How to Profit from...Hygiene — The Integrated Dental Practice

What does the term "hygiene department" conjure up for you? Do you think of one or more hygienists, who may work with an assistant or coordinator, who clean teeth, offer some home-care instructions, pass out toothbrushes, perform some root-planing and scaling, and pre-appoint their patient for more of the same?

by Dixie Gillaspie

What does the term "hygiene department" conjure up for you? Do you think of one or more hygienists, who may work with an assistant or coordinator, who clean teeth, offer some home-care instructions, pass out toothbrushes, perform some root-planing and scaling, and pre-appoint their patient for more of the same? I know many of you are thinking, "Sounds good to me," while some of you are thinking, "If only I could get them to do all of that."

Many dental practices consider the hygiene visit necessary to get the patients in the door, but hardly a profit center. And while the hygiene exam is considered necessary to schedule restorative dentistry, it is perceived as an inconvenient interruption of what the doctor would rather be doing. In our consulting work we often hear a doctor say, "But I don't want to check more hygiene patients."

Most hygiene departments operate in isolation. The services they provide are referred to as preventive, while the services provided by the doctors are referred to as restorative, cosmetic, or surgical. The fees charged are significantly less per hour than what would be charged for the doctor's time, so their services are often perceived as less valuable to the practice. Even patients are seldom aware of the extensive and specialized nature of the hygienist's training; they are often heard referring to the hygineist as "the girl who cleans my teeth."

Not a pretty picture for the practice, the patients, or the hygienist. However, a practice with an integrated hygiene department operates as a much more efficient and harmonious business. In these practices, the hygiene department participates in every facet of the patient's dental care, while every team member participates in the success of the hygiene department. The hygiene department is a profit center, not only because hygienists perform high-production procedures like bleaching, root-planing and scaling, bite appliances, and more, but because they advance the relationship with the patient, leading to improved case acceptance. The hygiene department introduces the patient to the benefits of cosmetic procedures; their enthusiasm about early diagnosis and definitive dental treatment motivates patients to greater case acceptance.

Every team member is aware of the relationship between tartar, bacteria, and dental disease. They emphasize to patients the importance of the hygienist's role in oral health. They strive to make patients conscious of the individual qualifications, accomplishments, and education hygienists must have to successfully perform in the dental arena.

Everyone on the integrated dental team is happy to step in to record periodontal readings, develop X-rays, or pour up a model if it allows the hygienist to spend more quality time with a patient. Team members are willing to pull charts, confirm appointments, or answer the phone if it frees someone else to spend more quality time with a patient. So how do you move a hygiene department out of isolation and into an integrated role in your practice? The same way you achieve a healthy mouth: diagnose, educate, and treat.

First, recognize the signs of isolation. Do your hygienists discuss the patient's overall health — or only those conditions that relate to hygiene? Does your team take the initiative to discuss the value of prevention — or do they think that is the hygienist's job? Do your hygienists show accountability only to you — or do they recognize their accountability to the patient and the team? Does your team take responsibility for promoting the hygiene department — or do they expect that you will assign that duty to a "recall coordinator?"

Now, educate. As a team, discuss the importance of hygiene in the patient's overall health. Discuss how plaque forms, how it becomes tartar, the role of bacteria, and the limitations of home care aides. Use the same educational materials you would show to your patients, but allow your team to assume the responsibility for explaining everything. Make sure everyone understands how to discuss the way periodontal pockets form, how they are measured, why the patient cannot clean them effectively at home, and why bacteria loves to live there. Review the clinical studies showing links between periodontal health and total physical health.

Introduce your team to pathology and treatment benefits. Diagnoses should always be based on the observation of a condition that needs to be treated before it gets worse. While no one but the doctor can diagnose, your hygienists should be able to point out areas of concern during the hygiene visit. Your entire team should also be aware of the possible consequences of untreated conditions.

Most doctors dread the hygiene exam. They would rather avoid a patient's "kill the messenger" attitude that follows a recommendation for a crown or othher costly procedures. And they absolutely loathe the rejection that often follows. In an integrated practice, the doctor doesn't have to be the bearer of bad news. The hygienist has already established the possibility of a problem. The patient has already seen this tooth on an X-ray, an intraoral image screen, or at the very least, in a hand mirror. The hygienist has also promised the patient that the doctor will decide what needs to be done to save the tooth.

When the doctor enters the operatory, the hygienist shows what the patient has already seen and asks for the doctor's opinion. No longer the bearer of bad news and introduced as a definitive expert, the doctor has no need to fear rejection. Since the entire team is prepared to discuss the benefits of immediate treatment and the possible consequences of procrastination, the chances of the patient completing treatment are very good indeed. The patient now views the hygienist as "someone who discusses my health with me" instead of "someone who cleans my teeth." In fact, everyone on the team gains credibility with the patient because of this integrated style.

Finally, banish the perception that hygiene procedures are preventive, but restorative procedures are not. Regardless of the procedure, all dental treatment either prevents dental disease from starting or prevents it from causing further damage. Even many "cosmetic" procedures can be viewed as preventive if you consider the effect that a less than ideal smile can have on the patient's self-esteem. An integrated practice works on one foundational principal: everything we do provides benefit to the patient and the practice. Therefore, we are all of equal importance and bear equal responsibility to the patient and to each other. The result? A better hygiene department and a better practice.

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