Maximizing hygiene results

Oct. 1, 2003
Imagine a hygiene department where quality care and profitability go hand in hand with systems that wouldn't allow one to compromise the other!

Kristine A. Hodsdon, RDH, BS and Vicki McManus, RDH

Imagine a hygiene department where quality care and profitability go hand in hand with systems that wouldn't allow one to compromise the other! Imagine being able to create vital organizations with diverse income centers, freeing the doctor from the burden of being the sole revenue-generator in the practice.

Imagine your well-run hygiene department returning a net profit of 30 to 35 percent. In most of the practices we coach, this translates into $60,000 to $300,000 per year of additional personal income for the doctor, depending on the size of the practice. What could you do with an additional $180,000 per year?

Imagine no longer! This article is designed to support dentists in creating vibrant relationships with their hygienists, understanding the foundational principles of running a dynamic hygiene department, and offering clinical insights into the newest technologies and trends of hygiene services.

Hiring campaign

Nearly one-third of general dentists practice without the support of a hygienist; some by choice, others because of perceived workplace shortages. The challenges in hiring are multi-faceted:

• Distribution
• Career longevity
• Choice in working environment

Still, there is a way to find that special hygienist for your team. Here are five ways to get started:

1) Research local hygiene associations and licensed hygienists in your zip code. Obtain a mailing list and implement a direct-mail campaign. This will yield a high caliber of candidates, if not a high number.

2) Advertise in local or state hygiene component newsletters and Web sites.

3) Advertise in local papers. Be creativ and include your name and phone number in the ad. P.O. Boxes signal trouble and a limited number of quality applicants will reply.

4) Talk with your dental representatives. Word-of-mouth often is the best way to find outstanding people.

5) Volunteer at your local dental assisting or hygiene school. Agree to come in and do a one-hour lecture on smile designs for the senior class. Pass out your business cards and other materials. Once they meet you, they will love you — right?

Since employment issues are among the highest concerns in most regions of the country, we challenge you to find a trusted confidant within your local dental hygiene community and determine the reputation of your practice. Frequently, it's the same doctors who place the same advertisements in the newspaper and complain about a "hygiene shortage." In fact, your office's reputation may be one of the ones that quality hygienists avoid. Even if the local dental hygiene program quadruples its graduating class, your office still might never find a terrific hygienist. The reality is that not many people are sending their resumes to Martha Stewart Inc. or Enron. If your dental office has a difficult time hiring quality hygienists, it might be well worth your time to discover what hygienists are saying about you!

What hygienists want — No. 1

When facilitating continuing-education programs, the audience guides the topic towards career satisfaction and professional issues. After speaking with many hygienists across the country, here are some insights into what hygienists want and the keys to creating dynamic relationships.

1. Establish an ergonomically supportive environment in which hygienists have the time to optimally assess and treat oral health as it relates to total health.

2. Show genuine appreciation for hygienists' valuable skills

3. Create an appropriate compensation package and review it annually.

Keeping hygienists long-term by maximizing their results starts with a healthy work environment and appropriate instruments to provide care. Repetitive stress injuries affect hygienists three times more often than other dental-care providers. One such example is due to the nature of nonsurgical periodontal therapy and removal of secretions. Doctors need to consider upgrading their hygiene department's arsenal of tools to minimally include ultrasonic or microsonic instrumentation, ergonomically-designed chairs, loupe magnification/illumination, and properly designed and sharpened hand instruments. (See Figure 1) These are designed to place the practitioner in correct posture, minimize hand fatigue, decrease treatment time, and improve the result for patients.

What hygienists want — No. 2

A hygienist has five key roles:

1) Health-care provider
2) Periodontal therapist
3) Preventive specialist
4) Aesthetic hygienist
5) Department leader

Each of these areas focuses hygienists' efforts on helping the patient. The fifth, the department leader, also provides an outlet to support the practice. This will help put perspective in your day and heighten your appreciation of your hygienist.

As health-care providers, your hygienists' observations have the ability to save your patients' lives. The hygienist does this through detection of oral cancer, high blood-pressure screenings, identifying compromised immune systems and eating disorders, providing information and education about the need for premedications and the potential side effects of medications, as well as other special considerations regarding your patients.

Hygienists are highly skilled professionals trained to identify and treat periodontal disease. Links between periodontal disease and systemic illness are well- documented. Helping patients understand the connections is clearly a valuable role for hygienists. However, if 90 percent of your hygiene procedures are "traditional" hygiene services like prophies, your hygienist may feel unappreciated because she is not utilizing all of the skills she possesses. When hygienists are not provided with ways to expand levels of care and services to patients — which simultaneously "fuels" practice growth — this dangerous combination creates an unhappy employee who will eventually look for a more fulfilling position elsewhere ... which translates into a new hiring campaign for you.

The very heartbeats of a hygiene practice are the social interactions with the patients and the ability to educate them about prevention. Actively supporting hygienists in developing patient relationships leads to patients understanding the value of fluoride, sealants, home-care products, disease therapy, and the need for continuing-care appointments.

Aesthetic hygiene is a new and exciting role for most hygienists. We encourage doctors to spend some time chairside with their hygienists and to take restorative, clinical continuing-education courses together. Helping your hygienists understand the wonderful options in smile design, gingival and enamel contouring, conservative "tooth colored" posterior restorations, whitening, and bad-breath management will take your practice to the next level.

Your hygienist can support your practice as a department leader by looking ahead and forecasting future needs. Consider this: if you have 30 new patients this month and five patients leave, you have a net gain of 25 patients. The average hygienist sees about six to eight recare patients per day. Assuming your schedule is already filled, you would need to add three days of hygiene six months from now to accommodate the new patients in the practice.

Are you and your hygienist talking about creative ways to expand the department so that no one "falls through the cracks?" The tragedy is that, according to the ADA, the average dental practice reactivates only 30 to 40 percent of its patients. That means that six out of 10 patients do not return for continuing-care visits in a timely fashion. Does this meet your standard of care?

Once doctors appreciate hygienists in these critical areas, they can be coached to productively expand the department without compromising the quality of care.

What hygienists want — No. 3

Building an appropriate compensation package is the third step in creating outstanding relationships and maximizing hygiene results. Each practice situation is different, but the best method of compensation always puts patient care as the highest priority. A doctor's task is to select the most balanced method, keeping in mind profitability, competitive rates, and personal incentive needs for the employee.

The following are some options that can help you create dynamic relationships with your hygienist:

Initial interview: You should be prepared with facts and figures regarding compensation in your area. Check with local schools, the dental hygiene societies, or publications that publish generalized salary surveys (

Final interview: After a working interview and team approval of your best candidate, three critical steps should be taken during the final interview.

1. Restate and clarify the entire compensation package, as well as team goals and standards of care. Put this in writing and file a copy in the personnel folder.

2. Schedule and keep review meetings at 30, 60, and 90 days after hiring a hygienist. Continue these reviews at six-month intervals. These are goal-setting sessions and performance reviews. They are designed to offer opportunities for you as the employer to discover what your hygienist needs in order to be successful and to help him or her establish goals within the department.

3. Provide your new employee with office policies, team vision and agreement statements, and written standards regarding patient care.

Compensation possibilities

Commission: Commission-only compensation packages can work well for single-hygienist departments. Commission percentages range from 28 to 35 percent of production and can include a variety of income centers, depending on the doctor's philosophy. Products usually are factored in at a lower percentage rate to allow for the cost of goods. We do not recommend commission as a percentage of production for multi-hygienist offices.

Base pay + incentive: This can work well in a single- or multiple-hygienist department. The key is balancing the incentive. Base pay will be tied into a minimum goal per day. Production above this amount will be paid as a percentage above base.

Base pay + department bonus: In situations where the team works well together, you can create a monthly department bonus based on production. This bonus includes the hygienists and the coordinators that support the hygiene department with scheduling, charting and productivity.

Base pay + team bonus: This situation typically works best for well-balanced teams in which the hygiene and restorative departments are striving to hit targets on a regular basis. Team incentives recognize the multi-faceted aspect of how a dental office runs and equally rewards all players for going the extra mile.

Proper ratio: As a general rule of thumb, dental offices will allocate 35 percent of hygiene production for compensation. This includes gross salary, tax matches, and all benefits. If you are paid a 33 percent commission, then no other benefits would be offered. Hygienists would be responsible for creating their own benefit package.

You may find yourself in a situation where a shortage of applicants makes it necessary to offer a slightly higher compensation package to attract a talented hygienist. In either case, be clear about your expectations of daily production, restorative and periodontal enrollment, and team interaction. The salary itself is not as important as the total value a hygienist can bring to the practice.


They say all the good ones are already taken! While that's not true, it can seem that way when it comes to creating a dynamic working relationship with your hygienist and providing quality care all under the umbrella of a profitable hygiene department.

The mark of a professional is a pro-active nature, the ability to be held accountable, and an eagerness to contribute. This goes both ways! Educate yourself about the expanding roles hygienists can play and learn ways to open the lines of communication. We believe that whatever you give comes back to you 10-fold. That means maximizing your hygiene results is more accurately a selfish endeavor. So, go ahead, give a little more than you think you can. You will be amazed at the return on your investment!

Figure 1
Newest technologies and trends in hygiene services

• Adult fluoride therapy and family caries protocols
• Assisted hygiene/hygiene coordinators
• Automatic instrument sharpener
• Computerized and assisted periodontal assessment system
• Digital photography and case presentation
• Digital radiography/ visual treatment plans
• Educational systems (DVDs, dedicated loop channels)
• Expanded functions (restorations)
• Hand hygiene and time savers
• Hygiene post-graduate fellowships/ accreditations
• Hygiene-specific enrollment software
• Intraoral camera — 30-second tours
• Lasers (caries detection, periodontal therapy, whitening)
• Local anesthesia
• Local-delivery chemotherapeutics
• Magnification and illumination
• Occlusal analysis
• Oral abnormality/cancer detection devices
• Quantification and monitoring caries progression
• Whitening services

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