Home Dental Episode #600: Solutions to the Hygiene Crisis, with Dr. Sam Low

Episode #600: Solutions to the Hygiene Crisis, with Dr. Sam Low

by adminjay

We’re all asking how to attract hygienists. But there’s another question you should be asking. How do you keep the ones you’ve got? To help you motivate the right hygienists who are already in your practice, Kirk Behrendt brings back Dr. Sam Low, associate faculty member of The Pankey Institute, with his insight into what hygienists truly want and the best ways to provide it. To learn how to keep your hygienists happy, listen to Episode 600 of The Best Practices Show!

Episode Resources:

Main Takeaways:

Don’t wait to give your great hygienists a raise.

Empower hygienists with CE and provide opportunities.

Add technologies that can decrease your hygienists’ stress.

Understand what your hygienists actually want from your practice.

Hire hygienists for their people-person personality, not just their skill sets.

A huddle is not an option. Do morning huddles with your team every morning.


“I know that dentists have always appreciated a hygienist. But I’m sure they never appreciated them till they didn’t have one.” (2:31—2:44)

“When we go to any kind of service, we like to see the same people. We don’t like somebody different. Like likes like. And so, our patients, who are used to Sally being their hygienist for 20 years — now, Sally’s gone. Now, Martha’s there. ‘Who’s Martha? I don’t know. Martha’s going to be in my mouth. Is she the same as Sally?’ And then, they say, ‘Well, maybe I don’t want to go back there.’ Especially if you have, what? Constant turnover. How many times have you heard patients say, ‘I don’t know what’s going on over there. Every time I go over there, there’s somebody different’?” (4:09—4:52)

“The most frequent, perfunctory appointment in a dental office is a dental hygiene prophylaxis. Nothing else repeats itself like that. It’s predictable. You kind of know what’s going to happen. So, if that’s the situation, to me, it would be like a process. First of all, how much time do you want for each one of those perfunctory appointments to occur? Now, here’s going to be your problem. There is no way, with third-party reimbursement, that you can pay for a dental hygienist and the operatory with what you’re going to get off of a prophylaxis in one hour. We’ve worked the numbers. It’s impossible. In fact, if you’re not careful, it’ll be kind of like Medicaid — you’re going to be paying them.” (7:39—8:41)

“Dental hygienists spend 50% of their time scraping on teeth — 50% of their time at that one hour — with antiquated scalers and curettes that they will not let go of because that’s the way they were taught, and they were taught that, ‘If I ever give them up, I will die.’ And yet, power-driven instrumentation has been around since 1956. And now, we have the science to demonstrate that we can do the same prophylaxis 50% faster with technology. And now, I’m going to add the next one, and that is this thing called Air-Flow, air medicament erythritol — not a Prophy Jet, but these high-tech air medicinal delivery systems where you can do a prophylaxis on a normal patient with a little bit of calculus in seven to ten minutes with the sciences there. So, I’m not about, at this point, to tell a dental hygienist, ‘Hey, by the way, we’re going from 60 minutes to 50 minutes, even though I know you’re in the driver’s seat and you’re going to go bolt to somebody else’s practice.’ But if I give them something ergonomically to where they can do these procedures with less chair time and spend more time doing, what? Head and neck exam, blood pressure, talking to the patients, have relationships with the patients, and selling my dentistry. I’ve looked at this every possible way, and the only way we can pull this off is to decrease the chair time of the mechanical debridement that has no scientific base, at this point.” (10:27—12:49)

“I am talking to practices that are actually saying this to me: they’re moving towards a hygiene-centric practice. Isn’t that interesting? Now, I’m not sure I want to go so far over because, in my mind, a dental practice is comprehensive care. But isn’t that interesting that they’re moving towards something called a hygiene-centric practice? And there are some philosophies out there that a little bit of the core of a dental practice is that dental hygiene segment. Why? Because, first of all, they see the patient more than anybody else. Actually, they see a patient more than anybody in healthcare. So, with that, let’s take an opportunity.” (15:01—15:47)

“Something is very interesting. Dental hygienists are going to courses where the topics are about them. Now, it may say about their patients. But they’re going to courses that are on nutrition, yoga, exercise, and stress. Isn’t that interesting? Millennial hygienists, especially, they’re going to courses, ‘What about me?’ And when I pick up RDH, because I read everything, you know what I’m seeing? And I’m starting to see it now with us, ‘Are you stressed? How do you feel? Are you taking time?’ When you talk to a baby boomer dentist and you say, ‘Are you stressed?’ ‘What is that? I get up in the morning. I go to work. I do my stuff. I come home.’ But when you talk to a millennial dentist, they say, ‘I need time for my family. I need time. A five-day week? Are you crazy?’ So, hygienists are the same way.” (17:00—18:09)

“Start looking at the possibility of adding some technology into the practice to decrease [your hygienists’] stress. Assist with their ergonomics. Provide them with the time. I always say, what does the hygienist do at lunch? Catch up. And I’ve tested this in large audiences. They don’t take lunch.” (18:18—18:43)

“I think there are only three mission statements — in this order: quality of care, be happy doing it, and make money . . . It’s in that order. And I always have to do a small preface in that I have spent a lot of years in Key Biscayne at Pankey. The reason I say that is that I don’t want anyone to get the idea that we’re talking about money, money, money, money. Dr. Pankey always said, ‘Do what you do best, and the money will come.’ So, in that order. When I say quality of care, I don’t mean some altruistic, amorphous thing. I mean that they have the right equipment to do what they need to do, that they have the right amount of time to do what they need to do. To me, it’s tangible things; it’s metrics. It’s not like, ‘Okay, kumbaya. Everybody, quality.’ No, no, no. Show me what you mean by quality.” (19:18—20:24)

“Number two [of your mission statement is], be happy. What does that mean? Economically, mentally, and physically. When a hygienist can’t wait to leave the office because they’re so taxed — on a Sunday evening, if they don’t want to go in, you might say, ‘Well, that’s just them.’ It doesn’t matter. Dentists out there, you’re not in the bargaining position right now. But that doesn’t mean that you should be bending down to allow them to do whatever they want. No — there are positive solutions.” (20:48—21:20)

“Number three [of your mission statement is], there has to be an ROI in hygiene. But here’s where some people do not think about it. If my hygienist is so taxed that she has no opportunity to talk about my treatment planning, who I am, and what I can do — the word on the street is 50% of a dentist’s production comes out of the hygiene operatory. That’s the word on the street. But if she is so taxed, and so timed out, and so stressed, do you think that she’s going to have a meaningful conversation about the fact that you place implants, about the fact that you are into sleep dentistry, the fact that you are doing these incredible veneers? No. I’ll tell you what she’s thinking about, just like you and I would be thinking about. ‘When can I get out of here?’ And I’ll tell you what they do — sometimes they’ll deny it. They pray for a cancellation. They pray for a cancellation just to catch up. And guess what happens? There goes my ROI.” (21:20—22:36)

“[Hygienists are] being compressed at a time where we can’t let them go. So, you see where I’m aiming at? Almost like a perfect storm. We have got to pay attention to this. I was reading this article. They were saying, ‘How to keep your team.’ One of the things was to take them bowling once a month, or to have a party once a year. And I must tell you, I said to myself, ‘Are you kidding me?’ No — what they want is every day, hour by hour, ‘I want to be there. It’s a great place to work.’ Giving those kinds of things, perks, that’s not what they want. In fact, a survey was just done. They truly do think about money, as they should. Maybe these people are single parents. They should. But do you know what was number two? Positive workplace environment.” (23:45—24:47)

“Hire an associate dentist to be a hygienist . . . You’re laughing, but I can tell you there are DSOs out there that are doing that. And there are dentists in Southern California that are new graduates that are making as much money being a dental hygienist as they would be doing restorative as an associate.” (26:08—26:33)

“There actually is not an answer [to attracting and hiring great hygienists] when there’s no pool.”  (26:44—26:48)

“If you feel that your hygienist should be making more money, and the value that they can provide to you — especially if you have meetings with them and see what more can happen within that time frame — go ahead and raise them now. Do not let them talk to each other, go out and talk to a dentist down the street, and then come back and say, ‘Well, she’s going to offer me ten more dollars,’ and then, you say, ‘Oh, okay. Well, then I’ll increase you by $10,’ because what that says to her is that if she hadn’t come back with a competing hourly wage, you wouldn’t have raised her.” (27:24—28:14)

“I understand about overhead. I know the overhead is increasing. The production, to a certain degree, is decreasing. I’ve got it. I said advice is cheap. It’s a lot easier, you and I talking, than you and I owning a small business. But you may find that increasing their salary by X, potentially, will make your life so much less stressful, but also make more money if they’re doing the procedures that actually make money.” (28:20—28:54)

“There are many, many dentists out there that are doing everything perfectly. But I will tell you something. I don’t care who you are out there. You are not immune from a dental hygienist walking in and leaving. No one. So, in my mind, I would much rather you try to retain and have positive conversations than be in the position to where you’re trying out there with ads and circling the wagons because, also, hygienists know good practices are not.” (30:36—31:17)

“[If you want to keep hygienists long-term], treat them as a nurse practitioner. Empower them. Give them the opportunity and the time to be able to do what they need. Even though there may be a little bit of pushback, decrease the amount of time they are mechanically doing things at the chair. We forget that over a career life span, dentistry is very taxing on the body. We ignore that. And so, I’m suggesting, bring in the technology. Bring in the ultrasonics. Send them to continuing education courses. Let them be CE junkies. Give them time off to do CE. Every now and then, I’ll talk to a dentist who says, ‘Well, if I let them go there, I’m going to lose production.’ Well, you and I both know how shortsighted that would be. Give them continuing education.”  (32:05—33:03)

“Friends, you’ve got to do a huddle every morning. A huddle is not an option. It is something you have to do every single morning. So, you give them technology. That gives them the opportunity to have the time to be able — they’re going to appreciate that you’ve invested in them, for the most part. And you have to be a good listener. You have to be a good listener. The days of a prophy goddess is over if you want to create what we’re discussing.” (33:05—33:42)

“I believe you need commission and salary. I’ve worked with enough practices — I’m going to do a very simple formula. It won’t be best for everybody, but in my mind, this is the formula. It’s going to be quick. You tell me what you want your hygienist to make a day, a quota. You do know most practices don’t have that. You’ve got to have that. And you can tell what that is. Those are the procedures that your hygienist does. Any other procedures, they’re not going to get credit for. So, let’s say it’s $1,100 a day. Anything they make over $1,100, they get one-third of every month. Straightforward, transparent, and open. This is the way it is. If your quota is $1,500 dollars — I don’t care. But please don’t make your quotas so high that they can never achieve it.” (33:50—35:03)

“[Sally McKenzie] always said one-third goes to the dentist, one-third goes to the hygienist, one-third goes to the practice.’ She’s always talked about the third, the third, the third. I’m very concerned that hygienists are going to want to move towards practices that have some type of commission base. Now, I’m going to reinforce something. The dentist is still the CEO. We are not subservient. We are not at the mercy. If you feel you’re in that position, then we’ve got to have another conversation.” (35:38—36:20)

“I go to these meetings where they do teambuilding. It goes in one ear and out the other because they don’t practice it.” (36:25—36:32)

“There are only two kinds of days. There’s a “cardiac” day, and a “nirvana” day. Most cardiac days are caused by a process. Most nirvana days are caused by a process.” (36:42—36:55)

“I like to hire hygienists that know how to sell themselves. I like to hire hygienists who have been professionally trained in sales. I was with a hygienist, and she had been trained in selling shoes at Macy’s. She had been through sales training. She knew how to close. She knew how to develop relationships. She knew how to be eye-to-eye. In an interview, if a hygienist can’t look me in the eye and be eye-to-eye, I can tell you they’re not going to be hired because I can’t change that. I can show them how to do debridement. I can show them how to find calculus. I can show them how to do periodontal charting. But I can’t show them how to create a personality that is a people person. So, on your interview, don’t just think about their skill sets. You can send them to one of our CE courses and get that. You’ve got to think about, ‘Are they a people person?’ to have the kind of practice you’re describing that you want to be in.” (38:04—39:24)

“We always say in the business, ‘A dentist is quick to hire, slow to fire.’ . . . Now, let’s turn that around. First of all, there’s not a lot of “quick to hire”. But guess what? You don’t have to worry about “slow to fire” — they’re gone.” (39:39—39:56)

“I never understand why a practice would not have voice-activated periodontal charting. I mean, that is a slam dunk because that is one of the primary things that hygienists will tell you, ‘I have to do periodontal charting by myself. When I look out to find someone to help me, the rats have left the ship. There’s no one to help me.’ And then basically, as a periodontist, I’ll tell you what happens. ‘We’ll do it next time. We’ll do it next time.’” (40:45—41:24)

“Some global data just came out. We thought 47% have bone loss periodontitis. We now think about 62% to 64% of the population has periodontitis. And then, with the oral systemic link, everything else, I think we’re in the — it’s not going away.” (48:49—49:07)


0:00 Introduction.

1:39 Dentists’ number-one issue today.

7:02 The anatomy of a great hygiene department.

10:22 A Total Perio Solution you need to incorporate.

12:52 The role of a hygienist.

18:48 Three mission statements.

23:06 What your hygienists truly want.

24:47 How to attract a hygienist.

31:19 Ways to keep great hygienists long-term.

33:43 Think about the one-third.

36:24 It comes down to processes.

37:55 What kind of hygienist to hire.

43:09 What Dr. Low teaches in Total Perio Solution.

49:27 How to get in touch with Dr. Low.

Dr. Sam Low Bio:

Dr. Sam Low provides dentists and dental hygienists with the tools needed for successfully managing the periodontal patient in general and periodontal practices. As an associate faculty member of the L.D. Pankey Institute for 25 years and Professor Emeritus, University of Florida, College of Dentistry, Dr. Low’s many years of experience training dental professionals is evident in his straight-forward, informative, and entertaining teaching style. Dr. Low’s presentations focus on creating positive interactions between dentists, periodontists, and dental hygienists through communication skills and continuous quality improvement to enhance esthetics, tooth retention, and implant placement.

Dr. Low’s achievements and awards include:

  • Certificate in Periodontology
  • 35 years of private practice experience in periodontics and implant placement
  • Graduate of University of Texas Dental Branch at Houston
  • Diplomate of the American Board of Periodontology
  • Past President of the American Academy of Periodontology
  • Past President of the Florida Dental Association
  • Former Trustee to the ADA
  • Selected “Dentist of the Year” by the Florida Dental Association
  • Selected Distinguished Alumnus by the University of Texas Dental School
  • Recipient of the Gordon Christensen Lecturer Recognition Award

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