Home Issues2023 OSH Issue An Oral Systemic View from the Hygienist’s Chair 

An Oral Systemic View from the Hygienist’s Chair 

by Machelle Hudson

To successfully integrate any new treatment protocol into a dental practice, it is important to first establish “why” the decision was made. This is a critical first in gaining the support and trust of your team, the people responsible for making any new initiative successful. This is no different when deciding to expand oral treatment to focus on the entire patient’s health. 

Fortunately, most practice owners have discovered that creating a culture focused on the overall health of their patient engages their team and leads to more varied and profitable treatment plans, with a dramatically higher acceptance rate. 

While the goal of all healthcare providers is to help patients remain healthy, or treating those presenting with preventable disease, dentistry and medicine have always had an invisible barrier between them. Dental education, whether dental or hygiene programs, did not extend beyond the mouth, and medical school education focused entirely on a “chief complaint” strategy of care. Only now are dental and medical schools realizing the interconnectedness of disciplines and dabbling in adding curriculum on how they collaborate. 

Over many years in the dental industry, I saw firsthand how a patient-focused impacted both the patient retention rated, patient engagement in their treatment, and the profitability of any dentist-owned practice. When I first learned about the movement to establish The Academy of Oral Systemic Health (AAOSH), I could not join fast enough, and have never looked back. 

As a RDH, I began to start conversations with patients and was amazed by how many questions they had and how they responded when we discussed their overall health. I learned all I could about oral systemic health/connections, behavioral counseling and health coaching, and the power of including the patient in their diagnosis and treatment. Very quickly, I saw health outcomes improve, patient retention increase, and case acceptance rates climb. All because I changed how I engaged the patient. 

As a RDH, I began to start conversations with patients and was amazed by how many questions they had and how they responded when we discussed their overall health. I learned all I could about oral systemic health/connections, behavioral counseling and health coaching, and the power of including the patient in their diagnosis and treatment. Very quickly, I saw health outcomes improve, patient retention increase, and case acceptance rates climb. All because I changed how I engaged the patient. 

What I discovered was, the more I learned to release responsibility for the patient’s disease state, educate them on risk factors and hand the responsibility to them, the more productive our relationship became. Once they felt I genuinely cared about their overall health, was able to communicate real risks and solutions, and listened, they began to see their visit as so much more than a simple semi-annual check-up, and I felt excited to be doing so much more than just probing and polishing.  

Naturally, when my production began to increase dramatically, the doctor wanted me to teach the entire team how I did it. My first hurdle was to convince them that an oral systemic health focus was not simply some gimmick for the doctor(s) to make more money. It was not! 

I have since learned that, before the team learns to embrace co-diagnosis and help build confidence in the oral systemic protocol, it is critical for the doctor to become educated and lead the program. An oral systemic approach to patient care is not something that can be taught in a lunch-and-learn and implemented in an afternoon. To be successful, it must include the entire team, and be core to the practice culture. Once that happens, and everybody is on the same page, a sort of transformation takes place with positive team attitudes, patient engagement, and a new, vibrant treatment routine develops.  

To begin the oral systemic journey, education is key. Not only clinical, but communication skills are critical, so the entire team is speaking the same language. In a sense, we are re-educating our patients to see us differently, and to take a proactive role in their own care.  

My consulting company routinely takes teams that average between 7 and 10% perio patients, and by implementing the “How Skills” increase treatment acceptance to over 50%. We also teach techniques for airway screening and see average production growth of over 35%. When teams are empowered, filled with education and purpose, and they collaborate with their patient’s health concerns, the enthusiasm and motivation to do more becomes palpable in the practice, and the doctor discovers the unrealized treatment that has been hiding in the existing patient base. 

The CDC reports that slightly less than half of patients over the age of 30 and 70% over 65 have some degree of periodontal disease. If we include gingivitis, between 85-90% of patients fall into the group. That means, most dental practices are simply babysitting periodontal disease.  

While patient care is paramount, we cannot ignore the need to operate a practice profitably. Here are some projections do demonstrate how an oral systemic protocol can impact profitability. 

  • Perio codes measured as a % of total patients is less than 10% 
  • 1,500 patients a year: 150 Perio treatments at $160 = $24,000 perio revenue 
  • Perio codes measured as a % of total patients is less than 20% 
  • 1,500 patients a year: 300 Perio treatments at $160 = $48,000 perio revenue 
  • Perio codes measured as a % of total patients is greater than 30% 
  • 1,500 patients a year: 450 Perio treatments at $160 = $72,000 perio revenue ($48K Delta) 
  • Perio codes measured as a % of total patients is greater than 50% 
  • 1,500 patients a year: 750 Perio treatments at $160 = $120,000 perio revenue ($96K Delta) 

These numbers are merely examples of perio code increases alone. By including HbA1C testing at $20, with a 50% margin, a practice can realize $10,400 profit annually. HbA1C is recommended on all at risk patients and all perio and implant patients. 

For practices using lasers, oral systemic hygienists will bill $60 per patient, using all perio codes, including gingivitis. If utilized 3x per day that results in $180 per day per hygienist. If the practice has three hygienists working 4 days per week, this equates to $112,320 per year in additional billing.  

Salivary diagnostics are routinely part of the oral systemic protocol, and the ideal way to connect the mouth to the entire body. Once the team is up to speed on reading and presenting results, this becomes the part of the visits patients look forward to most. Again, in a three-hygienist practice, this results in over $31,200 in profit, and patients love the update on their health. 

All totaled, these simple, adjunctive procedures would add $175,000 to the average practice profit, in addition to the perio numbers above, while increasing patient health, patient retention, team attitude, and all without adding a single new patient.  

So, the big question is, where to begin?  

For me, finding the American Academy of Oral Systemic Health was a godsend. Not only did I find the education and science I needed to begin building patient relationships and help grow the practice, but I found a new family in the dental world I love. 

AAOSH has helped me learn how to better communicate oral systemic health with patients and to also feel confident collaborating with medical professionals. It feels good to have peers from both dental and medical worlds working hard to bring all of healthcare together to learn how to work together to help our patients get healthy.  

Let us not forget that only 2.7% of the United States healthcare expenditure is spent on prevention. It is time we all come together and learn to prioritize prevention. It is also ok to be profitable when practicing this amazing elevated ethical standard of care we are creating.   

Please join us as we pave the road to the future of dentistry!

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Machelle Hudson

Machell Hudson, RDH, FAAOSH is the founder and CEO of Integrative Dental Coaching. She is a proud and passionate fellow and member of the prestigious board for The American Academy for Oral and Systemic Health. Her newest accolade is being invited to sit on the education committee for Women in DSO. Because of her love for patient care she continues to practice clinical hygiene while also speaking and consulting with an expertise in oral-systemic connections and protocol implementation. She is a graduate of the Bale/Doneen method preceptorship which is advanced training in arterial disease with a focus on heart attack, stroke and diabetes prevention, Kois trained in periodontal health and a health coach. Machell cherishes time with her family and friends and a big part of her heart is spent volunteering for Unbound advocating and speaking on Human Trafficking Awareness.

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