Having solid evidence-based clinical protocols for each hygiene procedure is the cornerstone of a progressive and profitable hygiene department. It’s essential that these protocols are agreed upon and understood by every team member. The doctor(s), as well as the hygiene team, must recognize disease in its earliest stages and diagnose active infection with the same parameters. AAP case typing should be applied to each perio patient and treatment planning for treating periodontal disease follows agreed upon prescribed protocols and parameters.
See an example of what your clinical protocols for a preventive prophy might include below. As you read these protocols, keep in mind the ADA 1110 descriptor states following: Removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.
Solid clinical protocol for 1110
While these clinical protocols serve as a guideline for every prophy appointment, as clinicians we understand that we must use our clinical care skill and judgment with each patient to customize the appointment and manage our time. The patients’ priorities, chief concerns and needs always come first.
Let's look at a few examples from profitable dental hygiene departments:
I’d like to share two more examples of how statistics and benchmarks can confirm that each hygienist is ‘living’ the treatment philosophy and clinical parameters of a profitable dental hygiene department.
Let’s look at another example.
It’s clear from these statistics that these ladies are ‘living’ their treatment philosophies and making sure that the patients in their care are receiving periodontal therapy when it’s needed. And the fact that their dental hygiene departments are profitable proves that they are providing a high level of service and professional care for their patients. If you haven’t already done so, setting some reasonable and clear goals for the dental hygiene department provides benchmarks for performance so that each Hygienist can measure their progress and success. Below you will find the current industry standards. Use these guidelines to help set your goals.
Hygiene industry standards:
Balanced service mix is a reflection of your clinical philosophy. Looking at service mix is essentially looking at the variety of services, beyond a basic prophy, that are being offered and delivered in your dental hygiene department.
There really are no industry standards for dental hygiene department service mix, which makes this statistic driven completely by philosophy and protocol. I’d like to make the assumption that if you are reading this article, you have also watched the Principle-Based Dental Hygiene course available through Spear’s Course Library in the Staff Training section. Your principles of care will drive your service mix.
For example, if one of your principles includes eliminating sub-gingival bacteria, then your statistics would reveal the regular use of a locally applied antibiotic (LAA) such as Arestin. Typically, I would expect to see at least one site of LAA per quad of therapy (4341/2) and at least 30 percent of periodontal maintenance patients’ receiving one, two or three sites of LAA.
Additionally, if you believe that adult fluoride application can lower caries rates, decrease root sensitivity for those with recession and help your patients protect their investment in restorative dentistry, then your statistics would reflect the regular application of adult fluoride varnish. For an office that has adopted this philosophy I would expect at least 50 percent of adult patients would be receiving fluoride. To achieve that percentage, all adults would have to be offered the opportunity to take advantage of a fluoride varnish application.
Radiographs are another area you should evaluate. What is the frequency of PANOs and FMX being sourced from your dental hygiene department? Visualizing alveolar bone is a key component of periodontal diagnosis and risk evaluation for future periodontal disease. The use of seven Vertical BWs rather than four Horizontal BWs can help you visualize all areas of alveolar bone. When radiographs are neglected, disease will be missed.
At the dental hygiene chair we walk a tightrope between data collection, delivery of care and education/enrollment. We must make the most of the precious 60 minutes we have with each patient. The first step in this process is chart review!
You must know the following, before seating your perio maintenance or recall patient, to make a realistic plan for today’s dental hygiene appointment:
Once the patient is seated, break the dental hygiene appointment down into three components, as we do at Inspired Hygiene:
It’s always best to provide a periodontal screening, rather than a comprehensive perio exam when radiographs and doctor exam are scheduled to facilitate time management. In addition, the doctor exam should occur in the second 20 minute time frame whenever possible. This will prevent the hygienist from having to wait on the doctor and increase case acceptance measurably.
Using words and phrases that have the biggest impact can help you get your point across quickly. A great exercise you can do as a team is "Start Saying/Stop Saying." I’ll get you started; see how many more words/phrases you can come up with!
Having solid clinical protocols in place is half the battle. Having the correct team members in place is the other half. All too often I find myself in a discussion with a client that involves an underperforming or negative hygienist. And after some coaching to help this team member things get better for a few weeks or even a few months. Soon, however, we are having the same discussion about the same team member again, and again. Does this sound familiar? If so, it may be time to ask yourself if you have the right players on your team.
Dental hygienists are well-paid, highly trained and skilled, health care professionals and should conduct themselves as such. An A-Team hygiene department consists of those that exhibit strong levels of commitment and dedication to not only their patients, but their team members as well. An A-Team hygienist may emerge as a leader; you will recognize them by their qualities and behaviors:
Having a solid foundation with clear systems, written protocols and agreements in place creates an environment, and the opportunity, for hygienists to function at the top of their game. Setting some reasonable and clear goals provides benchmarks for performance so that each hygienist can measure their progress and success. A-Team hygienists can be developed when these systems are in place.