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Extreme Hygiene=Extreme Team

Sept. 1, 2004
Four dental offices initiate a 'makeover' to create extreme dental hygienists.

by Trish Jones, RDH, BS

It seems like everything lately has been taken to the "extreme." Extreme sports, extreme makeovers, even extreme toothpaste. With all of the extreme dentistry going on, why not try extreme dental hygiene? Or how about extreme team? Aren't these just other expressions for maximizing dental hygiene abilities to the fullest potential?

From top to bottom: Kevin Winters, DDS; Sara Gullbrand, CDA, Angie Gaines, RDH, Snow Christopher, RDH, Janet Cesin, treatment coordinator, Matt Bynum, DDS, Mary Anderson, conceirge, Jennifer Whitehead, RDH, Art Mowery, DMD, Lea Ann Courtney, DA, Michelle White, CDA, Kelly Runzel, RDH
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Public awareness and demand for comprehensive esthetic dentistry has increased due to the many "makeover" shows seen on television and advertisements in magazines. Hygienists today are very savvy and are taking on many more responsibilities than ever before. These responsibilities can add to professionalism, job satisfaction, and increased patient compliance. Hygienists are no longer regarded as just "cleaning ladies." They can help choose shades for smile designs, finalize a consult, or even discuss a patient's case with the dental laboratory.

Is that considered extreme? Is it extreme to do what you are capable of doing, even if it departs from the normal stereotypical job description? How practical is it to do something aside from the normal periodontal responsibilities? According to the teams at four dental offices I interviewed, it is very practical and exceptionally rewarding for everyone involved.

These four offices incorporate not only regular and periodontal therapy; they also go to the next level and incorporate a team mentality that makes the offices run effectively and efficiently. From discussing treatment plans and consults, taking photographs, taking impressions, assisting the dentist, taking shades for smile designs, scheduling, taking payments, and reviewing laboratory communication, the hygienists in these offices outperform themselves.

The dynamics of each office are unique. But one thing is true for each office: They prove that if you set your mind to becoming an extreme team player, it can be done!

Over the past four years, I have been working for a dental laboratory at a postgraduate teaching institute. This has afforded me the opportunity of meeting many hygienists and dentists from around the world. It has definitely increased my awareness of how well some offices utilize the talents and skills of hygienists. As a technical advisor for a laboratory, I help train the team members on the importance of taking shades, laboratory communication, dental materials, as well as postoperative care of the esthetically restored smile. I realize hygienists are invaluable team members when it comes to consults, taking shades and working with the laboratory. Most hygienists have phenomenal communication skills that maximize benefits to the office and the patient.

One thing I have seen in prosperous offices is the cohesiveness of the dental teams. When I initially met with each office interviewed for this article, I had a difficult time figuring out who were the hygienists! The dentists actually see them as partners in patient care and treatment. Each dental team is unique in that they have developed a team philosophy specific for their office. They definitely engage in "team thinking" and everyone's opinion counts.

From left to right: Jessica Hunt, treatment coordinator, Misty Bennar, DA, Larry Winans, DMD, Desiree Bartolo, patient coordinator, Beth Showers, RDH, and Stacy Faust, RDH.
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Dr. Larry Winans — Pennsylvania
In the small town of Lewisburg, there are two hygienists — Beth and Stacy — who work with three clinical coordinators at Dr. Winans' dental office. Patients are known as "guests." Beth and Stacy's primary function is to provide superior soft-tissue management so that their guests may achieve optimal health. But Dr. Winans also expects them to support the cosmetic, neuromuscular, and restorative dentistry that is provided to their guests. Beth and Stacy expect that of themselves too. They have an excellent knowledge of esthetic dentistry so they are comfortable addressing their guests' issues and concerns. They believe guests can trust them for advice as an unbiased third party, while building a special relationship with them.

The philosophy of the office is to educate and motivate guests to move forward with care. Whether a guest is new or long-term, the better educated they are, the greater likelihood they will continue with care and treatment. The hygienists feel it is critical to the guests' overall health to be informed of various restorative issues. Both hygienists discuss dental materials pertaining to veneers, crowns, onlays/inlays, restorative procedures, as well as whitening products and smile care maintenance. They incorporate shade taking at hygiene appointments so they can demonstrate shade changes over time.

When I asked Beth how she likes her position in the office, she replied, "I love what I do, whom I work with, and whom I work for. We are a cohesive team that works exceptionally well together."

When asked how the rest of the team feels, she stated that the whole team is integral to maintaining healthy, happy patients. The Winans team has adopted a philosophy that better relationships within the team promote a more positive work environment, which is a tremendous value to the guests.

Above, left to right: Mary Anderson, conceirge and Janet Cesin, treatment coordinator.
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Dr. Winans sums it up this way, "We function as a true team, with each member being a spoke in the wheel. The wheel would not spin, or it would fall apart, with a missing spoke or one that was not working with the others."

Dr. Kevin Winters — Oklahoma

Dustee Halford, RDH.
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If you ever watch television or listen to the radio in or around the Tulsa area, you might have seen or heard Dr. Winters. He is a local advocate of keeping the public educated on the newest information available in dentistry. He is the "Dentist On Call" for a local television station.

Dustee, the hygienist in Dr. Winters' office, is regarded as a major player on the dental team. She appreciates the awesome opportunity to work in a unique practice where she is able to fully utilize her abilities. What are those abilities? She works closely with Dr. Winters on treatment recommendations and facilitation. In addition to regular hygiene protocol, she takes impressions, schedules appointments for hygiene and restorative care, makes financial arrangements, and collects payments. She is also well informed concerning the different dental materials available today.

Dr. Winters believes it is extremely important for his hygienist to continually gain knowledge in esthetic dentistry because she is perceived as an unbiased expert, and her recommendations carry a lot of weight.

He says, "The less you know, the more normal things appear."

As for Dustee, she feels that her extended role in the office adds to the unique relationship she shares with patients. The rest of the team respects her because they see her as a team player. The whole team supports Dr. Winters, whom they regard as being on the cutting edge. His suggestions for becoming a great hygienist are:

• Facilitate needed treatment.
• Take courses on communication in order to relate well with patients verbally.
• Provide outstanding periodontal care.

Dr. Art Mowery � Florida

From left to right: Jennifer Whitehead RDH, Michelle White, CDA, Art Mowery, DMD, and Sara Gullbrand, CDA.
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Dr. Mowery's dental office in Gainesville, Fla., could be mistaken for a relaxing spa. Utilizing feng shui methods, his office blends both the art and science of dentistry to offer clients the best in comprehensive care. This includes the role the hygienist plays in his office.

Jennifer, the hygienist, is a completely integrated part of the team. This means she is a key team player during consults, for which she takes X-rays, impressions, intraoral photographs, general photographs of the client, smile design imaging, as well as performing case presentation. Jennifer also assists in taking shades for clients. For esthetic reconstruction cases, Jennifer sees the client immediately after cementation for excess cement cleanup, and sees them again when they return to the office after a 24-hour final occlusion check to remove additional excess cement. She will also polish the final restorations.

Dr. Mowery strongly believes that hygienists should attend continuing education courses with all the other team members and doctors. Jennifer is cross-trained to help assist with procedures, go over financial information, and do case presentations. This cross training makes her a valuable team member.

According to Dr. Mowery, "Ours is a team. All team members — at the front desk, CDAs, RDHs — all work together to do records, whether it's study models, photos, imaging or case presentation."

How does Jennifer like her role in the office? She loves her position and states that she and her colleagues view each other as equal team members. She feels it is essential to build on the things you learned in school, and be open to learn new and improved concepts in dentistry. Each day is a new learning experience. As an added value to the office, Jennifer says it is beneficial to have a positive attitude personally and in business. "You have to keep the team motivated as well as the patients!"

Dr. Mowery has some advice for hygienists who are looking for an office such as his: "Be enthusiastic and find a doctor that believes in you. Don't limit yourself to only perio. Learn all aspects of dentistry to the best of your ability."

Dr. Matt Bynum � South Carolina

From left to right: Snow Christopher, RDH, Angie Gaines, RDH, Matt Bynum, DDS, Kelly Runzel, RDH, and Lea Ann Courtney.
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Patients who visit Dr. Bynum's office in Simpsonville, S.C., are in for an experience like no other. This office takes teamwork to the next level. Dr. Bynum practices comprehensive esthetic dentistry with three hygienists and one assistant. But, he will inform you that in his office there is no such thing as a job description. Everyone is cross-trained.

In his office, on a weekly basis, one of the hygienists will "cycle" through what would be considered the receptionist position. Two hygienists will actively see patients each day with the third serving to communicate with the patients. He feels this frees up one of the hygienists to utilize her communication skills while at the same time allowing for a higher level of service beyond what is considered good customer service.

He says, "I don't consider my team to be made of three hygienists and one dental assistant. Rather I consider my team to be made of team members committed to the success of the practice, the patients, and each other! We act as one, and we thrive as one."

Everyone in the office understands the dynamics of esthetic dentistry and the protocols for maintaining a healthy supportive foundation that surrounds it. From greeting guests to speaking with the laboratory, Kelly, Angie and Snow truly love and believe in what they do.

Kelly feels the versatility of the dental hygienists' role makes this practice unique. She enjoys greeting the guests and being their "concierge." From preparing beverages for them to helping with consults, scheduling treatment for hygiene and restorative, and discussing patient education, she does it all. By utilizing technology in the office — such as the intraoral camera, laser, or digital radiographs — customer service is optimized by making sure the guest is comfortable.

When asked if she likes her position, Kelly responded, "I love what I do! I love being able to assist with all aspects of the office. I love not getting bored or burnt out."

According to Angie, cross training makes all team members equal. Having her own smile restored, she feels it is advantageous to the patient to be able to see how natural the actual product can look. As for her feelings toward the office, she says, "Have fun doing what you love." Needless to say, she loves what she does!

The secret of a successful team, according to Snow, is "putting aside the 'degree' mentality and treating one another on a person-to-person basis, where we are all equals. Without this concept, someone will always be walking in someone else's shadow, and being in the dark is not anyone's favorite place to be. Instead, let the light shine on every member of your team!"

Snow believes their practice gives guests an experience they may never have had before. Their goal is for one person to take a guest from the initial phone call, to the consultation, to the new patient prophylaxis, to patient education, to treatment acceptance, and to dismissal. Keeping the guest with one person builds trust and rapport, and the guest feels that they have had complete and thorough care without being shuffled from one person to the next.

The whole team has adopted the philosophy that they are equals. With that in mind, I interviewed Lea Ann, the lone dental assistant in Dr. Bynum's office. How does she feel about her other team members since they are hygienists? Because their office is different, they are truly a team and help each other on a regular basis. Lea Ann said, "It really doesn't matter that I'm an assistant and they're hygienists. What matters most is that we're a team!" The feeling is mutual for Kelly, Angie and Snow. They respect the fact that Lea Ann is skilled in her profession and enjoys her career.

Dr. Bynum believes each of his team members add a completely different piece to the team puzzle and overall scheme of communication in the office. On a regular basis, this office reads current dental articles and reviews them together, as well as attending continuing education courses so that they are sure they are providing state-of-the-art dental service.

When asked if he has any advice, Dr. Bynum replied, "Concentrate on the concept of "team" and the reason why we all do what we do for a living. You must love what you do, you must love whom you do it for, and you must love whom you do it with. Never forget that!"

It is obvious that these four offices share overwhelming enthusiasm for what they do and the dentistry they provide to their clients. They definitely give meaning to the word "team" and take it very seriously.

Several common factors exist between all of the dental offices: Each follows special esthetic smile care maintenance protocols for the esthetically restored patient, such as utilizing special polishing pastes (for example, Proxyt by Ivoclar, Clinpro by 3M Espe, CPR by IC Care, Luminescence Plus by Premier Dental, and Nupro Shimmer by Dentsply). They provide the optimum in periodontal care, utilizing state-of-the-art equipment and procedures, including lasers and tooth whitening. All are cross-trained and use those abilities for the specific needs of the office they work in. Every office has a goal-specific philosophy that each team member is committed to. Everyone is regarded as an equal, which contributes to the success of each practice. All of the offices have attended continuing education courses above and beyond that which is necessary for licensure renewal. Raising the level of education for the entire team is essential to the fulfillment and success of the dental practice. All of the team members mentioned have participated in courses through the Las Vegas Institute for Advanced Dental Studies, such as team courses, occlusion courses, JP Consultants' Evolutionary Hygiene in Support of Aesthetic Dentistry, as well as actually teaching some of those courses themselves. Drs. Winters, Mowery and Bynum and their teams have collaborated together to develop a series called "Achieving Extreme Success" to introduce dentists and the dental "staff" to the concepts of dental "team."

Without a doubt, all of the teams love what they do. Not only do they have the utmost professionalism and job satisfaction, but they also provide ideal comprehensive periodontal and restorative care to their clients. It is definitely a win-win situation for all those involved.

Personally, I enjoy the opportunity to speak to a team hygienist about a restorative case on topics such as shade recommendations. It adds my "piece" to the extreme team "puzzle," or my "spoke" to the wheel ... and that puts a smile on my face!

More details

For more information on these offices, you may visit these Web sites:

• Dr. Larry Winans,

• Dr. Kevin Winters,

• Dr. Art Mowery,

• Dr. Matt Bynum,

• Las Vegas Institute for Advanced Dental Studies,, (888) 584-3237

• JP Consultants Institute,, (800) 946-4944

• Trish Jones, RDH, BS, [email protected]

• Aurum Ceramic Dental Laboratories,, (800) 661-1169

Trish Jones, RDH, BS, is a technical advisor for Aurum Ceramic Dental Laboratories and serves as a company representative at various dental conventions. She has an associate's degree in dental hygiene and a bachelor's degree in health care management from Southern Illinois University.