The “To Do” List - Make Time at Every Hygiene Appointment!
The hygiene appointment can often take on a predictable, routine, and rushed character. Seat patient, perform prophy, exam with the dentist, set up next appointment, on to the next patient. Experienced hygienists often report burnout and boredom with their jobs. They also say there is not enough time to perform all the procedures they know should be addressed, so procedures are left undone. They feel under pressure and pushed by the clock, unappreciated by patients and their dentist employers. They are nagged by an undercurrent of knowing that more should be happening at their hygiene appointments, but they can’t figure out how to make this happen. There just isn’t time. One experienced hygienist told me that when she retired she would never own a watch again!
A burned-out, bored, rushed hygienist is not an efficient advocate for any dental practice. This person is just going through the motions. The hygienist may still be able to function as a production center, but is not being utilized to his or her full capability as a catalyst for new treatment.
A hygienist who has the time and is appreciated for what he or she does is both a production center AND a practice builder. New patients are wonderful, but patients of record who have treatment identified and scheduled are the life blood of a dental practice. Where is this treatment identified? During the hygiene appointment. Who encourages the scheduling of said identified treatment? The dentist, of course. But the hygienist is often the one who provides that little extra push to be sure an appointment is set up.
Hygienists need to have a “To Do” list, and the time to complete it at every hygiene appointment. The hygienist will be happier, the practice will be more productive, and patients will be receiving better care.
Update the patient’s medical history. Just because a patient has been coming in for many years does not mean this step can be skipped. Many systemic conditions affect oral conditions. We need to know medical history, for the patient’s care as well as their safety. Patients appreciate that we are concerned for their general health. They accept treatment from offices who have their best interests at heart.
Perform a full-mouth periodontal probing and recording. This should be accomplished at a minimum of once annually. Better still at each recall. Why? Because pocket depths and bleeding points are essential in diagnosing periodontal disease. Early detection can allow appropriate treatment, such as isolated scaling and root planing of pockets deeper than 4mm. Just because a patient has not demonstrated any pocketing previously does not mean that probing can be ignored. To save time, the hygienist may need help with recording, or a vocal or “foot pedal” method can be employed. Whatever is required, identifying perio disease is an important function of a hygienist, fundamental to a patient’s health, and critical for office production.
Expose necessary radiographs. Patients don’t like x-rays. However, without them diagnosis of dental disease is severely curtailed. Explain to patients that a car mechanic is not able to tell what is wrong with an automobile engine by looking at the hood of a car. Similarly, a dentist and hygienist cannot tell what might be wrong in a person’s mouth by merely looking at the “tops of the teeth”. Be sure to document why any radiographs are being taken in a patient’s record. For example; four bitewing x-rays were taken to look for interproximal decay of molars and bicuspids. Many insurance carriers are now requiring documentation of the need for any radiographs in order for payment to apply. The “need for the radiographs” cannot be just because they are covered by insurance.
Point out any problem areas. Hygienists should mention any possible problems they notice to their patients prior to the dentist coming in for the exam. The issues can then be mentioned to the dentist, who can either confirm the problem or make another determination. When patients hear it first from the hygienist and then again from the dentist, they are likely to schedule treatment. For example, “Ms. Patient, your first molar on the lower right side has a broken filling. I am thinking that Dr. Dentist will likely recommend a crown for that tooth.” When the dentist arrives the hygienist can say, “Dr. Dentist, I noticed that Ms. Patient’s first molar on the lower right side has a broken filling. Does it need a crown?” Then the doctor can say, “I see that problem and a crown would be best” or “I see what you are noticing, but I think another restoration can work.”
Apply topical fluoride. Current thinking on the use of fluoride varnish is that patients of all ages can benefit from this outstanding product. Therefore, taking the time to make this happen is good for patients and good for the practice. The hygienist can say, “We now know that fluoride varnish is important for almost all of our patients. I can see that you have several teeth with 2-3mm of exposed root surfaces. The varnish will help to guard against these areas becoming decayed. Your insurance may cover this, but if it does not the cost is only X.” Very few patients will refuse this excellent adjunct to their hygiene appointment.
You may have other services that you want to include in your “To Do” list for every hygiene/dentist recall. The important thing is that time is allotted for the services and not just “crammed in” to an already too full schedule. Both the hygienist and the practice will be better for it.
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 email@example.com.
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