Would talking, uh, about money solve anything?

June 1, 1997
The answers to ending the conflict depend on finding ways to make dentistry and hygiene more profitable.

The answers to ending the conflict depend on finding ways to make dentistry and hygiene more profitable.

Dr. John A. Wilde

I `ve never been appointed spokesperson for hygienists - nor do I claim to be - despite being one of the profession`s most ardent and enthusiastic supporters. I employed the first hygienist in our community within months of opening my office in 1974, and have never since practiced without the benefit of a hygienist`s valuable skills. I`ve written four articles and two book chapters that extolled the virtues of dental hygiene.

As a married man of 30 years, blessed with three lovely daughters - and who works with a staff of seven delightful ladies - I really don`t need anyone else mad at me! But I humbly dare to speak, because I`m disturbed by the conflict that continues to fester between the honorable professions of dentistry and hygiene.

I would like to suggest a potential solution to this less than harmonious relationship that should be acceptable and equitable to all reasonable parties involved. (Unfortunately, some members of both professions are angry, closed-minded, and bent on retribution. Gentle reason has little chance of impacting such intractable and unhappy spirits.)

As to the form dental hygiene will assume in the future, while I`m not a prognosticator, I have no problem accepting independent hygiene. I practice dentistry in a nation famous for providing freedom and opportunity.

I also believe few hygienists will choose to face the misama of economic, government, insurance, staff, and other constantly shifting forces with which I`ve dealt for 25 years! I wish God`s speed to the hardy souls who desire to accept such a challenge.

But it is my belief that organized dentistry has the power and will to end the profession of hygiene as we know it, should direct confrontation occur. (Consider Kansas as a recent example.) My alma mater, the University of Iowa, ended a fine hygiene program a few years ago. I deemed this action disgraceful and wrote a letter to all 1,400 Iowa dentists seeking their support to stop what I felt was an ill-advised termination of this program.

Once the steps to close the program were set in motion - despite the appearance of due process - the hygiene department was doomed. I viewed it as a totally one-sided contest - i.e., the lion versus the mouse. My eyes were opened and I began to search for a more dignified solution.

The first step toward problem-solving is to determine why the quandary exists. There are many and varied reasons why any two individuals or groups can`t co-habitate in mutual harmony and goodwill. Attempting to deal with every possible source of disagreement is impossible. However, by stripping the contention before us to its essence, I proclaim the root cause of the hygienist/dentist conflict to be money. (What an original and unusual cause of strife!) This could turn out to be a blessing, though, because in the relatively affluent dental world, financially based concerns can be the easiest to rectify among two parties of goodwill.

If readers will consider this assertion, the answers to ending the conflict depend on finding ways to make dentistry and hygiene more profitable, thus increasing the "pie" so both parties can have more. (Increasing hygiene compensation without elevating production means taking profit from the dentist, something most practice owners aren`t particularly enthusiastic about doing!)

If you want to achieve joy within your office (and between professions!), share this article with the practice owner. Together, you can create a vision of the successful and happy office in which you`d both like to work. If the doctor is unwilling to work with you, you have three choices.

1. Surrender to your fate.

2. Continue to battle the existing system.

3. Identify an office with superior motivation and vision -and seek employment there!

Within success lies happiness. It`s fun to do things well! Life is too short and too precious to settle for less than you are capable of achieving or to work in environment that doesn`t provide fulfillment and joy.

Increase revenue, end conflict

Dentist/hygienist conflicts will subside when both parties share a common goal of enhancing the level of service they provide, thus increasing office revenue by offering more valuable care for patients.

Let`s examine some of the many ways in which this enhancement of revenue can occur.

1. Expanded hygiene - I`ve employed expanded hygiene for 15 years with marvelous benefits to office profitability, hygienist working conditions and remuneration, and excellence of patient care.

2. Hygienists paid on commission - When our office (already employing expanded hygiene) switched to a commission system of compensation, productivity increased 25 percent the first day and it`s never dropped. People will work harder to receive a larger reward. This is news?

3. Chart audit - This is a systematic review of files to identify and re-activate patients who have slipped away from your practice. By so doing, patients receive needed care, and both hygienist and dentist are able to provide greater levels of service and be rewarded in proportion to their efforts.

4. Implementing soft-tissue management programs - The days of treating periodontal disease with a prophy are over, if for no other than legal reasons! FMX, full-mouth charting, quadrant scaling with anesthetic, and three-month recare for patients with active disease are state-of-the-art essentials for every modern office.

5. Sealants - They`ve been in use over 30 years and should be aggressively suggested to all children and most adults. In our office, almost all sealants are placed in hygiene.

6. Tooth lightening - As a 52 year old, I`m desperate to look nicer (although I`m no longer sure why). No cosmetic enhancement I`m aware of is as simple, cheap, predictable, and effective as lightening teeth. (For contrast, consider the dangerous, painful, expensive, invasive, irreversible plastic-surgery procedures that are so in vogue within our appearance-oriented society.) Hygienists should ask every patient, "Would you like whiter teeth?" A positive response usually is forthcoming and easily leads into a discussion of tooth-lightening. In our office, the hygiene department performs every facet of the whitening procedures. This can be an excellent source of revenue and patient appreciation.

7. Sell quality oral-health aids - Sure, you can make a profit selling electric toothbrushes, fluorides, breath aids, etc., but some other good reasons to provide oral-health aids to patients include:

a) Being certain that each patient obtains the ideal product to satisfy his or her unique needs.

b) Being able to demonstrate proper usage of the product.

c) Monitoring the product`s effectiveness.

d) Standing behind the product if problems develop.

8. Recommending complete care - Modern hygiene must be involved with whole-mouth health, not just periodontal conditions. We have an intraoral camera in both hygiene rooms to facilitate our wonderful hygienist`s (Melissa, also known as "Sunshine") ability to explain needed care.

9. Many more - You are limited only by imagination in the manner in which hygiene may offer additional care and become a more valuable service.

Dr. John A. Wilde is the author of four dental books, practice-management articles, and is an associate editor for The Profitable Dentist newsletter.