Dental Practice Solutions

Optimize your dental hygiene department by taking an integrated, team approach

  • Do you feel like you are working hard and your production is not increasing?
  • Do you feel like your hygiene department is under performing?
  • Is your hygiene department producing 25-30% of your total production?
  • Are hygienists in your office treating bloody prophys?
  • Does your hygiene department help enroll implant cases and high-end treatment?
  • Do you have one or more holes in your schedule daily?

I am so happy that you are here because we have answers and solutions to your challenges.

Dental Practice Solutions - Debbie Bittke

3 Steps to Create Efficient and Profitable Doctor/Hygiene Exams

By: Debbie

June 25, 2014

Microsoft Word - TiME MANAGEMENT.doc

Do you feel stressed knowing there is going to be a patient exam in the hygiene room? Are you concerned the exam is only going to keep you waiting and running behind? Do you wish this process could be quicker yet more effective? As a practice management consultant, this is one of the most common complaints I receive from hygienist’s and doctors.

The hygienist’s tell me doctor keeps them waiting. Some hygienists tell me that doctor chit-chats for what seems like 20 minutes. They tell me “doctor wants to talk about my patient’s personal life and I don’t have time for this.”

The doctor tells me that when they get to the hygiene room there has been no conversation about the patient’s teeth. They say that when they arrive to do the hygiene exam there is no conversation –nada. They tell me their hygienist says nothing when they enter to complete the exam. Some doctors, who have never met the patient, don’t even get a proper introduction to the patient. BTW: Doctor should at least say a brief “Hello” to all new patients before any services begin. AND… doctor will be known as THE EXPERT and very well respected if he or she can let the new patient know they are making an individual diagnosis for a specific type of x-rays before hygiene treatment begins. This makes new patients really feel like they are King or Queen, like they are a VIP. This is only one-way to gain Raving Fans for the life of the dental practice! Continue reading to learn the 3 steps to create efficient and profitable doctor/hygiene exams.

Doctor 1st visit knee to knee

Step 1 is to create a strategic plan for the exam.

Break up every routine prophylaxis and periodontal maintenance appointment into three areas. These three areas (Shown in the photo above) are: 1) data collection 2) case presentation and 3) the hygiene treatment and doctor exam.

Step 2 is discovery and explanation.

Before the data collection, decide what you must know to treat your patient at the highest level of care. Much of your information needs to be pre-determined prior to the patient’s arrival.

Every hygienist should take time at the very beginning of their day – before the morning team huddle (usually about 10-15 minutes prior to the morning team huddle a chart audit should be completed by the hygienist), to review all patient charts, patient routing slips, previous x-rays, previous chart notes, etc. It is important to understand each patient’s current oral health/systemic health status, past dental and medical history, etc., before the patient arrives.

When the hygienist reviews each hygiene patients chart they will check to see if the patient needs to complete a new health history (It works best if you anticipate the need for a new health history prior to the patient’s arrival). The hygienist needs to be aware of patient’s medications; including herbs, vitamins, and even OTC medications that the patient is currently taking.

Once the patient is seated in the chair spend a few minutes (no longer than 5 minutes) reviewing the patients up-to-date medical history, asking if the patient is taking any new medications. Other important questions to ask are if they have had any recent hospitalizations, surgeries, etc., etc. All providers need to ask these medical history questions prior to beginning any treatment. Always review the chart before the patient has arrived for their appointment and understand if they have previously diagnosed treatment that is still unscheduled.

Are there other family members who are overdue for a hygiene appointment? The routing slip (if set up properly in your computer software) can provide valuable patient and family information. This is valuable patient and family information for the hygienist to report on at the morning team huddle. Also the hygienist will report on any outstanding treatment that needs to be scheduled at the morning team huddle (email our office for a morning huddle protocol you can use).

Once the patient has arrived for their appointment you will inquire if they have a chief complaint. Take blood pressure annually, and record in the patient’s chart. Refer patients to their physician if they appear to have a blood pressure that is not within normal limits. You will be saving a few lives when you discover patients who have need to see their physician and have their blood pressure checked by their physician. Many patients return to future hygiene appointments now taking blood pressure medication that would have gone undiagnosed if a dental professional did not stop to check this. This is a great way to be a hero in your patients mind!

Ask all patients: “Do you ever experience a dry mouth?” (Indicates they are at high risk for caries or at least need a rinse for dry mouth, etc.) Ask about frequent headaches, clicking of their jaw or if they have pain in their jaw (A possible sign they may need a night guard).

Annually complete an oral cancer exam using the latest technology to screen for any precancerous lesions (ViziLite, VELscope, IDENTIFI, etc. can identify a precancerous lesion versus look or palpate and find a lesion that may already be malignant). Oral cancer is on the rise due to HPV in young adults. (Read some of the research: Many insurance companies now pay for this important screening annually.

It is very important to annually provide a full-mouth periodontal screening exam. This will include a six-point probing along with documentation of recession, bleeding points, mucogingival involvement, furcations, mobility, suppuration, etc. When you explain to the patient (before you begin the exam), about the numbers you will be calling out, you will have the patient involved with their treatment, Begin by explaining what the range of numbers mean: health or disease. Always explain this before you pick up a probe or recline the patient back to begin your screenings.

Involve the patient by asking them to listen for the highest and lowest number you will call out. Let patients know that once you are done with the exam you will sit them up in the chair and ask them to report back to you the lowest and highest number they heard you call out. This will help patients to become involved in their treatment plan.

Explanation before reclining patients back in the chair, as well as sitting them up to explain your findings, will help you to establish great rapport with your patients. In return this will help to get the patients buy-in to schedule and pay for treatment in the very near future.

If you do not have another team member available to write down the periodontal probing while the hygienist calls out the numbers, use a recorder to talk into and later go back, listen to your probe readings, and you can quickly document in the patient’s chart. This may take a little more time but the benefits to the patient and practice are huge!

Before the patient arrives you should know if they need bitewings or a full mouth series of x-rays. In fact, the chart audit by the hygienist that morning should only be to double check to be certain that everything in the patients chart and on the schedule are correct. Usually patients will be pre-scheduled for future x-rays before the end of their current hygiene appointment (Don’t wait until the day of the patient’s appointment to decide what x-rays they need).

Step 3 is complete the doctor exam sooner than later.

There is no need for doctor to wait until the end of the hygiene appointment to complete the hygiene patient exam. At approximately thirty five to forty-five minutes into the sixty minute hygiene exam, doctor’s assistant should be able to give doctor a nudge to move into the hygiene treatment room and complete the hygiene patient exam. The assistants should have a timer or be aware of the time on a clock so they can lead doctor to the appropriate rooms at the best time.

The hygienist does not need to get up or stop what he (or she) is doing to notify doctor about a hygiene exam. Having doctor arrive at a specific time frame during the hygiene appointment to complete the exam should be standard procedure for every routine hygiene preventive care appointment. If there is a change in the patient’s planned treatment, then the hygienist can notify doctor or the assistant of this change and adjust the hygiene patient exam as necessary.

As a Dental Practice Management Consultant, I have worked with hundreds of offices who use this doctor/hygiene exam protocol and it has been a great tool to de-stress many hygienists and doctors. It also creates thousands of happy patients who feel like they are provided optimal care without having to sit and wait for doctor.

Using this strategic plan for Doctor/Hygiene exams will create a stress-free day for the entire team and your patients will leave your office feeling like you are the world’s best dental provider. This plan will create efficient and profitable doctor/hygiene exams.

Want more RAVING FANS?

Here is a little secret tip to decrease anxiety and the dreadful fear of the dental office: Wait to put on the patient bib until you have reviewed the patient’s health history and have explained the treatment you will provide. Now you are ready to put on the patient bib and recline them back in the chair. Sit down when speaking to your patients. Face the patient: knee-to-knee and eye-to-eye. Watch how this will create a more positive patient-experience. You patient’s may not notice what is different about their experience in your office because this is just a subtle change in the way things are usually done in the dental office. This also leaves patients feeling like you really care about them!

Would you like more ways to increase profits in your dental hygiene department? Get your complimentary subscription to our weekly Dental Profits Newsletter. You will also receive our 7 Day Dental Hygiene Profit Tips when you do subscribe here:


Debbie Seidel-Bittke, RDH, BS, is founder of Dental Practice Solutions, a full-service dental consulting, coaching, and speaking business, focused on increasing profitability through your dental hygiene department systems and services. Dental Practice Solutions will guide you and your team to provide a profitable, patient-centered dental practice that is team driven not micro-managed. Email or call Debbie to schedule a complimentary look at your profit potential. Ms. Seidel-Bittke, can be reached by email at: or by phone: 503-970-1122. Website: