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Becoming “unstuck” through assisted hygiene

Jan. 1, 2012
How many RDHs feel “stuck” in clinical hygiene, with no assistance and a schedule that makes them feel they are worth nothing more than ...

by Lynne H. Slim, RDH, BSDH, MSDH
[email protected]

How many RDHs feel “stuck” in clinical hygiene, with no assistance and a schedule that makes them feel they are worth nothing more than an hourly-paid assembly line worker? What exactly does it take to change that and join the ranks of other RDHs who practice under a smarter business model? Meet Liz Nies, RDH, who lives about one day and 14 hours from me by car.

Tasha Hall (hygiene assistant) and Liz Nies, RDH

I’ve never set foot in Idaho, but it’s a state I’d love to visit someday. The closest I’ve come is in conversation with Liz, and she quickly reminds me that Idaho is known for its potatoes, not corn. As an out-of-stater, I guess I need to visit for some ’taters. (By the way, that is not an original rhyme.) Liz has been working the assisted hygiene model in private practice since 2004. She created and implemented it at Bridgetower Dental in Meridian. Dr. Tom Cox had the foresight to envision a more efficient hygiene department, and with his support the assisted hygiene model has been a perfect fit for this particular general dental practice. I talked with Liz and asked her to clarify some of the unique features of this practice model.

Q Considering the U.S. economic downturn and its impact on private dental practices nationwide, will assisted hygiene result in greater hygiene department productivity?A In my practice we set hygiene appointments two to six months in advance and we do this through block booking. Block booking allows me to block to goal every day, while leaving appointment times for new patients and periodontal therapy. Each day I can appoint 10 to 16 patients of varying appointment types, including adult, child, perio, sealants, etc. I usually see on average 12 patients a day. Booking for 16 patients allows for attrition and broken appointments. This makes the hygiene department in my practice financially strong, and helps keep the restorative book filled and productive as well. With the sluggish economy, adding a hygiene assistant is economical. For example, if a practice employs only one hygienist and the patient load isn’t enough to justify the salary of a second hygienist, hiring a hygiene assistant is a great way to grow the practice and prepare for adding another hygienist to the team.Q Should hygiene assistants be shared between the dentist and hygienist? A That is a big fat “NO!” My assistant functions exactly the same way as the dentist’s dedicated assistant. A good hygiene assistant is just an extension of the hygienist, sort of like a mini-me! The assistant must be properly trained in technique and philosophy because she is a vital part of an effective assisted hygiene model. The assistant and I go through our appointments together. We get prepared for the day by checking each health history, determining need for anesthetic and desensitizers, and looking for any referrals that were made at the patient’s last visit. Any existing treatment that has not been completed is noted. I am very fortunate that other team members will chart with me as needed. If my assistant must leave the room to pass off to the dentist in the first treatment room, someone will be there to help me. It takes a healthy team to have a great practice and I am fortunate to be a part of one.Q Many hygienists fear becoming prophy machines with assisted hygiene. Is their fear justified? A When my appointments are booked properly, this just doesn’t happen to me. Some days I work hard, but I believe I do a better job now compared to when I worked alone and treated eight patients a day. The reason I believe I am more effective is because there is another pair of eyes that helps alert me to something I might have overlooked in the note history or collective charting. I never have to worry about leaving my chair if I need something because I can ask my assistant to get it via a two-way radio. Patients who don’t know my routine think I’m talking to myself when I use the radio! Keep in mind that I work out of two treatment rooms, which permits a smooth operation where patients are seen on time.Q What business skills are required of an RDH who wants to successfully implement assisted hygiene? A The hygienist needs to be able to set and track goals, supervise an assistant, and work with the front office personnel in a provider capacity. You become part of the management structure and a strong producer for the dental practice. The addition of new technologies increases productivity, and finding insurance codes that get reimbursed will increase your production significantly. I actually love this part of my job and it adds a whole new dimension to my professional life. My employer trusts me and never questions me on the supplies I need. I have a budget and I do my best to stay within it. I love never having to ask for things.Q How can dental practices plan to make the conversion to assisted hygiene?A When planning the conversion from conventional hygiene to an assisted model, I first worked without an assistant for about six months. I block booked my schedule for two treatment rooms, overlapping appointments by 10 minutes in the beginning of each appointment and leaving 10 minutes at the end. When the time came for me to start seeing patients out of two treatment rooms, one of the doctor’s assistants or team members (we are crossed-trained) worked with me until we found my own hygiene assistant. I am so passionate about assisted hygiene that I’ve started working with offices on assisted hygiene implementation.Q Is the hygiene assistant licensed and trained?A We hired an assistant who is a graduate of an accredited dental assisting program. Professionalism is a must, and training in polishing, fluoride application, X-ray technique, and sealants is essential. My assistant loves working with me and prefers hygiene to assisting a dentist. She practices just like me with the same passion! She has even attended our state dental hygiene association annual session with me.

If you are interested in becoming unstuck from operatory monotony, contact Liz Nies at 208-866-4271 or [email protected], or visit

Lynne Slim, RDH, BSDH, MSDH, is an award-winning writer who has published extensively in dental/dental hygiene journals. Lynne is the CEO of Perio C Dent, a dental practice management company that specializes in the incorporation of conservative periodontal therapy into the hygiene department of dental practices. Lynne is also the owner and moderator of the periotherapist yahoo group: Lynne speaks on the topic of conservative periodontal therapy and other dental hygiene-related topics. She can be reached at [email protected] or

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