Maximising the Role of the Dental Hygienist in the Examination Process

A question that often arises in Dental Office Management concerns the role of the dental hygienist in the physical act or the process of the examination of the teeth of the patients of the practice.

I feel that the way you “present” your hygienist to your customers and patients determines the way that your patients will accept and experience the services of the hygienist.

Firstly, in all of this, I guess, is how the dentist “frames” the examination in the hygiene room.


At Active Dental, I made it a rule that the dental examination was never conducted by the dentist until all the teeth were cleaned.

I did this for two reasons. Now I know there are dentists who like to enter the hygiene room and interrupt the hygienist to do the dental exam, purely because the dentist has a free moment, and it is a convenient moment for the dentist. To me this sends a signal to the patient that the dentist does not value the work of the hygienist; that he can just butt in when he wishes to interrupt her, at a time that suits only the dentist. To me this also sends the same message to the hygienist. Underlying this, it also creates a “culture” that interruptions are OK in the Dental Office.

The second reason I don’t do my dental examination before the teeth are cleaned is that I just don’t believe I can see everything if the teeth and gums have not been cleaned and debrided prior to my examination. Sometimes plaque can cover demineralization. Other times plaque can fill marginal defects in restorations. And other times, a dark mark may be a stain rather than decay. I also believe that the hygienist needs to and should collect and take any necessary radiographs required and have them ready for the Dentist prior to his arrival to do the examination.

Creating a *process* of hygienist and clean, followed by dentist and dental examination, also prepares the patient for any treatment required that the hygienist may see during her cleaning.

Now we know that in some states and countries dental hygienists are not “qualified” to diagnose some dental conditions or treatments. However, a good dental hygienist will recognise areas as she proceeds around the patient’s mouth performing her cleaning, that she feels she needs to draw attention to the dentist when he comes in to do his examination. A good hygienist will let the patient know that there are areas that she will draw to the Doctor’s attention. And the hygienist may also run through some of the treatment scenarios that the doctor might recommend.

Having the hygienist treat the patient in this manner also allows the dentist to “move quickly” through the hygiene room, if he requires. A great dental hygienist will always have done a significant amount of patient preparation prior to the dentist’s entering the hygiene room.

At Active Dental, we encouraged the hygienist to record all existing restorations as she saw them, and to make a list of any areas of concern that she noticed that she wanted the dentist to look at. In most cases she would also take intra-oral photographs of any areas of concern and have those available for the Doctor to review. Often, too the hygienist would discuss these photos with the patient prior to the Doctor entering the room.

Some patients are unaware that a Dental Hygienist is a further career step above and beyond the role of dental assistant in the Dental Office.

Sometimes I hear Dental Offices say that the hygienist does not have time to perform all these additional necessary duties in this manner. To this we said, at Active Dental, that if we needed more time then we needed to book and schedule (and bill) longer appointments or multiple appointments with the hygienist, or employ more hygienists.

There are no prizes in dentistry and delivering dental services for being brief and for skimming over necessary and thorough diagnostic procedures.

There are also no prizes in dentistry for the dentist doing things in the dental office that other personnel can perform. Nor are there any prizes for the dentist performing his skills in less than optimal conditions, for time and practicality issues.

In these instances we have discussed today, a good hygienist can be an asset to the dental office in preparing the patient and providing information prior to the Doctor arriving to do the examination.


“How to Consistently Exceed Your Customers’ Expectations” and “How to Prevent Your Dental Office Being Caught In A Race To The Bottom” are just two of the many straight forward chapters that make up The Ultimate Patient Experience, a simple easy to implement system I developed that allowed me to build an extraordinary dental office in an ordinary Sydney suburb.  If you’d like to know more, ask me about my free special report. Email me at

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