The Business of Dental Hygiene By Trisha E. O’Hehir, RDH, BS, Editorial Director, Hygienetown Magazine

Success in dental hygiene treatment is measured using probing depths and bleeding points. Measuring the business of dental hygiene is quite similar; it just uses a different set of numbers. Understanding and implementing a few basic business principles will give you the tools to measure your financial success, and your contribution to the restorative side of the practice. By adding business skills to your clinical and communication skills you will take your dental hygiene department (DH Dept.) to the next level.

The business of dental hygiene is very similar to patient care. With patients you collect their data, create a dental hygiene treatment plan with specific goals, and evaluate the results following treatment. In business, you gather the numbers, set goals and evaluate the outcomes. It’s fun, easy and will expand your dental hygiene horizons. Let’s get started.

Gathering the numbers

Just like collecting periodontal records on a patient, you will need to collect business numbers on your office. Those numbers include overhead, production and budget. A worksheet is included to help you gather these numbers (see Table 1, page 10). The DH Dept. Worksheet lists numbers to get from the dentist or office manager to figure out the approximate overhead for your operatory.

The first number you need is the percentage of the entire office occupied by the DH Dept. To figure this out, find out the square footage of the entire office, and how many of those feet are occupied by the DH Dept.

For example, if the entire office is 1,000 square feet and there are two hygiene operatories, each measuring 10 feet by 10 feet (or 100 square feet) the total square footage for the dental hygiene space is 200 sq. ft. The hygiene space in this example is 20% of the entire office space. Therefore the DH Dept. overhead will be 20% of the fixed office overhead figures for rent or mortgage, utilities, and insurance and taxes (see Table 2, page 10). With these three figures, you have calculated the fixed overhead for your DH Dept.

Next gather the numbers for equipment and instrument expenses. You may need to look at what was spent last year and divide by 12 to get a monthly figure. If that proves to be complicated, simply estimate this cost based on the equipment and instrument needs of the DH Dept.

The cost of disposables (gloves, mask, sterilization products, cover wraps, prophy angles, prophy paste, suction tips, bibs, cotton rolls, gauze, oral hygiene aids, etc.) will depend on the number of patients you see each month. Estimate a per-patient fee for infection control products and disposables used for each patient. Your estimate will probably be less than five dollars per patient. Multiply this number by the number of patients you see each month. For example, if you see an average of 10 patients per day, four days a week, your monthly total may be 160 patients. Four dollars multiplied by 160 patients provides an estimate for monthly supplies of $640 for the DH Dept. (see Table 3, page 10).

The last number to get is the monthly salary and benefits figure for the DH Dept. This number is your salary and employee taxes paid by the employer. If a dental assistant is dedicated to the DH Dept., that salary should be included. If the assistant also helps the dentist, calculate the number of hours in a day that the assistant is providing services directly to the DH Dept. If the assistant helps with setup, clean-up and recording probing depths, that may translate into 10 minutes per patient or less than two hours per day total. Calculate the hourly salary for the assistant for that figure. If other staff members devote specific time to the DH Dept., that should be considered; however, if the practice had no DH Dept., some staff would remain with no change in salary. The receptionist, for instance, would be employed with or without a DH Dept. Add all these numbers together and you have the overhead figure for the DH Dept.

Production is the next figure to calculate, both active and passive. Active production includes all dental hygiene services provided by you in your operatory. Depending on the needs of your patients and your treatment philosophy, there should be a significant amount coming from periodontal procedures.

Passive production includes product sales and dentistry originating in your operatory. Product sales include toothbrushes, irrigators, interdental cleaners, toothpastes, mouthrinses, remineralizing and desensitizing products and whitening systems. By providing the products you recommend to your patients, you create a passive source of income for your department and a valuable service for your patients. If you’ve looked at the dental aisles in the drug and discount stores lately, you know how valuable it is to provide patients the products they need. Hair stylists have done this for years.

The other source of passive income is the dentistry that is diagnosed and scheduled from patients seen in the DH Dept. As you track this figure, you will probably see that 60-80% of the restorative procedures scheduled in the office come directly from the DH Dept. This number isn’t used directly in the overhead and production calculation of the DH Dept., but it is important to show how the DH Dept. contributes to the overall success of the practice.

Setting Goals

You now have the financial picture of your DH Dept., so it’s time to set goals. It is important to understand that the DH Dept. goals are set for both the health of the patient and the financial health of the office. In order to provide the best care possible, you will need good-quality equipment, instruments, products and continuing education. You may even decide your DH Dept. would benefit from the services of a dental hygiene consultant to enhance your skills or refine periodontal protocols. In order to set oral health goals, you need to think about how healthy you want the patients to be. How successful do you want your DH Dept. to be in controlling the two dental diseases, caries and periodontal disease? The best way to reach a goal is to set one.

Financial goals take into consideration fixed and variable costs. Rent or mortgage, utilities and insurance are fixed items that you do not have control over. Adjustable budget items are production, equipment and instruments, and salary. Changing one, changes the others. Increasing fees, providing more services, and/or seeing more patients will change the production number. You’ve probably seen this when periodontal or whitening procedures were added to your services and DH production increased. This is where you have control over production.

It’s a good idea to have a specific budget item for DH equipment and instruments to allow planning for DH Dept. purchases. Simply replacing equipment and instruments when they are broken or worn out does not allow you to plan for the future. As new technology, products and instruments are introduced, having a budget in place allows you to plan for purchases large and small. It would also be helpful for the dental hygienist to have a credit card for purchases at dental meetings, rather than asking the dentist employer to make the purchases on his/her behalf.

Practice management consultants suggest things in thirds. The hygienist’s production should equal one-third of the dentist’s production, the RDH’s salary should equal one-third of the DH Dept. production and the dentist should realize a one-third profit on the DH Dept. Many dentists realize the value of the DH Dept., based on the level of passive production contributed to the practice, and would be happy simply to break even considering the impact the DH Dept. has on restorative treatment acceptance.

“I for one have tried to cultivate as a large a hygiene pool as I can handle…this has served me and the patients well, and been a big part of the overall profitability of the practice,” posted Dr. Greg Holm of Wichita, Kan. on the Dentaltown.com message boards. “That recall pool is far more important to me than the dollars from hygiene production itself.”

Practice management expert, Linda Miles, CMC posted on Dentaltown.com that “without the preventive care department you (dentists) would run out of dentistry.”

However, we are looking at this as a business, and the dentist-employer should realize a profit.

From the money allocated for overhead, a budget for equipment and instrument purchases should be established. According to the poll on page 20, 90% of Townie dental hygienists report that purchases of equipment and instruments account for 4-15% of their production. Seven to 10 percent appears to be a reasonable figure to set aside for equipment and instruments, leaving the rest of that one-third for rent, utilities, assistant, and supplies. I encourage you to create a “DH Dept. Wish List.” With a budget for the DH Dept., you can plan for future purchases, based on production.

Evaluating Outcomes

The dental hygiene department is both valuable and essential to the success of the dental practice. Knowing the numbers, you can determine if you are reaching your goals or not. Your primary goal is improving patient health, and the secondary goal is contributing to the success of the entire practice, both financially and by the restorative dentistry that is scheduled from your operatory.

Join the discussion at Hygienetown.com and share your views on the business of dental hygiene with your colleagues. What’s working for you? What changes have you made now that you manage the DH Dept. in the practice with a focus on patient and practice health. Your experiences will be helpful to other hygienists just like you.