Join Michelle Strange, RDH, and Lindsey Bieligk, MSDH, RDH, for a conversation exploring how making the right clinical recommendation is only the beginning. Learn how hygiene coaches within Dental Care Alliance help teams translate evidence, technology, and whole-body health concepts into practical workflows that support clinical confidence, patient understanding, and follow-through. Discover how identifying barriers and strengthening the steps surrounding a recommendation can help transform it into meaningful, measurable patient care.

OK, everyone. Welcome to this episode of Inside Dental Hygiene's A Strange Curiosity with me, Michelle Strange. Today, we're diving into another clinical conversation, and this one is about, uh, you know, what happens after we make the recommendations. Making that right clinical recommendation is really only the beginning. And in this episode, we are sponsored by the Dental Care Alliance. And today we're gonna really just look at like, it's not just about knowing the evidence, it's about how we take that evidence and technology and the whole body health concepts and turn them into clinical work flows and, you know, support our clinical confidence. And today I am joined with Lindsay. Felli Fellik, is that I say that correctly? OK, thank you so much because I was like, I know I'm gonna mess this up, but Lindsay is an RDH, uh, she is a hygiene, uh, coach with Dental Care Alliance, a clinician, an educator, a published author, and also a guided biofilm therapy trainer with more than 20 years of experience in preventive dentistry. Um, she actually supports more than 40 hygienists across multiple practices and really helps teams strengthen their clinical confidence and preserve their clinical autonomy. All things that I also support and I'm very excited to talk about today. So welcome to the podcast, Lindsay. Oh, thank you, Michelle. I'm happy to be here and thanks to Dental Care Alliance for sponsoring it. Yes, definitely. So, Today we're gonna talk about like, OK, you've made that clinical recommendation. Now, what needs to happen for that recommendation to actually become the patient's behavior? Yeah, and I mean, you said it perfectly yourself, like it's actually just the beginning. So when a clinician makes that recommendation to the patient, what happens? Like does that, does, do, do balloons pop out? Like, I mean, does the patient get a text like, hey, I told you to floss. Uh, the patient has to understand. To exactly why that clinician made that recommendation and they need to know the next steps. So it has to be realistic. We've interviewed them, we've done our motivational, uh, questioning, figuring out why, uh, they present to us in the way they do, what keeps them from their day to day activities like a 2 year old or, uh, their caregiver, and, and then we need to know how to implement those next steps realistically for them. Um, like a patient with sensories, uh, challenges, you know, using an electric toothbrush while in the shower to dull those sensory messages, uh, we as clinicians are innately, uh, clued into those little cues that we get through our motivational interviewing and so. The team also needs to know exactly who is supposed to carry through that next step. So, um, when the clinician makes the recommendation, it's, it's the beginning of that patient's journey. Like, Uh, now we need to recommend scaling and root planning. Well, who follows up with that? Who schedules that patient? Does the hygienist schedule it? Does the PSR, uh, or front desk schedule it? Um, who provides the information to the claims or follows up on that patient? Who revisits that conversation with the patient when they don't schedule? Otherwise, we make great recommendations for, uh, these patients revolving around their oral health, but. If nobody ever takes accountability for that next step, we don't know if it ever became actual treatment for the patient. It's such a good point. How would you measure whether a recommendation actually like landed? Well, I think for an example, like if you take uh bacterial testing or uh uh personalized preventive recommendations like the electric toothbrushing, it's not enough to say like, oh I think you'd benefit from this. Does the patient understand why that it relates to their findings of their oral health? And do they know Um, how the next steps involved in that bacterial testing, does the team know how, uh, the, the test gets ordered, or does that fall on the responsibility of the clinician, right? Will someone, uh, look at that bacterial test once we get it back, and will someone review it? Uh, how are you gonna, is somebody gonna call that patient? Um, all of these things are, are steps in the process of care and. So, uh, if the whole team isn't clued into who owns that next step, uh, does the patient actually complete the care is the question. Uh, yes. Yeah. And I do think that this is, you know, I talk about this in infection control when systems and protocols are not in place. Um, it's just inevitable that the clinician will fail. And in this case, the patient may, uh, will fail. And I think when we don't have those recommendations, The follow through with them that is I would consider a failure. Would you? Oh yeah, OK, yeah, if they don't understand how it's relevant to their care, their oral health, um, and then if there's no follow through right with that next step, um, because it relies on us, the clinician, to usually make that decision. Well, when is it appropriate to contact that patient after we get the bacterial result, for example. Um, who reaches out to the patient? Why, and then how do we build that value continually through that process, through their journey of that recommendation? Like, uh, what do we, what are the next steps? Because limbo is a weird place to be. Like health is not going to come from a patient being in like. No, no land. Like we don't know where they are and how that recommendation is working at home or if they are confused about it itself. Yeah, absolutely. And so, I mean, once that appointment ends is not where that, that conversation should stop. So how do we create that continuity of care within our limitations of one-hour appointments and protocols, uh, to make sure patients are successful at their care. Um, so I mentioned at the beginning of this, you were a hygiene coach. And, um, I would love for you to kind of tell us like what role does a hygiene coach play in helping like clinicians turn that new evidence that we've been talking about, like salivary testing, things like that, technology and that clinical education into something they can use, uh, during a real appointment. Yeah. Yeah. That's hard to do. I mean, you know, hygienist, Uh, my role, I don't see myself as like teaching them like little robots, like you need to say this as soon as the patient, uh, responds or as soon as you discover Pio. And I'm not certainly going to tell them how to practice, how they need to exercise their clinical acumen, but I'm usually helping them determine exactly what is getting in their way. Today, I had a Really great coaching conversation with the hygienist who uh let her personal values with money interrupt the fact that she doesn't offer care to a particular patient. um, yeah, I mean, you know, and, and as, as hygiene coach, my, my job is not focused on money or KPIs or any anything that. Is what has once been thought of as corporate um my role I see as being just giving the standard of care, um, educating that clinician to, you know, we have experts on how to make sure the patient can get it fitted in their financial future. I need you to just hand off that to our financial experts to make sure that they can get that service that they need. Your job is to inform the patient that. Your clinical, uh, skill of manual disruption of bacteria is not going to solve the entire infective process. We need to focus on adding additional services, not to grow KPIs. Yes, I'm measured by KPIs, but I want her to utilize the services that help fight the infection that she feels comfortable recommending. And unfortunately laser wasn't one of those for her, but I introduced a new product, the desiccation therapy, to her today. I said, well, yeah. Oh, I personally, I love them as well, but she wasn't comfortable doing LBR. She likes LAPT, just not LBR. And so, well, as an alternative to that, why don't we use some desiccation on those patients instead? So it gives her that clinical autonomy to still be in control of the appointment, still understand the evidence, and unders and agree with what her, um. where her ethical compass is taking her and uh agree with the recommendation and then fit it into that patient's appointment. Um, and so, really just coaching them through, you know, how to get the patient from recommendation into actual practice. It's, um, It it's a, it's a fun kind of activity to do with each person because everybody's very different and, and so it's been really, um, really Part of my growth professionally is to try to help them overcome their challenges just as we did in the clinic, right? Are we motivated by aesthetics? Are we motivated by. Uh, money, are we motivated by infection? So just helping the clinician then figure out how to translate that into, uh, care recommendations has, has really been a, a, a joy of the role, I think. No, that sounds very valuable just for patient care to being seen to working through our own experiences and Values and hang-ups in life. I think that sounds so very valuable. Um, I do have another follow-up question, but before we jump into that question, um, we're just gonna take a quick break and hear a message from our sponsor. Come OK. So we are back, and I, my follow-up question too is around your guided biofilm therapy uh training. Um, what did like rolling that out teach you about introducing new technology to a team? Yeah, I think um that was, you know, coming from being a GBT trainer, um, and, and implementing that type of uh Technology to scale really was really an interesting experiment and it taught me a lot about um the amount of data one can process, right? So it was really great having me as kind of the backup, yeah, like the backup quarterback because every clinician received a different message. They, they ultimately received the same message, which is we're doing this protocol, but the maintenance, uh, is its own chapter in challenges as far as what they, what they receive. and what they, they missed, um, and it's really just fascinating to me the things that they latched onto was everybody was very different. No, I heard this, no, I heard that, and they heard it all uh cumulatively, but like individually it's like, well, actually the protocol and the and the advice we have is contrary to what you're saying we're both saying, um, and I've had to make. A lot of follow throughs with um with extra training one on ones um one of the biggest challenges I think was adopting PAson technology to ultrasonics um and and as you know they're very different uh mechanical systems and sometimes clinicians were choosing their preference over the patient's comfort and those were difficult conversations to have. With them to have this established protocol and say, well, uh, we know how uncomfortable that ultrasonic can be. So how are we going to move through to try to utilize this actual system that we have in place. So, um, those growth conversations don't come lightly and like, you know, there are challenges with personalities and, and opinions and life experience and, and preferences, right? So Um, I have clinicians still using ultrasonics. They're using airflows and ultrasonics. Um, so, our protocols are, are, are, they are, but, um, I just wanna make sure that they're fully comfortable with the service that they're providing and, and they feel confident in that service. Um, but we really focused a lot on, on that transition. That seemed to be the hardest transition to date. So yeah, yeah, you know, building on that, um, when you have a new hygienist, uh, not just in at Dental Care Alliance, but just a new hygienist in their profession, uh, versus somebody that's been doing it a little. Longer, a veteran, if you will. Um, how, yeah, exactly. How do you build that confidence, um, and do you see that there is a difference between a newer hygienist learning their confidence and a veteran hygienist trying to switch it up and finding the confidence in something new? Yeah. I mean, I think I'm, I'm so grateful this year we had uh actually 5 hygiene students join our team uh within our region, 5 brand new baby hygienists. Um, so I was able to really mentor them and kind of um Take them under my wing. I think that's another piece to coaching that is comforting from their side that they know they have somebody they can rely on. There is a difference even in the clinicians because some clinicians came from a dental background and some clinicians came straight out of. The college, you know, so they don't have any dental experience and those two clinicians, both being new hygienists are very different in their vernacular, in their confidence, in their time management, uh, all of those things, uh, really, really, um, form how they practice clinically, and I think the best quality that they can have is just being those, um. Forever learners, those lifelong learners and the, the go getting initiative, uh, type people that, that will set their career, uh, really, really far out because we've implemented quite a few things since they've even started in June. So they've been really open-minded and, and, and open to new. Suggestions and seeing like I had a conversation today with the hygienist. She's new, she's been an assistant before, but I started just asking her, well, what, what helped you make that decision? Like did you, did you consider this? Are you looking at that? And then she showed me all the evidence and I was like, I agree with your decision like. So I think going through cases and, and not to hover and not to kind of be controlling, but to just look at the evidence, like follow the trail and, and support their decision making. Um, another hygienist, I said, you know, she had treatment planned mini quads over full quads, and I had to have a conversation with her and I said, well, you know, considering the amount of bone loss, could you have treatment planned a full quad scaling instead of a mini quad? And she's like, oh, I didn't consider that. And, and I even had that growth moment the other day with my boss when I didn't. Consider this in my calendar and that in uh in my whole setup. So, you know, as long as they're open to growth and, and, um, not criticism but constructive feedback, that really just helps set apart those new hygienists because I'm, I'm not hovering, I'm not trying to helicopter their, their practice, just trying to help guide and provide that layer of support for them. Uh, as long as they're open to that, I think they're gonna be very successful. It sounds like it's more of a conversation than micromanaging or a critique, and I think that I would be so much more open to that than like, why didn't you offer this? Like you could have made this production goal today if it's like I could have helped the patient a little differently today because I made choices. And from our formulary that would have been a little bit more helpful for them. Like, uh, my whole, I think a lot of my 1st 10 years as a hygienist would have been a little different. Yeah, and, and I think that's why we got such a good group of hygienists, this, this cohort, because they were looking for that mentorship. They were looking for that feedback. I, I would, uh, provided Dental Care Alliance, obviously we have great leadership right now, so they, uh, really feel that we're not there to Micromanage and on that I don't feel like that's my role um and and they don't make us feel like that's our role so our leaders right now Kristen Lindsby, Stacey Halleck, uh, they're amazing mentors even to me and I learn every day uh on how to be a better coach so I really am lucky to have that kind of leadership above me so that I can continue to carry that forward into the clinics because I think that's to your point really what makes a difference in coaching. Um, I'm not asking why they didn't do something. I just wonder if they could approach it a different way. Um, and that really has been successful for me. And I think it makes sense and like for future differential diagnoses to have to justify your thoughts and why you chose one thing versus another thing and how you had that conversation with the patient and if they ask questions, you can like actually have a I think a more profound conversation with them because you've already had to kind of, I don't wanna say debate this with somebody else but explain your reasoning behind it. I know that sometimes it does come off as like an attack because like you are justifying things that you have decided that day. But if you had good reasons for it or patient responses or patient information that somebody maybe didn't have, um, I think that makes it a stronger treatment planning in the future as well. Yeah, absolutely, yeah, and just helping them learn those verbal skills, right? Like it's, it's a dance between you and the patient and you're right. I'm not there, uh, the doctor's not there, and so they have to use their clinical judgment based on the feedback that they get from, from their patient, from that engagement. So teaching them the open-ended questioning and we learn all in hygiene school, but as you're absorbing everything, you're like, how do I regurgitate all this into a hygiene process of care and And so just teaching them those verbal skills and how to overcome objections and, and just really being there and being patient, I think that applies to every clinician, not just new grads that, um, I, I think having a sound mind to bounce ideas off of and just being open to the feedback because if you do take it critically, I think the feedback can come off as um. Criticism, but it's, it's really not, it's coming from a genuine place where we just need to elevate the patient experience, elevate the level of care, and follow our perio management protocols. So, um, just holding them accountable, um, but, uh, uh, overall we just had a really great. Hygiene event. So I celebrated every single one of my 40 hygienists with dinner and education and samples from all our wonderful vendors. So I'm, uh, I hope they feel as valued as I feel, uh, about them by that experience. That sounds lovely. Um, as we close out today, Lindsay, is there anything that I didn't ask, anything I didn't have you touch on, or any like pearls that you want to share with the audience? Um, I mean, you know, I think the first step just needs to be clear after the hygienist, uh, makes a recommendation, uh, just to know who carries that torch and to make sure that the patient gets, uh, the follow-through. And that, and that's part of coaching too is keeping to the workflow, which then, uh, results in a patient acceptance, care acceptance, and then the outcome of the patient, which can be celebrated. And once the patient turns a corner and ends up uh healthier than where they started. So, and that's especially relevant with our whole whole body health connections, um, really just helping clinicians, uh, see that the whole body is connected and we all know it. It's just a great way to understand it when you have somebody to bounce ideas off of. And I'm, I'm so happy and so lucky to be part of, um, the Dental Care Alliance team and, and hygiene coaching with the leadership I have right now. So. That's amazing. That's a great way to close out, and I just want to tell everybody thank you um for joining us on this episode of Inside Dental Hygiene's a Strange Curiosity. And you know, on behalf of Inside Dental Hygiene Dental Care Alliance and our guest Lindsay here that gave us a lot of great information. Uh, thank you for spending your time with us today, and we'll see you again soon. And until then, stay curious.