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April 28, 2025 14 mins

Dental practice owners across the country face a mounting challenge—skyrocketing hygienist wages that strain traditional production-focused models. But what if obsessing over hourly production metrics is actually holding your practice back from its true potential?

In this transformative episode, I reveal why the real value of your hygiene department extends far beyond cleaning teeth and covering overhead. Your hygienists aren't just maintenance workers—they're relationship architects creating memorable patient experiences, treatment acceptance facilitators preparing patients for necessary care, and health consultants offering solutions that improve lives.

When patients spend 40-60 minutes with your hygienists but only 2-5 minutes with you as the doctor, those hygiene appointments become the defining experience of your practice. Patients form their strongest impressions and build their trusting relationships during hygiene visits. The loyalty this creates drives retention and word-of-mouth referrals that no marketing campaign can match.

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Transcript

Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
with dental hygienist wages being higher than ever,
we as the practice owners aresometimes sitting there saying,
oh my gosh, how do I make thismodel work?
And we're wondering am I givingmy hygienist too much time?
Should I shorten the times thatI'm paying them so much and are
they producing enough?
And that's what came uprecently in our last online
mastermind meeting on the dphhero collective.

(00:23):
We had somebody asked they werestarting a practice.
They said, hey, I'm about toopen a practice.
I wanna make sure that I startwith the right appointment times
as far as recalls, srps and newpatients go.
Because he didn't want to givehis hygienist too much time
because it would be hard to takeaway.
But then again he didn't wannagive them insufficient time.
So he asked the group and wediscussed it and what I noticed

(00:50):
is that most dentists theyreally think the hygiene
department is all about crankingout cleanings, covering the
hygienist wages and making surethat there's enough production
so that it makes sense.
And we're entering an era whereit's starting to not make as
much sense in that regard.
But what if I told you thatthat mindset is actually holding
your practice back?
Today I'm going to break downthe real high-level function of
the hygiene department and how,when you see it differently, it

(01:14):
can transform your patientloyalty, your treatment
acceptance and even your profits.
Let's get into it Now.
You are listening to the DentalPractice Heroes podcast, where
we teach dentists how to workless, earn more and build
practices that run themselves.
I'm your host, dr Paul Etchison.
I'm the author of two books ondental practice management and a

(01:35):
dentist who more or less wentfrom burnout to building a
multi-million dollar practicewhile working just one clinical
day each week now.
So if you want more time, moreincome and more life outside of
your dental practice, you are inthe right place.
I think the true value of thehygiene department it's just not
in profitable appointments.
It's so much deeper than that.
It comes in those non-tangibles.

(01:56):
It's so easy for us to look atdollar per hour production of a
hygienist and say this hygienistis worth it to the practice,
this hygienist is making aprofit, and I think we're
completely missing the big point.
Although they are a revenuecenter, I want you to really
look a different way about whatthe goals of the hygiene

(02:17):
department are and when I lookat them, I think it's so
important for them to create anunforgettable patient experience
and that really builds loyaltyand referrals with your patients
.
I want them to set the stageand tee up the doctors to
diagnose and get bettertreatment acceptance.
Think about how poor treatmentacceptance is in dentistry and
if you can improve that a littlebit, that is much more valuable

(02:41):
to practice than them seeing anextra patient a day so they can
get one extra prophyon.
And, lastly, they are there toimprove the patient health by
offering meaningful adjunctservices, things that the
patients need, that they mightnot know about and things that
the patients can really benefitfrom if somebody offers it to
them.
So let's talk about this.
Let's talk about your hygienedepartment really providing an

(03:03):
experience for your patients.
Now we've got to realize thathygienists, they're going to
spend the most time out ofanybody else at your practice
with the patients.
For the most part, mostpatients, patients that come in
as new patients.
They might have a few fillings,maybe a crown to do, and then
they're going to go into thehygiene recall system and
they're going to see thehygienist and guess what?
You as the doc, you're going topop in there for like two to

(03:26):
five minutes and all yourfriends are going to tell you
man, you don't even do anythingat the practice.
I mean, the hygienist does allthe work and then you just pop
in there for like two minutesbecause they think that you know
you're not doing anything.
You're just sitting in youroffice farting around on the
internet.
They don't realize that you'reover in your operatories and
you're producing two thirds ofthe revenue of the office.
So the patients are going toassociate how their dental

(03:48):
experience is so much more withthe hygienist than they are with
you.
So we need to pay attention tothis and we need to make this a
focus of our office.
A great hygienist is going tobe friendly.
They're going to be personal.
They're going to make thatpatient feel cared for.
They're going to make them feelknown and understood.
So this is all thesecommunication skills they need.

(04:09):
They need to be good listeners,they need to be good
communicators and when you cancreate a hygiene patient
experience that makes thepatient feel all those things,
you're going to get betterpatient retention, you're going
to have more word of mouthreferrals and you're going to
have more patients feelingcomfortable because they trust
you and like you, which leads tothem saying yes.
So the hygienists aren't justcleaning teeth, they're building

(04:31):
brand loyalty.
So what do we do to help them dothis?
Well, first we need to have ourteam keeping relational notes.
This is somewhere in the chart.
I can tell you where we put itin our charts.
In Open Dental we put it in thecom log.
I don't think it's the bestplace for it.
In Open Dental I think there'sa little ortho chart that we
don't use on hygiene patients.
That would be such a perfectplace to put it in.

(04:51):
But my team has fought me onthat tooth and nail and I've
decided that is not a hill Iwant to die on.
So we keep it in the com log,but check out that ortho chart
in.
So you got to make sure thatthey're keeping those notes so
that when the patient comes inthey remember things about them.
Did they go to Vegas?
Do they watch their grandkids?

(05:12):
Because the fact of the matteris, you might have people on
your team that remember everyone of your patients.
I know you have one, I havesome too, but for me, I'm never
going to remember that stuff.
So we keep notes on the patientbecause we want them to feel
valued and there's nothingshallow about that at all.
I remember back when I was indental school, I saw a new eye
doctor.
I went, I saw him one time andI didn't go back there for

(05:35):
probably like three years.
Now.
When I came back there for mysecond visit three years later,
he came in and he was like hey,paul, he's like, oh my gosh,
last time I saw you, you, and Iknew that there was somewhere
written in the chart that I wasin dental school.
There's no way this guyremembered me.
It was a total uneventfulappointment.

(05:56):
I hadn't seen him in threeyears.
I wasn't going there my wholelife.
But it didn't matter to me.
The fact that they took theeffort and they made those notes
because they wanted to providean experience.
That's what mattered to me wasthe intention behind it.
I didn't care that if I saw himat the store he would have said
, hey, paul, you must be adentist now.

(06:16):
He probably wouldn't evenrecognize me.
So it is part of the patientexperience.
We've got to keep those notes.
So we've got to make surethat's part of our culture.
All right, now the hygienist Italked about.
They need to tee up treatment.
This is like one of the mostimportant things they can do for
you, because, if you thinkabout it, they are like that
unbiased person that's going totell the patient what they need.

(06:37):
There is this view withpatients and it's awful, but
it's true they feel likedentists are out there to rip
them off.
I don't know, I'm sure thereare dentists that actually do
that.
I think it's such a smallpercentage and I think a lot of
us get blamed for things likethat and we don't really do that
.
But the fact of the matter isis that's part of the psyche of
the patient?

(06:57):
They think that we might bemaking things up that they don't
need because we got to pay forour boat or pay for our vacation
house, stuff like that.
So we want the hygienist to bethe first opinion.
They are going to spend 40minutes or so doing the prophy,
taking x-rays, takingdiagnostics, and it's kind of
weird if they see all thesethings in the patient's mouth

(07:18):
and they don't say anything.
And then you, as the dentist,walk in and say, hey, you've got
all these issues.
The patient's sitting therelike, hmm, why didn't the
hygienist mention any of it?
And then what do they do?
When you walk out of the room,they look at your hygienist and
they say do I really need allthat stuff?
It happens every time.
Ask your hygiene team.
You want your hygienist, whenthey're doing the prophy, when
they're doing the diagnostics,to look at the teeth and say you

(07:42):
know what?
This tooth's got a crack in it.
And they tell explain what thecrack is, explain why it's a
problem, and say the doctor mayrecommend a crown on this tooth.
Or you know what?
See this on your x-ray, thisdark area here, this kind of
looks like this might be somedecay.
We'll see what doctor saysabout it, but you might need a
filling.
There it's.
They don't have to diagnosebecause legally they can't
diagnose, but they can at leastbe the first opinion for the

(08:05):
patient.
So how do we do this with ourteam?
We have two things we have todo with our hygienists.
First, we got to give them theblessing.
We got to say hey, this is howI want my practice to operate.
I want you to be the firstopinion.
I want you to be able to becomfortable talking to the
patients about treatment.
Okay, that's the first step.
The second step is you've gotto do calibration meetings.

(08:26):
So that means you've got to sitdown with your hygiene team and
you've got to go through casesand say this is what I'm looking
for, this is how I diagnose,this is my treatment philosophy
and this is how I explain it topatients.
Because when you get everybodyon your team on the same page,
you're all recommending the samethings.
And now you're a team that isworking for the best good of the

(08:49):
patient.
And let me be honest with youYou're hygienists.
They don't want to sit thereand just scrape teeth all day.
They want to play a more activerole in the patient's health.
So give that to them.
Ask them if they're comfortabledoing that.
If they're not comfortabledoing that, work with them until
they are, because if they areuncomfortable doing it, it's
because they just need trainingand they don't feel confident in

(09:11):
what they're seeing.
But that can change, just likeit changed for you when you
showed up for dental school.
You didn't know crap and Iguarantee you it doesn't take
four years of dental school tobe able to diagnose problems in
teeth.
Oh, do you see this hole inhere?
It's all sticky and soft.
That's probably a cavite.
You, as the doctor, you want tobe the closer, not the cold

(09:34):
caller.
Okay, so you need to work withyour team.
Got to do this case calibrationmeetings with your hygiene team
, all right, at the beginning ofthis episode we talked about
how, when this person wastalking in our online mastermind
meeting, which, if you'reinterested, it's the DPH Hero
Collective.
It's a very low monthly rateand you can find out more about
that at dentalpracticeheroescom.
But this person was asking howmuch time should I give, because

(09:55):
I want to make sure that I'mstill profitable with my
hygienist.
Now, the third thing that'simportant for the hygiene
department is that they're notjust maintenance workers.
They're health consultants.
They are there to help thepatients.
So they are there to monitorthe patient's perio to make sure
they're getting all the rightdiagnostics on a schedule that
you determine.
What kind of x-rays do you wantevery year?

(10:16):
So these are things that you'llestablish with your hygiene
team, but they're responsible tomake sure that you're not
missing it, like they're yourbackstop, to make sure that
we're doing the best thing forthe patients, because you, as
the owner doctor, you've got alot to juggle, so they're there
for that.
They are there to recommendfluoride topical fluoride for
anyone who is high caries risk,to do laser gum therapy for
anyone who's got perio risk orjust some inflammation, some

(10:39):
gingivitis.
They are there to talk aboutadjuncts like PerioProtect, talk
about rinses that you can offer.
Maybe some desensitizers talkabout a night guard for somebody
who's bruxing.
They are there to serve thepatient and help them have the
best dental health.
They can Now guess what thisbenefits everyone.
Right, this benefits thepatients.
They get healthier outcomes.
It benefits the hygienistbecause they feel like they're

(11:02):
improving lives, not justscraping teeth.
They are feeling like they'remaking a difference.
And, lastly, it benefits thepractice because it builds
additional revenue ethically.
So I said that we're notfocusing on what they're
producing, but this is anopportunity for them to really
produce when they're offeringadditional treatments that can
be done in the hygiene chair.
To me, that's a very differentthing than shortening

(11:23):
appointment times so they cansee more people.
No hygienist wants to shortenappointment times to see more
people.
They want to be able to spendenough time so that they can
serve the patient because, let'sface it, guys, that's what
we're doing in dentistry we'reserving.
So hygiene not just aboutproduction goals, it's not about
seeing enough patients tooffset their salary.

(11:44):
It's about buildingrelationships, providing a
patient experience, teeing upcase acceptance and offering
better health solutions for ourpatients.
So, coming back to what wetalked about and this person was
asking, I will share with youwhat we do as far as times at my
office.
We do 60 minutes for a recall,we do 90 minutes for a new
patient and we do 90 minutes fortwo quads of SRP.

(12:06):
That is what we have settled on.
We used to have less time, butwe added more time when COVID
happened because we hadadditional protocols and what we
discovered serendipitously,when we gave the hygienist more
time, they had more time to talkwith the patients, to build
relationships, to talk abouttreatment and to offer other
products that the patient couldbenefit from.
This is all material from ouronline training, our seven-phase

(12:29):
OmniPractice program that wehave online.
This is part of phase threeteaching your hygiene department
how to do all these things andgiving them the training that
they need.
Check that out,dentalpracticeheroescom, if
you're looking to build a betterpractice that has systems and
is profitable and teaches youhow to set it up in a way that
you can take more time off.
Go check that out.
I know you'll be really happywith it.

(12:50):
So this week when you're doinga hygiene check, I want you to
ask yourself did this patienthave an experience or just an
appointment?
Which was it and what can youimprove on?
Involve your hygiene team, geta discussion going, start
talking about it and create thebest patient experience that
serves your patients, unlike anyother office in your community.

(13:11):
Thank you so much for listeningand we will talk to you next
time.
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