by Sheri B. Doniger, DDS

The cost of downtime

Sept. 1, 2011
Imagine receiving the phone call you never wanted to receive. Your hygienist of 10 years has been diagnosed with carpal tunnel syndrome ...

Imagine receiving the phone call you never wanted to receive. Your hygienist of 10 years has been diagnosed with carpal tunnel syndrome or a rotator cuff injury and will be out of the office for weeks, possibly months. You look at your schedule and see that her book is filled solid for the next month.

The American Dental Association recently published results from its survey center on dental hygienists’ weekly patient load. The data indicates dental hygienists see, on average, 25 patients per week. According to practice management gurus, the average daily production from a solo hygienist may be from $1,500 to $2,500. With a hygiene salary of between $28 and $47 an hour, a large profit center will be missing.

Hygienists forge a special bond with their patients because they see patients on a routine basis. They are able to discuss treatment needs and present options that the office offers in their scope of therapy. When you lose your hygienist, you lose a solid link to the treatment goals of your patient.

When you lose your hygienist, you not only lose a trusted team member, but many intangibles. The dental hygienist has the most direct face time or contact with patients. During a 40- or 60-minute appointment, the hygienist is focused on one thing: the patient in the chair.

If a hygienist is lost to the practice for any amount of time, the cost of replacement may be $40 an hour on paper, but the actual cost to the practice is higher, even if you have a good replacement. Nothing works like the existing team.

The intangibles are great. Loss of continuity in care is paramount. Let’s face it, patients like their hygienist. Sometimes they come to our office to see her or him, not us. Patients have been known to follow their hygienist from practice to practice. This is a costly dynamic to upset.

More than one-third of our hygienists have workplace-related injuries. These musculoskeletal issues are from repetitive stress due to improper positioning, which results in them twisting like a pretzel to accomplish their tasks. Due to the procedures being performed, hygienists often experience prolonged neck or shoulder abduction or flexion due to the static nature of scaling. These areas may be avoided if the dental practice is set up with ergonomics in mind.

Forward-thinking companies are now concerned with ergonomic dental equipment. Manufacturers are thinking about function rather than form. From dental stools to cordless prophy units, the industry has heard, loud and clear, that the cost of downtime is just too much for the dental practice. As almost 99% of practicing dental hygienists and more than 40% of practicing dentists are women, dental manufacturers are creating products that will enhance and elongate clinicians’ practices.

Dental magnifiers or loupes have become standard of care in many dental practices. Not only does the accuracy of the visual inspection improve, there is a reduction in eye strain and an increase in focal distance. The bottom line is, dental loupes help improve posture, increase visualization of the oral cavity, decrease neck, shoulder, and eye strain, and increase patient satisfaction because patients know we can “see” better.

The following companies specialize in dental magnification — Designs for Vision (, Orascoptic Research (, General Scientific Corporation – Surgitel (, Eagle Optical Products (, Keeler Instruments (, Light Tech Incorporated (, Microsurgery Instruments, Inc. (, PeriOptix (, and SheerVision (

Dental lighting is paramount to accurate visualization of the oral cavity. Loupes are available with or without additional lighting systems. The addition of a light will increase visualization and improve posture. Products such as the Isolite System ( not only give direct lighting at the point of action, but also provide for hands-free retraction and aspiration. A clear, dry, lit dental field is also an invaluable asset to working posture.

DentalEZ ( has an innovative new operatory light that uses LED technology. DentalEZ EverLight™ (right) is a functional addition for any dental procedure, from dental hygiene to esthetic dentistry. This light saves 70% energy over halogen operatory lights. Operating with LED, similar to curing lights, the energy efficient light is very functional and ergonomic.

Nine lighting options are available — three Kelvin color settings, daylight for excellent shade matching,
composite for when it is time to cure composites or sealants, as well as three intensity settings (low, medium, and high) to personalize each setting. The 12 LED lights give focused illumination for all procedures. The light runs cooler and is user friendly.

Dental operator chairs are not just movable ottomans. They need to support and aid the clinician. The circular or oval-shaped dental stools have given rise to newer, more comfortable units with saddle seats, active and passive backrests, and declined dynamic seating.

There are a plethora of different styles and fit for different sized clinicians. Two specific companies come to mind with ergonomically designed seating — Crown Custom (, and RPG Dental ( Crown Custom, RPG, and DentalEZ have added armrests to their chairs.

Dental light cure systems also range in shape, size, and weight, depending on the manufacturer. Each unit should be personally evaluated prior to purchase to determine which weight balance works best for your team member.

Ultrasonic instruments are great for debridement, removing large areas of calculus, and subgingival scaling. Inserts now come with a variety of tip designs and are available in both non-swivel and swivel. The swivel inserts are more ergonomically functional because they only need fingertip movement to change the direction, not a twist of the wrist, hence eliminating some hand stress.

Hu-Friedy ( Swivel Direct Flow® inserts offer great maneuverability and access. Discus Insight™ ( has both swivel and an LED light for optimal visualization, especially in the posterior regions of the oral cavity. Along with proper magnification, this insert has major advantages for ergonomics.

Dental handpieces come in all shapes and sizes. There are several lightweight brands available, such as DentalEZ ProphyStar®3 (62 grams), and the Midwest RDH (three ounces or 85 grams). Finally, the tethering of the handpiece to the dental unit may be both cumbersome and add unintentional additional weight to the unit. Regardless if the tubing is coiled or straight, there is still “pull.”

Discus ( has an innovative product, the Zen (right). This is a cordless portable prophy unit, which affords complete portability from not only operatory to operatory, but for either right- or left-handed clinicians to use without the hassle of limited cord length. Based on the freedom, weight, and shape of their cordless LED curing lights, the Zen features a well-balanced handpiece to prevent hand fatigue and any undue pressure. It weighs a mere 94 grams, which is remarkably less than any other handpiece due to the increased weight the cord or tubing brings to the mix. The barrier and prophy angles are textured for easier control without grasping. A plus on the relaxation side, it sounds less like an ordinary slow speed. The Zen is lithium battery-operated, comes with a wireless rheostat foot petal, and is a great ergonomic addition to any operatory.

Some might think recreating an existing dental office with more ergonomic friendly products may be costly, but the cost of losing an employee is much greater. Small steps may be taken to convert an office to a more user-friendly environment.

Decreasing work-related injuries and increasing the comfort of your practice for team members, especially the hygienist, will improve your bottom line. The hygienist is a valuable link to comprehensive dental care. Being aware of all the functional factors of body mechanics will elongate the entire team’s practice lives. Think about these components the next time your back screams at you.

Sheri B. Doniger, DDS, is a leading dental clinician, author, educator, and consultant who currently practices dentistry in Lincolnwood, Ill. Dr. Doniger has written numerous articles on topics ranging from periodontal disease to effective communications, and has presented many lectures with an ongoing focus on women in the dental industry.

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