The $8,000 hygiene day

By Carol Tekavec, RDH

Editor’s note: Reprinted with permission from McKenzie Management.

Hygiene production should be three times hygiene salary. Time management, professional skills, technology, and fees all play a part in making this happen. However, the financial contribution of the hygiene department might also be measured in more than just what is accomplished in the hygiene department today. Treatment needed, identified, and scheduled due to the efforts of the hygienist and dentist working together can be a huge factor in overall office production.

Here’s how: Katherine is the full-time hygienist for a busy general practice. She typically sees eight patients per day, with fewer scheduled to account for scaling and root planing appointments and periodontal maintenance. She and Dr. G have developed a cooperative method of approaching recall appointments that facilitates identification of necessary periodontal treatment as well as restorative needs of patients.

Her first recall patient of the day is a professional man with a tight schedule and a disinclination for small talk. Following the protocol of the office, Katherine takes things step by step. First, she updates his medical history, takes blood pressure at least one time per year, takes necessary radiographs, performs periodontal probing at least one time per year, performs a preliminary oral cancer screening, and accomplishes a visual assessment of the teeth. During the visual assessment, she notices two teeth with existing amalgam restorations that show cracks. Knowing that broken teeth due to cracks are one of the most common emergencies of the office, she points out these teeth out to the patient and takes two photos, which are displayed on the monitor in front of the patient chair. The enlarged photos make the cracks unmistakable, and the patient is engaged. When Dr. G. comes in, Katherine gives her assessment of what she has seen and what she and the patient have talked about, and Dr. G verifies that the two teeth definitely need crowns. Katherine walks the patient to the front desk, the treatment coordinator gives him an estimate, and he sets up an appointment for next week. Projected production for that appointment is $2,000.

Katherine’s next appointment is also a recall. This retired lady has had a tooth missing in the areas previously occupied by the mandibular left second bicuspid for several years. She has been living with the situation, and Katherine knows that a solution to the “space” has been offered to her several times. Despite knowing that the patient has not sought treatment previously, Katherine follows the same protocol as before, and points out to the patient that an implant and crown could restore her smile in a very effective and long-lasting way. Katherine turns on the patient monitor and shows the patient a one-minute video on implants. When Dr. G. comes in, Katherine gives her assessment and Dr. G. verifies that the patient would be a good candidate for an implant and crown. Due to Katherine’s suggestion, the illustrations in the video, and Dr. G’s explanation, the patient decides this time to go ahead with the treatment. Projected production for the implant and crown is $4,000.

Later in the afternoon, Katherine encounters a patient whose teeth are showing extreme incisal wear. Posterior teeth also show wear facets, and the patient tells her that most mornings she wakes up with a headache. Katherine explains that an occlusal guard may help reduce or eliminate her headaches, while possibly preventing further damage to her teeth. The patient is interested. When Dr. G. comes in, Katherine gives her assessment, Dr. G. tells the patient more about the way an occlusal guard functions, and the patient decides to schedule an appointment to get started. Projected production for the occlusal guard is $800.

Katherine’s direct hygiene production for the day was $95 per prophy x 8 = $760. Bitewing radiographs at $60 x 4 = $240. Fluoride varnish at $40 x 5 = $200, plus the sale of two tubes of prescription fluoride toothpaste at $20 each. Total = $1,240.

While direct hygiene production must be an important consideration when deciding on how the hygiene department is functioning, indirect production in the form of restorative treatment, identified and scheduled, cannot be ignored! The keys to success lie in the way the hygienist approaches the recall appointment, uses technology to support explanations, the hygienist’s ability to the truth to the patient in an empathetic way, and the interaction between the dentist and hygienist when he arrives to complete the recall. The dentist and hygienist have to be on the same page as to how the dentist approaches treatment, and their individual philosophies must jibe. Nowhere is the need for the dentist and hygienist to work as a team more important to patient care and financial success than during their interaction in front of the patient. When both are functioning well together, with professionalism and mutual respect, the $8,000 hygiene day (direct and indirect production) can become a regular feature of the practice.

Author bio
Carol Tekavec, RDH, is the director of hygiene for McKenzie Management and can be reached at [email protected].