Hygiene Protocols

Successful Hygiene Scripting

Use the following scripting to support strong practice systems and to address effectively common patient questions.

Build Value in the Next Hygiene Visit

The goal of the hygiene visit is to build value for the next scheduled recare or periodontal maintenance visit. If the next visit is treated as a “standard check-up,” the practice may experience a higher rate of no-show or last-minute cancellations. Instead, we recommend you identify and verbalize a specific reason for the next visit using the following hygiene scripting as well as document it in the chart. In your chart notes where you enter the next visit, you would also list the identified value for that visit. This will help the front office during recare calls as well as help the hygienist remember those specific areas of concern.

“I am looking forward to seeing you again in (3, 4, or 6 months). We’ll plan to check this area again on the (UR, LR, UL, LL) where the (deeper area/beginning decay/gum concern/inflammation/etc.) is and make a plan if it isn’t resolved.”

“Let’s plan to monitor the (deeper area/beginning decay/gum concern/inflammation/etc. on the (UR, LR, UL, LL) carefully. This will be the first area we check when I see you again in (3, 4, or 6 months).”


Preferred Provider Questions

The front office routinely fields the question, “Are you a PP provider on my plan?” The first part of the answer should always address what we can do for the patient. The odds of successfully scheduling the new patient will increase if the value provided is addressed at the onset of the call.

Patient: “Do you accept Met Life Insurance?”
Response: “We do accept this insurance and we can provide your dentistry and submit claims to MetLife for you.”
Patient: “Are you a Preferred Provider for MetLife?”
Response: “We can bill MetLife for you, maximize your benefits available, and provide customer service for your claims; however, we are not set-up to adjust the difference in fees. This may or may not affect your co-pays.”


Response: “We are a non-restricted provider with MetLife and work closely with them. In fact, we have many patients with a similar plan to yours. We will work with you to maximize your benefits under your plan and will provide you with an estimate before starting any dental treatment, so you won’t have any surprises. How does that sound?”


Introducing a New Doctor

Ideally, the hygienist or dental assistant should build the patient’s confidence in the Doctor. This applies to all new patients meeting the Doctor for the first time, as well as for existing patients who are meeting a new Associate/Doctor-owner for the first time. The existing patient has already established trust with the dental staff and this trust can be transferred to the patient with the proper verbiage outlined in the scripting below. It is less effective for the Doctor to do their own introduction; it can sound like they are interviewing for a job.

Sample verbiage:

“While we (take x-rays, start your cleaning, etc.) let me give you a little background on Dr. Smith. He/she grew up in ____________ and graduated dental school from _______________. (See additional notes below to add to the introduction.) We love him/her! We have been so glad he/she joined the practice.”


Meet with the Doctor and make a list of the information a patient would likely want to know about the Doctor. These items can be added to the introduction as applicable.

Sample questions for the Doctor to build the introduction:

  1. Where did you grow up?
  2. What dental school did you graduate from?
  3. How long have you been practicing? (If less than 3 years, consider other areas to include for introduction purposes)
  4. Any specialties? Advanced training?
  5. Each staff member should know what the initials behind the Doctor’s name stand for.
  6. Family/Children?
  7. Favorite hobbies outside dentistry?
  8. Volunteer efforts they are passionate about?

The staff should author a list of adjectives to describe the Doctor they can use in the introduction as well. It can be helpful to do this at a staff meeting and reflect on statements patients have made in describing the Doctor. Examples include caring, dedicated to his/her patients, meticulous, gentle-touch, spends a lot of time with each patient, skilled, always concerned with the patient’s comfort level, etc.


Overcoming Barriers to Periodontal Therapy

“To achieve the healthiest result and to reduce the chance of tooth loss in the future we would recommend…”

“It’s our obligation to recommend the best treatment possible and let you choose.”

“Can I share with you what could result from not treating the periodontal disease soon?”

“With improved home care and regular periodontal maintenance appointments, this will potentially be the only time you will need this treatment.”


Periodontal Maintenance Interval

“We will extend your maintenance interval as far as possible; as long as we don’t see tissue breakdown, let’s try three months this time and see how it looks…”

“We have found more frequent maintenance intervals will help keep your gums stable and prevent the need for another round of periodontal therapy in the future; let’s try a 3-month interval to start and we can re-evaluate when I see you again next time.”

“We have found there are many factors that contribute to gum disease, and only one of those factors is your individual homecare. Some factors are simply out of your control. Three (or four) month intervals have been proven to keep gum disease more stable than trying to extend your interval to six months.”


Transitioning from Prophy to Periodontal Therapy

“Periodontal disease is episodic in nature. It is a chronic disease that flares up at different times. Many contributing factors lead to the need for periodontal therapy. Based on the results of today’s findings our recommendation would be … Let’s look at some of the factors potentially increasing the level of disease in your mouth. Have you had any changes in your health? Are you under more stress than usual? Are you on any new medications? Are you getting enough sleep? What about your diet? …”

“New technology and studies find treating the level of gum disease you have more proactively is resulting in a better long-term prognosis”

“What I see today is….”

“We have been monitoring several areas for some time. Your condition now indicates the need for further treatment, to stabilize those areas”

“Today I am finding several areas in your gum tissue indicating gum disease. Please know over 50% of adults will have some flare-up of gum disease at some time. The most conservative treatment approach is to complete periodontal therapy here in our practice. We are very successful in stabilizing this condition. Of course, we work closely with a periodontist who offers surgical options if your condition needs further treatment. After therapy, we will evaluate the condition again and go from there.”

“Gum disease is very cyclic in nature; sometimes it becomes more active and needs further treatment…”

“You have been taking great care of your teeth for a long time and have been pretty successful. Today I am finding some isolated areas on the upper right showing signs of gum disease. The newest research has proven if we take a proactive approach at this level of disease you can successfully manage it indefinitely. Of course, once you are diagnosed with gum disease we can’t cure it, but between the two of us we can manage it.”

“Let me show you a couple of areas where you have beginning gum disease. I know this is new to you. You have been fortunate – over 50% of all adults develop gum disease at some point. Fortunately, by identifying it at this early stage we can treat it very conservatively with periodontal therapy. Of course, there are surgical options and we will refer you to a specialist if we don’t get it managed.”

“Let me sit you up for a minute, I need to talk to you about what I’m seeing. You have not had gum disease in the past, today I am finding it in three areas. Let me show you where it is and how to treat it.”

“I don’t want you to have any surprises, and Dr. Smith believes we should inform you of any changes in your gum health as well as any financial considerations. The insurance plan your employer purchased may not cover this treatment completely, it’s not uncommon to have a small portion the plan expects you to pay. ______ can help you understand the plan your employer chose and any financial considerations. I can tell you periodontal therapy is the most conservative and least expensive investment for treatment for your condition.”



5-Step Hygiene Scripting Sequence to Discuss Periodontal Therapy Recommendations


1. Data

Gather and record findings from digital films, visual appearance, and complete periodontal charting to include probe depths, recession, furcations levels, mobility, and bleeding on probing. Attachment loss should be evident.


2. Diagnosis

Relay the diagnosis to the patient following this hygiene scripting example (the Doctor will determine who holds this conversation). A take-home brochure personalized with the patient’s situation is helpful.

“The data we’ve gathered appears most consistent with a diagnosis of (beginning/moderate/advanced) gum disease. In dental terms, we would classify the finding as a Type ___ periodontal disease.”


3. Commonality

Remove possible feelings of anxiety over the diagnosis on behalf of the patient by stressing how common this condition is through these hygiene scripting examples.

“You are not alone; did you know by the age of 50, the statistics from the ADA tell us 70% of adults are touched in some way by gum disease?”

“It is more common than you might think; over 50% of all adults have some level of gum disease.”


4. Prognosis

Determine the treatment needed and patient options. If a referral is needed, transfer trust to the referring specialist and do not proceed with step #5. If the patient will be treated in-house, use these hygiene scripting examples to discuss the advancements in dentistry and your ability to manage their condition. You are now promoting non-surgical options.

“The wonderful part of dentistry today is our ability to recognize early stages and bring in management strategies before much damage is done.”

“The latest research has consistently shown us treating a condition like yours proactively will have good long-term results.”

“In the past, this type of diagnosis was routinely treated with surgery, but dentistry has come a long way. We can effectively treat it with periodontal therapy right here in our practice.”

“Today, dentistry is finding much more success in treating the level of gum disease you have with non-surgical approaches. We actually have tremendous success treating gum disease right here in our practice. Let me tell you what this means…”


5. Discuss Future Management

Use hygiene scripting to discuss the goals of periodontal maintenance and why it is appropriate for their diagnosis. Discuss how this treatment differs from the type of preventive cleanings appropriate for people without a gum disease diagnosis.

“Following your periodontal therapy, we will be managing your condition more closely in the future. It is not uncommon to shorten your interval to every 3-4 months to keep your gum disease stable.”

“Gum disease is a chronic condition, and although it can’t be cured, it can be managed through more frequent visits and close monitoring of areas susceptible to break down. It is not uncommon to repeat therapy in the future if the condition does not remain stable.”

“Studies show us gum disease is a cyclic condition that can be aggravated by several things such as stress, medications, and certainly your own home care routines. We will be closely monitoring your condition and offering suggestions and special homecare tools to help you be more successful at home. We will also provide additional therapy, as needed.”

“Your condition will require close monitoring and more frequent maintenance visits. The dental benefits plan your employer purchased for you treats this differently than cleanings for people without gum disease and may require a small out-of-pocket expense. One of our treatment coordinators can let you know a close approximation of cost.”




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