Transforming Dental Hygiene Care

Do you ever feel like a day in the life of a dental hygienist is much like Groundhog Day? Doing the same thing over and over. Many times having to squeeze so much into a one-hour prophy appointment that you can’t hardly breathe let alone grab a snack? Furthermore, wondering if “prophylaxis” is even the right name for the service you provided. I get it. The hamster wheel we have been on in the private practice setting is real and exhausting. What if I told you there was a way off? A way to completely reimagine your days and the care you provide the patients you love so much. Would you consider it? It took me years of trial and error to get a new dental hygiene care plan in place, but I did it. And if I can, anyone can.

Individualized care

What is the magic reimagined dental hygiene day I speak of? It takes only a small tweak to our approach to exit the hamster wheel. The modification starts with the way that we complete the assessment phase of each appointment. You see, the reason we are in repeat mode of doing the same thing over and over, squeezing the patient’s dental hygiene care into one hour is because we expect to follow the schedule. Our schedule says that we have a prophy appointment every hour with every patient. Being highly effective professionals, we try everything imaginable to make our day reflect what the schedule says. Unfortunately, half to three-quarters of our adult population has a disease depending on their age. That means that rather than trying to make our days match the schedule, we ought to consider making our days match the disease needs of our patients. Enter individualized care!

The recipe to transform our days and patient care

Commit to never, ever, skipping any piece of the assessment. No matter how far behind schedule. No
matter if the only item completed is assessment. This is the key to unlocking a new routine that supports
the health of us (the providers), our patients, and our practices.

1. Medical history: thoroughly evaluate every positive response. Ask appropriate and probing questions. Educate ourselves on any medications or ailments we aren’t familiar with. Oral health and overall health are not separate. If there is an infection in the mouth, it travels through the body continuously. Likewise, if there is trouble in the body elsewhere, the oral environment will be hindered.

2. Blood pressure reading: heart disease and periodontal disease are intimately intertwined. We lose 800,00 Americans every year to cardiovascular disease. In the blocked arteries guess what we find? The virulent bacteria of periodontal disease that originate in the mouth. Here is a great visualization for our patients that I use all the time, “Our hearts pump blood up to our gums, that blood becomes infected and then the infection is dragged through the entire body creating a low-level total body infection that our immune system has to battle. This makes us less able to fight normal stresses and larger diseases.” These simple 2 sentences are effective and easy to understand. Feel free to take them, modify them as you like, and try them out!

3. Oral Cancer Screening: early detection saves lives. That is reason enough to complete an OCS in my opinion. However, as we thoroughly evaluate the patient in our chair, we set ourselves up as the expert who not only is knowledgeable but CARES. Ever heard the adage, “No one cares about how much you know until they know how much you care?” There is profound truth in that statement. Completing a well-done extra and intro oral examination
will be a practice that serves the patient and our effort to care well for them in spades.

4. Appropriate and excellent x-rays: To diagnose bone involvement, we need a direct picture perpendicular to the interproximal space. Bitewings either horizontal or vertical are the x-ray of choice. I recommend teaching our patients how to read these themselves. Simply state, “This thick white line should go up, over, and down between each tooth.” We know the thick white line is the lamina dura and that when it shows signs of periodontal disease
(“Do you see where the line is gray and fuzzy?”) 30-50% of the density is already lost. The vocabulary words and scientific descriptions will lose our patient as a teammate. However, that simple explanation will equip them to make a quality decision on their own. If they diagnose their own disease, we don’t have to do a case presentation…. Brilliant right?!

5. A full mouth periodontal probe and documentation: this rounds out our 5-part assessment process. Start by saying, “1-3mm is normal, and healthy gums don’t bleed or hurt while I measure.” Remember when we wanted the patient to diagnose their own disease on the x-rays? Same idea here. If we say the parameters for the disease and then call the perio chart aloud, we can skip case presentation. We simply let our patients evaluate what they are hearing and seeing in their own mouths. Then we support their discovery with treatment plan options.

Freedom for patient care

At this point, you can see that if a patient needs anything other than prophylaxis we will have no choice but to schedule the appropriate dental hygiene care that their disease needs. A disease that they discovered on their own! A disease that we no longer need to sell them on. A disease that is now their responsibility. You can imagine the freedom that comes along with not carrying the weight of our patient’s disease that was never ours to bear to begin with. Consider us off the hamster wheel! Groundhog Day is over. Now we have the freedom to schedule and care for our patients with the services they need to regain their best version of health! Beautiful right?!

Many of you may be thinking there is no way there is time for all that. Because I am a talker, I have had to put this to the test for years. The truth is that in health (when someone really needs a prophylaxis) this routine takes less than an hour. I allow 20 minutes for assessment, 25 minutes for instrumentation, floss, and polish, and 15 minutes for an exam, scheduling, and a warm handoff to the administrative team. If a patient needs more than prophylaxis, we can schedule more time. If they don’t, they receive impeccable individualized dental hygiene care and are often done early!

This system opens our days to be responsive to our patient’s needs rather than dictated by a schedule that we should never have been in charge of, to begin with. At last, this is our chance to make a change. More importantly, this is our chance to help our patients become equipped to care well for themselves. Seeing our patients finally get healthy,
having fulfilling days, and having the time to complete the services needed is rewarding beyond measure. Good luck giving this new system a go!

About the Author

This gal is a joy and sun seeker. You can find her in the kitchen cooking, outside adventuring or spending time with her family. She also loves to travel and isn’t afraid to practice yoga in the airport. (Don’t worry her kids have learned not to be so easily embarrassed).

As a professional, Brandi is an international speaker and published author passionate about turning science into action. Audiences are captivated by her engaging courses, leaving them inspired and equipped with valuable tools to provide exquisite,
individualized care and lead a truly fulfilling life.

Currently, Brandi owns and operates Stellar Outcomes and Evans Dental with her husband, Dr. Eron Evans. Her enthusiasm for the dental profession is contagious and uplifting. Spend some time with her to add delight and expertise to your career!

Follow her on social media @StellarOutcomes or check out her website and join the Stellar Infusion Study Club (your ticket is complimentary).  Look for her book “Dentists, Hygienists, and Cows: How Brilliant Dental Professionals Have Great Days While Providing Exquisite Individualized Care” in March 2024.