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Dental hygienists are in a unique position in their dental practice and are sometimes asked to sell products and services to their patients. We look at how to navigate these tricky situations.
You may be in the business of providing comprehensive patient care, but the bottom line is that dentistry is a business, and sometimes, these 2 models don’t align. One of the hardest parts about providing treatment is navigating the line between the 2—what products or procedures are hygienists encouraged to promote, and which ones would benefit the particular patient currently in your chair?
It's easy for a practitioner to get caught up in a new product that they think would benefit the practice, but it’s tricky when hygienists don’t necessarily embrace the product—or are forced to tout it to patients for which it may not be a good fit. What happens when hygienists are being pressured to promote such a product, even if it’s one they don’t fully believe in? How can you avoid feeling like a pop-up ad that just distracts and misdirects?
“The work that we do should be it should be evidence-based,” says Katrina Sanders, RDH, BSDH, MEd, RF. “We should be able to look back to the science and research. And if we don't have a level of confidence in the science or research, or in our experience with the product, and in our evaluation of if the patient is a terrific candidate for this product, it absolutely tarnishes the layers of trust within the patient/provider schematic.”
While practitioners are rarely trying to pull a fast one on patients, the temptation to increase the bottom line with a service or product can be tempting. However, one tenant of the American Dental Association code of ethics that practitioners should be fully embracing is not recommending unnecessary services or procedures. The ethics code states, “a dentist who recommends or performs unnecessary dental services or procedures is engaged in unethical conduct. The dentist’s ethical obligation in this matter applies regardless of the type of practice arrangement or contractual obligations in which he or she provides patient care.”1
That’s not to imply that selling in a practice is necessarily unethical; there’s nothing wrong with providing patients with products or services they can’t get elsewhere, but patients aren’t stupid. They know when they are being sold something. Overselling can ultimately damage the patient’s trust in the provider, potentially leading to patients then not accepting services they actually do need, or leaving the practice altogether
“Part of the challenge of the work that we do is that we have to make sure that we are maintaining the trust of our patients,” Sanders says. “If our patients do not trust us, it doesn't matter what we say from a procedural standpoint. We're not going to able to move the needle in helping them to acquire the level of care that we believe they need.”
So where does this leave hygienists, in this tightrope walk of promoting products and services?
Building Community Trust
The first step in getting a patient to listen to a needed product or procedural recommendations is for hygienists to become trusted advisors. Positioning themselves as an authority on oral health (because they are!), hygienists can build a reputation as trusted key opinion leaders that patients turn to for advice and recommendations. But building this patient trust is critical to this success.
“Societal trust is critical,” Sanders says. “It is one of the core values instituted by the American Dental Hygienists Association. Societal trust is that concept of, what does the public believe? What do they think about when you say ‘I'm a dental hygienist?’
For a long time, Sanders says, people believed that dental hygienists were just the dentist’s assistant. Patients thought (and some still think) that when the doctor comes in to do an exam at the end of the appointment, he or she is just checking the quality of the hygienist’s calculus removal work. There is often a mentality that the hygienist is the assistant who just hounds people to floss and pokes their gums and makes them bleed, and is not as educated as the dentist.
“From a societal trust standpoint, what have dental hygienists done to establish themselves as true leaders in oral health?” Sanders says. “How are we helping the community to understand the level of education that is required to do the work that we do? How are we helping the community understand the level of continuing education for us to continually elevate standards of excellence in our profession? That societal perspective and trust becomes more and more critical.”
Once patients can understand the true role of dental hygienist—as highly educated experts—hygienists have a unique opportunity to be the front door to oral-systemic health. Since patients are potentially coming back every six months, with that appointment scheduled ahead of time, there is an opportunity to build relationships with patients that other healthcare providers cannot. But sometimes dental hygienists don't realize the influence they have on their patients.
This influence, Sanders says, extends beyond the operatory. Hygienist voices on social media and digital platforms reach an audience in their communities and beyond. Now, hygienists can really leverage conversations to help people understand what hygienists are trying to educate about—and not just the people in the chair, but the other people who are interacting with hygienists’ thought leadership pieces or articles.
“We see dental hygienists creating YouTube channels to help educate the general public,” Sanders explains. “We see dental hygienists on the news. We see dental hygienists, going into school programs, sending letters to parents to educate them, etc. So, as we look at the level of influence, it’s really incredible. We are influencers within our own profession.”
Building an education platform like this is not a new concept. Sanders references the “got milk?” and “this is your brain on drugs” campaigns of the 1990s. These programs, she says, were instituted to target the community to educate people on a concept—a model that also applies to increasing access to (and interest in) good oral healthcare. Promoting this good oral health on a larger scale initiates the process of building community trust in what dental hygienists have to say.
“When we talk about the pandemic, for example, there was a strong initiative that the mouth is a portal of entry for infection,” Sanders says, referencing the COVID-19 global health crisis. “Many clinicians feel as though patients don’t care or don’t want to know about these links. But the irony is that that is exactly what society was asking for: How do I prevent this? It’s through a lot of these initiatives that dental hygienists are strongly armed to be an influence for the community. This is really our opportunity to help educate and change the dynamic of what society truly believes about oral health.”
Patients are looking for guidance when it comes to their oral health, and hygienists can provide it to them. By increasing patient understanding of the hygienist’s role—that they are licensed, registered clinicians—the recommendations of the hygienist become more than just a suggestion.
“When a dental hygienist says, ‘I think you should use this toothpaste’ or ‘I think that you should use this toothbrush,’ that is not simply a recommendation,” Sanders says. “That is a prescription from an oral healthcare practitioner to a patient for what it is they believe will help improve the oral health of that patient. And that’s the truth. So, the reality becomes, why would a doctor write a prescription for a medication they don't believe the patient needs or they don't believe will help the patient?”
With this mindset, it is critical that hygienists are healthcare providers that stick to this model. Overselling products that you don’t believe in can damage the trust, and if the patient doesn’t trust the hygienist, nothing else matters. A hygienist can recommend a crown, a referral, an airway specialist, a primary-care physician—but if the patient doesn’t have trust in the hygienist, they won’t follow through on any of it.
When it comes to instituting a new product in a practice, or a new medicament, or a new toothbrush (or whatever it may be), the clinician who is prescribing that needs to believe that A) this is an effective product, and B) that this will be an effective product for this specific patient. Patients can understand the difference between a provider saying, “you might want to try this,” and saying “I believe this product will help you.” Ultimately, this difference does influence the patient’s decision to accept or decline treatment.
But, Sanders says, if the clinician is robbed of a clinical decision-making opportunity, it creates challenges in the level of competence that provider has in offering the product or service to the patient.
Sanders uses the example of fluoride treatments of one where clinicians may not confidently stand behind the promotion of it. In some practices, someone in the front office, or perhaps a hygiene team lead, are encouraged to go through the appointment books and add fluoride treatments to all 6-month hygiene appointments. The big elephant in the room becomes, why are they doing that?
“I believe that 9 times out of 10 most dental professionals would say the reason why they're doing that is because they want to increase the production in the practice,” Sanders says. “They want to know that when the patients come in that they are being offered this $35 or $40 service, whether the insurance covers it or not. And quite frankly, most dental hygienists will say that is not a good enough reason to add a procedure to a patient's care plan. And they would be right.”
While dentistry is a business, Sanders believes that if you do the right thing, production will always follow. If a fluoride treatment is added to the treatment, and a hygienist is pressured into talking about it, it becomes an upselling situation, akin to a patient buying a car and being pressured to add on tinted windows, or being asked, “do you want fries with that?”
“That one question completely changed the McDonald’s business model,” Sanders says. “That’s great—if you’re selling French fries. But we’re selling, or rather institutionalizing, health care. That's different. This is somebody's health. These are medicaments that we're putting on people's bodies.”
As a result, hygienists must think about selling a little bit differently and recognize their role not only to the bottom line of the practice, but specifically to the healthcare and promise that they provide to their patients that they will uphold their care to the highest level of standard. If a hygienist’s ability to do this is compromised, it takes away their independence to provide what they believe is the best patient care.
“For dental hygienists, it is quite insulting to be told that we lack the clinical decision-making strategies to build out the appropriate scaffolding of what we qualify a patient for,” Sanders says. “That we need to have a front office team member or hygiene team that adds those things like fluoride treatments in. They essentially are becoming our ventriloquist, in telling us that all the things that we need to be employing. That removal of autonomy for dental hygienist does feel quite insulting, and also has the potential to compromise our patient relationships.”
When it comes to ensuring those relationships aren’t compromised, and that hygienists remain in charge of their own patient care, there are a few things to remember—and embrace.
Don’t be pressured
The practice’s doctor may be excited about a new product, and exclaim over the value of the product, but that doesn’t mean it’s the best fit for your patients. While doctors may incentivize the implementation or a product or service, or promise increases in income if quotas are met, hygienists should continue to prioritize patient care over promotion—despite potential rewards. Promoting a product that you don’t believe in will be obvious to patients, and will leave you feeling deceitful. It’s not worth the potential payoff or profit, particularly if you alienate patients in the process.
Ask for more information
If you aren’t sure about a product or service, ask the practitioner why they think it’s beneficial beyond potential production effects. There are lots of great products that hygienists can confidently promote to their patients that will benefit their oral health—but you can’t decide on whether this particular product is one of those unless you understand exactly what it does, or how it differs from other options on the market.
Likewise, production goals are not always a bad thing, provided they aren’t putting inordinate pressure on hygienists to sell a product. When this happens, the precedent and priorities shift from patient care to sales. Ask the practitioner for more information so you can determine whether or not this product is one you feel comfortable promoting. Request a product presentation, or background materials to review, so that you can comfortably—and accurately—make recommendations to your patients.
Recognize your voice
The hygienist is an important clinical party in the practice, and your opinion matters. Talk to your doctor about any new product policies, and express any concerns. Since hygienists are in the trenches with the patients, they have a unique opportunity to say, ‘hey, our patients aren’t responding well to this promotion, they think we are just trying to upsell them, how else could we go about this, or is this product even necessary at all?”
Recognizing the value of your opinion—and your position as the voice of your patients—can go a long way in shaping practice policies.
“I think step 1 is helping dental hygienists to recognize the critical role that they play as patient care advocates, and that we are partners alongside the doctor in my practice,” Sanders says. “None of us should say, ‘I work for Dr Smith.’ We don't say that. I say, ‘I work with Dr Smith. I work with them.”
In the end, the hygienist’s voice shouldn’t go unheard. As defenders of patient trust and the front line of oral healthcare, hygienists should place value on both their patient care and themselves.
“We all have different strengths, and we have different wheelhouses,” Sanders says. “We have different responsibilities within the practice, but number one our collective responsibility is patient care. I think a huge barrier that we've had for a long time is seeing the level of importance that we truly hold into practice. It is critical, and we should embrace it.”