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?

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Dental Practice Solutions - Debbie Bittke

Your Doctor/Hygiene Exam Science Project

By: Debbie

July 16, 2013

Male dentist assistant and patient

Dentistry has experienced many changes these past ten years. The economy is a lot different and the way we will deliver our treatment recommendations to our patients also needs to change today.

The dental hygienist has a big influence on how and when patients will accept treatment.

In addition, the entire dental team must rely on advanced communication skills to improve case acceptance. The dental hygienist plays a very important role in case acceptance for comprehensive care.

Let’s take this apart and study this system for the doctor/dental hygiene exam and how it can affect case acceptance. Doctor needs to write down how he/she wants this to be streamlined to create highly effective case acceptance. Role-play with your team using scripts and practice this system until you have it down perfectly.

 The Doctor/Dental Hygiene Exam

The doctor/dental hygiene exam is highly effective when there is a specific format for delivering the information: 1st from the hygienist to the patient and 2nd the delivery from hygienist to doctor while your patient is present in the treatment room.

Often times the doctor enters to complete a patient exam and it is rush-rush. Either the hygienist is running behind, maybe the hygienist has been waiting ten minutes for doctor to complete the exam and in addition, the patient may be stressed because they need to leave to return back to work, etc.

At Dental Practice Solutions we recommend a specific method for determining when doctor will complete an exam. The doctor should never wait until the end of a dental hygiene appointment to complete an exam.

When the doctor enters the treatment room, the computer monitor should show images of the teeth, showing calculus, plaque, BOP, fractured restorations, etc.

The dental hygienist also needs to have the most recent radiographs available for doctor to view when completing the exam.

Here is a scenario of how this exam process will be completed:

The dental hygienist needs to have written notes to herself/himself about what they discovered with the patient. Now the doctor and hygienist will have a specific flow to the exam conversation. (This is your roadmap)

Doctor only needs a quick “Hello, how are you Mr. XYZ?” For a patient of record there does not need to be a lot of conversation. Anything over 2 minutes is too long!

The hygienist can begin reporting to doctor with a quick personal update.


Hygienist:“Dr. Goodtooth, Mr. Dundee’s son is getting married this summer!”

Doctor: “Congratulations! I remember when Matt was only six years old! How can it be that he is getting married?!”

Hygienist: “Dr. Goodtooth, today I reviewed Mr. XYZ’s health history and there are no changes. I took his blood pressure and it was 100/70. We completed an oral cancer screening with the ORALID®. That was negative. Mr. XYZ told me that he wants to have whiter teeth for his son’s wedding. We talked about completing those implants and before you complete those he wants to do the whitening of his teeth. I told Mr. XYZ that you would like to have the annual x-rays next time we see him in 6 months. His pocket depths were all within normal limits and there was no bleeding today. We talked about him using the Sonicare and he may buy one next time he is here.”

Doctor: Nods in agreement and says something like “Ok, or ah-huh.”

When the hygienist is finished with her/his verbal report doctor can begin to expound on the necessary treatment.

Before the patient leaves the treatment room the hygienist will schedule Mr. XYZ’s next hygiene appointment.


Patient’s usually need to hear something new about three times before they are able to fully comprehend their treatment needs. Now they can attempt to make a decision to schedule and pay for treatment.

Imagine we are speaking Greek to them! They have no clue what these funny sounding words mean!

Do not attempt to discuss payment options or schedule the treatment until the patient has confirmed they understand the diagnosis.

Three Verbal Communication Opportunities

When the patient has a new condition that needs treatment it is helpful if you can talk about this three different times during this appointment. The 1st time is when the hygienist completes her or his assessments and discovers the need for treatment. At this point in time the hygienist will co-diagnose the area(s) of concern with the patient seated upright in the dental chair.

The 2nd time the patient will hear about the condition in their oral cavity is when the hygienist reports to the doctor.

The 3rd time with be at the front desk with the treatment coordinator.


Always have patients stop off at the front desk before they leave the dental office. Patient’s should always be escorted to the front desk and the dental hygienist or other auxiliary will report to the treatment coordinator or another auxiliary at the front desk, what was completed at today’s appointment and what will the next appointment be scheduled for. If the patient was scheduled in the back office treatment room, this needs to be reported when the auxiliary is speaking to the treatment coordinator at the front desk.

When patients are left to wander out of the office without a team member escorting them, appointments will many times go unscheduled and/or payment is often not received the day services are rendered.


As a Dental Practice Management Consultant, I always recommend that you create scripts for all communication that routinely occurs. If you are talking to a new patient on the phone or maybe you are talking to a patient of record about a recent diagnosis, script out these various scenarios and role-play with your team. Role-play these various opportunities and create solutions to overcome patient objections and discover how to work in harmony as a team. Effective communication is key!

This should be an ongoing process. Learn how to understand the various ways your different patients communicate and learn how to respond to these various personality and communication styles.


Not every patient will accept your treatment recommendations the 1st time a patient is informed of a diagnosis. Many larger cases, above $2,000.00 USD  may take three follow up attempts to finally have patient schedule for treatment.

This means that the dental hygienist plays an important role in follow up each time they see the patient.


There is a very systematic, scientific way to complete an effective doctor/dental hygiene exam.

This process really does need to be practiced until you have it down to a science.

Write scripts for everything that is said in your office between the team and patients. Always take time to role-play with the team. Practice until you make it perfect.

If you want to dig deeper into this topic Dental Practice Solutions has a one-of-a-kind 30 Day Dental Hygiene Profits Program which spends 3 Days of the 30 days on this topic of the doctor/hygiene exam. You can find more information about this program here: READ MORE

About Debbie

ME not too high jpeg

Debbie Seidel-Bittke, RDH, BS, is founder of Dental Practice Solutions and for over 20 years she has been committed to creating a dental hygiene department that works enthusiastically, creating a high performance teams, improving patients’ total health and consistent profits to the dental practice.

She is an author for journals such as Dentistry Today, HygieneTown and RDH. Debbie speaks internationally about systems and services in the dental hygiene department to create a team that works like a well-oiled machine,  improving the total health of patients’, utilizing the most recent science to prevent disease and consistently increase profits.

In 1984 she graduated from USC in Los Angeles in with a Bachelors Degree in Dental Hygiene. She is a former clinical assistant professor from USC. In 2000-2002 Debbie co-taught the practice management course for the dental students. Debbie is also a former dental hygiene program director for a school in Portland, Oregon where she wrote the accreditation, hired the instructors, purchased all the equipment, worked with project managers on the building of the school while managing a 2 million dollar budget.

Debbie works with dental practices throughout the world and is considered a leader in creating consistent profits to a dental practice through services and systems in the dental hygiene department.