By Rachel Wall, RDH, BS

Dentist-Hygienist Relationship

During this global pandemic, we’ve seen the dynamics of dental team relationships shift dramatically. Some teams fractured, while others grew stronger. The dynamics are certainly more complex than what we can solve in this short article, but I do believe some principles hold true as dentists and hygienists work to rebuild a supportive, collaborative relationship.

In the Powerful Partnership course I teach, I highlight three leadership actions dentists must take to elevate the level of collaboration and co-diagnosis their team is willing and able to provide. While these still ring true, there are some additional points to consider at this time. There are some elements that, when nurtured, can help you strengthen your collaboration as our industry and your practice recover. I’ve also added a 4th action I think is especially critical right now.

Leadership Actions for Dentist-Hygienist Communication and Collaboration

1. Permission: It’s important for dentists to understand that hygienists are often taught in school that they are not allowed to diagnose. We learn the basics of decay and restorative dentistry, but the vast amount of time is spent on clinical hygiene skills and what I call the art of observation. While (in most states), the dentist is responsible for the final diagnosis, hygienists and assistants are in a perfect position to create a preliminary treatment plan for their doctor’s review and confirmation.

Co-diagnosis is observing conditions and risk, sharing what is observed with the patient, and then educating them on what the dentist may recommend. It is well within the scope of practice for a hygienist or assistant to make observations, notes and assessments and take the patient down the path to readiness for the final recommendation.

Dentists, your clinical team needs your specific permission to share their observations and educate patients on your treatment recommendations. Would you like them to share with patients the problems they are seeing and potential treatment solutions you’ll share? Let them know exactly how far down the diagnostic path you’d like them to take patients.

In addition to empowering hygienists to collaborate with you in the diagnostic process, now is also a great time to give them permission to contribute ideas and solutions to navigate the new world of expanded PPE, scheduling considerations, and patient management. When hygienists participate in these decisions, they are much more likely to be eager to implement and refine the process.

2. Knowledge: Doctors, once you give permission, you MUST spend time with your team educating them on your treatment philosophy. Even if they’ve been with you for years, please don’t take for granted that they know your true clinical reasons for replacing old, leaky fillings. Hygienists and admin don’t see what you see every day. They don’t see how close that decay gets to the nerve and what really happens when a crack penetrates the root. Take as many photos as possible and show them to your team!

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Start to calibrate your treatment planning by bringing cases to your team meeting. Start with a simple case. Ask the team to create a treatment plan and see how closely it matches yours.

As the COVID situation evolves, keep your team in the loop. This is another opportunity to share your knowledge and encourage them to bring facts to the table as well. This will help them feel heard and allow them to see where you’re coming from in your decisions.

3. Accountability: If you agree that your team will tee up treatment for you, then it’s important you hold them to that agreement. If you agree there will be a photo on the monitor of any treatment recommended and there is a camera in the operatory, remind them you need that photo to complete the hygiene exam.

As you have re-opened your practice, I encourage you to hold time in the schedule for team meetings and huddles. Let your team know you want open communication so you can continually improve, not only patient care, but also the team’s day-to-day experience; then hold each other accountable. Any side-bar conversations about a team member not wearing the proper PPE, for example, should result in a reminder that you all agreed to positive and open communication.

4. Commitment: A 4th principle is staying true to your core values, your mission as a team. What I’ve noticed when I encounter a hygienist eager to return to work is a commitment to their role as a dental hygienist and healthcare provider. To quote John Maxwell, “You can’t NOT lead by example.” Dentists who keep strong communication and a commitment to ensuring their team members feel like supported colleagues yield a team that has their back.

Positive communication between dentists and hygienists has been more critical than ever in the past few months. The investment in the relationship has impacts far greater than ever imagined. Developing a powerful partnership for diagnosis and collaboration takes weight off your shoulders and empowers your team to be a critical part of the treatment planning process and a valuable part of your patients’ overall healthcare team.

Rachel Wall, RDH, BS

Rachel Wall, RDH, BS

As an international speaker, coach and owner of Inspired Hygiene, Rachel has guided thousands of dental professionals to elevate their hygiene services and systems, while driving profits to the bottom line and developing empowered, engaged hygienists. She is a past recipient of the Dental Excellence Award from for “Most Effective Dental Hygienist Educator,” and has been named one of the Top 25 Women in Dentistry by Dental Products Report.

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