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Your hygiene direction: Is it "just a cleaning"?

Oct. 1, 2008
Take a moment to sit back and examine the various services represented within your hygiene department.

by Anastasia L. Turchetta, RDH

For more on this topic, go to and search using the following key words: hygiene, cleaning, health, wellness, preventive visit, assessment, Anastasia Turchetta.

Take a moment to sit back and examine the various services represented within your hygiene department. Are you and your team on target to prepare for the future direction of your hygiene department?

If not, how can you implement a realistic action plan? Begin by recognizing whether you view hygiene appointments as "just a cleaning" or a "health and wellness" visit. This article will address the difference between both views. It also will help you understand the role of past perceptions and their effects today, productivity gains with more efficient time management, and the significance of universal verbal skill sets involving the entire team.

Most patients' perceptions of the meaning of their hygiene visits were formed by their experience with other practices prior to coming to your practice. Factors influencing the way a patient feels about your practice include the total time the hygienist spends providing treatment with ultrasonics or hand instrumentation, and the amount of time the doctor and hygienist spends in the treatment room.

They also are influenced by the hygienist's ability to explain the link between total health and oral health. Outdated equipment or technology can have a negative effect on a patient's perceptions and limit your ability to provide excellent preventive treatment.

Click here to enlarge image

An example of creating the wrong perception by using poor verbal skills when confirming or scheduling an appointment would be: "Mrs. Patient, we are calling to confirm your cleaning appointment with Lois tomorrow at 10 a.m." or "We'd like to schedule your cleaning in six months."

Although hygienists and dentists who term health and wellness visits a "cleaning" may be productive and deliver quality care, the word "cleaning" does not reflect a beneficial service provided by health-care professionals. You will be pleasantly surprised at what will happen when you begin to reference your hygiene department as one that provides preventive or health and wellness visits versus "cleanings."

Hygiene departments that use the term "health and wellness visits" exhibit a balance of screenings, assessments, preventive therapies, and verbal skills which promote education from a focused, cohesive team.

Screenings and assessments — including taking the patient's blood pressure; obtaining a complete health history; assessing diabetes and caries risk; checking for dry mouth or oral cancer; performing periodontal charting, noting bleeding points and recession; and documenting decalcification, bruxism, and malocclusion — connect patients' risk factors to their current state of oral health.

Each of these assessements encompasses varying degrees of recommended treatment that assist in finding a treatment solution for that particular patient.

Let's use a patient with diabetes as an example. The hygienist notices on the patient's health history that diabetes is circled. A conversation may begin by asking the following:

  1. Are you a Type 1 or 2 diabetic? Explain the difference if the patient is not sure.
  2. What was your last Hb1Ac score?
  3. What was your last blood sugar reading today?

After receiving the answers to these questions, you might say: "Mrs. Wilson, research has shown that diabetes is a risk factor not only for heart disease, but also periodontal disease. An Hb1Ac score of seven or higher is often reflected in the mouth. Symptoms that are noticable include puffy, bleeding gums and — depending upon how long this score has been high — bone loss and tooth mobility problems."

Your practice might also offer in-office Hb1Ac testing to monitor and communicate with the diabetic team of experts, such as the patient's cardiologist or physician. By identifying overall health condition and its relationhip to a patient's oral health, you are creating a perception in the patient's mind of a health and wellness visit rather than a "cleaning."

Immediately, you may think this makes sense; however, will it make cents? The answer is "yes," but only with efficient time management. From my 20years clinical hygiene experience, I have learned health and wellness hygiene departments operate both stress-free and productively.

They keep to a schedule of 60 to 90 minutes for adult preventive and periodontal visits. This timeframe accommodates an assisted hygiene protocol nicely. Keep in mind, assisted hygiene is practiced out of two treatment rooms with a designated dental assistant.

When the health and wellness visit is limited to 30 to 45 minutes, there is not enough time for screenings and assessments to be integrated into the appointment. With this time frame, the main goal is to accomplish an update of films and perform routine preventive care. Time is not on your side for something as easy as taking a blood pressure reading or a periodontal recording. Doing anything more may impede on much-needed instrumentation time.

Adding more time per patient and turning a "cleaning" appointment into a health and wellness visit means the hygienist will apply the same principle the dentist does — working smarter, not harder. Table 1 on page 56 illustrates the probable baseline productivity for one adult patient with varying appointment time allotments.

Anastasia L. Turchetta, RDH, is a national and international speaker, author, and coach. Her seminars empower and educate in a lively, team-centered, patient-focused atmosphere. She maintains memberships with NSA, SCN, ADHA, and ADA. You can contact Turchetta at

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