Extended hygiene: a winning concept for everyone

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Since many dental offices have a backlog of care appointments, they are faced with a problem of time. Extended hygiene can be a possible solution when managed properly. When I was in practice, I was able to build a program that was beneficial to my dental hygienist, my patients, and the well-being of my practice.

Because no practice can reach its full potential without maximizing hygiene productivity and profitability, many offices underperform dramatically and chronically. But ancient wisdom proclaims that where one stumbles is his treasure, and by no means is the lack of business acumen of dentists more glaring or a viable option for improving returns more achievable than when it comes to ‘hygiene.

But here’s the catch, especially since the COVID-19 pandemic hit, many hygienists are disillusioned, feeling overworked and undercompensated, some seeking alternative careers, while many dentists view hygiene as a waste of time. time, a waste of time and a pain in the necessarily diabolical rump. Both factions have valid arguments, but a significant part of this conundrum stems from the fiscal inefficiency of a system rooted in decades of incompetence. This failure to excel painfully affects hygienists, dentists and patients, but the situation must not stay that way.

My office has used extended hygiene for about 30 years. Meanwhile, seven hygienists have graced our premises, all producing similar tax results, so we are discussing a system rather than the individuals who led it. Extended hygiene requires two rooms and a dedicated chair assistant, but it allows us to comfortably accommodate 12 patients per day instead of eight, which creates an instantaneous increase in production of 50%.

Have we sacrificed quality of care for the almighty dollar? Barely. With conventional hygiene, the eight patients seen in the age-old standard of eight hours each receive 60 minutes of working time. Our improved system supports 12 people for a total of 16 working hours, so 80 minutes are spent on each patient. The pace is calmer and extra time is available for relationship building, a key to acceptance of the case. (Patients ask staff straightforward questions they would never ask dentists, for example, “Are physician-recommended implants really a good idea?” And since staff responses are not self-interested, they are are more credible to the patient.)

Consider how the system works: at 8:30 am, as our hygienist finishes her treatment in the first room, the assistant places another patient in the second room already prepared. The assistant helps complete or review medical history, displays necessary x-rays or imaging, takes blood pressure (BP) readings, and answers questions. (Having films waiting for the hygienist and doctor is helpful, and we have identified many cases of extremely uncontrolled hypertension, such as BP 220/120. Would you like to inject this guy?)

After our hygienist has completed the care of her original client, she moves to the patient in room two. As the assistant enters room one, she warns me, “We’re ready for our first recording in room one. The assistant then polishes and flosses (if state law permits), applies fluoride, reviews cleaning techniques or any adjuvants / medication prescribed by the hygienist, and plans the next visit to the hygienist. resuscitation of the patient. (The assistant also sterilizes instruments, helps with periodontal mapping and sealant placement, and works in the chair during messy periodontal procedures.) Wilde, Mr. Businessman is ready for his second check. This is the code for “Enter here now!” “

This system means that I rarely have to interrupt the expensive talent of our hygienist and force her to wait while I do my exam, talk too much, and put her not too happy self late. It also gives me a window of at least 20 minutes to complete the exam at a time that is most convenient for me. Everything needs to be explained to patients in a way that shows that all choices are made in their best interests. Leaving for a hygiene check I would say, “Wow, you’ve been an amazing patient and you deserve a break. Rest and relax for a few minutes before you finish.

Having the assistant take care of the care planning avoids bottlenecks in the reception area, and because this team member is aware of any special needs or circumstances, time can be allocated in a timely manner. to maximize efficiency and productivity. If the patient is constantly chattering, difficult to process, or accumulating deposits quickly, for example, we can anticipate these scenarios and make ideal time allocations. Accurate planning is an important part of keeping an office running on time.

If they are discharged directly from the operating room, some patients leave without seeing the administrative staff and without meeting their financial obligations. We avoid this by having the assistant escort patients to the front office and hand over the case directly to a teammate. The assistant then returns to room one, cleans and sets up, then places the hygienist’s next patient. And the rhythm continues.

Two rooms and two staff for hygiene? Why bother? I love to hunt, fish, garden and play tennis, and I do it with joy and for free. But dentistry is my job, and at work I’m a hard-line businessman who is all about profit. In light of this pragmatic mindset, let’s consider some hypothetical numbers, which you can customize by inserting the numbers from your practice.

Fees and salaries vary widely, but let’s say your current excellent hygienist earns $ 36 an hour, or $ 288 for an eight-hour day. Ms. Hypothetical has routine cleaning for $ 85, fluoride treatment for $ 40, recall exam for $ 52, and bitewings for $ 65, for a total investment of $ 242. If the hygienist sees eight patients per day, the total output is $ 1,936 ($ 242 x 8), which exceeds the hygienist’s salary by $ 1,648 ($ 1,936 – $ 288).

With expanded hygiene, our hygienist’s salary remains at $ 288, but a dedicated chair assistant at $ 20 per hour, or $ 160 per day, makes total compensation of $ 448 ($ 288 + $ 160 ). At our arbitrary cost of $ 242 per patient x 12 patients per day means an output of $ 2,904 per day, which exceeds the salary of $ 2,458 ($ 2,906 – $ 448). To put it simply, I ignored the more lucrative periodontal procedures which should include one-third of hygiene care, sealant placement, panoramic x-rays, and teeth whitening, but I ignored appointments. not filled and patients who do not pay.

Let me help you with the final math: $ 2,458 – $ 1,648 = $ 810 increase in production per day. If a practice sees patients 200 days a year, that would be a $ 162,000 annual increase in hygiene revenues ($ 810 x 200). The addition of a fully equipped room dedicated to hygiene will pay for itself in a few months.

Here is a little grain to grind. My group of three doctors saw patients 313 days a year, and with split schedules, our office stayed open 10 to 12 hours a day. Even ignoring overtime, overtime resulted in an additional $ 91,530 (113 x $ 810) in hygiene production per year. I am a strong supporter of small groups. The solo practices that were once the norm are a fad in decline, practically indefensible. Recent uncertainties have amplified the reality that it is high time dental entrepreneurs wake up and smell the coffee.

Of course, overhead is not limited to salary. To determine profitability, you have to come up with a figure for general operating expenses. If hygiene produced 33% of my total income, I guess operating costs were responsible for a third of rent, telephone, utilities, marketing, support salaries, supplies and others. various expenses. Feel free to sharpen your pencil as much as you want here (how much is a container of prophylactic paste?), But I was satisfied with this estimate.

And here’s the kicker: the first day we went from hourly wages to income-based pay, hygiene productivity – and therefore hygiene wages – increased by 25% and never decreased. . This is in addition to the 50% increase in going from eight to 12 patients per day.

The salary percentage was calculated by taking our hygienist’s W-2 compensation from last year (which included all benefits paid, so these were not removed but automatically included in future production) and dividing it by its total production. If our hygienist’s W-2 income for the previous year was $ 60,000 and the hygiene output was $ 180,000, she would now receive 33% ($ 60,000 / $ 180,000) of every dollar she received. ‘she produces. We compensated the assistant in the same way: percentage of production.

People work harder to earn more, and unoccupied time, for which no staff member has been paid, has become anathema. They have moved heaven and earth to fill every day, for it is one thing to enjoy sipping coffee with your full paycheck and quite another to earn nothing by twiddling your thumbs for an hour. Dentistry may be the only industry where obsolete systems remain the norm for decades. Can you imagine a McDonald’s open 32 hours a week, 48 weeks a year? And do you think our business model is superior to theirs?

Expanded hygiene will dramatically increase practitioner profits, increase hygienist compensation, improve the work environment, and provide superior care to clients. These advantages are hard to surpass. For those of you who are determined to excel, here is a plan. I wish you good luck.

Editor’s Note: This article appeared in the July 2021 print edition of HDR.


After eight years of higher education, paying 100% of the fees himself, John A. Wilde, DDS, spent two years with the Army Dental Corp before starting a practice from scratch in Keokuk, Iowa. He was debt-free at age 30 and was financially able to retire at age 40. He retired at 53 and has written six books and published over 200 articles. You can contact him at (309) 333-2865 or [email protected]

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