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Welcome to dentistry’s largest dental hygiene practice management resource center! We are the leading dental hygiene consultant/coaching business.

We will increase your TOTAL dental practice profitability without working more hours or days each year.

- Debbie Seidel-Bittke, RDH, BS, Speaker, Author. Dental Hygiene Coach & Consultant

Dental Practice Solutions - Debbie Bittke

Assisted Hygiene Model for Practice Part 3

By: Debbie Seidel-Bittke, RDH, BS

April 26, 2010

In part 1 and part 2 we discussed critical components to a successful assisted hygiene business model. In part 1 we discussed a systematic approach, developing a specific protocol for how this will work. In part 2 we discussed communication with your patients and also team meetings to make this a seamless process and get every team member on the same page. In part 1 scheduling was briefly mentioned and in part 3 we will discuss this in more detail.

Organizing the Assisted Hygiene Schedule

When organizing your assisted hygiene schedule you will first begin with what procedures will be accomplished in the hygiene appointment for preventive care. Write the list and then put a number next to each one in order of importance. If you believe review of the medical history and blood pressure screening are most important these will have a 1 by them. If Caries Risk Assessment is not as important as the Periodontal Screening Exam you will put a lower number on the Periodontal Screening Exam so this goes higher on the list. Later you can put these in numerical order. Every team especially members of the hygiene team need to be a part of this exercise. During this meeting write down other services you may be missing. Services you may not currently offer are a smile analysis, Invisalign, selling products for halitosis or xerostomia, etc. These are just a few suggestions but can add value to your hygiene department in many ways.


The next part of organizing the schedule once the procedure and their importance and amount of time needed is to write down in another column /the person who will be able to provide this procedure. The hygiene assistant can seat, greet, review the health history and even take a blood pressure. Is the assistant able to coronal polish? If this is within their scope of practice write them down in the column next to the procedure when you have decided your order of importance.

Something else to identify is what you consider to be high production, moderate production and low production. You will be organizing your procedures and the pieces to the schedule by these classifications.

Writing the Assisted Hygiene Protocol

It is very important to have this all written down and kept in a place where you keep your practice protocols. Discuss how you will communicate with patients and exactly what you will say. Is a patient says they can’t afford to come in every 3 months what will your response be? This is one of the questions you will all systematically want to be able to answer. Of course not every patient is the same but what information do all of you in the entire practice need to know to give an educated response?

Putting the Pieces of the Schedule to work

Now that you have your list of important procedures and the name of the providers who can provide this treatment make another column and write down how many minutes you will need to accomplish each procedure. The patient coming in for a scaling and root planning procedure will most likely need 1 hour of uninterrupted time. This will most likely be 60 minutes. A patient coming in who is getting a fluoride varnish and oral hygiene instruction review because their caries risk assessment showed they are moderate to excessively high risk for caries needs no more than 20 minutes and they can be seen by the hygiene assistant in a second room while the hygienist is scaling and root planing. If the assistant is able to do coronal polishing they can see a pediatric patient in the room next to the hygienist while the RDH is administering anesthesia and then scaling and root planning.

Putting the pieces of the puzzle together is where it gets difficult. On the opening day of this new program and even while putting the pieces of the puzzle together you may want to enlist an expert in assisted hygiene.

When you are able to put these important steps together you will work in harmony to create a masterpiece. Utilizing the assisted hygiene business model can create a fun place to work and very happy patients who feel they are well cared for!

Happy Patient = Successful Dental Business

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Assisted Hygiene Model for Practice Part 2

By: Debbie Seidel-Bittke, RDH, BS

April 19, 2010

Many years ago most dental practices gave the hygienist 40 – 50 minutes to provide preventive and non-surgical periodontal treatment for their patients. The hygienist had one treatment room to complete the appointment.

Dentistry changes very quickly and with research and technology we have many paradigm shifts. Most offices now offer one hour hygiene appointments for their patients. Many offices also have an untapped hygiene potential. Many offices also have empty treatment rooms or their treatment rooms are filled with an overflow of unused equipment, offices supplies or just a place to put an overflow of patients.

How can we take advantage of the untapped revenue from patients who have not been into your office for the past year or two? What about those patients who have not said “Yes” to non-surgical periodontal treatment? Where will all these patients be put into a schedule which has one hygienist and four days in the week which you are open to see patients?

How can you develop a positive patient centered plan so patients can been seen in the hygiene room and you don’t have to add another $150.00 per hour to your overhead and more days of work to your schedule?

Having a plan in place can be one of with a “win-win” result. The patients can leave your office feeling well cared for and your end of the revenue will be sky high when you implement a well thought out plan.

Meetings are number one

Everyone on the team needs to embrace this new working model or possibly you are revisiting the assisted hygiene model you currently have in place. Patients also need to become aware that you are an office that is preventive and patient centered practice. These thoughts and your vision can be shared through implementation of your mission statement and code of ethics. (aka: Practice Principles) Share these important statements in everything you do; on the walls of the office, in your newsletters, brochures, website, Facebook Fan Page, etc. The take away here is that patients need to understand they are Number 1 and they are important. The assisted hygiene model will not work if patients don’t feel like they are a priority. Patients will leave the office if they feel it’s all about the money. Sometimes you may need to bring in a coach or consultant who can direct this assisted hygiene model.

Communication is key

We know that with good oral health patients can improve their overall health. This is scientifically proven. When you begin asking patients “How long do you want to live a healthy life”, when you share your knowledge about the oral/systemic link, patients will sit up and listen. Patients will absolutely know you care about their total well being when you communicate in this manner.

This is only one way to get patients to say “Yes” to their treatment needs and schedule their appointments no matter if money is an objection. People buy what they want not necessarily want they need. Most people want to live a longer and healthier life.

Communication is also key within the team. When setting up the assisted hygiene model it is of primary importance not only to communicate with all but delegate to the team members. When delegating, also have written protocols so everyone can remain on the same page. Identify all the auxiliaries’ duties and have them written down in a notebook or manual. The goal of assisted hygiene is not to hire an assistant to seat the patient and then clean up. Plan out who will seat the patient and then review the medical history, take x-rays, provide oral hygiene instructions and even make future appointments. Making appointments in the hygiene room can be a new concept to many but it makes perfect sense to have future hygiene appointments scheduled in the hygiene room. The hygiene department knows exactly what the patient needs are and this is where the initial buy in of future treatment came from. When you understand a working communication model this makes sense. It keeps a direct line of communication.

The goal of assisted hygiene is to improve patient care, provide optimal care for all patients in the practice, provide a less stressful atmosphere for the team and increase the bottom line of the dental business. The hygiene department when set up correctly is a profit center and a valuable department in the dental business model. The hygiene department when set up correctly adds great value to your dental practice.

When the assistant and hygienist(s) have communicated and written their responsibilities and expectations down you will have a dynamic team that is patient centered. Your patients will know they are well cared for, your team will be happy and the bottom line (your revenue) will be in the black.

Happy Patient = Happy Team = Successful Dental Practice

More on this next week….


By: Debbie Seidel-Bittke, RDH, BS

April 12, 2010

Many dental practices have implemented an assisted hygiene program. Many offices are still on the fence and need to know if this will fit their business model.

The profession of dental hygiene has improved over the past 20 years and if we are forward thinking about how we can benefit our patients and add value to the practice, assisted hygiene (AH) can be a benefit to your patient care and your current business model.

Many dental practices have implemented an assisted hygiene (AH) program but are not utilizing it to its full potential. One of the reasons it may not be utilized at its full potential is because of misunderstanding the concept. What comes to mind when you think of assisted hygiene (AH)? Do you think treadmill or roller coaster? Assisted hygiene (AH) is not about getting more patients in for a “cleaning” and it is not a lower standard of care. The opportunity is to develop optimal care around a preventive patient centered practice.

The challenge is to develop this course of action where the hygiene team can continually strive to develop optimum oral health and preventive patient care with consistency and effectiveness.

Critical Components:

A systematic approach is key to making this seamless. Cross-training the hygiene department and having the operatories set up the same in a systematic manner will promote a system of effectiveness. The hygienist and assistant must acknowledge the benefit of sharing duties which overlap their scopes of practice and contribute to the success of the assisted hygiene program.

Define what assessments are to be completed during the hygiene appointment and which auxiliary can perform these assessments. The hygiene team in particular needs to meet and write down what screenings will be completed and at what intervals. An example may be: “At each preventive appointment patients will receive the medical history review and an oral cancer screening. The patient will also receive a caries risk assessment form and this will be reviewed by an auxiliary. The auxiliary will ask about xerostomia (dry mouth) and give oral hygiene instructions (or a review of) before the patient leaves the operatory.”

Annually each patient seen for preventive treatments will receive a full mouth periodontal screening exam, a blood pressure screening and smile analysis.” This is just an example so you may want to meet and decide what is in the best interest of the patients and your practice model.

Once you meet with the team and create this model you will nurture and create an atmosphere of optimal patient-centered care.

It is very important that you develop a customized and written protocol so each member of the assisted hygiene (AH) team and even future members of the assisted hygiene (AH) team can acknowledge, accept their role and responsibility within this new business model. The written protocol will include the daily goal(s) for production and may even include how many referrals you ask for from current patients. The written protocol will include challenges and how they will be handled, when to implement new technologies, budgets for new equipment and treatment adjuncts to continue improving the quality of patient care.

Scheduling is very important and the various patient treatments (procedures) need to be categorized into low, medium or high production. Having specific blocks of time pre-scheduled in the appointment book will also help keep the assisted hygiene (AH) program on track for not only a patient centered practice of optimal care but will help the team meet production goals.

Determine your expectations and each persons’ perceptions. Be open to listening to your patients’ perceptions about this change or implemented program. This awareness will help you and the team to proceed with clarity for success and to progress towards peak performance with a patient centered preventive program.

Journey through Peaks and Valleys

These are just a few guidelines to begin your journey for patient centered hygiene care. Possibly you already use the assisted hygiene (AH) business model. There will always be peaks and valleys in anything we do in life.

Even if you have already implemented this program of assisted hygiene (AH) you may consider the expertise of a hygiene coach or consultant as they are the experts who will provide the team with powerful solutions to bring the valleys up to peak performance.
When you become clear about your values and understand everyone’s perception not only will you exceed your expectations but those of your patients.

Happy Patient = Continued Success!

Profit Centers…the Shining Light in Economic Darkness

By: Debbie Seidel-Bittke, RDH, BS

April 5, 2010

No, this isn’t going to be another article about recession, dodging economic downturn or how to brace for this year financially. My intention is to paint a beautiful picture of the reality you can create in practice for yourself…truly by design!

It is amazing to me when I think about the history of dentistry, how far we’ve come yet, how young we still are as a profession. Years ago, the thought of a dentist advertising or marketing was inconceivable. In fact, one of the first matters at hand in the establishment of the ADA was addressing the ‘undignified’ practice of advertising. This belief permeated the minds of dentists for decades, which I suspect led to many precautions taken around seeing dentistry as a business. Undoubtedly, the stigma about soliciting referrals and even carrying products in the office were all a result of upholding this ‘professional’ posture in dentistry.

Over the years, dentistry has cleansed itself of those positions and evolved into realizing that we can absolutely carry out a patient-centered, health care practice that is prosperous. Actually, we cannot afford to NOT employ sound business principles and expect our practice to be an environment in which our team has an opportunity to build a rewarding career and our patients receive extraordinary care and service. Therefore, in moving forward, we’re in an exciting and expansive period of discovering new technologies, marketing strategies, building websites and looking for ways to set our practice apart from the rest. We pay close attention to increasing profitability, efficiency and our overhead while providing a high level of quality, attention and detail in our patient care. These are exciting times in dentistry as we explore and implement new strategies to enhance our practice.

One sound business strategy constantly evolving is profit centers within the practice. Profit centers can be a positive and pro-active step for any practice and for every aspect of the practice, particularly one that involves home care products. Home care products not only make an unbelievable profit center but are truly a practice builder for any office. Because of the small investment upfront, home care products may not seem like much of a profit center initially. However, with a minimal investment in product, not only do you get an unbeatable return on investment; what emerges in the environment of your practice is priceless. It really is that simple. Let us take a look at the four cornerstones of how this profit center can impact your practice.


Despite the economic climate of this country, our patients still have the same dental goals. They want a pain-free, healthy mouth and they prefer white, straight teeth and fresh breath. One thing that may change for our patients is a re-adjustment of their priorities as it relates to their treatment plan. The reality is, patients may delay or post-pone treatment for now. However, one thing that will not change is they will continue to brush their teeth, use mouthwash and try new products for better taste, fresher breath and whiter smiles. In fact, the latest consumer spending report on dental care basics (toothpaste, mouthrinse and floss) is roughly 2.7 billion annually. To push a patient into treatment may not only cost you the case, it may cause you to lose your patient’s trust and perhaps a patient for good. An alternative is to take a patient-focused approach by listening for what it is your patient can do, reinforcing prevention with home care and ultimately protecting the investment in their smile. Not a bad holding pattern until they can move forward with treatment.

Consider this…

You know exactly who is more qualified to recommend home care products to your patients…so why would you hesitate? You know the materials in their mouth, the condition of the tissues, their oral and medical history and health. It makes no sense to leave this final step in the hands of patients, advertisers or the grocery store clerk. Carrying products in the office not only resolves the confusion plagued by patients who have seemingly endless choices when it comes to home care products. And it raises the bar by increasing the level of service, care and professional guidance your patient can’t (and shouldn’t) get anywhere else.


With a cross-training system put in place, your entire team is enrolled in providing patient education, delivering home care instruction and increasing the patient’s dental IQ. This can provide a rich environment for enthusiastic teamwork, enhanced level of communication and a committed effort to improving the overall health and wellness of your patients. With a team fully engaged, your patients begin to connect and establish trust with your entire team and view them as an invaluable resource for their oral health care. This provides an immediate and lasting impression your team can have on your patient base – talk about internal marketing. Additionally, a profit center like this can generate its own pool and provide profit-sharing opportunities for the entire team — without taking money out of your pocket.


Increasing productivity does not have to involve loading up the schedule with patients, running a prophy mill in the hygiene department or coming in early, working through lunch and staying late. You can increase your bottom line with a home care product profit center by $25,000 to $50,000 without adding one more patient to the schedule. Could you ever imagine patients coming by the office even when they don’t have an appointment? They do when they purchase home care products from you. That’s one more opportunity for personal touch, service and exposure to your patient without marketing, taking time out of your schedule or making one phone call.


Do you want a piece of that 2.7 billion? You deserve it. You are the professional and these are your patients who are also consumers. Find a system you can stand behind and embrace it. Your leadership will be the inspiration your team is yearning for and the guidance your patients appreciate. Don’t add to the confusion by loading up on an array of commercial products your patients can get in the stores. Research products and programs that offer superior benefits, are unique, exclusive and fully support your cosmetic, restorative and hygiene services. Offer products and programs that you and your team personally use and are in alignment with your values and the service you provide.

Homecare products can bring out the vision, values and quality of the practice and set your practice up to harness the waves and ride any economic climate, both good and bad.

It’s priceless!