Stay Innovative, Retain Employees and Implement Diagnostic Testing in Hygiene: A discussion with Amanda Hill

You're listening to the Phil Klein Dental Podcast. So how do we elevate our practice? And what does elevating our practice actually do for our career, business, and patients? It actually does quite a lot. For one, it helps with employee retention. A recent poll showed that the number one reason why a dental hygienist leaves a dental practice is because the practice is not innovative. It's doing the same old, same old, and they feel they are stuck in a rut. not learning anything new, nor are they trying new techniques and products. Also part of the episode today, we'll be talking about incorporating diagnostics into our practice. Instead of rushing through the medical history and moving right to our scaling, root planing, and prophys, perhaps we should dedicate some time to diagnostic testing, getting to the root cause of the problem. As our guest Amanda Hill will explain, diagnostic testing is a game changer for the practice, and it not only builds trust between the practice and the patient, but also drives revenue. Also, in this pretty packed episode, Amanda will talk about specific products that should be considered in the hygiene department for any patient that complains of tooth sensitivity. And this is related to recession, exposed root surfaces, etc. So without further ado, let's introduce our guest, Amanda Hill. Amanda is a registered dental hygienist for over 25 years. She is an enthusiastic speaker, innovative consultant, and an award-winning author. She's also a regular contributor on VivaLearning.com. Amanda, it's a pleasure to have you on the show. Bill, thank you so much for having me. I'm excited to be back. Yeah. The last time we talked to you was in 2022. It's hard to believe two years have passed. Time is definitely moving forward pretty quickly. And you've done a lot of webinars in between then. And I even see now that you have a couple scheduled. So our audience could look you up. Hill, H-I-L-L in the search tool at vivallearning.com. Amanda Hill, and you can find out a lot about the mouth-body connection, which is such an important issue today. Amanda does such a good job of articulating that important point, how we're connected. The mouth is actually connected to the rest of the body. It's a big surprise, isn't it? Yeah, surprise, surprise. I mean, we all knew that for many, many years and many decades of practicing dentistry. But it's just something that was kind of siloed for whatever reason. And practitioners, clinicians are starting to communicate that to their patients that, listen, there's real literature on this. And I know in one of your webinars, you talked about your father who always sends you headlines on the mouth-body connection, which is he's keeping his daughter up to date so you don't miss anything when you talk about it on the podcast. He is. I know what AARP is sending to their people and all sorts of random people. Yeah, I know. Yeah, be careful the AARP stuff. I'm not a member, but I'm in that age group. Okay, so let's talk about what we're going to talk about today. And part of what we're going to talk about today is elevating your dental practice. So when we talk about elevating dental care, raising it to a new level. That can mean many different things depending upon your role in the practice and who you talk to on the dental team. In your mind, Amanda, when you talk about elevating dental care from the hygienist perspective, what are you specifically referring to? Well, Phil, it really brings in a little bit about what you talked about, that mouth-body connection and being far more... preventative than being as reactive as we have been. Traditionally, medicine and dentistry alike have been in more that reactionary state where we, you know, oh, there's a cavity, let's fix it. And really taking dentistry to a whole different level, and I call it dentistry 3.0, which I stole from Peter Atiyah in the book Outlive, where he talked about medicine 3.0, but taking dentistry to that 3.0 level where we are far more preventative, we're looking out for oh my goodness, you have some low pH that could put you at risk for decay. Let's look at some things that will bring up your pH. taking taking dentistry to that level as opposed to just trying to do a patch and fill process so i think for the most part dentistry has moved away from the drill and fill mentality and i think that many dentists are starting to understand more and more based on the literature how connected the mouth is to systemic disease so how does a dentist make sure that the culture of his or her practice aligns with the connection between oral health and systemic health? And how does that trickle down to everybody in the practice? What goes on at the dental appointment when you onboard a patient and so forth? What is the big challenge here? The first thing that a practice has to do, particularly an owner, is you have to let go of the scarcity mindset that, oh my gosh, if we move to prevention, we're going to lose money. And the truth is, you aren't going to lose money. There's enough practices out there that are successfully implementing this that can show you, indeed, they aren't losing money. In fact, they're doing much better. But one interesting thing that I have noticed in particularly right now, I mean, if you ask a dentist what their big issue is right now in dentistry, you're going to hear hiring, right? Hiring and retention. It's huge, right? We can't find hygienists. We can't find assistants. And fascinatingly, rdh magazine and dental post every year do this salary survey and they you know they survey thousands of clinicians and and the one thing that ended up in every single clinician every single role every single person's list of a reason why they were seeking to leave a practice was they're looking for to to learn and grow and have new challenges and i think by changing the model Just the, you know, this is what we do. This is how we've done it. This is what we're always going to do. You actually are growing your team and you actually might be more successful with team retention by giving this option to try new things and explore new things and see how these things work and see the benefit to your patients. And when you know that you're caring for patients, when you know, like in your heart, like you see every day. that thing that you did for Mrs. Jones and what a difference it's made in her life, it really resonates with that. I can get up every morning and go to work. You know what I mean? Yeah. Well, so there's no question about it. Everybody wants to make a good salary. They want to pay their bills. But, you know, the difference between one salary and another salary at another office, however incremental it may be, it's not going to take you to a level of happiness if you're not happy at the current practice you're in. So what you're saying makes total sense. We need to know that we have impact on our patient population. We're actually doing something for them rather than just doing routine procedures over and over again. So when you talk about prevention, you're saying that's the key thing, the foundation of the mouth-body connection is prevention. It's not even prevention. Maybe prevention isn't exactly the right word. I think it's root. I think it's getting to the root of what the issue is. The root cause. Yeah, root cause. What is causing that low pH? What is causing that dry mouth? What is causing that? And instead of just continually trying to throw these Band-Aids at things, and when we're really getting to the root, I really think that's when we're making the big difference. So give us an example of how a dentist or hygienist would engage with the patient in the operatory when they're looking to pursue a practice culture. where it emphasizes the mouth-body connection and getting to the root cause? I think the biggest thing to remember, particularly when we're sitting down with our patients, is to remember that there are two experts in the room. You are the expert on dentistry, and they are the expert on them. And if you can discover what's going on in their mouth with them, this process of co-discovery. And I like to use things like, I always like to make sure I'm using disclosing solution with my patients so they can see the plaque in their mouth. But I and, you know, and use intro cameras like you mentioned and things like that. But a lot of it comes down, I think, to building trust with patients. I don't even know the stats off the top of my head about how many people are afraid of us, but we know how many people walk in and say, I hate being here, right? And so establishing that trust. And one of the big things that I find with a lot of patients is, you know, they all have sensitive teeth. Well, we can throw a lot of different... at sensitive teeth but understanding the root of that sensitivity is really the root cause of that sensitivity is is really important and and when you can help get people out of pain people's ears open up people can now listen to you and then you've solved one issue and now you can move forward with whatever else is going on and so that's one of the ways that i really love um like products like voco Like they have numerous solutions for hypersensitivity. And whether that's the light cured product like Admirer Protect, which does a great job. Oh my gosh, you can do that right before your instrumenting and patients will just be so happy. Or you can do things like their Pro Florid varnishes. Those are great for desensitizers. Even their Pro Florid L is great if you're whitening. And they, you know, and they're sensitive to that. And then lastly, there's take-home products that they have, like Remin Pro, that you can send them home with for helping with desensitizing. I really think helping get patients out of pain is the first step to building that trust, to getting them to open their ears and understanding and owning their disease or owning their condition. Because then they're less worried about, oh my gosh, she's going to poke me. Oh, they're going to, you know, they're going to hurt me. And it's more like, okay, wait, they, oh my gosh, they're listening to me. They understood that that. That tooth was, you know, that tooth that I was like, please don't touch that tooth. And I'm like, listen, I have to touch that tooth, but I have something I can use on that tooth so that we can properly diagnose that tooth. So all of us, to some extent, are creatures of habit. We all have our comfort zone from which we are somewhat resistant and reluctant to drift out of. So you mentioned some products that are out there, and let's just say they were new products and many offices did not use them, but they offered some significant benefits. What's your secret sauce to get team members? to buy into using these new products that perhaps will necessitate them to change their techniques and workflow. And as I mentioned, a lot of people don't like moving out of their comfort zone. I think, Phil, I think the secret sauce is to get the entire team to try these products. Any product, like you hear about a product and it's, you know, you're like, all right, well, let's, you know, heck. Let's, oh my goodness. You know, I have that spot every time I see the hygienist, I'm the front desk person, you know, and I have that spot that when the instrument goes by that is sensitive, let's try that admirer protect. Can you try that on me? And let's see how that works. And it's amazing. It's pretty easy to get samples from companies. I mean, seriously, it's not hard or whoever your rep is, you can ask them and have an office meeting where you figure out like, okay, guys, today we're going to talk about desensitizers. Let's bring some in and let's try them. Or even something as simple as fluoride varnishes. Like, have you ever taken the fluoride varnish in your office and put it on your own teeth and figured out how does it feel? How does it taste? The other day, I had a ton of samples lying around and I did a different brand of fluoride on each quadrant just to kind of feel what the residue was like. What does it taste like? And I think that when everyone in the practice, and I'm talking front desk in two, often I feel like we leave out our admin team. When they can have experienced a product or they have seen firsthand someone they trust experience that product and they'd be like, oh, no, Mrs. Smith, you know what? When she called, you know, Mrs. Smith calls on the phone. Oh, Mrs. Smith, you know what? We actually have this new great product that, you know, Susan tried on, you know, Kimberly and it totally took away her sensitivity. When the whole team has that buy-in, when the whole team sees it and values it. that's when people get excited to implement it. When it seems like it's just another thing to do. You're like, oh my gosh, I don't have enough time anyway. And now you're telling me to do this. That's when everybody, that's when it expires in the drawer, right? But when everybody has seen it in action, has, if possible, experienced it in their own mouth or seen case studies of it with patients that they love and care for in the practice, that's when everybody becomes like the biggest cheerleader for whatever that new technique and technology is. And do you think it's usually the same person that brings these new products into the practice? the same team member? Or do you think, generally speaking, different people bring it up at the morning huddle or whatever the lunch meeting that they're having? Every dental office has its own culture. And maybe the dental owner doesn't want individual team members to bring up these things because he doesn't really want to start investing in new products. For whatever reason, what do you see as the kind of obstacle or some of the challenges to get this off the ground? Oh, I mean, I think you named the, you know, certainly a big obstacle would be certainly the practice owner. You know, no, we don't want to do that. I will caution any practice owner against that right now and come back to that statement I made earlier about what staff retention, team retention comes from people want to know they're growing and making a difference. And so allowing people to just. trial in something or again, trying it at a team meeting, like, you know, getting it together and be like, all right, well, let's try this thing that you're so excited about. If we continue to shut each other down, no matter who that is in the practice, that's when people start to feel defeated. And that's when people start to feel not seen and not heard. And that's when people start to look at, at, at one ads and start to pay attention to the, you know, there's every other office in the, in your city, your County is hiring. And so really finding ways to, to listen and value. what your team members are bringing to the table. I would love to think that everybody in the office is like, hey, I heard of this product or hey, I heard of this product. And maybe you have a system where maybe once a month you evaluate a product or, you know, so you don't feel so overwhelmed. But giving people the opportunity to grow and be curious. And I think when we sit in that state of curiosity. I mean, that's when we continue to want to show up for work and want to make that difference and know that we truly are indeed having a powerful impact. Yeah, no, for sure. And I think the once a month idea is something that would work really well because you certainly don't want to have four new products every single day be brought into a morning huddle because then you can't focus on any. You know, create a Google Doc, have everybody share that document, list the product, write the benefits on it, what it does, some links to some literature. And then when you have the meeting, everybody's kind of got a little bit of background on what you're trying to propose to the office. That preparation in advance seems to always help no matter what business you're in. So let's pivot over to the dental patient for a second. What are some of the ways we as dentists and hygienists can help instill agency? in our patients, getting them to act on their own behalf based on the state and condition of their oral health. So if a patient has got some issues with recurrent periodontal disease and they go to their routine re-care visits, but they're just not getting the results that, you know, their hygienist nor they are happy with. And, you know, you got to figure out what the problem is. Like, is this genetic or am I not, is my home care non -compliant? What am I doing wrong? So there's, there's got to be a conversation. between the healthcare provider and the patient so that they start to work on their own behalf. They become their own dental health advocate and the person that actually follows through with the instructions they're getting from the hygiene bay. Tell us about that. I think that the first step is to slow down in the medical history. And as a hygienist, I know that I am... trying to whiz past the medical history so that I can get on to the hygiene appointment so that I can get to the next hygiene appointment, right? But often I think we go so quickly past that medical history that we... miss a lot of these red flags that exist that are directly connected we know now you know science is showing us directly connected to their oral health and if we can start connecting those things those those dots for them and letting patients know you know mr smith i noticed that you know you're really struggling with your diabetes and i want to tell you i'm seeing a lot of bleeding gums you know there's a lot when i go through and i'm doing this probing there's a lot of bleeding that's happening those are those are completely bi-directional those are completely connected and until we get this gum disease under control until we can figure this out you are going to continue to struggle with your diabetes and so let's step forward to really see what we can do to help set you up for success or or something even like decay you know we could see that that they're having you know just every time they come back it's another cavity it's another cavity and so we can start to look at perhaps using things like really inexpensive things like ph paper to show them how low the pH is in their mouth. They see that. It's like they understand their cholesterol, right? So they see that paper. It's proof. It's not just me saying things. It's them seeing things. And then we can send them home. You know, we can make sure they get that fluoride treatment, even though their insurance might not cover it. We can send them home with, you know, a fluoride, an extra fluoride like, like Remin Pro, you know, and something like that to really help them succeed in not coming back with cavities, everything you play. But when we can show them sort of these diagnostic things as well, I really think that that's a powerful tool. And even darn it, the old hand mirror, handing a patient a hand mirror, you know, you go to the dollar store, have a bunch of them and letting them see, you know, letting them see what's happening in their mouth. I mentioned disclosing solution, like using that, letting them see that plaque. You know, letting them see the bleeding, go in with a little, you know, gum pick before you even instrument and let them see that bleeding occur. And so they can own that disease as opposed to, oh, you just poked me. It only bleeds when you poke me. Well, it's because I'm the only one that's ever touched your gum line. That's why. But, you know, helping them see that. I think you actually did a really good webinar titled, It Only Bleeds When You Poked Me. Yeah. I did. Yeah. So there's a lot to that one. It was 50 minutes of education just on that one title. So do you think a lot of... dental practices in their hygiene department are not really focused on diagnostic tests, such as saliva. You mentioned pH. What is that? A nitric test of some kind? Nitric oxide. A nitric oxide strip. Yep. There's several others. So what are the tests that you think are really not a big hurdle to implement in a practice? And how does that work with the hygiene visit? You know, with that first visit, when do you start using these tests? What do you communicate with the patient about these tests, especially the results? And how do these diagnostic results help the hygienist and the dental practice get that patient more compliant? And you end up seeing much better success in the long run with clinical outcome. So yeah, Phil, I do think many that we are rushing past that step to get their teeth cleaned, quote unquote, teeth cleaned, you know, because that's what we feel like they came in for. And I think we're selling dentistry short that way. And so simple things, like I said, you know, pH is easy. You buy a strip on Amazon. It is easy and simple to read. It's easy to understand. You can even like have a patient do a little pH test and then hand them a piece of xylitol gum, have them chew the gum, and then have them do the pH test again. And they can be like, oh, wait, look, wow, that was amazing. I mean, what a super score. That nitric oxide, super fascinating, particularly for our patients that have elevated uncontrolled blood pressure. You know, that makes a big difference. doing those airway evaluations and then once we get into things like air well really airway evaluations salivary diagnostics it's a it's it is another hurdle because i have seen lots of these salivary diagnostics and i gotta tell you phil i don't always know what to do with the results and i think that we in dentistry really want to know what want to feel like we have all the answers before we even like you know try it And I want to encourage all of us, myself included, that it is okay to not have all the answers. It's okay to start and sort of learn the process as you go. And so there are lots of companies out there that do celebrate diagnostics that actually offer a lot of clinician support as well. So whenever you go to choose a company, I would ask about, like, what kind of clinician support do you have? How are you going to help me learn how to read these and then learn what that means? How do I disseminate this to my patient? The great thing about these tests are, again, patients know tests, right? We know our cholesterol tests. We know our vitamin D tests. We understand that from the medical side. So when I see it in dentistry, I'm like, oh, okay. all right, well, what does this mean? What do I need to do? And then we can retest and you can actually see progress, which is an amazing thing because otherwise, you know, you're like, well, I didn't get a cavity. Well, maybe I just didn't get a cavity because I didn't get a cavity. But really when you can start to see that, oh, this, you know, this AA, I had AA, oh my goodness, right? This is bad. I had this and now I don't have this anymore. All that work that I've been doing is working. And I'm going to continue to do it. In that co-diagnosis course that I did, I also talked about phase contrast microscopes. which is not something I've ever practiced with, but man, if you've never seen one in action, those things are cool where clinicians are taking a plaque sample and putting it under a microscope and then they're able to see the activity of the oral microbiome and, you know, are the bad guys in there, you know, are there tons of spirochetes, which we know spirochetes live in Alzheimer's brains. Man, you want to talk about a visual to bring to your patients about why it's so important for us to, you know, take care of our oral health and perhaps why that non-surgical. periodontal therapy is going to be needed or why they should get those perioprotectors or whatever it's going to be, whatever that next treatment is, but really happen to understand the why behind this lecture that we give, right? We're called nags all the time, but how about we not be nags? How about we help patients discover their disease and own it? Yeah, the microscope thing is amazing to me. I mean, that's a no-brainer. To me, that should be in every single dental practice. that's doing perio care, I don't know how much training it takes for someone to look at that microscope and see the results and understand it. Do you need to have a whole microbiology degree or can you just get the idea from a half-day course? Are there CE courses that help you diagnose or look at a microscope sample from a perio patient or a hygiene patient and know what's going on? You know, I don't know if I've seen a specific course around it. I do know that I do know that. The, the biologic hygienists, there's a few out there that are really working on that. Barbara Tritts is one, and she's the one that I got my slides from when I was showing the slides in that presentation. I do not think it's all that hard to learn. I think it takes a little while, but I think, I mean, it is really easy to go, oh, that's a spirochete. Okay. That's a bad guy. You know, and so really starting to just sort of learn what, you know, what healthy looks like and what unhealthy looks like. And then, you know, then you move the next step. Okay. This is unhealthy. Now. What are we going to do about that? Yeah. And it seems to me that's another AI application where the microscope snaps a shot, they get an image, run it through AI, and it gives you your differential diagnosis in five seconds. Yeah. I haven't seen that yet, but that's a good idea. Somebody should make that. I just gave away a multi-million dollar and I'll never get a penny for it. I'll never get anything for it. Never, never. I'm just so dedicated to education. Started here, folks. Yeah, started here. So my last question before we wrap up this podcast, how does a dental office schedule hygiene patients to take these tests in consideration that you're not just going through the medical history quickly like you suggest, but actually... spend time on the diagnostic part of it which is totally in line with medicine i mean the first thing do when you get your annual checkup is they take blood, they take urine, send it out to the lab. They're looking for something that's, you know, not in the normal range and they can go further and dig deeper. And like you said, the first thing we do is pick up a scaler, start doing our cleaning, our profis, whatever we do. Does that require, I mean, it does require more scheduling time. So how does a practice that wants its clinicians to be good diagnosticians by taking these tests, accomplish this through scheduling, through adjusting the way they schedule patients. So it's funny. I just yesterday had a call with a hygienist, Charissa Wood. She's an amazing hygienist in Atlanta. And we were just talking about this scheduling concept. So I'm so glad that you asked that. And she, her practice, very diagnostic based. And first off, she knows that no one will be upset with her if she doesn't clean someone's teeth in the visit. Like she is, she is fully aware of that. So it takes, first off, takes a ton of pressure off of her as a clinician. So she can really treat each patient individually. And they have actually gone from eight patients a day down to six patients a day. And you would, you know, there's all the dentists listening like, whoa, no. And she says that they are making. far more money now than like you know that's not her end goal that's but man it's it has nothing it's like so why are they making more money because they're having more patients follow through with treatment and they're They're doing additional treatments. They're doing things like salivary diagnostics regularly. Patients are taking home products regularly, which they're selling in the practice. They're, you know, patients are doing perioprotect trays or they're doing, they're following through with that scaling and root planer or laser therapies or different therapies that oftentimes, I mean, I will admit to you, Phil, as a busy clinician, as an on-the -hour clinician, you know, I had a laser and I knew there were times that that laser would be beneficial, but darn it all, I didn't. I didn't have time to discuss it. And I certainly didn't have time to do it because there was no wiggle in my, you know. that me asking a patient to come back would be very frowned upon. So it really is a, it is a big shift. And some of it might involve having, having, you know, a hygiene assistant to where perhaps, heck, maybe patients come in, you know, before my last physical, I had to go in a week early, right? Do my blood draw, like you said, so that that way all that data was there for me when I showed up at my visit. Maybe patients come in early and they do that salivary diagnostic test together. That can be done with a dental assistant. Like that, things like that don't. necessarily have to happen in the hygiene chair or in the dentist chair. And so I think there's some really creative ways to be able to shift that, but it does take a shift in mindset, which is hard. Yeah. And I think the whole point of me doing this podcast show and also working with our Viva Learning team on the webinars and getting great KOLs like yourself is to open the minds of our... audience and say, hey, you know, a dental hygiene bay does not mean that you're picking up hand instruments and scalers and root plane, you know, whatever instruments they use these days, ultrasonics and piezo. That's not all we do here. I mean, and starting off with, like you said, it's a great idea is to have a separate visit just for diagnostic testing. They do it in medicine all the time. So we just have to. realize that we are physicians of the mouth and everything is connected and the literature is supporting that, you know, 100%. And like you said, down from eight to six patients, the office is making more money because if I was a patient and I was tested with even simple tests, you know, I don't know how sophisticated these tests are, but even simple tests like that nitric oxide strip and the salivary tests and even disclosing solution, whatever. I would be much more prone to listening and agreeing with future treatment work from that practice because it's based on tests that were done on me, not just open your mouth. Let me take a look. You know, I think you could use then it sounds salesy. It sounds like the office is trying to sell me something and make money on it. We all know it's a business. But when I get tests, definitive results on tests, I'm. Personally, for me, I'm much more likely to say, yeah, we need to do this. If that's what it shows, I want the best for myself. And if that's what the test shows, let's go. Let's move forward. Yeah, we need to do a separate podcast, Amanda, just on diagnostic testing and developing a hygiene department with that built into it. I think that's the future of dentistry as far as hygiene. I think it's so important, underutilized. And thank goodness we have people like you. promulgating this important information around to our colleagues so that they get the idea of what really they should be focusing on. Amanda, thank you very much. We'll see you on another podcast soon. And thank you for all your contributions to People Learning. Thanks for having me.