Increasing dental hygiene production

Feb. 1, 2012
Many dental practices are still struggling in the post-recession economy. One solution is to reinvent the dental hygiene department.

by Roger P. Levin, DDS

Many dental practices are still struggling in the post-recession economy. One solution is to reinvent the dental hygiene department. For too many years in too many practices, the sole purpose of the hygiene appointment has been for the hygienist to provide twice-yearly prophylaxis to patients. Unfortunately, in that model, opportunities are missed to create greater patient awareness of beneficial practice services and potential treatment options.

Consider this — the hygienist spends more time on average with patients than any other team member. The typical recare appointment runs 40 to 60 minutes. Devoting even a small portion of that time to patient education and case presentation can transform the hygiene appointment into an effective engine for increasing doctor production.

In too many practices, the hygienist is almost entirely focused on scaling and root planing. Of course, that is what hygienists are clinically trained to do, but practices are missing a real opportunity to educate patients, improve their understanding of treatment options, and ultimately increase case acceptance for need-based and elective treatment.

I have found hygienists to be highly skilled professionals with excellent verbal and interpersonal skills. Yet, many practices are not capitalizing on these skills, and patient education is being neglected. For many years, Levin Group has trained hygienists to become critical participants in the patient education process, which ultimately results in increased practice production. By expanding the role of the hygienist from merely a “tooth cleaner” to an oral health-care provider and educator, practices can realize the potential that’s sitting in their hygiene departments.

The new dental hygienist

In addition to scaling, root planing, radiography, and other traditional duties, the job description of today’s dental hygienist should include educating patients, identifying potential treatment, and motivating patients toward accepting recommended care.

Clearly, it can be challenging to engage patients in conversations about improving their oral health when scaling and root planing are underway. But further consideration reveals that the hygiene appointment is an appropriate place to begin discussing treatment options. There are numerous opportunities for the hygienist to educate and motivate patients before and after prophylaxis. In addition, during the actual recare appointment, there may be occasions for the hygienist to briefly inform patients about oral health issues (e.g., gingivitis, caries, edentulism, etc.).

The following steps will help hygienists improve patient education and increase practice production:

1. Review all case presentations with patients who have not accepted or completed treatment prior to the hygiene appointment. Many patients put off treatment due to economic concerns. If the hygienist politely reviews the recommended treatment plans each time a patient presents for a hygiene appointment, the practice will be quite surprised at how many patients decide to accept treatment six months or more after the original treatment presentation. Failure to regularly review recommended treatment is a classic mistake made by many practices.

2. Educate patients about the concept of phase treatment. Patients are often willing to accept partial treatment now, and then schedule to complete treatment within one or two years, when someone truly takes the time to explain the process to them. Phase treatment is an excellent strategy for closing cases, but often the second and subsequent phases are never completed because no one follows up with these patients. The dental hygienist has an opportunity during the recare appointment to reinforce the value of treatment to the patient and the importance of optimal dental care. This type of attention ensures that patients schedule to complete the subsequent phases of treatment. Such an approach will have a significant effect on increasing case acceptance and long-term practice production.

3. Build support for potential treatment. While hygienists might not be able to present treatment due to state regulations, they can certainly set the stage for the dentist. Hygienists play a critical role in patient awareness, education, and overall quality of care. It is paramount that the hygienist and dentist work together in a highly collaborative environment to ensure that all patients receive the treatment they need to achieve excellent long-term oral health.

When the collaboration works like a well-oiled machine, doctor time with the patient is reduced. This increases production time and patient treatment, leading to an overall increase in practice production and, ultimately, happier and more satisfied patients. It is essential that dentists and staff become more aware of the value of the hygiene department, and to look for ways to maximize its contribution to practice production. Practices that have trained hygienists to identify and present treatment with doctor confirmation are increasing practice production despite the economy.

The new hygiene schedule

For practices to maximize the potential of their hygiene departments, hygienists must receive appropriate training in the areas of relationship building and case presentation. In addition, hygienists and other staff members must do everything they can to reduce no-shows and last-minute cancellations. The hygienist can’t build support for optimal oral health care if there isn’t a patient in the treatment chair.

The following steps can help practices motivate hygiene patients to keep their appointments:

1. Build greater value for the hygiene appointment. Many offices refer to the hygiene appointment simply as a “cleaning” or a “recall” visit. None of these terms describe the true value of the hygiene appointment to patients. I recommend that the hygiene visit be referred to as “the periodontal maintenance and oral cancer exam appointment” or something similar. Describing the hygiene appointment this way will create a sense of greater value for patients who may not recognize that periodontal disease is a true disease and that oral cancer exams are just as critical as other types of cancer exams.

2. Schedule the next hygiene appointment during checkout. The front desk team should be trained to schedule the next recare appointment before patients leave the office. Hygienists can assist the front desk team by reminding patients that if they schedule early, they can usually get their preferred time. Keeping patients on the schedule helps them maintain their oral health with regular hygiene appointments.

3. Implement an effective confirmation system. Every patient should be contacted 48 hours in advance of the recare appointment via cell phone, e-mail, text, or work phone. Some practices have successfully engaged the hygienist in the process. This enhances the sense of one-to-one personal care between the hygienist and the patient.

4. Keep track of unscheduled hygiene patients. Overdue patients represent a significant challenge for many practices. Many times, these are the patients who do not schedule their recare appointments in advance. Do not wait until these patients are overdue for hygiene care before contacting them. Be proactive. If they are on a six-month recare schedule, a personal call from the hygienist can make all the difference. In some highly productive practices, the hygienist schedules these patients during that call.

Make your hygiene department an asset

The hygiene department is an overlooked asset. Training the hygienist to educate and motivate patients about optimal oral health care is essential for practices that are ready to increase both hygiene production and doctor production. Practice growth begins in the new hygiene department. Use these action steps to turn your hygiene department into a true practice builder based on quality care for every patient.

To learn how to run a more profitable, efficient, and satisfying practice, visit the Levin Group Resource Center at This is a free online resource with tips, videos, and other valuable information. You can also connect with Levin Group on Facebook and Twitter (Levin_Group) for learning strategies and sharing ideas.

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