New year, new goals

Happy New Year! The start of a new year is the perfect time for reviewing goals. Throughout the country, a pattern for effective and productive hygiene has emerged.

Annette Ashley Linder, BS, RDH

Happy New Year! The start of a new year is the perfect time for reviewing goals. Throughout the country, a pattern for effective and productive hygiene has emerged. Here are four key elements - benchmarks for success.

1) Hygiene services

A) Periodontal procedures: Analyze hygiene services for 2004. If production consisted of 90 percent prophies and 10 percent periodontal services, then something is wrong. The AAP estimates 70 to 85 percent of adults have some level of periodontal involvement. Current research correlating systemic health and periodontal infection mandates the need for ongoing periodontal evaluation. Translation: Do not assume that because a patient-of-record was "healthy" at the last dental hygiene appointment, that he or she will be periodontally stable forever.

Goal: Twenty to 40 percent of hygiene revenue is generated for periodontal procedures - Codes 4341, 4342, 4355, 4910, and 4381. Many of the offices I work with have had nonsurgical periodontal protocols for over 10 years. It is not unusual in these practices to see 25 to 30 percent for Code 4910 (periodontal maintenance) and another 10 to 15 percent in "new perio."

Step to solution: Review and update office periodontal protocols, based on the current research. Consider an external consulting source to facilitate the transition.

B) Radiographs: Make sure your patients are up-to-date in complete radiographic analysis. A 10-year-old FMX does not "cut it."

C) Complete range of services (per state regulations): This includes nonsurgical periodontal treatment, fluorides, sealants, anesthesia delivery, tooth-whitening, halitosis treatment, tobacco cessation, nutritional counseling, and dispensing and training with home oral health-care products.

2) Patient retention (recall)

Patient retention is the heart of the practice. However, the average dental practice averages 50 to 60 percent in recall. Translation: Four to five out of 10 existing patients-of-record (often good patients) are sitting in the central file, overdue and overlooked. The hygienist plays a huge role in the continuing success of the patient retention (recall) program. Chart audit and patient activation need to be ongoing projects which include a daily review of charts, computer reports, and accountability.

Goal: Generally accepted normal attrition rate in dentistry is 10 to 15 percent. An achievable goal is to retain 85 to 90 percent of patients.

Step to solution: Do you have a clearly defined system in place (and in written form) for patient retention? Who is responsible for recall and the daily schedule in your practice?

3) Scheduling efficiencies

Cancellations, failures, and open time in hygiene cost the practice big bucks, with losses in both hygiene and doctor revenue. The typical practice averages one to 2.5 openings each day in hygiene. Prereserving appointments - ideally with the hygienist in the treatment room - enables the hygienist to build a productive schedule. Scheduling patients with the units of time based on clinical need, rather than every patient being appointed for the same length of time, is working very well throughout the country. Time is reserved to properly assess, inform, educate, and instruct the patient. An appropriate fee is charged for services rendered.

Goal: Ninety percent of patients leave with their next appointment, and the patient is involved in the reservation process. This creates ownership and accountability, and reduces cancellations and appointment failures. Written information is dispensed, such as the "Oral Health Fitness Report" (visit and download a copy).

Step to solution: The scheduling ratio is 93 percent for the month (i.e., patients actually seen measured against available units of time).

4) Compensation

Total compensation-to-production ratio does not exceed 35 percent. The hygienist understands the goals and is equipped to meet and exceed them. Consider an incentive for production once the break-even point has been met. Review at a monthly hygiene meeting to stay on track.

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 email at, or by phone at (804) 745-6015.

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