The Clinical Edge: Part 12

July 1, 2002
Your future depends on your ability and desire to keep up with the always evolving circle of life in dentistry.

by Tammy L. Carullo, RDH, PC, PS

Your future depends on your ability and desire to keep up with the always evolving circle of life in dentistry. New innovations and technologies are continually being developed and made available to us. As a result, we are better equipped to offer a higher quality of services to our patients, and, ultimately, these services lead to vastly improved results. The future also depends on our ability as a profession to unite, and, as one voice, shout from the rooftops that we make a tremendous contribution to the dental community.

Long gone are the days when it was acceptable to graduate from hygiene school and slip into your operatory - not to resurface again until thoughts of retirement filled your head. Patients are much more aware of what "good" dentistry is. There is no room for the complacent at heart to sit idly by and not practice what they preach. Patients compare hygienists, basing their entire perception of the practice on the level of dental hygiene care.

In the past, patients didn't ask questions or hold you accountable for their oral health. However, the profession has been in existence for almost 90 years, and, while once viewed in the very conservative role of "supragingival tooth cleaner," the hygienist is now an integral component of the dental team. The role of the dental hygienist in relation to patient education has never been more important with the advancements in elective dentistry.

That role is an active one and it consists of more than just cleaning teeth. In the future, we will be heavily involved in the decision-making process about the direction of treatment. The gathering of data for diagnosis and analysis is critical, given the connections between oral health and systemic diseases such as Type II diabetes, heart disease, strokes, and even certain types of cancer. Detailed medical histories analyze medications to determine not only what treatment to conduct, but what caused the origin of breakdown to occur.

As businesses, dental practices gain if they expand the role of their hygiene department. Dentists need to realize that if the hygiene department is not operating at maximum capability, does not boast outstanding clinical abilities, and is not on the cutting edge with technological and informational breakthroughs, the practice could be losing money. Why should this matter to you as a hygienist? Well, if hygienists position themselves to grow as income generators, they will not lose their appeal to the dental community. On the contrary, they will establish a long-term status as a crucial and very important commodity for the practice.

Three steps benefit all involved - the hygienist, the patient, and the practice's bottom line.

Dedicated assistant.

The addition of a dedicated assistant enables the hygienist to operate out of two operatories, allowing her to treat 12 to 14 patients per day - rather than seven or eight - without sacrificing quality. The assistant can account for a 50 percent increase in production.

The dedicated assistant frees the hygienist from duties such as X-rays (taking, developing, and mounting), sterilization, and periodontal charting. The assistant allows the hygienist to spend more time on building the relationship with patients, answering questions, reviewing potential drug interactions, and investigating causes of change in periodontal health.

The lack of time is a common excuse for not conducting procedures such as extraoral examinations, thorough cancer screenings, and blood pressure monitoring. A dedicated hygiene assistant can alleviate this problem altogether. Recent statistics show that early detection of oral cancer at Stage I improves the survival rate in a five-year period from the current 52 percent to 79 percent. But dental professionals simply do not catch it in its early stage because of time constraints. You cannot afford to overlook the obvious benefits of an assistant.

Commission vs. salary.

Many hygienists cringe when approached about giving up their salaries for a commission-based income. Yet, those who have made the transition are earning more income than they ever thought possible. Some say it's a high risk for both parties, but not according to my math! A switch from salary to commission brings about the important factor of accountability in its highest form. All of a sudden, hygienists get fired up about seeing patients, excited about truly making a difference, and, well, the money isn't half bad either.

Some hygienists say they would not switch for two reasons. First, it would become all about "money," and "quality" would go out the window. Secondly, they would lose the security of bringing in a set amount of money each week. On the contrary, commission-based income takes someone who is truly dedicated to excellence. It takes someone who is willing to go out on a limb and have her worth based purely on her effort and ability.

A commission-based percentage does not lead to the mentality, "Get them in, get them out." It simply is an incentive to be accountable for what you do. Far too often, crucial components of care such as X-rays are overlooked, forgotten about, or simply not done because it's easier not to do it. People tend to work harder and care more about the outcome when they have a vested interest in it. In fact, the average practice that makes this kind of transition can expect a 25 percent increase in production in addition to the 50 percent produced in conjunction with a dedicated assistant. Everyone benefits - the hygienist's work ethic increases, patient care is more meticulous and focused, and the practice's production numbers rise dramatically.

Expanded soft-tissue management.

The first step to expanding periodontal therapy is for staff members to stop treating all cases with a "cookie cutter" approach. Individualization is key to the treatment of every one of our patients, and it's even more important for perio patients. The first step is to make the commitment to begin offering whatever level of care and treatment is required to get the job done. That means delving deeper than simply noting that the patient has periodontal disease.

What caused the breakdown? Is the patient taking medication that may be a contributing factor? Does the patient have any potential warning signs of systemic disease that could be the origin of breakdown? Or is it a simple case of self-neglect where the patient's home care is atrocious and in need of detailed home care instructions?

Refuse to become outdated and complacent. Reconfirm your commitment to the profession and provide top-notch care for patients.

If you dream of great things, develop a game plan to achieve them. You can begin realizing your dental dream today and avoid the clinical complacency rut forever!

Tammy L. Carullo, RDH, PC, PS, is CEO of Practice by Design, Inc. She may be contacted by e-mail at jtncar@ or by phone at (717) 867-5325. For more information about her company, visit