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

Success Plan For Your Dental Hygiene Patient Exams

By: Debbie Seidel-Bittke, RDH, BS

January 3, 2014

Male dentist assistant and patient

The hygiene appointment can seem stressful and yet it is not meant to be that at all! Time is limited and there is so much to complete in just sixty minutes. Doctor is rushed and the hygienist feels that he or she is waiting forever for doctor to complete the patient exam.

The last thing the clinical assistant wants is to have doctor stop their current procedure and spend time on something else and in another treatment room! Doctor’s patient and the patient in the hygiene room get frustrated waiting for doctor! When the hygiene patient is dismissed the last thing they want is a bill for over $100 and all they feel they did was sit and wait!

Continue reading to discover your success plan for dental hygiene patient exams. Stop running behind and feeling stressed! Here are solutions to the frustrations we feel as a dental professional on a set schedule of time all throughout the day.


Microsoft Word - TiME MANAGEMENT.doc

Rather then continue to rant about this, let’s talk about solutions to these frustrations.

Change can sometimes be uncomfortable but let’s face it, somethings gotta give!

Here is the success plan for your doctor hygiene exams:

Let’s divide the hygiene appointment into three sections. Section 1 is the data collection. Section 2 is the case presentation and section 3 is the clinical treatment, the doctor exam and dismissal of patient. (Section 3 is the clinical treatment for continuing care and periodontal maintenance appointments.) And, I want to empahsize that the doctor exam is completed between 30 and 45 minutes into the dental hygiene appointment. Not the last five or ten minutes of the appointment.

Learn to prioritize what is most important. For example, once a year you will complete a full-mouth periodontal screening exam and x-rays. Oral cancer is unfortunately one of the highest forms of cancer in today’s world so I hope that you are using one of the latest technologies such as ViZilte® , VELscope®, or Identifi® by Henry Schein for annual oral cancer screening exams. These are just a few of the new technologies that can diagnose a precancerous lesion.

The point is that you need to prioritize these screenings. If you are completing the perio exam then you don’t do the x-rays at that appointment but alternate between these screenings so you can have time to do it all of the screenings over the next year.

The challenge we seem to have is that we have to get it all done right now! What must you do at each dental hygiene appointment?  Here is a “to-do” list that needs to be top priority: (see for recommendations)

a)      Medical history update including risk assessments for disease

b)      Screening for any known sensitivity or pain

c)       xerostomia/halitosis

d)       Blood pressure screening (annually)

e)       Radiographic assessment to update (annually)

f)        Oral cancer screening including intra- and extraoral exam and use of adjunctive screening technology, as indicated (annually)

g)       Periodontal screening including an annual comprehensive periodontal assessment as recommended by the AmericanAcademy of Periodontology (spot probe each appts)

h)      Salivary diagnostic tests, (as indicated)

i)        Caries management by risk assessment (CAMBRA) including caries detection technology and interventions to lower risk and implement remineralization strategies

j)         Restorative and esthetic screening including identification of occlusal disease

k)        Smile evaluation (annually)

During data collection portion of the dental hygiene appointment, the important priorities will begin to emerge. This is what will allow the dental hygienist/clinician to provide treatment based upon a diagnosis. Many times what may be a priority based on a past clinical patient notes is now forgotten due to what the hygienist sees at the current appointment.

After you have prioritized and collected the data for your dental hygiene patient you will begin to make a provide a clinical diagnosis and present what you “see” in the patients mouth. (Note: many patients resent that they always seem to go to the dentist and they find something!)

Patient Example

Mr. Yee has an appointment today with his dental hygienist. Chris, the hygienist, has scheduled to use Identifi® for the oral cancer screening.

Mr. Yee has not been in to see his hygienist for over two years so Chris is feeling stressed about getting it all completed today! This patient is a male, 56 years old and slightly obese. His only risk factor is high blood pressure.

Chris quickly reviews Mr. Yee’s health history and notices that he is taking new blood pressure medication. Mr. Yee also has high blood pressure today. It is 160/100.

While completing the clinical exam, Chris notices that Mr. Yee has an abcess on the lower left first molar (tooth #19). Chris also discovers that there is generalized bleeding upon probing with generalized 3-6mm pocket depths.

I think you can probably relate to this experience and possibly this is an every day occurrence for many clinicians. The answers to how you would prioritize your patient will be different for each of you, dependent upon your individual patients and findings.

One approach to treating Mr. Yee would be to call his medical doctor and/or send him to his doctor before beginning any further treatment today. Since Mr. Yee has taken his blood pressure mediation prior to his hygiene appointment, it is in his best interest to see his physician as soon as possible before beginning any future dental treatment. But what would a diagnosis look like for Mr. Yee?

Will doctor complete an initial exam (D140) or a comprehensive periodontal evaluation (D180)?

Code     Procedure                     Description                                                  

D140      Initial Exam                    Specific to a concern

D150      Comp Exam                   New/Current pts

D180      Comp Perio Exam         New/current pts w/ perio risk factors & clinical evidence of perio

This is a perfect scenario to recognize that a dental hygiene appointment is not about cleaning teeth but about the oral all total health of the patient.

It is fine to update the data and have doctor complete the exam but best (in the patients best interest) to recommend that Mr. Yee sees his physician to check his blood pressure and if his medication(s) needs to be changed prior to beginning periodontal or future dental treatment.

What treatment would you recommend for a patient that has a chronic slight to moderate periodontal diagnosis?

The American Academy of Periodontology Recommendations

Many dental offices today recommend that you do the best cleaning and have the patient return in six months. However, the AmericanAcademy of periodontology recommends that patients with chronic slight to moderate periodontist have the following treatment: (See for these recommendations)

a)      Discuss risk factors (tobacco use, Diabetes and other systemic factors)

b)      Instruction and reinforce plaque control  (home care instructions)

c)      Supra-subgingival scaling and root planing

d)      Antimicrobial agents used

e)      Eliminate localized factors such as: restorative overhangs, over-contoured crowns, ill-fitting prosthetic appliances, tooth movement

f)       Restoration of open-contacts which result in food impaction

g)      Treatment of occlusal trauma

Periodontal surgery may need to be considered if initial therapy does not resolve the periodontal condition.


The biggest clinical challenge in the dental office is time management. The doctor should never wait until the last five or ten minutes of the hygiene appointment to complete the patient exam. After the data has been collected and the treatment initially presented by the dental hygienist, the dentist can enter to complete the exam. This usually means between thiry minutes to forty-five minutes into the hygiene appointment, doctor can complete the patient exam. There is no reason to wait until the very end of the appointment to complete the patient exam.

The clinical assistants need to be aware of the time and signal to doctor when it is time to move into the hygiene treatment room and complete the patient exam. This relieves the hygienist from stopping what he or she is doing to signal doctor to complete the exam. The clinical assistant is with doctor and should be able to know when it is approrpiarte to stop the current procedure to go complete the hygiene patient exam. See the photo of the Pie Chart for how this can work out.


Use a triangle position of doctor on one side of patient and hygienist on the other side. The patient should be able to look to their right and see a cliniana and then look to their left and see the other clinician. This is a subliminal comfort when both clinicians are positioned in this manner.

This is known as “Proxemics”.  The term “proxemics” was coined by researcher Edward Hall during the 1950’s and 1960’s and has to do with the study of our use of space and how various differences in that use can make us feel more relaxed or anxious.

The advantages of this position is many but here are a few reasons to create a triangle for patient/clinician conversations with a patient:

a)     The patient hears the dental hygienist’s input to the dentist.
b)     The hygienist and the dentist have a professional exchange of information about the patient, in front of the patient, and this means that the patient hears the same conversation.
c)     The dentist understands the priorities for the examination. The exam is thorough and concise.

d)     Increases interaction of the patient, and brings them into a partnership with their oral health.

e)     The patient is more likely to pay attention when someone talks about them when they are present and in the center of the conversation.

(See the photo at top for an example of proxemics)

Creating a successful hygiene patient exam requires planning for success. The rewards for this successful plan are plentiful. Working in a dental office can be stressful and this is only one way to reduce stress. Practice this success plan at your next team meeting. Take note in the future about how this decreases your stress and increases your case acceptance. Do you see more patients returning with improved health when you create your success plan for the highest level of patient care?

Please comment below and tell us how your doctor hygiene exams are going. We would like to hear from you.


Debbie has been named once again, for the seventh year in a row, as one of Dentistry Today’s Top Consultants. She has a background in academia and has started a dental hygiene program in Portland, Oregon. She is a former assistant professor at the University of Southern California where she co-taught the practice management course for the senior dental students as well as teach in the dental hygiene department.

Debbie has clinically in all aspects of a dental office. Through her knowledge of working in the trenches and her academia background she knows what it takes to create a successful dental practice as well as lead dentists to be their most successful and profitable as a business owner.

If you are looking to get to that next level of success, you will want to schedule a no-fee practice profile and have her review your practice’ true potential. You may be one of those who is leaving over $100,000.00 USD inside patient charts. It costs nothing to have Debbie look at your numbers and potential but it costs you millions if you never look.