Oral Health Group

The Right Question

February 16, 2017
by Debra Engelhardt Nash

“How’s your dog?” “What’s new with the kids?” “Are there any changes in your health history?”

These are typical and appropriate questions to ask patients during their recare visit.


But there is one question that sometimes isn’t asked that should be the first review when the patient sits in the hygiene chair, and it can have a profound affect on practice productivity.

“Tell me what has prevented you from having your treatment completed?”

This inquiry should be presented to those patients who have previous treatment that has been indicated but not accomplished.
And timing is everything. This question should be one of the first questions asked when the patient is seated in the operatory. If it is placed at the end, or delayed until the doctor comes in for the examination, previous conversation time is lost. At the end of the visit, the patient is ready to go – especially if they have had to wait for the doctor.

Be careful assuming that the patient doesn’t want to talk about their outstanding care, or that their answer will be the same as how they previously replied during past visits. Situations may have changed; finances may be better, and priorities may be different. If the practice doesn’t place importance on the recommended treatment, how do we help the patient understand and appreciate our intended care?

Avoid throwing the conversation away by being too casual; “You know Mrs. White, we’ve talked about this treatment before”, and then proceed with the recare visit without asking the question. Prevent perceived apathy about incomplete treatment by making assumptions based on familiarity or history.

Familiarity May Generate Apathy
Sometimes the strength of having a long-term relationship with the patient can become a weakness. Although having a social discourse with the patient is important, too much of it can hurt the patient experience. Here is a case in point:

A friend called me and asked me to help him understand why he was charged a recall exam fee when he didn’t feel as though he received one. I asked him if the doctor came in to see him and did he look into his mouth with instruments. He replied that the doctor had done this but the conversation he had with my friend was not about his dental health.

“He talked about my work, my wife and my family, but he never talked to me about my teeth. I don’t think it was a dental exam. I think it was a social visit”.

What may appear to the dental practice as building and retaining strong relationships with patients by friendly conversation may be taken to an extreme that minimizes the importance of the dental health review and the conversation about their dental care and their dental future and reduces the worth of the dental exam. (Have you ever heard a patient say “I just want my teeth cleaned, I don’t want an exam”? Or “It’s just a cleaning”?) These comments may be indicative that the patient does not perceive value in the doctor exam. The doctor and the hygienist need to re-focus on demonstrating the value of the visit.

Reviewing daily hygiene productivity is a gauge for effectiveness. In addition to this measurement, additional treatment being diagnosed from hygiene patients is a critical statistic and vital emphasis in every dental office.

Let’s Do The Math
Let’s create a scenario that would be typical in many dental offices:

Two (2) hygienists working four (4) days per week= eight (8) days per week x fifty (50) weeks provides four hundred (400) hygiene days annually.

If each hygienist treats eight (8) patients per day x four hundred (400) days there are thirty two hundred (3200) available appointments annually.

If there are 3200 appointments available annually and patients are seen an average of twice per year (2.0), there is capacity for sixteen hundred (1600) patients seen per year.

If sixteen hundred (1600) patients appointed and only ten percent (10%) appointed for additional dentistry averaging $800.00, an additional $128,000.00 additional treatment production would be generated from hygiene.

This is a very conservative projection. Other experts suggest the average is closer to sixty to seventy percent of patients in hygiene could benefit from something beyond today. 1 If the office sees eight patients per day and if six patients have potential treatment needs, it translates to $3200.00 per day. If there are four hundred hygiene days, that totals over 1.2 million dollars in treatment revenue per year!

Training Time
The continuing care appointment the ideal time to let existing patients know about new treatment modalities in our office introducing new treatment options. Hygienists are able to interact with patients and build a trusting relationship. This relationship will enable them to recommend procedures, and teach patients preventative measures to guarantee their dental health. As patients trust the hygienists, they are more likely to feel that trust when previously diagnosed treatment is being discussed. The hygienist should feel responsible in helping the patients understand and accept treatment that has been recommended and make it a part of their hygiene appointment regime.

Ongoing training to learn new techniques, technology and communication will boost confidence in talking to patients. A well-informed auxiliary can help patients better understand treatment recommendations. The more knowledgeable in materials, and treatment processes, the more information they are able to share with the patient. Confirming the doctor’s diagnosis and helping define the treatment plan aids in patient understanding and promotes treatment acceptance.

Providing in office training programs, sharing journals and manufacturer’s materials for review helps the Team stay current in dentistry.

Pay attention to how much is being spent with each hygiene patient. Focusing on the quantity of patients seen per day more than what is happening with patients during their visits may impede the effectiveness of moving patients to their restorative care. Packing fifteen patients into one hygienists schedule in a typical eight hour day will prevent him or her asking the right questions and waiting for the patients’ answer.

Here is an example from one of my consulting client’s offices: the doctor was frustrated because he had a large established practice with a very busy (and full!) hygiene department. But outstanding treatment previously diagnosed and presented but not completed was not being converted from hygiene visits.

His two hygienists had worked for this doctor for a long time, and they believed in his dentistry. They worked four days per week and were scheduled nine hours for patient care. Each hygienist was scheduled with an average of twelve patients per day, without the aid of a hygiene assistant.

Once we scaled the number of patients down to eight patients per day and trained the hygienists in communicating treatment to patients, and asking the right question at the right time, additional treatment being accepted from the hygiene department dramatically increased.

It is critical to appropriate the correct amount of time to ask the right question – and give the time for the patient to answer.

Ask the right question at the right time.
Review practice statistics.
Train the Team.
Schedule Right.

Review your patient recare visit protocols. Evaluate your current treatment acceptance rate from hygiene, and use it as a guidepost for measuring progress. If you haven’t been using this statistic to guide you, now is a good time to start.

Establish an environment in hygiene that is inviting to patients and creates a positive atmosphere that encourages treatment acceptance. This includes scheduling the proper amount of time.

Be excited about the prospect of serving others and they will seek your help. Give yourself the proper amount of time to discuss incomplete treatment with hygiene patients. Your practice and patients will benefit from the exceptional dentistry you provide.

1. The hygienist’s role in promoting dentistry, Cathy Jameson, PhD http://www.dentaleconomics.com/articles/print/volume-94/issue-10/features/the-hygienists-role-in-promoting-dentistry.html

About the Author
Debra Engelhardt Nash
Founding member and served two terms as President of the Academy of Dental Management Consultants. She is currently the Vice-President/President Elect for that academy. She is an active member of the American Dental Assistants Association Foundation and serves on the board of the American Dental Assistants Association Foundation. Debra is also a member of the American Academy of Dental Practice Administration. She has been repeatedly recognized by Dentistry Today as a Leader in Continuing Dental Education and in Dental Consulting.

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