How to effectively collaborate with a hygiene assistant

When many hygienists hear “assisted hygiene," they run away like their hair’s on fire. We must bust some myths before we implement the assisted hygiene model. One myth is that assisted hygiene means accelerated hygiene. These are not interchangeable. Accelerated hygiene is not assisted hygiene.¹ Another myth is that assisted hygiene is used to increase speed or see more patients. Even though part of this may be true, assisted hygiene is not about increasing the speed of care.¹

Assisted hygiene is a coordinated effort with an assistant in order to work more efficiently.¹ Traditionally, as hygienists, we’re trained to do everything ourselves. This includes set up, review patient record, seat and greet patient, blood pressure, review and update medical history, oral cancer screening, expose radiographs, identify dental concerns, oral hygiene instruction, behavioral modifications, determine dental needs, periodontal charting, preventive or periodontal therapies, dental exam assistance, dispense oral hygiene aids, relate concerns to doctor, fluoride treatments, sealants, schedule next appointment, document in patient’s chart, dismiss patient, infection control, and instrument sterilization. Some items need to be completed outside of patient care. These include ordering and restocking supplies and instrument sharpening.¹

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Assisted hygiene improves care

Working in an assisted model can improve patient care and the hygiene experience. Patient involvement and experience are essential for this to work; the assisted model helps develop the relationships between patients, hygienists, and assistants. If the patient experience is good without assisted hygiene, it will undoubtedly be just as good or better with a hygiene assistant.²

With the assisted model, patients are never alone in a treatment room; the hygienist or assistant are always with them. Using an assistant within their scope of duties set by the state practice act, such as radiographs and coronal polishing, allows this model to work. To put it simply, this is a process of putting all the moving pieces together by "allowing assistants to do all they are legally able to do."³Patients can communicate their desires and goals and make better-informed decisions, which makes it easier for them to accept recommended treatment.³

Setting up for successful implementation

Team success is by design, and this means having a dedicated, skilled assistant in charge of the hygiene schedule.⁴ An assistant should have the skills needed to be helpful, and this can mean being certified to take radiographs, coronal polishing, and trained on office systems. Don’t sabotage this model by hiring an assistant and expecting them to help both the doctor and hygienist; sharing occurs when downtime happens.⁴

For the best outcome, ensure the office has two properly equipped hygiene rooms. Also, the scheduling coordinator should know how to schedule two hygiene rooms so as not to overbook. This usually involves two columns in the practice software with slightly overlapping treatment times. Preparing your office for an assisted hygiene schedule means clearly stating expectations and not sacrificing patient care by overscheduling the assisted columns.⁵

An ideal assisted hygiene preventive appointment is the 20-20-20 design. The first 20 minutes the hygiene assistant seats the patient, exposes radiographs, takes blood pressure, reviews medical history, completes initial plaque removal with coronal polishing, and provides initial oral hygiene instruction. The middle 20 minutes is dental hygiene assessment and instrumentation with the hygienist. The doctor needs about 10–15 minutes for the exam, then it’s time for patient dismissal and infection control.⁶

This process varies if a patient needs periodontal therapy. The 20-20-20 design is for healthy patients. If more time is required, the patient is told and the hygienist calls for the dentist while continuing the homecare discussion.⁶ It's essential to understand that perio therapy appointments and new-patient experiences need more time. These appointment times should not be overlapped like the assisted hygiene columns.⁶

Many believe the hygienist leaves the room after instrumentation and begins with another patient. This is not necessarily true. The assistant is a direct extension of the provider and is empowered by effective team building and continuing education.⁶The hygienist completes the first appointment, while the assistant begins the next patient 30 minutes later. The hygienist's downtime allows for completing chart notes on previous appointments. A verbal hand-off can occur once the hygiene assistant has completed radiographs, oral hygiene instructions, polishing, and assisting with the dental exam. The verbal hand-off enables the patient to hear recommendations multiple times. Repeated messages from more than one team member reinforces the need for good oral hygiene and treatment acceptance.⁶ Finally, the dental hygienist can begin the final assessment and instrumentation.

There can be hiccups in this assisted model. Good communication must occur, and there should be adjustments for the hiccups. As a guideline, if a patient needs more than 20 minutes of instrumentation, they need subsequent visits to complete care. Communicating this directly to the patient is vital.⁶

Effective collaboration and teambuilding

Communication is vital when collaborating with an assistant. An assistant must have a thorough understanding of the job expectations, should be dedicated to hygiene care, and must be intuitive to the needs of the hygienist. The hygienist must see the assistant as their strong right arm because there is no room for egos. Discussing treatment protocols, oral hygiene instruction, and product recommendations will give the team a firm understanding of the expectations. Allowing the assistant to oversee and direct the hygiene schedule is the best way to form a collaborative team approach to care.⁴

One last piece to consider when implementing this model is to ensure that the patients in assisted hygiene are suitable for it. If the schedule is not designed properly, patients will feel like they have less time with the hygienist.⁷ Tailoring treatment times ensures patients don't feel rushed or neglected. The goal is to provide patient-centered care with the best experience possible. If you’re committed to this approach, the practice will flourish, patients will value their care, and you’ll feel satisfied. In a nutshell, you and the assistant will benefit as providers, and patients will benefit from the assisted hygiene care model.⁶

References

Glasscoe D. Assisted hygiene: A coordinated effort in the hygiene operatory. Today’s RDH, October 1, 2011. Accessed January 24, 2022. https://www.rdhmag.com/patient-care/radiology/article/16408711/assisted-hygiene
Dykstra B. Assisted hygiene: the real benefits. Dental Economics. October 1, 2006. Accessed January 24, 2022. https://www.dentaleconomics.com/practice/article/16391167/assisted-hygiene-the-real-benefits
Chillock C Assisted hygiene: who really benefits? May 1, 2007. Accessed January 24, 2022. https://www.dentistryiq.com/front-office/scheduling/article/16348573/assisted-hygiene-who-really-benefits
Sanders K. Assisted hygiene part 3: are assistants prepared for assisted hygiene? Today’s RDH. December 30, 2018. Accessed January 24, 2022. https://www.todaysrdh.com/assisted-hygiene-part-3-are-assistants-prepared-for-assisted-hygiene/
Sanders K. Assisted hygiene part 1: is your office prepared? Today’s RDH. August 2, 2018. Accessed January 24, 2022. https://www.todaysrdh.com/assisted-hygiene-part-1-is-your-office-prepared/
Simmons C. Can assisted hygiene really work? RDH March 1, 2008. Accessed January 24, 2022. https://www.rdhmag.com/patient-care/article/16408223/can-assisted-hygiene-really-work
Sanders K. Assisted hygiene part 2: are your patients prepared? Today’s RDH. September 15, 2018. Accessed January 24, 2022. https://www.todaysrdh.com/assisted-hygiene-part-2-are-your-patients-prepared