ReD Hot Hygiene, Part 4: H Is for Helpful

Dentistry Today


Help, or helpful, is defined in Webster’s Dictionary as: to contribute, to give assistance to; to further the progress or advancement; to be able to prevent, change, or rectify. In other words: to be useful

How many of you have heard the nasty rumor that hygienists are “prima donnas”? Where did this myth come from? More importantly, what can we do to dispel the myth? In my final segment of ReD Hot Hygiene, I hope to offer ways to keep your passion alive and to stretch your ability to function as a team player. Here are three ways to be viewed as a helpful team member: 

(1) Be flexible.

(2) Expand your scope of duties.

(3) Support and articulate the practice philosophy.


Flexibility is a wonderful quality. In nature, it’s the flexible willow tree that withstands storms. The brittle pine often breaks under the stresses of the environment. Gaining flexibility in your approach to life, and dentistry, will help you to develop as a strong leader with tenacity. You’ll be respected as someone who not only weathers the storms, but one who actually becomes stronger and more beautiful in the process. 

The game of basketball is a great equivalent to dentistry. Think about it. The players are trained for specific positions, however, you never know when the ball may be passed to you, when the opposing team is going to upset your play, or when you may have to temporarily switch positions to get the play back on track. Doesn’t this sound like dentistry? You never know when someone may be out, causing you to fill in; your patients change their schedules at last moment, upsetting your perfectly orchestrated schedule; or you have to fill in at the front desk to offer them relief. 
This is very different from baseball, where the players rarely leave their assigned areas and spend most of their time on the field waiting for something to happen. From this brief two-sport analogy you can see how being alert and flexible can serve you during the day! 

In the late 1970s and 1980s, perhaps dental hygiene resembled baseball a little more. Doctors did not understand how to utilize our talents and often relegated us to our “rooms” when we didn’t have a patient. We were not encouraged to take on expanded roles and certainly had no idea how to help others in the practice. 
As times have changed, many hygienists have expanded their skills—supporting the doctor chair-side, assisting administrators, and researching new avenues of growth for the practice. These hygienists are playing “basketball” and being rewarded. Others are still standing around waiting for the next ball to land within their 2-foot radius. Perhaps this is where the “prima donna” myth erupted—a simple misunderstanding of the game we play in dentistry, a misunderstanding that can be cleared up with a little flexibility in roles and support. 
There are several areas of the practice that require hygienists to be flexible. The most important is scheduling. Having the ability to “roll with the punches” and make the schedule work in varying circumstances is not always easy, particularly for hygienists with limited experience in different systems. Hygiene school did not adequately prepare us for the pace of the real world. I often think it would be excellent to have 2 hours for a class I prophy, however, that is not the reality in which we live. 
A master hygienist knows that she is there for only one purpose: to serve the patients at the highest level. This sometimes means being creative in accommodating the patient’s schedule. There are three areas in which hygiene team members can assist the full team in creating flexibility in the schedule:

(1) Schedule from your operatory, adding value for the appointment.

(2) Support confirmations.

(3) Declare your needs during the morning “huddle.” 
Many of my suggestions focus on the hygienist working with a qualified cotherapist or administrator assigned to the hygiene department, to make the day flow smoothly. In previous articles, you learned of my passion for team hygiene, and the area of flexibility in scheduling is certainly one where this concept shines. 
In-operatory scheduling (preferably with computer network in place) gives the hygienist the ability to customize treatment for the patient, ensuring appropriate time management. Hygienists and hygiene assistants can create long-term value for preventive care, ensuring the patient doesn’t walk away and schedule their next “cleaning appointment” without understanding the value. 

The hygiene team should also support the confirmation process. Before you go and block out time for the hygienist to confirm appointments, hear me out. I said the hygienist should “support” the process. By this, she should offer guidelines, scripting, and insight into the patients so the hygiene cotherapist or administrator is more effective in the confirmation process. If there are a few patients who cannot be reached during the day, it is appropriate (and usually appreciated by the patient) to take their phone numbers home at night and give a quick call. Which would you rather have—10 minutes of your evening taken up with calls or 60 to 120 minutes of your day in nonproductive time? Some of you are feeling the “stretch” in this suggestion. Perhaps this is an area for newfound flexibility to take hold. 

The third area where hygienists can offer flexibility occurs during the morning focus meeting. Review your schedule and see if there are any patients who were not confirmed. Ask someone to support you early in the day in reaching these patients. Also, ask the assistants to be aware of any patients in their schedule who may need your services. See if there is a way to work them into your schedule. You’d be amazed how appreciative patients will be to know they don’t have to take additional time off work to visit you on another day. 
Make sure that someone is looking at your schedule on an hourly basis and letting you know when you have open time. If your 10:00 am slot is unexpectedly open, you have the possibility of extending services for your 9:00 am patient if warranted, or working in the new patient from the doctor’s side. Think outside the box; always ask the question, “How can we serve even more patients at a higher level today?” Rarely have I found that this type of thinking causes a “crisis” in the schedule. Usually it bails me out of an otherwise unproductive day. 
Don’t get caught in the trap of “Mrs. Jones is 10 minutes late, it’s your job (administrator) to read her the riot act and have her respect my time!” This is not only rude to the patient, it is inconsiderate of your teammates and an unproductive way to run a business. Instead, mastermind ways to gain support during the day should you run off track for any reason. It’s been my experience that with proper communication and a willing spirit, your teammates are more than happy to pitch in and get you back on track.

When I was deciding on a career path in dentistry, I noticed three things: the assistants were limited in their ability to work independently, the hygienist was licensed to perform both hygiene procedures and assistant duties, and the doctor paid the bills. I chose hygiene because it gave the broadest range of duties with a lower risk than being the business owner. 

Think about that. You are licensed to perform all duties of an expanded-function assistant (in most states). Isn’t this exciting! All the fun with very little financial risk! Now, the big question—can you list the duties of an expanded-function assistant in your state? 

If you’ve been out of the field for awhile or you’ve never assisted, how do you begin to expand your skills? Well, the first step is a willing spirit. The truth is, materials are changing at such a rapid pace that if you were proficient 5 years ago, you are most likely outdated now. The good news is, you have experts working within your practice who are more than willing to teach you. 
First, get a current copy of your state practice act, including the state laws and board rules and regulations. Mark your calendar and request an updated copy each year. Legislation changes very quickly, and it’s your responsibility to keep up. In order to create an exciting, profitable practice, you must continue to delegate and expand duties to the fullest extent of the law. Be aware: letters issued by the board as “board opinions” are not necessarily legally binding; follow the rules and regulations or call your attorney general for clarification of the law. 
Armed with information of what can be delegated to you and the assistants in the practice, you can begin to develop systems to support the doctor in performing only those tasks requiring a dental license, hygienists performing the next tier of duties, and assistants performing those things that can be delegated to them. This frees valuable examination, diagnostic, and treatment time for primary providers (doctors and hygienists), and adds new dimension to the assistants’ roles. Start thinking of hygienists as “physicians’ assistants” capable of providing triage, examination, and primary care. Please note that all duties delegated must fall within the confines of the practice act, and in no way constitute diagnosis on the part of any auxiliary personnel. 
Once you are clear on duties you can perform, set up time with the doctor and the assistants to create a training schedule. Some of the new duties you may want to incorporate are: intraoral camera videography, digital photography, impressions, fabrication of study models and whitening trays, placement/removal of temporaries, and emergency patient care. Some states now allow hygienists to provide anesthesia, use soft-tissue lasers, and place composite restorations. 
Imagine the smile on the doctor’s face as his patient load begins to be shared with other providers. Imagine the smile on the hygienist’s face as the doctor runs on time for hygiene examinations! Expansion of duties allows you to care for more people within your community in a lowered-stress environment. With the reported shortage of hygienists and dentists in certain regions of the country, I can see how this philosophy of “team dentistry” will expand and give rise to an even higher standard of care.

This is a tough one. Sometimes we find ourselves working in an environment where we love the patients and the staff, however, we either don’t know or don’t agree with the practice philosophy. 

Most hygienists in this situation will take the approach of keeping their lack of faith to themselves. Or so they think. Oftentimes, you do not have to verbally communicate an objection for it to have an impact. 
Imagine if you will, your doctor has just attended a hands-on course and is changing the materials used in the office. The reasons and the costs of the change were never fully explained to you. Somewhere inside, you began to feel that the patients were being overcharged for “new fangled” or unnecessary procedures. While you never say a word to the doctor, you may communicate doubt to the patient. 
How do we communicate this doubt? In several ways: our body language, our tonality, and uncertainty in our words. When the doctor leaves the room and the patient asks if he really needs to have a particular procedure done, if your response is anything less than “absolutely,” then you may not be in full alignment with your doctor’s philosophy. A sigh, a hesitation in your voice, turning away or looking down, saying the words “well,” “umm,” or “hmmm” in your response show doubt. 
Here are some suggestions for creating a congruent practice philosophy. First, set aside time on a monthly basis to have “peer review” with the doctor. Pull patient charts and review the diagnostic tools such as x-rays, intraoral camera films, charting records, etc. When there are multiple options for treatment, ask the doctor why she/he recommended that particular course of treatment. One of the most difficult areas to understand is that of adhesive dentistry. When does your doctor recommend direct composite versus inlay, or onlays versus full-coverage crowns? How will you know how to educate your patient to this process? 
Ask the following questions of your team: 

(1) When do we actually begin treatment? When we first notice breakdown? When the breakdown advances? Or when the patient reports pain?

(2) What are the parameters for “watching” an area? 

(3) When does periodontal disease begin? When do we begin treating it as disease in need of therapy and not merely a “difficult prophy”?

(4) Who would benefit from topical fluoride treatments (in-office professional treatment combined with take-home prescriptive products)? 
Take time to review the philosophy of care with your team. Determine which diagnostic methods will be used, when treatment is deemed necessary, and which methods of prevention you advocate. Supporting and articulating one congruent philosophy helps the patient understand their needs and supports them in moving forward with treatment.

I challenge you to make 2002 your year to become ReD Hot, to take your career to a new level, and enjoy the look of amazement on your team’s face as they see you stretch and grow. Be resourceful by increasing the tools and skills at hand. Be dynamic by becoming a stronger communicator. Be helpful by expanding your thinking and creativity. Remember why you entered this wonderful field and let your passion shine through!

Ms. McManus is the director of Hygiene Mastery and a coach with Fortune Management. She is on faculty with PAC~live and the author of the collaborative book FUNdamentals of Outstanding Dental Teams. Call today to receive a complimentary Hygiene Mastery analysis, (888) 347-4785, or e-mail