Hitting the Hygiene Gas Pedal

Hitting the Hygiene Gas Pedal. Photo courtesy of WavebreakMediaMicro/stock.adobe.com.

The hygiene department provides preventative oral care for their patients. However, they also do a lot more than that, too. All these tasks take time, and take time away from working with patients. We share products, practical tips and best practices that can help them manage their critical role in the dental practice with more efficiency and effectiveness, so hygienists can spend more time with their patients.

Tim Quirt, DDS, Vice President of Clinical Operations at Heartland Dental thinks technology is the foot on the gas pedal for the hygiene department to keep teams feeling engaged and happy with their work. Quirt says hygienists are doing more procedures than before, but often with the same time allotted for patient appointments.

“It’s time that we as an industry help hygienists by understanding that they have so much to do and finding ways to make that easier for them,” Dr Quirt says.

Mike Massotto, Founder and CEO of Staff Driven Dental and Dental Coaching on Demand, agrees the perception of hygiene as teeth scraping should change. While the prophy is part of hygiene, and what patients remember most, the total care hygienists provide is much more. He also advocates creating an optimum working environment where everyone feels accomplishment.

“When hygienists feel that they're winning, successful and happy, you're getting the most efficiency and effectiveness out of your hygiene team,” Massotto says.

Katrina Sanders, RDH, a practicing dental hygienist, dental hygiene educator, and an international speaker, says that changing patient perceptions about how hygienists serve them is also an important priority to increasing efficiency and effectiveness of the hygiene department. While hygienists understand the disease process, prevalence, and problems of periodontal disease, decay, and oral cancer, patients don’t. Patients sit in the chair thinking they are in good health and ask about whitening, but the hygienist knows they need more, Sanders says.

“Patients don't understand if your gums are bleeding, if you have a pimple on the side of your gum tissues or early decay where bacteria has literally eaten away at your enamel, the hardest substance in your body, if you smoke or have an elevated risk for human papillomavirus 16 or 18, you have an elevated risk for these diseases, and we're screening for them,” Sanders says. “Patient value in their oral health has been a big barrier in us feeling comfortable, even telling the patient they have a disease process.”

Ways to Hit the Gas on Efficiency and Effectiveness

So, how do we change these perceptions and create the optimum working environment for efficiency and effectiveness? It starts with planning.

Tina Clarke, RDH, instructor at Lane Community College, practicing clinician, continuing education speaker and industry speaker thinks planning ahead for the next day, or even a few days out, can help hygienists’ efficiency in the operatory. From getting organized with what treatments are lined up to ensuring that all the tools are sharp and ready for treatment, planning helps things run more smoothly for the hygienists’ schedule. Clarke compares it to using meal planning to reach nutrition goals.

“When we are trying to have a strong healthy diet, we do prep cooking and plan head for the store, right? Planning for our treatment for the week is similar. We see what patients are coming in and plan for them,” Clarke explains. “If you see in the chart that a patient has a high caries risk, the hygienist can ensure that the supplies are on hand to treat them for that.”

Clarke says having backup instruments on hand organized by type can also help.

“If you individually wrap them and organize them where the Gracey 13/14s are in one place and the extra universal scalers are in another, you can easily grab and go,” Clarke says.

For sharpening, Clarke does her instruments by hand, which she says isn’t for everyone. She says other hygienists like the PDT Gleason Guide™ or Hu-Friedy’s Sidekick®. She also likes the Hu-Friedy Diamond Sharpening Instrument Card because it’s thin, about the size of credit card so it’s easy to hold, and sharpens instruments in a few strokes. She also suggests hanging onto the old instruments even when replacements arrive.

“Brand new instruments are beautifully sharp, but they’re pretty wide and don’t always work well for all of our patients. Make sure you hold on to some of those thinner instruments that you can use for your patients who have really tight gum tissues. Don’t just automatically replace and have all brand-new instruments in there,” Clarke says.

In addition, Clarke likes ultrasonics and all the appropriate aerosol guides. She also says having a variety of ultrasonic insert tips makes a huge difference in operatory ergonomics. Moreover, dental loupes with a head light also support better ergonomics while delivering patient care.

“It makes such a difference,” Clarke says about her Q-Optics loupes. “I don’t know if I could ever live without them.”

Another helpful product are color-coded probes. Hu-Friedy has color-coded single-end Colorvue® Probes that have yellow tips to add contrast in the oral cavity.

“The yellow markings instead of silver and black markings are nice when you are working in a dark environment,” Clarke says.

Clarke says hygienists should also use that planning to control and manage their schedule, arranging for complexity and preparation. For example, if a patient is coming in who needs x-rays and appropriate assessment along with their usual treatment, hygienists can schedule them for an appropriate amount of time. However, she realizes this approach can present challenges.

“If you are also an employee that has other individuals looking to see if you are being productive financially, it can be a big challenge,” Clarke says about managing the schedule. “Hygienists should advocate for themselves in those situations that this scheduling is how production is going to go up. Really, you’re advocating for your patients and the health care your patients deserve.”

Alyssa Aberle, RDH, Executive Administrator for the Colorado Dental Hygienist Association,and hygienist for a community health center, says hygienists need assistants. Hygienists have efficiency challenges because they work alone. Forgetting or dropping equipment or needing something that isn’t in the room requires changes in personal protective equipment (PPE) and inhibits efficiency.

“It’s a lot of taking off gloves or switching barriers to get something from another room. Most of the problems could be alleviated if there were other people available,” Aberle says.

Another way to increase efficiency is to alleviate some tasks, like scheduling or room turnover, to free up hygienists for patient care.

“Having effective system in your office where each person has their role and knows where it fits in the timeline of an appointment can help things be more efficient,” Aberle explains.

Tools that free-up hygienists’ hands while working with patients are also valuable to efficiency, Aberle says. Trying to hold everything during the appointment contributes to poor ergonomic positioning, which leads to injury. Moreover, the high-volume evacuation (HVE) units hygienists have incorporated since the COVID-19 pandemic have exacerbated the problem. Aberle likes how the Purevac HVE (Dentsply Sirona) has a mirror on the end, alleviating the need to hold suction and a mirror. Aberle also likes DryShield® or IsoDry® (Zyris), which have a bite block with an isolation system that frees up hygienists’ hands. Aberle also started using Aerosol Assist, an HVE for aerosols that also has a saliva injector in the same device.

“It rests on the patient’s cheek. So, you’re getting fluids out of their mouth but also mitigating the aerosols and, again, not having to hold it with a hand that you need for something else,” Aberle says.

Hands-free charting options help efficiency, too, Aberle says. Whether using foot pedals or a headset with voice recognition, or the Florida Probe System that perio charts while probing, having instant charting makes a significant difference in clinician efficiency.

“Then you are not, seeing 3 numbers in your head and trying to remember them as you turn around and type them in, and then turning back around to reposition. It’s amazing how much extra time that takes,” Aberle says.

Dr Quirt also thinks investing in technology and digital processes that increase patient convenience has benefits for the hygienist. For example, if a patient is late and then has to fill out paper forms, the schedule is off already. Sending digital forms in advance can help.

Ensuring that the technology the hygienist wants to incorporate is compatible with practice management software is essential, Dr Quirt says, otherwise you are only creating more work for hygienists. For example, Heartland Dental supported offices use Dentrix (Henry Schein One), which has a Dentrix Periodontal Chart to capture periodontal measurements, but Dr Quirt says there are many products out there that can help with the hygiene team.

“Over the years, we have given them so much to do over the years, and all of it is extremely important. So, we need to continue to find ways to make it easier for them,” Dr Quirt says. “They have been a jack-of-all-trades for years and we have the technology out there to make it much easier so they can spend their time coaching their patients and getting the care they need, want, and desire.”

Sanders says that imagery can make a significant difference to build patient trust. However, hygienists need training on the camera to take clear photos and how to explain what they are seeing there. Sanders likes to ask patients what they see when she shows them an image of their oral cavity. Moreover, she wants hygienists not to make assumptions when patients say, “does my insurance cover this?” it doesn’t mean that finances are their only motivator. Patients might just want to know if its covered, she explains. As patient advocates, Sanders says hygienists should help motivate patients to change based upon their value system.

“So, when we use tools like an intra or extra oral camera, we have to onboard the patient in that process. When we use tools for perio, like the Florida Probe, we are giving patients the opportunity to ask, ‘what are those numbers? What does it mean?’ We have to bring patients into the equation,” Sanders says.

In addition, Sanders thinks that remembering how the pandemic changed things is essential. People are more aware that there are people with higher risk factors for certain conditions, and that being asymptomatic doesn’t mean you are not infected. Sanders thinks this experience presents an opportunity for the necessary change in hygiene perception.

“Patients learned on the news to cover their mouth with a mask to protect themselves against this virus. So, they learned that the mouth is a portal to the rest of the body,” Sanders says. “A huge layer to this effort is that hygienists have to understand that society and our community as a whole are different.”

In addition to technology and tools, Massotto thinks practices should establish a collaborative, step-by-step hygiene system that creates consistent delivery of patient care and brands the practice.

“With a system, they get everything in, nothing is missed, and expectations are met,” Massotto says. “The doctor's happy; they're happy and less stressed. The day flows better.”

So, How Can Hygienists Get Their Feet on the Gas Pedal?

Aberle recognizes that these products and staff resources are not always available already. She recommends breaking down the numbers for the practice stakeholders to demonstrate how the investment will provide a return. Show how the efficiencies lead to comprehensive patient care in a shorter time, minimize downtime between appointments, and make it possible to provide more services in an appointment.

Ergonomics is another significant consideration for practice stakeholders. When hygienists have chronic pain, they need more time off and see fewer patients. Poor ergonomic conditions also lead to hygienists going part-time or developing long-term health issues that require surgery. It could also mean worker’s compensation claims.

“You are going to be able to increase your production and, if you look long term, a lot of these things help ergonomically, too,” Aberle says.

Joe Fogg, CEO of onDiem, an online temporary staffing agency, thinks additional staff can help increase production in the hygiene department. Fogg recommends bringing in supplemental professionals to help the practice maximize revenue.

“Most of our customers usually have an empty operatory,” said Fogg. “Consider hiring a temporary hygienist for the day to see routine prophy cases, and free up your regular staff hygienist to perform the higher-value more complex cases. Not only will this result in increased production, but you’ll also see the payoff in increased revenue both from the higher-value procedures and the additional referred procedures for future care.”

Clarke says that in addition to advocating for themselves in the office, hygienists should also take a firmer stance with patients regarding scheduling when they do complex procedures.

“You want a surgeon to be at their peak when they perform a procedure. Often, complex surgeries are scheduled early in the morning when the entire team is well rested. That’s how we, as hygienists need to start thinking when we are talking about our schedules and being productive,” Clarke says.

Clarke also thinks hygienists hold back recommendations because they don’t want the patient to feel pressured to “buy” something. She recommends letting go of these preconceived notions and telling patients their health status and what you recommend for it, and then letting the patient decide.

“Remember, we prescribe medicine because the patients need it, not as a way for the practice to make money,” Clarke says.

For hygiene systemization within a practice, Massotto recommends determining the desired patient experience outcome from the appointment and working backward from there. Also, he suggests surveying patients about their experience afterward.

“The patient experience is huge because it’s all about that. That’s what keeps people coming back,” Massotto says.

Getting an outside perspective helps, too, Massotto says. Working with experienced professionals can eliminate the trial and error a dental practice might have systemizing alone. Staff Driven Dental also has free consultation and coaching for hygienists wanting to improve efficiency and effectiveness.

“A lot of times when I start off with a practice it is because the staff reached out to me,” Massotto says.

Dr Quirt suggests approaching the conversation from a patient care standpoint. Framing the investment in terms of the elevated care would appeal to the practice stakeholder.

“I would bring it up to whoever is managing your practice with this notion that you are trying to do what is best for your patients, to provide the best patient care,” Dr Quirt says.

Sanders thinks part of doing what is best for patients involves taking an active role in oral health education. She knows some hygienists that have begun patient-centered newsletters, so that even when patients are not in their chair, patients still get education. Sanders says this effort also creates an opportunity for patients to see hygienists as more than the “cleaning lady.”

“If this pandemic taught us anything, it's that we are resilient,” Sanders says. “All of us had to pivot so much during this global health crisis, and we've done so beautifully. If we can pivot the way we look at infection control, and handle moving back into a new normal with new PPE and new patient communication strategies, it shows we have the opportunity to create the changes our profession needs moving forward.”