Feb. 1, 1997
Dental hygiene assistants ease the burden of operatory breakdown and boost productivity by allowing hygienists to practice hygiene

Dental hygiene assistants ease the burden of operatory breakdown and boost productivity by allowing hygienists to practice hygiene

Cindy Quinn, RDH

Many corporations apply basic business processes that also have an application in dental offices. Progressive business concepts, such as those outlined in Hammer and Champy`s best seller, Re-Engineering The Corporation, transform outdated business practices by eliminating duplication of effort and maximizing performance. The concept of re-engineering, defined as the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in performance, has an application in the dental office too.

Many dental practices have witnessed the erosion of profitability in their hygiene appointments. Climbing labor and supply costs are blamed, as well as the foothold that managed care programs have in dentistry. According to the National Association of Dental Plans, approximately 22 million employees and dependents currently rely on a managed care program for dental care. The number continues to grow.

Most managed care and other third party reimbursement programs authorize two prophylaxes annually for each member of the family. This alone dictates careful evaluation of how time is spent during routine preventive procedures. The goal is to maximize profitability in this aspect of the dental practice without compromising care.

Evaluating efficiency

Dental hygienists should view preventive procedures from a new perspective. They must incorporate efficient work practices rather than attempt to work more quickly through preventive procedures. A methodical evaluation of daily procedures may reveal that current task distribution is obsolete. Hygienists need to focus on appropriate tasks which require specific dental hygiene skills.

The primary objective in evaluating the process of treatment is to achieve an efficient distribution of tasks to a dental hygiene assistant, within legal guidelines, that increase productivity and the effective use of the hygienist`s time.

The breakdown of the tasks involved in a routine adult prophylaxis reveals a minimum of 12 different procedures, as listed in Table 1. Certainly, dental hygienists can perform 11 of these procedures, but should they? When the concept of re-engineering is applied, an emphasis on efficiency would suggest using the hygienist only to evaluate the patient`s oral and physical health, perform the scaling and prophylaxis, and record related documentation. Aside from the exam, a trained dental hygiene assistant should perform all other procedures while the hygienist moves to another operatory to treat another patient.

Similar reasoning should be applied to other dental procedures as well. Each procedure should be evaluated to determine if the staff member performing the task can be the lowest paid individual who can legally do the work. Once the hygienist`s time is restructured, focusing on the skills for which they are specifically licensed, their time should be scheduled as a revenue producer - much like the dentist.

Hygienists should perform expanded functions that, within legal parameters, may have previously occupied the dentist`s time. The dental hygienist should perform procedures listed in Table 2, such as sealants and temporary restorations. Similarly, the dental hygiene assistants` role should be expanded to include procedures listed in Table 3 within legal limits. This diversity of responsibility typically produces more job satisfaction and minimizes burnout for both the hygienist and the assistant.

According to hygienists already using dental assistants, the treatment sequence should be as indicated in Table 4. The length of time required for each procedure should be modified to suit the needs of a particular office, though 30 to 40 minutes of chairside time with the hygienist is usually sufficient for an adult routine prophylaxis. An additional 10 minutes is added for full-series radiographs.

The dental hygiene assistant need not remain in the operatory during the scaling and prophylaxis, but should remain available as needed. The assistant`s time should be used to develop radiographs, confirm patients, set up another operatory, sterilize, seat the next patient, or assist other dental assistants who are with operative patients.

The dental hygiene assistant, though, should always be present during a hygiene patient`s exam to record information and process the patient for additional treatment or recall.

Free time to be a hygienist

Well-known educator Laura Mallery-Sayre, RDH, MSDHEd, has practiced with a dental hygiene assistant for 21 years. She is considered one of the pioneers of the concept. Her assistant sets up and break downs both hygiene operatories, sterilizes instruments, charts, and performs the first five functions listed in Table 1. The assistant also joins Ms. Mallery-Sayre at chairside during root detoxification procedures and dental sealants, where four-handed dentistry expedites treatment.

"I find that sealants take one-half the time they used to when I use an assistant," she adds.

A dental hygiene assistant also facilitates more comprehensive care. The dental hygienist can focus completely on evaluation, documentation, and treatment of oral conditions in the role of a periodontal care therapist. In addition, there is less risk of breaking the chain of asepsis or interrupting a procedure to complete an administrative task. The hygiene assistant records initial observations and sets up additional materials that may be required for treatment. The process also improves adherence to OSHA guidelines and reduces the cost of additional barrier protection.

On the surface, it may appear that a dental hygiene assistant increases the cost of treatment. But that`s not the situation. Look at one example of a week`s productivity with and without a dental hygiene assistant in Table 5. For simplicity, the example excludes cost of materials, which would be higher with larger patient volumes, and assumes under-utilized chair time is available. The example clearly illustrates that a dental practice can gross an additional $42,000 annually through the effective use of a dental hygiene assistant. The revenue translates to more than a 44 percent increase in dental hygiene production without compromising patient care. In fact, the level of care usually increases.

Terri Rubino, RDH, has discovered that patients often recognize quality service more than a thorough prophylaxis. Ms. Rubino has worked with a dental hygiene assistant for more than two years in a Chicago suburb. She believes that patients sense a higher level of service when they have continuous contact with a member of the dental team who is focused exclusively on their needs. In her office, patients are never left alone in the operatory while waiting for an exam or radiographs to be developed. Rather, this valuable time is used to educate patients about their oral health or new procedures that may interest them.

The advantages of a dental hygiene assistant are seen throughout the dental practice. Ms. Rubino said, "A dental hygiene assistant frees up my time so I can spend more quality time with each patient, helping the dentist explain and sell the dental treatment that is needed. The same approach applies when the dental hygiene assistant helps me explain home care products that we have available."

In addition to increased job satisfaction and decreased burnout, the overall stress from dental hygiene procedures is reduced because adjustments for unexpected delays or unplanned treatment are easier with two staff members. Similarly, the dental hygiene assistant can be used for operative dentistry should a scheduling problem arise.

Along with the benefits of increased productivity, dentists often experience less stress as well. They are able to examine the patient without interrupting the hygienist or using too much of the appointment time. This leaves the patient with the image that the office is calm and professional.

A tight ship is needed

The disadvantages of a dental hygiene assistant relate to scheduling. The dental office must maintain a good confirmation policy for appointments and recalls, keeping the appointment book full. This system also requires two operatories dedicated to hygiene patients or, at least, scheduling that uses available operative dentistry rooms.

According to Ms. Rubino, the best way to introduce the use of a dental hygiene assistant is to hire a "floater" dental assistant who initially has responsibility for operatory setup, tear down, and instrument sterilization. It is wise to hire an individual who shows initiative and willingness to help out everywhere. The dental assistant should get progressively more involved in daily operations, working with others to fully understand office procedures. Once the assistant is acclimated, routine hygiene appointment times should be shortened.

By re-engineering the procedures of the dental office, patients receive comprehensive examinations, thorough prophylaxes, and clear explanations early in their care - without a significant drain on office resources. This focus on service creates patients who are more likely to remain with the practice, as well as maintain good home care.

Cindy Quinn, RDH, BS, is the founder of CreativAtion in Chicago, Ill., a marketing company that specializes in creative communication for the dental industry. Her career spans 19 years in dentistry, working as a product manager for two corporations and chairside as a dental hygienist.