Often, patients don’t put a lot of thought into the actual operation of their dentist’s office. They expect to see somebody at the front desk – whether an office manager or someone you also see helping chairside – as well as, that person who assists the dentist. And, of course, the dentist! Sometimes you might see a hygienist…someone who’s not the dentist, but does procedures separate from those performed by the dental assistants. But, this particular member of the team, may not always be around the office, or could not even be a part of the practice clinical staff. Wonder why? This is a major decision many dental practice owners usually face…Either/Or: The Dentist Hygienist Crossroad!

So, we consulted a highly successful dentist and former practice owner, to get the inside scoop on WHY an office may – or may NOT – have a hygienist on their team. The answer provided new insights into the thought process behind this decision. Additionally, he brings a dual perspective: first as a multiple-office practice owner and then, as a associate with a respected regional group of dental offices…giving us both sides of the “hygienist coin” AND the multiple reasons why, or why not!

At first glance, it may seem like pure economics would be the deciding factor. And, it is – sort of. Obviously, the financial viability of the practice “business” must be sound and ensure varying degrees of profitability. So, every person added to the office team represents additional overhead. An expense which requires a financial justification. So, no specialized hygienist, no salary or fee schedule percentage. BUT…that is NOT the whole picture!

It actually all boils down to the practice patient profile. In the case of this doctor’s experiences. The offices he owned consisted of a large pediatric patient base – in the 75-80% range – and NOT the prime demographic for the intensive periodontal care offered by Registered Dental Hygienists (RDHs). Thus, no real need for the specialized service, since any routine children’s cleanings could be handled by the RDAs (Registered Dental Assistants) already on staff. Anything more involved, could easily be performed by the dentist, themself, since their licensing and training enable them to do anything an RDH can do.

Plus, if this sort of treatment would be fairly rare within THAT particular practice, Associate Dentists would then be able to add those expert hygiene services to their billable procedures…and, as a result, their income. For anything outside that scope, referrals to a certified Periodontist allowed the practice to ensure the patient received the advanced care they need, without any worries of that specialist “poaching” the patient for routine dental treatment and maintenance. WIN-WIN!

In terms of scheduling and space allocations, resources and, yes, economics, this decision to not include hygienists in the practice team, made perfect sense in every respect. However, in his new role with a practice featuring a totally different patient base, this was NOT the case.

Going from an environment that catered predominately to the dental needs of children, to one with a much heavier focus on adults who either carried comprehensive dental insurance or could afford private pay, proved a significant difference. And, in THIS situation, hygienists played a MAJOR role in the operation and profitability of the offices.

With a higher focus on the need for periodontal procedures and maintenance, scheduling multiple hygienists for each office, allowed the dentists to devote their time and skills to the care ONLY a dentist could perform. It all comes down to percentages. Higher percentage of adults, the greater the financial sense a staff hygienist makes. Of course, figured into that economic equation, are the office space and resources needed to support dedicated hygiene staff, along with the level of patient receptiveness to adopting regular, scheduled, hygienist appointments.

This means, you CAN sustain a hygienist in a practice with a high percentage of children…IF their other family members also trust the practice with their own dental care. And, conversely, an office primarily treating adults may NOT be able to support a hygienist if too high a percentage do not understand or remain compliant with a recommended hygiene schedule. Soooo…it all depends! But, most successful practices DO have a good picture of their patient profiles, and staff accordingly. Bottom line, if you wonder why YOUR dentist’s office has a RDH, take a look around at who the other patients are and that should give you the answer. And, if not, then you need to decide if YOU’RE the kind of patient who has not heeded a recommended periodontal hygiene schedule!

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