Dental hygiene: Loss leader no more

In the past, hygienists were considered "tooth scrapers." They were prima donnas who were paid very well for what they did. The hygiene department was considered a loss leader. Not so today.

by Drs. Matt & Ann Bynum

In the past, hygienists were considered "tooth scrapers." They were prima donnas who were paid very well for what they did. The hygiene department was considered a loss leader. Not so today. A hygiene department that is run effectively is so much more than a "tooth scraping" department; it is a critical contributor to the dental practice's profit.

Having just returned from the RDH Under One Roof conference held in Chicago, it is very apparent that hygienists have something valuable to offer. Today's hygienist can provide adjunctive and supportive periodontal treatment through co-diagnosis, introduce aesthetic and restorative treatment, and contribute toward increased practice profit. In this article, we'll discuss how you can be productive doing dentistry while your hygienist can be productive doing hygiene.

Because there is a shortage of dentists for the increasing population, dentists should perform very little, if any, hygiene themselves. Spending time "cleaning teeth" simply is not profitable. You graduated from dental school so you could practice dentistry!

Dentists who practice their own hygiene are either stuck in the old paradigm of dental practice, scared to relinquish control, scared to relinquish money, or have very small practices. If it's the latter, performing your own hygiene is likely the most efficient thing to do. It is congruent with this style of practice philosophy. However, if you are performing your own hygiene for any of the other reasons, you have no excuse for falling behind in the profession of dentistry. You are the one who creates your office environment and philosophy, which affects your team's attitude.

In the past, hygiene carried with it a negative attitude. On one side were the front-desk people and the assistants. On the other side were the hygienists. They always made more money and didn't seem to work as hard as everyone else in the office. The hygienists hardly ever cleaned their own instruments. They believed that they were better than everybody else. And they always left before anybody else did!

Without getting into the concepts of team, suffice it to say that everyone in the office — everyone — is there to do two basic things: serve the patients and serve the practice. That means that everyone — hygienists included — should be doing his or her own part to achieve these goals. There are many tasks that must be taken care of in a dental office: scheduling, making phone calls, confirming appointments, sterilizing instruments, cleaning treatment rooms and readying them for the next appointment, assisting patients in making financial arrangements, and more. There is no one person on the team who is more important than another. The fact is, if you took away any one team member, your practice and your patients would suffer.

I hear constantly from dentists of all ages, especially young dentists just starting out, that they cannot afford to pay a hygienist at this point in their practice. I say you can't afford not to have one! How much profit do you think you are making by doing your own hygiene? If you spend your time doing hygiene, when will you do the profitable restorative procedures? Picture this scenario: You're scheduled to do hygiene on new patients for several days. Some of those patients need restorative work. Now, you must find time to fit them in an already packed schedule. When will it stop?

The philosophy I hold is that of potential. I justifiy my hygienist's salary by determining if she makes enough money production-wise to pay her salary. In return, this gives me time to treat the needs of the restorative patient. The two feed off each other with regard to practice profitability.

If fear is what is driving your reluctance to change, then it is time to venture out of your box! Because you create the office environment, it is imperative that you understand the basic principles of business. The dental practice productivity leader is restorative dental work. It is time to relinquish control of the patient's periodontal health and maintenance to the hygiene department. Just as a specialist receives training beyond the basic elements of dental education, so do hygienists. Allow your hygienist to maintain and treat the periodontal health of your patients. This is where the concept of the profit center comes into play.

The profit center

Hygiene profitability is made up of more than just money. Your practice prospers by restoring your patients to health using state-of-the-art treatment modalities. Roughly 60 to 80 percent of your patients suffer from periodontal disease. No longer are a prophy, brushing more, and flossing more going to stop this silent killer of teeth and surrounding structures. As with any disease, rapid removal of the infection is imperative. Hand scaling and polishing alone will not eliminate this persistent disease process. It is time for dental practices to begin using antimicrobial therapy and ultrasonic instrumentation.

With ever-improving instrumentation, there should be no reason why we cannot offer patients the luxury of periodontal health. This means that patients need to be seen more often, and treated more aggressively. More visits and higher fees due to treatment modality result in monetary profit to our practices. The profit to our patients is health.

In addition to treating patients periodontally, hygienists have the ability to expand our practices restoratively and aesthetically through co-diagnosis. For this to succeed, you must make continuing education a priority. Hygienists should be allowed the same opportunity as dentists to attend meetings to learn and converse with colleagues. While attending the RDH Under One Roof conference, I observed some 350 hygienists from around the country learning new treatment modalities, the latest advancements in aesthetic dentistry, and motivational techniques. The conversations I heard were positive and productive, and the outcome is enthusiasm for the profession. How can this not translate into profit? I would strongly suggest that you send your hygienist to the next RDH Under One Roof conference in Las Vegas, Feb. 6-7, 2003.

Co-diagnosis involves diagnosing by two individuals: the dentist and the hygienist or the hygienist and the patient. A hygienist cannot legally diagnose a patient's condition, but the hygiene department is very well-versed in diagnosing and treating periodontal disease. When you enter the treatment room, your hygienist shows you what they are seeing, the symptoms, and the recommended treatment. This is, in fact, a diagnosis. Most of the time, you walk into the hygiene room, agree with the hygienist, and walk out — a co-diagnosis. However, by educating your hygiene department about your restorative philosophy and treatment, your hygienists can co-diagnose this type of treatment as well. Keep in mind that something heard twice by the patient is more profound than something heard only once.

By using these basic principles, it will become obvious that hygiene is anything but a loss leader. You can turn your hygiene department into a practice profitability department. Your practice will prosper, your hygienists will be more enthusiastic, and your patients will be healthier and happier. How can you lose?

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