February 3, 2020
Creating the Ultimate Doctor Hygiene Exam

Hygienists serve the entire population in every dental office and it’s one of the reasons why we see patients saying “yes” to their dental needs. A typical exam “in the good-old days” used to look like: Doctor comes in and says hi to the patient and catches up on the latest camping trip taken with the kiddos. The dentist then would take a look at the X-rays and see if there was any new decay and let the patient know what needed to be done. There is much to be gained and learned from these past experiences. The number one reason why case acceptance was high had little to do with the equipment, facility, or hours. It had everything to do with the experience. Competition can be fierce or so it may seem to many. The reality is the practices that are successful are the ones that have created powerful distinctions by living their word and vision with patients.

Let’s consider one of the most valuable tools in bringing both depth (committed patients) and width (new patients) to the practice: The Ultimate Doctor Hygiene Exam. If every patient is touched or connected to the practice through the hygiene exam, then a serious look at that process is extremely important. The 20/20/20 rule is an excellent guide in bringing case acceptance to 85%, up from an average is 25%.

The 20/20/20 Rule

The first 20 minutes of every hygiene visit should be dedicated to getting to know your patient and updating all diagnostics. Consider how it would feel if you were greeted by name with a warm handshake before being escorted back to the operatory. The number one value patients seek in dental care is trust. The real power of influence comes from knowing your patients and it starts with a simple smile and handshake. As a hygienist, I know we are not allowed to make a diagnosis but we certainly can share our concerns.

After we have built a relationship the rest of the first 20 minutes should be a time in gathering diagnostics. Creating value comes from receiving more than what is paid for in services. We can create value by developing a co-discovery relationship. For example, while using the intra-oral camera a hygienist could say, “Mrs. Jones, I’d like to show you a picture of your tooth on the upper right side. It has a large silver filling that appears to be breaking down around the edges. I know Dr. Smith is going to be concerned about this area, as well. The bacteria that is found in our mouths are sneaky little creatures that will creep into those areas and often times we will find decay around those margins. Has that tooth had any sensitivity that you are aware of?” If they say no, you can then follow up with “That’s a good sign that we have caught this early and you are not experiencing any pain.” Having the hygienist take an active role in pre-framing possible treatment by uncovering concerns is an important part of the Ultimate Doctor Hygiene Exam.

The second 20 minutes is the called the window of opportunity to see the results you want in creating value for recommended treatment. The traditional model has the doctor coming in the last five minutes of the hygiene visit for the exam. Too often, there is a diagnosis but the patient is ready to get on with their day and is, therefore, less likely to make a commitment to care. By simply moving up the time to complete the exam during the second 20 minutes allows:

  • Time for the patient to ask questions
  • The doctor does not feel rushed and knows the hygienist has already pre-framed the patient for possible care
  • The hygienist stays on time and does not run late for their next patient
  • Case acceptance significantly improves
  • The administrative team has time to prepare an estimate without the patient being present and becoming impatient
  • The process becomes seamless and the patient’s experience is greatly improved

The hand-off takes place when the doctor comes in for the exam, has had a few minutes to visit with the patient, and then askes the hygienist “Susie, what have you and the patient been visiting about?” Now is the time for the hygienist to shine. They will let the doctor know of any changes in the medical history and what their findings and concerns are. Be sure to include any periodontal concerns. There is a good rule of thumb; a patient needs to hear something seven times in seven different ways to truly understand and feel good about committing to treatment. This can be accomplished through the co-discovery process and the hand-off. We want patients to be a part of the choice for their dental care. Perfecting the hand-off process allows patients to hear why the diagnosis is important and gives them time to make a commitment.

The final 20 minutes is to finish the hygienist visit, schedule the patient’s next recare appointment, and answer questions relating to the recommended treatment. To avoid “I only want what my insurance covers,” it’s important to have the patient’s commitment in the hygiene room before the handing them off to the treatment coordinator.

Discover and discuss ways to implement the 20/20/20 rule and then measure the results by monitoring your case acceptance.

If you would like to have sample scripts for the hygiene exam please reach out to Deanna Goodrich at


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