Did you know dental hygienists are responsible for preventing and treating gum disease? According to the Canadian Dental Association, “7 out of 10 Canadians will develop gum disease at some time in their lives. It is the most common dental problem, and it can progress quite painlessly until you have a real problem.”1 This statistic is rather alarming as dental hygienists are prevention specialists. All other healthcare professionals treat diseases, such as dentists, doctors, nurses, dieticians, audiologists, chiropractors, chiropodists, respiratory therapists, pharmacists and many more.
The World Health Organization states that “almost half of the world’s population suffer from oral diseases,” yet I still see many dental hygiene patients booked for 6-month dental hygiene intervals.2 It puzzles me how patient care has yet to evolve after the 2017 American Academy of Periodontology (AAP) Guidelines which were updated in 1999.
Dental hygienists are currently in high demand, and many often ask me the best way to ask their employer for a raise. The first comment that usually comes up when I have a conversation with dental hygienists is the number of years that they have worked in the dental practice. While loyalty is vital, it is only a portion of the reasons why one should get a raise. Patients share that they return to the dental practice because of their relationship with their dental hygienist. They trust the dental hygienist and like the continuity of care they receive. They feel comfortable returning to the practice because they know what to expect.
Dental hygienists are known for saying, “I don’t want to sell anything; I am in healthcare.” I couldn’t agree more with them. When I was working as a clinical dental hygienist, I did not feel I was selling anything. Furthermore, I provided options to my patients to prevent disease – informed consent so they could make the best decision for themselves. To me, it is always healthcare first, followed by business. We wouldn’t dream of going for a pedicure and asking the technician to paint all ten toes and saying I only want to pay for five, would we? I do not favour discount dentistry as all providers are educated and have spent many years in school. Refrain from devaluing yourself by offering discounts or offering free dental hygiene services. We all know that at times the dental practice supports our role in social responsibility which is a different situation.
As a dental hygienist, how do you share how you have been able to measure what matters in the care that you provide? Dental hygienists need a framework to set themselves up for success when discussing their performance and requesting a raise. This supports the business to have you highlight your production, Google reviews, case acceptance rate and clinical conversation skills. It also helps to celebrate your wins and identifies gaps that may need to be closed on time. I am so proud of dental hygienists that come to a performance evaluation with a plan of what they will need to do their job for the following calendar year. They know how many dental hygiene cassettes they have, what instruments are in those kits, which instruments can go to an instrument recycling program, and what they need for the year’s remaining months. It is broken down into four buckets in the year to be budgeted accordingly. This is a well-laid-out plan by the dental hygienist which sets them apart from others.
Here are my five recommendations for having a productive discussion with measurable outcomes when you have a conversation to discuss your performance and raise a request. This shows you have come prepared and are well informed of the care you provide rather than having a random conversation without any facts about your performance.
1. Hygiene production per hour.
You might be thinking, why does this matter? It does matter if the dental hygienist is continually billing two scaling units in a 60-minute appointment and not adjusting the patient’s appointment length for the next visit. It may occur from time to time that a patient needs to leave an appointment early, but when the patient is habitually excused early, the business hurts. You can always have value-added discussions with visuals for patients to learn. Knowing the variance of dental hygiene production within a team is essential. I do not mean knowing who is producing what on average but identifying a variance, such as $168.78–220.76. This would show a variance in dental hygiene billing per hour of $51.98. With a significant variance, there is always a story about why this might happen. One dental hygienist may be treating more children or seeing more social assistance patients, but nothing will change if you are not looking at this and talking about it. I often am asked if we should add more patients daily to up our dental hygiene production. My simple answer is no. Having the proper amount of time with each patient is critical in ensuring the dental hygienist meets the Standards of Practice, the patient is treated effectively, and there is time for the patient to ask questions and understand their treatment options. Rushing through patients does not enhance any business or maintain the retention of the patients.
2. We measure pre-booking rate in percentage.
When the dental hygienist books back patients for their next dental hygiene appointment, it makes it easier for everyone in practice. Patients have the best bond with their dental hygienist and are more apt to book back with them rather than the admin team. The language used by the dental hygienist is critical to patient booking. It may sound like this: “Mrs. Jones, as we discussed during your appointment, you are due to return for your next dental hygiene appointment in 3 months. Good news, I have Wednesday, August 16th, at noon available at the same time as today. Can I reserve that appointment for you?” Dental hygienists, do you currently know your pre-booking rate? An industry-wide benchmark is having a 90% pre-booking rate.
3. Fluoride varnish is one of the most effective preventive services we can offer our patients.
Why, you ask? The dental hygienist completes a thorough review of the patient’s medical history and is aware of the medications the patient takes that cause xerostomia. Second, they know the patient’s home care habits or lack of home care habits. Third, they dig deeper into what the patient is drinking throughout the day and night to learn that most of the drinks that patients are consuming today have a low pH, which has the oral cavity at an acidic level throughout the day, causing acid attacks, including some bottled water and diet sodas. Lastly, dental hygienists know that when we polish our patients’ teeth, we recommend fluoride to remineralize the tooth’s surface. Dental hygienists, do you know your fluoride acceptance rate for children and adults?
4. Radiographic guidelines are fundamental to ensure that dentists and dental hygienists have the proper X-rays to treat the patient effectively.
We know that it is always patient-specific care and that a standard X-ray protocol is inappropriate. I encourage communication with the dentist to ensure that the dental hygienist has the appropriate X-rays to perform staging and grading for each perio patient. Radiographic guidelines should be on a team meeting agenda each year to address any concerns. Practices often set guidelines for PANS between 3-5 years or 5-10 years, and the team needs clarification on what interval they should begin assessing for a PAN. Some practices have the dentist prescribing anterior PA’s, while others do not. I ask many dental hygienists, if you were a temp dental hygienist coming into your practice, how would they know what the dentists’ guidelines are if they are not written down? Many do not know how to answer, and I learn various answers. Dental hygienists, can you add this topic to your next team meeting to ensure everyone has the clarity to advocate for the patient?
5. Technology is at an all-time high level in dentistry.
There is no better way to educate your patient on what is happening in their mouth. Yet not all dental hygienists get on board with including technology consistently during their dental hygiene appointments. One can use digital scans, intra-oral camera pictures, or even a clean hand mirror. In dental hygiene school, we always used two tones disclosing solutions so our patients could visually see how they were brushing and the plaque left between their teeth. Remember, seeing is believing for the patient. If you have a digital scanner, do you know the number of scans you do monthly?
Overall, dental hygienists provide optimal patient care daily. Of course, it will always be healthcare first, followed by business, but now more than ever, it is essential to measure what matters to set yourself up for success as a dental hygienist. Your attitude, attendance, being a team player, advocating for your patient and providing top-notch dental hygiene services will set you apart from others and help you obtain the raise you deserve.
About the Author
Jennifer is the Vice President, Dental Hygiene Operations at 123Dentist. She is the North American recipient of the “Educator of the Year”- Speaker award from Dr. Bicuspid, 2023. In addition, she has been globally recognized as one of the “10 Most Influential Healthcare Leaders to Watch in 2022.” She has built her reputation in the dental hygiene world as a natural leader through her professionalism and leadership. She has worked with hundreds of dental practices across Canada, supporting teams with change management and implementation of clinical systems to enhance and elevate optimal patient care. In addition, Jennifer is an inspirational, knowledgeable, dynamic speaker passionate about the dental profession.