Contemporary Hygienist – establishing the hygiene department as a practice cornerstone

Contemporary Hygienist

Claire Berry and Faye Donald kick off a new column by opening up about why a hygiene department is crucial to a thriving practice.

You may be asking, why even consider establishing the hygiene department as the cornerstone of a practice? If you have to ask that question, you are most probably someone who still thinks that hygiene treatment predominantly consists of a scale and polish.

It doesn’t and this old school way of thinking shows a misunderstanding. Not only regarding what clinical team members are truly capable of these days, but of what patient needs are in 2022.

The term ‘scale and polish’, which is now widely considered outdated, first came about because it was literally the entire scope of practice for a 1950’s hygienist. And when I say literally, I mean literally. It almost solely read ‘scale and polish’. That was their job.

This is no longer the case, yet it continues to haunt our profession. The scope of practice of a hygienist is significantly more extensive nowadays. There’s less focus on scaling and more focus on the concept of achieving optimal health.

Different connotations

Reconsidering the language we use can have such a positive impact on patient engagement and treatment uptake as well as elevating the status and importance of hygiene care. Whilst ever treatment is referred to as an S&P, scale and polish or a ‘quick clean up’, that’s the total sum of what the patient will expect and desire.

If instead we talk to patients about oral health, gum health and preventative care, the message and expectation takes on a different connotation and the narrative changes.

The Contemporary Hygienist supports a movement to change industry mindset surrounding how hygiene treatment is thought about and talked about. Opening our minds to a hygiene-led practice could see potential growth of business and growth of the patient’s attitude towards prevention orientated care.

So how do we change how the practice and our patients think about hygiene treatment? First of all, doing what you’ve always done will get you what you’ve always got. The definition of madness is doing the same thing over and over and hoping for a different outcome. To change outcome, we have to change pathway. And to change pathway, we have to change mindset.

Start by thinking about what you currently refer to your hygiene appointment as. Are they still S&Ps? I challenge you to alter the name of the treatment.

What terminology could you use to better describe what you’re hoping to achieve? Here at Contemporary Hygienist, we decided to call the treatment we deliver ‘Oral Health Optimisation’.

Disease free and functional

Oral health is defined as ‘the practice of keeping one’s mouth free of disease’. Optimisation is defined as ‘the act or process of making something as fully perfect, functional, or effective as possible’. Therefore, we define Oral Health Optimisation as ‘the process required to ensure a patient’s mouth becomes and remains as disease free and as functional as possible’.

This encompasses anything and everything required to get someone to an optimal state. It’s all about education. It could involve managing risk factors, it might incorporate general health screening or maybe consist of saliva flow testing. It will absolutely involve periodontal screening, oral cancer screening, oral hygiene assessment and advice.

And yes, it will most likely involve biofilm management and calculus removal. But it’s important to stress that that’s not all it is.

So, to define it as S&P is like defining an implant as merely the crown that goes on top of it and disregarding all of the groundwork that goes into ensuring that the crown has somewhere sturdy to sit.

We now have the S3 guidelines clearly stating that a staged approach, which addresses the main aetiological factors related to periodontal health, should and must come ahead of the removal of detectable deposits. Unless we make this clear to our patients, we run the risk of everything outside of the physical scale and polish being seen as unnecessary.

‘Optimisation before Restoration’

Who’s been in the position when the patient has said: “Just get on with the treatment without the lecture?’ (a sea of hands no doubt raises into the air).

This is because patients feel a scale and polish is the thing they are paying for, not all the education that goes with it. In actual fact, it’s the management of the whole person. It’s not just inert deposits on the teeth that will ultimately make the difference.

Oral Health Optimisation (OHO) also implies it is going to be a process to get to optimal health. Whereas a scale and polish implies a one off and standalone treatment. OHO paves the way for multiple appointments (if required).

You don’t go the gym and achieve optimal fitness in one session and that’s the same for oral health. It doesn’t take one appointment with an ultrasonic scaler and a slow speed handpiece (insert your prophylaxis equipment of choice here) to get someone to health.

Once you switch to an Oral Health Optimisation mindset, it sets a precedence throughout the practice. It becomes the prerequisite to almost all restorative treatment or elective aesthetic improvements, be it implants, ortho, Invisalign, composite bonding and so on.

The Contemporary Hygienist calls this ‘Optimisation before Restoration’ or, ‘Stabilisation before Restoration’. The patient journey through the practice always starts with consultation. But is then immediately passed over to the hygienist/therapist for Oral Health Optimisation. When (and only when) the patient has achieved a status of either healthy (non-perio patients) or stable (perio patients), are they referred back for other work to begin.

This mindset elevates the importance of achieving and maintaining oral health. Itbsets the standard for patients to understand their role in caring for their mouths and/or restorations once completed.

Hygiene that’s better for patients, practices and clinicians

This change in approach has a number of benefits:

  1. Reduces risk of dental disease
  2. High standards of patient care
  3. Ensures a clean and easier working field for any restorative work
  4. Achieves a better aesthetic result
  5. Improves success and longevity of work
  6. Ethical patient care
  7. Reduces risk of litigation, especially in the case of implants
  8. Puts prevention before profits
  9. Increases ethical profitisation.

Changing the way we describe the hygienist/therapist can also subliminally help with elevating the importance.

Referencing the hygienist/therapist as an expert in their field and helping patients to see that they are trained to very high standards – which puts them as best placed to deliver this part of their care – will help the treatment gain the gravitas it deserves.

Placing the hygiene department as the cornerstone of the practice and making the hygienist/therapist a treatment gatekeeper will benefit the patient (better oral health and long term prognosis), the practice (increased ethical profitability and business growth) and the clinicians (easier working field, more engaged patients, better job satisfaction).

It starts with changing mindset, changing the name of treatment, changing the patient journey through the practice and changing how you refer to the hygienist/therapist. Patients will soon start to see the benefits of prevention-led care. The results speak for themselves and demand will soar.

With increased demand comes increased value, and with increased value comes increased profit.

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