11.15.13 Issue #610 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter
 


Carol Tekavec, RDH
Hygiene Consultant
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Five Ways to Improve Hygiene Production Now
By Carol Tekavec RDH

In the past, the hygienist in a dental practice functioned as a “cleaning lady”. The faster she could get patients in and out was the measure of her successful contribution to the office. Restorative treatment has always been important, with sustainable health and perio concerns somewhat on the back-burner. In that practice model, the hygiene department is thought of in the old-fashioned way of “loss leader”.

For many years now we have known that this is just not the case in a profitable and patient centered practice. Patients rely on their hygienists for more than just “cleanings”.  They rely on their hygienists to provide them with general knowledge, specific home care instructions for their individual needs, appropriate treatment, and on-going continuity with the office. Often a patient will look to the hygienist for confirmation when the dentist suggests restorative treatment. The relationship is important. Therefore, the hygienist is in a powerful position to help identify and support necessary patient care, as well as functioning as one of the backbones to production in the office.

The hygienist should not be on a treadmill of appointments that consist of only prophys and bitewings. Her appointments should not be rushed to simply force in more of the same. Hygiene services are a separate production and income center, and as such deserve careful attention as to how these services are being delivered. Here are five ideas to improve hygiene production right now:

1. Review patient records to determine when the last complete radiographic review was performed. This should be done before the daily morning meeting. ADA recommendations for prescribing dental radiographs were updated in 2012 (complete information available at ADA.org). Guidelines for all age groups and with complete, partial, or edentulous conditions are shown. While the guidelines are helpful, they do not infringe on the individual assessment and recommendation of the dentist as to when and how many radiographs should be exposed. Many dentists recommend a full mouth series at a minimum of every five years. More frequently if the patient has had a history of dental disease. Many dentists also recommend bitewings at least annually. The ADA guidelines show bitewing radiographs being recommended at 6-12 months for children and adolescents with clinical caries or at risk for caries if proximal surfaces cannot be examined visually or with a probe. For adults, under the same circumstances, the guideline suggests 6-18 month intervals. Children and adults with no clinical caries and not at risk for caries have bitewings recommended at 12-24 month intervals, even going as long as 36 months for some adults. The prime directive is the dentist’s assessment; therefore his assessment should determine when radiographs must be taken. Also of concern to most patients is insurance coverage. Most plans cover bitewings once per year and a full mouth series or panograph every three to five years.

Use the morning meeting to look over the patient’s clinical history and determine the need for the dentist to examine and assess the patient’s condition concerning radiographs. In many cases a patient may have been receiving bitewings only for a period of several years. This may not be proper and should be corrected by a full mouth series being exposed today. Be sure to also document the need for any radiographs taken in the patient’s record.

2. Note the patient’s last complete periodontal charting and probing. While a perio assessment is considered a part of any dental exam, sometimes it may be overlooked in favor of other pressing concerns. Perio charting should document probing depths, bleeding areas, recession, furcations, and mobility. According to the American Academy of Periodontology, probing depths of 4mm or deeper may be indicative of the need for active periodontal treatment. If the patient shows these results, it is not appropriate to continue to use standard prophys every six months as their “treatment”. The hygienist should explain all readings and recommend scaling and root planing where necessary.  The dentist and hygienist need to coordinate their message on this. “Watching” and waiting are typically not in the patient’s best interests.

3. The use of intraoral photographs should be a part of every hygiene visit. Identifying and explaining restorative needs are expedited with photos, and showing a periodontal probe disappearing into a pocket easily demonstrates the patient’s perio issues.

4. Hygiene appointment times should not be too brief. If the hygienist does not have the time to perform a complete perio assessment, take photos, expose radiographs and explain the patient’s condition, then the patient and the practice may be short-changed. Less than an hour is typically too little time to provide what is needed. Appropriate perio identification and subsequent treatment is better for the patient and the office. Taking the time to make this happen improves hygiene production in the long run.

5. Make products available to help patients sustain their home care efforts. These might be home fluorides and toothpastes, prescription mouth rinses, xylitol items such as sprays and candies, and dry-mouth remedies. “Selling” items is not unprofessional. Our patients appreciate being able to obtain the products that can support their success.

Because patients see the hygienist on a regular basis, anything that can be done to improve their care and treatment helps them and helps the office. Small changes can improve hygiene production now.

Carol Tekavec RDH is the Director of Hygiene for McKenzie Management.  Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department?  Email hygiene@mckenziemgmt.com.

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