Maximizing hygiene production: 4 ways to build a better, stronger practice

Aug. 25, 2016
Whether you as a dentist do exceptionally well in your dental hygiene department or not, there are likely a few things that could be done to either strengthen your successful actions or improve your weak areas.

Editor's note: This is Part 1 of a three-part series on building a better, stronger practice through your hygiene department.

Whether you do exceptionally well in your hygiene department or not, there are likely a few things that could be done to either strengthen your successful actions or improve your weak areas. If you find even one tip in this article that will help you, it will have been worth reading.

How do you motivate hygienists to not only build better relationships with your patients, but also directly influence total practice revenues?

During the past 30+ years, we have found four basic categories that, when combined, answer this question and help to create a powerhouse practice:

1. Personal and clinical caliber of the hygienist;

2. Efficiency;

3. Internal coordination (scheduling, fees, insurances); and

4. Remuneration.

Personal and clinical caliber of the hygienist

Practices know the caliber of the hygienist is important, but some still hire hygienists of subpar caliber. Be sure the hygienist not only matches the culture of the practice you want, but contributes to that culture. Here are the key qualities the hygienist must possess:

• Clinical expertise sufficient to meet your standard;

• A personality friendly enough to build long-lasting relationships with patients;

• A willingness to work within the policies and protocols of the practice;

• An ablilty to perform duties to the maximum legal level allowed in your state; and

• An ablility to easily and willingly work with other staff and the doctor in the coordination of duties (appointments, recall exams, fees, insurances, and more).

Surprisingly, we've talked with doctors who have knowingly tolerated actions that are severely contrary to these points, which results in tremendous liabilities for the practice and the patient, such as: (1) The hygienist actually telling patients they don't really need the treatment the doctor has planned; (2) advising patients to go to the periodontist for their scalings rather than have them done in-house; (3) refusing to insist on x-rays, even though the doctor has laid out standard protocol regarding how often x-rays should be taken on all patients; (4) skipping probing, although protocol insists on it; (5) not charging for isolated areas of curettage or scaling; (6) not suggesting products that patients need that are available in the practice at known fees; and (7) refusing to work within the allotted time for specific procedures and changing that agreed-upon amount of time without the doctor's agreement.

Whatever your protocol is, it must be standard. No one is perfect and certain things can easily be missed, especially on days when unexpected problem patients or cases occur. However, there are certain points that are liabilities to patients and you if not consistently done.

For instance, in one practice, the hygienist was running behind due to a complicated case. We've all had these days. Being in a hurry and not wanting to make the remaining patients wait long, she then skipped the standard probing of a young adult patient. The patient was in his 30s and had measured at 3 mm on an upper central tooth during the last recall appointment six months earlier. While 3 mm may not be much, and the patient was young, skipping the probing was still against protocol.

The next recall was six months later, and it was not one year since the patient was last probed. That 3 mm central pocket had amazingly advanced to a 9 mm pocket! The patient was sent to the periodontist. For specific clinical reasons, the periodontist could not save it. The young patient, unfortunately, lost that tooth. This is a sad but true story that could have been avoided.


Of course, the protocol you want depends on your own education and experience. While maintaining the integrity of how you wish to clinically treat patients, there may be some portion of the actions discussed here that you can use to increase the amount of production your hygienist is capable of performing daily.

Schedule for the maximum amount of scaling and root planing to be done in one visit. Whether that is one quad, half of the mouth, or the full mouth, the maximum amount that you allow at one time should always be scheduled, just as you do for operative.

If you currently have hygiene delivered prior to all new-patient exams, your hygiene department might be more efficient if the new-patient exam is scheduled in the doctor chair rather than the hygiene chair. This could allow more time and comfort for the exam, as well as more time for the hygienist to seat another patient. The exam could be scheduled in your chair the same day as the cleaning, directly following the prophy.

If you have the chairs for it, consider hiring a hygiene assistant in order to schedule two chairs for each hygienist. This has been prevalent in many practices for years. If the hygienist is performing the cleaning, the assistant can perform the additional duties. This can increase your hygiene production between 50% and 100%, depending on how much time you currently allow for cleanings. Use the assistant for seating, taking vitals, preparing the operatory and patient chart, taking x-rays, charting, (including plotting the existing treatment suggested by the hygienist and probe measurements), coronal polishing, providing oral hygiene instructions, dismissing the patient, cleaning the operatory, sterilizing and preparing tray setups, and setting up for the next patient.

Kevin Wilson is CEO of Sterling, an award-winning management consulting firm that has twice appeared on the Inc. 500 list of America's fastest growing, privately held companies. Founded in 1983, the firm has delivered more than 500,000 hours of business consulting and completed more than 135,000 training sessions among 175,000 business professionals from 1,700 cities throughout the United States. Wilson is the author of Personnel: Your Most Valuable Resource or Greatest Burden (2010). He can be reached at [email protected]. Visit for more information.

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