Finding more room at the inn!

Following November’s column, “Key hygiene statistics,” I received several e-mails and telephone calls asking for more information on this topic and the health of the recall.

Following November’s column, “Key hygiene statistics,” I received several e-mails and telephone calls asking for more information on this topic and the health of the recall.

The article discussed a dental practice so busy that it had no room for additional patients requiring periodontal treatment. “No place to put ’em,” the scheduling coordinator said. Patients were encouraged to come in for more “frequent cleanings” (if you know me, you know I am gasping for air as I write this), and they watched and waited until the perio was severe enough to send the patient off to the periodontist. We could write 14 articles about why you are treading on thin ice if you go down that path, not the least of which is the legal and liability issues surrounding that scenario.

My analysis of the practice began with determining the hygiene/recall requirement of the office, using the formula described in the November article. The practice had 1,500 patients of record (good patients), and averaged 20 new patients per month. Allowing for 25 percent of the patients to be seen for periodontal treatment, active treatment, and maintenance - as well as a 15 percent attrition rate - the hygiene department needed to see 290 patients per month. The practice currently had seven (eight-hour) days of hygiene per week or approximately 224 monthly hygiene hours. How do you accommodate 65 more patients each month? At first glance, 65 additional patients may seem impossible. However, if you break it down, that is only 16 more patients each week.

If finding room for additional periodontal patients is your practice’s “problem” (and it is a great problem to have!), here are three ideas to explore. Use the one(s) that fits in best with your practice requirements:

The easy and quick solution is to offer 16 additional hygiene hours. Before you do, consider the following:

How efficient is the current hygiene schedule?

Are there some patients who do not require an hour?

How many children are seen monthly and how long are their appointments?

What about patients with partial dentitions and patients that are exquisitely healthy, fully restored, and up to date on everything?

In other words, allow the hygienist to schedule units of time appropriate to the clinical needs of the patients.

Are you fully maximizing office space and time? If there is more than one doctor in the practice, consider making the office schedule more flexible and extending your hours of practice. If your state’s rules and regulations provide for indirect supervision, then extend hygiene hours to see patients-of-record.

Consider the assisted hygiene model. In this scenario, the hygienist works with two treatment rooms and a skilled assistant. The hygienist delegates duties allowed by state law. so the focus is on the highly technical skills for which the hygienist has been trained. During the first 10 minutes of the appointment, the assistant seats and greets, updates the all-important health history, sets the stage for periodontal education, takes necessary radiographs, reviews the treatment plan and any undone dentistry, and presents visual education regarding the treatment the dentist recommended at the last appointment. A great assistant will answer questions and discover why the patient has not proceeded with the treatment. Additionally, the hygiene assistant sets the stage for esthetic dentistry and elective procedures.

The hygiene assistant also completes the end of the appointment by “standing by” for the doctor exam and relating “facts and findings,” summarizes any discussion by the hygienist and patient, reviews patient education, polishes teeth and performs fluoride treatment (if allowed by state law), schedules the patient’s next appointment(s), prepares all take-home materials, assures that all questions and concerns have been addressed, and handles infection control and set-up for the next patient. Once the hygienist and assistant develop a work-flow pattern and good partnership skills (similar to the dentist and assistant), this team can see two to five additional patients in the day as a hygienist working solo. (Factors vary depending on the number of children seen in hygiene, prior perio services, etc.)

The result is the ability for hygiene to practice to the highest standard of care (which is what clinical hygienists strive to do), a substantial increase in the health of the patient, and increased profitability for doctor and staff.

Warmest wishes to all for a happy holiday season.

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, via e-mail at, or by phone at (772) 546-2207.

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