How to add $20,000 per year to your hygiene revenue

by Annette Ashley Linder, BS, RDH

For all the years I have been in dentistry, one of our main goals has been to reduce the caries rate in the patient population. For awhile, the dental profession succeeded in doing so. But did you know that for the last several years, the caries rate in America has turned around and is on the upswing?

There are several reasons for the upturn. These include poor diet, access to dental care, and longevity. Thanks to science, modern medicine, and drugs, we are now living longer. While this is good news, it is not unusual for dental providers to see more gingival recession in patients. Recession may be the result of the aging process, occlusal considerations, improper brushing and home care, periodontal imflammation and infection, etc. Whatever the etiology, the final result is a higher incidence of root caries.

This trend is not just seen in our older patients. According to the National Institute of Dental Research Studies, 7 percent of 18-year-olds and as high as 21 percent of 35-year-olds have already suffered from one or more teeth with root caries.

So why are we not recommending topical fluoride treatments to our “at-risk” adult patients? Patients presenting with sensitivity, high caries rate, poor diet, medically compromised, recession, and xerostomia are ideal candidates. Xerostomia is becoming more and more prevalent in the population, as many patients routinely take prescription drugs that induce dry mouth. Why are we not prescribing and/or dispensing prescriptive home fluorides to these patients when we know the benefits? The short answer that I get from many hygienists and staff is that “insurance won’t pay for it and I know my patient won’t go for it.” You bet they won’t accept it if you say, “Mr. Smith, you would benefit from a fluoride treatment, but I am pretty sure your insurance won’t pay for it.”

In my consulting work, I routinely hear patients tell the hygienist to “stay away from this tooth because it is really sensitive.” In this scenario the patient is literally asking for a remedy. This is the ideal time to show the patient (use a mirror or the intraoral camera) the recession, the root, the cervical abrasion, the white spot precavity lesion, etc. It also is the ideal time to briefly share the research with the patient and describe the benefits of a professionally-applied topical fluoride treatment. The hygienist advises the patient that “we can accomplish the treatment today at the completion of the prophylaxis. This will help to remineralize tooth surface (or) reduce the sensitivity and strengthen your teeth.”

The hygienist continues by saying, “My concern is that, as you can see, the root of your tooth is exposed. The roots of the teeth are covered with cementum, which is not as strong as enamel.” If the patient is caries-prone and at risk, the hygienist discusses this and advises the patient that “we are trying to prevent the root from decaying or getting a cavity.”

Many of my clients’ offices have oral health, home-care, professional-display centers where patients have the opportunity to purchase the best professional oral home-care products in the office. Typical products include power toothbrushes, malodor and oral medicaments, intraoral cleaning devices, irrigators, fluoride toothpaste, etc. Oral health home-care products make great gifts, and displaying them as such help peak the patients’ interest. (Example: a big red bow on a Sonicare® box at the front desk with signage saying, “Give the gift of good health to your special Valentine.”)

The ADA published a special report (see JADA insert, May 2006, titled “Professionally Applied Topical Fluoride; Executive Summary of Evidence-Based Clinical Recommendations”) on this research. This report contained the clinical recommendations developed by an expert panel established by the ADA Council on Scientific Affairs. The research team evaluated a collective body of scientific evidence on the effectiveness of professionally-applied topical fluoride for caries prevention.

As stated in the report, general panel conclusions included the following:

Fluoride gel is effective in preventing caries in school- aged children.
Patients whose caries risk is low may not receive additional benefit from the professional application of fluoride.
There is considerable data on caries reduction with professional gel fluoride treatments of four minutes or more. There is laboratory, but no clinical-equivalent, data on the effectiveness of one-minute fluoride gel applications.

Click here to enlarge imageThe recommendations divide the population into low, medium, and high risk, as well as those under six years of age, six to 18 years of age, and 18 years and older. The report also discusses fluoride gels and varnishes. Go to www.ada.org for more details on the study and specific recommendations. Risk factors for developing caries are outlined in Table 1.More good news on fluoride applicationsThere is more good news to support the efficacy of professional fluoride application for the adult patient. The new insurance code, D1206, is established in the CDT 6 Code Book (January 2007). The code is described as “topical fluoride varnish, a therapeutic application for moderate-to-high risk patients.” Include a narrative with a treatment history, describe the “caries-active” state of the patient, and medical risks, along with any other risk factors.If the above information is not enough to get you going, consider this:One hygienist working four days a week and seeing eight patients per day = 32 patients per week x 49 weeks = 1,560 patients per year. If two-thirds (1,050) of these patients receive a fluoride treatment at a hypothetical fee of $20, your hygiene production increases by $20,000. Double that figure to $40,000 with two hygienists. The math is easy and so is the application of fluoride (especially the new varnishes).Allow me to be very clear - we are not just adding this procedure to generate revenue. We perform this procedure because it is clinically the right thing to do. When we do what is clinically correct, an increase in productivity follows. Develop office protocol and review it with your hygienist and the entire team. Share the research to help move patients out of the constraints of insurance. An annual professional fluoride is not going to break the patient’s budget … and it is far less costly than a restoration.Perhaps with this effort and more patient education regarding healthy diets with parents and children, as well as noninvasive medical therapies (including professionally-applied fluorides), we will once again reverse the caries rate.

Annette Ashley Linder, BS, RDH, is a recognized leader in the field and an award-winning speaker and consultant. She is a featured speaker at dental meetings and provides in-office consulting services with her team of business and clinical consultants. She may be reached at her Web site at AnnetteLinder.com, via e-mail at [email protected], or by phone at (772) 546-2207.