Are you drowning from high volumes of exams in your diary?

This is a big problem for so many dentists, which creates stress, a deficit of comprehensive care, impacts productivity of the room and reduces overall practice profitability. 

Once upon a time, most dental practices worked within the NHS system, and millions of patients in the UK became programmed to the six-monthly exam, scale and polish re-care model.  Dentists looked after high volumes of patients doing mainstream restorative work, and cosmetic dental practices were not commonplace, nor was implant dentistry.  Not all dental practices offered hygienist services, and in those that did, the hygienists commonly worked in 15–20-minute appointments (usually with no nurse), delivering 'bloody' 'scaling and polishing' treatments all day long.

Fast forward to the late nineties and early noughties, this period witnessed many dentists moving away from the NHS to work in the private model, and dental practices focusing on cosmetic and implant dentistry were found in most counties and cities. 

Today, a much larger portion of dentists have moved away from the NHS, and there is a larger offering of cosmetics, implants and orthodontics within the general practice setting, not to mention the fast adoption of digital workflows and now AI technology.

How does the modern dental practice utilise the DCPs to support the exams?

The opportunities that are present are very exciting; we have DCPs with a much larger scope than ever before, and yet there are so many dental practices struggling to manage their patient bases for their exams and periodontal and prevention services.

The evolution of dentistry has been transformative, but the infrastructure within the dental practice has not evolved at the same pace, and this is where most challenges in managing re-care arise.

Many of the dentists that I have worked and talked with confess to the fact that having schedules filled with exams causes issues such as:

• Exhaustion - many dentists are close to burnout from the pressure of volumes and the responsibility of assessing, diagnosing, planning and presenting treatment, along with the time it takes to communicate all that to the patient
• Encourages placing watches on teeth because they have very little time or energy to go through full planning and presenting, not to forget managing objections and questions from the patient
• No space to fit treatments into, so admittedly, they don't always mention non-urgent treatments to the patient

So, what's the solution?

I've heard of practices limiting the number of exams per day to enable a better working day and accommodate different treatments, and whilst I agree with limiting the number of exams each day, you also need to avoid a backlog; you need to calculate your patient numbers to ensure you aren't underserving your patient base.

Another consideration you need to make, especially when moving from NHS to private, is that although that is a positive move on many counts, when the exam structure remains in the dentist room, there is usually extra time allocated, so it doesn't solve the problem of the number of exams each day and can still restrict an optimised schedule.

You can, of course, adopt the therapist-led exam or consider the collaborative model where the dentist conducts the exam in the hygiene room, but before you do that, you need to know the number of patients to determine how you can best accommodate the exams and, of course, their periodontal and preventive care.

Here is a very simple formula you can use to help you to determine that:

• Number of adult patients that have been active for the past 2 years (active, being they have attended an exam)
• Double that to calculate two exams per year
• Number of exams per year divided by 47 to get weekly exam numbers
• Weekly exam numbers divided by the number of days worked to get the daily exam quota

Do the same calculation based on an annual exam to identify the exam quota per week and the same for your paediatric patients.

How to decide upon solutions?

In established dental practices, you will very likely identify that the numbers don't look manageable, but you mustn't seek a quick solution and, instead, you should plan a solution that will stand the test of time, and that considers the patient experience, full utilisation of DCPs along with clinical efficiency within a profitable business model.

Below are some suggestions to explore:

• Conduct risk assessments on your patients with a view of moving as many patients as possible to annual exams
• Make a list of all the areas of scope of care by your dental therapist, dental hygienist and dental nurse and consider what can be delegated to capture screening and data gathering to support the exam
• Before considering if you need another dentist, consider operational models that fully utilise the skillset of the DCPs
• Explore and detail the therapist-led exam
• Consider having exams conducted in the hygiene room where the dentist moves location between appointments in their schedule
• Think about how to communicate changes as an added value to the patient
• If you already have dental plans, develop a strategy of how you cater for their exams without those being in the dentist's room
• If you are moving to a dental plan, build value in total oral care and be careful of the language you use so that you state the 'exam value' but do not specify 'appointment with the dentist. '
• Include a calculation of hygiene hours required

The Result

Managing re-care by fully utilising the DCPs truly supports the modern dental practice and digital workflow operations to maximise the outputs in the dentist's room and increase the productivity of the dental therapists and dental hygienist rooms.

Overall, dental practices improve clinical efficiency, reduce patient volume, standardise care among clinicians, increase productivity, reduce stress, maximise profitability and contribute to very positive patient experiences.

Have you created an optimal workflow utilising the DCPs?

What steps have you taken that have given you the greatest success?