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Topics include oral hygiene and insurance.

1. What are your typical oral hygiene instructions for patients with fixed appliances ?

All offices reported that their patients were given oral hygiene instruction. In some cases this started at the consultation appointment, with the orthodontist showing some examples of the effects of good and poor hygiene. The patient and parent might be shown a videotape as well.

Most offices began their instruction at the first banding appointment. Several different toothbrushing techniques were recommended, including modified Bass, scrub, and sulcular. Almost all practices asked their patients to brush after each meal, and many recommended brushing again at bedtime. Most respondents stressed good eating habits, often giving their patients lists of foods to avoid.

In many cases, patients were provided with two toothbrushes--a soft orthodontic brush for home use and either a small travel toothbrush or an interproximal/prophy brush for school use. About half the offices gave patients "toothbrush kits", and most gave some sort of written material to supplement the verbal instructions. Visual aids such as videotapes and slides were used occasionally.

Virtually every office instructed patients in the use of floss, and most provided floss threaders. A large majority recommended the use of a fluoride rinse or gel at night. Disclosing tablets were occasionally provided, particularly to problem patients. An oral irrigator was prescribed by most respondents to dislodge food from between brackets, but an electric toothbrush was rarely mentioned.

Oral hygiene instruction was generally limited to the first banding appointment. Although many practices reported progress checks, grading, and reinforcing instruction, few appeared to have a regular follow-up schedule.

Comments included:

  • "We instruct on proper brushing techniques, showing them exactly what we mean with the use of models."
  • "We review the signs of periodontal disease (swollen and red gums) and decalcification (plaque plus acid and enamel equals decay), and the bacterial concept of plaque (bacteria and food debris)."
  • "Gingival areas are to be brushed first, followed by interproximal areas, then the occlusal surfaces."
  • "Patients showing graphic areas of previous caries involvement, gingival hypertrophy, or poor hygiene must see their dentist every three months."
  • 2. How do you manage insurance forms? What types of forms do you use? Who fills them out and when?

    The readers generally reported similar methods of handling insurance forms. With an "initial" form, the patient was requested to fill in his or her part first and then the diagnostic and see information was added after the consultation. Most offices used the forms provided by patients--frequently adding the standard AAO endorsement form for the diagnostic and fee information. Most discouraged separate forms for the initial visit and the records appointment. Several offices preferred to use "superbill" or "easy-claim" forms; this seemed to depend on insurance plans and regulations in their states.

    For "continuation" forms, many offices used a filing or index-card system in which the forms were sorted, based on the billing cycles of the insurance companies. These files were then checked either weekly or monthly by a staff member. Several offices used rubber stamps to speed the completion of these forms. Most refused to accept assignment of benefits.

    Specific procedures included:

  • "I either complete the patient's claim forms, or AAO endorsements are attached to these forms and completed by me in ink at the initial examination. Both forms are then signed by me and given to the patient or parent. If they agree to this procedure, I have effectively countered later patient shopping or indecision in most instances."
  • "We are on a computer system for our insurance forms. Every time a charge is made to the patient's account (and there is insurance coverage) an insurance form is submitted."
  • "We have two rubber stamps that can be utilized with almost any standard size insurance form. One contains the doctors name, address, phone number, ID number and license number. The second elaborates on the case presentation and diagnosis, with blank spaces for the class of malocclusion, overbite and overjet, total fee, etc."
  • "For time management purposes we have compiled an insurance notebook stating the procedures of the companies our patients utilize."
  • "An index card is filled out for each patient with the patient's name, address, fee, insurance carrier, terms of fee agreement, beginning treatment date, and the dates and amount of billing. It is then filed alphabetically in the appropriate billing status that each insurance company requires, whether it be monthly, quarterly, etc. At the end of the billing time, the card is pulled for that month and the billing is done as requested. This enables us to keep an active eye on the amounts being paid to the patients or to our office."
  • An Insurance"Superbill"

    One office (Drs. Douglas J. Shilliday and Victor J. Cook, Jr.) sent an example of an insurance "superbill" with the following description: Our secretary of 17 years, Ms. Sarah Dunfee, felt she was spending too much time retyping the same names, address, and numbers on insurance claim forms. After considerable research, she developed this "superbill".

    The form contains all the information required from the orthodontist and is printed on triplicate NCR paper. After the appropriate procedures are checked on the form, one copy is given to the patient to attach to the primary carrier's claim form; a second copy is available if there is a secondary carrier; and the third copy goes in our office files.

    So far all insurance companies have accepted our form.


    JCO wishes to thank the following contributors to this month's column:

    Dr. Robert E. Bertoldi, Redding, CA

    Dr. Lucien Bosse, Dorval, Quebec

    Dr. Jeffrey S. Cooper, Ramsey, NJ

    Dr. Michael J. Cripton, Moncton, New Brunswick

    Dr. Eugene Eagles, Bedford, MA

    Dr. Burdett R. Edgren, Greeley, CO

    Dr. Steven I. Fein, Kingston, NY

    Dr. Stanley P. Kessel, Hollywood, FL

    Dr. Jerry D. Mills, Bedford, TX

    Dr. S. Edwin Noffel, Cape Girardeau, MO

    Dr. Larry Okmin, San Diego, CA

    Drs. Jon Ousley and Gayle Glenn, Dallas, TX

    Dr. Charles E. Parsons, Richmond, KY

    Dr. Peter C. Tomasi, Wausau, WI

    Drs. Laurence, David, and Douglas Wright, Amherst, NY


    Associate Professor, Department of Orthodontics, Baylor College of Dentistry, 3302 Gaston Ave., Dallas, TX 75246.







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