March 22, 2024
by Gabriele Maycher, CEO, GEM Dental Experts Inc. BSc, PID, dip DH, RDH: 


As a dental hygienist, I’m finding it harder to provide comprehensive care due to time constraints stemming from my dentist’s actions. Prolonged examination periods during an hour-long appointment, sudden requests for extensive pre-authorizations, and other delays like showing up at the end of the clients appointment are making it difficult to attend to client needs. What should I do?


On some days, balancing it all is tough! And you’re right to be concerned about consistent appointment delays. They impact client satisfaction, strain team dynamics, and lead to suboptimal billing practices. To navigate these complexities effectively, implementing strategic solutions becomes imperative and requires a multifaceted approach.

For starters, sit down with your dentist and discuss your concerns. If you don’t already have established protocols for appointment scheduling and preauthorization requests, discuss a system that will help streamline workflow and minimize disruptions. But the truth is, when a dentist takes longer than five minutes to conduct a recall exam, it’s not unusual for hygienists get frustrated. With this premise in mind, here are some protocols I’ve implemented in the practices I work with:

Get the dentist in early. As soon as the client’s radiographs are taken, promptly invite the dentist to conduct the examination. Exams should ideally occur at the beginning of the appointment, allowing the hygienist ample time to adjust treatment accordingly. In the event of unforeseen circumstances causing delays, the dentist should communicate this with the hygienist so that the exam can be conducted in another room or rescheduled. Such occurrences should be rare.

Don’t rush your pre-authorizations. During the exam, if extensive treatment requires pre-authorization, the client should be scheduled for a follow-up appointment. This allows sufficient time to gather necessary radiographs and information to develop a comprehensive treatment plan. Pre-authorization for extensive treatment should never be performed at the end of a hygiene appointment, as it disrupts workflow, compromises client care, and doesn’t provide sufficient time to discuss planned treatment and costs.

Don’t treat a COE as a recall. If a client hasn’t had a recall appointment in more than two years, the office policy should dictate scheduling additional time for a comprehensive oral exam. If additional time alternatively is not scheduled, the hygienist should inform the client that the dentist will only conduct a quick examination and schedule him or her for a more extensive evaluation either as a stand-alone appointment or as part of a future restorative appointment. It’s essential to adhere to the five-minute rule for routine exams to ensure efficiency and maintain client satisfaction. By implementing these protocols, we can streamline operations, optimize client care, and uphold professional standards while mitigating stress and ethical concerns for the hygienist.

Get your information exchange down pat. I find it extremely frustrating when the dentist comes in and repeats the same questions or conversation that the hygienist just had with the client. Establishing an office policy on how and what information is exchanged between the hygienist and dentist is essential to prevent redundancy and ensure efficient use of time. A structured dialogue can serve as a helpful tool in this process (see dialogue guideline example).

Keep chitchat to a minimum. When the dentist/hygienist ask clients generic questions like, “How are you today?” you may be opening the door to a negative or lengthy conversation that could completely derail your appointment. Instead, when the dentist enters the room for an exam, they should tailor the greeting to acknowledge the client’s presence and redirect the conversation to the hygienist for an exchange of pertinent information regarding the client’s needs.

Be flexible. When you welcome new clients to the practice (and have extended scheduled time), the five-minute rule for examinations can be modified. This adjustment allows the dentist to engage in more dialogue, fostering a deeper understanding of the client’s needs and building trust. Given that approximately 95% of clients exhibit some level of periodontal disease and are likely to return for followup appointments, the extended time allocation becomes justified. This additional time facilitates thorough assessments and comprehensive discussions, ensuring that new clients receive the personalized attention necessary from both the hygienist and dentist for optimal care.

Ask for feedback. Finally, maintaining a client-centered approach remains paramount. Continuously seeking feedback from clients about their experience and promptly addressing any concerns demonstrates our unwavering commitment to providing quality care. By proactively addressing challenges and fostering a collaborative environment, we can effectively navigate these complexities while upholding the highest professional standards and ethical integrity.

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