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How to profit from hygiene: Super-charged hygiene!

Oct. 1, 2010
The hygiene department of every practice is the key to its growth and future.

By Dr. Louis Malcmacher

For more on this topic, go to and search using the following key words: super-charged hygiene, how to profit from hygiene, Dr. Louis Malcmacher.

The hygiene department of every practice is the key to its growth and future. This will be even more important in the future as hygienists take on great roles within the practice and expand their diagnostic and therapeutic duties.

One way to profit from hygiene is to turn your hygienist into a referral source. A hygienist can be the key to doing more periodontal, restorative, prosthodontic, and esthetic dental procedures, thereby building your practice. No one in your office gets to spend as much quality time with patients as the hygienist does. No one can speak about the patients' mouths on a tooth-by-tooth basis better than the hygienist.

That is why it is imperative that you spend time educating the hygienist about the procedures you can do for your patients, especially procedures you'd like to perform more often.

There's no better way to spend money than to take 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.

Make sure staff looks good

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 veneer cases, then your team members must have sparkling smiles. Testimonials are a sure way to help 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. Also, dentists, don't forget about your own smiles.

It's tough to motivate patients to accept esthetic 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!

Let's expand those opportunities even further with the recent advances dentistry has made in total facial esthetics. Specifically, the integration of Botox and dermal filler therapy into dental practice is now estimated at 20% of dental offices that offer these procedures. You, your hygienists, and the whole dental team should now have beautiful faces to complete your great looking smiles.

Botox and dermal filler procedures are incredibly popular with patients. Botox is the most common cosmetic procedure in the world.

We need to teach our team members to get as excited about our dental procedures as they do about the facial esthetic procedures, and we need to educate them how they all fit together.

Hygienists perform many functions

Your hygienist is capable of providing a 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 perform the regular duties of prophylactic examinations, fluoride treatments, and oral hygiene instructions.

There is also expansion of their hygiene duties in the area of periodontal treatment. Most dental offices do not use their hygienists to full capacity. I believe that dentists should delegate as much as possible to their staffs. This frees them to perform the heavy-duty dentistry that only they can do.

In terms of periodontal services, dentists do not use their hygienists enough. They also don't listen to their hygienists when they direct them to areas in patients' mouths that need periodontal treatment. There have been great advancements in involving hygienists more in gingival and periodontal treatment, especially if they are trained to use a laser.

Get your office a few soft tissue lasers – the Picasso Lite by AMD lasers has radically changed the industry by making one of the best and affordable soft tissue lasers. Every dental practice should now have a soft tissue laser, and hygienists should be trained in its use. You will be amazed at how often you and your hygienist will use a soft tissue laser every single day for curettage, disinfection, troughing, gingivectomies, biopsy, and so many other treatments.

These treatments are generally bloodless and can be performed with topical anesthesia in just a few minutes. Training is key to properly accomplishing these laser procedures.

Don't let this happen in your office

Here is a scenario that 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 5 mm bleeding pockets and a broken tooth. Where does the general dentist immediately direct his attention? To the broken tooth. In many instances, when the hygienist asks the dentist what should be done with the bleeding pockets, the dentist often says, "Let's watch it."

This completely boggles my mind! First, there is a periodontal disease process happening that 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.

It's a good idea to take a 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 also ready because the hygienist has done such a good job of educating the patient about the problem.

If the dentist swoops in and says, "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!

More ways to profit the practice

There are so many limited periodontal cases that come through the dental office every day that could easily 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 or laser treatment.

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 that 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 patients with our recommendations.

We need to learn how to recommend oral care products to our patients, including toothbrushes, toothpaste, mouthwash, floss, and other adjunct oral devices. Patients expect us to know about every toothbrush and toothpaste on the market. Indeed, we get questions every day from 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 is OK."

There are two problems with this response, and they are the same two reasons you should make specific recommendations for oral care products. The first is from a practice management standpoint. Your patients expect you to be the dental expert who knows everything about anything dental. They are asking you what they think is a very simple question: "What is the best toothpaste?"

When you respond with a vague answer, patients think, "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 a question, patients lose trust in you. You need to be able to look patients in the eye and say, "I have looked at all the toothpastes in the world, and I recommend 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 patients believe that you have their best interests in mind and that you know what you're 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 placed in the mouth is in constant function and in 100% 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 an abrasive toothpaste, then he or she can easily 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. A 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.

My personal favorite is the entire Crest Pro-Health product line, which has been clinically shown to sharply reduce plaque, cavities, sensitivity, and bad breath. Take a look at for the studies done by the University of Florida on the Pro-Health toothpastes and alcohol-free mouthwashes, in addition to the Oral-B product line.

Patients who present with few, if any, restorations that have a very healthy condition generally can use almost any toothpaste. But patients who have many restorations, especially if they are bonded restorations, or patients who have had teeth whitening, should use low-abrasive toothpastes with carbamide peroxide to prevent bleaching relapse. The wrong toothpaste (i.e., highly abrasive) can turn an esthetic 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 U.S., and the market is growing.

Halitosis is a major concern to your patients. They hear about it every day on television commercials for toothbrushes, toothpastes, and mouthwash. Volatile sulfur compounds produced by gram-negative anaerobic bacteria in the mouth cause close to 98% of malodor cases.

Your hygienist is uniquely positioned to offer these services to patients because he or she can perform virtually every aspect of oral malodor treatment. Oral malodor treatment is based on the bleaching model. 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 hygienist 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.

Dr. Louis Malcmacher is a general dentist and international lecturer, author, and consultant known for a comprehensive and entertaining style. An evaluator for CLINICIANS REPORT, he is president of the American Academy of Facial Esthetics at Contact him at (440) 892-1810, [email protected], or

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