How to double your hygienist fees

dentistSimon Hocken says what many patients may be thinking when it comes to formulaic hygienist appointments, and gives some tips on how to maximise profitability.

I suspect my hygiene visits are pretty much the same as yours. They go something like this: a quick prod with a pocket probe, a careful and thorough ultrasonic clean; a bit of a polish; a chat about my holidays; a ‘see you next time’.

The real issue for me is that it feels so old fashioned. My hygienist appointment follows the same script that my own hygienists used in the 1990s and the whole structure is the same (why half an hour, why £50, why two times or four times a year? Why, why, why?).

Adding extra value

Now we know so much more about the link between periodontal disease and systemic disease, surely it’s time to reinvent the 1990s hygienist appointment. I think I would appreciate (and pay more for) an appointment that included some or all of these components:

  1. A review of my current medical history and lifestyle, highlighting areas where I am putting myself at risk
  2. Some screening procedures such as blood pressure, blood sugar, cholesterol
  3. A full examination, at least once a year, including some patient-friendly indices, use of a Florida probe, some photos and visuals of the condition of my gums
  4. Some diagnostics, treatment planning and the reason why any periodontal disease is still active
  5. A careful and thorough clean
  6. Help to focus on any areas where there is active disease
  7. Help to finesse my oral hygiene regime
  8. Top ups and recommendations to supplement my oral hygiene tool kit
  9. Something to take away to remind me of where I still have active problems and what I can do to help
  10. When I need to visit next and for how long.

I’d be willing to pay £100 for this and I wouldn’t miss the banter about my holiday. And I will probably live longer. Even better, I’d like to join a plan and pay £33 a month and not have to think about the cost and the value. I’d go more often and my dentist would probably see me more often too and I would have my teeth checked on two out of the four appointments.

Now, isn’t this a little more 21st century? Surely it’s time to offer more than tooth cleaning? Oh yes, and I’d really like a Saturday morning appointment please!

One last observation, I don’t think my dentist knows what his hygienist is up to during these half-hour sessions, and I suspect you don’t know what yours are up to either. Maybe it’s time to reinvent the tooth-cleaning visit.

If you’d like help updating your oral hygiene offering, get in touch with Simon by emailing [email protected].


  1. 1

    I am a dental hygienist/therapist and I find this article a tad condescending towards my profession.
    If dentists do decide to ‘find out what we’re up to’ during our appointments I think they’ll find that we’re already doing most of your points – without nursing support and in 20 minutes for a large portion of hygienists. 1 of my colleagues had 15 minute appointments and no nursing support. How is she supposed to effectively manage perio disease in that short time? This is more common than you’d like to think.

    If you really want to make more money from your hygienists – provide us with nursing support and longer appointments. Have you tried to do a 6PPC by yourself? How about a clinical exam or just a BPE? Or put your own instruments through decon when you’ve got patients in the waiting room and no time for a drink or relief break? No, I thought not.
    We’re not scaling machines who just like to have chat and do a quick flick round with a scaler. Maybe that’s how dentists do a scale and polish. We’re highly trained professionals with invaluable skills and knowledge. Given the right clinical support and freedom we are outstanding.
    The days of seeing the hygienist for a scale and polish have long gone.
    I’d welcome any dentist to sit in on my appointments and see what a hygienist ‘gets up to’.

  2. 2

    Mr Hocken,
    Your article has in its short time since publication caused upset among a hygienist/therapist community. We find your comments about holiday chit chat bellitling and patronising. This may have been the experience you have had but don’t tar us all with the same brush. Many of us find ourselves struggling with short appointment times (20-30mins) and no chair side nursing support and therefore have to do the best we can in the time that we have. We feel our profession is sadly often not given the respect it deserves and we are not invested in enough. Should we be provided with Florida Probes, Intra oral Camera, a nurse to turn our surgery around and decontaminate, help with taking indices for plaque charts etc, support with suction to save our poor backs and allow us to use a mirror properly to to perform better clinically, and a longer appointment time in which the patient understands why their visit to the hygienist is important we could do a much more superior job in the communities which we serve . Screening services such as blood pressure, blood sugar and Cholestertol do not form part of our scope of practice and we are not qualified to provide these. Unfortunately most of us are being undercut by dentists who don’t value their hygienists and are just concerned by the bottom line and peers who desperate for work in a competitive market place accept conditions that are far from Ideal both in terms of remuneration and support.

    I have been along to one of your courses and actually find you very much in support of developing the hygienist services as “not just a scale and polish” but this is a mindset of the practice owner that needs to change, and not the long suffering and feeling undervalued hygienist.

  3. 3

    Oh dear. This article would have been cutting edge thinking about 15 years ago. Very narrow and unaware and not good for professional relations or business.

  4. 4

    Very patronising post. How unfortunate that you haven’t met a hygienist that follows all AND more of the points that you have addressed, as they are out there.

  5. 5

    think some of you are being very harsh in your comments. I do agree that the introduction may be viewed as a bit patronising, but I don’t believe that it is intentional.

    For those who have read the full article, I really believe that Simon has raised some interesting points in his article. We could be offering much more holistic appointments for our patients that would screen not only their oral health but their general health also. After all, you can’t have oral disease and it not has an impact on general health and vice versa.

    I do agree that our current hygienist appointments are in great need of a shakeup. The term “scale and polish” has no place in modern dentistry. It is an outdated and useless term and why the NHS still use it, beggars belief. Yet for a lot of hygienists, a scale and polish underpins the whole appointment. This is not because we want to do this but our hands are tied. Our appointment times are dictated by the practice and there are some dentists who think that a good hygienist is one who can remove as much calculus as possible and couldn’t care less about all the other, much more important aspects of the appointment. Some of us have 20 minutes in which they are expected to do medical history, pocket, bleeding and plaque scores, oral hygiene instruction, dietary advice and remove calculus and staining. Some are lucky enough to have a nurse and 30 minutes but this still isn’t enough time to offer a truly holistic service.

    I do see where Simon is coming from. We are highly trained health professionals. We have a great understanding of not just oral disease and health, but general disease and health. We know about the links with chronic conditions such as diabetes and cardiovascular disease and periodontal disease along with several other medical conditions. We are great at health promotion and encouraging and enabling patients to look after themselves. Patients trust and respect us, so why could we not expand our remit into helping them care for their general health as well? How many of us have suspected that a patient might have undiagnosed diabetes and suggested they see their GP. Would it not be a good idea to be able to take a blood sugar reading to strengthen our concerns and prompt the patient to go as soon as possible? Same with hypertension. Men particularly are notoriously bad at going to their GP until they are really ill. We could offer to do a BP reading at their oral assessment. Other health professionals do this. We used to do this at the hospital I worked in and take bloods for testing. My chiropractor does my BP and Blood Glucose at my annual assessment. She wants to know how my general health is before she can work out what is causing my back problems.

    OK, I appreciate that we have to draw the line at how much screening we would undertake and certainly need further training to do this, but it wouldn’t be impossible.

    We need to change. Simon offers some suggestions which may or may not be workable (impossible in the NHS dental system) but they are a good starting point for discussion. We need to work alongside our medical colleagues and to ensure that we are offering the best patient-centred care. We are not just scaling monkeys. I would love to use all my knowledge and experience to benefit my patient and improve their health. So, all the dentists reading this. – it is your call as you hold the reins. What do you think and how could we sell it to our patients?

  6. 6

    Hi Simon, I am amazed and shocked at your comments. I found the below suggestions particularly obscene:
    Some diagnostics, treatment planning and the reason why any periodontal disease is still active
    A careful and thorough clean
    Help to focus on any areas where there is active disease
    Help to finesse my oral hygiene regime. In my experience these points are the backbone of preventative care given by hygienists. What a disappointing and unrealistic article.

  7. 7

    You have your GP / nurse practitioner to check your BP , blood sugar and Cholesterol.
    There is no way I as a dentist (who fortunately doesn’t work in the UK anymore) would recommend any of my hygienist colleagues to get involved with something like this with the current litigious climate in the UK.

  8. 8

    Thanks for your comments. Some of the hygienists who commented may have missed the fact that I am on your side! The first part of my article simply described my real-life experience of visiting a hygienist. I believe it’s also the experience of many other patients who pay £50 for an appointment.

    And as a dentist, I completely understand that you can do very little for a patient with gum problems in 20 minutes (or less), especially with no nursing support.

    The title of the article is tongue in cheek really because the doubling of the hygienist fee requires the referring dentist to double the time of the hygiene appointment. It’s my suggestion that longer with a patient is the only way hygienists can be more effective at treating periodontal disease.

    Lastly, I am surprised at the vitriol in some of the comments I received. Surely we can have a dialogue without resorting to insults?

    Simon Hocken.

  9. 9

    What a shame this opinion has been published. What a disappointment to read and frankly quite upsetting. I work hard to provide my patients with the best care I can. I think you sir, should try working back to back with no nursing support, with sometimes less than adequate equipments and not enough instruments. Whilst trying to put the patients interest first.

    As a women in dentistry I find your comments verging on the sexist. You clearly have a “them” and “us” attitude. However, this is just the attitude I have experienced throughout my career so it’s no surprise.

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