Six ways hygiene and therapy can rescue your practice

hygiene rescue Nick Coller examines how effective deployment of hygiene and therapy personnel during the COVID-19 pandemic and beyond can turn them into practice heroes.

The pandemic has forced dentistry, like many other industries, to examine profitability, resources and effective staff deployment. This has inevitably led to job losses amongst dental hygienists and therapists (DHTs).

This article focuses both on the importance of encouraging patient uptake of hygiene and therapy services during the ongoing pandemic and also as an effective means to help practices recover.

Hygiene income pays straight into the bottom line

The reality is that most DHTs, especially those solely performing hygiene services, work alone unassisted. Thus, the DHT comes with none of the associated fixed staff costs of a dental nurse.

Overheads are therefore negligible (amounting to not much more than some polish and an apron). Many self-employed DHTs even bring their own hand scalers and fitted mask.

Some practice owners in the past have tended to see the income generated from hygiene services as less lucrative. Compared with other private treatments (orthodontics or implants, for example), the current pandemic has seen the public spend more cautiously. This has delayed elective ‘big outlay’ treatments.

For some, patient numbers for hygiene services might be down. However, there is still a significant number of patients who want to keep on top of their oral health. They are prepared to find the money for hygiene treatment.

A vital revenue stream

Further, hygiene patients are a vital revenue stream. Not just today but also for the future. They have a high lifetime worth, returning every three to six months over years. With careful management, these patients might well in time take up other services that the practice offers. Services such as: bleaching, facial aesthetics, or private fillings. Therefore further increasing their lifetime worth (and that of hygiene services).

Lastly, NHS dental practices are not running at normal patient treatment capacity. This means that many routine treatments cannot take place, including routine periodontal appointments.

This presents a great opportunity to convert patients who have only ever seen the dentist for periodontal treatment to private hygiene services. This has the potential to increase practice revenue in the short and long term. Some patients will choose to access private hygiene services moving forward.

Given the fallow times still in place, this presents the DHT with more time to explain the importance of regular visits and focus on OHI.

Changing patients’ thinking increases revenue

It has already been shown how hygiene patients have a high lifetime value. But further steps can be taken to ensure that patients see the value of their treatments, thus encouraging regular attendance:

  • The term ‘scale and polish’ should be avoided by the whole dental team as it implies a ‘one-off’ based around cleaning rather than treatment. New hygiene patients are often surprised that treatment takes place at the gumline rather than just the teeth. This highlights the extent to which patients misunderstand what DHTs do and why explanation of the value of ongoing treatment is necessary
  • Encourage patients to see themselves as having a gum treatment with a highly trained professional. This establishes the appointment as of value to the patient’s health
  • Encourage patients to see themselves on a hygiene programme, tailored to their needs. This programme changes over time in line with their changing oral care needs
  • Accompanying patients to reception to book in the next appointment, reminding them of the ongoing nature of the hygiene programme can also help to ensure future bookings
  • A change of focus onto ‘active’ and ‘dormant’ disease when talking to patients can help motivate them from visit to visit and prove useful in explaining why the hygiene programme is of value. To this end, providing a bleeding score and/or explaining what percentage of sites bleed helps highlight disease activity and underpin the need for further sessions to reduce this bleeding level and help the disease ‘go to sleep’. Highlight the consequences of leaving gum disease untreated to ensure patients book their next appointment.

Hygiene services are at the heart of self-care and systemic health

The pandemic has made many patients see their hygiene treatments as vital.

It should not be forgotten that patients couldn’t access care during the first lockdown last year. Many have seen their periodontal condition become unstable as a result.

There is now a heightened public awareness of the importance of preventive care, healthy living and holistic treatment. Hygiene services are at the heart of such topics – prevention is at the heart of the therapist’s role.

Even before the pandemic, DHTs were highlighting to patients the effect of oral bacteria on the rest of the body. The pandemic has brought a new willingness amongst patients. It has highlighted the mouth as a gateway to the rest of the body. Oral bacteria affects many other bodily systems.

Put bluntly, healthy patients who practise good self-care overcome infections more quickly.

The therapist-patient relationship carries great weight

Regular hygiene treatments create a regular touchpoint between the practice and its patients.

Most patients visit the DHT more often than the dentist. Hygiene treatments also last longer than the average dental check-up.

For this reason, there is great value in the patient-DHT relationship. Hygiene treatments present a chance for patients to ask questions about proposed treatments with other clinicians before coming to a final decision. This relationship can be a reason that patients stay with a practice and feel less bound to the practice if the DHT leaves.

Due to the value of this relationship, a DHT’s capacity to ‘upsell’ other services is of great value. Patients naturally bring up questions to do with certain treatments time and again – such as whitening, facial aesthetics, orthodontics and implants, for example.

Positive effect on other clinicians’ treatment uptake

For the reasons already outlined, DHTs have a great capacity to positively affect other clinicians’ treatment uptake.

By reviewing unaccepted treatment at the start of the day with the rest of the team, DHTs can raise unaccepted treatment. Due to patient rapport, you should welcome such discussions and not feel sales orientated to the patient.

Further, many DHTs are extending their clinical practice into the field of facial aesthetics.

This offering works particularly well when working hand in hand with a dentist colleague and can prove a profitable revenue stream for the practice (especially when clinicians are working together to promote the offering).

For example, one clinician focuses on the treatments that they perform particularly well (such as lips), referring patients to the other clinician for treatments they perform well (Botox, say).

Facial aesthetics patients will often choose to have multiple treatments over time. They also represent a patient base that look forward to coming into the practice (where many dental patients do not).

Therapists’ key role as dentistry returns to normal

Therapists are able to perform many of the functions of an associate, leaving dentists able to spend more time effectively focusing on more complex treatments.

As dentistry returns to normal and there is increasing pressure to see patients who have not been able to have a check-up or any routine treatment over the past year, the role of a therapist in practice is of obvious benefit.

Given how many DHTs are dual-qualified, this appears to present the ideal opportunity for practices to utilise their skills rather than recruit externally. This capitalises on existing patient rapport.

A lifetime’s difference

In conclusion, there has arguably never been a better time for practices to encourage patient uptake of hygiene services not least because of the current zeitgeist of preventive self-care, which is only likely to increase in importance.

Hygiene treatments in particular provide patients with a regular practice touchpoint. As such, regular attendees to hygiene treatments have a high lifetime worth.

Regular attendance establishes patient rapport; when leveraged, this can also be of great value to other clinicians and the practice as a whole.


This article first appeared in Dentistry magazine. You can read the latest issue here.

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