Do You Love Your Dental Hygienist?

If you're a health care provider—and dentists in particular—your hygienists are probably an essential part of your care.

I'm a periodontist, and a lot of my periodontal colleagues don’t love their hygienists. They find them an annoyance, a disruption. They think they have to check their patients for them. They say they have different personalities.

In our practice, we have a pretty busy office with three periodontists and five dental hygienists. That’s a lot of people! However, we work together as a team to keep our patients healthy.

I learned a long time ago, in school and in my residency programs—and the literature tells us very clearly—that periodontal surgery without follow-up care and good hygiene is pretty much worthless.

Why Maintenance Matters

Doing bone grafting, implant surgery, and other sophisticated procedures is great for patients, but if we can’t keep them healthy, it’s pretty much a waste of our time.

Most people who need these treatments—whether it's periodontal surgery, implant placement, bone grafting, or extractions—have lost their teeth because of poor hygiene.

It’s imperative that they keep their hygiene at an excellent, very high level if we’re going to maintain their health for years to come.

The Problem with Preventive Care

It’s always irked me a little that in our health care system, we don’t really practice preventive maintenance. We give it lip service. Insurance companies don’t reimburse doctors for giving good advice.

If you give hygiene instructions in a dental office—teaching patients how to brush and floss—you’re really not compensated for that.

It’s the same in a physician’s office. If you talk to a patient about their diet and exercise, you’re not really compensated.

But if you need bypass surgery because of coronary artery disease, your chest gets split open for a 2- or 3-hour surgery, and you have to recuperate. Very rarely are these patients truly taught how to eat properly or exercise properly.

They might have a little cardiac rehab, but are they really taught to do HIIT training or the necessary things to get all their muscles in great shape and increase their VO2 max?

Does anyone monitor their sleep? Talk about mindfulness or decreasing stress?

The Foundations of Health

Probably the most important things to get people healthy are to eat properly, exercise daily, decrease stress, and improve sleep. But we’re rarely taught that, because providers aren’t compensated for it.

In a periodontal practice or any dental practice, the most important aspect of care is oral hygiene instruction: brushing, flossing, and getting your teeth cleaned every 3, 4, 5, or 6 months depending on your risk for periodontal disease and decay.

There are 8 billion people in the world. Out of those 8 billion, over 3 billion have oral diseases. It’s the biggest epidemic in the world—oral disease, including periodontal disease and caries.

Yet we don’t spend enough time talking to patients about that.

My Role as a Periodontist

I’m a periodontist. I don’t do fillings, treat decay, or do crowns.

What I do is treat periodontal disease. I help people get healthy through scaling, root planing, periodontal surgery, bone grafting, extractions, implants, and so on.

However, many of my patients come in with very poor hygiene and often have decay along with periodontal disease.

All of these patients are put into a program.

The Diet History Program

Every patient receives a diet history form. It’s a 4-day program where they write down everything they eat.

They send it back to me as a PDF or fax it in, and I review their diet.

Often I find hidden sugar in their meals they weren’t aware of. Most patients don’t realize sugar leads to caries.

Within 20 seconds of eating something sweet, bacteria can turn that sugar into acid. It doesn’t take long to go through glycolysis, and that acid leads to decay.

Coaching for Better Health

I coach my patients on how to improve their diet.

I also place them on fluoride and make sure they have proper hygiene instructions. I refer them to a dentist for caries control.

We have a six-part program—based on guidelines from the American Dental Association—that teaches exactly how to control someone’s caries.

Yet very few dentists talk to patients about preventive health.

Preventive Care in Dentistry

As a periodontist, we’re taught to tell people to brush, floss, and come in every 3 months.

As a restorative dentist, you’re not always taught to put people on an anti-caries program.

We tend to give it lip service but don’t really do it.

Yes, we fluoridated the water—and now that’s under siege. Removing fluoride will likely increase caries rates. That’s a whole separate topic.

The Role of the Dental Hygienist

It’s incumbent on all of us as health care professionals to teach our patients.

Education is the most important part of our practice. It’s done by me, my dental assistants, and most importantly, our dental hygienists.

The dental hygiene room is one of the most important rooms in our practice. That’s where prevention happens.

When I walk into the hygiene room, I don’t want to be looking for gold nuggets of restorative or periodontal treatment. I want to see healthy patients.

If I don’t see a healthy patient in that hygiene room, one of two things happened: either I didn’t do my job educating and motivating them, or they didn’t care.

Setting Expectations with Patients

Every new patient in our practice gets this message at the initial visit.

If they’re going to go through treatment, they have to commit to getting their teeth cleaned every 3 to 4 months.

If they don’t make that commitment, my treatment will fail.

The literature is resplendent with articles, dating back to the 1960s and 70s, on the importance of long-term maintenance to keep teeth healthy.

Don’t Lose the Opportunity to Educate

It’s a golden opportunity for all of us to educate our patients about the importance of dental hygiene.

If you’re a physician, it’s equally important to talk about preventive care in all aspects of medicine and health.

You know the old expression: “If I knew I was going to live this long, I would have taken better care of myself.”

My average new patient is 65. At 65, they come in with severe periodontal disease and decay.

They didn’t expect to be in my office for 30, 40, or 50 years after their 30s—but that’s how they arrive: broken.

If they’d been educated earlier, they wouldn’t be here.

Treating People Not Patients

Don’t lose that opportunity to educate your patients.

Be the gift to them—and be the gift to your dental hygienist, too. They’re probably the most important employee in your office.

Have a great day, everyone. And remember: Treating People Not Patients and Be the Gift.