How can dental practices move beyond the ‘scale and polish’ mindset

The addition of further skills and flexibility around the Hygienist and Therapist scope of practice has seen this role transform into one that can become the supporting foundations of a well-run business. There are, however, still a number of practices who continue to see their Hygienist or Therapist as a ‘tooth cleaner’ – rarely moving beyond scheduling 30minute appointments for 30 minutes of cleaning, reinforcing to the patient the unfortunate message that it is somebody else’s responsibility to keep their teeth clean and healthy. 

There are a widely varying number of different ways a hygiene or therapy department can be set up within practice, but the overall ways can be roughly split into four models:

Models:

S&P Only

·      Predominantly works with NHS

·      Relies on GDP to provide more in-depth treatment and referrals 

·      Limits treatment success due to time constraints and staff/patient understanding of hygiene treatment 

 

This predominantly out-dated model hails from a time before Hygienists had extended duties and responsibilities.

When considering Periodontal treatment the onus was solely on the dentist to provide complex periodontal treatment and trends in litigation are beginning to demonstrate that often the treatment was limited or seen as secondary to treatment of the hard tissue dentition. 

Practices still working to this model are sometimes stuck in a loop of seeing patients with longstanding periodontal inflammation not treated in accordance with the BSP guidelines - often as the Hygiene diaries are full to bursting with short appointments and little scope to expand.  Conversely some are empty with a lack of interest in seeing the Hygienist due to lack of support from the rest of the team. 

The fix to this issue is to re think the hygienist appointment types, to introduce a periodontal protocol which involves the GDP focusing on educating the patient, and planning comprehensive treatment with the Hygienist. This may mean blocking out sections of the Hygiene diary in order to make space for these sessions. In the long run these patients continue with their regular hygiene maintenance but with healthier, more treatable mouths and longer lasting dentitions. 

 

Full scope Hygiene – GDP referral based

·       Gives freedom to follow a protocol for treating perio – better outcomes overall with emphasis on patient education from all team members 

·      Allows for further treatment planning on Hygienist prescription 

·      Brings further revenue in the form of fluoride applications, fissure sealants, suture removal and restoration adjustments

·      Additional Digital Scanning opportunity can be a cost effective way of promoting patient education and discussing cosmetic treatments 

·      Hygiene Diary is more flexible and will free up time in GDP diary by removing  small treatments from GDP 

Most progressive Dental Hygienists are working toward the above model whereby they are able to work to their full scope.  The Periodontal treatment planning is carried out by either the Hygienist or the GDP, the Hygienist is also able to maximize their daily profit by providing additional treatment such as fissure sealants or whitening treatments. 

The GDP diary has no reflection of a change - but the patients are accessing comprehensive evidence based periodontal treatment and additional treatments are available with the hygienist such as whitening and fissure seals. This reduces surgery time spent on these treatments for the GDP and allows for more free space in the GDP diary for more profitable complex treatment.

Hygienists can also be equipped with digital scanners in order to record patients dentitions, help to monitor soft tissue movements and tooth wear and also promote the conversation around orthodontic work, replacing worn or leaking fillings and to educate patients on their own dental health. 

 

Full scope Therapy –under GDP referral

 

·      As Full scope Hygiene but with additional scope of Therapists

·      Frees up GDP diary for Large restorations, Extractions crowns and Dentures 

·      Can work well in NHS practice if all Band II is referred to Therapist 

 

Often seen more in the North of England, the Therapist is slowly but surely becoming more popular in Primary Care Dental Settings.  Traditionally Therapists were only permitted to work in Hospital settings but as legislation changed in 2002 and Therapists were allowed to work to prescription of a Dentist in Practice. The situation improved further when in 2013 Direct Access was approved for Dental Therapists and Dental Hygienists. 

By adding the services of a Full Scope Therapist to the Dental practice, you free up time for the GDP to concentrate on the larger and more complex restorative cases. This works especially well with GDPs who have further training in Implant placement, or have a special interest in complex restorative cases. The Therapist is on hand to provide the Class I-V restorations, Whitening, Impressions and Periodontal treatment, they can also be utilised when treatment planning complex cases, taking impressions once the Periodontal condition is stable and generally condensing the GDP diary into check-ups and complex treatments only.  The Therapist has time with the patient to reinforce what the Dentist has suggested and talk through any concerns or different questions the patient has. The Therapist may also suggest further cosmetic improvements that have not been covered by the consultation and leave the conversation open for the GDP to pick up. 

Therapist Led

•      Potential for excellent multidisciplinary approach if more than one Therapist works alongside GDP. 

•      Treatment coordination and referral time reduced for GDP

Realistically this may need a seismic shift in understanding within the dental Team, but is an entirely possible model when working with a well-trained and integrated team members. 

When you move toward a Therapist led model you can start to really see a benefit in multidisciplinary working. If there are multiple Therapists working alongside a GDP, in a close working relationship the Therapist can take over the Routine Check-ups, allowing the GDP more time for case planning and high profit treatments. With more than one Therapist working alongside a GDP the diaries can be arranged for the GDP to oversee treatment plans and pop in to the Therapist check-ups in order to review and agree any complex treatment required.  The model requires exceptional team working and communication but ultimately reduces lone working and gives patients a phenomenally efficient service. 

This model works best under the Direct Access arrangement. 

·      Can be a good additional stream of revenue for Hygienist / Therapist Diary

·      Excellent practice building potential 

There is also a softer way of integrating the Therapist led model, by means of GDP initial consultations for new patients, and Therapists undertaking the routine examinations thereafter. The GDP is still referred to for complex treatment planning, and makes themselves very visible during the Therapist appointment in order to maintain the relationship with the patient and demonstrate a well-integrated and approachable team.

 

There is a ingrained sense of uncertainty in some Dental Surgeries around utilising their Hygienists full skill set or the Therapists full scope. Often because the diary management hasn’t changed for many years or the previous person in that role was not trained in additional skills later added to the Scope of Practice.  Practices ought to take the lead from their Hygienists and Therapists, exploring together the ideal set up and ways to make that happen. The additional revenue, patient contact and patient care can be an invaluable addition to a successful business, and a happy team.