A survey of northern Arizona's dental hygienists examines the trend of dental assistants in the hygiene operatory.
by Alexis Stokes, RDH, BS, Lisa Otterness, RDH, BS,
Aubree Petersen, RDH, BS, and Tricia Moore, RDH, BS, MA
Dental assistants are considered essential in the practice of dentistry. It is well-accepted that an assistant increases a dentist's production and effectiveness. In 1974, a study by Dr. Dale Redig, former dean at the University of the Pacific School of Dentistry, showed that the addition of expanded-duty auxiliaries led to an increased number of patients seen, increased production, and an increase in net income of approximately 30 percent.
Many hygienists, including Deborah Dopson-Hartley, believe that a hygienist's time can be maximized in a similar way with an assistant. She believes that using assisted hygiene is an ideal business decision for an office. She produces over $300,000 in hygiene revenue per year with the help of a full-time assistant. She points out that it is inconceivable for a dentist to do tasks that could easily be done by an assistant and that the same case can be made for a hygienist. It makes sense to pay a hygiene assistant $8 to $10 an hour to perform the routine tasks; so the hygienist, perhaps earning $25 an hour or more, can perform procedures that only she is licensed to perform. (These figures may vary with region.)
Using input from the nation's leading hygiene consultants, Risa Pollack-Simon implies that using hygiene assistants may solve many problems, including the dental hygiene shortage problem. Jameson Management Group (JMG), a group that consults with dental offices to help make the dental hygiene component profitable, found that the addition of a hygiene assistant could increase the office production by $300 per day, or three times the assistant's salary. O'Grady and Williams, a nationally recognized consulting firm, also recommends assisted hygiene because it can help the hygienist see more patients per day with less stress. Jim Rhode, a dental consultant, in discussing the concept and benefits of assisted hygiene, suggests that using a hygiene assistant may help when there are too many patients, too little hygiene time, low productivity or profitability of the hygiene department, or a shortage of hygienists in an area.
Although many consultants support the use of hygiene assistants, the dental community has not widely accepted the concept. Most dental practices have continued to allow hygiene to operate largely unchanged for the past 20-30 years. Change is difficult; however, if dentists will look at the advantages, more may begin to consider assisted hygiene. According to the Diffusion of Innovations Theory, the stages of adoption of a new innovation are: awareness, interest, trial, decision, and finally, adoption.
The purpose of the survey conducted by Northern Arizona University (NAU) was to collect data about dental hygienists' knowledge, attitudes, and behavior regarding hygiene assistants, and to help identify the attitudes of practitioners in relation to the acceptance phases of the idea.
The survey and results
Three senior dental hygiene students from NAU developed and pilot-tested the survey. Anonymous surveys were mailed to all 189 dental hygienists in northern Arizona in February of 2001. The results were statistically analyzed.
The average time spent for a routine cleaning was 54 minutes with no assistant, 51 minutes using a part-time assistant, and 47 minutes with a full-time assistant. The seven-minute time savings per hour is significant when applied to a full day of work.
Duties may vary
The survey clearly showed that the majority of hygienists in northern Arizona desire to work with an assistant and perceive many potential benefits including increased quality of patient care, productivity, and job satisfaction. These results, however, are limited to northern Arizona hygienists. As such, take care when trying to generalize to other areas, particularly where state practice acts and permitted duties for hygiene assistants may be different.
Hygienists should be involved primarily with those procedures that require the skill, knowledge, and judgment of a licensed hygienist. Many consultants propose assisted hygiene as a strategy that is superior for increasing productivity and heightening the quality of the patient's experience.
Pollack-Simon also questions the use of higher-salaried hygienists for tasks that can be delegated to an employee at a lower hourly rate or salary. She agrees that a hygiene assistant can provide increased service to the patient without increasing the amount of time spent by the hygienist.
Despite the popularity of the idea among hygienists and practice consultants, it is still unclear why many dentists have not adopted assisted hygiene. There has not been any research conducted to identify the reasons for this lack of general acceptance.
Most consultants agree that, to schedule appropriately, assisted hygiene requires the availability of two rooms and an assistant dedicated to nothing but hygiene. Although this may increase initial fixed costs for the practice, they are quickly overcome by an increase in production. Dr. John Wilde reported an immediate 50 percent increase in productivity and the number of patients seen when he implemented this strategy (see "Peace and Prosperity," RDH, April 2001). Additionally, he reports enhanced educational opportunities, more effective relationship-building, less downtime, and increased case acceptance.
Perhaps studies comparing production by hygienists with and without hygiene assistants could eventually lead to higher general acceptance of the concept. More efficient use of dental hygienists also may help alleviate the shortage of dental hygienists that is perceived in some regions. It may take some time for the concept to reach "critical mass," but why wait? Take advantage of a proven winning strategy.
Tricia Moore, RDH, BS, MA, is an associate professor of dental hygiene at Northern Arizona University in Flagstaff, Ariz. She teaches traditional and Web-based courses in research methods, oral health research evaluation, oral health outcomes, and periodontics. Moore works periodically in clinical hygiene, and has conducted research commercially. She may be reached at (928) 523-4012 or by email at firstname.lastname@example.org. Alexis Stokes, RDH, BS, practices in Kingman, Ariz. She and her father, Dr. Joel Stokes, present seminars on increasing dental practice and hygiene productivity. Stokes can be contacted at email@example.com. Aubree Petersen, RDH, BS, practices clinical dental hygiene in Payson and Chandler, Ariz. Lisa Otterness, RDH, BS, and practicing dental hygiene in Phoenix.
116 out of the 189 surveys were returned. Results showed that most northern Arizona hygienists:
- Have used an assistant at one time — 76%
- Find the idea appealing — 88%
- Know how to use an assistant — 87%
- Need and want an assistant — 75%
- Continue to work without one — 65%
Of the hygienists who had worked with an assistant, 84 percent expressed a need or desire for an assistant. Fifty-six percent of periodontal offices used hygiene assistants compared to only 29 percent in general practices.
The survey responses indicated the following perceived benefits to having a hygiene assistant:
- Increased productivity — 87%
- Increased number of patients seen — 86%
- Increase in service provided to patients — 85%
- More individualized care — 72%
- More enjoyable work — 68%
- Increased patient comfort — 62%
The following procedures were identified as most important to delegate to assistants or to have assistance in doing:
- sterilization of instruments and room turnover — 98%
- recording of periodontal probing scores — 96%
- taking and developing radiographs — 83%
- placing sealants — 83%
Procedures considered least important to have assistance included:
- ultrasonic instrumentation — 59%
- fluoride application — 52%
- patient education — 49%
- documentation — 44%
- polishing — 22%
- scaling — 13%