HOW TO PROFIT FROM… hygiene: Super-charged hygiene!

Oct. 1, 2002
The hygiene department of every practice is the key to its growth and future.

Dr. Louis Malcmacher

The hygiene department of every practice is the key to its growth and future.

One way to profit from hygiene is to turn your hygienist into a referral source. A hygienist can be the key to doing more aesthetic dental procedures, thereby building your practice. No one in your office gets to spend as much quality time with your patients as your hygienist does. No one can speak about the patients' mouth on a tooth-by-tooth basis better than the hygienist. That's why it is imperative that you spend time educating your hygienist about the procedures you can do for your patients ... procedures you would like to perform more often. There is no better money spent than taking your staff to educational courses. This is especially true of your hygienists. The hygienist is in the very unique position to intelligently and gently suggest treatment options to patients without diagnosing. Because of the amount of time spent with patients, hygienists usually are the ones who have developed the most trust and best rapport with your patient base.

It is vitally important that your hygienist have a beautiful smile. Nothing gives patients a better image of your office than the smiles of your staff members. If you want to do more bleaching and more veneer cases, then your staff members must have sparkling smiles. Testimonials are a sure way to help your patients want treatment. When your hygienist can say, "I bleached my teeth, and it was very comfortable; I just love the way they look now," it is a very powerful statement. And, dentists, don't forget about your smiles. It is tough to motivate a patient to accept aesthetic dentistry if you have calculus buildup, stained and crooked teeth, and, worst of all, bad breath. Ask your staff to evaluate your smile when you evaluate theirs. Make sure everyone in your office has a million-dollar smile!

Your hygienist has the capability of providing a wide range of services for your patients. Check your state dental board's law to find out exactly what hygienists are allowed to do. You may be surprised. In most states, hygienists can place sealants, give medication, do scaling and root planing, take alginate impressions, as well as the regular duties of prophylactic examinations, fluoride treatments, and oral hygiene instructions. Most dental offices do not use their hygienists to full capacity. I believe that dentists should delegate as much as possible to their staff. This frees the dentist to perform the heavy-duty dentistry that only they can do.

In terms of periodontal services, dentists do not use hygienists enough. We also don't listen to our hygienists when they direct us to areas of the patient's mouth that need periodontal treatment.

This scenario happens in many offices every day: The hygienist calls the dentist in to do the examination and informs him that the patient has a couple of 5mm bleeding pockets and a broken tooth. Where does the general dentist immediately direct his attention? The broken tooth. And, in many instances, when hygienists ask the dentist what he wants to do with the bleeding pockets, the dentist will say, "Let's watch it."

This completely boggles my mind! First, there is a periodontal disease process happening and it needs to be treated, not "watched." Second, I know a lot of dentists shy away from doing periodontal surgery because they have not had much experience with it. Take a good course in performing limited periodontal surgery with bone regeneration. You will find these procedures easier to do than a crown prep on an upper second molar. Your hygienist has already informed the patient of the disease in these sites. The hygienist is ready to go for treatment, and, in most cases, the patient is ready too, because the hygienist has done such a good job of educating the patient about the problem. Then, the dentist swoops in and says, "Well, let's just watch the situation." The hygienist quickly learns not to even bother pointing out these areas to the dentist. She can simply make a note in the chart that the particular area needs to be watched until next time. This is a major mistake!

There are so many limited periodontal cases that come through the dental office every day that easily could fill your schedule. The cases are relatively easy to do and can be highly profitable. They are done in one appointment with a quick second, postoperative checkup. There are many instances where there is a need for an intrasulcular medicament. In many states, the hygienist can place it with the dentist's oversight. The bottom line is that there are many periodontal services that the general dental office can offer which benefit the patient and profit the practice. The hygienist is the key to opening the door to these services.

The dental profession can benefit from paying close attention to patients' choices of oral-care products. While we can directly benefit from selling these products, there are other ways to indirectly benefit our practices (and our patients) simply by the recommendations we make.

We need to learn how to recommend oral-care products to our patients, including toothbrushes, toothpastes, mouthwashes, floss, and any other adjunct oral device. Patients expect us to know about every toothbrush and toothpaste on the market. Indeed, we get questions everyday from our patients about which is the best toothbrush or mouthwash for them to use. Many dentists and hygienists give vague answers such as, "Well, any toothpaste with fluoride will be OK."

There are two problems with this kind of response, and these are the same two reasons why you should make specific recommendations for oral-care products. The first is from a practice-management standpoint. Your patient expects you to be the dental expert who knows everything there is to know about anything dental-related. They are asking you what they believe is a very simple question: "What is the best toothpaste to use?" When we respond with a vague answer, the patient thinks, "Gosh, I'm asking my dentist such a simple question. If he doesn't know about toothpaste, will he know about bleaching, bonding, or crowns?" When you dodge an answer, patients lose trust in you. You need to be able to look the patient in the eyes and say, "Mrs. Jones, I have looked at all of the toothpastes in the world, and I recommend the XYZ toothpaste for you. It is the best toothpaste for the conditions in your mouth. It will help you maintain a healthy, bright smile for years to come." Now the patient will believe that you have his best interests in mind and that you know what you are talking about.

The other reason to give a specific recommendation for over-the-counter oral-care products is to protect your dentistry. It turns out that your patients' choices of products can directly affect the longevity and cosmetics of the restorations you place in their mouths. Remember that any restoration that is placed in the mouth is in constant function and lives in 100 percent humidity. Anything you can do to make that restoration last longer will result in a happier patient with a healthier mouth. Oral-care products that are used frequently can affect the dental materials that you put in, and they certainly will affect the margins of your restorations.

For example, every porcelain veneer or all-porcelain crown that is placed with resin cement will have some of that resin cement at the margin. If your patient uses a hard toothbrush with a fairly general abrasive toothpaste, then he easily can abrade some of the glass particles in the composite resin cement, causing microditching and slightly open margins. These areas likely will turn brown or black. We all have seen cases like this. The patient walks in with a beautiful set of porcelain veneers with black or brown margins. This can be caused by abrasive materials that patients use to clean their teeth. If you don't control (strongly suggest) the types of products your patients use, they may have reason to be upset a year later when stains develop.

If you want your dentistry to last longer, you must recommend exactly which products your patients should use routinely. This will result in fewer remakes, healthier mouths, and happier patients who will refer their friends to your practice.

A patient who presents with few, if any, restorations and has a very healthy condition generally can use almost any toothpaste. But a patient who has many restorations, especially if they are bonded restorations, or a patient who has had teeth whitening should use a low-abrasive toothpaste with carbamide peroxide to prevent bleaching relapse. The wrong toothpaste (i.e., high abrasive) can turn an aesthetic case into a nightmare.

Another area of hygiene that is virtually untouched by most hygienists and dentists is malodor management. Four billion dollars worth of over-the-counter products for oral malodor are sold every year in the United States, and the market is growing. Halitosis is a major concern to your patients. They hear about it everyday on television commercials for toothbrushes, toothpastes, and mouthwash. Close to 98 percent of these malodor cases are caused by volatile sulfur compounds produced by gram-negative anaerobic bacteria in the mouth.

Your hygienist is uniquely positioned to offer these services to patients, because virtually every aspect of oral-malodor treatment can be performed by the hygienist. Oral-malodor treatment is based upon the bleaching model. So, if you provide tray bleaching in your office, then you certainly can provide oral-malodor treatment. Just like bleaching, it is well-accepted by patients with a high satisfaction rate.

As you can see, there are many wonderful opportunities to build your practice through your hygiene department. Communication with your hygienists is the secret to motivating patients to accept comprehensive treatment plans and elective dentistry. Welcome your hygienists the next time they signal you for an exam, and thank them for the time they spend with your patients.

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