A Profitable Hygiene System: Not an Undervalued Practice Resource, Part 1

Dentistry Today


What does it take to create a clinically successful, productive, and profitable hygiene system within a dental practice? Over the past years, research and technology in periodontics has created exciting changes in the responsibilities of hygienists and the scope of technology available for practicing dental hygienists. With these changes there is also an opportunity to achieve ideal preventive care for our patients. However, the idealism needed to achieve clinical excellence must be merged with sound business strategies. Simply stated, clinical excellence must be merged with a profitable hygiene department. With the increased costs to run a quality practice with excellent service, receiving a deserved and healthy profit from your practice is more essential today than ever before. Throughout this 2-part article, we will discuss the milestones, goals, and roadblocks that you need to look at in order to make the hygiene department productive and profitable.


A successful dental hygiene system is the backbone of a general practice. It is a vital component to any dental practice that allows patients to attain the highest level of dental health. It provides the doctor (and the entire dental team) the opportunity to treatment plan patients based on their restorative and aesthetic wants and needs. A successful hygiene department requires a philosophy that includes the mouth-body connection and helps patients maintain and “keep their teeth for a lifetime.”
A successful dental hygiene department has many components. The key performance indicators must be monitored and the team must be kept on track and motivated through effective leadership. Protocols must be in place, to guide dental hygienists
who are dedicated and motivated, to provide each and every patient treatment that meets or exceeds current standard of care. Most doctors agree on this point, but the systems and protocols necessary to create a thriving dental hygiene department, are often missing or only partially developed.
To get started building (or reworking) your dental hygiene department, the doctor and team must develop their own vision of what the ideal hygiene department should look like. This vision should include the purpose of the dental hygiene department and what the dental hygiene team hopes to accomplish for the patients, the practice, and themselves. Purpose is what truly leads people. A clearly defined purpose established with guidelines gives the team (specifically the dental hygienist and doctor) the opportunity to discipline themselves, and to operate on principle not desire. To establish a purposeful vision for the hygiene department, one must consider developing and following these essential issues, ie, practice goals, outcomes of the patient’s periodontal treatment, American Association of Periodontology guidelines for the treatment of periodontal disease, maintenance of disease remission, when to refer to the periodontist, use of adjunctive therapies, and fully understanding oral-systemic relationships.


One of the main reasons for low production in a hygiene department is that there isn’t a team approach to the preventive/periodontal philosophy of the practice. Everyone must be on the same page. For the team approach to be meaningful, each team member have a clear understanding of their individual role as related to supporting and maintaining proper patient oral health. Unfortunately, it is not uncommon to find practice administrators and front desk staff members who do not fully know and understand what periodontal treatment/services are available to their patients through the practice. (This sometimes applies to clinical team members as well.) It is our belief that the patient is first and foremost to be served with optimum clinical quality. In serving the patient to the best of our abilities, we also serve the practice and the team at its highest level as well. In order for patients to increase their perceived value of management of periodontal disease by the practice, it is imperative that the entire team is always involved.
The entire team must be ready to deliver the necessary information to educate the patient on how to keep their teeth for a lifetime. To accomplish this they must understand the practice preventive philosophy and what proper dental health means. It is important to understand that we not only focus on what is “above the gums,” but also what is “below the gums.” With this concept in mind, we need to educate the patient concerning the importance of treating and maintaining good oral health.
Management of a successful hygiene department cannot be done haphazardly and requires leadership, education, and team dedication to the process. The returns on the investment of time and effort required will be a well-cared-for, educated, and motivated patient who “owns” their dental health. Our experience also indicates that the ultimate reward is found when your dental hygienist cannot imagine a career any more satisfying!


Hiring a hygienist is one of the most feared aspects of staffing by most doctors. With the current dental hygiene compensation packages, making the right choices is imperative to sustain the growth of your practice. If the hiring process is carried out correctly, it will also positively affect your profit margin. For every practice, and each individual dentist, there is a somewhat different vision regarding the “ideal” hygienist.
The doctor must determine the particular personal and professional qualities that would work best and fit the culture and framework of his or her practice. Our experience dictates that one of the best ways to determine the traits of a potential new hire is to have them participate in a personality profile study (see Web sites at discprofile.com and therainmakergroupinc.com). There are numerous advantages to using the personality profile to hire the right candidate. You will improve hiring success up to 75%, better matching individuals to jobs in which they will excel. Most importantly, it will improve employee retention, improve communication, and definitely will help you in identifying each team member’s potential strengths and weaknesses.
It is vital that you select the right person to work within your hygiene system for the following reasons: the cost of hiring the wrong person, which could be extremely expensive; what is not known about a future employee could and will hurt you; and the cost of turnover for 1 team member can range from 3 to 4 times the employee’s annual compensation. Here is a list of the important qualities and personality traits, which we perceive would be desirable and essential for a professional dental hygienist. The best of the best traits are: warm, friendly, productive, committed, loyal, pays attention to detail, follows up instantly without having to be told, conscientious, follows protocols, trustworthy, knowledgeable, motivated, able to lead, and loving what they do.


It is imperative that you consider the following issues, and that you not focus only on the bottom line. Today’s dental consumer is interested in health and beautiful smiles more than ever before. With media attention on body and smile transformations, the marketplace in dentistry has never been better for treating patients within the hygiene department, enhancing and preserving smiles! If you develop and maintain a continued focus on optimum care, always standing up for what is best for your patients, it is our belief that you will profit. Current research compels us to diagnose and treat the early stages of periodontal disease very seriously with nonsurgical treatment. In spite of these realities, most dental hygiene departments operate with a “business as usual” approach, utilizing minimal or even antiquated technology while profitability levels remain stagnant or even decline. Let’s examine 3 components of a highly profitable hygiene department and see what makes them successfully different.

Chart. An Example of a Hygienist’s Comprehensive Day Seeing 8 Adult Patients Per Day Using Sample-Fee Structures.

4 prophylaxis ($75 x 4) $300
2 periodontal maintenance ($105 x 2) $210
2 scaling and root planings ($180 x 2) $360
4 bite-wings (7- verticals) ($56 x 4) $224
1 panoramic film $78
1 periapical x-ray $14
1 Vizilite oral cancer screening $50
5 sites of ARESTIN ($30 x 5) $150
4 fluoride varnish treatments ($28 x 4) $112
2 desensitizing applications ($28 x 2) $56

Profitability in any hygiene department is directly proportional to the billable services provided, and increases as the comprehensiveness of services increases (Chart). Take for example “the business is a usual practice” where a hygienist sees 8 to 10 patients a day, provides primarily prophylaxis, bite-wing updates, and intermittent fluoride treatments. His/her hourly production generally averages around $85 to $95 in production per hour (PPH), and the percentage of hygiene production to the total practice production is approaching 25%.

The successful dental hygiene system recognizes the need for consistently providing more comprehensive services such as: scaling and root planning (including the utilization of locally applied antimicrobials such as ARESTIN [OraPharma]); applying desensitizing agents (such as AcquaSeal Benz [Acquamed Technologies) or varnishes (such as Omni Vanish [3M ESPE]) especially to adult patients; updating full series and panoramic x-rays instead of just bite-wings (when indicated); helping to provide whitening treatments in office; and providing oral cancer screenings. These are just some examples of services that can easily raise production to $180 to $200 PPH or more, increasing the percentage of hygiene production to total practice production to around 35%. The end result can be healthier patients and a healthier business! The chart shows an example of what a comprehensive day might look like for a hygienist seeing 8 adult patients per day utilizing sample fee structures.


Preblocking the hygiene schedule in advance for necessary nonsurgical procedures helps to ensure profitability. In the movie Field of Dreams, the premise “if you build it they will come,” proved to be true. Preparing or building your schedule for patients needing nonsurgical therapy gives hygienists the freedom to enroll patients into the early stages of periodontal disease right away once a diagnosis has been confirmed, rather than instructing the patient to simply “work on their flossing.” If hygienists know that the schedule is booked solid for several months, it is difficult for them to create urgency for the patient to return for scaling and root planning appointments. On the other hand, when a schedule is preblocked in advance, knowing a patient could begin treatment within a week or 2, increases the likelihood that optimal treatment options will be presented.
Depending on the practice, 1 to 3 appointments should be preblocked per day, per hygienist; specifically reserved for nonsurgical treatments given the high incidence of periodontal disease among our adult patients. Most software programs used in dental practices enable preblocking to be done through a template. If not, one can do so manually. Once reserved, the preblocked appointment should be held until 2 days prior. If it is not filled with a scaling and root planing appointment 2 days out, then administrators can begin to call patients identified on a “priority list” and offer the opening to anyone.


Profitability increases as deliberate steps are taken to reduce average open time from missed appointments to 5% or less. Missed appointments through no-shows and short-notice cancellations have the ability to completely eliminate profitability. Practices managing open time to maintain it around 5% of the hygiene schedule do so through team effort and with a plan. Benjamin Franklin said, “Drive thy business or it will drive thee.” In other words, control the schedule, or it will control you. One can calculate open time percentages by dividing the number of unfilled time units by the number of time units available, per day.
When a patient cancels an appointment with short notice for any other reason other than an emergency or illness, they should NOT be offered the next available opening simply to fill another hole in the schedule. Offer the patient who is canceling an appointment, an appointment in 6 weeks or more. Then, let them know that you will place them on a priority list and do everything you can to work them in at a time closer to their interval. You can always call them back later that day, or the next week to offer them an open appointment. Most patients, knowing the alternative is many weeks away, are inclined to accept the new appointment time and to keep it, realizing the alternative is another 6 weeks out.
Rather than confirming hygiene appointments the day before, which leave administrators scrambling to fill openings due to cancellations, calls or email confirmations should be made 1 week to 48 hours prior to the appointment. Patients should be given written appointment guidelines requesting 2-business days notice to change reserved appointments. Many patients call at 4:00 pm to cancel a 9:00 am appointment the next day, which means an administrator may or may not reach another patient to fill that appointment time.
Providing more comprehensive hygiene services, preblocking the schedule for nonsurgical treatment, and taking steps to reduce open time can take your hygiene department to higher levels of profitability. Capturing your patient’s desire to improve health and to enhance smiles by utilizing state-of-the-art technology to improve hygiene care can be a return on investment that you cannot afford to miss!


In summary, we have addressed the necessity of how to create the vision of a successful dental hygiene department, and that success is best realized when you have used a team approach. In order to have this happen, you must take the time to select the right person for the team. These issues are vital components to consider when developing and improving production and profitability for the hygiene system. It is a well-established fact that profitability in any hygiene department is directly proportional to the billable services provided. In addition, without proper scheduling, elimination of cancellations and no-shows, profits will drop. Next month in Part 2 of this article, we will discuss how to hire the right hygienist, clarify the expectations for both the hygienist and doctor, create a win-win hygiene compensation plan, and how to successfully introduce and integrate new technology into the hygiene system. All of these components will help you build a successful dental hygiene department.

Dr. Doherty is a certified financial planner, national lecturer, and CEO of Doctor’s Financial Network. For more information on his future upcoming Financial and Management Boot Camps for Dentists, or to received a free newsletter “Doherty’s Bottom Line,” please contact him at (772) 225-3021 or e-mail hughdohertydds@comcast.net.

Dr. Doherty did not report any disclosures.

Ms. Davis earned her bachelor of science in Dental Hygiene degree from Midwestern State University. She is the owner and founder of Cutting Edge Concepts, and she lectures internationally. She is also a senior consultant of The JP Institute. She can be reached at (972) 669-1555 or Karen@karendavis.net, or visit her Web site karendavis.net.

Ms. Davis did not report any disclosures.

Ms. Miller is a senior consultant and partner of The JP Consultants Institute, and is also a director and featured instructor of the JP Institutes’ postgraduate curriculum certification program in Carlsbad, California. She can be reached at (800) 846-4944 or visit the Web site jpconsutlants.com.

Disclosure: Ms. Miller is an employee of JP Institute and is paid per diem when she provides office training for dentists, workshops, seminars, etc. She lectures occasionally for OraPharma, and is currently providing Webinars for Philips Oral Health Care, receiving honorariums on a project basis from both companies.