By Deborah Dopson-Hartley, RDH

Do you know the true value and real potential that hygiene represents to you, your business, and your patients?

If you do know and understand what hygiene could and should mean to your practice, are you frustrated because your hygienist is not making it happen? Do you wish you and your hygiene team knew how to make this happen?

Hygienists, are you tired and fed up with this outdated practice mode yet?

First, it must be understood that most hygienists have a lack of sound business education and training. Just read the hygiene literature and it will be very clear why they have not professionally grown in a direction that is advantageous to all.

Second, hygiene courses given today and the hygiene profession have remained the same for the past 30 years. Few lecturers are hygienists and even fewer work full time in the day-to-day world of dental hygiene.

Working for your spouse's business has special privileges, such as consistently having the doctor's ears outside the parameters of the office. I have been a full-time practicing hygienist for 23 years. I've worked full time through the 1970's, 1980's and 1990's with each decade facing entirely different challenges. I know and understand the complexities and the challenges of working in today's real world of dentistry and dental hygiene. I practice everyday what I preach in my lectures. Anyone who has been in dentistry as long as I have will agree that today's world is more challenging, yet more enjoyable than ever before. What we can offer our patients today is rewarding and fulfilling.

I still do my job everyday because I believe in what I do and understand my importance not only to our patients but to the business as well. I simply love what I do for a living. Moving our patients from levels of infection and disease to health and wellness without drugs or surgery in an hour for less than the price of their Nikes makes me feel great about myself and what I do.

I also know that if hygiene does not grow as a profession and become more open and flexible to change, hygiene will soon find that the changes will be made for us by others, such as the ADA and AGD.

How many practices need their hygienist to be on the leading edge of business technology? Does your business need it?

Everyone asks me how I have earned and kept the title as the most productive and profitable hygienist in the country for the past 10 years. There is little luck and no magic in business. People need the right education, training, encouragement, and direction outside their scope of comfort and expertise by the experts in their particular fields. Pick the teachers, trainers, and courses carefully or you will certainly burn everyone out, including yourself. It is then that communication, guidance, and applications can begin.

Through the years, I have spent a tremendous amount of time, energy, and money training and educating myself on the inner workings of the business of dentistry and hygiene. I've always understood the need to go beyond the mandatory hygiene CEU requirement. How can any professional grow if all they take is the required three courses every 2 years, and those courses are related to the job specific?

Wisely, my dentists have invested in me also. They understand the high yield of returns on the continuing education unit (CEU) moneys spent on me. I take on average 50 to 80 CEU per year. I read all my doctors' dental journals and newsletters. I listen to tapes and attend every seminar I can. They are not all dental related and those that are dental related must be clear, specific, and explicit information or I don't waste my valuable time or our business's valuable money. Many of these courses do not offer CEU but the information I receive is priceless. Seminars given by Tony Robbins, Tom Hopkins, Brian Tracy, Drs. Stephen Covey, Paul Homoly, Charges Givens, Zig Zigler, and the Peak Performances are courses to improve upon myself, my relationships with others, and my sales. I also attend as many seminars for doctors as possible. how can I improve the patients' dental IQ without improving my own? How can I educate, motivate, and influence the patients to pursue their dental treatments if I do not know or understand what and why they need it?

I am frequently asked how I learned to be so effective in sales, business, and with people. I do what all successful businesspeople do: read, listen, watch, and attend everything I can.

It is important for every member in the practice to constantly re-educate to re-motivate. The same holds true for patients. The patients should never leave the practice with empty minds or hands.

According to Dr. Roger Levin, "The key to practice productivity is the marriage between clinical skills, management, and marketing techniques."

By incorporating high-quality hygiene services with effective business management and communication skills, I not only increased hygiene production, I increased the recall flow, which in turn generates an ever-growing number of referrals; the type of referrals our practice wants and needs: compelled target patients.

By my doctor combining what she considers my true values, I've helped to build our practice into her dream: a state-of-the-art, aesthetic boutique, insurance-free, solo practice in a small community.

First and foremost, hygienists are clinicians. Hygienists need to accurately collect, process, and use data. They need to find and identify the problems, then proceed in formulating a pretreatment plan advising doctors and patients of the findings to ease the burden for their time during the examination.

I do an oral cancer, head and neck, and soft-tissue exam and periodontal screening on every patient at every appointment. I do accurate full-mouth periodontal charting updates every year.

We all know the No. 1 malpractice suit against dentistry today is failure to diagnose, inform, and give treatment options for periodontal disease. Who wants that legal problem? the law holds the dentist and hygienist legally accountable for the patient's oral health, but hygienists are held morally and ethically responsible for the patient's periodontal health. It is my job to have and keep the patients and their periodontal chartings accurate and updated.

Apart from the legal issue is the issue of patient compliance and homecare. I want my patients to own their dental problems! My patients understand their periodontal health. I constantly talk with them, discussing what must be done to take care of the problems. Also they are told what must be done to prevent the problem in the future, to help keep things under control. This education goes beyond just hygienist-patient care. This requires the efforts of the entire team -- the doctor, the assistants, and the hygienist.

If everyone in the office understood, diagnosed, and was educated about periodontal disease as effectively as decay, this area of the practice would thrive.

The success of the soft tissue program will come from treating the patients true periodontal needs.

With approximately 75% of the US adult population experiencing some form of periodontal disease, we must reconsider the ways hygiene services are rendered and charged. Many practices fail to differentiate the hygiene services when it comes to diagnosing and treating periodontal disease. I must get the patients who have active disease into a therapy and support program.

The best way to get patients to adhere to a good maintenance program is to start the new patients off right. Diagnosing and treatment planning the patient's true periodontal needs must come first.

If the patient's periodontal conditions are undiagnosable at this time, Dr. Wright will inform the patient of the periodontal problems and the probable need for some root planning. She tells the patients, "You have periodontal problems. I am turning you over to my registered dental hygienist, Deborah, who is my soft tissue therapist. Today, she will perform an investigative cleaning to determine how many appointments she will need to get you healthy. It will require some level of root planning. During these scalings, she often finds things I can't see. When she has you healthy I will complete my examination."

She then gives the new patient to me for a gross debridement ADA code 4355. During this appointment I can prediagnose my scheduling treatment plan for each patient. I am confident, competent, and am held accountably in prediagnosing and treating the periodontal treatment needs for patients. Fortunately, my doctor is confident in my abilities too.

After undergoing extensive periodontal therapy with the hygienist, the patients will understand what can and does happen in ignored and difficult areas of their mouths. They will understand the difficulty of removing undetectable and hidden deposits from their diseased roots. They will appreciate all efforts in helping them achieve health and wellness. So will you.

How nice would it be to know the extent of the damage of the decay before you start the restorative procedures? How nice would it be to do work on tissues that don't bleed?

After spending many hours with the hygienist, patients build a trusted bond that can last forever. They trust the hygienist as they trust the doctor. This will enable doctors to always have their own in-house second opinion.

After periodontal health has been achieved, accurate diagnosing can be made, a written treatment plan established, sound financial planning completed, and patients are treated accordingly.

Now, during those 3-month maintenance appointments, the hygienist can continuously educate, motivate, and influence the patient to pursue those needed treatments.

Many practices want to start new patients with the restorative phase first, ignoring or forgetting the legal and moral ramifications of performing restorative treatment on periodontal compromised teeth. By implementing a soft-tissue program you will not only double production but you are going to legally and ethically treat patients right.

Next, we use instrumentation for cleaning. Whether it be ultrasonic, hand scaling, or a combination, the cleanings should be thorough and as comfortable as possible. It is during the hand scaling time where I give OHI, nutritional counseling, and do my education and motivation to help influence the patient into making the right decisions for their long-term dental health.

Years ago, I taught myself to hand scale and educate at the same time. This system has saved me a lot of time, time I use in a more productive way. I can now communicate the important treatment information to patients while I am treating them. Patients like this because it distracts them from the difficult work and makes the time pass quickly. I do some form of education on every patient because I want patients to want only the best that dentistry has to offer.

This brings me to hygiene's next value: the producer.

As the only direct revenue producer other than the dentist, hygiene time is valuable to the practice. Not being allowed to produce to the fullest potential is costly to the business. Just as doctors are the main income producer and have a goal they must reach and maintain to keep the business healthy, hygiene must have a goal. My goal is $1,300 a day, and for that to happen, everyone must understand diagnosing and scheduling for hygiene production.

A hygienist can only obtain a daily goal if she is scheduled correctly. The scheduled daily coal is the main considering factor. I am often asked how many patients I see in a day. It's not a magic number of patients seen in a day, it's what and how many procedures I need to perform in a day to reach my daily goal. The more prophy-only scheduled, the more patients I will need to see. The more periodontal procedures scheduled, the less patients I will need to see.

I know what you're thinking: "If I have lots of 3-month recares, I'll have to check all those recare patients too. I hate checking hygiene and I don't have the time for all those exams either." You don't have to! In fact you shouldn't need to. Dr. Wright tells the patients with any gingival problems, and the assistant documents in the chart, that the patient's protocol must change to reduce and control the periodontal disease. "We are going to try the least invasive procedures first, which requires some root cleanings and a shorter maintenance program requiring you to maintain a 3- to 4-month recare schedule with a doctors exam only one time per year, unless there is a problem." If you diagnose it and it's documented in the treatment column, is it now considered part of their legal treatment plan? I'd call your local society or a periodontist and see if they must physically check every patient. The code is called a 4910 or periodontal maintenance.

I personally love patients on 3-month prophys or periodontal maintenance and so do most of our patients. Who amongst us do not want our teeth cleaned frequently? Ask your hygienist and I'll bet she doesn't go more than 2 months herself. I can't go more than 6 weeks, so why would I expect my patients to want anything less? I tell patients, "I'm like the oil change for your expensive automobile. The older the car, the more important maintenance becomes. What happens if you don't comply to periodontal maintenance, the bone becomes compromised and will never grow back. How much infection or bone loss is acceptable to you before you will become concerned?" I rarely get noncompliance.

Patients really don't want to see the dentist most times anyway. If there are no problems, chief complaints, or concerns, why interrupt the dentist? Understand there will be a loss of the exam fee, but look at what the dentists are gaining: precious time they so desperately need. If this happens, dentists have to ensure that the hygienist is educating, motivating, and influencing every patient into pursuing their dental needs. how do dentists ensure this? They spend the money and take the time and energy it needs for education and training.

But dentists need to understand that when the hygienist does call them, she has production dollars in the chair! Do not give this motivated and hot prospect the chance to cool off, become annoyed, get angry. No one buys under those circumstances.

There are times, however, that the doctor cannot meet with the patient. This is why everyone needs to know where everyone is with their time. If Dr. Wright can't leave another patient, the assistant should inform so the other patient can be rescheduled at their convenience for their examination.

By making aggressive, well-coordinated scheduling, confirming and having a great-active-and-current call-list a top priority, the front office can control the expense of hygiene down time.

Hygiene down time costs the average dental office $50,000 per hygienist per year in lost revenue opportunity and unproductive labor expenses. These are just the hard costs.

The cost of down time does not stop there. They also include the loss of potential sales and referrals. Patients not seen represent lost opportunities for dental marketing and sales. I educate, motivate, and influence every patient I see to pursue their treatment needs. Averaging one restoration at $650 is a $157,000 in lost sales opportunity. This is the cost of doing business the way it's always been done. controlling hygiene down time must become a No. 1 priority for the front office.

The reality is the appointment scheduler makes me profitable, but my full-time hygiene assistant is who makes me productive and profitable. I'm able to perform more procedures per day on more people. She also gives me the time necessary to market and sell all of our products and services.

Hygienists can only produce income and market dentistry on the patients that are scheduled for the day. it is very important for the front office to make a commitment to preblock booking so a variety of procedures can be done to compliment the day. To get even better results, find other ways to increase production besides just decreasing down time.

This brings us to the third job description, management. the entire office must be committed to maximize hygiene time efficiency. Is your hygiene department being run as a business or a loss leader? Is it profitable or barely breaking even? Do you actually know its bottom line in terms of expenses and revenues? Is your hygiene department producing what it should? Is it doing what it could, in both direct production and practice-building sales and referrals? Or is it just being allowed to exits? Does this branch of your business have checks and balances? Is it being tracked and monitored? Who, if anyone, is held accountable for this department?

Being part of the business's management program requires carefully detailed systems, strategies, and planning. Managing oneself requires a very focused agenda to reduce surprise and avoid the potential troubles ahead.

It requires tracking and monitoring of not only hygiene production but daily sales projection. My daily sales presented goal is $3,500 but my scheduled sales goal is $2,500 per day.

By doing this, you always know where you are, where you've been, and where you want to go.

Not only does my hygiene department generate a profit of more than $100,000 a year in direct hygiene production, we also directly influence a substantial portion of the doctor's production totaling more than $400,000 in direct revenues. But that's the topic of the next article.

This is a new era, full of opportunities for everyone. By presenting and giving everyone the education and training needed, you are helping your hygienist to become the hygienist your business wants, needs, and deserves. You are also giving them the opportunity to become the hygienist they want and need to become. They just might not know it, yet.