How instruments increase productivity

April 1, 2013
Tracking numbers is essential to every business. Even though a dental office is a health-care business, it still needs to turn a profit in order to support the team that works there.

An efficient hygiene operatory supports the numbers for the business


Tracking numbers is essential to every business. Even though a dental office is a health-care business, it still needs to turn a profit in order to support the team that works there. As dental hygiene consultants, tracking practice numbers is something that we evaluate daily. Dental hygiene production numbers are something that you may or may not be familiar with. Some practice owners do not discuss production numbers; for others, it is a topic that is discussed daily. Whether you are familiar with the production numbers or not, evaluating how a dental hygiene practice can be more efficient and profitable is an important part of any successful business.

The evaluation of a dental practice makes it easy to see that the hygiene department is at the center. Hygiene appointments are what bring the majority of the patients into the office a few times each year. The continuing care appointment is focused time on the patient by the hygienist, which is essential in building patient relationships. The majority of the doctor's schedule is filled through diagnosing treatment from the hygiene appointment. A well-run hygiene department is integral to practice success. To accomplish this, dental hygienists need to continually evaluate the hygiene systems and protocols, as well as consider alternative options that may increase production for continued success of the department.

In most industries around the world, time equals money, and dentistry is no exception. To increase production, an office can either raise fees or become more efficient at what they are doing, allowing them to schedule more procedures in a day. You might be wondering how a dental hygienist could increase efficiency, so let's look at what some hygienists have done to do just that.

Our hygiene instruments are an integral yet often overlooked aspect of our job. The dental hygienist's hand instruments are essential in helping our patients achieve health. Hygienists use many hand instruments on every patient. Yet, they often pay very little attention to them. We struggle to find the time (and desire) to sharpen them, for example. When it is time to order new instruments, we often continue to order what we have used in the past, because that is what we know and are comfortable with, or because we are afraid to gamble on a new brand.

When evaluating a new instrument for purchase, there are six areas that are most often considered.

  • Tips on the instrument. The tips are an important part of instrumentation since the shape of the tip must fit against the tooth to achieve optimum calculus removal. The tip design reflects how often you need to flip the instrument to access specialized areas, or place it on the tray and grab a new one.

This may not seem like a big deal; however, multiple instrument changes for each patient add up to a lot of time and contribute to repetitive stresses on small muscles throughout the day. Similar to taking a full set of radiographs and organizing your method according to the smallest number of X-ray holder changes, we need to evaluate how an instrument will affect the number of instrument changes needed.

  • Ergonomics of the handle. The handle is important due to the repetition of instrumentation and the hand problems that some hygienists experience. A larger handle tends to be more comfortable for the hygienist as she/he doesn't need to have as tight of a grip on the handle. Some instrument handles are shaped so that there are different diameters to lessen the repetitive pinch grip.
  • Length of time that the instrument stays sharp. Hygienists love using brand new instruments because they are sharp and can remove deposit more quickly and easily than with dull instruments. The challenge is in achieving the cutting edge created at the factory with hand sharpening.

Ideally, instruments should be sharpened before use on every patient. Realistically, they should be sharpened at least once each week. In the majority of offices, sharpening isn't even accomplished once a month. Employees who work for instrument companies sharpen over 150 instruments every day. It is extremely difficult for dental hygienists to become proficient in sharpening when they do not have much time to devote to it.

Understanding how important it is to work with sharp instruments, and how difficult it is to find the time and desire to sharpen, let's explore some alternatives. Hu-Friedy has a line of instruments called EverEdge that do not need to be sharpened as often. They use a stainless steel alloy to help instruments stay sharp longer. This will lengthen the time the cutting edge stays sharp after sharpening.

Sending your instruments out to be sharpened is another option. Nordent has an instrument sharpening service and will sharpen any instrument that is mailed to them. Nordent returns your instrument within 48 hours after receiving them. An instrument sharpening service ensures that the instrument will keep the factory cutting edge. However, you will need additional instruments so that it will not affect your ability to see patients while some of your instruments are being sharpened.

While attending a recent CareerFusion conference, I had the opportunity to learn more about American Eagle instruments and speak with hygienists who have used them. One type of American Eagle instrument does not require sharpening — ever! This means that you will always have the factory cutting edge without the drudgery of sharpening for the life of the instrument.

American Eagle also creates a line of curettes that have a double cutting edge on each end. This allows you to replace two instruments with one. You will spend less time searching for instruments on the tray and repositioning yourself with the new instrument. You also can scale all mesial and distal surfaces without flipping the instrument. The entire handle of all American Eagle instruments are thick, light, and brightly colored. This allows you to easily identify which instrument you would like from a distance without having to pick up the instrument and study the handle for the instrument number.

  • Cost. While cost is always a factor in evaluating instruments, it does not directly reflect efficiency and productivity in the hygiene department. Cost does, however, have an effect on the office overhead and needs to be considered.

To evaluate the cost of an instrument, we need to step back a bit and look not only at the price of each instrument but also at how many instruments are needed for a setup. In an average instrument setup, there are approximately six instruments — a sickle scaler, 204S, Gracey 1/2, 7/8, 11/2, and 13/14. If you can replace six instruments with four, that will likely save the office money.

Another factor when evaluating the cost of instruments is the cost in sharpening. If you send your instruments out to be sharpened, that is a direct expense. However, time that a hygienist spends sharpening is also an expense. There are other tasks she/he could be accomplishing with open time that would immediately benefit the practice.

Let's look at the following example. If a dental hygienist spends one hour per month sharpening instruments during unfilled time in the schedule, by switching to instruments that never need to be sharpened, she/he could use that time for reactivating hygiene patients. In one hour, the hygienist could make approximately 30 calls to patients that are overdue for their hygiene appointment. Patients that speak with their hygienist are more likely to schedule an appointment. Of the 30 phone calls that the dental hygienist makes, suppose she/he was able to schedule two hygiene patients. The average cost of a routine hygiene appointment is $150 so that is an added $300 to the practice each month, as well as helping two more patients care for their dental health. That makes the dental hygienist a valuable team player!

Dental hygienists need to continually evaluate their protocols and systems in an office. As the technology of dental products and services improves, it allows hygienists to increase efficiency, patient care, and productivity. I challenge you to consider your instruments and identify untapped potential that would decrease stress, increase efficiency for you and your patients, and increase productivity for your office. RDH

JENNIFER SCHULTZ, RDH, s a certified consultant with HygieneFusion and Bent Ericksen & Associates. She is a member of the Academy of Dental Management Consultants (ADMC) and Speaking Consulting Network (SCN). She can be contacted at [email protected].

Six considerations for purchasing a new instrument

  • What tips are on the instrument?
  • Ergonomics of the handle
  • Color of the handle
  • Length of time that the instrument stays sharp
  • Whether we have a relationship with the salesperson
  • How easy it is to identify the instrument at a distance
  • Cost

Cryogenic process

The term cryogenic sounds futuristic but it's a common practice started in the very early days of metallurgy in a process called quenching. We've all seen blacksmiths quench a horseshoe in a trough.

All dental instruments go through a heating and cooling process in an effort to make the metal stronger and more wear resistant. The cryogenic process takes the quenching to a new level of cooling. Using nitrogen gas to bring temps down to below -200 degrees Fahrenheit can make the metal harder. On a Rockwell Hardness Scale where a diamond is about 100, a cryogenically processed instrument may reach 60. Plasma engineered instruments are 89.

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