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Inside Dentistry
February 2014
Volume 10, Issue 2

Finding Lost Profitability in Dental Hygiene Departments

Hygienists facilitate the flow of information and income

Christa Crilley McConaghy, RDH, PHDHP, BS

Many years ago, I was interviewing for a new dental hygiene position. The interviewing dentist explained to me that he did not diagnose anyone with periodontal disease or retreat any teeth that he had worked on before. Patients with periodontal pockets were to have the areas debrided and be charged a prophy fee. If a restoration was failing—especially if this particular dentist had done them years previously—patients were not to be told.

The salary at this office was phenomenal, but I knew that I could not treat disease in this setting. I told the dentist that we would not work well together, because I had a responsibility to tell the patient what I saw and to treat and code procedures accordingly.

The dentist I interviewed with didn’t realize that my time could be worth more by helping him diagnose periodontal disease and educating patients about restorations that appeared to need repair. Our philosophies were not the same. He did not understand that patients could be told about their needs tactfully, not negatively. The practice could have treated patients appropriately and been compensated appropriately, too.

Dental hygienists play an essential role in how a dental practice operates and if it succeeds. In addition to having excellent clinical skills, hygienists need to understand practice marketing and patient education. For a practice to thrive, the hygienist and dentist need to have a similar dental/business philosophy.

All too often, hygiene departments are viewed as loss leaders in the practice. A majority of practices overschedule to create a revolving door of patients, based on the idea that a full schedule is a profitable schedule. But is it? A scheduled appointment could produce more by providing necessary nonsurgical therapy and localized antibiotic treatment instead of a prophy that was planned. A schedule with enough time to view intraoral photographs could lead to an operative treatment plan that increases the dentist’s production by hundreds of dollars.

Hygienists have the ability to collect information about a patient’s periodontal and occlusal status during the appointment to determine if further services need to be rendered. Caries risk assessment and salivary testing for pH or periodontal pathogens can be performed. Fluoride and oral probiotics can be sold to a patient with a higher caries risk. All of these services can help the practice and the patient. It is the responsibility of dental clinicians to assess patients appropriately and bill accordingly for services that patients deserve.

According to the effective frequency theory used by marketing professionals to market their products, people need to hear a message at least three times to act on it. Dental practices can use this theory when presenting treatment to patients. Giving hygienists the time needed to educate a patient that a problem exists and to reinforce a treatment plan will ensure that the patient is fully aware that a problem exists and can be fixed. Patients who accept that they have a problem are more apt to treat it. A practice should never lose the opportunity to provide a crown just because time was not scheduled to educate a patient on the need for one.

Creating a practice philosophy, setting goals, and attending practice management classes together create an environment in which everyone understands the importance of the practice’s advancement. Increases in production will ensure that a practice continues to move forward. Overall compensation depends on a thriving practice. Team members who are aware of the office’s performance and recognize how their role impacts the practice’s bottom line will want the practice to be successful.

Working as colleagues, the dentist and the hygienist together have a responsibility to set goals for quality and profitable care. Dental professionals have an ethical responsibility to diagnose correctly and inform patients about the issues with which they present at their appointments. Giving away free dentistry does not help a dental practice. The key to helping a practice become successful is to create an excellent clinical team that values the services they provide.


Christa Crilley McConaghy, RDH, PHDHP, BS, has been a licensed registered dental hygienist since she graduated from Montgomery County Community College in 1996 and recently received her BS in Oral Healthcare Promotion from O’Hehir University in 2013. Her career goals are to improve oral healthcare by implementing disease prevention programs in offices and help dentists realize the potential of their dental hygiene department through clinical and consultative services. More information is available on her website,

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