Ep. 46: Getting Serious About Your Hygiene Department, Part 2
This week we wrap up our hygiene department series with specific steps you should take to build up the hygiene department and get productive!
Topics:
:11 – Laying the foundations for a sustainable hygiene dept
8:18 – 9 steps for building a productive and efficient hygiene dept
Links:
Hygiene Formula spreadsheet - https://www.mgeonline.com/hygieneformula
Reactivation Guidelines - https://www.mgeonline.com/mge-reactivation-program
MGE Power Program - https://www.mgeonline.com/power-program
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Questions From This Episode
What are the five fundamentals every hygiene department needs in place before trying to grow it?
Employ an actual hygienist rather than the doctor doing their own hygiene long term, avoid excessive booking delays for both new and existing patients, always pre-schedule the next appointment before a patient leaves, make sure the hygienist is a genuine clinical and cultural fit for the practice, and put clear written guidelines in place for exactly how new and recall patients should be handled.
Should you increase hygiene capacity or increase patient volume first?
Increase volume first. Hiring additional hygienists before you have the patient flow to fill their schedule just means paying 60-plus dollars an hour for idle chair time. It's better to build up real demand through reactivation and marketing until capacity genuinely can't keep up, then add hygiene days to match, temping it out if needed while you find the right long-term hire.
How often is too often to call a patient who's overdue for hygiene?
Roughly once a week until they respond is a reasonable cadence, calling daily starts to feel excessive. The bigger planning question is capacity: if a practice has 3,000 inactive patients and wants weekly contact with each of them, that's 500 to 750 calls a day across a typical work week, easily a full-time job for one or two people.
How do you actually add a new day of hygiene without overstaffing?
Pick the easiest day of the week to fill based on your scheduler's read on demand, then start booking a second hygienist onto that day roughly six weeks out while your existing days stay solidly booked. That gives enough runway to either hire a hygienist willing to work one or two days a week or bring in a temp, without paying for capacity nobody's using yet. Once that day fills consistently, repeat the process for the next day.
What should you do if you run out of physical chair space to keep growing hygiene?
Before assuming you need to move or add chairs, check whether dropping PPO participation could free up room by increasing revenue per patient without adding volume. If space is still the constraint after that, options include adding chairs if space allows, relocating, or running a split shift where a second doctor and team cover different hours in the same physical space, which keeps fixed costs like rent steady while only variable costs like staffing increase.
Episode Transcript
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This episode is part two of a two part series on hygiene department growth and fixing an underperforming hygiene department. Last week, in part one, episode 45, we covered why so many hygiene departments underperform and how to actually evaluate the strength of your own, essentially, how to determine where you're starting from. That matters, since you need a clear read on your starting point before any of this week's steps will make sense. If you haven't listened to part one yet, I'd genuinely recommend going back to it first, though it's not a strict requirement if you'd rather roll straight into this one.
This week, we're getting into the specific steps for actually building the hygiene department up. My name is Jeff Blumberg, and I'm your host. Let's start with five fundamentals every practice needs in place, whether you're trying to grow hygiene or simply sustain it, and then move into the concrete action items: reactivating patients, adding capacity, and so on.
Fundamental one: you actually need to employ a hygienist. I understand hygienists are expensive right now and genuinely hard to find, and I've seen doctors avoid that cost by doing their own hygiene instead. Long term, that doesn't work. If you're doing your own hygiene, you'll never be as productive as you could be chairside doing actual dental procedures. If you're a brand new practice starting from zero volume, you obviously wouldn't bring on a hygienist day one, you'd build up to roughly the equivalent of one day of hygiene a week, 8 to 10 patients, before adding one, and you can always use an associate to cover hygiene in the meantime if needed. But once volume starts genuinely interfering with your ability to do dentistry, you need to bring a hygienist on. It's simply not a sustainable long term solution otherwise.
Fundamental two: lack of capacity is a real problem, not a sign of success. If it takes a patient of record six months to get a hygiene appointment, that's not evidence you're booked solid and thriving, it's actively limiting your growth. You should be able to get a regular patient of record in within roughly two to three weeks at most, that's my own general guideline, not a hard rule. New patients are even more time sensitive: you should be able to see a new patient initial, not an emergency, within 24 to 48 hours.
Whether new patient initials go on the hygiene schedule or the doctor's schedule is a personal preference, since the doctor has to do the exam regardless, but the timeline matters either way. Think like a consumer for a second. If you called a business and it took weeks to get in, would that make you consider going elsewhere? A new patient calling you has essentially no existing relationship with your practice unless they were referred, they're testing you out, and a long wait time will send them looking at other options, even after they've technically booked with you. Once you notice booking delays consistently stretching to a month or two out, that's your signal to add capacity.
Fundamental three: pre-schedule every patient's next appointment before they leave. This is straightforward but genuinely important, and it's usually the hygienist's job, though whoever handles scheduling should be checking on it too. The worst outcome is a patient walking out with nothing on the books. Here's a useful diagnostic: pull your total patient chart count from your practice software, then pull a report on how many patients have a next appointment scheduled after today. That gap is often startling, you might have 4,000 total patients and only 500 to 900 with anything scheduled, meaning roughly 80 percent of your patient base is effectively inactive.
Every patient needs their next visit locked in before they leave, backed by some kind of confirmation system, whether that's software, postcards, or whatever method you prefer, we go over this in our scheduler training on DDS Success. The alternative, I'll call you, then you call me, we miss each other, is how a month or two quietly turns into a couple of years and an eventually deactivated patient.
Fundamental four: make sure your hygienist is genuinely the right fit, clinically and otherwise. The same standard you'd apply to a doctor who consistently upset patients or delivered subpar dentistry applies here too. If you're not satisfied with your hygienist's clinical performance, try to address it directly, and if it can't be fixed, you may need to make a change. Fit also means alignment on role expectations. If you expect your hygienist to help with case presentation or patient education, asking about a missing tooth, mentioning implants, that has to be something they've actually agreed to, not an unstated assumption. If that expectation was never made explicit and it turns out to be a mismatch, that's worth addressing directly, since ultimately they need to meet your clinical standards, have a genuinely good working relationship with you, and fit the practical requirements of the role.
Fundamental five: if your hygienist sees new patients, make sure they're completely clear on exactly how those visits should be handled, sequencing, X-rays, any periodontal screening steps, whatever your process is, and put it in writing as an actual practice policy. The same applies to recall patients, every recall visit should follow a consistent, documented process.
Those are the five fundamentals we're building on. So say you've evaluated your hygiene department and found a real gap, you're seeing 20, 30, or 40 recall patients a week when the hygiene formula from last week's episode says you should be seeing 90, 100, even 120. What now?
At its core, this comes down to two things: bringing back patients who've fallen off the schedule, and adding hygiene capacity as that reactivated and new patient volume grows. I'm a strong believer in increasing volume before increasing capacity, not the other way around. If you hire additional hygienists before you actually have the patient flow to fill their schedules, you end up paying 60-plus dollars an hour for genuinely idle chair time. I'd rather have the problem of too much demand and not enough hygiene days, temping it out short term if needed, than the problem of empty chairs and payroll running regardless.
So here are nine steps to actually build the department, followed by the practical mechanics of adding hygiene days.
Step one: make one specific person responsible for building the hygiene department. In a lot of practices, three people share the front desk and all get labeled generically as front desk staff, with no one specifically owning scheduling or finances. When everyone is a little bit responsible for something, no one is fully responsible for anything. You want one clear owner here, it might be a hygienist who takes this on directly, not necessarily making every phone call themselves, but owning the overall project, possibly with a financial incentive tied to hitting specific hygiene day targets. It could just as easily be a non-hygienist functioning as a hygiene coordinator. Others will help, but one person needs to be genuinely accountable.
Step two: make hygiene and recall a genuinely big deal in your practice, the way most practices already treat things like Invisalign or teeth whitening. Very few dental practices actively market to their existing patient base, even though marketing's whole purpose is getting people to want something, and that applies just as much to patients of record as it does to new patients.
Start by crafting a clear mission statement you can share with both staff and patients, something like restoring health, function, and aesthetics, and helping patients keep their natural teeth for life, since that directly improves both longevity and quality of life. The reason for regular hygiene visits ties directly into that: catching small problems early, maintaining gum and tooth health, and making sure prior restorative work holds up long term. Communicate that message directly to new patients too, explain your practice's philosophy on why recall visits matter and why you're recommending a specific interval.
Repetition matters here more than people realize. Think about why a brand like Geico is instantly recognizable, constant, repeated messaging across every channel. The same principle applies internally: every patient interaction is an opportunity to reinforce why keeping their next appointment matters.
Get your entire staff genuinely educated on this too, not just trained to say the right thing. A recurring lunch and learn works well here, where you walk through topics like the health implications of gum disease, what actually happens during a hygiene visit, or why a missing tooth matters clinically. Record these sessions, a basic tripod and a phone is all you need, and keep them in a shared, centralized location so new hires can catch up easily and nothing has to be repeated live every time. Remember, your staff are the ones actually talking to patients day to day, so if a patient mentions skipping their hygiene visit, or asks a staff member about a treatment the doctor recommended, you want every team member able to speak to it knowledgeably and confidently, not just repeat a line.
Extend the same messaging to any outward-facing practice communication, newsletters, in-office signage, email footers, statements. Keep a consistent, ongoing reminder that patients should have their next hygiene visit scheduled, without going overboard to the point of feeling excessive. Give this the same visual and promotional real estate you'd give any other service you're actively marketing in the practice.
If you're active on social media, consider short videos explaining why hygiene visits matter, how gum disease connects to broader systemic health, or introducing a new hygienist to your patient base, each ending with a clear call to action to get scheduled if they haven't already. Patient testimonials work well here too, the same way practices already do before-and-after testimonials for major restorative cases. A longtime patient who's never missed an appointment in years explaining, in their own words, why staying consistent mattered to them can be genuinely persuasive.
Step three, now that hygiene is being actively promoted and staff are aligned, we move into patient reactivation. How you approach this depends heavily on your specific numbers. In last week's example, a practice seeing 31 recalls a week against a potential 96 was losing roughly 500,000 dollars a year. At that scale, hiring someone full time specifically to chase down a few thousand inactive patients, even at 40,000 to 45,000 dollars a year, is a clear, easy return if they recover even a solid majority of that patient base. And once your hygiene schedule is genuinely full, that person doesn't disappear, they often transition into a hygiene coordinator role managing the ongoing schedule.
If your inactive list is smaller, say four or five hundred patients, a full time hire may not be necessary, reactivation-focused software or a part time role might cover it. It really comes down to weighing the size of the problem, the potential revenue recovery, and the cost of the person needed to execute it.
Beyond a dedicated reactivation role, consider what we call an all hands activity, pulling in available staff for a focused push, similar to how a team might tackle a large mailing project together rather than leaving one person to do it alone. Financial or scheduling coordinators, dental assistants, even a hygienist comfortable on the phone, can all contribute an hour a week toward outreach calls when reactivation is a significant, active priority.
On call frequency, once a week until a patient responds is a reasonable cadence, daily calls start to feel excessive. If you're working through 3,000 inactive patients and want weekly contact with all of them, that's 500 to 750 calls a day across a typical four or five day work week, easily a full time role for one or two people. The MGE Reactivation Program includes a structured sequence of outreach steps and sample letters if you want a ready-made framework, link on the episode page.
One more habit worth building in: whenever staff speak with any patient, regardless of the reason for the call, a billing question, directions, anything, their hygiene status should always get checked, and if their next visit isn't on the books, that's the moment to schedule it.
Step four: track real metrics as you go. As covered last week, the key growth statistic is number of recall visits specifically, three, four, and six month recalls and periodontal maintenance, not total hygiene visits generally, which can be inflated by new patients or an active periodontal program without reflecting genuine recall health. This number should show consistent growth month over month, especially while active reactivation work is underway. Track it weekly, monthly, and quarterly, if it isn't climbing, something in the process needs attention.
Step five, and this one's more about productivity than growth specifically, but still matters: put clear clinical guidelines in place for your hygienist around procedure classification, particularly the distinction between a routine prophy and a gross debridement. If a patient comes in significantly overdue with heavy buildup, and the hygienist performs what's genuinely a gross scale but bills it as a standard prophy, that's real lost revenue and understates the actual clinical work performed. Establish clear guidelines for what conditions constitute a gross scale versus a routine cleaning, and how that gets communicated to the patient and diagnosed appropriately, particularly if you're running any periodontal program.
As reactivation efforts bring patients back, new patients continue coming in, and your periodontal program develops, you'll naturally need to increase actual capacity, adding hygiene days. As a general guideline: booking delays beyond 24 to 48 hours for new patients, or beyond two to three weeks for patients of record, signal it's time to add a day.
Here's a simple, practical formula for adding a hygiene day. Say you're already running four days of hygiene and need a fifth. Talk to your scheduling coordinator or office manager about which day of the week tends to be easiest to fill, say Tuesdays. Pick a Tuesday roughly six weeks out and start actively booking a second hygienist into that day, while your existing four days stay solidly booked in the meantime. That six week runway gives you time to either hire someone willing to work one day a week or bring in a temp, without paying for hygiene capacity nobody's using yet.
Once that new day is consistently and solidly booked several weeks out, repeat the process for the next easiest day to fill, say Wednesdays, and keep repeating this cycle as demand continues to grow.
As this works, you'll eventually hit some genuinely good problems that need managerial solutions. If you're a solo doctor approaching two full time hygienists and starting to consider a third day, you're likely approaching the point where you need an associate. The ideal ratio to maintain is roughly one doctor to one or 1.5 hygienists. Push much beyond that, say a doctor managing three hygienists, and you start losing real productivity and selling time, since you're constantly gloving and degloving between rooms rather than having adequate time for each patient and each treatment presentation.
If you're also running out of physical chair space as hygiene grows, don't default to suppressing that growth, which is what a lot of practices unfortunately do. A few options worth considering, in order. First, if you're carrying significant PPO participation, consider dropping some of those plans before adding more physical capacity, since that alone can meaningfully increase revenue per patient without needing more space or added time at all.
If PPO participation isn't the constraint, or you've already minimized it, and you genuinely need more physical space, you could add chairs if your current location allows it, though be aware that adding a third hygienist will likely mean needing an associate too, which may mean needing two additional chairs, not just one. If there's truly no more room to expand within your current space, you're generally left with two options: relocating, which tends to be expensive unless a genuinely good opportunity presents itself, or running a split shift, essentially operating two effective practices out of one physical space across different hours, one doctor and team working mornings, a second team working afternoons and evenings.
A split shift keeps fixed costs like rent essentially flat while only variable costs, staffing, some additional utilities, increase with the added volume. It requires real organizational skill to run well, which is exactly the kind of thing we cover in depth in the MGE Power Program, link on the episode page. Growth-related stress usually comes from not having a clear system for managing it, which can lead to reactive, poor decisions. But genuinely, having too much hygiene demand to keep up with is a great problem to have, and one absolutely worth working toward before worrying about how to manage it.
Those are the fundamentals and the concrete steps. If you have questions about any of this, feel free to email me directly at jeffb@mgeonline.com, or if you'd like broader help with your practice, visit us online at mgeonline.com and request a free practice consultation. I hope this was genuinely useful, this is a built-in growth mechanism most other businesses would kill for, patients who are supposed to keep coming back on their own. It's absolutely worth the investment to build this out properly.
I appreciate you listening, and I'd love any feedback you have. If you want more information about MGE, call 800-640-1140. Downloads mentioned in this episode are on the episode webpage. Have a great week, and I'll see you at the next episode.