Hygienists are NOT Scaling Machines – IC034

Jaz’s introduction:
Whereas in the UK, we depend so much on our hygienists. I feel like we work together well with hygienists. However, I sometimes worry and hygienists I speak to worry that all they become is a SCALING MACHINE.

And so, I talked about that today with Morgan and Lou. Two lovely hygienists I use to work with in Oxford and they share their struggles, how they had to work in quite a few practices where the environment just WASN’T RIGHT FOR THEM to thrive in as part of prevention minded hygienists. And I think what they have to say, well, if you’re a hygienist, listen to this.

Or maybe a dentist has said this episode to you, then this is gonna be a real source of inspiration from two lovely ladies who’ve been in the game for a little while. They know what they want and they’re gonna tackle those difficult themes such as HYGIENISTS working WITHOUT NURSES like. Where does that stand now in 2023?

My practice now where I work as an associate, only now is it starting to really implement a nurse working with a hygienist. Whereas I’ve worked with a few practices for where there is no such thing. It’s unheard of for the hygienist to have nursing support and I know lots of young hygienists who tell me that they feel really uneasy about working alone and really, is this the best way to deliver ideal patient journey that’s safe and effective? I don’t think so. But then again, a lot of you will say, ‘But Jaz, you are not a practice owner. You are not paying the bills.’ And I totally get that. I respect that.

As an associate, it’s easy for me to say that, but I’m hoping after this episode with Morgan and Lou, though, you understand why it is so important for our profession to work together with hygienists to get the best outcomes, and I do believe that starts with a hygienist being provided a nurse. Now, what I don’t want after this episode is lots of hygienists handing their notice or dentist getting pissed off and saying, ‘Jaz, what the hell do you do? Why did you encourage my hygienist to think a little bit differently and inspire him or her a little bit too much?’

I mean, I want to inspire. I want to get the word out. I want to help these hygienists through Morgan and Lou and what they have to say in learning from their journeys. But I don’t want there to be friction between dentists and hygienists.

I want there to be synergy, and I want us to create an environment where hygienists can be happy at the workplace because a happy team breeds a culture in the practice that’s palpable and patients can detect it, and I think it’s a big part of the patient journey.

Hello, Protruserati. I’m Jaz Gulati and welcome to another episode. This is an interference cast. It’s like a nonclinical interruption. So we talk a little bit about clinical here, but it’s more about the bigger picture stuff, how we can work together with hygienist the best way possible. Let’s join the main interview now.

Main Episode:
Morgan and Lou, welcome, very warm welcome to the first ever hygienist to Protrusive Dental Podcast. How are you, both?

[Lou]
Good. Actually excited for our first podcast with you Jaz.

[Jaz]
I’m just excited just to see your faces again and then just have this connection and catch up with you. So those of you who don’t know, I probably said in my intro, but we used to work together in Summertown, Oxford, and you know, Morgs because you reached out to me on Instagram, cuz I think you heard me mention about how much I loved working with you two.

Right? And then I said, listen ladies, you have to come on the show because like what I do for dentists and I’m a little bit shameful in the way that I do very much make the content for dentists, and I do sometimes feel as though I’m leaving our cousins, our brothers, our sisters, our hygienist, therapists out a little bit because some of the themes I cover are just slightly different to the themes that perhaps you guys want.

But then, what hygienists have been doing, they’ve been DMing me, saying, ‘Jaz, can you just cover this one thing for us about how we can work together better?’ And I think, who better than you two? And I’ll just start from the top. I guess. Let’s have a couple of introductions first before I give you, my introduction. So Morg, start with yourself please. Tell us a little bit about yourself, how you got into hygiene, and you are interest in that regard of working in the capacity with dentists.

[Morgan]
So, I was a dental nurse for seven years before I got into hygiene. Yeah, we were talking about this the other day about how we think it’s a really great base because you already have that background knowledge.

So yeah. Then obviously met hygienist on route and thought, hang on a minute. I think I would like to do a bit of that. And then lucky enough-

[Jaz]
Did you find that jump difficult? Because a lot of dental nurses consider that move and then something comes along and they don’t do it, they don’t commit. Did you find it a big jump? A big hurdle?

[Morgan]
I mean, I was young, I was 21, I was at university, studying hard, playing hard. So, I actually think I had it really easy. We had women on the course that had children, families back home, and they were sacrificing that time away from them and studying, and they were working way harder than I was.

That was for sure. So, I think I did it an easier time in my life, but I have real respect for people that do it later on. And you know what? Great, because I have even more experience. So, yeah, I would say if you are considering it, go for it. It’s a great flexible career.

[Jaz]
And one of the themes we’ll talk about later, is a common theme I’ve spoken about on the podcast Morgs, which is finding the right place of work and how you have to kiss lots of frogs before you find your Prince Charming. And I know we had that chapter four. I’ll talk a little bit about; we’ll talk about that. Right? We’ll talk about the state of the play and the situation and stuff. But, Lou, let’s hear from you. Tell us about your background, how you got.

[Lou]
It’s, yeah, pretty similar to Morgan’s actually. I, after leaving school, I worked as a dental nurse, for a little bit longer, about 10 years.

And I used to always pop in to see the hygienist and see how she worked and offer some help sharpen her instruments and ask if she wanted some charting and everything, because she worked without a nurse. And I really loved what she did. It really, really interested me.

And she said to me, ‘Lou, you must gone do dental hygiene. You know, you’ve obviously got an interest for it.’ And that’s what I did. I started applying. I was a little older. I was 26, so it was, no, and I’ve never looked back. It’s been the best thing ever. I always knew I wanted to go into some form of dentistry, but I never quite knew why. Or what. It’s been absolutely amazing. Never look back and I would never have a different career. I love it.

[Jaz]
Brilliant. You know, that shines through when I used to work with you two, like I could say it now, I don’t want to offend any hygienist listening at the moment, but you two are just the best hygienists ever worked with, honestly, the understanding, the culture at work, just you two, just amazing, and I want to bottle you two up and spray you around the country in terms of your, just how you work together and this is what this episode’s about, right?

Because, and before we delve deeper, I’m getting so many thoughts and questions in my head already, but Morg, you said something really important before I hit the record button, and I guess it’s kind of like a disclaimer before we talk further. Do you want to just say it, go on. Just spill it out, get it out your system.

[Morgan]
So we work in a really, really lovely practice in Norfolk, Oxford. It’s a very affluent area. We were very fortunate to be hired by an amazing dentist called Guy Duckworth who was very, very prevention savvy, forward thinking and the ethos of that was carried on through the practice.

But we are not stupid to know that it’s not a cheap practice. What we can offer and the people that come here, a lot of them can well afford what we’re offering so we can completely tailor make their treatment for them. And we do appreciate that there are practices where it would have, the way we work would have to be very adapted because affordability is definitely an issue, especially in the times we’re living in. So yeah, I didn’t really want us to come across as a couple of divas that just said, this is our way enough highway in the way that everybody should be working, but what we can offer is the best of the best because of the-

[Jaz]
And it works in your business model. Lou, is there anything you want to add to that?

[Lou]
I think that you can, I think it works. We can tell patients what they need, and they obviously take up the advice, they take up the appointments. So, we find that we have the best success rates, you know?

But I would think even if you haven’t got affordability and you have got reduced time, it’s actually about set what your goals are. Your expectations and work to them. I find a lot of the time people think that, you know, oh, you’re just going to become an, you know, it’s all about removing the calculus.

It’s all about removing, you know, the staining. But actually I think that’s very, very shortsighted, basically. That’s a short, quick fix, but actually it’s not helping anybody. It’s just actually you are stressing yourself out. Your expectations are never going to be met doing that. So actually, I think you’ve got to play the long game, you know, like I said, goals, expectations, definitely in any capacity.

You know, if you’ve got 30 minutes, then I think adapt that appointment. Two, what is the most important thing? What is the priority here going forward for that patient?

[Morgan]
I was just going to say, giving a patient value for money does not just mean scaling their teeth. So, you know the whole give a man a fish for a day, you’ll feed them for a day, but teach them how to fish and you’ll give them a lifetime’s worth of achievement.

That’s exactly the same with what we do. Us offering somebody educational on how to clean their teeth is going to mean that they’re going to get so much less issues further down the line, just scaling them. No clinical benefit.

[Jaz]
And as we explore this episode further, that’ll become clear in terms of messages we’re want to send out. But I’ll give everyone an example straight off the bat, is that the way we worked together in Oxford at the time was when patients would come to see you Morgs, there were some patients and you know, you got into heated confrontations because you’d refuse to do any calculus or plaque removal until they sought them.

So, you just spent in the least patronizing way as possible. Patients always be like, wait a minute, I’m paying you x amount, clean my teeth and you are just telling me how to clean myself and you’re doing the right thing. You’re doing it by the book. But you know, you are ready to have your purpose. You have your purpose in terms of their overall health and actually sorting them out, prevention base so that they can look after themselves rather than just being a scaling machine.

You have the holistic health in mind rather than just, let me get the scaler out and stick it in as soon as possible. So that’s the kind of what we’re talking about here. The bigger picture. So taking a step back, I know about your journeys now and you did nursing first and you got into hygiene that way.

And it’s nice to know your individual, journeys and then let’s talk about actually finding the right environment and the struggle that you found to find the right place. And it’s very much ties into what you said morgues. That the young hygienist who’s listening to this, who’s just, a couple years out, and if we didn’t say that disclaimer, first up, they would listen to this, and they might feel really disheartened that they’re just a scaling machine and they get miserable.

But what you’ve made very clear is that actually you work in a very specific practice. They’re set up for this, but the second thing they’re not hearing or seeing until now we’re going to reveal it now, is that it took you a long time or a lot of practice to find the right place. So Morg, let’s hear your journey of the frogs that you kissed along the way.

[Morgan]
There’s been many, and in one practice I did five hours in their practice, and I said, ‘This isn’t going to work.’ You either get on board with how I want to work, which looking back as a newly qualified hygienist with very big head, you either get on board with how I want to work, or I won’t be here on Monday. Guess what? I didn’t go back on Monday.

[Jaz]
Well done.

[Morgan]
I think I left 12. Yeah, I left 12 practices when I first started. This is the only practice I remained at. And I remember Louise saying to me at the beginning of my journey, there are enough good practices that you’ll be able to leave the bad ones. But I would say to the newly qualified hygienist, working as many different practices as you can.

Because eventually what will happen is you’ll get offered more days in the good ones and you’ll be able to leave the bad ones but choose to be the clinician you want to be. If you feel undervalued, if you don’t feel listened to, if you’re made to work 20 minute appointments with no nurse, move on because obviously on the forums all the time is these poor, newly qualified hygienists, they come out of university so full of enthusiasm and I can remember that feeling.

You just want to go and like spread the word about all hygiene and change the world and you feel so limited and unsupported. And when I see those conversations, I just think you are literally flogging a dead horse. You need to leave that practice and move on.

[Lou]
What I was going to say, I think what we are finding is happening is because if you are working in these practices where you are not feeling valued, where you are not being able to utilize all of your skills and make that difference, then the stress levels are high and people are actually leaving the profession.

And that’s not what we want. You know, they’ve spent a long-time training and we want them to stay. I think they do have to find the right practices and be the hygienist and dentist that you inspire to be when you actually started your journey of actually, of the education, of the training. Definitely.

[Jaz]
I mean, that applies to dentists and hygienists. And Lou, just to give us your background in terms of how many practices until you found where you are at now.

[Lou]
Wow. I qualified, 23, 24 years ago, and one of my tutors actually said to me, do not become a scaling machine.

And she’d said to me, you love the oral hygiene side of it. Find the right practice for you. locum first. And that was the best bit of advice that I had. I locum first. And even though they had permanent positions, but what I’d said was that I will lock them. So, my day, I was traveling two hours one way, two hours another, but it was worth it because then I could see whether it was a practice that I wanted to be in, whether they got me and whether I got them basically.

So yeah, I lock them first. And then even when I came to Diamond House, my interview with Guy was very, very relaxed and we just had a chat and he’d said, ‘ We’d like you to start working for us.’ And so what I’d said was actually, ‘How about we actually have a month together?’

I said, ‘Just as a locum, I will do a month for you and then we’ll have a conversation at the end of the month. If you like me and I like you and we’re working well together, we’ll then you know, we’ve got a deal we can go forward.’ And that’s actually what I did. And it was the best thing. It was the best thing ever.

But I think if I haven’t got that advice at the start by saying, ‘Be the hygienist, work the way that you want to work.’ Then I don’t think I would’ve had maybe the confidence to actually say that right from the beginning. A lot of people, a lot of my colleagues that actually started qualified at the same time.

Within months, they were stressed, burnt out, saying, I’m not going to be able to do this forever. And that’s even after a few months, you know? So, I feel very, very fortunate that I took on board the advice that I was given right from the start.

[Jaz]
So the theme already we talked about is, you know, I have to kiss a lot of frogs before you find your Prince Charming. The second theme based on that is date them before you marry them. And that was a great example.

[Lou]
Yeah.

[Jaz]
Even though you’ve got this great vibe from Guy Duckworth, you said, ‘Hang on a minute. You know, I like this, but I’m going to do a month first.’ I love that. And I think that’s great. It’s a little bit brave. But I think, it’s good to have that and the themes I’m seeing here, I don’t know if you listened to an episode I did with my good friend, Laura Bailey. She is a therapist I work with in Richmond and she’s doing a lot of bonding. And the common themes we’re seeing here is you have to take massive action. You have to put your best foot forward. And that can sometimes that map, that journey can look very uncomfortable. That’s a very squiggly line from point A to point B. It’s a lot of tough conversations to have along the way. A lot of goodbyes, a lot of upsets, a lot of new places, new environments.

A lot of commuting that you did, Lou, these are the real-world issues until we found it. What I don’t want on the back of this episode is a mass exodus of any hygienist who’s unhappy. And then this episode comes out on Monday and by Wednesday, all these principals are calling me up saying, ‘Jaz, stop podcasting! You just ruined it for everyone.’

[Lou]
And then you’re getting hate mail!

[Jaz]
Hate mail, and love mail. I’m sure what you’re saying is resonating with a lot of hygienists. So really, if a hygienist is feeling stuck, rather than taking a big risk and being out of income and out pocket and struggling to find new work.

What is the first step that you could use, but perhaps you employed but it didn’t work because maybe the principal wasn’t receptive, wasn’t open that communication, it wasn’t the right environment. Whatever. What is the first step a hygienist can do to open that conversation to improve so that’re no longer a scaling machine?

[Morgan]
I think evolve. The biggest thing that everybody has to do in practice, and that’s not just the hygienist, that’s the dentist, the practice manager, everybody, nurses, we all have to learn to evolve. So, I think, if you’ve got good communication in the practice, we definitely don’t work how we first worked when we lost each other.

Yeah. Communicate. And you need to be in a practice where you can evolve. So yeah, I mean, definitely don’t do what I did and just walk out after five hours. I think try, have communication within the practice.

[Jaz]
Give it a shot. Give it a chance.

[Morgan]
Yeah, give it a shot and try and communicate and air your views as to how you feel that things could be improved and in then at that case, if you think that things aren’t improving and you have it what you are feeling, then maybe it is time to move on.

[Lou] Mm-hmm. I think good communication. We say that we are a team, actually be a team, actually converses a team, get everybody together and actually find out what everybody’s expectations are. Set some goals. Set some action plans together. Go on some courses together. Go on some, you know, so everybody has a really good understanding because I kind of think a lot of the time we think that the other person knows all about the subject. Okay? I’ve had dentist, said to me, ‘You know what, I had six weeks perio.’

I haven’t got a clue what I’m doing kind of thing, you know, holding their hands up. You know a lot more than me. And when it comes to decay and occlusion and everything like that, I’ll say, ‘You know, that’s your skillset.’ And recognize everybody else’s skillset and actually utilize it in the team, and don’t be afraid to say, ‘I don’t really know much about this, but can you tell me about it?’

And, you know, every day’s a school day, we don’t know everything about all subjects, so actually educate each other as well. You know, maybes have regular meetings with each other, even if it’s just a 20-minute coffee and just say, ‘Can you tell us a bit about what you do? Can you tell us a bit about motivating patience? Can you tell a bit us about what you’re doing, what your successes are, what your failures are?’

[Jaz]
We used to go out for Chinese food and curry and that kind of stuff a few times that we went out as a team, back when Amme and Yiannis and whatnot. So that was good actually. So, it’s nice to have that team building, you know, team building gets into everyone, but also suggest the changes and have that open conversation. Right.

[Lou]
Absolutely, and don’t be afraid to actually say, let’s do something. It’s almost like it’s positive criticism, you know? And I think take it as a positive. This, just saying that actually I think we could improve on things, I think is monumental for every practice and for ourselves as well. Everybody wants to like you said, evolve. We need to evolve as people, but we need to evolve within our work as well.

[Jaz]
Like you don’t just go into work one day and then hope that’s a day that the principal’s going to have an epiphany and be like, you know what? We’re doing it all wrong. How about we change the model and do this? No one’s going to do that. You know, things are going to not just change miraculously overnight. You need to be suggestive. You need to plant some seeds; you need to arrange some meetings. You need to come up with, you know one of my favorite things is, don’t come to someone with problems.

Come to them with solutions. So don’t be that person. That hygienist would be like, ‘Oh, this is not working. That’s not working. I want a nurse, blah, blah, blah.’ How about you come up, if we have a nurse, so this is one awesome thing that Laura did when she approached the principal Hap, who’s very open and receptive and great leader is, she said to him, ‘I want to use EMS airflow. I know there’s a huge expense, but I’ve done a calculation that if we raise our fees to this amount, we can cover it.’ And then they had that conversation. And what a great way to approach someone rather than, ‘I want an EMS airflow.’ You know what I mean? Yeah. So, so I think that’s a great tip. Any examples of when you two might have done that?

[Morgan]
Yeah, we were told at one point that when the practice couldn’t afford to have a nurse, we couldn’t have nurses. So we took a pay cut to retain having the nurse because we feel like well, it makes our day so much easier. We hugely value the girls and we want to offer the best service, and the only way we can offer the best service and give a hundred percent of our time and attention to the patient is to have a nurse.

[Lou]
And to utilize the nurse as well. Yeah, definitely it is.

[Morgan]
It’s the best decision we ever made.

[Lou]
We accepted taking pay cuts for the better machinery and to have the nurse and we enjoy our day. We enjoy what we do. And it’s because of I think of making those changes and making the sacrifices as well of it’s less financially, but actually we have a less stressful day, and we enjoy what we do. Patients are happy and everybody’s happy and it’s a win-win.

[Morgan]
And we can justify our costs because if a patient set, they’ll even come in and say, ‘Oh, no nurse with you today.’ And you’ll say, ‘Oh yeah, they’re just processing the instruments. They’ll be with you in a moment.’ And we make them fully aware that yes, we’re not the cheapest, but it’s because we’re using the best equipment. We have support a hundred percent of the day, and our focus is solely on them.

[Lou]
It’s that patient journey. I hear that word banded around a lot these days. You know, the patient journey. But it is the patient is our business basically.

[Jaz]
Mm-hmm.

[Lou]
Isn’t it?

[Morgan]
Yeah. Yeah.

[Lou]
So to make them feel really cared for and important and that they are getting the best treatment, then everybody’s a winner.

[Morgan]
I was just going to say, the biggest litigation in dentistry is perio.

[Jaz]
Mm-hmm.



[Morgan]
So the only way we can do our notes fully and all of that kind of stuff is with that support. So, yeah, we love our girls.

[Jaz]
And what you did, those were so selfless, like, you know, taking a pay I didn’t expect you to say that. I was like, that took me by surprise that you said that, and that’s just amazing. Like those who are listening on the podcast, who are driving on their commutes, and they didn’t see me. You might have noticed my hair’s raising, right? Because that was a like, listen, listen. I was like, wait, what?

You took a pay cut? That’s like, that’s such a selfless thing to do. It was like that is amazing. I don’t know many people who would do that. So, kudos to you. Like, you know, the reason why you two are in environment that you are happy is because you’ve made this environment, you’ve fought for this environment.

And I was, you know when I said, give me an example. What a great example. Then having that conversation like, wait, if we can’t have our nurses, then we are willing to have a pay cut. But for you to do that and show leadership from the bottom is just amazing and absolutely kudos. So, let’s cover that topic now of nurses, because that’s one of the questions I want to cover.

Where do we stand nowadays? Right. In terms of nurses, I think it’s having worked with you two. I think it’s fundamental. Cause obviously before I joined you guys, I was already used to hygienists not having nurses. So, this is a huge topic now you can see it from both aspects, right?

As a business for a principal to change their business model overnight and pay nurse, additional nurse wages. Especially with a shortage of nurses at the moment. We talked about earlier as well, before we hit record button. That’s a big thing, but in terms of a difference, it makes for your clinical longevity, clinical enjoyment, what you can do for patients to patient journey. How can we find a balance?

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[Lou]
Me personally is that without your nurse, it would be substandard treatment. Basically it’s, you know, to be able to personalize your treatment, do plaque scores, bleeding scores, have fantastic cross infection and be able, like Morgan said, to actually give the patient your time is paramount to really good oral hygiene and really good patient experience and really good outcomes basically.

I think everybody needs to know their value. Basically. Education does come at a cost. So actually you know, patients might say, oh, like you are talking, I don’t know whether I’m going off subject here, . But anyway, it’s patients might say, ‘Oh, you know, well, I’ve paid 110 pounds for this and no has taught to me.’

You know, but like I said, that was invaluable information and all of these in order to actually measure and motivate all of these indices is so important and they have to be recorded, like Morgan said, for the legal aspect of things, but also for the patient motivation. If we do plaque scores on every patient that’s measurable, we can say-

[Jaz]
But what you’re saying, Lou, is that without a nurse, it’s almost impossible to get good records. And to, you know, the reason you mentioned about the fees is because yes, if you’re going to be working in the model where about you have a nurse, You can’t expect to just for that to work in your current business model.

The entire business model needs to change. The prices need to reflect that, but that’s not necessarily, you know, I think dentists and principals are scared that if they raise their prices by 20 pounds to be able to cover the nurse, that they’re going to lose their patients. But, from any experience I have had so far whereby we’ve introduced that model and increased the hygiene fees, I haven’t noticed a mass drop, and I’ve only noticed that the team are working together better. The hygienists are so much happier, and the patients are getting better care now. That’s what I’ve noticed.

[Lou]
Definitely, I think you just have to take that leap and actually believe what you want to offer patients, how you want to deliver that and just take the chance. And it will be absolutely fine.

But like I said, it’s just taken that risk. Some people don’t want to take the risk, but I think really, really push for it because if they take the risk, a few months, years down the line, you will not regret it. You will definitely not regret it.

[Morgan]
From an education point of view as well have everybody on board as to what it is that you are offering. So when a patient rings up and they say to reception, oh gosh, that’s expensive, that you haven’t just got the receptionist saying, yeah, it is, you know, our receptionists are fully versed in knowing that they are telling a patient what is offered at this practice, which they’re not getting at other practices.

[Jaz]
Just to make that clear to a young hygienist who hasn’t worked in the kind of environment that the lovely work that you do. What are patients getting for their money in terms of, you know, you’re working in a place where both of you have an important role and have had an important role in designing the protocols of how you’re going to treat perio in the practice.

And you two are fundamental, at the top of that actually. So what is it that you offer that stands you out and is able to justify the piece of fees to the patients when they pick up the phone and call reception?

[Lou]
I think it’s definitely; it’s tailored to the individual. It’s not just come in every six months and have your teeth scaled and polished basically. It’s tailored. So, do you want to say what we do?

[Morgan]
Yeah. I think as well because we’re given free reign, we’ve never been told this is how you must work. We were trusted enough that they would say, you know, you need to go off and see Morgan or Lou, and then we would tailor make the package of the hygiene as to how the patient needed it individually.

It was never, you’re going off for a scale and polish. It was, you are going off to be educated about how to care for your mouth and in doing that they will clean your teeth. But fundamentally the long term is that we want you to keep your teeth. The more you see Morgan and Lou, hopefully the less your dental treatment you’ll need. So, you were big on that Jaz. You were big on saying, you know, I’d like you to have a better relationship with your hygienist than you do with me.

[Jaz]
If you’re seeing me too much, things are going wrong. You know, you keep seeing the ladies and they’ll sort, then they make sure you’re on the straight and narrow. Very much true. Very much true. And do you feel as though you have been well supported at the management level when you’ve suggested to have a preventive focus in the practice.

[Lou]
Absolutely. I think because when we started this practice, it was very a prevention led anyway. I think we’re really fortunate that actually what we had to do was maybe have difficult conversations with new clinicians coming in and even we were getting them to shadow us to actually say that this is how we work and equally, I’m really happy actually shadowing dentists as well to say, actually, I want to see how you work as well because obviously, you have lots of different patients, lots of different personalities.

And so, it’s quite good actually. I always find that the patient have the best relationship with people that suit them as well.

[Morgan]
I think information is key and our appointments are very information heavy. There’s not a single appointment, patient doesn’t leave with a plaque or a bleeding score and god forbid we’d forget to do that. A patient as they’re exiting, would say, oh, what are my scores today? They want to know those numbers.

[Lou]
Yeah.

[Jaz]
Do you still do your A5 card with the traffic light system and the percentage of the bleeding score, plaque score and the smiley face, et cetera? Do you still do that?

[Lou]
You know what? We don’t. Since I left. Actually, no, that actually stopped. But I tell you what we do is actually, well, I always vocalize what there, I always get the nurse to actually say, what was their bleeding score last time? And she will shout out. So obviously the patient can hear, I can hear, and then I’ll say, and what is it today?

Because, then obviously, you know, you can say which whether it’s improved, got worse or stayed the same, and that leads you into what you need to do. We need to focus on these specific areas as well. I think it’s a great motivational tool.

[Morgan]
We are making the patient realize that they need to take ownership of their disease. It is not about coming and having a quick cleanup every six months to a year. It is about them realizing that what they do at home is so much more important than what we do. And that’s the difference. I think that we have the support to push forward in this practice, which I definitely didn’t get in another practices.

It was about get them in, get them out, get the money. And the education was just really not that important, but that’s what’s kept us at this practice.

[Lou]
Yeah. I tell you what I find very, very interesting as well, is that when the clinician starts with the seed of you’ve got inflammation, starts to talk about the health of the gums with the patient and even shows them a TePe, it’s that the patient has heard something and then they came to us.

And then we get them to, obviously, we educate them to understand what was meant by that. And then they just get to know, obviously the whole picture of what’s happening. You know, plaque bleeding scores, six-point pocket charts. We found that, you know, if they’re perio patient, there definitely should be having full mouth Peri-apicals as well.

And actually, so courses are good. Keep up to date. And actually, if you haven’t got that information, if you are qualified, take the PAs yourself, tell the patient, why you are taking it. Bring them over to the computer, talk to them about their bone levels. Tell them why they have bone loss in certain areas but tell them what they need to do to actually stop that and actually to halt the disease.

If you are not qualified to take the x-rays or confident in doing so. Actually, don’t be afraid to actually go back to your clinician and say, I would like full mouth PAs, please, get the patient booked in. And I’m sure the clinician would be more than happy to do that for you. But I do think communication and actually building some bridges and working together is-

And singing from the same hymn sheet. Because like you said, the clinicians are saying it and you are enforcing it and you are saying it and we are enforcing it. So, you have to work together. And I guess that brings in the whole perio approach.

Cause I got my last two questions are how do you treat perio in your practice? And it sounds like a stupid question in a way, is that what do you mean how do you treat perio? We treat perio like we’re supposed to treat perio, but you’d be amazed ladies about, and you’ve experienced these different practices.

You know, some practices don’t talk about how we treat perio and you guys like, this is how we treat perio. We have a protocol in place. So, tell us a little bit about what that looks like in your practice.

[Morgan]
So number one, OHI, as you know, and obviously we’ve discussed a lot. We spend pretty much the first appointment with every patient, and this is whether they’re direct access or sent from the dentist.

The first appointment is spent showing somebody how to brush their teeth, and then often two weeks later, we are reviewing and seeing how they’re getting on. We’re not just sending them off and saying good luck. We want to know that everything we’ve done with them, they’ve understood. We do a lot of tell how, do lots of literature, leaflets, flip charts. We can send them videos, whatever we can do to support helping them learn about how they can care for their teeth themselves.

[Lou]
Oh, the mouse map. I found really good actually getting a mouse map and actually saying which TePes or which incidental aids suits best for that area as well, and that’s where the tailormade care comes into place as well, so they know exactly they’ve got something to take away with them.

Put it up in their bathroom so they can actually reflect and say, because obviously I think it’s being found, hasn’t it? On each appointment, isn’t it? Audio-wise? They actually retain very little knowledge of what we say. So, if you give them something as well, then that just supports and reinforces exactly what we’ve been saying to them.

[Jaz]
Perfect. We’ll talk about locum cause that’s for me is really important, but something that maybe you ladies now maybe take for granted because you are working, you’ve been working this way for so long, but just remind me if you still do this and everyone who’s listening is TePe brushes.

You are actually getting out the long handle ones. You’re actually putting it in their space, you’re showing them, and then they get to take that one as a sample to go home. And is it single tufted as well? What tell us the kind of things they walk away with.

[Morgan]
Definitely we’re big into single tufted brushes, bending single tufted brushes with a burner if you need to. So that you’re adapting it for specific areas, showing patients how to use them down the pocket. Yeah, we actually, we don’t just give the patient an electric toothbrush. We are actually showing them in their mouth how to use the electric toothbrush. Because so many times you’ll hear, oh yeah, I’ve been told to brush for longer, or brush harder or soft, whatever. That means nothing to anybody. We’re actually showing them in their mouth how to use it.

[Lou]
And I find what’s really good. I mean, the IO it’s absolutely amazing. I think that’s been a real big game changer.

[Morgan]
Yeah.

[Lou]
The technology behind that is fantastic. And actually, having all the heads show the patients what to do, basically we tell them what to do and actually getting the patient to actually brush, you know, give them a mirror, sit them up, get them to brush.

You’ll actually find the reason why they actually, that they haven’t been getting anywhere for years kind of thing, is basically because, you know, the angle of the toothbrush is not right. The technique is just completely right, but they think that they’ve been holding the electric toothbrush and moving it, but the majority of patients actually use that electric toothbrush, like a manual one, you know, and but you need to just stop them, show them, and just say, you know, how does that feel? You know, can you see-

[Jaz]
Do you ever get worried or scared that by asking them to brush in front of you that they might feel patronized? Is that something that ever crossed your mind in the early days of, of doing this protocol? And have you ever had these encounters where the patient’s personality type is like, what do you mean brush? Like you try and say, I can’t brush, tell us about some of those encounters.

[Lou]
Absolutely.

[Morgan]
Yeah.

[Lou]
Quite, quite a few.

[Morgan]
We’ve both been shouted at over the years.

[Lou]
Absolutely. Yeah, we have definitely.

[Morgan]
And I will say to a patient, especially if they’re older than me, please don’t find this patronizing. I do teach people in their nineties how to brush their teeth, but I am only here to help you. But yeah, you get pushback, and one size doesn’t fit all. I have had very rarely, but I’ve had an occasion where I’ve said, look, I think the way that we are working together doesn’t work. Why don’t you try and cover hygiene? Visit with my colleague and I’ll say to Luke, can you take one for the team as well.

[Lou]
Vice versa if I’ve had somebody where I’m just not getting anywhere, or we haven’t been looked that good rapport. But like I said, you know my way of working my way advising them things, they’re just, it hasn’t, kind of got through or it just hasn’t worked for them or for me.

You know? Then yeah, Morgan’s seen them as well and it’s amazing because even sort of, it’s such successes with some people that I haven’t, so actually be fine and just saying, you know what? I think you might be better suited to see my colleague; you know? And I think that’s absolutely fine to say as well. And I think at the end of the day, the patient, even though they might, you know, obviously yeah. Have a few grumbles at reception and things like that. I think they’d depreciate just. The honesty as well really.

[Morgan]
But you can’t please everybody. You are not going to have a hundred percent success of every single person loving your practice. But you know, as long as you retain 99%, I think you’re doing okay.

[Jaz]
Yeah. But then you attract the like-minded people, right? You attract the people that buy into the health philosophy, that buy into prevention, that understand that ‘Hey, I’m paying a little bit more. Yeah, but this is way more than what I’ve ever had before. And these two, they actually care about me and my health outcomes, and I get an objective score at the end.’ And those people who value that will say those who. Well won’t, and, and you probably are happy that way, I guess.

[Morgan]
Mm-hmm. Yeah. True.

[Jaz]
It’s self-selecting.

[Lou]
If our prices have gone up kind of thing, people have actually gone and said, you know what? I can’t afford to come here anymore. I’m gone somewhere else. I would say within a year they are back and they just said, you know what kind of thing, we’ve been to other practices and actually we can see where hygienist’s going?

[Morgan]
Yeah.

[Lou]
And what you do different. And we are back, which, which is quite nice. And sometimes you have to lose a few patients and if they come back, then that’s fantastic. You know, then patients will be the patients for life.

[Jaz]
What is the number one quality or trait that hygienists should look for in a practice or practice manager or a practice principal? Anything from the practice of the management team? What is the number one trait or quality? Is important in finding the right place.

[Morgan]
I think they need to be a human first and a dentist second. I think when it’s just solely business and with the management as well, then you don’t feel cared for, because most of us spend more time at work than we do at home.

That’s just a reality of life. So, you need to enjoy yourself. I mean, yeah, we are not scaling from nine to five. We have a lot of fun on route as well, and you need to feel looked after and we really, yeah, coming to this practice was like working for my parents. I’ve never experienced anything like it.

And it’s just carried on, hasn’t it? It’s just a lovely, happy environment. We actually have a nice time and I wish that for everybody, and when I see the forums of the unhappiness, it is heartbreaking because there are so many good practices out there. So please don’t quit the career because it is an amazing one. Yeah, seek out good practices because they are out there and you will find lovely practices and environments to be in. Don’t lose the faith.

[Lou]
And just make little changes as well. Like I said, drop the seed in and make little changes, you know, because like I said, it’ll have that snowball effect.

[Morgan]
Yeah, definitely.

[Jaz]
For me, I think a really important fact for me, if you ask me that question, I would say and you know, you say human side, which is lovely and I love that. I also think leadership, just having a good leader, okay, he or she should be a good leader. They should be a good leader because that really trickles down, leadership is how the culture is brewed.

It sets the tone of the practice. Having a present leader or the presence felt of leadership, I think is the most important thing. And sometimes, if you are not getting that from the powers above, then I’m very much a proponent that leadership can start from the bottom. And then you could start being the little mini leader in your sort of capacity to try and drive the changes from the bottom.

And that looks like a much rockier road, a lot of resistance and uphill battle, but it is one which does have a pot of gold at the end, if you like. So, I think it is worth fighting that battle. And sometimes it means you to change mountains, change course, go off piece, all the themes that we discussed at the beginning. But I think it’s worth, you know, if you are feeding the lack of leadership, then become the leader that you want to drive the changes that you need.

[Lou]
Absolutely.

[Jaz]
Yeah. No, totally agree.

[Lou]
And I kind of think be a leader. I’m willing to listen to people as well, you know? And obviously make the final decision as the leader, but I think actually being open to other people’s ideas even if you tried something and just that actually we’ll try it for six months, and if it’s not working, then we’ll think about something. You know?

[Morgan]
Yeah. Yeah.

[Lou]
I think it’s better if you tried.

[Jaz]
As a final point, you’ve got the microphone to dentist and hygienists in an episode, which may become viral. I think it’s going to become viral because it’s such a- The face he made everyone, anyone know who’s listening and not watching the face that Morg has made was not one of joy

[Morgan]
It’s like love island, we’re just these two little hygienists slip kind of thing.

[Lou]
Jaz, do we need to start organizing our merch or what? ,

[Morgan]
Water bottle.

[Jaz]
Ladies? Yeah, you can totally do this. You know, your own EMS airflow kind of thing. You can do this.

[Morgan]
Jaz, on a serious note, what I do want to mention though is refer big, big point of the perio, which we haven’t discussed is have an amazing relationship with a periodontist that you trust. You’ve seen their work and that you have open communication with. We just pick up the phone to our periodontist or ring them, whatever. But we’ve got that open communication. How do you think this is going? How do you think that’s going?

Should we refer at this point? As a hygienist, we are not the end of the road. We know that. So yeah, seek out good local periodontists. That is also a massive, definitely piece of advice.

[Lou]
Yeah, definitely. And I think as well is, you know, I think a lot of the time, because we’re in different rooms, you know, everybody works independently, but actually, you know, I think supporting each other as a team is paramount to a happy practice basically, you know, support each other, be there for each other and help each other out. Definitely.

[Morgan]
Buy your nurse lots of cake and coffee.

[Jaz]
That’s something I already do. That’s something I already do as well. So, ladies, honestly, I’ve loved seeing you both again.

I miss you both so much. I wish you all the best. Thanks for inspiring. I think a generation, because I think, you know, believe it or not, people hygienists have been messaging me on Instagram saying, because I promised this episode a while ago, and hygienist messaging me on Instagram saying, is that episode out yet?

Is that episode out yet? And they’re really what they need. I think what we need in dentistry because look, the BDA aren’t doing it right, is leadership. And I think if this is a small step to get people to start thinking about that and how we can get some sort of the change in the right direction, then so be it. And I look forward to hearing people’s feedback. How can we send you roses, flowers, chocolates, cakes? How can we reach out to you?

[Lou]
We’ve got our ins, we have got actually the Instagram page. But because we’re a bit dinosaurish of the old technology-

[Morgan]
We’re going on a course.

[Lou]
Yeah. We’ve gone on a course to actually see how to actually market ourselves and actually how to actually get the word out there. So, we’re doing this course in February?

[Morgan]
February, it’s called Thrive, and it’s the hygienist and therapists to market themselves. So, if you could just use our Instagram names on your podcast. That’d be great.

[Jaz]
I will do.

[Lou]
Instagram names. Is it the-

[Jaz]
Here’s what I’m testing you because you didn’t say it because you probably forgotten your Instagram name.

[Lou]
We only go on it once a year. It’s the diamond, the dynamic duo. Yeah. I’ll message you.

[Jaz]
Is it actually @dynamicduo?

[Morgan]
Something like that. Yeah, but honestly there’s only about three posts on it. We’re so terrible.

[Lou]
We’re not that dynamic on Instagram. But in the surgery, we are. So, we’re ready to evolve.

[Jaz] But after February you’re going to see lots of more posts and stuff. So if you wanna show your appreciation, if you want to ask some questions, if you want to engage @dynamicduo or the equivalent of where, whatever it actually is, I’ll put it in the show notes as always, ladies, thank you so much.

[Lou and Morgan]
Thank you, Jaz. We love you.

Jaz’s Outro:
Well, there we have it guys. Thank you so much for listening all the way to the end. A lot of the episodes are eligible for CPD. This one isn’t. There wasn’t enough substance, but that doesn’t mean there wasn’t enough juice, right? So, there wasn’t enough substance for questions and CPD, but I’m hoping you found that as a stimulating and inspiring episode with your hygienist.

I’m hoping you’re feeling like you can leave from the bottom, and if you’re a dentist, I hope that’s opened your eyes to the struggles of some hygienist and an opportunity for you to put yourself in a hygienists’ shoes who’s working alone day in, day out, and how they’re not able to operate at their highest level when they’re not in the right environment.

If you know anyone that will benefit from this episode, whether it’s your principal or an associate or a hygienist that you work with, please send them this. And I’ll catch you in the next episode.