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Hygiene Anxiety

Posted Oct 04 2009 10:01pm

   It seems like the economy is really starting to have an impact on hygienists in some practices.  More and more resumes come in for hygienists and I see more posts on DentalTown by hygienists looking for work.  It seems that patients are looking to cut expenses wherever they can, and sometimes they see their hygiene visit as a luxury along the lines of having their nails or hair done.  We can do something about that.  Dentists also sometimes look at the hygiene department as their loss leader and feel that they can cut their hygienist's hours and do some prophy's themselves and save money.  We can do something about that as well.  There are probably other reasons for hygiene anxiety, but let's concentrate on those two because I think they're the main problems.

    Ok, so your patients are looking at their hygiene visit in the same category as their more optional grooming appointments.  That may be a sign that you need to educate your patients more about the importance of regular hygiene visits.  If you can make them understand that oral health is directly related to overall health and well-being, you will take yourself out of the manicure, waxing, hair coloring loop, and put yourself back into the necessity category.  I think it's great for hygienists to develop a good rapport with their patients, but you have to remember to guide the appointment and include patient education in the conversation.  If you go through the entire hour and the patient has learned nothing more than your dog's name and the adorable thing your six year old said, they may think you're just wonderful, but not necessarily the vital part of their health care team that you truly are. 
    Make every visit a co-discovery of their oral health.  Talk as you examine their soft tissues so that they know what you're doing.  Discuss your probing results and when you do find deeper pockets, describe the reason it's important to disrupt the bacteria that is colonizing under their gums.  Help them understand so that they can help themselves.  Treat each tooth as an individual and discuss it's health or disease with the patient.  Talk about the overall condition of the tooth - does it have a large fracture line, an old amalgam with breaking down margins, etc.?  Let them know that acting preventively can help avoid more costly treatment that postponing or ignoring the problem could cause them to need.  When you're done, sit them up and review your findings before the doctor comes in.  Then go and brief him/her on what you discussed with the patient.  Your patient and your doctor will see you in a new light.    When a dentist thinks that he can save money by cutting hygiene hours, I often wonder if he is seeing the whole picture.  When anyone sees hygienists as loss leaders, I know they are only looking at part of the equation.  It tells me that they are saying, "My hygienist charge for the appt is $75 and she gets an hour to do her work.  I pay her $xx per hour.  I have to pay for her supplies, the front desk person to schedule her appointment, the room..., hey, I'm barely breaking even on her!"  And then they stop thinking.  If they continued to think realistically, and they have a hygienist that does what I've described above, they'd realize that a hygienist who educates her patients plays a big part in treatment acceptance and that keeps both the patient and the practice healthy.  A dentist doing his own prophies should be a last gasp effort. 

    "But my hygienist is sitting around with hours of open time on her schedule!", you might say.  First, you have to see if you really have hired her for more hours than you need.  Multiply the number of patients in the practice times two and that's how many hours of hygiene time you need to have available.  For instance, a practice with 2,000 patients will usually see those patients twice a year for recall, so they will need to have 4,000 hours of hygiene appointments available for the year.  If that all adds up, then maybe patients are falling through the cracks.  This is what the hygienist should be working on during her open appointment time.  Don't call it downtime because it sounds like time when she is shutting down.  This is time that can be as vital to the health of the patients and practice because she can get on the phone and get patients motivated to come in and continue their good oral health regimine.   

Many people think that hygiene is boring because they just do the same thing patient after patient, day after day.  Not so, if the hygienist is truly up to date with current practice modes.  The hygienist should be classifying patients by periodontal type from health to severe periodontitis.  If she isn't, your patients might not get the treatment they need and your practice could be falling short in that part of patient care.  Patients don't like to hear that they have periodontal disease, but let's face it, many of them do.  By educating them about their condition and helping them accept the fact that their disease literally lives in their mouth, the hygienist can help them attack the problem and, if not completely conquer it, at least improve and control it.  So many patients come in with problems that 1. they don't know they have, 2. they don't realize there's help for, and 3. they don't understand the consequences of.  Let's take a patient with xerostomia (dry mouth).  A dry mouth can wreak havoc with oral health.  Bad breath aside, it can cause food to stick to both hard and soft tissues leading to periodontal disease and rampant decay.  How often do we really have time to invest in discussing the causes, effects and treatments for xerostomia in the course of a routine hygiene visit?  Set up a protocol for a xerostomia visit and give the patient 30 minutes of the hygienists time to go over products and treatments that can help.  This patient may even benefit from a three month mini recall visit during which the hygienist can evaluate home care, plaque score, give a fluoride treatment and polish.  Keep the fee reasonable and keep in mind the preventive value and benefit of this appointment. Look at how you are using your hygienist's skill and knowledge and you may find that you are underutilizing talents that have been right there all along.  Hygienists, take a part in finding ways to put your talents to use for the good of the patients and practice.

    These are just a few thoughts about reducing hygiene anxiety.  Hygienists can look at what they can offer in a new way and help themselves while they help their patients and practices.  Hard times don't always mean we have to fall apart.  We are always so much stronger when we pull together and use adversity to gain strength.  Look for ways to build up, rather than ways to shut down and you may get what you're looking for.

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