Question: I work in a busy general practice where our production numbers are constantly tracked. Sometimes it feels like the more periodontal and restorative needs I identify, and the more treatment I complete or help schedule, the more successful I'm considered by my practice. I was even offered production-based pay. Since I'm a productive hygienist, I seriously considered it. However, when I thought about the long game, I decided against it. My goal is to help my patients become healthier over time. So, if I do my job well, I expect many of them will need less treatment in the future. It seemed a bit backwards to me that doing my job of improving my patients' health could eventually reduce my own earning potential.

I became a dental hygienist because I wanted to help people prevent disease not constantly treat patients with disease.

Answer from Sarah Crow, RDH: This is one of the most thought-provoking questions I've received, and I believe it's something many dental hygienists have quietly contemplated throughout their careers. The reality is that today's dental practices often rely on KPIs such as production, collections, case acceptance, and treatment completed. These are important indicators for running a successful business, but should they be the only way we define a successful hygienist?

The answer is no.

Treatment is only one chapter in a patient’s oral health story

Let me explain. Identifying periodontal disease, recognizing restorative needs, and recommending and scheduling appropriate treatment is excellent patient care. When disease is present, we have an ethical responsibility to identify it, educate our patients, and help them receive the treatment they need. That work changes lives, and there is nothing wrong with practices celebrating that.

However, treatment is only one chapter in a patient's oral health story; it should never be the entire book.

Think about the typical patient who enters your practice with years of neglected dental care. They may present with gingival inflammation, periodontal pockets, active carious lesions, failing restorations, and heavy biofilm accumulation. During those first months or years, the amount of treatment completed is significant. Scaling and root planing, restorative care, periodontal maintenance, and patient education all contribute to improved oral health. Production naturally increases because disease is being addressed.

But what happens after that?

The patient who becomes healthier

Ideally, that same patient becomes healthier. They improve their home care. They understand the relationship between oral and systemic health. They attend their recare appointments consistently. Through biofilm management, individualized prevention strategies, and ongoing coaching, they experience fewer periodontal flare-ups, fewer new restorative problems, and fewer dental emergencies.

Is that patient now less valuable to the practice because they require less treatment?

Of course not.

In fact, in my opinion, that patient represents one of our greatest professional successes.

As dental hygienists, we are preventive specialists. Our purpose extends beyond treating disease. We are entrusted with preventing it whenever possible. If our patients require less treatment over time, then we have accomplished exactly what our profession was designed to do.

What if our definition of success shifted?

Imagine if our definition of success expanded beyond traditional treatment production reports. What if we also measured improvements in bleeding points, reduction of inflammation, stabilization of disease, lower caries incidence, patient retention, and long-term oral health outcomes? What if we recognized the hygienist whose patients consistently maintain health just as enthusiastically as the hygienist who generates significant disease treatment?

Those outcomes may not always appear on a monthly production report, but they can.

Let me explain what I mean.

What if production stemmed from prevention instead of disease treatment?

We traditionally associate production with periodontal therapy, restorative referrals, and identifying disease. While those services are undeniably valuable, today's hygiene department has evolved into so much more. We now have an incredible toolbox of preventive therapies, advanced diagnostics, and minimally invasive technologies that not only contribute to practice production but, more importantly, help patients prevent disease before it develops or maintain the healthy outcomes they have already achieved.

Imagine a hygiene appointment where production is generated through prevention rather than repair. What a concept! Preventive therapies such as fluoride treatments, hydroxyapatite applications, antimicrobial varnishes around implants, and silver diamine fluoride can strengthen tooth structure, reduce sensitivity, arrest early carious lesions, and protect vulnerable root surfaces.

Advancements in diagnostic technologies can also increase preventive production. Caries detection devices with AI, transillumination technology, biofluorescence, pH testing, and salivary diagnostics allow us to identify disease at its earliest stages. Early intervention can often halt or reverse the progression of early lesions before restorative treatment becomes necessary.

And we also know that prevention extends well beyond the teeth. Periodontal therapies may now include localized antimicrobial therapies, laser bacterial reduction, probiotic applications, personalized home-care products, and custom fit at-home periodontal delivery systems. Incorporating sleep screening, oral-systemic risk assessments, and other evidence-based screening tools enables hygienists to identify health concerns that extend far beyond the oral cavity.

Production can also come from helping patients maintain their health between appointments. Dispensing professionally recommended home-care products such as power toothbrushes, water flossers, prescription-strength fluoride toothpaste, dry mouth therapies, and other preventive products empowers patients to continue their care at home while supporting the overall health of the practice.

When we begin viewing prevention as a valuable clinical service, production no longer depends solely on treating disease after it occurs. Instead, it becomes the result of providing evidence-based preventive care that keeps patients healthier for longer.

What if the future of dental hygiene isn't choosing between prevention and production. What if the future is recognizing that prevention is production.

Also by the author:

• Dental hygienists and their authority (or lack thereof): How to keep from being a hygiene puppet
• Periodontal charting fatigue: Are we documenting for care or compliance?

Editor’s note: This article first appeared in RDH eVillage newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.