Are you a proactive partner?

June 25, 2014
Every dental team member plays an important role in the practice's success. While team members have their specific areas of expertise, it's important for each department ...

Include a greater awareness of treatment financing as part of patient education

By Rachel Wall, RDH, BS

Every dental team member plays an important role in the practice's success. While team members have their specific areas of expertise, it's important for each department to respect and understand the value of the other colleagues.

The hygienist often spends more time with patients than the dentist does. You have the opportunity to establish very strong relationships and be a proactive partner in your patients' health. While these relationships can support the recommendation of high-level dental care, they can also sometimes hinder recommendations because you may know too much about a patient's personal affairs.

Helping patients say "yes" to needed dental care goes far beyond the operatory. While many hygienists are reluctant to discuss the financial aspect of dental care, a few steps can bridge that gap for patients when they say, "Yes, but how much is that going to cost?"

Be the doctor's proactive partner

Although the doctor always makes the final diagnosis, as a hygienist you are in a strong position to be proactive in sharing observations about the patient's oral health. As part of the hygiene appointment, you are responsible for doing a soft- and hard-tissue evaluation, collecting diagnostic data and sharing your concerns, first with the patient and then the doctor.

Intraoral photos are an extremely valuable tool as they dramatically reduce the amount of time needed for explanation of existing conditions. For example, when a patient returns for a preventative hygiene visit, you would say, "Mrs. Jones, I'm concerned about this molar on the lower right. It looks like the old metal filling is breaking down and putting the tooth at risk for breaking. I know Doctor is going to be concerned as well so I'm going to take a quick photo so you can see what I see and so he can look at this specifically and provide his treatment recommendation."


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This prepares the patient for the doctor's examination and treatment recommendations. Once the doctor comes into the hygiene op for the exam, you can then hand off the information, involving the patient in the conversation. "Doctor, you remember Mrs. Jones. During my exam, I noticed the filling on the lower right molar is breaking down. Here is the photo I took today. Would you please check this area carefully and give us your recommendation?"

This shows Mrs. Jones that the hygienist is part of a diagnostic team and that regular hygiene appointments are important, because often there are treatment needs that, while they aren't causing pain today, can quickly progress into bigger problems.

Deliver value that far outweighs the cost

As a hygienist, you have a unique ability to help patients and the practice by validating the importance of the doctor's diagnosis of needed treatment. This is especially true for patients with uncompleted treatment. In many cases, patients have the strongest relationship and level of trust with the hygienist. If you don't believe in the value of the treatment or are hesitant to validate the doctor's recommendation, this lack of confidence will translate to less-than-optimal case acceptance.

Beginning the hygiene exam with a medical history review -- including any current medications and new or chronic conditions such as diabetes, high blood pressure, or rheumatoid arthritis --enables you to be aware of contributing genetic and inflammatory risk factors before performing the clinical exam.

When you see periodontal infection in a patient with additional inflammatory conditions and/or risk factors for heart disease, the care you recommend has the potential to reduce the patient's risk for more serious health problems. When hygienists take a holistic view, there is an opportunity to communicate to patients how the value of the care provided far outweighs the cost.

Communicate confidently

When you truly believe in the value of care, patient communication is confident and encouraging, and you avoid minimizing statements such as, "You probably don't want to hear this …," or "You have a little bit of bleeding…" Minimizing words also minimize the value of the treatment you're recommending. A little bleeding doesn't sound so bad.

Instead, confidently communicate the need for care. "Mrs. Jones, I noticed on your medical history that you have high blood pressure. We now know there's a connection between your oral health and your overall health. I am observing significant infection in your gums. Inflammation like this is another risk factor for heart attacks and strokes and many other serious health problems. The treatment the doctor and I have recommended will stop the progression of this infection which will reduce this inflammation in your body."

With existing patients returning for hygiene, you have a chance to present again uncompleted treatment. Before the appointment, review the patient's chart to identify what has previously been diagnosed and planned. Then, during the exam, look for anything new going on in the mouth and remind the patient of needed care using either a past photo or a new photo if the condition has worsened.

"Mrs. Jones, I know we've discussed this before. I'm concerned about the molars on the lower right. You see these cracks here? [pointing to the photo on the monitor] The doctor recommended a crown last time we saw you to prevent these teeth from breaking. I've seen untreated cracks like these go into the root of the tooth. When that happens, those teeth can't be saved. Let's have the doctor review this again today."

Confidently discuss costs

Our responsibility as health-care providers requires us to share with patients our observations regarding their oral health, provide them with treatment recommendations, and review ways for patients to pay for care with less stress.

In most practices, the hygienist is not the primary team member responsible for making financial arrangements. It is, however, incredibly important for every member of the dental team to be very familiar with the financial options that are available for patients.

This means the hygienist must have general knowledge of the cost of common procedures and be able to easily access the treatment plan. If a patient says, "The doctor said I need two crowns. How much is that going to cost?" the hygienist can respond with a range of cost based on the treatment plan that has been created.

The response could sound like this: "Jane, that's a great question. Based on what the doctor recommended, the cost is approximately $3,200. Before you leave, I'm going to introduce you to Kim. Kim is our treatment coordinator, and she can give you all the details on what your insurance will contribute and options for working out your portion of the cost."

Being able to confidently share fees adds another layer to the value you're building for the treatment. When a team member avoids answering the patient's direct question about cost, doubt starts to set in. Having payment options is absolutely essential. They should be clear, written, and consistent, so every person in the practice is able to talk about them with patients.

Even if the patient doesn't specifically ask how much needed dentistry is going to cost, more than likely they are thinking about it. In this situation, the hygienist can save the patient worry by saying, "I see the doctor has recommended this crown on the upper right. After we're done here, I'll take you to talk with Kim, our treatment coordinator. Kim will find out what benefit your insurance may provide and then discuss payment options for your portion." An informed practice means an informed patient -- presenting them with options, information, and assurance that the practice will do everything possible to make it easier for them to get care.

As confident as you are about your doctor's clinical recommendations, it's just as important that you are confident that your administrative team can find a comfortable financial arrangement for your patients who need care. This takes clear, consistent communication between the administrative and clinical team.

Today's hygienist is much more than "the person who cleans teeth." It's up to us as hygienists to step out of our comfort zone and into the role of health-care provider. With a strong, confident administrative team handling the financial options, clinicians can focus on helping patients get the care they need and support the practice in delivering the best care possible.

As the founder of Inspired Hygiene, Rachel Wall, RDH, BS, serves the dental community as a hygiene consultant and speaker. Inspired Hygiene is committed to helping dentists tap into hygiene's profit potential through coaching, webinars, and mastermind groups. In addition to private coaching, Rachel draws from her 20-plus years of experience as a hygienist and practice administrator to deliver clinical articles and speaking programs. She has spoken to numerous groups, including RDH Under One Roof, the AACD Annual Session, and the Hinman Dental Conference. Rachel has written for many dental journals. Inspired Hygiene's programs include private in-office coaching, a free weekly e-zine, the Hygiene Profits Mastermind group, and the Profitable Perio Online Workshop. For more information, visit

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