Five ways to increase hygiene production

Oct. 1, 2008
Dental hygiene is a key driver of practice production. Unfortunately, many practices aren't maximizing the potential of their hygiene department.

by Roger P. Levin, DDS

For more on this topic, go to and search using the following key words: hygienist, production, hygiene department, Roger Levin, Waterpik, Previser.

Dental hygiene is a key driver of practice production. Unfortunately, many practices aren't maximizing the potential of their hygiene department. In a typical scenario, the hygienist will treat seven or eight patients in a given day, providing prophylaxis and basic ancillary services, such as bitewings. While this may be appropriate, it is not utilizing the hygiene area to its full potential by providing comprehensive and outstanding care for patients. Especially in today's economy, practices need to maximize all of their resources, including the hygiene department.

The Hygiene Maximizer™ is an approach to dental hygiene with the goals of reaching the true production potential of the hygienist, providing outstanding clinical care for patients, and creating increased production for the dentist.

Using the Hygiene Maximizer, you can increase annual hygiene production by $100,000 to $200,000 per hygienist. It has been proven in hundreds of practices and can be implemented almost anywhere. Five of the principles of the Hygiene Maximizer are listed below.

Have 98% of your patients scheduled at all times

While many offices feel that they are close to this mark, the truth is that they are farther away than they might believe. Levin Group finds that practices usually present with fewer than 90% of active patients scheduled and often less then 70%. Obviously, if patients aren't scheduled, you can't provide them optimal oral health care.

Most hygiene patients receive basic hygiene care and are assessed regarding any obvious dental needs. However, for practices to reach their hygiene potential, hygienists need to educate patients on all services, including cosmetic and elective procedures. All too often hygiene patients receive information on only need-based dental services.

There are several ways to deal with this situation, including performing a complete analysis of each patient's hygiene and dental needs during the hygiene visit; bringing every patient back once every seven years for a comprehensive examination; and using a predictive index, such as Previser, which provides a detailed report on the patient's periodontal health.

Hygiene can be a major production driver for the practice, but only if patients are coming in.

Promote comprehensive dentistry

As mentioned above, there are different techniques that practices can use to provide complete analysis and care. However, in most cases, this is not happening. One reason is that the dentist is so busy with restorative patients that the hygiene appointment is more of an interruption than anything else. Dentists go into hygiene to make a quick diagnosis, if any, and get back to their original patient. While a focus on immediate patient needs is understandable, this approach goes against the grain of a practice reaching its true potential, especially through hygiene.

Using the Hygiene Maximizer method, the dental hygienist will do a complete analysis (hygienists are typically not legally allowed to provide diagnosis) of the patients' intraoral condition. Once hygienists become educated to find all potential hygiene need-based and elective treatment opportunities, the entire orientation of the hygienist begins to change.

To assist hygienists in identifying treatment opportunities, I recommend the Levin Group Five Stage Patient Examination™ — the periodontal exam, tooth exam, cosmetic exam, implant exam, and occlusal exam. While many dentists believe that they provide all of these five phases (and they might in some way, shape or form), they are not focusing individually and emphasizing each stage properly to the patient.

Build strong relationships with patients

The Hygiene Maximizer has a series of protocols that include learning a specific number of personal items about the patient, building the relationship with common interests (such as family, interests, hobbies), etc. Each hygiene appointment represents an opportunity to build stronger relationship with the patient. Patients value coming to a practice where they are valued and appreciated.

A strong focus on at-home home care can be an effective way to build even greater trust between hygienist and patients. Encouraging patients to use at-home oral health products can have a tremendous impact on how patients feel about the hygienist and the practice. It is one thing to say you care and another to demonstrate it. Many practices offer in-office dispensing of dental water jets and other at-home care products, giving patients the opportunity to purchase these items at a reduced rate without having to drive to the store.

Enhance doctor-hygienist communication

Dentists need to stop thinking of the dental hygienist as an interruption, and quit putting off going to the hygiene room as long as they possibly can. Throughout the day, dentists should be prepared to meet with the hygienist after she has completed the five-stage examination and educated the patient on treatment possibilities. The meeting should occur outside the treatment room and last one or two minutes. When meeting regularly with their hygienists, doctors become more focused, understand the patient's situation, and are well-positioned to sow the "seeds" planted by the hygienist about potential treatment. This enhanced doctor-hygienist communication will have a dynamic effect on hygiene production and dentistry referred back to the dentist from the hygiene department.

During the meeting, the hygienist should tell the doctor exactly what she has found, what she recommends, and any special circumstances regarding the patient. For example, the hygienist may have identified an opportunity for cosmetic dentistry, presented it to the patient in a motivating manner, and discovered during their discussion that the patient is getting married in six months. The upcoming wedding may be more important in the decision-making process than any other single aspect, yet there are dentists who are unaware of this motivating factor. The good news is that the dentist-hygienist meeting takes only a minute and the hygiene exam by the dentist can usually occur in less then five minutes.

Increase hygiene production

Many hygienists think of production as prophys, bite-wings, an occasional panoramic radiograph, and a few other services sporadically offered. This is different from a hygienist who has a checklist of potential hygiene-related treatment. In-office dispensing has been very effective for a number of practices, but many are still not comfortable offering specific dental-related products for sale. This is unfortunate because most patients report that they would rather purchase a recommended product directly from the office as they find it more convenient. In-office dispensing is an opportunity to make specific recommendations to patients and have the product available for immediate purchase. This not only acts as a convenience factor for patients, but also increases practice production and contributes to higher hygiene department production.

Having dental water jets, power toothbrushes, and whitening kits available for sale is a positive and excellent strategy. It also helps to create a "wow" factor for patients who are pleased to learn they can purchase an oral health-care product in the office. Many retail products can be purchased at much lower costs in the dental office due to a professional rate offered by the manufacturer.

When the hygienist offers these home-care products, production will immediately and significantly increase. Of course, it is up to the hygienist to discern which ones are appropriate for each patient, but the most important aspect of patient acceptance and cooperation is to make these home-care products seem like a standard.


Dental hygiene is one of the great opportunities to increase overall practice production, especially in today's economy. The Hygiene Maximizer principles described above will immediately set your practice on a growth path as well as create more value for patients. Hygienists following this protocol receive higher patient satisfaction scores than those who simply see patients for prophys and basic ancillary services. Hygiene is changing in many offices. These six Hygiene Maximizer principles will give you an outstanding overview of how to reframe your hygiene program and take your practice to the next level.

DE readers are entitled to receive a 20% courtesy on the Levin Practice Power Seminar™ for general dentists to be held Nov. 20-21 in Chicago. To receive this courtesy, call (888) 973-0000 and mention "Dental Economics®" or send an e-mail to [email protected] with "Dental Economics®" in the subject line.

Roger P. Levin, DDS, is founder and CEO of Levin Group, a leading dental management consulting firm that is dedicated to improving the lives of dentists through a diverse portfolio of lifetime services and solutions. Since the company's inception in 1985, Dr. Levin has worked to bring the business world to dentistry. Levin Group may be reached at (888) 973-0000, or at

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