Story by Linda Drevenstedt, RDH, MS. Photo by Brian Beard, Creative Images Photography

Don’t let your hygiene schedule look like Swiss cheese!

Nov. 1, 2011
Does your hygiene schedule look like Swiss cheese? You are not alone in this challenging dilemma!

For more on this topic, go to and search using the following key words: hygiene schedule, recare, productivity, hygiene perio, cross-train, Linda Drevenstedt.

Does your hygiene schedule look like Swiss cheese? You are not alone in this challenging dilemma! The downturn in the economy, job loss, and corporations converting to the least expensive dental plans have created a huge tidal wave, whooshing patients from your chairs.

Today, dentists are laying off hygienists due to their Swiss cheese schedules, and recent hygiene graduates are having a hard time finding jobs. Is this the new normal for patient retention in your hygiene department?

If your recare system is weak, it is now very evident in your hygiene productivity. What’s a practice to do? Here are six ideas for improving your hygiene productivity and getting rid of the holes in your schedule.

Improvement Idea No. 1— Analyze the true health of your hygiene department. Here are the benchmarks and the calculations you will need:

A. Recall effectiveness
Calculation: Add up the number of prophies (adult and child) and half of the periodontal maintenance (4910) treatments from your procedures by procedure code report for six months. Divide this number by your active patient number. This will yield a fraction; multiply the fraction by 100 to get your percentage.

No. of prophies + perio maint. in 6 mos. / active patients = ______ x 100 = _____%

*An active patient is defined as one seen in the practice within the past 18 months.

Benchmark: 75%–80% Your practice = _____%

B. Hygiene perio analysis
Ratio of perio procedures (4000 numbered ADA codes) done by hygienist(s) as a percentage of hygiene production

Perio procedures total / Hygiene production = ____ x 100 = _____%

Benchmark: 25%–30% Your practice = ____%

Divide the total hygiene production (less the exam fee) into the total perio procedure production. Multiply your fraction by 100 to get your percentage.

Perio Analysis Example:

Perio (hygiene) production / hygiene production $12,400 / $97,428 = 0.127 x 100 = 12.7%

Unless your practice has had formal soft-tissue management training, this number is generally lower than the benchmark. A low perio percentage often goes hand-in-hand with low recall percentage. A formal periodontal therapy program helps increase the patient’s value for the recall appointment.

C. Hygiene open time rate
Open hygiene appointments kill profitability. Open time is a combination of unfilled appointments, plus all broken, cancelled ( with less than 24 hours’ notice), or no-show appointments within a time frame.

Open hygiene appointments / no. of potential hygiene appointments = ____ x 100 = _____%

Benchmark: 5%–7 % or less Your practice = ____%

Calculate this percentage from data you collect over the next month. Keep all of your schedules with the BAs and CAs marked. Count the open time each day plus the cancellations. Tally the number of appointments available and divide that number into the number of openings in your hygiene schedule. For those of you with two hygienists, the tally needs to be done for only two weeks. For dentists with only one hygienist, the tally should be kept for a month.

Example: Harriet Hygienist averages $98 per patient.
She averages two open appointments per day.
$98 x 2 = $196 x 200 days worked = $39,200 lost revenue
Pearson’s Law: “That which is measured improves.”

Now, let’s go to work. First and foremost: The hygiene appointment has to have value to the patient if you expect the patient to make a financial and time commitment to return in six months.

Improvement Idea No. 2— Manage your conversation. You have a captive audience in hygiene, so use your time to benefit the patient. Linda Miles gives the following parameters that I also advocate.

The hygienist’s conversation needs to be 75% clinical about the patient’s condition, new discoveries in dental health, etc., and 25% personal about the patient, not about you. Take your adult-to-adult conversation style up a notch. In your patient-education and conversation, make the paradigm change to “asking” more than “telling.” The actual root word “educate” means “to draw out.” How do you draw something out of someone? Ask rather than tell.

When we tell:

We set up an “I know; you don’t know” position (adults hate this!).
We explain in a monologue, not a dialogue.
We don’t breathe.
We don’t involve the person.
We assume we know what is best for the patient.
We often use jargon or words that have little meaning to the patient.

When we ask:

We let the patient be the expert on his/her health.
We are in a dialogue, which means an exchange of ideas.
We listen with the intent to understand.
We draw out concerns, points of view, situations (kids in college or moved back home, someone has lost a job, etc.).
We use visual aids appropriate for the patient.
We use co-discovery.
We are more committed to what is best for the patient right now than we are to our diagnosis. This commitment alone helps retain more patients.

Words that work:

Bleeding, pus
Nonsurgical gum/periodontal treatment
Decay, cavity
Worn out
Corroded, leaking
Germs, bacteria

Words that bomb:

Terms with “cleaning”

Improvement Idea No. 3 — Have a fabulous, wow hygiene exam! Inform patients about what you are doing. Show the results. Ask for their input about any problems.

Adult hygiene exam improvements:

  1. OCE — beyond the eye — VELscope®, VizLite®,, Trimera®
  2. Perio — use new diagnostics — GoProbe®, Oral DNA®; gingivitis identified and treated early, not watched
  3. Restorative — use transillumination — DIAGNO dent® or Spectra™
  4. Home care — choices — Stop the floss insanity —Water flossing is in! Discuss nutrition. Consider probiotics.
  5. Pictures — Intraoral camera pictures always! If there is treatment, always print the pictures to send home.

Hygiene treatment improvements:

  1. Ultrasonic as primary instrument — Remove that biofilm and save time!
  2. No pain — use topical N20 anesthesia to assure comfort.
  3. Refresh with mouth wash so their mouth tastes fresh and clean as they leave.
  4. Hygienist makes the patient’s next appointment and personalizes the reason for return interval and appointment. Record this in the record and on the appointment card.

Improvement No. 4: Treat children special and always include parents.

Child appointment improvements:

  1. Review home care first with disclosing — always!
  2. Discuss healthy nutrition, snacks, xylitol, etc.
  3. Show decay/sealant need — DIAGNOdent or Spectra
  4. Inform about eruption pattern/ortho referral
  5. Talk with parent in the operatory — have parent there for the hygiene exam

Hygiene exam improvements:

*** The hygienist delivers a “talk-over” when the dentist enters the room for the exam. “Talk-over” is similar to “grand rounds” at a hospital. The RDH gives a full report of all things done, seen, the results of the exam, and areas that need a diagnosis. This is always reported at the beginning of the doctor exam.

Doctor exam improvements:

  1. OCE every recare — four eyes are better than two!
  2. Perio exam and diagnosis before restorative.
  3. Restorative exam with camera.
  4. Review X-rays and make specific comments about them. Be sure to give comment and value to the radiographs.
  5. The doctor should reinforce specific recall interval as well as the treatment plan.

Improvement No. 5 — Don’t turn them off! These things turn patients off and decrease their desire to return:

  1. A judgmental attitude or conversation about the patient’s home care or lack of follow-through with treatment
  2. Pushy or wishy/washy dentist or hygienist
  3. Distracted doctor or hygienist (You can’t have a bad day no matter the situation in the other operatory or at home!)
  4. Poor body language, posture, or appearance
  5. Leaving mask and loupes on during communication about treatment.
  6. Standing up and talking to patients, even if you are leaning on the counter. Sit and face them eye-to-eye.
  7. Not enjoying your patients. But do not be too social. This is a professional appointment.
  8. Being too quick or too rough.

Improvement Idea No. 6 — Have committed administrative support of the hygiene department. Someone who is on the business staff must own recare, the hygiene schedule, and all of the follow-up involved.

Your hygiene department will never be all it can be if the management of recare is left to the hygienists. There must be someone at the front desk who is as committed to keeping the hygienists busy as they are to keeping the dentist busy.

For every full-time hygienist or hygiene schedule, there is at least three to four hours of administrative work daily. (Please e-mail me for a checklist of these daily, weekly, and monthly administrative duties.)

Hygienists, on the other hand, should be cross-trained to assist with these administrative duties when they do not have a patient. With today’s use of ultrasonics, hygienists should not be disappearing when their patient cancels to “sharpen instruments.” Most importantly, have a staff meeting to discuss and implement these six improvements.

Remember: The largest room in the house is the “room for improvement”!

Linda Drevenstedt, RDH, MS, has “in the trenches” experience to assist practices with improvements. From periodontal therapy training to managing a group practice, she customizes her consulting. Lecturing credits include Hinman, ADA, AGD, and the Yankee Dental Congress. Drevenstedt is a member of the ADMC, AAOSH, AADPA, and AADOM. Contact her at [email protected] or at (800) 242-7648.

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