Kathryn Gilliam, BA, RDH, discusses why she believes the dental hygiene department within a dental practice should be run as a business within a business.
Q: Isn’t the dental hygiene department meant to be a loss leader?
A: In the past, dental hygiene was seen as a loss leader. The dentist owner would charge nominal fees for a “cleaning,” which would allow the doctor an opportunity to do an examination and find needed treatment, and that’s where the real revenues would come in.
If dental hygiene was a loss leader in the past, it is no longer. We have elevated the value of our profession as we have become integrated, whole-health hygienists. We are diagnosing, treating, and managing patients with chronic infections. We are connecting oral disease with systemic diseases and disease risk. We are partnering with our patients toward their optimal oral and overall health. We are healers and practice builders.
Q: Is it really just a prophy?
A: Very often, when I go into a coaching client’s office, I find that while they try their best to treat and manage disease, they are not educating patients about their true conditions. They are working very hard and calling it a prophy. I believe the dental hygienists who are doing this are cheating their patients, as the patients don’t know the truth about their oral health, and they are also cheating their practice out of the higher fees that come from using the proper codes. They are also cheating themselves out of having adequate time to do a full periodontal procedure by attempting to do it all within the time allotted for a preventive prophylaxis. It is no wonder so many dental hygienists complain of burnout and physical pain. These practices cause tremendous physical and mental strain. I fully believe that the hygienists don’t intend to keep their patients uninformed or underinformed, and they do not intend to cheat their practices. I believe this practice comes from misguided good intentions and fear.
They fear upsetting the patient who is used to receiving a “routine cleaning” that his or her insurance covers 100% by telling this patient he or she has a serious disease that needs treatment that involves an out-of-pocket cost. They fear patient objections and rejection and the question, “For the last 10 years that I’ve been a patient here, my gums have always bled. Why are you recommending this treatment now when you never have before?”
These clinicians have what is called low confrontational tolerance. They do not feel comfortable telling their patients bad news. They would rather take on the burden of doing a difficult procedure in just a few minutes and call it a prophy than tell a patient the truth about his or her condition. As a clinical coach, I train dental hygienists to elevate their communication skills to navigate difficult conversations successfully.
As healthcare practitioners, it’s our job to honestly and forthrightly tell our patients what their health conditions are, what their treatment options are, and what the risks of choosing not to treat are. One of the biggest dangers of not addressing a patient’s disease proactively is that the health of the patient almost inevitably declines.
Q: What does it mean for a dental hygienist to be “conservative?”
A: Many dentists now practice “minimally invasive dentistry,” a philosophy of preserving as much natural tooth structure as possible. As a dental hygienist, I used to believe it was “conservative” to do as little treatment as possible. I would encourage my patients to floss subgingivally every day using a very specific technique to disrupt the plaque that begins reforming just hours after I thoroughly “cleaned their teeth.” I was a great cheerleader, assuring my patients that if they only adopted this regular practice, their gums would look much better next time. But they would come back in 6 months looking no better and often worse, with deepening pockets and increased bleeding. This would go on for years. I had the best intentions, but I was failing to address my patients’ disease fully. Finally, it dawned on me that I was not practicing conservative dental hygiene. To be truly “conservative” means to conserve as much of the natural attachment, bone, and overall health as possible. To do this, I had to be proactive and treat patients at the earliest signs of gingivitis and periodontitis. Learning to act early meant elevating my communication skills. My confidence grew as my patients accepted my treatment recommendations, and their health improved. Initially, I saw the reduction of pocket depth and the elimination of bleeding. Then I saw that blood glucose levels improved and that blood pressure medications were reduced or eliminated. Reducing chronic oral inflammation was a huge boon to my patients’ overall health and our practice’s bottom line.
Many dental practitioners don’t like thinking about dentistry, and dental hygiene in particular, as a business because we feel like it’s our calling; it’s our mission. In reality, it is a business. If we don’t treat it like a business, we won’t be in business very long. When dental hygienists adopt a new mindset around conservative and proactive treatment, they can run the hygiene department as a wellness center and a business within the business. When we do this, the patients, the practice, and the practitioners all win.
About Kathryn Gilliam, BA, RDH
Ms. Gilliam is an integrative dental hygienist and a certified biological dental hygienist. She is the founder of PerioLinks, LLC, a consulting and speaking company, and a lead clinical coach with her dream team, Inspired Hygiene. Her interest in the medical side of dentistry led her to years of advanced study of oral-systemic connections and the medical model of care. She guides teams to integrate the latest science into practical clinical protocols. She can be reached via email at kathryn@inspiredhygiene.com.
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