The Dental Hygiene Multiplier: How Aligned Systems Fuel Sustainable Growth

Welcome to Austin, Texas, and welcome to the Phil Klein Dental Podcast. Dental hygiene has always been viewed as important in dentistry. But what if it's actually the most underutilized growth engine in the entire practice and the key to elevating the overall patient experience? On today's episode, we're unpacking what it really means to optimize the hygiene department and how that shows up in a dentist's day-to-day life when it's done right. Because when hygienists are empowered to do more, patients don't just feel cleaned, they feel educated, cared for, and connected to the practice. So if you're looking for a thriving, growing practice built on exceptional patient care, this conversation will challenge how you think about hygiene and show you what's possible when it's fully optimized. Our guest today is Tiffany Wuebben, a registered dental hygienist and founder and CEO of The Hygienepreneur. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases and our entire production team will really appreciate it. Tiffany, it's a pleasure to have you on the show. It is such a pleasure to be here. Thank you so much, Dr. Phil. I appreciate you. Yes. Yeah, we're very happy to have you. And I know you have The Hygienepreneur. That's your company. And you have a website, thehygienepreneur.com website. So we certainly encourage everybody to visit that after the podcast if you're interested. But to get this one started, you often say that hygiene has the power to elevate an entire dental practice. And by that, you mean the hygiene department, of course. What does that actually look like? in a dentist's day-to-day life when hygiene is truly optimized and how does that compare to the flip side the traditional mindset of just getting patients through cleanings absolutely so when doctors lean in on hygiene and all of the gifts of the hygienist because hygienists have a lot big things happen our doctors don't have to stress so much about doing another crown or doing another procedure to, you know, meet the goals for the day or whatever they're trying to do. When they lean on hygiene, it just happens naturally. It's less stress for the doctor, better culture. The team feels good because they're being empowered to lead. And you know what? That's what we see in the practices that we work with. And it's amazing. So when you say lean on hygiene, what do you mean by lean on hygiene? Well, a lot of us hygienists, most of us, have these beautiful gifts that come out naturally to build relationships with patients and lifelong relationships. Like for myself, I would see children and then they would grow up and have babies and I would see those babies and then claim the grandparents. And it's really generational. And I'm sure you can agree with that, Dr. Phil, that it's like amazing. When we can lean on those gifts and building relationships is how you build a practice. Yeah. So yeah, I'm an endodontist retired. So it doesn't, the relationship thing wasn't as critical for me because, you know, most of the procedures that we did were two visits or less. A lot of them in a single visit. And we were hoping we wouldn't see the patient again. For us, relationships was more important with the referring dentist than it was the patient. But no, you're totally correct. So most dentists know hygiene is important. Yet, as you know, many still underutilize it. So from your perspective, Tiffany, what are the biggest blind spots and obstacles that keep practices from taking full advantage of their hygiene department? Well, I think our doctors just don't know what they don't know. And then what ends up happening is I come in and I'm like, guys. doc this is what's going on here all we have to do is elevate the clinical side of hygiene elevate the gifts that that the hygienist naturally has really hone in on that patient experience and watch what happens get out of the hygiene hustle really lead with intention like what do i want for this patient what do i want for my practice what do i want for this department and then you gather your team you gather them around with team meetings and say guys this is what we need to do to really gain that patient for life to really attract and retain the patients that we want to serve. So give us some concrete examples. Give us some real examples that we can tangibly get our hands on. Typically, the patient comes into the hygiene department, they sit down at a dental chair, the hygienist comes in, and they're scheduled for either a prophy or an SRP, whatever they're scheduled for. And that's traditional hygiene. work clinical work now you're talking about elevating what are we actually talking about so our listeners can say okay i see the difference between what you're proposing and what we're currently doing in our office which may be the traditional mindset Okay, so here's the deal. My background is in hospitality. I worked at the Ritz-Carlton. I worked at high-end resorts. And it was all about gaining the customer for life through really elevating the memories that you're making for that customer on the property and making it an exceptional experience that makes them want to come back. So the practices that I work with, there's an imaginary red carpet from the front door to the front desk. and down the hallway and you see the operatories to the right or left right and it's really about gaining the patient for life by really making and creating memories with them that last and doing things special with intention and that's the thing you don't just go through the motion you lead with intention what is our why what do we want to achieve and how can we do it together and you know what It has to be about the team. The team has to take that on because our doctors, they can't take that on. It's too much for one or two. So you're talking about the patient experience. So if I'm a general dentist and I'm listening to this podcast and I go back to my office, what do I have to do to get... the patient experience elevated through my hygiene team? What are we actually looking? What am I expecting them to do differently? They're all nice to the patients. When the patient comes in, they greet the patient. They ask them how they've been since the last time they saw them. It may be a community where they know that their son plays baseball and they go, oh, wow, I heard you won the championship. So whatever relationship they have, I'm going to tell you. that's going on right now. I have that in my office. What should I do beyond that, that I'm missing? So it's all based upon hospitality-based care. And so what that means is we've got to have an even bigger elevated experience. So I have an example for you. I had a hygienist that was seeing a patient late at night, and this hygienist is me. And it's happened to us. The patient comes in, we clean their night guard, and then Patient leaves and we're like, oh, my gosh, they left their night guard. And you know what? They've got veneers on the front, upper, upper anterior teeth. And you call the patient. They go, I'll come by tomorrow. And you're like, no, not on my watch. So guess what I did? I cleaned up my operatory, jumped in the car, went down to the softball field that her daughter was playing a game in. And I hand delivered the night guard to her. And that's the Ritz-Carlton way. And those are the things that I learned when I worked in hospitality is you do things next level if you want next level results, if you want a next level outcome. And so I actually sat there and did watch the game. Now, I'm not saying that all of us have to do that, but it's really making sure that we are providing things for our patients before they even know they need it and offering things to them and really making sure that we are. doing the things that make them feel extra special and really served well. So you believe, Tiffany, that in large part, general dentists are under utilizing their dental hygienists, which is keeping them from really taking their practice or elevating their practice to the next level. And you've assessed many dental practices. Is that what you're finding? A hundred percent. And you know, when I wrote... my first book, Hygienepreneur, I tempted over a hundred practices while I was working Tuesday, Wednesday, Thursday, seven to seven. And I did that because I wanted to see all the great things we were doing in our industry. And I wanted to see the things that maybe we needed to work on. Right. And I saw it. I was like, oh my goodness, these doctors don't even know what they have. And the hygienist didn't really realize. who they were and their real role and the power that they had in their role because they had such beautiful gifts. Right. But I mean, they're trained to do scaling root planning. They're trained to do prophys. They're trained to do risk assessment. And if they're nice to the patient as they do that and they get along with their patient, you're saying that's not enough. They need to go. It's not enough. It's not enough. We have to do something different than the practice down the street. And when I'm working with my practices, I'm like, okay, guys, how can we be different? What can we do different that really helps that patient see us in a different light? You gave an example of running to the softball field with the night guard. What other things on a daily basis do you think? dental hygienists should keep in mind with, of course, the culture and the guidance of the leader of the place, which is the dental owner. All this has to go together. What are some of the other things, the concepts, as specific as you can be, that they could do to, again, differentiate themselves from the dentist down the block? So it's not just the hygienist. It's the entire team. So patient comes in the front door. We're not seated and greeting them. We stand up. We recognize, we say to them, Judy, it's so nice to see you. We've been waiting for you. How's your day going and how is that cruise? When we stand up and we recognize the patient and give them the warm greeting, number one, and then when they go to the back and they sit in the chair and it's a little old lady, what are we doing? It's cold in here. Can I offer you a blanket? We give them what they need before they know they need it. That's the whole thing. And then it's the warm farewell, making sure we use their name, making sure that we're capturing those moments, those stories and putting them in the computer so that way everybody on the team can share and building that great memory with that patient. It's hospitality-based care. Right. So the person who that dentist is hiring, and there's a hiring crisis right now, so dentists are happy to hold on to the hygienist they have. Um, but when they're hiring someone, um, during that interview period, they need to understand that that patient's person, that hygienist personality is well suited for this kind of approach. Because if someone tends to be a little quieter, they may be a very nice person, but they come off as being somewhat of an introvert, but they're great hygienists as far as the teeth go and the gums, they're the best, but they're just not as friendly overtly. What do you recommend to a dentist when they come up with that kind of potential candidate when they're doing the interview? Well, I love that because there needs to be a balance in the practice because trust me, our patients who are introvert sometimes would love to have our quieter introverted, lovely hygienist. And that's not just hygiene. That's every team member in the practice shares a specific role. is really special in that role. And we all fit like a puzzle. And that's the thing. You don't want 14 extroverts running around the office. When we're all a little different, we can nurture our patients the way they want to be nurtured because they're different, right? So you're saying that if you have more than one hygienist, it might be a consideration to pair up an extrovert with a patient who loves to talk and listen to a conversation versus putting that. extroverted hygienist was someone who wants to be quiet and just meditate. And that a better fit there would be probably a hygienist who's more introverted. It's just sometimes it's just sometimes that happens. Like I had patients that saw me and here I am this extrovert, right? Extreme extrovert. You said it, I didn't. I am. I love to share and I love to be out there and taking care of people. And sometimes maybe I could be a bit much to a patient who's an introvert and especially at six o'clock at night, right? And so, you know, sometimes the front office will say, you know, Tiff, this patient, I think I'm going to schedule them back with Judy. And because she's real quiet and all this. Me having high social intelligence, I'm like, you know what? Good choice. That's great. Now, do we want to do that all the time? No, because when a hygienist has high social intelligence and great communication skills, she knows when to be quiet and when she's taking care of a patient that maybe doesn't want to talk so much. And that's a gift of all hygienists. Hygienists have that gift. They know. when they need to talk, when they need to not talk, when they're dealing with a patient who wants to know everything about the procedure, when they're taking care of a patient who maybe just doesn't want to know, just do, right? So we don't have to do too much. You know, we really make sure that people are in the right seat and that they're supported and that the gifts that they have are elevated. So when you go into a dental practice and you review that practice, When you run into a dentist that says, you know, everything you're saying I'm supposed to be doing, I think we're doing. I think Sarah is a doll. Her patients love her. She is very adaptable when it comes to changing her approach to different patients based on their personality. We go above and beyond with extra services as far as walking the patient to the car with an umbrella. If they don't have one, we'll actually hold the umbrella for them as they go to their car and they feel they've got it all right. Now, do you see yourself in those offices sometimes saying, well, not really. You don't, you're not even reaching near the potential you could be at. Do you find that to be common? It is sometimes. However, every practice has so many wonderful things going on. But all of us, because we're treating patients, we're in that mode, have missed opportunities. So I get to come in. And by the way, I show up in scrubs, you know, and I manage. I do overall practice management and also hygiene department management. So I do both, whatever serves the practice best. But when I come in, I work side by side with the team. And so we really do hone in on, okay, what are the missed opportunities here? And how can the patients and the practice and yourself be better served? And we look at that together. Now, we talked offline about this briefly, Tiffany, and you mentioned that one of the exceptional patient experiences is being treated by a hygienist that really understands risk and knows how to go forward with the treatment plan to minimize that risk assessment. Tell us about that, how that is very important that the general dentist makes sure that their dental hygiene department and the team focuses on this as well. not only for the clinical benefit to the patient, which is so important, but also the exceptional patient experience. I almost feel like hygienists, we have to be almost like mixologists because we have a lot of tools in our tool belt as far as being able to take care of patients. You know, practicing as long as I have, it used to just be fluoride, right? Well, now we have, you know, based upon risk factor, low, moderate, high. We can offer, you know, dental creams like Vocos Remen Pro, which, you know, has the xylitol and the calcium phosphate and the fluoride in there. I mean, when you have a plethora of products and services for your patients. That also does elevate the patient experience. And to your point, Tiffany, in order for a dental hygienist to know about these new products, they need to stay up on their continuing education, which is so important. And that's new products and techniques. And that's an example of what you said. Certainly, VOCO has a lot of new, innovative, preventative products. They lead the... They lead the industry in that area without a doubt. They really do. And they're really helping us serve the patients better. And I think when we sit down with our patients and we go, okay, what's going on here based upon risk? And then we can come up with, yes, we're going to do the care, meaning the scaling and root planning, the perio maintenance or whatever. But when we can also come up with a special mix of ingredients, that's going to really make sure that that patient is taken care of. We get exceptional patient outcomes. Well, that's where it's at. When we do that, and most practices aren't giving these options, then what happens is that sets us apart. Well, what are the other practices doing? If they're not offering these new innovative products like the one you mentioned, what are they offering? Well, sometimes it's like the standard, right? It's fluoride. Everybody gets fluoride. But things are changing. We're seeing that in dentistry. Technology is happening and it's beautiful to embrace that. And it really does help our patients get better served. And then in the end, we as clinicians, boy, that makes us feel really good. So let me ask you this. You talk about this in your book. You talk about this when you teach. And that is the dental hygiene department being treated as a strategic growth engine rather than just a department. tangible results should a dental practice owner expect to see when they start really aggressively implementing this approach of turning their hygiene department into a strategic growth engine? Okay, so when you start honing in on hygiene, big things happen right away. So like in 30 days... you can increase your hygiene production definitely by 10 to 15%. I mean, I've seen that. Even just doing one procedure, like one little tweak, we saw growth within two weeks, $6,000 in production. So if we're just talking about ROI. What was that tweak? This office were taking images, but they weren't taking the necessary images on the front teeth. And we were missing the canines, one of the surfaces of the canines. And so the doctor came to me and he goes, you know what? I missed decay there and there. And this isn't good. And I said, well, why don't we just add an extra PA on the maxillary anterior? I mean, that'll be fine. And so we were delivering exceptional clinical care. The doctor felt comfortable because now he could see or she could see what was going on. But then the production went up. You know, sometimes it's just a little tweak. Or when they had sealants in the drawer, right? They have the sealant material and none of the hygienists were using it because they just weren't thinking about it. And so that was another practice. The minute we had the conversation, one hygienist did 58 sealants in one month. So there were no systems in place. There was no SOPs in place or there were no huddles or meetings that would go over what should be done, what's expected from the hygienist to do on these patients. And part of that is using a sealant. So it was really maybe one hygienist felt. I'll put a sealant in today and the other hygienist fellow, I don't feel like putting it in today. So it was kind of like random, you're saying. So it means we're not calibrated. And so, you know, that's one thing. My teams have to be calibrated from the front office. All the way through that practice, every team member knows what's going on. We all know how to communicate properly with procedures. We know exactly what's happening with our patients. We have absolute synergy. But that's because we put in protocols and systems and operations. And then we have meetings. We have power hours to make sure that all the systems are working correct. And if they're not, then we've got to tweak it. Right. I mean, one of the things that dentists sometimes don't understand is they think if they schedule more patients and work harder, they're going to make up for any deficiencies because they're just doing more volume. But that doesn't really solve the problem. Sometimes it compounds the problem into a chaotic situation. So having systems in place and taking the time to, like you say, communicate to everybody so everybody is on the same page. you have synergy, then in a lot of cases, you don't even have to see as many patients and you can certainly make more money that way because it's just more efficient. Let's pivot for a moment to something that affects all of us at one point or another, and that's burnout. Burnout is something to be taken seriously. It's often amplified, like we just talked about, when systems break down and team members feel out of sync. Now, you work with many hygiene teams that are quote unquote, burned out or disconnected. How does leadership alignment or just as importantly, misalignment actually show up in the hygiene department on a day-to-day basis? So when you elevate a person, when you elevate a team member, it just makes them feel better. And then the whole burnout is going to be less. When you look at them as a person and say, okay, how can I best support you both professionally and personally? What's going to happen to that employee? What's going to happen to that team member? They're going to look at the practice a little different. They're going to look at the brand a little different. So what we want to do is we want to nurture our team members, both professionally and personally. We want to elevate them with great leadership, empowerment. We want to bring them in as... partners in the practice like what's happening in your operatory and and what should we do different right what's happening in the practice what should we do different what are your thoughts and when we start having intentional meetings and asking those questions there's a shift that happens then if we have if if pay if the hygienists are burned out and our doctors are burned out when we start introducing new technologies new procedures sending them to continuing education classes where they're getting revitalized that's what we need as clinicians We have to do that. We see positive results from that. What do you think are some of the low-hanging fruit that could actually revitalize a practice and kind of shift out of that burnout phase? Number one, we've got to be good listeners. None of us are listening. I mean, we're having these hallway side chats like, hey, how you doing? What's going on? We're not having intentional meetings to look at our systems and operations and look at us as people and say, okay, what's going on? How are we doing? What's going on with that patient? Or are we aligned? How are our handoffs between doctor and hygiene? Is there total flow there where things are just popping and everything's good? Because I know the doctors I've worked with, we worked on that together. It's not like it just happens, right? The handoff you're talking about. Yes. We train the handoff between, you know, hygiene and dentists, dentists and hygiene. Assistants are in there. Hygiene to front office. It's kind of like, you know, a ballroom dance. And so, you know, and we edify each other. We build each other up, especially in front of the patients, which builds trust, which builds all of the beautiful things. And that boosts case acceptance, of course. Oh, yeah. But a dental office can be a very chaotic scene. Even if you have systems in place. So I think what you're getting at, and correct me if I'm wrong, is that you want to minimize the chaos and try to keep everything under control. But everything is running in, you know, it's running live. It's like a live show. You know, you hope it runs smoothly. But when things go wrong or there's little hiccups here and there, you try to smooth them out as you go through the day. But it doesn't always work that way. But if you don't have any systems in place and you have no fundamental communication to fall back on and no systems to fall back on, then you're in trouble. Because then you have, it's like the Wild West out there in a dental practice, right? Well, here's what you're talking about. And this is why I get the calls to help. The practice is running us instead of us running the practice. So I had a dentist who called me last week and I said, okay, are you doing hygiene meetings? Are you having hygiene meetings with your hygienist? And I don't have time for that. And I said, well, who owns the practice? Who owns the practice? My practice is too busy. I said, who owns the practice? He says, I own the practice. And I said, then let's schedule a meeting. Yeah, that's it. Yeah, that's the biggest mistake. When a doctor says, I don't have time for that, that means he or she is already in trouble because they're being, like you said, they're being controlled by their schedule. They're too busy to get things in alignment because their schedule is creating that chaos. And it just, you have to get to the root cause of what's causing the problem so things can smooth out. Let's talk, as we get to the bottom part of this, well, we're past the bottom half, we're getting towards the end. Let's talk systems. Give us two operational systems that every practice needs in hygiene to help support prevention, consistency in care delivery, and better case acceptance, which is really important. Okay, so... Number one, when we go into a practice, the first thing we want to do is we want to empower calibration. And so what that means is we've got to get our protocols in order. So we meet as a team and with doctors insight because it's their vision, right? They're the ones that have the stamp on the door. It's their name. We establish what the perio protocol is, what the assessment protocol is. what the adjunct therapy protocol is. I mean, we mentioned risk factors earlier. And we really make sure that we're honing in on that and that we agree as a team, if a patient is observed with this, what are we doing? And what is the recall? And what is the tool that we're going to suggest? We do case studies together. When you talk about how to change the trajectory of us directing the practice on what's going on, number one, we got to get our protocols in order and get them written down, put them in a book. And then the second thing is we have team meetings to make sure that we continue to be calibrated. And that even goes with our doctors, an owner doctor and an associate. We want them calibrated in care as best as possible. So that way, whoever comes in to do that exam, the hygienist already knows Dr. A is going to say this and Dr. B is probably going to say the same thing. Yeah. Now, do you see one of the major problems from the mindset standpoint that a dentist looks at himself or herself as the dentist? and looks at the hygienist as the hygienist. And these are two separate entities. I have to do my dental work. I'm doing veneers. I'm doing some onlays. I'm doing some all-on-four implant cases, more sophisticated stuff. And the dental hygienist, they went to school. They need to worry about their department. And we're very happy to have a dental hygiene department here. But the two things are kind of mutually exclusive. Is that the problem? that they're where they're under utilizing their hygiene department well it's a bi-directional relationship so you know the hygiene team needs to recognize what doctors got going on over there and then the doctors need to realize what the hygiene department has going on over there and then you have the great coming together so you know i absolutely knew exactly what my doctors were doing on their side and if i needed to jump over there and quickly give an injection to help out the schedule I would do that. It wasn't about hygiene side and doctor side. It was about how do we serve our patients the best way and be pro-practice. Because when I come in, I'm pro-practice, I'm pro-doctor, and I'm pro-team. Now, do they teach any of this in dental hygiene school? No. Because I know they don't teach it in dental school. I don't think they teach anything about building a collaborative approach with the hygiene department. I don't know. I learned this outside of dentistry and then thank goodness, thank goodness I was in hospitality and, and, and worked for really good companies. And, and I took that information and came in and was like, this is how we've got to do it. I mean, that's the, that's the basis for the exceptional patient experience is the hospitality background you have. In fact, I do know, I do know a very good dentist who's, who also. speaks and he's very active on VivaLearning.com and other areas. He does episodes with us. He hires people, or he used to hire people, I don't know if he does it anymore, from Nordstrom. He used to go to Nordstrom and he'd go to different departments. He'd find someone to talk to that he thought was very polite and just spoke well and carried themselves very well and said, by the way, are you looking for another job? Here's my card. And they said, well, I don't know anything about dentistry. And he said, I could teach you dentistry, but I can't teach you how to make people feel good and elevate the customer experience. In our world, it's the patient experience. And he would hire people from Nordstrom. And that's what he did. Sounds crazy to me a little bit, but he was very successful with it. And I do want to mention, Tiffany, you are the first person that I think I've ever interviewed on the show, since 2018 the show started, that transitioned from the hospitality industry, working for a major hotel operation, to dental hygiene. That's a first. And without a doubt, with your background, that's helped you formulate your whole approach towards elevating the patient experience, which ultimately leads to a thriving and successful practice. So I do want to ask you, Tiffany, as we wrap up this episode, any last thoughts for our listeners? Elevate the service. that we're providing. Make sure that the patients are really served and that they're being seen and listened to as a unique person and watch what happens to your practice. Oh yeah, without a doubt. Word of mouth, it'll grow very quickly. And without that special relationship with the patient, it's hard to run a very thriving, growing practice. You're constantly fighting the momentum of the patient not being engaged with the practice. And that's... obviously more difficult to make it successful. I think that's been very good, Tiffany. Again, if people want to get a hold of Tiffany, look at her website. It's thehygienepreneur.com. So it's thehygienepreneur.com. Check it out. And we'll have Tiffany on again. In the future, I'm sure. And she'll be doing some webinars with us. Thank you so much, Tiffany, for your time. Well, thank you so much. This was so fun. And I really appreciate it. The questions were awesome. And I just love this. Thank you so much for your time. You're welcome.