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Should your hygienist sell dentistry?

Oct. 1, 2008
Did you know that the aristocrats in ancient Rome employed teeth cleaning slaves? Sounds pretty outrageous, but as I pondered this I realized that early in my dental hygiene career, there were many days when I felt just like a slave.
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by Annette Asley Linder, RDH, BS

For more on this topic, go to and search using the following key words: hygienist as educator, "selling" dentistry, technology for education, Annette Ashley Linder, training, communication, dental team.

Did you know that the aristocrats in ancient Rome employed teeth cleaning slaves? Sounds pretty outrageous, but as I pondered this I realized that early in my dental hygiene career, there were many days when I felt just like a slave. When I began my 30 plus years' career practicing clinical dental hygiene, we did not have the science and research describing the etiology and treatment of periodontal infection and its impact on total health. Ultrasonic scalers were just being introduced, and we worked without gloves or masks. Yikes! It's a wonder we all survived.

Fortunately, the important role of the dental hygienist as educator, mentor, and clinician is clearly understood. This is especially true in light of current research that links periodontal health and total health. The days of "just cleaning teeth" are over — or at least, should be.

If your hygiene department is stuck in the "just cleaning teeth" model, I invite you to read on as I share information brought about through 20 years of providing seminars, speaking at dental meetings, and consulting with some of the finest dental teams across the country. These teams have the same common attributes when it comes to successful dental practice, including a superb dental hygiene department and a superior and dedicated staff.

Many articles have been written discussing the hygienist's role as clinician and educator. This article focuses on the hygienist's role in increasing practice, not just hygiene, productivity. When I ask hygienists what they love most about their work, their No. 1 answer is "My patients!" Hygienists are in the unique position of building a trusting relationship with patients they see over time.

Patients often look to the hygienist for help in making decisions. It's not unusual for patients to ask for feedback when the dentist leaves the treatment room. "Do I really need that? What would you do?" are frequently asked questions. Many successful doctors have come to this realization, and several (very happy) dentists from throughout the country share their reality on the topic.

When I asked Philadelphia dentist and University of Pennsylvania Dental School clinical faculty member, Dr. Paul Berson, his thoughts about the team "selling" dentistry, he responded, "We do not sell dentistry. We educate our patients and build lasting relationships based on trust and confidence. We give patients our best opinion after considering all of their wants and needs. It is imperative that our entire team understands diagnosis and treatment choices. Our hygiene team is a critical component because the patients know them and feel comfortable with them."

Dr. Melissa Tucker started her practice from scratch 15 years ago in Temple, Tex., and now employs three hygienists. Dr. Tucker realized the potential of a strong dentist/hygiene team early in her career. "The time the hygienist has with the patient is an incredible opportunity to bond with the patient, and most importantly, educate the patient about dental care and optimum oral health.

I have invested in office consultants and CEU courses for staff, which has provided me with hygienists who have excellent communication skills. Thanks to many hours of meetings and open dialogue between us, they are clear on my expectations, and I am confident in their ability to set the stage for restorative, esthetic, and periodontal treatment."

The hygienists at Dr. Mark Bentley's busy practice in Troy, Ohio, report that they appreciate the clearly defined systems the office uses for transitioning the patient from hygiene to exam (periodic oral evaluation). Dr. Bentley's risk profile assessment includes medical history, blood pressure, periodontal examination, soft and hard tissue evaluation, tooth structure, occlusion and TMJ, and preliminary smile evaluation. He expects the hygienist to report the findings out loud to him when he enters the treatment room. This prompts further discussion from the patient and also saves time, as it allows Dr. Bentley to have all of the information as the exam is being performed.

Dr. Steven Miller's 27-year practice in Asheville, N.C., is geared to adult restorative and cosmetic dentistry. Dr. Miller and his team strive to partner with patients to develop relationships that will ensure lifetime dental wellness and create an environment for learning so that patients make conscious health decisions. Dr. Miller states, "Who better to ask the right questions than hygienists? They have built a trusting relationship, and have time to discover the patient's wants and needs and provide non-threatening treatment."

Dr. Miller's hygienists have been with him for 16 years and 10 years, and he is confident not only in their clinical skills, but also in their great communication skills with patients. It has taken hard work, many staff meetings, trial and error, and most importantly, ongoing training for the team to become the best.

The common thread running through these practices is the ongoing training and communication between the dentist and hygienists (and entire team). All of these doctors have systems in place for:

Daily morning meeting to review the day. In Wisconsin, Dr. John Ulloa and his hygiene team identify the incomplete (undone) dentistry, discuss any questions for the doctor, and receive input from the financial coordinator. The hygienist is then prepared to do a tour of the mouth with the intraoral camera. Patients that "see" the broken or leaking amalgam, fractured tooth, and more feel comfortable talking to the hygienist with their questions and concerns, and the hygienist is prepared because she/he had the opportunity to thoroughly review the patient notes.

Regular staff meetings (not a rushed 20-second conversation in the hallway between patients). The amazing team of hygienists in Dr. Jim Munro's Ontario dental practice says that it is a pleasure to experience the quality of dentistry and variety of services that they offer to the patients. They are proud that Dr. Munro has confidence and trust in them, and that he encourages them to communicate with clients on all aspects of their oral health. Dr. Munro has worked hard over the years to coach them and they are very comfortable in preassessing, codiagnosing, and setting the stage for restorative and cosmetic dental treatment.

Regular meetings with the hygienists. Many hygienists report they are not sure of the doctor's expectations with regard to discussing dentistry with patients. This obstacle can be overcome by meeting with the hygienist in a private and supportive setting to answer questions and clarify expectations. Discuss office protocols and provide a supportive environment to explore new ideas, encourage initiatives, and revisit goals. It requires more than just recruiting the right hygienist. The lines of communication must remain open at all times. Dr. Tucker employs this principle by taking one hygienist to lunch each month.

Encouraging and taking hours of relevant CEU and working with consultants for on-site training. Consultant Linda Drevendstedt believes that the dental hygienist needs to move away from "tooth cleaning lady" and become the oral health coach/consultant. After all, she/he has 45 to 60 minutes with every patient. The conversation should consist of 10% to 15% personal and 85% to 90% about the patient's oral condition and how to become healthier. This means that the dental hygienist is well versed in the restorative philosophy of the dentist.

Providing in-service training with the latest in dental techniques and materials so that the hygienist will know and understand the recommended procedure. Once the hygienist has "permission" to educate and set the stage, then he or she can role-play presentation skills. Hygienist statements such as, "I'm so excited about the dentistry that we're able to provide. It's changing patients' lives," are one way to prompt a restorative/esthetic treatment discussion.

Technology that includes monitors and terminals in the treatment rooms, visual aids, communication, print media, before and after photos, digital photography, and computer-based patient education programs. In Dr. Ulloa's office, the hygienist reports facts and findings when the doctor enters the treatment room for the exam. She restates the discussion with the patient, pointing to the picture on the monitor in front of the patient. The patient hears it again, questions and concerns have been discussed, and Dr. Ulloa does not have to spend 20 minutes reviewing the importance of the dentistry.

Dr. Scott Parr of Virginia Beach sums it up well.

"My feeling on hygienists 'selling dentistry' is that it is their ethical responsibility to promote dental health," he said. "It's part of their job to motivate patients to be dentally healthy, and it should not come across as selling. The dentist should hire and train their staff to understand and believe in their philosophy.

"Team members cannot 'sell' dentistry they don't believe in, no matter how hard they're pushed. Find team members that believe in what you're doing, or educate them as to why you do things the way you do, and the 'selling' will come naturally," Dr. Pharr added.

Across the country, the most successful and productive practices are those with productive and efficient hygiene departments that also set the stage for education and promoting optimum dental health. Working in concert with the doctor and promoting the same vision results in maximum personal, professional, and productive rewards for everyone.

Once the lines of communication are open, it's easy to achieve these goals. The happiest and most successful doctors I know surround themselves with the sharpest hygienists and teams, clarify what their expectations are, come to the office every day to do what they love, continually ask for innovative ideas from the staff, and reward the team for a job well done.

Annette Ashley Linder, BS, RDH, is a recognized leader in the field and an award-winning speaker and consultant. Since 1989, she has presented more than 250 seminars and consulted in dental practices throughout the world. She is a featured speaker at dental meetings and provides in-office consulting services with her team of business and clinical consultants. She may be reached at her Web site at, via e-mail at [email protected], or by phone at (804) 745-6015.

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