Do I need a hygiene assistant?

Dec. 1, 2006
I received a call from a dentist concerned about scheduling. This doctor had a patient base of 2,500 patients and had been in practice at the same location for 20 years.

Annette Ashley Linder, BS, RDH

I received a call from a dentist concerned about scheduling. This doctor had a patient base of 2,500 patients and had been in practice at the same location for 20 years. Now, however, the doctor realized her schedule was “slowing down.” Analysis of the practice revealed that one of the problem areas was an inadequate number of hygiene hours to meet the needs of the patient base - in other words, recall visits.

Patients-of-record were not getting back in for their hygiene (recall) appointments because there was no room built into the hygiene schedule. (Note: I would rather be faced with this “problem” than not having enough patients to fill the schedule!) As a consequence, the dentistry was not getting diagnosed, and this ultimately resulted in a downturn in doctor productivity. Treatment rooms were available to meet the patient volume, but hygienists were not readily available in this rural area.

If this scenario is applicable to your practice environment, a new plan of action is needed. Integrating an assisted hygiene model is one approach to solving the dilemma. Here are some steps to consider as you make the determination.

1. Determine need

Variables include:

  • Hygiene schedule is too full to accommodate the patient volume.
  • Doctor and hygienist seek alternatives for increased clinical excellence and profitability.
  • Difficulty recruiting hygienists.
  • Idle space/unused treatment rooms.
  • Skilled, cohesive dental team operating in a goals- based, shared-profit model.

2. Physical plant

Since hygiene assistant utilization requires at least two treatment rooms, available space should be evaluated objectively and creatively. If you are short on space, but long on patients, an analysis of treatment room utilization is required. In addition, ask yourself if all the space in the practice is utilized efficiently. Consider underused areas such as storage, audio-visual, doctor’s office, lounge area, lab, and any other small-space rooms that can be easily and inexpensively converted. Consider consolidating these areas to free up space for the second hygiene treatment room.

3. Benefits

For the patient: Patients who are cared for by a skilled hygienist-assistant team receive more (not less) professional care, concern, and individualized attention. Rather than feeling rushed through, patients have the attention of not one, but two talented and professional members of the dental team. There is ample time (key word here is ample) for attention to clinical detail when the hygienist knows that the assistant will spend all the time necessary in patient education, reinforcement, treatment discussion, asking for referrals, practice growth and development, and relationship-building. In other words, this is not a 30-minute prophy polish. The key to creating a dynamic and happy duo is to actively engage the hygienist in the recruiting, training, and delegation of duties (always within the scope of state regulations).

Introduce the CDHA (clinical dental hygiene assistant) in a professional manner: “In our continuing effort to provide optimum care for our patients, we have added a wonderful new member to our great dental team. Mrs. Smith, this is Leslie, our clinical dental hygiene assistant. Leslie has had specific training in oral health-care education and she will be working with you to ensure the best ways to eliminate bacterial plaque, as well as answer all of your questions.”

Benefits to the practice

With increased capacity, patients can be scheduled appropriately and seen in a timely fashion. Hygienists’ efforts are concentrated on procedures that only they can perform, and delivery of necessary therapeutic services is more efficient. Patients are better served and the hygienist is both clinically excellent and highly productive due to structured capacity and the ability to accommodate more patients each day. Just as important is the increase in dentist production. Many dentists have discovered that they can spend more time during the examination because there is no pressure to “get in and get out because the next hygiene patient is waiting!”

Additionally, three providers now have the “time” to present and schedule dentistry. In several of my client offices, dynamite hygiene assistants act as treatment coordinators. They review findings with the patient, answer questions and concerns, discuss the financial aspects, and schedule the dentistry - many times right from the “hygiene” treatment room! Typically these hygiene assistants have a strong clinical-assisting background and may even have been with the doctor and practice for many years. (Note: My personal observation as a consultant is that we have long overlooked the potential of our talented dental assistants.)

Benefits to the hygienist

Hygienists report a major benefit of working with a skilled assistant is the reduction of what I call RSR - running, scrubbing, and recording. Fatigue for the hygienist occurs from the myriad of repetitive tasks (now termed multitasking) that absolutely must be done on each and every patient. As you can see in the hygiene anatomy chart (Figure 1), as much as 50 percent of the typical hygiene appointment is spent in nonclinical duties.

In addition to the operations during the scheduled appointment - and depending on patient volume and practice hours - additional duties of the hygiene assistant include equipment maintenance, instrument-sharpening, appointments and scheduling, recall system, inventory control, stocking and hygiene inventory, public relations notes, and phone calls.

Increases in production equal increased profitability margins. The dentist and hygienist have an equitable and agreed-upon incentive program that clearly defines the hygienist’s compensation. Set achievable goals and incentives for the team.

How to make it happen

  • Determine what you will delegate, and create a preliminary job description. Modify as skill levels and confidence increase.
  • Evaluate and meet with current staff members.
  • Implement slowly - Following the hiring and training period, begin integrating with a half day, then a full day. Allow for the learning curve. Don’t be deterred if a day falls apart or things don’t flow perfectly at the beginning. In dentistry, we are such perfectionists that we often do not give ourselves the time we need to learn or try a new practice principle.
  • Schedule a mix of services, including periodontal procedures, preventive care, sealants, and cosmetic procedures such as tooth-lightening, splints, fluoride trays, etc. Create a scheduling template. Reevaluate and modify as needed.
  • As with all systems in the practice, always regularly monitor the results through data analysis and staff meetings.

Don’t hesitate to refine your system and modify it along the way to meet the changing needs of your practice and people! Careful planning and appropriate implementation of the assisted hygiene model can open a whole new world in the practice. It is a concept that we will see more of in successful dental practices.

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 [email protected], or by phone at (772) 546-2207.

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