• Dentistry Magazine

Six Ways Hygiene And Therapy Can Rescue Your Practice

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 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.



1. Hygiene income pays straight into the bottom line


The reality is that most DHT’s, 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.


Whilst some practice owners in the past have tended to see the income generated from hygiene services as less lucrative compared with other private treatments (e.g. orthodontics or implants), the current pandemic has seen the public spend more cautiously, delaying elective ‘big outlay’ treatments. For some, patient numbers for hygiene services might be down, but there is still a significant number of patients who want to keep on top of their oral health and who are prepared to find the money for hygiene treatment.


Further, hygiene patients are a vital revenue stream not just today but for the future, as they have a high lifetime worth; returning every 3 – 6 months over years. With careful management, these patients might well in time take up other services that the practice offers (e.g. bleaching, facial aesthetics, private fillings) further increasing their lifetime worth (and that of hygiene services).


Lastly, with NHS dental practices not running at normal patient treatment capacity, many routine treatments cannot take place; including routine periodontal appointments. This then 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, as some patients choose to access private hygiene services moving forward. Given the fallow times still in the place, this presents the DHT with more time to explain the importance of regular visits and focus on OHI.


2. Changing patient thinking away from a ‘scale and polish’ mindset to increase revenue


It has already been shown how hygiene patients have a high life-time value. 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 to what extent patients misunderstand what DHTs do and why explanation of the value of ongoing treatment is necessary.

  • Patients should be encouraged 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.

  • Patients should be encouraged 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’. Highlighting the consequences of leaving gum disease untreated can be of benefit in ensuring that patients book their next appointment.


3. 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. 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, hygienist therapists were highlighting to patients the effect of oral bacteria on the rest of the body. The pandemic has brought a new willingness amongst patients to see the mouth a gateway to the rest of the body, with oral bacteria affecting many other bodily systems. Bluntly put, healthy patients who practice good self-care overcome infections more quickly.


4. The value of the relationship between therapist and patient 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, the patient / DHT relationship should not be undervalued. 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. E.g. whitening, facial aesthetics, orthodontics and implants.


5. Positive effect on other clinicians’ treatment uptake


For the reasons already outlined, DHTs have a great capacity to positively affect other clinician’s treatment uptake. By reviewing unaccepted treatment at the start of the day with the rest of the team, DHTs are in a position to raise unaccepted treatment. Due to patient rapport, such discussions can be welcomed 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 (e.g. lips) referring patients to the other clinician for treatments that they perform well (botox). 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).


6. Therapists have a key role to play 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 focussing 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, capitalising 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. The resulting patient rapport established by regular attendance, when leveraged, can also be of great value to other clinicians and the practice as a whole.


Publication: Dentistry | P.21 | 7th Jan 2021


Six Ways Hygiene And Therapy Can Rescue
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