The value of a hygienist

Oct. 1, 2003
The practice of dental hygiene is illegal in France and Belgian. Half the dentists in those countries are working hard to change the law, but the other half still believe they can do cleanings better than a hygienist.

Trisha E. O'Hehir, RDH, BS

The practice of dental hygiene is illegal in France and Belgian. Half the dentists in those countries are working hard to change the law, but the other half still believe they can do cleanings better than a hygienist. They're also convinced that having a hygienist would cost them too much money. It's hard to believe that these misconceptions still linger, after so many years of dental hygiene practice.

It has always puzzled me that a handful of dentists are convinced they can do "cleanings" better than a hygienist. Those dentists probably never even worked with a hygienist. Show me a dentist doing cleanings, and I'll show you a struggling dental practice. Adding cleanings into the dentist's schedule doesn't make sense, either financially or clinically. The fees for routine dental hygiene are lower than restorative fees, so whenever a dentist provides dental hygiene services, production goes down. Dentists are trained to do highly technical restorative work and diagnostics, and that's where their time should be focused.

Years ago, I was an instructor in the perio department at the University of Minnesota. Our department was just like others in dental schools across the country. Perio never won any popularity contests, no matter what we did to make it "fun and exciting." As a doctor, you probably tolerated perio because you had to, but you went to dental school to learn to do the more profitable restorative procedures. Restorative is your expertise ... why would you want to do dental hygiene?

I remember working with a young dentist just beginning his practice. He had been a student and then later became an instructor. He was opening his own practice in a small town and convinced me to join his team. He was eager and talented and enjoyed working with an experienced team. He learned a great deal from the experienced assistant he hired. He also learned from me, as we performed the dental exams together. On the flip side, he brought the latest in science and technology to the practice, and the assistant and I enjoyed learning from him. It was a win-win situation all around, and patients reaped the benefits of high quality care. It was an office filled with fun, learning, and excellent dentistry.

A year and a half later, I was offered a teaching position in another state and sadly resigned my position. The dentist was reluctant to see me go, as we had built a successful practice on a foundation of dental hygiene and conservative periodontal therapy. We were a good team, each learning from the other the best ways to enhance patient health. I was surprised when he decided to wait a while before hiring a replacement hygienist, his second hygienist. No arguments I made could change his mind. He wasn't ready to go through the advertising and interview process necessary to hire a new hygienist. He thought a little break from all those exams would be nice. I offered to help in the search for a replacement, but he declined. It was with great trepidation that I left the practice, with no hygienist hired to take my place.

At the end of a month, the dentist was absolutely stunned to see the void created in his practice without a hygiene department. First came the drop in production. Sure, he was enjoying the break from writing checks to me, but what he hadn't calculated was how much my production — above and beyond my salary — had contributed to paying the office overhead. I was gone and so was my production, but the office overhead hadn't changed. Just as the French and Belgian dentists see hygienists' salaries as high, it's easy to overlook the contribution their production makes to paying office overhead.

Secondly, his schedule fell apart. Rather than being booked several weeks ahead, his schedule had more openings each day than the day before. The link between hygiene and restorative was broken. Depending on who you ask, somewhere between 40 to 85 percent of restorative visits scheduled in the dentist's chair comes directly from the hygienist's chair. Without dental hygiene feeding this dentist's schedule, the production of the office dropped painfully low.

Seeing the mistake he made, the doctor quickly corrected the situation by hiring a hygienist to take over the vacant position. Hygiene production increased right away, but it took several more weeks to get the restorative schedule back on track. In the meantime, his production fell far short of the goal.

When we spoke later, he confided in me that he would never be without a hygienist again, even for a few days. This had been an expensive lesson to learn.

Recently, I had the opportunity to fill in at an office for a couple of days. It was a great reminder of how effective the dentist/hygienist team can be and how important the hygiene department is to the restorative side of the practice. The hygienist in this practice took off an extra week of vacation without pay, but the dentist realized how valuable those missed days would be. Replacements were found. It wasn't just the hygiene care that was needed. More than half the patients I treated needed restorative work, due to new disease, broken restorations, or elective cosmetic procedures. A conservative estimate of the scheduled restorative work is $5,000. Why would dentists not want a hygienist working with them? The French and Belgian dentists focus on the high salary they must pay for a hygienist, but they overlook not only the increased hygiene production, but the diagnostic skills of the hygienist in determining a patient's need for restorative procedures, which she then refers to her dentist.

Someday, the French and Belgian dentists will welcome the addition of dental hygienists to their practices. A new profession will be born in those countries. The dentists will see production increases and, even more importantly, patients in these practices will enjoy better oral health. The hygienist/dentist team is a win-win situation for everyone involved.

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