Dental Practice Solutions

Optimize your dental hygiene department by taking an integrated, team approach

  • Do you feel like you are working hard and your production is not increasing?
  • Do you feel like your hygiene department is under performing?
  • Is your hygiene department producing 25-30% of your total production?
  • Are hygienists in your office treating bloody prophys?
  • Does your hygiene department help enroll implant cases and high-end treatment?
  • Do you have one or more holes in your schedule daily?

I am so happy that you are here because we have answers and solutions to your challenges.

Dental Practice Solutions - Debbie Bittke

Check Your Dental Hygiene Department Pulse and Increase Your Profit Potential

By: Debbie Seidel-Bittke, RDH, BS

May 21, 2013

Dental RDH an intraoral camera

Is your dental hygiene department the second highest profit center of your dental practice? What do profitable hygiene departments have in place that will allow them to work like a well-oiled machine and be their most profitable? Why does one hygiene department create more treatment plan success from their dental hygiene department than many others? Do these hygiene departments see more patients to create these higher results? Do they perform more dental hygiene services? Do these auxiliaries work longer hours?

Strategic Systems

New patients are the lifeline to every successful dental practice. Without new patients, production will decline and the practice will not exist. Every dental practice has a normal attrition of patients. This is a fact of business. People move, pass away, or leave because you are not on their “insurance plan” and this can mean an annual loss of 10%. Just as your heart beats at least 60 beats per minute, you must have a continual flow of new patients walking in the front door to make up for those patients who are walking out the back door.

Patient retention (continuing care) is the heartbeat of the dental practice. Your active patient base consists of patients who value your care, accept your recommendations, and pay for treatment. These are the people who trust you and your team. They refer their families, friends, and colleagues to you. These are the are key players to the ongoing success of your business Most patients see the hygienist more than any other auxiliary of the dental team. This is what makes the hygienist carry and important role in building and maintaining the current active patient base.

Maintaining the Active Patient Base

Always preschedule 90 percent of your hygiene department patients. Patients are more likely to understand the importance of why they need to schedule their next hygiene appointment. When the hygienist schedules the patients for their next hygiene visit there is a continuation in the practioner/hygiene communication process. You most likely see a positive patient attitude and an increase in patient compliance occur when the hygienist is engaged in scheduling the patient next hygiene appointments. Ideally this should occur when the patient is still present in the hygiene treatment room.

Words do matter

The dialogue between the auxiliary and patient is extremely important. Here is an example of how the conversation may go:

Example: “Today I found a few areas of bleeding that were considered abnormal and doctor is observing and area where you have the beginning of decay. Our schedule is very tight because patients usually schedule before they leave their dental hygiene appointment. I know that you like to come in first thing in the morning on Thursdays so I recommend that we reserve your next appointment to assure that you can return on that day of the week and at that time in fact that is a very valuable and popular time for most of our patients. To make sure you have your next appointment on this day of the week and at this time, I want to schedule and reserve this time for you now. I can see you on Thursday, October 18th at 8am. Will this work for your schedule? ”

The dental hygienist is the oral health educator for every dental practice. It is the role of the dental hygienist to educate patients about the relationship between oral health and systemic health. Patient involvement and active participation create ownership and accountability and will ultimately reduce the cancellation and failure rates of the continuing care patients. The preventive care and supportive periodontal maintenance appointments have the highest cancellations and failed appointment rates of any service in the dental practice. If you have one hygienist working four days a week and each day you have one cancellation you this can lead to an annual loss as high as $150,000 in hygiene department profits and this does not account for the treatment normally diagnosed from the hygiene appointments.

For a hygiene department achieve success they should be scheduling 95 percent of their future dental hygiene appointments at the time of the patients current dental hygiene appointment. Always create monitors and track the scheduling ratio. Count the total number of patients seen in the hygiene department each month and divide this number by the number of appointments available for the month. The hygiene or scheduling coordinator should then report the current scheduling rate to the team at monthly team meetings. The scheduling coordinator needs to always report in the morning huddle the open times available on the hygiene schedule each day for the next week.

Many dental practices charge a fee for failed appointments, and the effect of doing this has been positive in raising patient awareness of the importance of the time set aside for their appointments.

Team approach

Everyone on the team should understand the words which are effective for a positive patient response. Courtesy confirmation calls, emails, text messages and written communications define the hygiene appointment (continuing care) with dialogues such as this:

“Hello Mr. Goodman, its Megan calling because Maria (Insert the name of the hygienist seeing the patient) and I are looking forward to seeing you tomorrow at 3 o’clock for your preventive care appointment. I see on the schedule that Maria will be doing your annual periodontal screening exam and Dr. Goodtooth mentioned to me that you were in tested in the new whitening product we are using. We’ll see you then. By doing this, patients are moved beyond the“just-a-cleaning-and-a-check-up” mentality. It is best not to discuss any type of cancellation policy because this is only a subconscious reminder that if something else comes up they can cancel and it sets up for failure for your continuing care systems’ success. Do not ask for calls back to the office to verify an appointment. Have the expectation that patients understand the importance of their dental service and desire to come to see the doctor and/or hygienist.


Chart audit and patient activation must be ongoing systems that are frequently performed in the office. This is completed through daily reviews and computer reports. While everyone on the team plays an important role, one auxiliary (the hygiene or scheduling coordinator) is responsible and accountable for keeping the daily schedule full and productive. At team meetings, the scheduling coordinator reports and discusses the scheduling effectiveness rate. Everyone needs to be aware of what is working and what is not working so that problem-solving can take place.

Create a plan of action when there is a crack in the system. Ask for suggestions to overcome these challenges which may occur and when you are feeling like a hemorrhaging is occurring in your dental hygiene schedule you may want to consider the advise of a dental expert who is knowledgeable in overcoming these challenges, especially during these stressful economic times.

Scheduling effectively for today and the future

To achieve and assure a full and productive schedule (for all providers), the team should always prepare for the day by auditing patient records. The hygienist reviews patient records for incomplete dental treatment, updated X-rays, status exams, perio, update the medical history, etc. The hygienist needs to be prepared to discuss, demonstrate (with an intraoral camera), answer questions, and provide the facts and findings, risks and benefits, when the doctor enters the treatment room to provide the patient exam. Ideally, a brief meeting (the morning huddle) enables the entire team to communicate, delegate, and maximize the day. One of the most important topics reviewed at huddles with my consulting clients is having the clinical assistants audit their records and identify patients who are seeing the doctor that day that are overdue for hygiene care.

Picture Paint

When patients are in for the appointment with doctor and overdue or need a dental hygiene appointment ask them to stay for the dental hygiene appointment using words such as: “save you-time missing work another day, Save you time returning to the office, etc. Create statements that are certain to benefit the patient. The hygienist does the same if the doctor has an opening and the hygienist has a patient with undone dentistry.


Finally, by working together, the doctor, hygienist and entire team, communicate and share a practice philosophy for the patients, the hygiene department, and the practice. Working with the dentist as a partner in oral/systemic health care, everyone on the team is committed to the vision of the practice, proudly recommends dental treatment, and refers family and friends to the doctor.

Facilitate change by regularly scheduling meetings with your hygiene team and as a whole team to support and reinforce initiatives and explore new ideas and opportunities for growth and development. Open pathways for communication will lead to mutual respect and admiration and will be reflected in increased profits, a harmonious dental team, and most importantly, healthier patients. It’s a win for all!