The Doctor’s Role in Keeping Hygiene ON TIME

By Rachel Wall, BS

In a world of daily schedules and dozens of appointments, we live and die by the clock. Nothing is more frustrating for everyone on the team than chronically running behind and making patients wait. While you and your administrative team may feel that this is the hygiene team’s problem, there are some specific things YOU can do to help keep them running on time. The truth is, your hygiene team is probably just as frustrated with this as you are. So why not get to the root of the problem once and for all?

Let’s face it; we’re not dealing with widgets that move along the production line without a fuss. We’re dealing with actual human beings who can be unpredictable and whose needs can change with little notice.

In all of my work with thousands of dental professionals through coaching and speaking, I am convinced that the number one reason for running behind is that your hygienists are stuck in the “Prophy Trap”. There’s much more going on in a successful hygiene program than just simple prophy appointments.


  • Your hygienists habitually run behind
  • Most hygiene appointments are scheduled as prophy appointments, and few scaling and root planning appointments are on the books.
  • You often see there has been bleeding during the prophy. This is a clear indicator that the patient may be in need of more extensive perio therapy rather than a simply prophy or “maintenance” appointment.
  • Your hygienist complains about pain or physical fatigue from scaling. Again, it may be time to speak with your hygiene team about a more comprehensive approach to your patients’ oral health.
  • Your hygiene department is not profitable. This may be an indicator that it’s time to confirm that you’re billing for the types of services that are actually being performed.
  • Many of your patients are on a 3-month prophy recall

Dental teams often ask ‘what should take place during a hygiene visit?’ If you breakdown the 60 minute appointment into 20 minute increments, the time is used like this:’

20 MINUTES — Hygiene Exam and data collection (perio charting, oral cancer exam, x-rays, review of restorative needs, medical history review and patient concerns, photos)

20 MINUTES — Scaling and Polishing

20 MINUTES — Doc Exam and room turnover, schedule next appointment

If your hygienist spends much more than 20-25 minutes on scaling and polishing, it’s likely the patient needs something other than a prophy.
If during a 60-minute prophy appointment, 45 minutes are spent on scaling, your patient is clearly in need of more than a simple prophy. In this situation, there’s also little time left for restorative and/or perio co-diagnosis, documentation, complete perio charting and other critical components of a complete hygiene evaluation. To give your patients the care they need, it’s important that they’re being scheduled for the appropriate treatment and with adequate time to get the job done!


1. The first step is to determine whether you’re stuck in the Prophy Trap. One way to do that is to determine your perio percentage. If it’s below 20%, chances are you and your team may be under diagnosing perio in new and existing patients. Pair that with lots of heavy scaling during prophies or more than 20-25 minutes of scaling and you’re in a risky position where your hygienist may be doing SRP but calling it a prophy. To determine your perio percentage, go to to download an easy to use tool to determine your percentage in 5 minutes or less.

2. Next, give your hygiene team the tools they need to get out of the Prophy Trap. Whether this is hiring a consultant or taking a continuing education course or virtual training, it’s critical to develop a clear, written plan for determining when patients are indeed healthy and when they need to move into some other type of treatment.

3. The third step is to give your hygienists enough time. If your hygiene appointments are 45 minutes rather than 60, your hygienist now has 25 minutes to do the complete hygiene exam and squeeze in the doctor exam. Inevitably, things get left out and the prophy quickly becomes the primary objective for the visit. Not determining health or disease, not enrolling in restorative treatment, not utilizing adjunct services…just the prophy. And you have to perform a lot of prophies to be productive.

If your hygienist starts scaling 4-5min after seating the patient and/or dismisses the patient early, chances are there is no clear system for a complete hygiene exam and co-diagnosis. When hygienists have the luxury of a 60minute template, if they don’t use it, they may lose it.

Finally, give your hygienist permission to call for the doctor exam as soon as they finish their data collection. So as soon as they complete the hygiene exam and BEFORE they pick up a scaler, they should call and let you know they’re ready. This means you can do the exam at any time during the remainder of that appointment. No more waiting until the last minute, often resulting in a mad rush to get through the exam. And also give them permission to call you again if needed within 10-15 minutes of the end of the exam.

Your hygiene team is an extremely valuable part of the overall experience and connection your patients feel towards your practice. Give them the tools that result in a lifetime of health for your team, your patients and your practice.

As owner of Inspired Hygiene, Rachel helps dentists tap into hygiene’s profit potential. In addition to coaching, Rachel draws from her 20 years of experience as a hygienist and practice administrator to deliver to-the-point articles and speaking programs. She has spoken across the country including RDH Under One Roof, the AACD annual session and the popular The Profitable Dentist seminar in Destin, FL. Rachel has written for and been featured in numerous industry journals as well. Inspired Hygiene’s programs include in-office coaching, a free weekly e-zine, the Hygiene Profits Mastermind group and the new Profitable Perio Online Workshop. Inspired Hygiene is the preferred hygiene coaching group for the Productive Dentist Academy and a corporate partner with Philips Sonicare. To contact Rachel, email her at [email protected] or call her at 877-237-7230.

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