Last updated on November 2nd, 2017 at 10:57 am

Greg Winteregg - How Your Hygienist Can Help Increase Case Acceptance - The MGE BlogIf you have an operational recall program, your hygiene department should be a fruitful source of productive procedures for your (the doctor’s) schedule. But there are a few ways this can go wrong.

I was in practice for about 13 years before I became an MGE client, and I can tell you from experience that it’s easy to fall into bad habits where you have thoughts like:

Sigh. Here comes that patient again. They’ve needed a couple of crowns for 5 years…”

How Your Hygienist Can Help Increase Case Acceptance - The MGE Blog

You already “know” the words that are going to come out of their mouth. They’re going to tell you why they are not doing the treatment now, or how they want you to “talk to them about it their next checkup,” etc. Before you walk into the treatment room, you are already objecting for them, even though you haven’t said a word to each other on this visit.

So, my first piece is for both the doctor and hygienist:

Treat every recall patient like a new patient. 

Now, I’m not talking clinically. We don’t need to do a full-mouth x-ray (unless it’s needed of course) and initial exam. I’m talking about your VIEWPOINT. Take a fresh look at this patient. You haven’t seen them in 3-6 months. Things change. Review any outstanding treatment with them newly – regardless of having discussed prior.

I promise you that most patients don’t remember what they need or why; and even if they do remember, you can bet that in most cases they didn’t “get it” with regards to how important it was – or they would have accepted it the first time it was discussed!

How Your Hygienist Can Help Increase Case Acceptance - The MGE Blog

So, don’t just “pick up from where you left off.” Explain it again and don’t assume anything. Don’t put objections there for them. Sure, you can prepare for them, knowing that they might come up and you’ll have to address them.  I used to tell my my patients:

“Look, if you were a new patient this is what I would tell you. This is why you need this.”

Sometimes it takes persistence and repetition for the patient to get it. We have a rule here at MGE, which you may have heard in other blog posts or YouTube videos of ours, that you must tell the patient what they need at least three times. Not robotically of course like a tape recorder – you can vary your explanation – but explain it three times. It really does work. Persistence pays off.

The hygienist is also an educator.

As far as I know in every state or province, a hygienist is not allowed to diagnose. But they do have a wealth of valuable knowledge that they can utilize to educate.

Your hygienist typically spends more time with patients than anyone else. In many offices, I’ve seen this time spent primarily on small-talk with a little home-care advice thrown in. That’s fine. Build good relationships with the patients and be friendly, but keep in mind this is also a great opportunity to educate the them more extensively on the treatment they need and the reasons they need it.

I think most hygienists can get on board with this because, ultimately, the goal here is to help the patients make educated choices and get healthy—and that’s why hygienists got into the profession, just like doctors. It’s a win-win scenario. It helps the practice grow and helps patients become healthier from a dental perspective.

Of course, for a hygienist to speak with the patient about their outstanding treatment, the hygienist must know ahead of time what that treatment is! This brings me to my next piece of advice:

The doctor and hygienist(s) must coordinate in the morning—before seeing patients.

How Your Hygienist Can Help Increase Case Acceptance - The MGE BlogFirst thing in the morning, the hygienist should quickly go through the charts for the day, look at what treatment was planned prior, what has not been accepted, and just quickly jot down on a sticky note: “on this patient two crowns,” “on this patient a bridge,” or something of that sort.

Then they should get together with the doctor to make sure they’re on the same page with these patients. (This may be done as a part of a morning production meeting if you are already holding those. More info on that in the article Kick Off Production with a REAL Morning Meeting.)

I don’t want to add too much time to your days spent in meetings, but this is important. It’s also a very quick meeting. 5 minutes or less.

So there MUST be coordination which literally just takes a couple of minutes.

Then as the hygienists sees patients, during the cleaning or the scaling and root planing or whichever it might be, can reiterate the treatment that has been diagnosed. Of course, depending on how long it’s been since the patient’s been in, the treatment may have changed – i.e. that tooth that needed a crown may be sensitive (or painful now) and need a root canal, etc. So, obviously as the doctor and only one who can diagnose you would have to look at this yourself. Before presenting treatment. You can do this when you do your periodic exam during the recall appointment. Or, if it’s a hygiene appointment that does not require an exam, you can always pop in for a minute to take a look.

When presenting treatment we know that some patients are going to be resistant, you can expect that. But you have to persist through that and again say listen, if you were a new patient, this is what we’d be telling you. And a hygienist, can point up areas of concern. You have areas that have been noted for years, or you have areas here that are slightly getting worse. Whatever it might be, just get the patients engaged into at least thinking about it and break through some of the brick wall that they are putting up.

The doctor must follow through with his/her end of the bargain. 

This is another reason for having that morning meeting I mentioned: so that the doctor also knows what they need to communicate to the patient.

How Your Hygienist Can Help Increase Case Acceptance - The MGE Blog

This doesn’t work very well if the hygienist does their job speaking with the patient about treatment and handling their objections…and then the doctor is so busy that they just run in and say, “Well, we’ll talk about it next time,” and then runs out again.

This can cause a serious clash between the doctor and hygienist. It really makes the hygienist look bad and the office look uncoordinated generally. It leaves the patient confused thinking “What? Do I need this or don’t I?” and the hygienist thinking “Why am I having this conversation in the first place? Next time I’ll just go back to small-talk.”

Now, there’s one more key piece here that will undermine the success of all this if it’s not addressed correctly:

The doctor and hygienist need to be on the same page regarding clinical and treatment philosophy. 

This should be obvious, but it becomes a problem much more often than most people think.

I’ve interacted with some offices where the doctor and hygienist are telling patients opposite things.

The doctor comes in, tells the patient what they need…and then after they walk out the hygienist says “Oh you don’t need all that. It’s going to be expensive. I wouldn’t worry about it if I were you.” Beyond the fact that this leads an office into murky waters from a diagnostic perspective (big problem), it again creates a real issue for patients!

Even if the doctor and hygienist aren’t necessarily opposing each other, just saying different things, it is very confusing to the patient.

How Your Hygienist Can Help Increase Case Acceptance - The MGE BlogSo it’s up to both the doctor and the hygienist to make sure they are on the same page about treatment philosophy. If there is a disagreement or something doesn’t seem right, speak with each other about it and sort it out until both parties are satisfied.

If this isn’t sorted out, then best case scenario is that the hygienist will only be paying lip-service when they discuss treatment with the patient and it will come across as half-hearted. Worst case scenario is that the doctor and hygienist will completely undermine each other and it will make the office look bad and scare away the patient, meaning they don’t get the treatment they need.

So, discuss this head on. Don’t bottle up the disagreements inside and grumble about it later. Nobody wins that way.

And if there is a real, fundamental disagreement here that neither side can budge on…well, it might not be the best fit on either side. A hygienist is not going to be happy in a job where their opinions aren’t valued and things are being done that they don’t think is right.

And doctor, the hygienist is such an incredibly important part of the office and can be so valuable in their role of educating patients that it’s worth ensuring that they are 100% on board and building the right team around you.


So, the key here is that the doctor and the hygienist take a few minutes every day to coordinate, get on the same page, and make a quick list of the treatment that you are going to talk with the patient about. Because ultimately, the ultimate purpose and objective is that the patients keep their teeth for the rest of their lives. So just sit down with that purpose at the beginning of every day and let’s help every patient get the treatment that they need!


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