Ep. 814 - The Right Perio Mix for the GP

Are you confident that your hygiene department is truly diagnosing and treating periodontal disease at the level your patients deserve — or are you leaving significant clinical and financial opportunity untreated?

Dr. Marc Goldman is a board-certified periodontist with over 40 years of clinical experience, founder of a premier periodontal practice in Millburn, New Jersey, and an educator at a general practice residency program at Beth Israel Hospital in Newark. With decades of mentoring general dentists and residents on the realities of periodontal and implant therapy, Dr. Goldman brings both the clinical depth and the practice management perspective that few specialists can offer.

This episode examines one of the most underappreciated revenue and risk management opportunities in general dentistry: periodontal therapy. Dr. Goldman and Dr. Phil Klein break down which periodontal services GPs should confidently keep in-house, which cases warrant referral, and how the GP-periodontist relationship should function as a collaborative business partnership rather than a competitive one. The conversation covers crown lengthening, implant treatment planning, hygiene department efficiency, and the real-world consequences of underdiagnosing periodontal disease — including malpractice exposure.

Episode Highlights:

• Scaling and root planing is consistently underutilized in general practices where hygienists perform prophylaxis on patients who clinically require debridement at a therapeutic level. Using local anesthesia to anesthetize one or two quadrants at a time dramatically improves patient comfort, clinician efficiency, and case throughput, with per-quadrant fees substantially exceeding standard prophylaxis reimbursement.
• The full-mouth debridement code is frequently misused as a preliminary step before diagnosis, but this approach wastes a clinical visit, reduces reimbursement, and displaces the opportunity to initiate scaling and root planing immediately. If periodontal disease is present and the patient requires root planing and scaling, initiating treatment by quadrant during that same appointment is both more efficient and more appropriate.
• Crown lengthening is a significantly underutilized procedure in general practice, partly due to misconceptions about post-operative healing timelines. In many cases, adequate gingival healing occurs within two to three weeks, allowing the referring dentist to take a final impression or adjust a provisional restoration shortly thereafter — making the workflow disruption far less significant than commonly perceived.
• Implant treatment planning requires a systematic, multi-specialty approach before any surgical intervention is initiated. Key pre-implant considerations include periodontal health, attached tissue adequacy, bone volume and proximity to anatomical structures such as the sinus, adjacent tooth vitality, and whether orthodontic tooth movement is indicated to optimize implant site dimensions.
• Underdiagnosing or under-presenting periodontal disease carries both malpractice risk and significant consequences for long-term patient retention. Patients who later discover untreated moderate or advanced periodontal disease through a second provider consistently lose trust in their original dentist, resulting in permanent loss of that patient relationship and potential legal exposure.

Perfect for: general dentists at any career stage who want to optimize their periodontal and hygiene department profitability, dental residents building foundational practice management skills, and any clinician looking to develop stronger specialist referral relationships and reduce medico-legal risk.

If you want a clearer picture of where your practice stands on periodontal diagnosis, treatment, and referral strategy, this conversation will give you the framework to act on it.