By Lee Ann Brady, DMD 

One of the most common ways that we temporize a patient who is having maxillary anterior implant dentistry is with an Essix retainer. Some patients will wear it 24 hours a day and others for less. Hopefully they are taking it out to rinse, brush, and floss, but the reality is they are wearing a removable device that covers all of the tooth surfaces for a lot of hours every day, and we’re increasing their risk of caries, decalcification, and gingivitis. 

In addition to discussing the normal oral hygiene to be done at home, in our practice, we typically dispense a product like Clinpro 5000 from 3M or MI Paste from GC America. These are high calcium and fluoride products that provide fluoride treatments inside the Essex retainer. 

• If a patient is sleeping in the Essix, the instructions are to brush and floss the teeth and then use a toothbrush to spread a little bit of Clinpro or MI Paste on the inside of the retainer before going to sleep. 
•  If they are not wearing the Essix during sleep, the instructions are the same but to wear the Essix for up to an hour every evening before removing it to go to sleep. 

If the patient’s caries risk is high, I prefer using 10% carbamide peroxide gel instead of Clinpro or MI Paste. This is the active ingredient we us in perio trays to help prevent gingivitis. This is also the means by which patients can whiten their teeth while wearing an Essix retainer. 

To prevent damage to the Essix, instruct patients to rinse it with cold water and, when not wearing it, to store it in the provided container.  

The original owner of our practice recently retired.

Although he had been planning on retiring and a new associate had been identified by both of us months in advance, this transition was very profound and stressful for the entire team. So, with a long term game plan in place, we began the transition between associates. It became evident that each individual within the practice was struggling with this change in their own unique way. Supporting others through change became my part-time passion.

While some team members were engaged in the process, no one was fully comfortable with the transition to this unknown “new practice.”

We had 1.5 years of an office atmosphere that was taking us to this destination with new team members that we did not fully know. We were wondering if it was going to be an office environment with which each person would want to identify. Thankfully, one of the values that binds us—education, came into play in a positive fashion.

In recent years, our team has attended continuing education together, locally.

However, it has been a long-time goal of mine to travel greater distances with the team. Coincidentally, The Pankey Institute unveiled the first Pankey Learning Group for hygienists. The effect that this had on my practice has been amazing thus far.

Although I offered the opportunity to the entire hygiene department, only one hygienist chose to attend.

She attends this learning group, and it has been meaningful to her personally and professionally. She has become highly engaged with her patients, and while leadership and gratitude had not been her most prominent attributes in the past, they certainly are now.

Upon her return, she begins to pull the rest of the team enthusiastically through this transition that embraces a new associate and has us enthusiastically embracing our new unknown. This one hygienist has been embedded in my leadership for twelve years, and now it turns out she has always been absorbing my vision and philosophy. She just needed a little bit of investment from me to become a leader within the team.

The value of having a team member learn, from the colleagues who have helped frame my personal and professional growth, has been priceless.

With more education planned for each of my team members at The Pankey Institute, I am thinking this will be the foundation for a cohesive group of similarly minded professionals working together to provide the best comprehensive dental care for our community.

It’s important to consider your hygienists as autonomous skilled professionals independent from your management. Of course, as the leader you must provide guidance, but you should still defer to their training in their specific field.

A Hygienist’s Expertise

This is one of the hardest parts about managing a team – letting go of the reigns a little. But you don’t have to entertain a free for all to provide some freedom. If a hygienist has made it clear to you that they have both clinical and behavioral skills, then it’s your job to open up a dialogue.

You should discuss with them what you will individually bring to an exam. Find out what they feel comfortable recognizing and diagnosing, that way you can both be on the same page. Don’t rely on the antiquated belief that hygienists only know how to recognize. They are also fully capable of diagnostic techniques.

In hygiene school, they will have thoroughly reviewed the signs and symptoms of multiple conditions. But for them, their education tends toward directing them to call the problem to the dentist’s attention.

The key to all of this is to only offer advice in your area of expertise. That goes for both hygienists and dentists. As with most things, individuals vary. Dentists and hygienists will have different qualifications, therefore providing different perspectives in the practice. No matter our level, we must offer our opinions as opinions and be willing to listen to the thoughts of others.

Diagnosing versus recognizing comes down to semantics, while both are very different from the actual treatment planning designed by the clinician. It’s a hygienist’s responsibility to serve the patient’s needs to the best of their ability based on their skill level and judgement.

What do you consider a hygienist’s purview in the dental practice? We’d like to know what you think! 

Hygienists make up a huge component of a dental practice’s atmosphere and productivity. You should be devoting plenty of time to understanding their motivations as well as your own. Even better, you should actively consider how best to support them.

Supporting New Hygienists

One obvious instance of support a dentist can provide occurs with the dental hygienist who is fresh out of school. Hiring someone new to the field confers pros and cons. The biggest upside is that you can mold them to your preferences. But in that upside lies a heavy burden: You must be willing to guide their learning and influence their patient care.

A hygienist who is very new to either your practice or dentistry itself needs plenty of time to become oriented. You can support them by seeing all of their patients for a while and completing an extremely thorough exam. This will ensure both the hygienist and patient get the most out of the experience.

Take steps like:

1. Ensure all deposits that can be removed are removed.
2. Observe the gingiva and determine if prophylaxis has caused as little trauma as possible.
3. Measure pocket depths to calibrate the hygienists readings to yours.
4. Look closely for decay and provide an opportunity for the hygienist to feel the signs of disease that you do.
5. Check for wear or breakdown and teach both patient and hygienist how to see it.
6. Carry out an oral cancer exam and clarify what is cause for concern.
7. Point out what draws your attention on an x-ray.
8. Finally, make any diagnostics you offer into a learning experience for both the patient and the hygienist.

Once you feel comfortable that your hygienist is appropriately skilled, you must open lines of communication surrounding who handles what responsibilities.

How do you bring new hygienists into your practice culture? Please let me know! 

How you help patients become healthier in your practice is a big question. That’s even more true when the role of your hygienists is unclear. The best method of serving patients well can become hazy due to procedural problems that have nothing much to do with care.

Hygienists in the Dental Practice

For example, there is some confusion over the relationship between the insurance company, dentist, and hygienist. Essentially, what level of care are hygienists allowed to handle and why? This brings up multiple concerns such as their ability to diagnose, who the patient wants to hear recommendations from, and how a periodic exam is charged.

The only way to figure out the right answers to these areas of interest is to take a hard look at your individual dental practice. There is no one perfect solution, no size fits all. You have to decide what is appropriate based on your relationship to hygienists on your team as well as their skill and knowledge levels.

Who Does What?

Clarity is a great motivator. When people understand their purpose, they are better able to carry it out well. The only way you can have clarity around the role of hygienists that will then seep over to them is to separate the expectations you feel bound by from what you actually think is best.

Taking the time to consider the big picture of your practice can go a long way. You can only maximize all the personnel resources at your disposal, including a hygienist’s communication skills, technical knowledge, personal perspective, and time, if you know why you’ve hired them in the first place.

First, determine where a hygienist’s value fits into your practice. What clinical service is your best and what behavioral service is your best? Most importantly: Who provides these services and why?

Where do hygienists fit into your dental practice? Give me a shout in the comments below!

Time is a major priority in the thriving dental practice. Balancing the need for comprehensive care with the efficiency necessary to get everything done in a day is a serious challenge. When it comes to periodontal assessments, the numbers today shockingly still show that a majority of offices are not routinely completing a perio exam.

It doesn’t have to be that way!

Implement a Quick Perio Screening

Consider making your life a lot easier while still improving patient care by offering periodontal screenings. An efficient screening that divides the mouth into scored sextants shouldn’t take more than a minute or two.

Your hygienists will appreciate the opportunity to show off their probing skills. They will be able to help patients recognize the signs of gingivitis and periodontal inflammation that may have gone unnoticed otherwise. If the patient scores high enough, then that will necessitate a full-mouth periodontal exam that includes full mouth probing furcation scoring and measuring muco-gingival attachment loss and recession.

This simple addition can lead to more dentistry in your practice and therefore higher production. That’s a boon for both patients and dentists, as the former improves their health and the latter is able to offer more complex treatment.

Periodontal disease is a sneaky, pervasive issue that can be detrimental to a patient’s entire health. Systemic diseases like atherosclerosis and diabetes have been associated with periodontitis. Gingivitis, while reversible, can still be exceedingly unpleasant and eventually lead to worsening periodontal health.

The way your hygienist educates patients about periodontal disease contributes to how patients understand the screening’s purpose. The hygienist must make it clear that you are checking for gingivitis and periodontitis because they can lead to pain and tooth loss. This would require much more invasive care in the long run.

Get our take on dental esthetics by reading this awesome Pankey blog here. Do you carry out perio screenings in your practice? We’re dying to know more, don’t be a stranger!

There are many reasons to continually think about how you can add more value to patient appointments. First and foremost, though returning patients want to feel comfortable, they will also appreciate small beneficial changes when they visit.

Value is the number one motivator that will keep patients coming in regularly on time without missing appointments. If being at your practice is particularly enjoyable, they’ll be excited to keep their commitment to regular recall appointments. Additionally, if you provide expanded health services, you’ll be elevating your hygiene appointments to another level.

Here’s a value add that’s easy to implement and good for patients:

Hygiene Boost: Taking Blood Pressure

Many patients may see their hygienist more often than their regular physician. That’s why taking their blood pressure at the start of an appointment is so beneficial. Blood pressure can tell you a lot about the state of their general health.

Patients may be surprised at the result gathered from the blood pressure cuff. If it reveals seriously high blood pressure, a recommendation to a physician may be necessary. The hygienist should explain that your practice takes this additional measure so that you can truly provide comprehensive care. It’s part of your thorough screening process, including periodontal assessments and oral cancer screenings.

Your hygienists will also appreciate being able to provide this extra touch of healthcare. They could really be making a difference for someone who had no idea they were experiencing an issue. Most importantly, it’s another relatively inexpensive way to show patients they are cared for. The entire process should take less than two minutes.

For more Pankey fun, check out this blog on our favorite places to eat Cuban food here. The next time you’re in Key Biscayne, you won’t be able to resist.

What add-on services do you provide during hygiene appointments? We’d love to hear your good ideas!

Dentists can feel like they have to do everything and decide everything in the dental practice. After all those years of training, hard work, and practice, it’s no surprise we take the lead.

But even only five years into practicing, doing everything and always being the expert can get pretty exhausting. You may want to provide exceptional care, but you can’t be everywhere at once. That’s when it’s time to start taking on more of a mentorship role with your team members.

Leaning On Your Hygienists and Assistants

If you’ve developed a positive, collaborative practice culture, you’ll likely be surprised by how many of the people you employ jump at the opportunity to learn more and embrace more responsibilities. Some might seem hesitant, but likely this stems not from disinterest but from not wanting to disappoint or threaten their position by messing up.

You actually can’t and shouldn’t do it all. First and foremost, rely on your team to fill in some of the gaps of kindness/emotion/consideration that you may not be able to fill as easily if your schedule is packed. Even if you can’t hear about the patient’s life story, someone on the team should be making an effort to get to know them more personally.

Hygienists and assistants can be trained for many specialties you might not even be aware they are allowed to perform. They can handle impressions, facebows, photographs, sealants, whitening, and oral hygiene instructions and make lucia jigs, quicksplints, and provisionals.

That’s no small amount of tasks. Think of all the time you could save by entrusting more to team members who may already feel complacent in their work. You’ll end up fostering a more engaged working environment.

How do you lean on your dental assistants and hygienists? We’d love to know your tips and tricks!

During an occlusion-focused hygiene exam, there are certain things the hygienist should pinpoint. This will help them develop a deeper relationship with the patient as well.

A Hygiene + Occlusion Exam

What the hygienist should look for:

1. “Can you eat/drink cold things comfortably?”
2. Subtle wear facets – those shiny spots on the edges of teeth.
3. Chipping of the edges of teeth. Can you get the patient to line up an incisal “chip” with a sharp edge of a lower front tooth?
4. Fremitis – that subtle shimmying of an upper front tooth when you gently place your fingernail on the facial of a maxillary incisor and ask the patient to grind side-to-side and front-to-back.
5. NCCL – could that be from clenching or orthodontic expansion? Both/and?
6. Persistent marginal inflammation that could be a sign of clenching (or an imbalanced bite).

The hygienist’s role is to raise patient awareness –  to “discover” changes that can be brought to the doctor’s attention for long-term protection of the patient’s teeth.

The doctor’s arrival for an exam is the time that real skill and teamwork begins. The hygienist takes the lead and informs the doctor what they (hygienist and patient together) have been discovering/discussing.

Many times, the most significant questions come when I am behind and feeling rushed. Our goal, practiced for years, is for me to get in and out of the hygiene room in under 5 minutes. Therefore, our total goal together is to encourage the patient to schedule another appointment for a more thorough evaluation of any changes/discoveries.

The hygienist then supports and reassures the patient about the need for a more thorough understanding to protect their teeth and eating for a lifetime. They confirm the uniqueness of a full understanding of teeth, harmonizing bite forces, and oral-systemic health and well-being.

“This is what sets our office apart. Together we strive for the best in your total oral health prevention.”

A well-thought-out and choreographed hygiene appointment can truly establish you in the relationship-based sector of dental care.

Dentistry is rapidly segmenting into two distinct professions.

One will be what most patients think of as traditional dentistry. The tooth fixer and cleaner. The technician. These dental offices will focus on bits and pieces of treatment to get full insurance dollars from each patient each year. The staff will likely also be fragmented by tasks.

The other profession will be the doctor of the oral-health system. The valued family advisor on health and wellness. As Pankey-trained dental offices, we are well positioned to become the relationship-based advocates for our patients’ health.

Training Your Team to Advocate for Patient Health

How about your team? Have you put in the time to train and behaviorally change your most valued support?

A most important person in that team approach is the hygienist. Are they having conversations about total health? Social conversations don’t lead to behavior change that improves the health awareness of our valued patients.

Again, as Pankey-trained dentists, our hygienists can have a huge impact on our patients’ perception of our unique thoroughness. Occlusal awareness should be part of hygiene discovery about their health.

Bringing Up Occlusion in the Hygiene Appointment

This can involve simple questions: What have you been noticing about your bite? Chewing? Jaw? Headaches? “What have you been noticing about [fill in the blank]…?” can begin a discussion.

Depending on the conversation, one can follow with: “We are noticing that, as people live longer (keep their teeth longer), we see things slowly develop that can lead to big concerns. In our office, our purpose is unique – we want you to be able to enjoy eating all the foods you love the remainder of your life. I will look at potentially traumatic bite forces for you.”

How do you introduce occlusion in your hygiene exams? Let us know in the comments!