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Inside Dental Hygiene
September 2017
Volume 13, Issue 9

Prevention and Productivity

Maximizing the effectiveness of the hygiene team

Roger P. Levin, DDS

With the exception of emergencies, nearly every patient comes to the practice through the hygiene department, which drives not only hygiene production, but also doctor production. The hygienist spends more time with patients on average than any other person in the practice, including the dentist. For many people, hygienists are the public face of the practice.

The case presentation process for nearly all treatment should start with the hygiene appointment. Identifying caries and damaged teeth is only part of the process. There should also be a concerted effort to educate patients about other services, including elective treatments such as sealants or oral cancer screenings.

Even with a tight hygiene schedule, there are opportunities before, during, and after the prophylaxis portion of the appointment to provide patients with information about services they may need or want. Sometimes all it takes is asking the right question. Levin Group teaches a process called the 4 Hygiene Factors that trains hygienists to become skilled influencers in their interactions with patients, increasing production in many practices by 10% or more. This process does not require any more time or necessitate seeing fewer patients in a day. Practices can easily implement it as part of their current schedule, while saving the doctor exam time and limiting the need for follow-up consultations.

The 4 Hygiene Factors for increased treatment acceptance and higher production include:

➊ Identification

Identification focuses on finding all potential treatment, whether need-based or elective, that will benefit the patient. By communicating your treatment philosophy to your hygiene team, they will know what to look for during prophylaxis. It makes no sense for hygienists to spend time identifying treatment only to be overruled by the doctor during the patient examination.

❷ Education

Once treatment options have been identified, the hygienist can then educate patients while performing hygiene services. All too often hygiene appointments are dedicated to general conversation, which is certainly acceptable, but hygienists should also spend time educating patients about synergies between oral health and overall health, as well as any clinical findings and the associated benefits of treatment, or preventative options that may reduce or eliminate the need for treatment.

❸ Motivation

Hygienists are often excellent motivators. Once treatment has been identified and explained, the hygienist should take the opportunity to influence the patient. Motivation can take many forms, from presenting the options with enthusiasm to emphasizing the benefits of each option. For example, if a crown needs to be replaced, the motivation may be more technical than functional. If it is a discussion of whitening or cosmetic dentistry, the approach may focus more on self-image and self-esteem, while a recommendation for an oral cancer screening can revolve around risk factors, both genetic and environmental.

❹ Close

Although hygienists can and should close cases, most of them rarely take that step—largely because they believe only doctors should diagnose and close cases. This misunderstanding leads to missed opportunities. To be clear, the hygienist should close cases, which includes presenting fees. Practices must provide or arrange for this specific training. Case presentation is a professional sales skill that any hygienist can master with proper training.

The 4 Hygiene Factors are a powerful way for practices to increase the amount of treatment that is identified and performed; however, this process does not change the role of the dentist. Doctors will always perform the final diagnosis and have the final decision regarding any treatment. (Regulations vary from state to state on the hygienist’s role in the diagnostic process, which practices must take into account.) For complex procedures, hygienists play more of a set-up role, handing off the presentation to the dentist by explaining to the patient that the doctor will confirm her findings and recommendations during the final exam. This enables the dentist to provide additional information regarding the proposed treatment.


The hygienist plays an invaluable role in the success of the practice. But in today’s dental economy, that value diminishes greatly when the hygienist’s role remains a purely clinical one. It’s a mistake to think that doctors are the only influencers. The hygienist is also viewed by patients as an authority and that––coupled with the amount of time spent with patients––presents unique opportunities for education, diagnosis, and recommendations. Training your hygienist to be a better case presenter will result in more comprehensive care offered to patients and more recommended treatment being accepted.

About the Author

Roger P. Levin, DDS, Chairman and Chief Executive Officer of Levin Group, Inc., a leading dental consulting firm

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