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Help! Why does my hygiene schedule have so many holes?

Nov. 19, 2018
Industry standards and experience tell us that there are more failed appointments in the hygiene column than in the doctor’s column. One solution—creating value around what hygienists do.

Industry standards and experience tell us that there are more failed appointments in the hygiene column than in the doctor’s column. Open chair time is costly to a dental practice and in turn could also affect the hygienist’s compensation.

Some are asked to come in late or leave early if the schedule falls apart, and worse, some are asked to clock out when there isn’t a patient. That is a point of debate that is a separate article in and of itself. The point here is that if the office is not successful, there will not be enough resources to attract and retain good staff or the equipment needed to provide the best care.

Why are there so many more disappointments in the hygiene schedule? There is a need for systems regarding scheduling. It’s important to pre-book appointments and have a top-notch recall system in place that involves follow up as well as tracking patient retention. Patients with a history of being unreliable need to be identified and managed appropriately. Also, it’s critical to know the proper verbiage and protocol to use when a patient calls at the last minute to cancel or fails the appointment altogether.

At this point, you may be thinking, “I don’t have control over many of these things.” True, in most practices the administrative team is responsible for much of this. This doesn’t mean, however, you cannot or should not know how these areas are managed in your practice. You are in a position to offer ideas and suggestions to help make them better. An administrative team member doesn’t want to spend their day patching holes and practice owners want to see a well-managed schedule, so working together as a team to get good systems and protocols in place is key. The hygiene department is like a business in and of itself with the hygienist as the proprietor; it is to your benefit to see that your department/business is run well.

The biggest way a hygienist can impact the holes in the schedule is by creating value around what we do. Here are few thoughts and ideas.

Choose words wisely

This applies to all staff members when discussing hygiene appointments. Words such as “a cleaning” or worse, “just a cleaning” need to be eliminated from the office vocabulary. Cleaning is something that is done with a broom. You are not an oral custodian, and people can “clean” their teeth at home. What is happening in a hygiene visit is so much more than that.

Dear Patient: This is more than 'just a cleaning'

The reality is that as much as dentistry and the role of dental hygiene has evolved and grown—we are comprehensive health-care providers with a focus on prevention who do so much more than “clean teeth”—the average patient is often unaware. They may not know the preventive, diagnostic, and therapeutic value of a hygiene appointment. We are often the first to see and identify signs of disease or risk factors for potential disease, yet many patients don’t know this. They often don’t realize the amount of schooling and testing we need to complete. Some of the general public doesn't understand the importance of what we do and the value we add in the field of dentistry. You know how they find out? They learn from providers who take every opportunity to educate and create value around that appointment and our field.

When we step away from those trivial words to describe the visit, it elevates the importance of what we do. Consider words like “hygiene therapy,” “continuing care,” or “professional hygiene appointment” to use instead of cleaning.

Walk patients through what you are doing during each step of the process and why. For example, instead of “you’re due for x-rays” or “we need to do the perio chart because it’s the standard of care,” treat the individual in the chair and explain why what you are doing is specifically important to them. “Suzanne, when I took a look at your chart, I see the last time we took x-rays there were areas the doctor was concerned about. We talked about some of your risks for cavities, and I know we gave you a few strategies to use at home to attempt to keep that potential decay from breaking through. It’s really important we evaluate those areas again today, as we can’t see them clinically.” If you were this patient, wouldn’t you be more likely to see the importance of the visit and be glad you are in good hands?

Schedule your own recare

Notice how I didn’t use the word “recall”? Recall is something that happens to your car, not your valued patients. The word sounds like “it’s just time to show up.” Let’s face it; patients can look at hygiene visits that way. “It’s time for my cleaning and check-up; nothing is bothering me.” When you think of it like that, it surely sounds like something you can easily postpone without it being important. Recare is a word that better fits the situation and it’s importance.

With regard to scheduling recare appointments in the hygiene room, I am sometimes met with resistance: “That’s the person at the front desk’s job” or “I don’t have time for that.” I used to feel the same way until I started keeping track. Patients for whom I made the appointments were less likely to miss those appointments. When I booked them, I made it clear I was reserving time especially for them and would mention something that we would be doing or following up on at that next appointment and why it was important. Patients are less likely to break an appointment with you, as you have a different relationship with them than a person from your front desk team. They don’t want to let you down.

Provide comprehensive care

If your appointment is spent going through the motions or simply cleaning teeth without promoting the importance of what you and the patient are doing together, you will likely have a patient who doesn’t value the time. They may ask, “Are you almost finished?” because they don’t ’know enough about what you are doing to want to invest the time. "No, Mr. Jones, you aren't here today for just a cleaning. We will be doing comprehensive assessments, evaluating risk factors, and performing therapies to best manage your oral health, which is part of your overall health.”

Tell patients things like “We will be doing a thorough exam of your head and neck, which includes an oral cancer screening. Early detection of this disease is of critical importance, and the most thorough oral cancer screening you get is at the dentist office.” In that scenario, the patient is appreciative of your thorough care, realizes that this appointment is important, and they are glad they showed up. It’s likely they will show up for the next visit you schedule with them.


We know the value of what we do and we have the responsibility to be sure that patients understand this as well. Taking the time to educate, promote, explain, and tailor the message to individual patient need, helps to shift the paradigm from those “just a cleaning” appointments. Selecting words that elevate versus minimize the important work we do gives patients the opportunity to see their appointments with their hygienist as important appointments that must be kept.

Originally posted in 2018 and updated regularly

Julie Whiteley, BS, RDH, is certified in human resources. She holds degrees in business administration and dental hygiene and has worked extensively in both fields. She is on the faculty of Massachusetts College of Pharmacy and Health Sciences University in Boston. Julie bridges her knowledge and experience from business, clinical hygiene, and teaching to deliver information and programs that enhance dental practices. Contact her at [email protected].