When other dentists find out that I do dental house calls, there are always a lot of questions. One of the first questions, especially from dentists, is "Exactly which procedures can you offer at someone’s home?"
There’s a ton that you can offer at home! I’ll share my most detailed answer to this question during this podcast.
Three of my beliefs about dental home care that will inform my answer to this question.
Dental home care is not for everyone.
Dental home care is amazing and can help so many people who truly need it. I also believe that MOST patients should be treated in a traditional clinical office setting because that’s where they’ll find panoramic radiographs, cerec machines for crowns, and other equipment that you just can’t bring into a dental office.
Just because you can offer a procedure at home, doesn’t mean that you should.
I don’t offer root canals at home because I can just imagine the sodium hypochlorite and all the tiny files flying all over someone’s favorite blanket or couch after Fluffy the cat jumps near your setup. As always, the services you decide to offer at home or anywhere, are up to you and your judgment.
AccommoDental is evolving
I am happy to discuss the services that AccommoDental currently offers. That being said, I also have to admit that my answers have changed and may change over time as I learn. AccommoDental will never have it figured out. It will never “arrive,” it will constantly be evolving and changing, as will your dental home care practice. So with that in mind, let’s begin.
Dental home care services can include…
Check-up
Let’s talk about preventive services. Many patients call for a house call without any chief complaint. They just haven’t been able to get to the dentist. They just want someone to come over for a “check-up.” They’re calling and looking for preventive or maintenance services. So we, of course, offer those services - exam, prophys, scaling, radiographs, fluoride treatment, the works. Now, remember, you can’t offer a PAN at home. Make sure these patients understand the limitations of at-home dental treatment and still agree that it’s best for them.
Palliative services
Patients or their loved ones may be calling you from hospice. They know their loved one has many dental issues, but they’re primarily concerned with keeping their loved ones comfortable. The palliative care offerings include, of course, the limited exam. You need to be able to diagnose some pathology and make sure you send in the appropriate script for amoxicillin or nystatin, BMX - whatever this patient needs to be comfortable. Palliative services often include enameloplasty - smoothing broken teeth that are traumatizing soft tissue. This could also include a periodontal splint for someone who cannot have an extraction but also deals with the constant annoyance of a B mobile tooth with traumatic occlusion. Keeping patients comfortable is the priority.
Removable services
This includes fabrication, repairs, relines, and adjustments. This is all pretty simple and easy to do at home. Actually, a lot of dentists in town who do not typically offer house calls have been known to stop by a long-time patient’s house for a denture delivery or impression because it’s just super simple to do while the patient is comfortably at home.
Minor oral surgery
This includes simple extractions or I&Ds. Now, I love extractions. Extractions are my favorite procedure to do chairside. In another universe, I’m an oral surgeon. When the procedure goes well, it’s super rewarding. But I’ve done enough extractions to know that they don’t always go your way, even ones that appear to be simple. I’m really picky about which teeth I decide to extract at home, especially considering how medically complex my patients are. Usually, the ones I’ll do are periodontally involved or root tips that are easily elevated. I recommend using your best judgment here. Remember, even as a house-call dentist, you can refer to an oral surgeon.
Operative services
In my case, I offer resin restorations. I will say a lot of patients decline restorations because they aren’t feeling up to it or they aren’t able to cooperate, so SDF is a very popular alternative. I want you to know that I’ve heard of house-call dentists running successful practices without offering any treatments with a high-speed handpiece. So yes, they don’t offer traditional restorations and they do just fine. Now, I’ve also spoken to mobile dentists that offer crowns in the home. Remember when I said to use your judgment? This is what I’m talking about. Today, I don’t offer crowns because my patient population doesn’t demand that treatment option due to their health or cooperation status. Also, my positioning with patients would make prepping certain crowns pretty difficult and I don’t want to offer any services at home that I’m not confident about. However, I’m not saying I’d never offer them if I were able to learn more or circumstances changed.
Adjunctive services
I offer minor orthodontic services at home, like Invisalign. We offer other adjunctive services like the fabrication of occlusal guards, athletic guards, and bleaching.
If you want to know how long certain procedures take, check out my free scheduling template called “A Day In the Life of a House Call Dentist."
In conclusion
Deciding what procedures to offer at home depends on your goals. Which patients at home are you trying to serve? What are they demanding? What is logistically possible? What isn’t?
Notice that you didn’t hear me list implants, endo, perio surgery, or anything like that. That’s because that generally isn’t what the patient population that I’m looking to serve is demanding. That’s also because it is logistically difficult and would honestly, be INCREDIBLY expensive and risky.
Notice that all of the procedures I commonly perform during house calls aren’t incredibly difficult. A new graduate absolutely has the skill level required to open their own dental house call practice. You can offer a lot of value at any stage in your career. Just saying!
I hope my answer to this question was helpful to you as you begin to build your dental home care practice.
Whether you choose to pursue dental home care or not, you can support those in need of it by contributing to the Home Smile Care Foundation. The Home Smile Care Foundation is a non-profit organization founded by myself and my loved ones in order to offer financial assistance to patients who cannot afford dental home care. Visit homesmilecarefoundation.org.
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