The sabotage of assisted hygiene

Oct. 1, 2009
Working in an assisted hygiene model can be productive, professionally gratifying, and fun.

by Dianne Glasscoe-Watterson, RDH, MBA

For more on this topic, go to and search using the following key words: assisted hygiene, model, sabotage, Dianne Glasscoe–Watterson, Focus On.

Working in an assisted hygiene model can be productive, professionally gratifying, and fun. However, the model can be sabotaged if any of the four essential ingredients for success are missing.

In order to implement assisted hygiene in any practice, four prerequisites must be satisfied.

  • First, there must be two operatories completely equipped with power scalers, instruments, and anything else that is needed to provide hygiene services.
  • Second, there must be a dedicated assistant that works with the hygienist exclusively.
  • There must be an understanding of how to engineer an assisted schedule.
  • Finally, everyone involved must embrace the model, and they must have a dedication to make it work.

Sabotage 1

When “Dr. Davis” heard a speaker describe how much more productive the assisted model of hygiene was than solo hygiene, he decided to try it in his practice. He had three operatories in his office — one operatory for hygiene and two operatories equipped for restorative procedures.

One of the restorative operatories was used primarily as an overflow treatment room, so Dr. Davis reasoned that both he and the hygienist could use it as needed. The doctor reasoned that the hygienist could place her power scaler on a rolling cart and move it from room to room as needed, as he did not want to invest in an additional power scaler.

The first day of assisted hygiene was a disaster, and Dr. Davis's hygienist was near tears by the end of the day. She was exhausted from the rigors of constantly moving the power scaler, instruments, and everything else she needed.

The second operatory was too small to function as both a restorative and hygiene operatory. At one point, Dr. Davis's assistant placed one of his overflow patients in the second operatory, which left no room for the hygienist's patient who was scheduled for the same treatment room. This caused the hygienist to run behind the rest of the day.

The assisted model of hygiene in Dr. Davis's office was doomed from the start because it violated the first principle, which is providing two completely equipped, mirrored hygiene operatories. The doctor put his hygienist in an uncomfortable position by asking her to work in a treatment room that was not set up for hygiene procedures.

Asking clinicians to move necessary equipment between treatment rooms is burdensome and frustrating! Most likely, the hygienist will resist any future efforts to practice assisted hygiene due to this initial bad experience.

Sabotage 2

“Dr. Moore's” practice was having difficulty keeping two full–time hygienists busy due to a decrease in demand. So when one hygienist retired, Dr. Moore decided to implement assisted hygiene rather than hire another hygienist. He hired an additional assistant to work with the hygienist, and her duties were delineated in a written job description.

The hygienist and assistant learned to work together, and the hygienist was less tired at the end of the day compared to when she worked solo. The hygienist enjoyed having help with periodontal charting, suctioning, and all the other duties her assistant performed, such as room set–up and turnover. The biggest advantage was the increased production. The hygienist was able to increase from an average of eight to 12 patients per day, which increased her production by about 45%.

However, the assisted hygiene model began to crumble when the hygiene assistant started being pulled from her hygiene duties to help the doctor and his assistant on a regular basis. When the doctor hired the hygiene assistant, he told her that her primary duty would be to assist the hygienist, but she would also be required to help with restorative procedures from time to time. Dr. Moore did not understand that requiring the hygiene assistant to function in two roles was a prescription for failure.

The only time the hygiene assistant should be expected to help in other departments is if there is downtime in the hygiene schedule due to an occasional cancellation or no–show. A hygienist cannot work an assisted model alone. Dr. Moore should consider how frustrated he would be if his assistant were absent when he needed her, only to be found helping in another part of the practice.

Dr. Moore's hygienist became disillusioned and frustrated because of increasing demands on her assistant by other staff members. The hygiene assistant felt stressed and overworked from being pulled in two directions.

Friction developed between the hygienist and assistant due to the stress on the hygienist to perform both her and the assistant's duties when the assistant was pulled away. So when the assistant resigned, the assisted model was abandoned.

Evidently, Dr. Moore did not respect the role of the assistant to the hygienist in an assisted hygiene model. The assistant functions as the hygienist's strong right arm in maintaining flow, staying on time, keeping treatment areas ready, dismissing patients, scheduling future appointments, taking radiographs, and sterilizing instruments.

Further, the problems the hygienist experienced in not having her assistant available when she needed her have most likely jaded her against assisted hygiene.

Sabotage 3

“Dr. Cathcart” decided to implement assisted hygiene to meet the rising demand for hygiene services in his practice. Since hygienists were in short supply in his area, assisted hygiene seemed like a good solution. He had four operatories — two restorative operatories, one hygiene operatory, and one “junk” room that was plumbed and ready for upfitting. With his hygienist's help, he ordered the necessary equipment and instruments and hired a hygiene assistant.

The scheduling coordinator did not fully understand how to schedule for assisted hygiene. She was simply told to “stagger the schedule every 30 minutes or so.” Before implementing assisted hygiene, the hygienist was accustomed to seeing about nine patients per day. However, on launch day, 16 patients were scheduled!

When the hygienist saw the schedule, she nearly panicked. How on earth could she be expected to nearly double the number of patients she saw and still provide high–quality care?

As expected, the first day was stressful from overscheduling. The hygienist worked well into her lunch hour and nearly an hour extra at the end of the day. She was so tired and frustrated after the first day that she felt like resigning.

A little common sense regarding appropriate scheduling would have been helpful. The best advice is to start slowly and gradually build as the hygienist and assistant learn how to work in tandem. If the hygienist is accustomed to seeing eight patients per day, the first assisted day should have no more than 11 patients.

As the protocol becomes established, the hygienist can eventually see a few more patients. However, depending on the patient mix, an assisted schedule (in an 8 a.m. to 5 p.m. day) will typically max out at about 12 to 13 patients (possibly more if there are several children in the mix). A highly qualified assistant can perform more duties, such as exposing radiographs and polishing. With an untrained assistant, the hygienist will have to perform many duties that could be delegated to an assistant with the appropriate credentials.

Sabotage 4

“Carol,” the scheduling coordinator, was not happy when the doctor announced that he wanted to implement assisted hygiene in the practice. She was vocal in her opposition at the staff meeting, and she stated she did not see how it could possibly work. Carol did not like the idea of hiring an additional assistant, and she felt that increasing the number of patients seen by the hygienist would complicate her job. Carol did not like change – period.

The assistant hired to help the hygienist was inexperienced but willing to learn. However, Carol projected a less–than–friendly attitude. The scheduling coordinator intimidated the young assistant, and when a job opened in a nearby office, she resigned. The schedule was thrown into turmoil, and it seemed the only alternative was to go back to solo hygiene. Carol was happy to return to the old familiar routine.

In this situation, the failure of the assisted model was due, at least in part, to the doctor not being enthusiastically committed to making the model work. He allowed his scheduling coordinator to sabotage the model through her negative remarks and passive aggressive attitude. If the doctor had provided more support and provided the scheduling coordinator with encouragement and direction, the model would have had a better chance of thriving.

Avoid the sabotage

Assisted hygiene can be a win–win–win situation for hygienists, patients, and the practice if it is not sabotaged by any of these situations. Hygienists that practice assisted hygiene overwhelmingly report a more relaxed work environment by having a dedicated assistant. Patients are provided comprehensive care from the hygienist and a well–trained assistant. Additionally, the practice benefits through increased production in the hygiene department.

If you would like to see a typical assisted schedule, send an e–mail to [email protected] with the subject line “Assisted Hygiene.”

Dianne Glasscoe–Watterson, RDH, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe–Watterson for speaking or consulting, call (301) 874–5240 or e–mail [email protected]. Visit her Web site at

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