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Profitable hygiene: 6 questions (and answers) for getting there

May 3, 2022
Increasing dental hygiene production doesn't mean selling patients services they don't need. In fact, foregoing or giving away services hurts both practices and patients. Here's how to look at the issue in a new way.

In "Why knowing your production numbers benefits everyone," I discuss why having some understanding around production numbers is beneficial for a hygienist. You don’t necessarily need to radically change up what you are doing. You don't need to “sell” services or treatment, nor should you suggest anything that's not in the patient’s best interest. Often it can be as simple as looking at old problems or pain points though a new lens.

1. Are you limiting what you do or suggest based on what you think the patient’s insurance will cover? 

Consider the limitations we can sometimes inadvertently place on what we suggest. For example, if you have a high-risk caries patient, do you update radiographs more frequently or do you shy away from suggesting that because more frequent x-rays may not be covered by the patient’s insurance plan? Do you find yourself thinking that radiographs are routine and set on a timeline versus done more (or less) frequently based on patient need and risk factor assessment (as outlined in the FDA/ADA prescription guidelines)? 

It is important to have honest conversations with your patients about their risks and your concerns, and that relying solely on dental benefits to make decisions could result in the need for more extensive and costly dental treatment down the line. I would strongly encourage you to come up with similar verbiage (that suits your individual communication style) to use with your insurance-focused patients to help them over the hurdle toward necessary care.

The bottom line is that payment for preventive services now often negates paying for costly and extensive treatment down the line. It is not your fault as to what individual plans cover or not. That is something that is negotiated by the insurance company and the patient’s employer. Dental insurance is intended as a benefit, not an all-encompassing plan that fully covers all expenses. 

Understand your patient’s goals, recommend the most appropriate treatment, and create value around it. Be sure to be open and honest that there may be out of pocket costs involved and do a solid handoff to your dentist and business team, so all are on the same page. Patients need to understand costs and financing up front. We cannot, however, let insurance benefits, our own beliefs about what the patient will do, what we think they can afford, and the like deter us from sharing appropriate treatment recommendations.

Also by Julie Whiteley:

4 things you can do now for better patient communication

Your clinical dream job: 4 ways to make it happen

2. Are your recare intervals appropriate given the way the patient presents and their risk factors, or are the intervals based more on insurance coverage or what has been done in the past? 

If you have more of the later, I encourage you to consider recommending shorter intervals for those with increased risk factors for periodontal disease and caries (like poor oral hygiene, active dental disease, those with orthodontic appliances, xerostomia, and systemic diseases with oral implications like autoimmune conditions, diabetes or cancer treatment). Open two-way dialogue coming from a place of concern, coupled with good communication skills are key.

In most practices in which I have worked over the past decade or more, the recare frequency for the majority of adults (as these risk factors are prevalent) was three to four months. It was better for the patient’s disease management and allowed for more proactive and frequent check-ins. An added bonus was that I found myself doing less “heroic hygiene” visits on those more involved patients. In the past I would try to accomplish the impossible with the limited time I had every six months.

3. Do you have enough time per appointment to do the necessary diagnostics and to educate your patients?

At one position I was offered many years ago, I convinced the dentist to let me try seeing patients for one hour (instead of the 45 minutes the office had been doing for years) for one month. I was certain that if I had enough time my appointments would be more comprehensive, more focused on communication/education, and more geared to the specific needs of the patient than what the office had been able to do in the past. My thought was that this would result in elevating the standard of care (which can be a liability issue if it is low), healthier and better-informed patients, and higher production than if I saw more patients per day.

With the time added to appointments, I was able to catch up on comprehensive periodontal assessments, incorporate risk assessment conversations, update full series of x-rays that were long overdue, take photos, and take time to explain the disease process. This resulted in an increase in both periodontal treatment case acceptance and outstanding restorative treatment case acceptance. Patients were also becoming more knowledgeable dental consumers and began to appreciate the value of a hygiene appointment; they rarely if ever cancelled appointments. The office never went back to 45-minute slots, and I was given an increase in my hourly rate of pay.

More time (and I am referring to time well spent, with clear standards and accountability) allow us the time to be more thorough, explain necessary care, perform appropriate care, listen to concerns and respond to objections. The time spent building a relationship based on trust and mutual understanding allows us to create an environment with healthier patients, healthier practices and healthier/more satisfied clinicians.1

4. Consider the value of the care, services, treatment, and prevention modalities that we can offer to our patients. Are we always forthcoming suggesting all we have to offer in the way of promoting optimal health? 

For example, do you recommend fluoride varnish or other adjunctive services if appropriate for adult patients?  Have you ever done what I call “the periodontal therapy in disguise” hygiene visit?  You have a patient who presents for their usual prophy and you see there is active periodontal disease. In the interest of the time, a financial conversation, and not being fully sure how to best proceed have you ever “cleaned the pockets out really well in hopes that next time things would be better”? Did we just perform undercover periodontal therapy billed out as a prophy, which is both unethical (the patient did not consent) and unfair to other patients who have accepted (and paid for) periodontal therapy?  This leads to the next point…

5. Are you using the appropriate CDT codes?

I used to think those numbers were “insurance codes” and were the business team’s responsibility. The codes, however, are our ethical and legal responsibility to report what we do as set forth by the ADA. "5 codes every hygienist needs to know" may help you if you need some clarification on the different codes to describe a hygiene visit.

It is also helpful when there are clear standards in the office as to how the office handles situations. For example, having a clear periodontal protocol makes it easier for all staff members to be on the same page with how to best proceed when treatment needs arise chairside.

6. What you do/say regarding outstanding restorative treatment? 

Do you make observations about findings such as cracked teeth, wear, crowding, etc.? All of these things are important for your patients to know and to bring to the dentist’s attention. Do you show the patient with a mirror, take photos, do a good handoff in front of the patient to the dentist for further discussion of these findings? This practice alone, although it did not increase the hygiene department numbers directly, was one of the things former employers told me they appreciated. It also helps patients to see the importance of these dental issues when both hygienist and dentist are stating similar information and concerns.

Foregoing or giving away services creates little value for the patient, for ourselves as practitioners/employees, and for the practices in which we work. The benefits to knowing your numbers is empowering. It can showcase where we add value and gives us backing as to our measurable contribution to a practice when we go to bat to ask for what we need and/or deserve. To show that we are both reliable and can make an overall impact can put us in a much more favorable position. The more profitable and well run a business, the more they have the bandwidth to create a more favorable working environment. It also can allow for healthier patients who can benefit so much from what you have to offer.


1.    Trzeciak S, Mazzarelli M. Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference. Pensacola, FL; Studer Group; 2019.

Editor's note: originally posted in 2021 and updated regularly.