How to Handle a Patient Who Insists on a Regular Prophy Despite a Periodontal Disease Diagnosis

One of the most challenging situations in a dental practice is handling patients who insist on receiving a regular prophylaxis (prophy) when they have been diagnosed with periodontal disease. These patients may resist the recommended treatment, often due to a lack of understanding, financial concerns, or fear of the more extensive procedures required to manage periodontal disease. As a dental professional, it’s crucial to approach these situations with patience, education, and firm but compassionate communication.

Understand the Patient’s Perspective

Before addressing the issue, take a moment to understand why the patient is resisting periodontal treatment. Some common reasons include:

• Lack of awareness – They may not understand the severity of their condition.
• Cost concerns – Scaling and root planing (SRP) or other periodontal treatments are often more expensive than a regular prophy.
• Fear or anxiety – They may be afraid of the procedure or potential discomfort.
• Insurance limitations – They may want a prophy because their insurance covers it but does not fully cover periodontal treatment.

By understanding their reasoning, you can tailor your response to address their specific concerns.

Educate the Patient on the Difference Between a Prophy and Periodontal Therapy

Patients often believe that a “cleaning is a cleaning,” but in reality, a prophy is intended for patients with healthy gums, while periodontal therapy is necessary for those with gum disease.

Explain the difference clearly:

• A prophy is a preventive measure for patients without active periodontal disease, focusing on removing plaque and tartar above the gumline.
• Scaling and root planing (SRP) is a therapeutic treatment designed to remove bacteria, calculus, and toxins from below the gumline to halt the progression of periodontal disease.

Use visual aids such as intraoral photos, periodontal charts, and educational pamphlets to illustrate why a regular prophy is not sufficient for treating their condition.

Explain the Consequences of Untreated Periodontal Disease

Many patients do not fully grasp the dangers of periodontal disease.

Educate them on the risks of avoiding proper treatment, including:

• Bone loss leading to loose or lost teeth.
• Chronic inflammation affecting overall health (i.e.., links to heart disease, diabetes, and stroke).
• Persistent bad breath, bleeding gums, and discomfort.
• Increased future treatment costs due to disease progression.

When patients understand that periodontal disease is a progressive condition that won’t improve with a regular prophy, they may be more open to recommended treatment.

Be Firm but Compassionate

While it’s important to be empathetic, you must also be firm in your professional recommendations. A simple but effective response could be:

“I understand that you would prefer a regular cleaning, but based on your gum health, that would not be the appropriate treatment. Just like a doctor wouldn’t prescribe a mild painkiller for a serious infection, I cannot ethically perform a prophy when your gums need a more advanced treatment as this would be substandard care.  My goal is to help you maintain your teeth for life, and the best way to do that is by properly treating your gum disease.”

By positioning your recommendation as a matter of ethical and professional responsibility, patients may take your advice more seriously.

Address Financial Concerns and Offer Solutions

If cost is a concern, discuss available options:

• Payment plans – Some offices offer financing options to make treatment more affordable.
• Insurance benefits – Help them understand what their insurance covers and if there are alternative ways to maximize benefits.
• Phased treatment – If full SRP treatment is too expensive upfront, consider breaking it into quadrants over time.

When patients see that you are willing to work with them financially, they may be more likely to accept treatment.

Use a Team Approach

If a patient remains resistant, involve the entire dental team in the conversation. The dentist, hygienist, assistant and administrative staff should all reinforce the importance of periodontal treatment. Sometimes, hearing the same message from multiple professionals strengthens the patient’s trust and willingness to comply.

Document the Conversation

If the patient continues to refuse periodontal treatment, document the discussion in their chart, noting:

• The periodontal diagnosis and why a prophy is not appropriate.
• The education provided and any resources given.
• The patient’s response and whether they refused treatment.
• Any follow-up recommendations or warnings about the risks of refusal.

This documentation protects the practice in case of future liability issues and ensures continuity of care.

Give Them Time to Process

Some patients may not immediately agree to periodontal therapy, and that’s okay. Instead of forcing them into a decision on the spot, give them time to think it over. Send them home with educational materials and offer a follow-up call to check in on their decision.

Set Clear Expectations

If a patient ultimately refuses periodontal treatment, it’s important to set boundaries. Some offices have policies that prohibit them from performing a regular prophy on a patient with active periodontal disease due to liability and ethical concerns. If this is the case in your practice, communicate it clearly:

“Because we are committed to providing the best possible care, we cannot perform a regular cleaning when active gum disease is present. We strongly encourage you to proceed with the recommended treatment, but if you choose not to, we may not be able to continue your care.”

This helps protect your professional integrity while encouraging the patient to make the right decision.

Handling a patient who insists on a regular prophy despite a periodontal disease diagnosis requires a combination of education, empathy, and firm communication. By helping patients understand the importance of appropriate treatment, addressing their concerns, and setting clear expectations, you can guide them toward making the best decision for their oral and overall health. While not every patient will accept treatment immediately, your dedication to ethical, patient-centered care will ultimately lead to better outcomes for both the patient and the practice.