Principles of Practice Management: The hidden $20,000–$50,000 hygiene production gap in most dental practices

Dental hygiene has become one of the largest production weaknesses in dental practices. What is causing that? According to Levin Group data, approximately 10% of dental hygienists exited the profession during the pandemic, many permanently. This led to a shortage of hygienists, scheduling challenges, and expectations for significantly higher compensation by hygienists. It is fair to say that the vast majority of dental practices have been touched by this issue.

How to increase hygiene production without adding hygienists

In the face of these challenges, Levin Group recommends five strategies to increase hygiene production:

1. Involve the hygienist in filling the hygiene schedule. The highest level of no-show and last-minute cancellation patients in any practice is for dental hygiene. When these occur it represents chair time that can never be recovered. It is lost forever. Dental hygienists need to become very skilled at building value for the dental hygiene appointment in the mind of every patient. Many patients think dental hygiene is just “a cleaning” and will cancel a hygiene appointment if they have a hair appointment scheduled at the same time. This low-value mindset must be changed. Hygienists should explain to patients that their appointment is not just about cleaning teeth, but also the prevention of periodontal disease. Make them aware that periodontal disease can have numerous negative health impacts for each patient – infection of the gums, loss of bone around the teeth, etc. Every hygienist should have a script that helps to educate each patient and emphasize these concepts in every appointment.
2. Dental hygienists should identify any gingival or periodontal disease. Research indicates that more than 40% of Americans over 30 have some level of periodontal disease.¹ The level is even higher (almost 60%) amongst older people.² Hygienists are very well positioned to be the primary source for identifying patients who would benefit from advanced treatment. What is good for the patient is also good for practice production.
3. Dental hygienists are high-level professionals and need to be trained and respected as such. They should be very well-versed in all treatment opportunities offered by the practice including aesthetic dentistry, implant dentistry, basic crown and bridge procedures, and any other services offered. Hygienists should be trained to identify these potential opportunities, educate and with confirmation by a dentist, motivate patients to accept treatment.
   
   
4. Every morning identify all patients on that day’s schedule who are due for basic hygiene procedures like x-rays, fluoride, or sealants. New clients of Levin Group usually tell us that all their patients are up to date with x-rays and fluoride, but upon closer inspection we then find that they are $20,000 - $50,000 behind in production due to overdue x-rays and fluoride. Clearly a missed production opportunity.
   
   
5. During their downtime, there is no one better suited than the hygienist to reach out to overdue hygiene patients and get them on the schedule. Whether by phone or text the dental hygienist will have a higher response rate with patients versus the front desk. Some hygienists are reluctant to spend time calling patients, but it is in the best interest of patients to schedule appointments for their regular hygiene treatment.

Systems and training turn dental hygiene into a production driver

Dentists need to implement excellent systems to ensure that the dental hygienist has the knowledge, training, and scripting to build value in the hygiene appointment, identify potential treatment beyond traditional hygiene services and increase practice production.

References

1. 1. Periodontitis. ADA. Updated June 9, 2022. https://www.ada.org/resources/ada-library/oral-health-topics/periodontitis
   2. Periodontal disease in adults (age 30 or older). National Institute of Dental and Craniofacial Research. Last reviewed August 2021. https://www.nidcr.nih.gov/research/data-statistics/periodontal-disease/adults