Home Practice ManagementManagementHygiene Management The Shortened Hygiene Appointment Myth

The Shortened Hygiene Appointment Myth

by Wendy Briggs

If you are thinking of shortening your hygiene appointment times – DON’T

Many dentists have been told that the solution to increasing hygiene production is to shorten appointments. Many Hygienists are now asked to provide world-class services in just 30, 40, or 45 minute appointment times. The shortening of appointment times is an adaptive strategy designed to drive revenue by increasing volume.

Increasing patient encounters usually equals an increase in production. However, it might also equal less referrals from existing patients, and an increase in broken appointments.

I understand the desire to see an increase in hygiene productivity – it’s what we preach daily – but especially because in many practices hygiene is still seen as the "The Loss Leader."

Hygiene services are offered at a discounted rate in the hopes of attracting new patients. Then once the new patient is in the chair for the discounted hygiene service, the hope that they accept restorative services – which will then help the practice to grow.

While this strategy was effective in the past, all the changes in dental insurance and the need to participate in varying levels of PPO’s, the reduction in reimbursements from the insurance companies have impacted in a powerful way the profitability of dental practices. The key to the success of this strategy, was dependent on the patient returning for restorative care.

The flaw in this structure is that it is impossible to provide a world-class level of care in hygiene in a 45 minute or less appointment time. I have even seen practices that expect the hygienist to do everything for a preventive care visit in just 30 minutes without an assistant.

For many hygienists, even experienced and talented practitioners, getting everything done well in a 30 minute appointment time is next to impossible. Providing a positive patient experience and completing the standard of care in this amount of time is just not realistic.

In my opinion this is like expecting a molar root canal and crown preparation to be done in 30 minutes. With even highly skilled dentists, there are too many steps to be done during the process to accomplish everything and still have an acceptable quality root canal and crown when finished.

While this example is not entirely accurate, as we are comparing apples and oranges, the concept of trying to provide quality in an unreasonably short time frame is similar.

Sadly, there are many practice management consultants working within dentistry today that advocate for shortening hygiene appointments to impractical lengths. Interestingly enough, many of these consultants are not clinicians, and therefore have never attempted to treat a patient in this shortened time period. Besides the impossibility of completing hygiene tasks, we can’t forget that restorative dentistry coming from hygiene is a vital component of success in that strategy. There is literally NO TIME to discuss restorative care in these short appointments either.

With all of this being said, a change to hygiene is needed. The current model of losing revenue in hygiene is not sustainable. My experience would suggest that the strategy of quantity over quality is flawed. I prefer an adaptive strategy that focuses on complete care. I have found that there are 3 benefits that the practice experiences when they focus on quality over quantity:

1. A more productive visit resulting in higher overall hygiene revenue: By providing hygienists with enhanced systems and just a little more time with each patient they can be far more productive and profitable than you would see with a shortened appointment time.

For example, one system that I use with patients and that I teach to all my private clients is to use a Caries Risk Assessment brochure with every patient. This visual tool helps the patient understand what their risk status is and what preventative measures would minimize their risk going forward. This one tool is also the springboard for conversations regarding preventative services.

When time isn’t given to use this tool we lose a valuable way to "sell" services through education instead of sounding like a used car salesman.

When we are able to add preventative services during the visit I have seen providers easily add $6,000-$8,000 on average each month. Some do far better than that!

2. A reduction in cancellations, no-shows, and open time in the hygiene schedule because of the value built for future appointments: If all we schedule is 30-minute appointments – and we run around like our hair is on fire, still unable to get everything done – we fail to build value for future hygiene appointments. It’s impossible to provide an impressive patient experience in just 30 minutes.

We can’t use technology that the patients rave about.

These tools are impressive; Intra-oral cameras, oral cancer detection devices, or cavity-detecting lasers.

These tools also help drive patient acceptance for restorative procedures and when they are not used, we see a decline in doctor production as well because case acceptance starts in the hygiene chair.

When the risk assessment, and other valuable preventive services are not completed, it becomes very difficult to overcome the perception that this is “just another cleaning.” If we are focused on providing worldclass level care, we’ve seen higher commitment from patients. They understand why future visits are important to their overall health and become partners in the process.

3. An increase in referrals to the practice due to the exceptional experience and personalized care: Our clients strive to see more than 50% of their new patients coming from patient referrals. If we focus on providing exceptional experiences and personalizing care for each patient, we often see a spike in patients willing to make a recommendation to friends and family. When the patient experience is poor, referrals drop. This trend is unfortunate, because the strategy of shortening appointments is designed to drive practice growth. But we’ve seen the long-term effects of this provide the opposite result.

When striving to increase revenue, be careful not to choose strategies that provide a negative patient experience. The good news is that we have proven that you don’t need to shorten appointment times in order to increase productivity. Embracing systems that help hygienists maximize their roles with patient services have been far more effective. I am all about finding more effective ways to increase productivity, but we shouldn’t be willing to sacrifice patient care for increased revenue.

Even in today’s unique challenges including PPO’s, it’s just not necessary. You can provide a higher level of patient care and increase productivity.

For more on Hygiene Productivity and how you can double production, we have made 100 copies of our newest book “The Ultimate Guide To Doubling Your Dental Practice Production” Free for readers of the Profitable Dentist. They will be available at www. DoubleProductionToday.com while supplies last.


If you have a specific question or hygiene-related topic you would like Wendy to address, please contact her at:


Wendy Briggs is the co-founder of The Team Training Institute. She is a registered Dental Hygienist with more than 25 years of experience. For the last 15 years she has taken her unique skills in doubling hygiene production directly to the practices. She has consulted with more than 3,718 dental practices in 12 countries. Hygiene is her passion… and exploding productivity, case acceptance, and profits are her areas of expertise.

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