over every single case to the periodontist itself. Yeah, so Dr. Jacoby gave a fantastic webinar that covered this device called BenTips. So you being the GP, and I think that's primarily... this device has been designed for, right, for the GP to do some of these things in-house. Correct me if I'm wrong. Do you want to comment on BendTips and how that's affected your practice, Dr. Oka? BendTips has definitely changed my hygiene department itself. Hygiene being normal cleanings that we do, but stepping up to the next level with periodontal work like you're talking about, BendTips has made it possible for us to be able to treat. gum disease or periodontal disease way more effectively. Basically, we watched patients for years doing root planing and scalene therapies for periodontal patients that come in one day, seem a little better, come back the next day, seem a little worse, come back again, seem a little better, and just teeter-totters back and forth year after year after year. It never really truly resolves itself. With the bentip procedure from Dr. Jacoby, basically, we're able to definitively treat the condition now and bring them back to a baseline where their pockets are within normal and the patient is able to actually take care of themselves now. Dr. Jacoby, from a financial and practice management perspective as a periodontist, what are your thoughts regarding periodontal treatment provided in the perio office versus a general practice? And also, I want you to talk about bentips, how that's changed the game plan a little bit for the GP. Sure. So in my office, it doesn't really affect the fees. But in, again, speaking with my colleagues and also Dr. Oka, I think when the restorative dentist, the general office, can render these more advanced procedures, they're going to end up saving a lot of money for the patients. So I think that it really expands their abilities. But, you know, coming to my office, it's expensive to see the specialists. There's no doubt about that. speaking to my colleagues, is that there's a lot of resistance from patients in going to see the specialist. And this is just one of many reasons. So I think it really is an access to care issue. I think that's what Ben Tips does, is it provides much more definitive treatment. This particular device that you developed, and I know you did a webinar on it, and it was very well attended, and the feedback was fantastic, actually. This is an opportunity for the general dentist to do procedures with a minimal learning curve, right? and create a periodontal environment where you don't have that teeter-totter effect that Dr. Oka just spoke about. You're actually doing something definitive and achieving an environment where the patient can maintain their periodontal health going forward. I want you to elaborate on that. So what exactly is the GP doing with this device, and what is the device? So the BenTip system allows the clinician to do not only better access for scaling and root planning, there's kind of two aspects. One is where the tip goes into the pocket, and you get better visualization. And my impression is that in states that allow hygienists to do curatage, that they can go in, get this access, because you get minimal bleeding. And I think Dr. Oka can attest to that. And then you can see the root surface much better and get much more complete calculus removal. But then Dr. Oka can come in and reduce the height of the pocket. So he's actually doing pocket reduction procedures, which then allow the patient to keep the keep it clean. And the literature is very supportive of that. When the patient can keep the area clean, then we get disease resolution, basically periodontitis in remission, as I like to call it. And so the thing that I see is like Dr. Oka was alluding to, is that the patient's going back and forth. What that amounts to is patients walking around with an active infection decade after decade. And I think the literature is very complete on that, that it shows that this significantly increases the risk for heart disease, stroke, and cancer. We can't have our patients walking around with infection. And this seems to really eliminate that. Dr. Oka, from a financial and practice management perspective as a GP, what are your thoughts regarding the periodontal treatment provided in the perio office versus the general practice environment? My perspective is that on the financial portion, it definitely helps the office out because hygiene is always a harder situation in the office because of reimbursements and amounts that hygienists get paid. I'm not grumbling about what they get paid. They definitely do a great job for what they do, but the reimbursement side is very hard. And then when you're seeing a patient year after year after year, you know how you always show up to the dentist's office and they always tell you you got pockets and you're doing a bad job. They always love hearing that year after year after year versus when we do the bend-hip procedure now. Yeah, it costs a little bit more, but basically once it's done, they do their regular home care. They don't ever hear it anymore because the pockets are gone. It makes it easier for them. But these patients could be referred to a periodontist. If you're seeing that continuous treatment loop where you're not getting... the results that you're looking for and the patient's frustrated, you know, you hate to tell them that they're not doing a good job at home, that's not a positive feedback they want to hear. In that case, you could refer to a periodontist. Is it the financial considerations where they don't have the financial capability of going to a periodontist, where having it done in your practice would help them out as far as cost? Also, it's good for your practice because it keeps your business in-house. Yes, definitely. Financially, it helps us. But on the patient perspective, just like what Dr. Jacoby was saying earlier, they definitely do not like seeing the specialist at all. If I can do more work in my office, they're more than happy to do the work. It's one of those when they hear a specialist, they get scared. And they're like, no, no, I don't want to do it. But doc, if you can do it, I'll do the work here. What were you doing before the BenTips came into your world? So normal general dentistry hygiene is what it was where you do cleanings every six months. If you're doing bad and you got some pockets and periodontitis and all of the like, basically you get root planing and scaling therapy where we'd go down in the pocket to the best of our ability. You know what I mean? You only can feel so much. You only can see so much. Whereas with the bent tip procedure, like Dr. Jacoby said, we're able to reduce the pockets. bring it back down to a healthy level and a cleansable level at the home level itself. So then the patient's able to take care of all of this stuff. Dr. Jacoby, what's the learning curve on this BenTip system? Is it something a GP could pick up rather quickly? And if the state allows, the dental hygienist can start using it fairly quickly? Yeah, that's been our experience, especially, I think, at Dr. Oka's office was a very good test case because he has two hygienists and then Dr. Oka, and then I trained them all up. And it went very quickly. I'll let him speak to that. But from my perspective, they did very well. We're across the parking lot from each other. So if an issue came up, they would just say, hey, Ben, come over and have a look. And I did. And they were doing a fantastic job and doing it very quickly. system, these tips, could you explain how they get energized and how to use them in the practice? Sure. So the system, it's actually a piezo surgery system. It's the same kind of thing they're doing sinus lifts with in perio offices and oral and maxillofacial surgery practices. They even use them in neurosurgery as well. But anyone doing sinus lifts or ridge splits or something most likely has something like this. And so what we do is we mount these peak plastic tips on the end, and then they ablate gingiva. And you can cut with it. It works like a harmonic scalpel like they use in general surgery. So you get sealing of blood vessels. And that's the biggest part that we don't really talk about is there's just really minimal bleeding, oftentimes none. And that allows you to be able to see all the calculus. get everything off. Now, could you remove too much attached gingiva? Because once it's removed, it's always hard to put it back. It's a really good question. So we addressed that in the webinars, but basically what the research has shown by the Scandinavians, I like to call them the rock stars of peria research, they show that that's not really an issue. First of all, if you cut it away, it grows back. And even if it wouldn't grow back, there's no increased risk of disease if you have mucosa laying up against the tooth with no attached gingiva. Right, but there would be an aesthetic issue. Oh, aesthetically, yeah, but then we run into that with perio anyway. I mean, this is the big conundrum in the maxillary anterior region with perio. Do you do pocket reduction surgery or do you just leave the pockets and go in there periodically with scaling and root planing and anesthesia? It's rough because there's no way to seal up a 9mm pocket predictably. Yeah, without a doubt. So, no, this has been very interesting. If our listeners want to get more information about Bend Tips, where's the best place to go? They can come to our website, www .bendtipsusa.com, and there's a contact button. And that actually sends an email directly to me. And then we can set something up, happy to do a demo. We've got some videos that can be seen and that sort of thing. okay very good no this is really excellent and it's great to hear that a periodontist invented this device obviously you found a need and went ahead and i know how tough it is to do that i actually have a couple of patents myself and it's a very tough journey to get something patented and then get something in production prototypes made and find reliable manufacturers it's incredible amount of work and dedication and very expensive so Hats off to you, Dr. Jacoby, for pursuing your dream and doing the things you're doing to help us with the GPs manage periodontal disease in a cost-effective way for the patient and also financial benefit for the GP. And I guess from Dr. Oka's perspective, it's career satisfaction, right? Because now you've got these patients that you're treating. I mean, let's close on that. How has that affected you as far as your career satisfaction, Dr. Oka, to have the ability to do this in your office? My satisfaction definitely is very high with the procedure. Being able to actually definitively help these patients where you see them over and over, like I said before, but able to actually get them to the point where they're back to health and they're able to actually keep things clean on their own. I mean, satisfaction is not even the word you'd use for it. I just want to add one thing is it's this is I invented the bend tips definitely to provide access to care but I do want to clarify that I end up using this on 98% of the procedures that I do so it's not like I'm doing this from a distance I think the results that I get with this are better than interventional periodontal therapy. So I'm using it day in and day out. Great to hear the feedback. Again, thank you both, Dr. Jacoby and Dr. Oka. Appreciate very much and enjoy the rest of your day. Thank you, Phil. Appreciate it. Thank you, Phil.