Phase One: Philosophy

During the next eight months, we will embark on a comprehensive journey to review the criteria necessary for the transition from a prophy-based hygiene department to that of diagnosis-driven care.

Beverly Maguire, RDH

During the next eight months, we will embark on a comprehensive journey to review the criteria necessary for the transition from a prophy-based hygiene department to that of diagnosis-driven care.

The importance of philosophy is foundational. Hygiene care today involves more than doing the best you can in 45 minutes; it involves evaluating the periodontal status, treating early disease, referring advanced cases, and maintaining periodontal health over a patient's lifetime. The standard of care received daily by your hygiene patients should correlate directly to your philosophy.

My recommendations for moving toward a more profitable and appropriate standard of care are to begin with a meeting of the entire staff to discuss hygiene philosophy. Don't assume that your staff is in agreement or has clarity on the matter. Many dental personnel have never given any thought to hygiene philosophy.

Somehow, we assume that if we employ a hygienist and treat hygiene patients, then it's all being taken care of. As a consultant with access to hundreds of dental practices across the country, let me inform you that the standard of hygiene care varies widely. Many patients have never been probed and charted - much less given a perio status report. Many are probed but have never been evaluated or diagnosed.

Many patients have periodontal disease and are uninformed. As the business owner and leader of your practice, it is critical that you convey the desire that your patients be evaluated properly (through consistent probing and charting), be informed of their perio status, and be offered options for care appropriate to their hygiene diagnosis.

The hygienist can then review the protocols currently being used within your office. How often are complete records taken and recorded? How is the information gathered, how is it conveyed to the doctor for the purpose of obtaining a diagnosis, and, finally, what systems are in place for the treatment of periodontal disease?

It is important for the hygienist to review current information and research and then educate and update the team about perio issues. Every team member should have the opportunity to discuss and understand the rationale behind the hygiene protocols and/or the need for revision of the systems. I have found the method with the most impact for educating the entire staff on perio is to simply put each employee in the chair for a complete perio exam, evaluation, and report of findings. Suddenly, it becomes important!

If excellence in patient care is the mission of the practice, it will drive the protocols and systems within the hygiene department. Does your practice philosophy call for excellence? If so, consistent perio charting is the one and only beginning point leading to excellent hygiene care.

This is the one area of constant discussion that I encounter in my seminars and consulting throughout the country. Hygienists have 101 reasons why they cannot probe routinely. The lack of staff to record the numbers is the most common complaint. You must now do whatever it takes to provide care reflective of your stated philosophy. Further coursework may be necessary and refinement of systems within the practice is likely.

The beauty of beginning with agreement of philosophy is that it strengthens the resolve and accountability within our teams to do our best and provide care that's appropriate for patients. It helps underscore the need to change. Take the time to meet, discuss, and critically evaluate your current approach. It's the first and most foundational step to excellence in your hygiene department.

Next month, we'll discuss creating systems that support your philosophy.


Beverly Maguire, RDH, is a practicing periodontal therapist. She is president and founder of Perio Advocates, a hygiene consulting company based in Littleton, Colo. She can be reached at (303) 730-8529 or by e-mail at perioadv@aol.com.

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