4.1.16 Issue #734 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Carol Tekavec, RDH
Hygiene Consultant
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Hygiene Production: Not Just Today’s Numbers
By Carol Tekavec RDH

The Hygiene Department is busy. Regardless of whether you schedule 50 minutes or one hour for an appointment, much more than “just a cleaning” must take place for a practice to stay viable. Ideally there are numerous tasks that should be addressed. Here are the basics:
An update of the patient’s medical history is vital. Simply entering “update med hist. no changes” may not be enough. A separate section of the patient e-record should provide for an entry that lists any changes in health or medications taken, with the entry person’s number or initials. Alternately this information can be listed in the progress notes. Be sure to ask if the patient has had any surgeries. Many patients who have received replacement “parts” for joints may neglect to mention this, and may or may not be candidates for premedication. There can be serious complications for a person needing a premed who is not given one. It is an office responsibility to find out if one is needed. The time for this update can range from 20 seconds to five minutes depending on the patient’s situation; or even longer if the patient’s physician must be contacted. Radiographs as necessary. Current ADA guidelines indicate that interproximal radiographs for an adult with a low risk for decay may be extended to two years in some cases. Many offices are more comfortable with a “once a year” schedule for all adults. Whatever the dentist thinks is appropriate still takes some time to accomplish. This can range from 3 minutes for a very compliant patient utilizing digital x-rays, to ten minutes for regular film exposures on a nervous, gaggy patient.

A Caries Risk Assessment is a newer addition to an effective recall appointment. The descriptions, format, and forms can be obtained through the ADA.  If the actual ADA form is used, and the interview process is adhered to, this can take at least five minutes.  Many offices like the idea of a Risk Assessment, but balk at some of the questions listed on the assessment form. For example, there is a question about Drug/Alcohol Abuse and another for Eating Disorder. If a discussion is going to be pursued on these topics, quite a bit of time, much more than five minutes, must be allotted and a very tactful demeanor utilized. If the hygienist is instructed to simply “observe all teeth for possible decay” this might be accomplished during the scaling and polish, but is not an actual Risk Assessment. Take a look at the ADA form online to see what should be noted.

A Periodontal Assessment is essential. This should include six pocket/sulcus depths, plus bleeding mobility, furcations and recession. If accomplished by the hygienist alone, 5 -10 minutes. If accomplished with an assistant or electronic recording device, 5 minutes. Then, the prophy at 20 to 30 minutes, followed by the dentist’s evaluation at 10 minutes (if the dentist is available to come for the exam right away).
We now will have spent approximately 40-60 minutes on this appointment. Revenue generated will be for the prophy and radiographs for the hygiene department, and the dentist’s exam for the dentist. If the hygienist had time during the appointment to discuss possible necessary treatment with the patient, these numbers could be greatly enhanced. Here are some examples.

Example #1
Linda the hygienist notices that Pam, her patient, has a cracked tooth #30. She takes an intra-oral photo and also utilizes a CariVu to show the tooth as an icy white image on the television monitor. The crack looks like the Grand Canyon on the photo, and appears as a large, black fissure on the CariVu. She tells Pam that the dentist will likely recommend a crown for this tooth.  When the dentist arrives for his exam, the hygienist informs him of what she and Pam have been discussing, he confirms the crack and recommends a crown. Since the patient has had time to get used to the idea, and can also clearly see the need, she agrees to the crown and schedules an appointment. Revenue generated for the future crown, $1500.

Example #2
The hygienist begins a discussion with Tony, a patient with a long-standing space where #4 had been previously removed. Although she has spoken with Tony about this before, she mentions again that he could have an implant and crown to fill this in, greatly improving his smile. While the patient has never appeared to be interested in an implant, the discussion today inspires him to finally decide to have the implant/crown. Revenue generated for the future implant and crown, $3500.

Example #3
The hygienist notices that Andrew has many worn anterior teeth. She explains that these worn teeth may indicate the need for a nightguard and possibly some incisal restorations. The patient agrees to six 3-surface incisal restorations plus a nightguard.  Future revenue generated, $175 x 6 = 1050 +700 = $1750.

With enough time, and the encouragement of the dentist, a hygienist can greatly increase office production by noticing and mentioning necessary patient treatment. Hygiene production for this hygienist might include the generation of future revenue by patients’ acceptance of treatment suggestions. In this example, $1500 + 3500 + 1750 = $6750.

While many practices have a schedule they are happy with that works well for them, some may be interested in ways to generate more treatment coming from the hygiene department. The addition of a little more time can sometimes offer a nice pay-off. Hygiene production can be thought of as more than just today’s numbers.

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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