Say goodbye to 45

July 1, 2011
At a recent dental hygiene advisory board meeting, one of my colleagues from a progressive periodontal practice commented that ...

by JoAnn R. Gurenlian, RDH, PhD
[email protected]

At a recent dental hygiene advisory board meeting, one of my colleagues from a progressive periodontal practice commented that she hoped hygienists were no longer using a 45-minute time frame for appointments. I enjoyed the comment and found myself thinking that some hygienists would be thrilled to have 45 minutes to care for their patients.

The more I thought about this in the context of providing oral health to the standards of clinical practice using the dental hygiene process of care (you can obtain a copy at, the more I wondered why in the world we are stuck in the rut of the 45.

No wonder dental hygienists are frustrated when they try to perform comprehensive health histories and assessments, take vital signs, evaluate for risks for various oral and systemic diseases, perform charting procedures, take radiographs when indicated, perform debridement procedures, offer patient education, and make referrals for further medical and/or dental care, all in 45 minutes. Is it any wonder we start trimming the sails a bit to get as much accomplished as possible in that 45?

So the question is, when are we going to stand up to the powers that be in the office and take control of our own schedules?

I know hygienists who have done exactly that. They talk about one-hour appointments in which they only conduct assessments and provide patient education. They treatment plan for what is needed and obtain an informed consent for treatment, offering options that are good, better, and best from which the patient can choose. Patients return for implementation of their treatment plans, which may require 15 minutes, 30 minutes, or even an hour or more. Some patients are scheduled for a two-month reevaluation appointment for a 15-minute time period. Others receive a "refresher" home care program for 30 minutes.

The point is that the dental hygienist should determine the time needed to perform these relevant procedures. Rather than fitting square pegs into round holes, time is individualized for each patient's needs. Why is this a novel concept? When did we give that responsibility to someone who does not have the capacity to determine what is appropriate for our patients? Who says that 45 minutes is right for every patient?

We talk about evidence-based practice. Has anyone shown you the evidence that 45 minutes is the right option for all patients? I'm going to take a wild leap here and guess that there is no evidence to support this practice pattern. Convenience or "this is the way we have always done it" are not reflections of best practice or evidence.

So let's try something different. Grab the appointment book from the office manager and tell that person you're doing some research for the next month. Appoint the patients yourself. Keep track of the time frames and financial charges for the procedures performed. Compare the month's activity and fees with the previous month. If there is a difference in the level of care provided and no fiscal damage to the practice, you can stake your claim to control the dental hygiene appointment schedule.

But before you talk yourself out of this or dismiss it as something the patient would balk at, think about some of the medical appointments we all experience. You go to the doctor or nurse practitioner for an evaluation. The primary care provider says your cholesterol needs to be checked and lab studies are ordered. This means you have to schedule blood work.

Then, you come back to the practice and discuss findings. Perhaps further treatment is recommended. If so, you return in three months with repeated blood work to see what improvements have been made and to make sure there have been no changes in liver function while taking cholesterol medication.

Or, maybe your feet are starting to hurt. You seek the care of a podiatrist or orthopedic surgeon. You have radiographs taken, and the doctor recommends bunion surgery. Do you have the surgery that day in a 45-minute period of time? No. You have to schedule an appointment with a physical therapist to learn how to use crutches and become safe non-weight bearing.

You return for an evaluation two weeks later after the surgery to have the staples are removed. Then, you return for subsequent evaluation appointments to monitor wound healing every three to four weeks for the next four months. I bet you would do all that without blinking an eye, because you're following a protocol designed to result in a favorable outcome.

See any parallels to dental hygiene practice? There is a whole world of time opportunities just waiting for you to consider. Say goodbye to 45!

JoAnn R. Gurenlian, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing-education programs to health-care providers. She is a graduate program faculty at Idaho State University, adjunct faculty at Burlington County College and Montgomery County College, and president-elect of the International Federation of Dental Hygienists.

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