Patient Experience Practice Management |6 min read

The Practice Manager’s Role in Creating a Dental Hygiene Standard of Care

by Rachel Wall, RDH, BS, CEO, Inspired Hygiene, Inc.

Last updated October 17, 2024

The Practice Manager's Role in Creating a Dental Hygiene Standard of Care.

As a dental practice manager and administrator, you expect to have the responsibility of implementing clear business systems and building a strong team to ensure your practice operates smoothly and efficiently. What you may not have expected is having the responsibility to develop, implement and maintain clinical processes to ensure the patients in your care receive appropriate diagnosis and treatment.

Wait…what?

Are you, as the manager and administrator, responsible for managing the clinical side of the business too?

The short answer is no. But also, yes.

Clinical Accountability

As a national dental hygiene coaching firm, we at Inspired Hygiene have an interesting view into the dental industry. Every week, we talk to practice owners and managers all over the country, and there’s a consistent issue we see in just about every practice we encounter—the lack of clear standards of care and clinical accountability.

Until the last 10-15 years, dentistry has primarily been a collection of small businesses owned and managed by dentists with very little clinical oversight. There is no dental governing organization that randomly evaluates the clinical standards and outcomes of an individual dental practice.

The clinical skill and ethics of a dentist typically only come under scrutiny if another dentist happens to see their work or a patient makes a complaint to the Board or to their attorney. In reality, dental insurance companies are the most frequent ‘auditor’ of clinical standards. They evaluate the diagnostic quality of x-rays and base their benefit decisions on often incomplete clinical data provided by the practice.

I’ve recently noticed another layer of complexity contributing to the wide range of clinical standards we see in hygiene departments. It’s the tension that’s been building between hygienists and practice owners the last 4 years.

I’ve lost count of how many times in the last few years I’ve heard practice leaders say they don’t want to ‘rock the boat’ with the hygiene department for fear of losing them. And yet, their patients are depending on them for quality care. Patients’ health and the licenses of dentists and hygienists are at stake when basic clinical standards are not met.

For example, we routinely see extreme gaps in protocols such as collecting updated medical histories, years between the documentation of complete periodontal exams, x-rays that are missing critical parts of dental anatomy and obvious periodontal disease being treated in a prophy.

So, what’s the practice manager’s role in all this?

It starts with being a leader. While you are likely not the clinical leader, it is well within your role to guide the clinical leader in your practice to step up with the clinical team to create clear, written standards of care that are to be followed by all.

These are practice standards of care, not provider-specific standards.

During a recent virtual event hosted by Inspired Hygiene and open to the dental industry, 67% of attendees answered ‘No’ when asked, ‘Do you have a written dental hygiene standard of care in your practice that is followed by all hygienists?’

In the absence of clear standards, consistency of care, diagnosis and treatment planning suffer and the larger the hygiene department, the more likely there are inconsistencies between providers and the care that is delivered.

A written standard of care is essential for clinical quality and consistency. It not only establishes clear expectations for your team but also safeguards your practice by ensuring that everyone is aligned on the procedures and protocols that ensure quality patient care that is well documented. Having a well-defined standard of care in place elevates both patient outcomes and team confidence, allowing you to lead with clarity and precision.

As practice administrator, guiding the clinical leader of your practice to create a practice standard of care allows you to then have a resource by which to evaluate clinical performance and the ability of your team to follow the standards. Without this, how does your team know how frequently to complete certain diagnostic services and what to do with that information?

How do you or the dentists give feedback to your clinical team if there’s no standard to follow?

The Foundation of Comprehensive Care

A comprehensive dental hygiene standard of care begins with a belief in the dental teams’ obligation to provide modern diagnostic and treatment services based on clinical evidence, credible research and science.

A comprehensive standard of care serves many purposes; when followed, it ensures a dental practice and/or group of practices will have:

Continuity of care between providers, honoring patients’ trust that they will receive the same level of diagnosis and treatment across all providers in a practice.
Clear expectations for team members communicated so they understand the clinical philosophy of the practice and clear expectations for clinical hygiene care.
Calibration of all team members to build confidence for when and how preventive and therapeutic services are provided.
Collaboration in decision making when hygienists and dentists face complex cases. Having a core standard and referring back to continually keeps providers on the same page.

The foundation of comprehensive care is a commitment to thorough diagnostic assessments. Conducting a comprehensive periodontal assessment, for example, for all adult patients allows for identification of problems early on. This proactive approach includes detailed recording of key factors such as pocket depth, bleeding, furcation, recession, and mobility, which are essential for effective treatment planning.

By integrating such assessments into the hygiene routine, the team is empowered to act swiftly and effectively, ensuring that no aspect of a patient’s oral health is overlooked.

In addition, this documentation is essential for accurate billing and claims filing and without a doubt, necessary to reduce claims delays and denials.

Creating a standard of care is not a one-time effort; it requires ongoing commitment and adaptation. Strong clinical leadership and clear expectations are critical to a thriving hygiene department. Having written standards at a practice and/or organizational level serves as direction for all team members and a point of accountability to go back to when hygiene standards are not being followed.

I cannot emphasize enough the value of investing time, knowledge and collaborative effort to create standards of care for your practice. Having agreed upon guidelines that all clinical care providers follow allows for more confident clinical decision making.

This calibration and process refinement will ensure every member of your hygiene team is aligned with the practice’s high standards, providing consistent care across the board and yielding continually improved patient outcomes. Fostering a culture of continuous improvement encourages trust and reliability, which are essential components of strong, lasting patient relationships.

Click here to download a Standard of Care Worksheet

Hygiene Tips (one per week in October)

Week 1

The health history is the foundation of all dental treatment, so be sure to review it carefully with every patient and have a new form completed and signed every 2 years.