A high-performing dental practice has clear goals, organization, and communication. A healthy and supportive relationship among all staff members plays a key role in the prevention, treatment, and maintenance of dental conditions. It is especially important for dentists and hygienists to provide the same message to patients about their oral health so that patients feel confident with their treatment plans. Having protocols and resources in place ensures that hygienists feel their findings are accurate and supported by the dentist, and vice versa.
There are many opportunities to create a teamlike approach to treatment. In our practice, both dentists and hygienists work directly with patients at all stages of treatment. For example, after the periodontist completes the initial evaluation, the patient is scheduled for surgery. Patients are often greeted by the hygienist at this appointment who will seat them, review instructions for the perioperative period, and answer questions or concerns.
The hygienist then administers local anesthesia, which allows several minutes before the periodontist comes in for surgery. Many patients appreciate this protocol because it is less intimidating than jumping immediately into surgery. The hygienist has 30 minutes to complete these tasks and reassure the patient, and by then, much of their dental anxiety has subsided.
For some surgical procedures, the hygienist plays a role during treatment. When full-mouth laser periodontal or implant therapy is indicated, a patient is seen in two visits to treat one side at a time. At the beginning of these appointments, a similar presurgical protocol is followed as the hygienist seats the patient, reviews pre- and postoperative instructions, and administers local anesthesia.
After the periodontist uses the laser in the first pass to disinfect the pockets, the hygienist performs scaling and root planing of these sites, and then administers more local anesthesia as needed. The periodontist then completes the procedure with the laser. The hygienist is familiar with the patient’s periodontal or peri-implant conditions and can better manage them through maintenance.
More hygienist involvement
Patients will see the same hygienist for suture removal, follow-ups, and maintenance. The hygienist can scale and polish the surgical site as needed to maintain an inflammation-free environment and promote optimal healing. This also allows them to follow the patient through the entire treatment and develop a strong relationship with them.
When the hygienist is this involved, it strengthens patients’ knowledge and confidence in diagnosis, treatment planning, and surgery. Patients gain comfort in the process with consistent follow-ups by the same staff who reiterate the same message. Overall, this approach allows the dental team to work closely and efficiently and enhance the patient experience. This deepened patient-provider connection increases compliance and treatment acceptance.
The tools we recommend
We use many tools and resources during follow-up and recall visits. Chairside videos and animations are particularly effective in breaking down high-level concepts and conditions, recommended treatment, and home-care instructions. Patients want to be included in their treatment decisions, so the quicker that value is instilled, the easier and more enjoyable the process is for everyone.
While there are a variety of commercial platforms available, our office uses the Spear patient education series for pre- and postoperative instructions, basic clinical concepts such as single-tooth loss, and surgical and restorative procedures. Patients watch these videos at their initial exam to understand each element of their treatment plan. The videos can be customized to reflect a patient’s exact condition. Referring dentists are encouraged to use these videos so patients arrive to their consultation with a baseline understanding of their treatment needs.
Spear patient education videos can be emailed or texted to patients. They can then share these with loved ones who want to be part of the decision-making. This has been particularly helpful during COVID-19, when we limited the number of people allowed in the treatment room. Patients can refer back to the pre- and postoperative video instructions, so they’re prepared for their procedure and confident in managing the surgical site at home.
Hygienists use videos related to home-care instructions during their scaling and root planing appointments to establish proper oral hygiene. These videos review brushing angulation, pressure application, and flossing patterns, among other techniques. They are a nice resource for patients with complicated fixed, removable, or implant prostheses when adjunctive aids such as interproximal brushes, waterjets, or floss threaders are required.
Other technologies help in patient education and case acceptance. While the periodontist shows patients before-and-after photos of treatment, an intraoral scan will be taken at the initial or recall visit by the assistant or hygienist. These scans capture live images of the patient’s teeth, hard and soft tissues, and occlusion. Patients look forward to these scans because they’re quick and less invasive than conventional alginate impressions. They help monitor recession, occlusal relations, and other dental conditions, especially when patients alternate maintenance between offices.
Hygienists can compare their findings with the baseline scan at each recall. They’re useful in treatment planning and executing comprehensive, multidisciplinary treatment because of improved communication between clinicians. Most importantly, patients appreciate the need and benefit of their treatment in real time.
Traditional tools, such as the patient mirror or anatomical model, will always be invaluable. A large patient mirror can be used to demonstrate proper oral hygiene techniques, reinforce specific aspects of the patient’s treatment, and set realistic expectations. Periodontists also use models for single and multiple implants, stages of periodontal disease, and edentulous cases planned for implant-supported appliances. These can be used by the hygienist during recall if the patient is at risk of losing a tooth or has a terminal dentition. Hygienists often defer to the toothbrushing models and typodonts. Some companies have toothbrushes that can be tested in the office, which is especially helpful when patients transition from a manual to electric toothbrush.
Hygienists can take charge
Hygienists have an opportunity to lead some areas of our workflow. It’s important for the dentist to empower the team by stepping back and truly listening to their needs. If the hygiene team is having difficulty with certain aspects of a patient’s treatment, they’re encouraged to voice these concerns. The dentist should respect the hygienists’ recommendations. At the end of our recalls, for example, the hygienists complete an appointment summary, which is then emailed to the general dentist. This allows them to mention areas of concern confirmed by the periodontist.
Frequent and effective communication is also encouraged with huddles and team-building exercises. The benefits of strong interpersonal relations go beyond practice walls. Our team is active in the dental community and takes part in study clubs for dentists, hygienists, and administrators. The hygienists have publishing and speaking opportunities because the periodontists encourage them to explore these interests.
Hygienists are the lifeblood of any practice. They complete most of the data collection, organization, and patient management. This allows the dentist to diagnose and treatment plan. A healthy relationship among all staff members improves the patient experience because clinical providers can focus on the prevention, treatment, and maintenance of patients. Dentists and hygienists are encouraged to work together on their chairside discussions so that patients receive the same message. Finding the right systems and resources for your practice can ensure that the entire team feels supported and empowered to best serve patients.
Editor's note: This article appeared in the July 2022 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.