Hygiene

by Rachel Wall, RDH, BS and Stacy McCauley, RDH, MS

It’s hard to believe we’re almost at the end of 2011. Your practice has probably had som bumps in the road. It’s what you do about addressing those bumps in the road that makes all the difference in the world. Have you reviewed your 2011 practice numbers yet? Did you wonder, “Why are our perio numbers so low”? Well, if you did, you are not alone. As we travel across the country coaching practices, one common bump in the road we see in the majority of offices is the under diagnosis and under treatment of periodontal disease. It doesn’t matter if we’re in a small town practice in Mississippi or a big city client in Houston, a low level of periodontal care is almost always the very first issue we begin to work on.

The Academy of Periodontology estimates that estimates up to 75% of adults have some form of periodontal disease www.perio.org. The data also suggests that of that 75%, 5-20% of that group have severe disease. So, if we take the liberty of saying that from all the research out there, it is safe to assume that a majority of adults have some form of gum disease, then why are most practices posting perio care percentages of 5,10 or 20%?
The first step in answering that question is to find out where your practice currently stands. Ask yourself these questions:

Is your hygienist routinely performing bloody prophies?

• This is usually a clear indicator of disease. Healthy gums don’t bleed. If they do, there is some level of disease present. This disease will not be effectively treated through a prophylaxis.

Is your perio care percentage 25% or lower?

• Run a practice productivity report to see where you currently stand. Set goals for how you and your hygienist will close the gap between where you currently are and where you would like to see your numbers at the end of 2012.

Do a majority of your patient’s charts have incomplete or no perio probe recordings?

• 6 point probing with bleeding noted must be performed on an annual basis. It’s our only way of establishing a baseline and it is our primary diagnostic tool for diagnosing periodontal disease.
• Annual documentation of the complete perio chart is also what protects practices in cases where patients have sued dentists for malpractice.
• One thing to note: if your hygienist has less than 60” reserved for prophy appointments, this critical piece of data collection is compromised due to limited chair time.

Are there notes in the patient chart that say “generalized 4mm pockets with moderate bleeding” but there is no perio charting and the patient received a prophy?

• These notes are usually a tell tale sign of a lack of data collection time. It also usually tells us there is no clear perio protocol in the practice. Maybe one hygienist considers 4mm generalized bleeding pockets normal, while the other hygienist considers them diseased. Writing a perio protocol for what data needs to be collected, how often, and what you’ll do if the patient’s findings reveal disease are critical for moving your perio program to the next level.

If you said “Yes” to any of the above questions, then you have a few bumps in the road with your current perio diagnosis and treatment system. If you’re not sure of your Perio Percentage, we have a tool that will help you determine that critical number in 5 minutes or less. Go to www.InspiredHygiene.com/periotool to get your free Perio Percentage Calculator Tool. Would you like more information on how to unlock the untapped potential in your hygiene department? We are pleased to offer readers of Contemporary Product Solutions our popular CD, “Top 3 Secrets to Increased Hygiene Co-Diagnosis” absolutely FREE. Please visit www.inspiredhygiene.com to order your free CD and to register for our free weekly e-zine where we share weekly practice tips to improve your hygiene department profits, systems and service. Rachel and Stacy can be reached at: rachel@inspiredhygiene.com or stacy@inspiredhygiene.com

e big highs and, maybe in some cases, a few low spots. Every practice is susceptible to a few.

by Deborah Hartley, RDH

It is estimated that dental hygienists perform approximately 200 million prophylaxis procedures annually. But many states are changing their practice act allowing the expanded function dental assistant to perform some of these procedures such as coronal polishing. These assistants are working along side the hygienist as hygiene treatment coordinators helping to make this department even more functional and productive. In fact in the majority of dental offices it is the dental assistant who is in charge of ordering supplies often choosing which products the hygiene department will use.

From the patient’s perspective, it is important that we comprehend the four distinct objectives that must be met for patient satisfaction. First is the cosmetic aspect of ‘their cleaning’, stain removal. This is often the most significant element to patients simply because they like the look and feel of polished teeth. Yet equally as important to patients is the taste and smell sensations that are perceived by the taste buds’ receptors. In other words what you choose to use should good. The next issue would be to understand what is in the compound that can be considered both good and bad to special needs patients such as aspartame, saccharin or gluten sensitivity. And lastly would be the blend and texture technology of the formula where the focus is on splatter-free thus helping to eliminate prophy paste in the hair, on the glasses, etc.

These advanced technologies along with innovative manufacturers have given us amazing products to work with that help us give patients the stunning smiles that they want and the end result we seek patients whose expectations have been exceeded. The use of traditional prophylaxis paste is the most common material for stain removal. However, for patients with coronal staining it becomes important to identify the type of stain present to determine the products that you will be using.

Extrinsic stains vary in origin and color and so does the protocols for removal. The most common external stains, yellow or orange results from poor oral hygiene and can be easily removed with light polishing.  Another common stain often seen in children with very poor oral hygiene is green staining, which indicates demineralized enamel. In these situations it is important to prevent any further loss of tooth structure so coronal polishing is contraindicated. Of noteworthy is the impact of pro-phy pastes on demineralization: not only will prophy paste remove the majority of the fluo-ride ion remaining on the surface, it may also render the enamel so damaged that it can be rather difficult to remineralize.

Brown stains are caused from drinking pigmented beverages and foods, tobacco use or chlorhexidine and are more of a challenge to remove. However black-line stain is calculus-like and forms along the gingival third of the tooth near the gingival margin. Black line stain is firmly attached to the teeth and often requires moderate instrumentation to be removed.

While removing stain with a prophy cup and paste, it is imperative to decrease the pressure applied to the tooth surface.  As we know root surface is much softer than enamel, and more tooth structure is lost when polishing exposed root as compared to enamel.

According to dental distributors, ‘the majority all prophy paste sold in this country is coarse or extra-coarse; fine prophy pastes only account for a small percentage of all sales.’ It is true that coarse pastes do remove stain faster but there is a price, especially to the root structure. Remember that more patients are being scheduled on a more frequent basis for periodontal maintenance, doubling the risk of potential damage.

For safe, effective polishing, it is important to remember that once polishing has been completed, a topical fluoride is recommended to replace what was removed during the polishing pro-cedure. The much needed fluoride therapy helps to reduce the solubility of the enamel sur-face by replacing the apatite with fluorapatite thus reducing further breakdown.

Walking in the shoes of a Dental Hygienist, this career offers so many rewards. If you have worked in this field even for one month, you already know there are many hats to this profession. Not only do you provide your patients with the best possible care, you also wear the badge of “EXPERT”. You are an expert in many fields such as oral health educator, radiographic specialist, pharmaceutical extraordinaire, Prophylaxis professional, and allergy consultant. Allergy consultant?   Read more

A picture is worth a thousand words is a proverb that refers to the idea that complex stories can be described with just a single still image, or that an image may be more influential than a substantial amount of text. When we take photography in our practice, we don’t have to say anything. It is so much easier to show the patient what we are talking about and they are able to visualize the key points as to the treatment plan.

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When you hear a title such as “The Business of Dental Hygiene,” what comes to mind? For many hygienists, a negative picture of the “prophy mill” practice is envisioned.

However, for Deborah Dopson-Hartley, RDH, it means much more than mere production numbers. Deborah has even named her company, The Business of Dental Hygiene, because she firmly believes that hygienists need to be aware of the business side of what we do.

In addition, the title doubles as the title of her favorite, yet most controversial, continuing education program. Deborah believes that there is so much more to dental hygiene than production numbers, giving OHI, or “cleaning” teeth. She sees the hygiene department as a business within a business.

That does not imply that patient care will suffer or that the hygienist, by paying attention to the business side of practice, will sacrifice any patient quality or service. Rather, by understanding the business aspects of dental hygiene, hygienists can survive and excel in today’s changing health-care market.

Deborah believes that a thriving hygiene department can have a major influence on the overall success of the practice. Not only are hygiene services important to overall patient health, they are important to the practice in terms of referral-generating potential, pure sales (that’s right, sales) power, patient retention, and practice growth.

Being both a service provider and a profit producer from the business aspect of the practice, the time spent by the hygienist with patients is the most valuable. To get the most out of that time, the hygienist must have a focused agenda, clearly defined goals, and a realistic, workable system. Under-utilization of the hygienist’s expertise and education does not make good business sense.

Deborah, through her program, tries to instill in hygienists the desire to get what they want from their work, get paid for what they do, and find ways to achieve their personal objectives. Concepts that she introduces in the program include but are not limited to:

• The bottom line of the practice of dental hygiene
• What makes a hygienist profitable
• Time-saving tips
• The esthetic hygienist – material maintenance
• Creating a comprehensive hygiene department
• Practical prevention

In all of her programs, Deborah examines specific strategies and protocols for achieving the results that create and reflect back on what should be the foundation of any successful hygiene department. Participants learn how to define their own goals, use their time effectively, and how to realistically achieve and control their compensation. All the audience needs to do is to be open to new thoughts and ideas and decide what it is they truly want from their hygiene department and themselves, and she will teach them how to get there!

For 14 years in practice, Deborah was like most hygienists – didn’t know and didn’t care about the financial and business aspects of a dental practice. Her focus was on taking care of the patients, helping to go from disease to health, and to remain with health. However, during that time, she reached the burnout stage of hygiene; she loved hygiene but felt extremely frustrated because she knew deep down that her job could be so much more.

Fortunately for her, a change in positions brought her to a job where she began to work with someone who was a businessman and a dentist. They both had similar philosophies as to the profitability of excellence and the desire to help patients. He gave her the opportunity to explore new and invigorating ways of doing the hygiene that she loved.

Through her experiences, she learned that there were many hygienists, dentists, and other team members who did not have a clear understanding of what is expected of them or what responsibilities they should be held accountable for, let alone what they really wanted in their day-to-day professional lives nor how to realistically achieve it. She became involved in presenting programs to entire dental teams: hygienists, assistants, dentists, business assistants, office managers, consultants, and administrators to enhance the overall effectiveness of the practice of dentistry and dental hygiene.

Deborah feels that, despite the advances in technology and practice techniques, many hygienists and hygiene departments still function in outdated practice modes. She is aware of many great hygienists who are trying to provide quality hygiene care. But because many do not have business training, freedom or flexibility of practice, incentive, motivation or the support they need from the rest of the practice to bring the hygiene program to the next level, they experience burnout and quit.

She has been fortunate enough to work with and learn from employer dentists who understood the true values of their hygiene team. She has helped build their practices into their visions and dreams, while she enjoyed the things that she wanted and needed out of the practice of dental hygiene. When she began as a hygienist, she viewed it as merely a “job” as do many hygienists today. But over the years, she has come to see it as an adventure, full of rewards and opportunities that she could only have dreamed about. In the words of Deborah’s friend and speaking coach, Dr. Paul Homoly, “The best thing about success in dentistry is who we have become to accomplish it.” And Deborah has become a special person through her success in dental hygiene.

A frequent speaker at the RDH Under One Roof conferences, Deborah will be speaking at the Yankee Dental Congress in Boston on January 27, 2011. For more information on her programs, contact her at hartleyrdh@aol.com or her web site www.deborahhartley.com.

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Throughout prehistoric times, the widespread of oral disease in early humans have been well established. Dental caries, abscesses, and chronic periodontal diseases were found in the oldest of Paleolithic remains. Through periods of time, there is documentation of people trying to take care of their teeth and fight bad breath. Read more

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