1. Systems = Success
• Systems allow for better delegation
• Provide for more production
• Save Dr. Time
A system is defined as having 4
components
• 1-Intent
• 2-Flow Chart
• 3-Scripts
• 4-Follow up
Goal = Serve offer all patients the highest level of service while
increasing productivity & profitability
= Everyone Wins!

2. Developing Hygiene Systems
Intent
Optimal oral hygiene not only results in healthier gums and
teeth, but also prevents serious systemic health conditions

3. Hygiene Flow Chart

4. Three key roles of a hygiene
provider
1-Preventive -Optimizing Hygiene Therapist
2-Periodontal Therapist
3-Patient Treatment Advocate
Wendy Briggs, RDH & John Meis,
DDS, FAGD,DICOL

5. Maximize Preventative
Therapist Role
“The more we involve patients in their own care and
making decisions, the higher acceptance rate we will have.”
Periodontal Probing is vital
Example Script
“I am going to check your tissues for infection. This helps us detect any
problems or disease in your gums. You will hear me saying a series of
numbers for each tooth & recording them. A 1-3 means that the tissue is
healthy, a 4 means infection is present, and 5 indicates that the infection has
already spread to the bone.”
Patient Education

6. Increase Adult Fluoride
Acceptance
Example Script
“New research shows that for patients who consistently have a professionally
applied fluoride treatment, we can see up to 75% fewer new cavities. This is
huge for patients…”
Here is why fluoride would be good for you
Customize to patient needs
If there are exposed root surfaces & dry mouth, they are at very high risk for
decay.
If they have crown margins, large fillings or multiple restorations, fluoride can
help protect their investment.
If they have made significant investments in rebuilding their mouth, fluoride will
help prevent recurrent decay & failure of their dental work.
Investing in fluoride makes good sense especially when compared to the cost
of restorations.
8 fluoride varnish treatments a day at $45 = $5,040 a 14 day cycle & $60,480 per year

7. Increase Sealant Acceptance
“Everyone has a 95% chance of experiencing caries in the pits and
fissures of their teeth if sealants aren’t used.”
American Dental Association
After 15 yrs there is a 54% reduction in decay. If you place a sealant
& monitor it & maintain it, it can reduce decay by 74% over that 15 yr
period.
Simonsen Study
Stress the value of doing convenient same day sealants
4 sealants a day @ $50 = $2,800 a 14 day cycle and $33,600 a year

8. Increase De-Sensitizing Agent
Acceptance
Over 80% of the adult population suffers
from sensitive teeth
Example Script:
“We have an exciting new service that can help immediately remove the pain &
discomfort from your sensitive tooth. It also protects it over time. It’s actually
easier if I show you how it works rather than try to explain to you how it works.
Let’s do this, we can try it & if it doesn’t work, you don’t pay. If it does work, its
only $39. If you start to notice sensitivity creeping back, most likely you have
had more recession in that area.”
4 desensitizing agents a day @ $ 39 = $2,184 a 14 day cycle & $26,208 per
year
Fluoride, Sealants & de-sensitizing combined potential=$120,208 per year

9. The ADA Recommends we treat all patients with Caries Management Risk Assessment CAMBRA

11. Maximize the Periodontal
Therapist Role
To clear up the infection 3 things are
needed
1-A deep, more aggressive cleaning. We have advanced technology that enables us to be
incredibly effective in dealing with the bacteria without pain
Example Script
“We need to do the cleaning to get the build up out and to clear the area of bacteria.”
2-If we want a different result, we change what we are doing.
Recommended home care: Prescription mouth wash, flossing & using a power toothbrush
Example Script
“With this level of infection in your mouth, a power toothbrush is a tool that will help eliminate it. We
don’t care where you get it as long as you get one. We carry them, here in the office, because we
know you are busy and we try to make everything as easy for you as possible, plus, we can provide
them for you at a cost less than you would pay at Wal-Mart.”
3-Bacteria has been proven to regenerate in just 21-60 days after scaling and root planning
Example Script
“We need to see you back more often.”
4- Laser bacterial decontamination of unhealthy gingival tissue and pathogens in a periodontal
sulcus
$43 per treatment @ 4 treatments day = $2408 per 14 day cycle & $28,896 per year

12. Maximizing the Patient
Treatment Advocate
65% of the production completed in the restorative department of the practice is
referred from hygiene.
What tools are you using in your case presentation?
3 emotions are behind case acceptance failure
1-Confusion
2-Overwhelm
3-Frustration
Rule 1-Simplify
–Talk in terms your patients understand
-Seeing is believing-use the intra oral camera so they see for themselves, then
there is urgency without the provider having to create it
Rule 2-Build value-In lieu of explaining procedures, focus on the benefits for the
patient.
Example Script: “If this were my mouth, this is what I would want to have done
and why.”

13. Type 1 • 1-3 mm pockets
• Gingivitis
• 6 month Prophylaxis
• Oral hygiene instruction
Type 2 • 2-4 mm pockets
• Bleeding
• Gingivitis
• Localized Pockets
• 6 month Prophylaxis
• Oral hygiene instruction
Type 3 • 3-5mm pockets
• Slight / Medium Sub. Gin Calululus
• Generalized Bleeding
• Horizontal Bone Loss / Recession
• No Mobility
• No Furcation
• Exposed root surfaces
• Debridement
• 4-6 month Prophylaxis
• Scaling and Root Planing
• Arestin
Type 4 • 5+ mm pockets
• Severe chronic periodontitis
• Mobility
• Bleeding and/or pus
• Periodontal abscess
• Advanced/vertical bone loss
• Calculus
• Furcation
• Exposed root surfaces
• Debridement
• 3-4 month Prophylaxis
• Scaling and Root Planing
• Arestin
• Peridex
• Referral to Periodontist for co-management after no
progress with above therapies
Type 5 • 6mm+ pockets
• Severe chronic periodontitis
• Mobility
• Bleeding and/or pus
• Periodontal abscess
• Advanced/vertical bone loss
• Calculus
• Furcation
• Exposed root surfaces
• Debridement
• 3-4 month Prophylaxis
• Scaling and Root Planing
• Arestin
• Peridex
• Referral to Periodontist for co-management after no
progress with above therapies
• Implant consultation
• Bone grafting
[MC1]
Periodontal Maintenance Program

14. Breakdown of NP
Appointment
Arrival
•NP Paperwork/online or electronic check in
•Assistant Greets
•NP Tour (build value)
• x-rays/intra orals FMX or Pano –
•Perio Probing (FMP)/ Charting
•Risk Assessment Tool-CAMBRA
•Exam
•Tx Plan
•Benefits of Tx
•Cleaning
•Fluoride Varnish
•Sealants
•Schedule next hygiene visit
•Hand off to TC

15. Breakdown of Hygiene
Appointment
• Medical History and questions about any problems with teeth, BP
• Take any radiographs needed: Pa’s, Bwx, pano, fmx
• Extra oral and intraoral exam
• FMP, chart in computer once a year, evaluate any areas of recession
• Take any intraoral photos that are needed
• Clean teeth with ultrasonic, handscalers, polish, floss, fluoride varnish
• Laser if needed
• Exam
• Tx plan
• Make recall appointment
• Hand off to TC
• Perio Breakdown
• FMP-
• Pts with untreated perio, explain periodontal disease and need for further treatment.
• Reiterate importance of homecare in maintaining periodontal disease
• Explain that once they have periodontal disease, they will always have it, explain the importance of
• periomaintance after scaling and root planning.
• Schedule for treatment
• Hand off to TC
• Periodontal Therapy
• Scaling and root planing appointments: usually broken into two appointments:
• laser /Arestin
• 4-6 week evaluation-laser/ Arestin
• 3-4 month periomaintance: laser/Arestin