#921: Why Perio Calibration Matters (Even When You Think It Doesn’t)

Dental A Team Podcast

This one's for the doctors and hygienists. Tiff and Britt discuss why perio calibration matters, how accountability on top of that improves practice-wide success, the right percentages your hygiene department should be reaching, and more.

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Transcript:

The Dental A Team (00:01.302)

Hello, Dental A Team listeners. I am excited to help with you today with me, with us. Britt Stone, Miss Britt is one of our hygiene queens. You know, we have a couple of them on our team and occasionally I like to bring them in for some hygiene flow and some hygiene spaces. Now, Britt, today we are gonna talk hygiene, but I wanna do hygiene from doctors.

perspective and like doctors really getting a lot of value out of that space. So today's hygiene is a little bit different. Your hygienists can listen to this always as well. Obviously there's gonna be nuggets in there for them, but doctors, this is for you. Before we jump into my hygiene, I'm so excited for this one, my hygiene stuff, Britt, how are you? You just went on vacation and it was a little chilly, I agree, because we're from Arizona, anything under.

80 degrees is a little chilly. I get it. Tell me, where did you ladies go and how amazing was it?

Britt (00:56.382)

That was true.

Britt (01:04.513)

It was amazing. One, thanks for calling us Hygiene Queens. I think all the hygienists out there appreciate that. So we love it. But I went up to Washington, Seattle area. So out to Woodby Island. So a little island out there. Took the ferry over, enjoyed it. It was great. I mean, we're all Arizona girls that went. It was like a high school crew, all my high school friends that went for a vacation once a year. And so we went out of town, enjoyed some fall, enjoyed some cooler weather since we don't...

The Dental A Team (01:17.913)

Super cold.

Britt (01:32.695)

get as much of that here and had a great time.

The Dental A Team (01:34.351)

No, that's awesome. And you froze, because you were like, those islands, they get really cold no matter what time of year it is. They're chilly, because they're way up there. You're almost Canada in those suckers.

Britt (01:46.497)

Yeah, and it's windy and it was rainy because it's fall time, but I mean, yeah, it's, yeah, which makes it nice and green and it was gorgeous. We saw like a bald eagle. Amazing. So it was.

The Dental A Team (01:52.333)

in Seattle.

The Dental A Team (01:58.028)

to.

that's really cool. Well, I am excited that you got to go and I think that's super cool. I know you guys do your once a year trip and it's always something really, really fun and you get to just disconnect for at least a weekend. So I was happy to see you're out there. Yeah, I love it. I love it. And I love, I do love my hygiene queens and I think hygiene is obviously an imperative space.

for dentistry and today's topic, it's actually, it's serendipitous, know, things always happen and come up. But the other day, my partner was asking me, he said, because he's a financial advisor, so he's always thinking numbers and he advises a few dentists. And so he's like picking my brain for things. And he's like, how much do dentists actually make?

off of a cleaning, because like he'll go in for his cleaning and then come out with like all of these financial questions for me and I'm like, I'm very smart, you like I'll walk you through it. Yeah, so I'm like, nothing. He's like, what do you mean? What do mean they make nothing? And I was like, they make nothing. Like you're not, you are not going to be profitable off of strictly re-care appointments. And so I literally like, that was my initial response was like nothing and like walk away, right? And he's like, no wait, tell me more. And I'm like,

Britt (03:22.275)

all the things and then eventually nothing.

The Dental A Team (03:25.539)

Yeah, and so I was like, okay, fine, I'll break it down for you. Let me tell you all the things that go into a hygiene appointment and that cost analysis per hour and why it's so important that a hygienist does 3.3 times his or her rate of pay and can produce 30 % of overall production for the practice because if they're not, that department is not profitable for the company. And the non-profitable space of the company

is an issue, right? And it's not to say hygiene that, know, we're never gonna say do things you don't wanna do or squeeze your appointments or do more. And like, that's not who we are. It's really just about finding the spaces where we can create more value for our patients utilizing the tools at our fingertips and creating more profitability for the company because for Dental A Team we believe that the profitability leads to reinvestment back into.

the patients and the practice. So we cannot reinvest back into our patients' experience and all of these, you digital workflows that everybody's trying to do, these new x-ray machines, the scanners, the cavitron tips, guys, like those pieces of things and, and cool lasers and all of these things that you want even for your hygiene space, those are reinvestments back into it. So that profitability creates the space to be able to do that. And doctors today, I really wanted to walk through that. His question the other day was just like,

my gosh, like, this is something that as a consultant and as a dental professional, this is one of those spaces that to me is just like, I'm like, why would you even ask that? Like that was, that was a weird question. Like, obviously it makes nothing. And then I'm like, you want me to walk you through it? Okay, this is one of those spaces that I think people know that they don't. And really taking an analysis and a look doctors at your hygiene department and how you're influencing that.

as well and making sure that you're staying on top of it. think hygienists are incredible. I think dental teams are incredible. I think doctors are incredible human beings. But I think a lot of dentists, a lot of doctors are like, well, they're hygienists. Like you've got this. You've got this. You do the periapart. You do that, which I totally agree with you guys, right? You are in that world. You are in the gums, right? You got the gums. I'm gonna give you that world, okay? My doctors.

The Dental A Team (05:48.642)

you diagnose the decay, the things that need to happen, like you are in that world way more than anybody else is. So for hygienists to be the lead on perio and periodontal pieces, whether it's a routine cleaning or sky's the limit, that makes sense to me. But my doctors who pull so far out that they don't actually know what's going on over there anymore, which...

That doesn't happen for anybody out there legally who's listening. That doesn't happen. But when we're not calibrated, or my doctors, I've had so many times a doctor that's like, yeah, I think they'll be fine, maybe a debridement. And the patient gets over, and the hygienist is like, five millimeter pocket. I'm like, no, he said a debridement. I guess we've already treatment planned it, so now we have to do a debridement. My hygiene team is upset.

Britt (06:15.165)

Yeah.

The Dental A Team (06:40.269)

I really wanted to talk periocalibration today and Britt, I wanna speak to the doctors specifically, hygienists too, and if you're listening to this and your doctor doesn't listen, like share this one, but go back and do these things with your doctor too. But Britt, from a hygiene standpoint, like how does periocalibration with your doctor, how does it positively influence your experience as a hygienist to...

obviously give your patients the best experience, but how does that influence your experience as a hygiene team member within a practice when you guys are more calibrated like that?

Britt (07:13.537)

Yeah, mean, is big, right? When it comes down to it, we need to have a standard when it comes to perio that we all agree on. It's doctor-led, right? And then someone's got to ensure that that standard is actually happening. And that's where doctors don't get so disconnected from it that you can't recognize when a hygienist is not following the standard that we've all agreed upon or that you have set forth and you want that level of care provided for your patients. That's where...

You know, as a hygienist, I love a doctor who trusts me. And you know what? You trust me because we are calibrated and you trust my opinion and you double check it and that trust continues to be there because we continue to be calibrated on how we treat our patients. And if we are not, then great, have a conversation and let's address it and let's reset things. mean...

We're all human beings. How many of us have a habit that slowly over time, gradually changes a little bit? It can happen. So we need to help each other, right? Keep that standard of care that we want to provide to our patients. And sometimes it goes both ways, right? I want that doctor double checking, spot checking things to ensure that that quality is there. If there is a question, great, let's have a conversation about it.

If doctor comes to me and says, hey, like question something, then like, great, let's have a conversation about it and let's recalibrate and let's get back on track with each other and get in line so that we ensure that the quality of care that we're providing to our patients is what we want it to be. So I think for doctors, right, anything we do, and even when we work with people on front desk items, it's like, well, how do I make sure that that's happening? Someone's got to spot check. There's gotta be accountability somewhere.

Clinical is where doctor needs to be strong accountability. Office manager is more strong accountability for front desk and doctors accountable for office manager to ensure things are getting done. So there has to be checks and balances. If you just let someone go, that's how one day you realize or you have a switch in hygienist and your new hygienist is like.

Britt (09:17.347)

What's been going on over here? I'm having to work real hard and I'm having to have a lot of conversations and hard conversations that are just tough for the practice all around to have to talk to a patient about, this is what the hygienist did for the last 10 years. Here's what I've seen today and we need to do something different. And those are just tough conversations to navigate. They can be done, but we don't want to get in a position where we need to do that.

The Dental A Team (09:43.637)

Totally agree. think that calibration piece you're talking about and the accountability on top of that is huge. And I think there's a couple of, know, step gaps that are put in there for that situation. And I want to implore upon all my doctors listening today that standards and metrics are set based on everyone.

Like it's a pool of people that the information is taken from that says we should be three to 3.3 times your rate of pay. You should be about 30 % of your overall production. So these standards are set based on multiple people being looked at, right? Multiple practices. So don't forget that because I know a lot of the pushback I get from a lot of teams, a lot of doctors, when I go into consult them and I'm looking for these pieces is what you don't know my patient base. Okay, and there are, I do have a few practices. I've got,

a practice out in Pennsylvania who was like right next to a university, right? So he's got a young patient base, like yeah, your period is gonna be a little bit lower, but it's still there. And he had a new hygienist come in and she's like, he's like, my gosh, my period percentage went up. I'm like, yeah, because it's still there. It just wasn't being diagnosed before. So he fell into that situation where we were like, well, know, okay, fine. And I'm like, fine, it's college kids. Hands in the air, I'm giving it to you. Fine, totally fine.

switch up a hygiene and she's like, no, she's got perio blocks all over the place because it's still there somewhere. I've got an office in Utah who's similar. They're in a younger area. There's a couple of colleges in that area, right? But they've got younger families, they've got younger patients, and there isn't a lot of perio in that area, but he's still hitting like 18 to 22 % with a non...

Perio involved area so that 30 % isn't super difficult to hit as long as the perio diagnosis is being done so Doctors when you're listening to this and you're like, okay, but like where does this standard come from? It comes from everywhere. It comes from everyone. This is across the country standards that 30 % I like it because it keeps everything in the threes I want 3.3 times your rate of pay and 30 % of my overall production should come from hygiene now

The Dental A Team (11:57.565)

If you're not seeing that or when you do the analysis, which is super easy, you guys, I want you to go in and do this. If you don't know how to do it, we're gonna tell you in a sec. If you're not doing it, I would do it every single month and watch your perio constantly or watch your hygiene department constantly. So realistically, all you do is you take your hygiene production. So what did all of your hygienists do for the month?

and divide that by the overall practice production, and that's gonna give you your hygiene percentage for your practice. Most practices, when they're not looking at it, when they're not tracking things like this, and they're not truly calibrating on hygiene department items on Perio, most practices are anywhere from 14 to 20 % on average, from what I've seen from my practices. They're on the lower spectrum because they're just not looking at it. We're just doing that hygiene mill where best...

know, backwards to the beginning of this where I was like, we don't make anything. Like that's where you're at, that 14 % rate and 18%, like doctors, you're working your tail off to make up that gap. So you should be covering 70 % of the goal, but typically doctors are closer to like 85 % of the goal and they're like, tch, Brett, why am I so tired? Like don't wanna do this anymore. I'm like, all right, let's look over here. So calibrating on those pieces is huge.

because you want your hygiene team to all be diagnosing it as similarly as we possibly can. You will have hygienists who have been there for a long time, but aren't getting a lot of new patients. Their perio diagnosis is gonna be a little bit lower, because they don't have the opportunity. And that's okay, but overall across the board, your hygiene department should be diagnosing enough perio to be getting you to that 30%, because based on the statistics of the country, we have enough perio in

you know, the people here in the general populace to account for that in every in every practice. So watch those numbers. then, but I think maybe speak to some more for me, from hygiene perspective, how the doctor and the hygiene department really truly calibrate on those. then, like, that's one space, right? The numbers is a space of accountability, office managers can do that.

The Dental A Team (14:13.546)

face real easily, let the doctors know and you can also watch your treatment plans if you're not getting treatment plans for perio, like you can start digging into that. But then from an accountability point chair side, like what is it that your expectation is for that doctor, that dentist in the chair with that hygiene department? What do you want that to look like?

Britt (14:33.825)

Yeah, when it comes to diagnosing perio, right? Our hygienists do a great job in helping to evaluate things, see the big picture and relay that information to you. You need to verify the information. I'm not saying go through and do a whole perio charting, but check some of those numbers, check those deeper areas to see, we getting the same reading?

Do I agree? Is this the diagnosis that I want to make as the doctor? Because you're the one that's making the diagnosis. And if so, awesome. If you're off a little between the two of you, then it's like, all right, maybe it's time to do a little calibration, which can even be going through, taking a team member, period charting, seeing what we come up with. Are we pretty close with each other? Are we way off? Do we need to go through and look at some of the clinical skills for that team member?

and evaluate. And sometimes it might be doctor or hygiene clinical skills, right? Like that's what's like, all right, let's work together on it because doctors don't do it all the time. But the more that you do it and the more that you're checking, you're going to keep your parietal skills up and you're going to keep your team calibrated and accountable on those things. And if you're not agreeing on something, hey, if it's just off a little bit, like great, go for it in front of the patient, but come back to it and know that it's something that we need to address and we need to talk about to calibrate and evaluate.

And that calibration goes both ends, right? Sometimes, you know, it's not diagnosing what's there. And sometimes it's been a little too aggressive, right? So it can be both ends that you're helping to manage and keep everybody in line. So I think doctors, if you're not spot checking, but you're making the diagnosis of perio, spot check it and know what's going on there and validate that, yep, I agree with what's going on.

The Dental A Team (16:17.322)

totally agree and that comes back to what makes me think of like no matter what, you're the only one doctors who can diagnose. And so if that diagnosis is off, it's not what it should be in either direction. It should have been perio and it wasn't caught or it wasn't perio yet and it was diagnosed as perio, that falls back on you. So I wanna scare you with that. Like I want you to be afraid of allowing someone else to truly diagnose with.

Britt (16:25.058)

Mm-hmm.

The Dental A Team (16:44.046)

for you, right? We're diagnosing as your support team, we're diagnosing with you or code, we're co diagnosing, we're saying this is what I'm seeing. Do you agree? So your hygiene team is like, I'm seeing some deep pocketing there, I explained to them that it could be a deeper cleaning that we might recommend. Like, that's, you know, the verbiage. And I just want to say that to remind you guys not to get so comfortable that you forget

that it is your license, it is your responsibility. And I love hygiene, I love support teams, I love all of them. And I'm not, I don't think there's many people, if any, out there who are just out to get something or do something wrong or inaccurate, but it does happen. We get sloppy, we get tired, we get fat, quick, we're like, gosh, we've gotta go, we've gotta go, and we start missing things. And so it's just that.

where you guys are looking out for each other and you're truly, truly just spot checking and double checking, a quick PSR. But I did have a practice for it as you're talking, I'm thinking of them. One, a lot of new patients right now are ending up on doctor schedules because our hygiene schedule is chock full and people are forgetting to do their new patient locks in hygiene. So don't forget to do that.

But a lot of those new patients, or I do have a lot of practices that prefer like a cosmetic approach to a new patient and a full mouth series, like scans and all that. So they put it on doctor's schedule first. That patient's gotta go over to hygiene. And in a patient's experience, going over to hygiene for the correct procedure, instead of going over to hygiene another day to be diagnosed to come back another day, creates a way better experience. So doctors knowing too, how to diagnose

what your hygiene department's gonna want from your chair is massive. I do have a practice that recently did exactly what you were talking about, Britt. They had the team in the back and they're doing all the probes together, the hygiene team and the doctor, because the hygiene team was like, what is happening? Like his probes are 10 times deeper than what I'm getting. And they realized they were reading the probe depths differently on the probe.

The Dental A Team (18:56.02)

and they had to buy all new probes because they couldn't calibrate on the probes that they had. They could not come to an agreement because it was one of the generic ones, know, where there just wasn't, there weren't a lot of lines. So was kind of like pick and choose what the long line meant, you know? And yeah, and it was impossible for this team to truly calibrate on that probe. And so they replaced all the probes with one that had smaller lines, that had more of the lines for the depths.

Britt (19:11.094)

at a time.

The Dental A Team (19:25.668)

And then they were like, and the doctor was, you know, and it was the doctor that was off is what we'll say, like, whatever, they came to an agreement, but the hygiene team was like, I don't know what's happening. And so they did exactly that. ran a test and where they were like, we've got to figure this out. And so they had to replace the probe. So it's not always to like, you're wrong. Sometimes it's like this, just this tool is not working for me. And I need a better tool, especially with, I mean, I'm not a hygienist.

I've never probed a patient because I'm not allowed to, but I can't imagine this like giant black line, right? That's just supposed to be so many depths and you're going in and being like, it's about this. So I get it. I would require many more lines on that sucker, but that's what it made me think of. So it is truly out there, you guys. It's not just you. You're not like some special case that did something wrong.

Everyone's doing this and everyone needs to do this. So really truly in order to make sure that you're calibrated, it's gonna take, Britt, you mentioned it, being on the same page, coming up with what you want, those parameters. Yeah, the standard, exactly. What is that standard? What's class one, class two, class three? Referral. What's omega class four? What are these standards and how are we going to follow them?

Britt (20:34.253)

this.

Britt (20:42.039)

Yeah.

The Dental A Team (20:49.253)

Calibrate on the diagnosis, not just what those are, physically, are you diagnosing the same? Are you getting the same probe depths? And really practice that. Do spot check PSRs on some patients as they come through. And if you are off and your trend is like, I'm off more than I'm on, start practicing with your team and really look at, is it the tool? Is it the person? How can we calibrate this? And look at your numbers, you guys.

Office managers can pull these numbers, they should be looking at them in my opinion, every month to ensure that we are reaching those percentages that we really truly want and that our hygiene department is paying for itself. And I hope your financial advisors too are thinking about that, like literally it pops into his head just because he has appointments with the clients or he goes and gets his teeth cleaned and it pops in. But I thought it was really cool because I'm like, gosh, that's just not something that I think all people think about. So I want you guys to go do those things.

Britt (21:29.155)

I'm

The Dental A Team (21:45.211)

Find your standards. If you've set standards, go back through them again. But I would say, I think every, I think once a year, mandatory. And maybe even every six months.

Britt (21:56.043)

Yeah, I almost even say quarterly. You should be reviewing cases together, honestly, and depending on, right, sometimes you might need to actually like pull out team members, calibrate on actual doing like probed ups to see where you're at. And sometimes it's just pulling cases and looking at it. So at least quarterly go through some cases to make sure you guys are calibrated.

review our perio standards to make sure we're on the same page and that there's no questions. The more turnover you have, the more often you should be reviewing these things. But even if it's hygiene department with doctor or quarterly reviewing things and also with that, not just perio, you can look at some preheating, right? Bring in some calibration on those things as well for the hygiene department are huge. And I love what you said about the perio probes. Usually doctors get the crappy ones. They get the old ones.

The Dental A Team (22:45.915)

Mm-hmm.

Britt (22:46.723)

and the hygiene gets the new ones. So yeah, thanks for everybody's got the same tools we're working with.

The Dental A Team (22:48.443)

So sure.

Yeah, that's so true. I love that, I love that. Go do those things, you guys. Go do those things. Make sure your standards are set. Review them as a team. I love quarterly, I would say at least quarterly. Spot check constantly. Always be comparing your probe depths to your hygiene department. Calibrate when needed. Buy new instruments when needed. And then always watch your numbers. Make sure that the standards are there for you guys. And you may have that patient base that doesn't have as much perio and that's okay.

Let's see what you do have and if it makes sense. As always, reach out, [e-mail] if you need more information or if you need help diving into it or you're just not sure what to do or you need more ideas, like whatever it is, just reach out to us, we're here. Britt, thank you so much for today. I love picking your hygiene brain and I think it was just a fantastic one for doctors to really see how they can lead and guide the hygiene department from the forefront. So docs, I hope you go do these things, enjoy it, love it.

Let us know how much you accomplished with your hygiene department. We love hearing from you. Drop us a five star review below. As always, we like to know that this hit home for you. Everyone, thank you so much. Britt, thank you. We'll see y'all later.