Th 172298


March 1, 2005
The right kind of doctor, the right kind of assistant, and, of course, the right kind of money helps evaluate whether a dental practice should boost production with a dental hygiene assistant.
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The right kind of doctor, the right kind of assistant, and, of course, the right kind of money helps evaluate whether a dental practice should boost production with a dental hygiene assistant.

by Kelly Taylor, RDH

Welcome to the age of the assisted hygienist. Many offices are turning toward this controversial “trend,” but can it really work to full advantage for all those involved? Even if you concur with the dentist about optimizing your production potential, this type of scheduling can still be fruitless for you, unless you’re blessed with at least three things:

• Spectacular teamwork (mainly with your assistant)
• A dentist who's immediately available for exams
• Proper compensation.
• Unfortunately, this perfect combination is rare.

Dr. Howard Shareff, a general dentist in Raleigh, N.C., has nurtured a successful practice for more than twenty years. While he prefers a “regular” hygiene schedule, he also understands what drives the hygiene-assisted office because he has tested the waters himself, and he offers comments concerning both worlds.

“Assisted hygiene allows for maximum efficiency in delivering hygiene services. This happens by allowing the hygienist to focus on direct care,” he says. “The assistant supports the hygienist in record-taking, room preparation, patient education, and secondary clinical procedures. This process can significantly reduce a backlogged hygiene schedule and the overhead cost of employing two hygienists.”

Alternatively, he adds, “It also puts a lot of physical and time management stress on the hygiene team. Not only do hygienists have no time to recover from the continuous manual procedures, the patients may also feel shuffled between staff and not perceive the treatment as focused on their needs. It’s also imperative that the assistant be capable in all areas, including communication, self-direction, and accepting a limited clinical role.”

In fact, a common complaint among hygienists is not having a qualified, skilled, or team-motivated assistant. It’s extremely frustrating for a hygienist to enter an operatory only to find unacceptable X-rays, unchecked medical histories, no hard tissue charting, or other discrepancies. It’s also embarrassing and looks bad to the patient, as it’s a reflection on the entire office. The hygienist trusts the assistant to “pack the parachute,” so to speak, in preparation for jumping from room to room ... and to prevent a fall.

What makes a spectacular hygiene assistant? Basic clinical skills such as skillfully reviewing medical histories, taking blood pressure and excellent X-rays, providing homecare instructions, and charting are only the beginning. They must also be able to manage time, move quickly, and anticipate what the hygienist needs for each patient, all while keeping a close eye on the clock. They must have a good working relationship with the hygienist and a naturally good rapport with patients, not to mention enjoyment of their vital role. Without these things, the program becomes confusing and stressful, forcing the hygienist to take up the slack, and results in the whole team running behind schedule. Excellent teamwork is paramount, but so are excellent teammates.

However, there are situations where even the most adept assistant is stretched to her limit. One possibility is employment in a thrifty office that requires one person to function as both a hygiene and dental assistant. This demands that the assistant be super-human and immune to stress. She must seat and begin treatment on one hygiene patient while the hygienist is busy with another. When finished there, she rushes to the dentist to assist with whatever procedures are scheduled, leaving the hygiene patient alone until the hygienist arrives. By the time the hygienist shows up, the waiting patient is wondering what took so long, especially if they have no clue that she was busy treating another patient during what they felt was their appointment time. They do not feel they have your full attention if different clinicians are darting in and out, if they are left alone for long periods, or if procedures are not explained to them. They’ll go elsewhere, because they do have a choice. Assisted hygiene is harried enough without sharing staff.

Clarice, a hygienist in Oak Park, Ill., states, “My boss told me he was hiring an assistant for me and that we were going to increase the hygiene load. He told me I’d be working ‘less hard’ with an assistant, and that all I had to do was scale, since the assistant would do everything else for me. What he didn’t tell me was that she was his assistant too ... and that I still had to do just as much as I had done before when the assistant was busy helping him. She wasn’t there when I needed her and I had patients waiting on me who were getting upset and blaming me. When I mentioned this to him, he told me that I’d be better off in another office if I couldn’t adjust. I gave him my notice two weeks later.”

In a recent article by Suzi Shada, RDH, appearing in Woman Dentist Journal (May 2004), she sings the praises of assisted or “accelerated” hygiene. She makes many good points, but her piece focuses on teamwork alone. While it’s true that staff roles and duties must be “very defined” in order to prevent burnout, other factors are involved if such a program is going to run like a well-oiled machine. There are still pitfalls, even if it’s smooth sailing from the staff’s point of view. One such pitfall is the patient’s perception of the hygiene appointment.

One hygienist who wished to remain anonymous cited patient complaints when her office suddenly incorporated assisted hygiene. The patients were used to spending their entire appointment with her, and they were disappointed to encounter a new staff member, who took x-rays and polished. Sometimes the dentist would come in and do the exam before they were even seen by the hygienist, which they also weren’t used to.

“They started asking me questions,” she said. “They didn’t like it, and they didn’t understand. Some of them thought my assistant was actually a new hygienist, so when I’d enter the room to scale, they’d tell me that the other girl had ‘already cleaned’ their teeth. The assistant never explained anything to them. People think polishing is cleaning.”

Unfortunately, this is an age-old complaint, but it could be bridged by proper patient communication from the assistant in this scenario. Unless it is established with the patient as to exactly what is taking place in the assisted hygiene office, this type of confusion will continue. The patient still may not agree with what’s going on, even if they are not kept waiting. Most people are used to seeing only the hygienist for preventive care, especially in an office they have been loyal to for years. When things change, they wonder why. They start to question.

As an example, this same anonymous hygienist added to her commentary, “Many of my patients were disappointed that we didn’t have the usual time together. They missed chatting and laughing with me, and just catching up. They felt that their appointment was interrupted, cut short, rushed, and impersonal. Some of them told the receptionist that if I couldn’t spend the entire appointment with them, they would leave the practice.

“But what hurt the most was when they asked if the dentist was ‘trying to buy a new car or something.’ They felt it was all about money and seeing as many patients as possible.”

This is understandable, as many patients are more intuitive than we give them credit for - they can “feel” when an office seems to be geared more toward production than patient care. Many also have a relationship with their hygienist and look forward to their time with them. They also don’t like to wait, as their time is just as valuable as our own. They expect to be seated promptly, and assisted hygiene patients are sometimes kept waiting longer than usual and left wondering why, especially if they are not used to this type of scheduling. Even if the hygienist is finished, if the dentist is running behind it can take much longer for the exam.

Ashley, a hygienist in Clearwater, Fla., explained, “I’ve had more than one patient complain to me about the extra time a simple cleaning took once we started assisted hygiene, and one of them was really angry because he was late for a staff meeting at work. The doctor was in the middle of an emergency root canal, so he couldn’t do the exam right away. This patient refused to schedule his next cleaning appointment and changed dentists. The other thing is, I never got a raise for all of the extra patients I was seeing and I felt taken advantage of.”

This brings us to the sticky part of any job. Whether or not you’re being justly compensated for assisted hygiene is completely subjective. Your situation, the office you work in, your perspective and your employer’s, are all very unique factors. There are different schools of thought concerning an office’s overall objectives for incorporating a higher production regimen, as well as how the staff will be compensated for an increase in patient load.

Vicky McManus, RDH, is the author of FUNdamentals of Outstanding Teams as well as her assisted hygiene program, Hygiene Mastery, which was named as “one of the most productive in dentistry”, in a 2002 article (see for the entire article). She feels there are four factors involved in the trend of assisted hygiene:

Community demand - demand for hygiene services in your community and your desire to meet this demand.

Capacity of your office - Do you have the space? The minimum number of operatories needed? If not, is expanding your office an option?

Availability of hygienists - Not only the availability of hygienists in your region, but the successful coupling of a hygienist with a competent assistant is of noted importance.

Style - Trying to adapt to a more efficient system can prove both unsettling and difficult when hygienists are honed into their own style.

McManus further notes that assisted hygiene can be “a cost effective way to expand the [hygiene] department in a high quality manner,” but is it only cost effective for the practice? Nothing is mentioned about individual staff compensation for these extra-productive duties. Many hygienists are paid depending on experience, not labor, no matter how many patients they see. Others are paid on commission and therefore are more motivated to raise their production because it pads their bank accounts as well as their employer’s.

The questions are:

• What is forfeited in direct patient care with this type of scheduling?
• What is acceptable pay for the hygienist and her assistant if it is being successfully utilized?

There is usually only a few dollars difference in hygiene wages throughout the United States (working for the government in military dental clinics usually pays much less, so heed this). If you are an experienced hygienist (defined as having approximately five years under your belt), then you have every right to ask for the same wages as a traditional hygienist. The work you’re doing goes mainly in the dentist’s pocket, not yours, so they should not expect more work without paying more money. No staff member wants to feel taken advantage of.

If you are unsure of what hygiene wages are in your region, you can find out by going to and download the free program Salary Expert ePro v1.0. There are directions to calculate what hygienists are making in your area. Find out what you’re entitled to and demand what you’re worth. If you’re not getting it, say so. This is in addition to any benefits offered.

Benefits are wonderful, yes, and most of us need them and greatly appreciate them. However, they should not be used as leverage against hourly wages that are geared toward production and require more work. Labor and manpower are worth something.

Although some dentists offer periodic bonuses when monthly production goals are reached or surpassed, it’s usually the entire staff that reaps these “blanket” benefits, meaning personnel outside of clinical staff. Handing out a few extra financial condiments for the assisted hygiene team shows appreciation of their efforts, and promotes morale as well as a positive attitude about their work.

The pros and cons in the world of assisted hygiene are expanding and changing right along with it. While it may never be an issue for some, it may be the main issue for others.

Evaluate your situation, and if it’s not working, take whatever steps are necessary to better your professional life. Remember, our professional lives spill over into our personal ones.

Kelly Taylor, RDH, is a 24-year veteran in the profession who keeps busy with freelance photography, writing, and also as a personal trainer. She resides in North Carolina with her significant other, Jay, and three Jack Russell terriers. Her photography Web site can be visited at, and she can be contacted at [email protected].