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8 Dental Tribune Middle East & Africa Edition | May - June 2014mcme > Page 9 The power of cross coding: How hygienists can support their patients’ overall body health By Marianne Harper H ave you lost the ex- citement? Are you content with what you might now perceive as the same-old, same-old every day? Day af- ter day you may be perform- ing hygiene procedures over and over again, all the while knowing you are helping your patients but perhaps you sim- ply don’t feel as though you are truly making a significant dif- ference in their overall health. If you feel that level of frustra- tion, or even if you don’t, but you are interested in advanc- ing your career, then read on to discover some ways in which you can make a significant dif- ference in the health of your patients. As you are aware, dentistry is becoming recognized as a medical discipline. We in the dental field are in a unique position to support our pa- tients’ overall body health. Our patients who maintain their regular recare schedules are quite probably seen by us more frequently than they are seen by their primary care provid- ers. “Around 39 percent of adults see their physicians in a year while 64 percent see their dentists, which means we see 25 percent more patients than they do.”1 Hygienists can be key players in this opportunity. By thoroughly questioning their new patients and by providing and reviewing medical history forms that are updated with the most current medical questions, hygienists can begin an evaluation of their patients’ medical state. In ad- dition, our established patients may have had a change in their medical history since their last appointment, so a recare update form is an efficient way to in- quire about their health. If your practice is not familiar with re- care update forms, please check my website to obtain a copy. Again, thorough questioning of all new and established patients is an essential component to getting the full picture of your patients’ health. What is discovered from these questions can be a strong de- termining factor in how each patient is handled. Patient ques- tioning should always be fol- lowed by dental exams, X-rays, blood pressure checks and clini- cal observations. For those pa- tients who may have a systemic disorder, your practice should become proactive by referring the patient back to his or her primary care provider. However, because dentistry has evolved over the last decade, there are more ways that the dental practice can help make these determinations. With the frequency of patients’ visits and the availability of numerous cutting edge diagnostic tools, we have the unique opportunity to administer different types of disease testing that, in the past, were performed only by medi- cal practices. If you are unfamiliar with the types of medical testing that are available for dental practices to perform, then the following in- formation can make a big differ- ence in the quality of your prac- tice’s treatment, and it may help to make a significant change in how you perceive your career. First of all, periodontal diseases and caries are bacterial infec- tions, but the majority of dental practices diagnose these condi- tions through the use of peri- odontal probes and explorers. Have you considered that medi- cal practices would never begin treatment without determining if they are treating bacteria or a virus? In dentistry, we need to differentiate between aspirin sensitivity, blood dyscrasias, other diseases, fungus, yeast or a cyst; so bacteriologic tests should be performed.2 Micro- scopic tests, DNA tests, or bac- teriologic tests should be per- formed if periodontal infections are apparent. Tests that can be performed in a dental practice: • HgA1c for blood sugar • C-reactive protein (CRP) for inflammation • BANA for bacterial patho- gens or their byproducts • DNA for the presence of specific pathogens or for patient susceptibility to per- iodontal disease • TOPAS for inflammatory markers • Oral HPV testing • Diabetes testing with a glu- cometer — finger stick or blood sample taken from a periodontal pocket • Oral cancer screening (e.g. ViziLite) • HIV testing • Screening for cardiovascu- lar disease (e.g. HeartScore System) • Saliva biomarker test — measures three specific bi- omarkers that play a role in cancer development in the oral cavity As you can see, these tests cover many possible systemic condi- tions. Your practice will have to determine which staff members are allowed to administer these tests, because your state makes regulations controlling this. Hy- gienists may be allowed and, if so, this may make a difference in your career. Even if hygien- ists are not allowed per your state’s regulations regulations, your encouragement in the practice to add these tests to the practice’s procedure mix will be invaluable to the practice. In addition, hygienists need to realize the importance of their observations and questioning of the patients in helping to move these patients to better overall health. This puts a new slant on the same-old, same-old. Power of cross coding There is, however, another area in which hygienists can make a significant difference in their practices. Dental-medical crossFig. 1 Photocopy of example CMS-1500 health insurance claim for treatment of sleep apnea, considered a medically necessary dental procedure that qualifies for coverage through health insurance. Many other dental procedures and tests also might qualify. But you need to know the diagnosis and procedure codes — and other nuances of the process. mCME articles in Dental Tribune have been approved by: HAAD as having educational content for 2 CME Credit Hours DHA awarded this program for 2 CPD Credit Points Centre for Advanced Professional Practices (CAPP) is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. CAPP designates this activity for 2 CE credits.