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August 2018--Dr. AJ Acierno of DecisionOne Dental Partners reports that a dynamic dental hygienist can quickly increase treatment acceptance in an office from a low of 24% to a high of 78%. This Chicago-based dental service organization (DSO) counts on their hygienists to help discover patient needs and assist in leading patients to see the value of accepting their dentists’ recommended care.

DecisionOne Dental Partners has grown to 25 locations since 2011, and we are at a new stage of expanding our support center to enhance the lives of dental hygienists and patients.  We want our hygienists to have the skills, tools, coaching and empowerment to be restorative partners with the dentists they work with. Investing in the development of our hygienists as leaders in their locations has really paid off. We see a direct correlation between Hygiene development and significantly increased restorative case acceptance.


The Hygienist-Patient Relationship

DecisionOne’s dentists and hygienists strive take an active approach to help patients move forward with the care they need. Hygienists are ideal leaders in a dental practice because of these factors:  

  • Their observations and conversations increase the efficiency of the dentist. The hygienist's observations enable the dentist to efficiently evaluate and treat problems. Not only do hygienists educate patients about oral hygiene but also the importance of comprehensive dental care and wellness. Hygienists can answer many patients’ questions and help them feel at ease about receiving the treatment they might need, or electively desire such as teeth whitening. 
  • They commonly, quickly develop trusting relationships. Ideally hygienists develop a positive relationship of trust with each of their patients. When serving patients with empathy, this can happen quickly. Over time, they may even become close. This happens as patients share oral health concerns with them and talk about their lives in general. A friendly bond forms as the patient catches the hygienist up on what is happening in the patient’s life, mouths are examined, teeth cleaned, and both talk about changes they have observed in the mouth. 
  • They spend more time with each patient during recall visits than the dentist. Hygienists have more time with patients to look for changes in the mouth and for open conversation. Once patients feel comfortable with their hygienist, they often ask the hygienist for advice about improving their oral health. They wonder about what dentistry can do for them. Often hygienists are the first they talk to about cosmetic dentistry. Patients wonder out loud if something can be done for their smile. 


Although hygienists are not allowed to diagnose, they are allowed to observe and say, “I think I see a little enamel erosion starting on this tooth so I’m making a note for the doctor to check that. The doctor will examine you before you leave and tell you if there is a problem.” Or, the hygienist might say, “The gum pocket around that left back molar has grown and there is a little bleeding. We don’t like to see a gum pocket get any deeper than 4 mm. When the doctor examines you, we’ll get her opinion on whether that needs treatment.” The patient is apt to ask about what that treatment might be, and then the hygienist has an opportunity to talk about how easily teeth scaling and root planing is performed. The patient may ask what could happen if it gets deeper. Opportunities for engaging with the patient are many.

When a patient asks, “The dentist said last time that I needed a crown here. Do you think that tooth looks worse since I saw you?” the hygienist has an opening to talk about the value of having a structurally weakened tooth crowned and the expertise of the dentist to do a beautiful job, adding “I’m sure the doctor will want to take a look and follow up with you on that in a few minutes before you leave.” The patient may even say to the hygienist, “I know the dentist thought I should have this tooth crowned. I think I am ready to make that appointment today.”


Empowering Hygienists

Hygienists are essential to any dental practice and having a hygienist who feels comfortable talking about dentistry and has the confidence to lead patients forward for treatment is priceless. Hygienists need to be empowered by the importance of what they do, and they need to feel permitted to have appropriate conversations with patients that support treatment recommendations of the dentist and inspire patients to follow up on their desires to improve their smiles. 

When a DSO provides optimal support to its hygienists, they develop their clinical and behavioral communications skills. They also eagerly learn more about dentistry when dentists share cases with them and explain the treatment options and why a certain treatment plan was made for a specific case. Optimal support includes best tools, best practices, guidance, and even practiced role modeling.

Hygienists cannot diagnose, but they are in the mouth longer than a dentist. They need to look at all the aspects and be able to communicate with the doctor what they are seeing. And that doesn't mean they might be right; sometimes it might be wrong, but there needs to be that communication. 

Not all hygienists are comfortable doing this. Most, in fact, need empowerment. With increased knowledge about dentistry, they will be encouraged to speak up when they see a problem, even if the patient says all he or she wants is a cleaning. Dentists need encouragement to think in this way, too. DecisionOne Dental Partners is focusing on its hygienists with mentorships and a full-time periodontist who teaches the teams. 

It is all about:

  • Helping hygienists and dentists understand the purpose of partnering to lead patients,  
  • Encouraging hygienists to facilitate the optimal care that is in the patient’s best interest, and
  • Providing hygienists with the training and support they need to do this well.


Career Satisfaction

DecisionOne Dental Partners believes in empowering their hygienists to have a greater impact on the lives of their patients, while enabling them to enjoy meaningful careers. The hope is that case acceptance will grow, not because of productivity, but because it is best for dental patients. This higher purpose is meaningful to DSO team members and engenders career satisfaction. Dedicated support for hygienists across DSO locations leads to career development, increased restorative treatment, and long-term employee retention. 

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