Common Hygiene Pitfalls and How to Avoid Them



Having a top-notch hygiene team is a wonderful thing, but assuming everything is being taken care of is a big mistake many practices make.

In almost every practice we work with we consistently see the following 3 pitfalls within the hygiene department. Are these happening in your practice?

1. “We are good about taking care of periodontal patients.”

We all believe we are providing a high level of care for our patients, but how do you know you are truly addressing the periodontal needs of your patients? In 2014, the American Academy of Periodontology (AAP) and the Centers for Disease Control (CDC) reported that 1 in 2 adult patients have periodontal disease, with the rate going up to 74% for those patients 65 years of age and older. Are you seeing these rates in your practice? If not, you need to look into your current systems.

One of the first things you should address is ensuring each adult patient is receiving a documented complete periodontal assessment. This is a standard of care you need, as it presents an area of liability for you, as well. It is the responsibility of the hygienist to collect, document and analyze this information.

The best way to identify if periodontal assessments are completed is to complete an audit on the patients recently seen in hygiene. Randomly pull 20 charts of adults seen in the last 6-12 months. How many have a complete periodontal assessment recorded in the last year? The chances are very good that if the percentage is low, so is the amount of periodontal treatment being recommended in your practice.

2. “We start scaling/root planing when they have generalized 5 mm pockets and sub-gingival calculus.”

Our interpretation of the American Academy of Periodontology’s Periodontal Classification system is that Beginning (slight) periodontal disease is 4 mm pockets with bleeding and slight bone loss and 1-2 mm CAL. This is a huge distinction for many dental teams, especially when these patients are typically described as “difficult prophies.” It is crucial for the dental hygiene team to accurately determine the difference between a gingivitis and a periodontal patient. Remember – by definition, if there is bleeding and attachment loss, then the patient is considered periodontal.

I see it time and time again – teams waiting until pockets are 5-6 mm deep before beginning treatment while the patient loses valuable bone that could have been saved.

3. “Our hygienists only need 40 minutes with their patients.”

In an attempt to improve hygiene revenue, many practices will cut back on hygiene appointment lengths in order to accommodate one more patient in their schedules. I find this decision to bring a minimal result and it typically sends the hygiene team into a “prophy only” type of practice method. The dental hygiene team needs to have adequate time in order to properly assess, educate and provide treatment to the patient. When the hygiene team is provided adequate time with the patient, you will see better treatment plans and happier patients. Adequate times = 60 minute recall appointments.

Here are 4 action steps you must take to avoid the common pitfalls:

  1. Do a hygiene chart audit and identify if the periodontal assessment is consistently being completed.
  2. Communicate the standard: Inform your hygiene team that a comprehensive periodontal assessment needs to be completed on every adult patient.
  3. Give your hygiene team the time they need to complete a comprehensive hygiene exam: 60 minutes – adult recall patient.
  4. Be proactive and get the information you need to embrace that starting periodontal therapy early is the right thing to do. You can find great information at perio.org.

Eliminate the common pitfalls in your practice, and you will experience improved patient care and your hygiene revenue will soar – guaranteed.

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