7.8.16 Issue #748 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Jean Gallienne RDH BS
McKenzie Management
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Is Your Hygiene Department Broken?
By Jean Gallienne, RDH BS

What type of hygiene department do you have in your practice? To help you answer this question, you can run a report that will tell you what procedures have been done in the past year based on the ADA code. If the majority of your hygiene department’s production has been produced because of prophylaxis, you may need to look at revamping your procedures.

It is the industry standard that 33% or more of total hygiene production should come from ancillary services and interceptive periodontal therapy. If your practice has a prophylaxis oriented hygiene department, the production will be a lot of routine prophylaxis, x-rays and periodic exams. A periodontal oriented department will be doing prophylaxis, periodontal maintenance appointments, root planing, x-rays, and periodic exams.

A diagnosis-based hygiene department will always evaluate the patient’s medical and dental history, then ask what changes or problems there have been since the last visit. The patient will be asked: “What changes would you like to see in your smile?” 

The next step is to perform the necessary diagnostic tests, which may include blood pressure measurements, radiographs, intra-oral photographs, periodontal probing, gingival bleeding index, plaque index, caries detection, restoration evaluation, cosmetic evaluation, joint sounds, and cancer screening. The patient should co-discover any problems during the diagnostic evaluation process. Once the patient’s comprehensive exam is complete, a determination of the necessary treatment is performed.

If the periodontal condition is stable and it is determined the patient does not need any periodontal treatment, then the hygienist can proceed with the prophylaxis. However, there still may be other treatment to be addressed. This can be scheduled at a subsequent visit.

Granted, a prophylaxis-based hygiene department and a periodontal-based hygiene department may do all of the diagnostic tests, but will continue on with the prophylaxis or assigned periodontal treatment without considering the specific needs of the patient that day or in the future.

Why would prophylaxis-based hygiene departments be so prevalent? Usually it’s because the practice has always done it that way and it’s easier to continue doing things the same. Change requires extra effort on the entire office’s part. There are many items that need to be established, such as protocol for co-discovering periodontal disease, written protocol on how to communicate and treat patients after co-discovering a problem, developed office communication skills, tactics for educating patients, staff and yourself, and financial protocol and arrangements.

There are also pre-existing team perceptions. “Well insurance won’t cover that.” If the team does not value the work they are doing for the patient, they will feel they should give it all away. They will just do the work of a periodontal maintenance appointment and not get paid for it.  

In establishing a treatment protocol for your periodontal patient, you should consider several characteristics.

• What determines the need for periodontal treatment?
• How much time is needed to perform the work?
• What will be done at each appointment?

These are just a few of the questions that need to be answered in order to start establishing your periodontal program.

There are even more systems and protocols to be determined when establishing a diagnosis-based hygiene department. An x-ray protocol needs to be in place so the hygienists and assistants no longer question when x-rays are needed for a particular patient. There must be a successful recall system in place – not one that the hygienist or other team members work when there is time, but one that has a person responsible for meeting goals and monitoring their effectiveness on a regular basis.

Have an intraoral camera protocol. How many pictures should be taken? Do you want specific pictures for every exam, in addition to suspicious areas? Determine what the doctor wants to have on the screen when he/she walks into the room. Protocol should also be established regarding how to approach a patient who has treatment pending, as well as how to help promote the treatment plan the doctor has diagnosed.

Once your practice is a diagnosis-based hygiene department, you may not only see the production go up in the hygiene department, but in the entire practice. 

Interested in improving your hygiene department? Email hygiene@mckenziemgmt.com and ask us about our 1-Day Hygiene Training Program or call 877-777-6151

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