by Mark Kleive, DDS 

A Four-Part Framework for General Dental Practices

In most general dental practices, the hygiene department is the engine that drives preventive care, patient retention, and diagnosis of early-stage periodontal disease. However, despite its importance, many dental practices struggle to achieve a balanced and productive mix of services within dental hygiene—often defaulting to routine prophys and underdiagnosing periodontal conditions.

A reasonable goal for general dental practices is for ADA 4000 codes to be 30-40% of total hygiene productivity. Improving the mix of services isn’t about increasing revenue—it’s about elevating the standard of dental care and aligning treatment with patient needs. Here’s a four-part framework to help your hygiene department provide more comprehensive, value-driven care.

1. Commitment to Dental Continuing Education

One of the biggest barriers to an optimal mix of services is outdated training or knowledge gaps among dental hygienists. Many dental hygiene programs, especially those completed years ago, may not have emphasized the current AAP (American Academy of Periodontology) diagnostic criteria. This includes recognizing the subtle signs of periodontal disease or confidently classifying cases using updated staging and grading protocols.

As a dentist, I’ve realized I’m not always the most effective educator for our dental hygiene team. Sometimes the message lands better when it comes from a respected peer, dental continuing education provider, or structured external course. That’s why we’ve made a formal commitment to ongoing dental continuing education, bringing in expert trainers, attending workshops, and subscribing to clinical hygiene platforms that align with our dental practice philosophy.

These efforts aren’t about pointing fingers or correcting mistakes—they’re about empowering dental hygienists to diagnose with greater confidence and accuracy. When a hygienist can confidently identify early-stage periodontal disease or gingival inflammation and understand the rationale behind specific codes and treatment pathways, they’re far more likely to recommend appropriate care. It raises the standard for the entire practice.

2. Commitment to Assessment – Leveraging Voice-Activated

Charting for Periodontal Disease

Assessment is the foundation of treatment planning—and consistent, efficient, thorough perio charting is non-negotiable. Yet in a busy hygiene schedule, manual charting often gets skipped, rushed, or delegated in a way that dilutes its effectiveness.

That’s where voice-activated periodontal charting technology comes in. In our dental practice, we use VoiceWorks, a voice-activated perio charting system that has transformed how assessments are conducted. Hygienists can focus fully on the patient—probing, observing, and talking—while the system records probing depths, recession, bleeding points, and furcations in real-time.

The commitment here isn’t just to a tool—it’s to a diagnostic process that holds up clinically and legally. VoiceWorks ensures that we assess every patient thoroughly, every time, with minimal friction.

3. Commitment to the Conversation – Offering Treatment with Empathy and Clarity

When the periodontal classification based upon AAP guidelines is completed the hygienist can talk with the patient about the findings and even potential next steps using co-discovery skills. The goal is to explore treatment plan options that be shared and confirmed with the dentist. Too often, patients are told what they “need” without being engaged in a way that allows them to choose.

This technology isn’t just about efficiency; it’s about consistency. Every adult patient receives a complete periodontal charting at appropriate intervals, and the data is always up to date and visible during exams. Over time, this allows us to track changes, justify treatment recommendations, and have objective data at hand when talking with patients.

In our practice, we’ve adopted a simple mindset: when a patient declines appropriate periodontal treatment, we treat it as a “no for now,” not “no forever.” We don’t take it personally, and we don’t give up. Instead, we agree with the patient to revisit the conversation at a future visit. In the meantime, it’s clear the patient has declined subgingival therapy. The only treatment the patient is authorizing is supragingival debridement and that’s the therapy we provide in the interim.

4. Dentist Support – Building Value for the Dental Hygienist’s Expertise

By validating the hygienist’s observations and potential next steps in front of the patient, the dentist shifts the perception of the hygienist from “cleaning provider” to “primary oral health care professional.” This not only encourages patients to follow through on treatment—it builds a stronger team culture where everyone’s contributions are respected and valued.

The foundation of trust built through this collaborative approach allows patients to maintain trust in the practice even if they aren’t ready to proceed. It also creates space for the hygienist to plant seeds of awareness and provide educational moments over time. Often, patients need to hear the same message multiple times before they’re ready to act. Our job is to be consistent, compassionate, and professional throughout that journey.

During exams, I take every opportunity to echo the hygienist’s findings and underscore their expertise. I’ll say things like, “I really trust Sarah’s judgment on this—she’s excellent at detecting early gum disease,” or “This type of care is why we’re proud to have a strong hygiene team here.”

Finally, perhaps the most impactful shift in improving service mix comes when the dentist actively reinforces the hygienist’s findings and potential next steps. When patients hear the same message from two different clinicians—especially when the dentist supports the hygienist—it builds credibility and confidence.

Final Thoughts about Dental Continuing Education

Improving the dental hygiene department’s service mix isn’t about a new tactic or a quick fix—it’s a fundamental shift in dental practice culture. It’s about empowering your dental hygienists with dental continuing education, tools, and confidence to assess and share their findings comprehensively. I recommend you join The Pankey Hygienist -a hands on course designed to create clarity, efficiency and improve the hygiene-restorative partnership.