The hygiene backlog: A serious and expensive problem

May 19, 2023
Assisted hygiene is a hotly debated topic in the dental arena. This RDH conducted a survey that reveals many reasons it can work, and some reasons it may not.

We see these situations often in dental offices—new patients wait months to schedule a checkup, and we have difficulty scheduling periodontal patients for urgent treatment for infection. In many practices, recare appointments are backlogged, and there’s little to no pursuit of past due appointments. These challenges make it hard for hygienists to care for their patients and keep them active.

Ironically, the dental hygiene department schedule might be full, but its limited capacity affects how busy the doctors are, so their schedules might be relatively light. Many of these problems are due to the staffing shortage, which has caused an estimated 10% reduction in practices’ patient capacity.1 The question becomes, how do we provide quality patient care while combatting staffing shortages so we can bring practice capacity back up to par? For many offices, the answer may be assisted hygiene.

A look at the numbers

Data gathered in 2022 by Advanced Practice Management estimated that the average dental hygiene visit can bring in $550 worth of treatment to a practice—approximately $180 in dental hygiene and $370 in doctor treatment.2 A difference of even five hygiene visits a week can mean a 10% difference in a typical sole practitioner’s production and have even more impact on their bottom line.

You might also be interested in: Assisted hygiene: Why it works, and how it’s changed my work life

Assisted hygiene is not accelerated hygiene

Providing assisted dental hygiene four hours per week per hygienist can make a big difference in the hygienist’s ability to deliver patient care. But there’s an ongoing debate regarding assisted hygiene, and many hygienists dislike this model of patient care. I polled dental hygienists across the Midwest in an effort to understand this debate.

My survey results concluded that hygienists’ perception of assisted hygiene is neutral. Many have great experiences and provide wonderful patient care with this model. When asked when assisted hygiene works well, 90% said it works when the position is held by a well-trained and educated assistant devoted to the hygiene schedule.

Some of the reasons in favor of assisted hygiene include:

  • “The model can work with a dedicated, well-trained assistant who plans ahead and doesn’t need to be told what to do.”
  • “I had a dedicated assistant who knew what the job expectations were, and we communicated well.”
  • “The model works great when everyone is on board. The assistant must be solely dedicated to the dental hygiene department and 100% committed to making the schedule work.”
  • “The assistants and hygienists must work well as a defined team.”
  • “It’s important to be selective about which patients are scheduled in the assisted hygiene block: there should be no periodontal treatments, no new patients, no high maintenance patients, and no patients who are past due for care.”

My survey results also showed some hygienists’ frustration associated with the assisted hygiene model.

  • “It needs to be banned in dentistry. It’s unethical, and it’s not patient care. Double columns are going to be the ruin of hygiene. I’ve already seen the RDH burnout and sad results for patients.”
  • “I had a horrible assistant. She was lazy and unavailable. I had to go find her for almost every appointment. I told the dentist either she goes or I go.”
  • “We scheduled periodontal patients, difficult prophies, and high maintenance patients, and we did not have an efficient assistant.”

How to start

The dental hygiene and dental assistant team can use interoffice communication to check in with each other and establish a timely way to alternate between operatories. They can use templates to make documentation efficient and effortless. The essential aspect of patient care is being able to see patients. By keeping an open mind and giving each other time to learn and adapt, this model of care can be a positive improvement.

Three Cs of assisted hygiene

Control the schedule

  • Patients need to fit specific criteria that the entire team is aware of.
  • 60-minute appointments should be staggered at 30-minute intervals.
  • There should be incorporated blocks for new patients and SRP.


  • Assistants need well-defined and concise directions from the hygienist.
  • The morning huddle should focus the team on the day’s patients, and let them reflect on what worked well or can be improved from the previous day.

Create a cohesive environment

  • Assisted hygiene is fluid. Be flexible. As much as you plan and set guidelines, there may be times when things do not go as planned and you must work cohesively to make it through.

Making it work

The dentist needs to agree with the process and have a plan for getting exams completed in a timely matter.If there is a negative mindset around the assisted hygiene model, then the experience will not go well. Flip the script in your practice. Design a model of care that means the practice will not only provide exceptional patient care but will encourage team members to work together, communicate, and celebrate the wins associated with assisted hygiene.


  1. Dental workforce shortages: data to navigate today’s labor market. American Dental Association. 2022.
  2. Taken from the Advanced Practice Management client database. 2022.