The hygienist's transformation in the integrated dental practice

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Overwhelming evidence now shows that gingival inflammation, caries, and sleep apnea are key multimorbidity factors in numerous health conditions -- conditions that are the costliest and most protracted in the healthcare system. It has been well documented and well reported that healthier teeth and gums provide substantial systemic health outcomes and effective care-gap closures in a number of disorders.

Furthermore, many primary care functions can be performed in the dental office, significantly reducing these procedures' delivery costs. Although it's not yet well documented, a dental office's ability to engender patient compliance -- the ability to affect a patient's behavior -- far exceeds that of medical offices. This particular attribute of better patient compliance certainly would be useful in chronic disease management.

Dr. Marc Cooper.Dr. Marc Cooper.

Integrating dentistry into the healthcare system would yield significant cost savings for patients, employers, federal and state governments, hospitals, and payers. Healthier patients cost less and risks are reduced. That is obvious. The problem is dental practices and dental service organizations (DSOs) are not well designed or well integrated. Dental practices, their ownership, and their management will need to change because the times and money will demand it.

Reducing costs, increasing efficiencies, and producing much better health outcomes is where the healthcare system has to go. COVID-19 showed the system's vulnerabilities and limited capacities. The system has to work better -- period. An integrated system works better. It is easier to achieve integrity when the system is integrated. A shining example is Amazon.

And once we're in this integrated system, the old paradigm in dentistry will no longer be present. In an integrated system paradigm, the roles and accountabilities of the dentist and particularly the hygienist will be held much differently.

This medical-dental integration will cause a transformation of who a hygienist is and what a hygienist does. Hygienists' importance to the entire healthcare system will be strongly elevated, their profile and status recognition heightened, and their value to the system more broadly appreciated.

I believe hygiene in most dental practices is basically held as an overpriced revenue center and dental maintenance shop. This will be dramatically altered in an integrated office. In the integrated office, the hygienist's value, worth, and stature will be directly uplifted.

Of course, their training, development, and education will need to correspond with performing primary care functions and some mastery of the software to manage their findings and recommendations, which are made available to the system beyond the dental office. A hygienist naturally becomes a vital system player in the provider cohort group -- physician, dentist, pharmacy, hospital, and payer -- each taking care of the patient. In this paradigm, the hygienist becomes a "starter" on the team.

Where dental practices have resoundingly succeeded is in preventative and maintenance management of patients. Who better to handle this component of healthcare but a hygienist? Expanding a hygienist's wingspan to include select primary care protocols and procedures and working with patients at their hygiene appointments on compliance and behavioral change is a natural fit.

Neither the hygiene schools nor the dental practices are preparing themselves for this eventual transformation. But for hygienists who can fulfill a much larger healthcare role, their value to the system goes much higher when they are considered cardinal players in the system. When the hygienist is seen as reliable and an indispensable part of patient care beyond the oral cavity, the dental practice will need to change to accommodate who a hygienist is and the work he or she is tasked to do.

Dr. Marc Cooper is the president of MBC Consultants. Cooper has worked throughout the healthcare industry during his career, with the majority of his clients being in the dental industry. His current focus is coaching leaders, dentists, and senior executives on how to effectively navigate their organizations and lead their respective teams during this period of tremendous uncertainty.

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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