Elevating Dental Hygiene Excellence and Beyond

Dimensions of Dental Hygiene’s Editor in Chief, Jill Rethman, RDH, BA, had the opportunity to visit with Shannon Richkowski, RDH, at the recent Dentsply Sirona World conference in Las Vegas. She is the director of Hygiene Mastery, a consulting firm that helps create a comprehensive dental hygiene department that is a state-of-the-art “health center” within the practice. Raising the standards of professional care is more than just a business mantra for this proud military wife. One of Richkowski’s passion projects is providing dental care in Nicaragua through Bridges of Hope International, a faith-based nonprofit that provides resources and relief to impoverished people in Central and South America.

Q: Tell me a little bit about your dental hygiene training.

A: Things have certainly changed in the 20 years since I graduated! I attended a small community college in Texas called Temple College and was in the third graduating class. Our courses were taught in a small classroom of an old building. We didn’t even have a clinic – we carried our equipment around in rolling suitcases and treated patients in various locations around the area. Most people thought we were training to be flight attendants! We treated patients at the VA in the evenings, at the public health department on Wednesdays, and provided dental hygiene services to the soldiers at Fort Hood. Looking back now, I realize how blessed we were to treat such very different patient populations. Temple College now has state-of-the-art facilities with a beautiful clinic. We’ve come a long way!

Q: Well that certainly gave you a great background for what you do today! In your program, “Doctor + Super Hygienist = Clinical Powerhouse” you talk about creating synergy between the doctor and the dental hygienist. What is one way to establish that synergy?

A: Great question! One way is for the doctor and hygienist to sit down and confirm that their goals are the same. They need to be in alignment with patient care, and in alignment with the type of services that the practice wants to offer patients. Part of that process is the doctor being very clear about the types of assessments he or she want the hygienist to complete. In some offices, the doctor may not want the hygienist to discuss any type of treatment … frankly, I would coach that doctor differently. In other offices the doctor may want the hygienist to identify the initial concerns in the mouth and sometimes hygienists don’t know how to go about that. They may be worried about saying or doing the wrong thing, identifying specific issues, and being wrong. I find that hygienists can be perfectionists and thus lack confidence, so we avoid the unknown altogether.

The doctor and the hygienist sitting down together, identifying the standard of care along with the vision for the practice, and what the doctor needs from the hygienist to reach that vision are key. The hygienist also needs the freedom to explain to the doctor, “This is what I need from you.” Working together as opposed to working separately establishes the synergy that is needed for success.

Patients definitely pick up on this! When a doctor and hygienist are working together collectively for a common goal, the patient’s experience is different. The patient has a sense of trust, of being in a good place. Patients know when the doctor/hygienist team respects each other, and sense that team will also respect them. It creates a culture that lets patients know they are in the right place.

Q: Communication is such a strong determinant for success, whether it’s a successful clinical team or a successful outcome for patients. Is there a specific type of communication technique that you prefer?

A: The best communicators understand their own style because the more you know yourself, the better you can understand others and understand how the patient communicates. For example, I am highly visual, vocal, and animated when I talk. So, when I have patients in the chair who are more reserved and quiet, that animated Shannon might cause them to pull away from me. This shows how being able to communicate to the patient in the way that the patient wants to receive the message is crucial.

Another tool is to focus on areas of concern that are most important to the patient, not what’s most important to the hygienist. If I am only focusing on concerns through the lens of the hygienist, then I am missing an opportunity. Ask patients questions about what’s most important to them during assessment.

Finally, using a “show me” vs “tell me” approach enhances understanding. Merely telling patients about oral health concerns is not nearly as effective as using visual aids, like an intraoral camera, to highlight those concerns. I believe this is vitally important in our communication process.

Q: How can you best engage the patient to take responsibility for treatment outcomes?

A: I’ll use the example of recommending in-office fluoride treatments. Most of us agree that nearly every patient could probably benefit from some type of fluoride. While some patients have made personal holistic choices to not use such therapy, we know that fluoride can limit the risk of caries. So, I could say to the patient, “You should have fluoride because you need to lower your risk of getting cavities.” That is a very generic, impersonalized approach. We get better treatment acceptance when we can link our recommendations to something that seems individualized and personalized for the patient. So, let’s assume this patient has recession. When I can show an image of his or her recession in his or her mouth on his or her tooth, it becomes very personal and therefore he or she owns the condition and wants to improve it.

Q: You discuss the importance of treatment scheduling to obtain optimum outcomes. Why is that important?

A: In some practices, the hygienist is the first clinician who sees the patient. In other practices, it’s the doctor. I’ve seen successful outcomes achieved with both models. It’s all about tailoring the treatment sequence or model to what the individual practice needs. Practices can be in different stages of growth or development. For example, if a practice has numerous openings on the hygiene schedule, but the doctor’s schedule is very full and new patients are calling, it makes sense that this practice should book patients with the hygienist first.

As we know, hygienists can perform phenomenal new patient assessments and interviews, so we can schedule new patients with the dental hygienist first and have very effective outcomes. On the other hand, let’s say a new associate has been hired and that associate has more time than patients. He or she has not built up a patient base, and the hygienists are booked solid. In that situation, we would schedule new patients with the doctor first and in that way establish a relationship with the practice. The most important consideration is to get the patients scheduled in the best way that works for the practice. And while they are there, they are given an experience to show them why they are in the right place. Either model will work when the patient experience is top-notch.

Q: What is one piece of advice you can give to hygienists who feel burned out by day-to-day clinical practice?

A: I have personally experienced that. Burnout generally means boredom. It means we aren’t growing. During the time when I started to feel burnout, my job felt monotonous, and I wasn’t being challenged. I learned to re-ignite my passion for my profession. Think about why you decided to be a dental hygienist in the first place. Something creates that spark in us! Then, get hungry for knowledge. If you’re learning, you’re growing. And if you’re growing, you are evolving and developing into the best you can be. That ongoing development eliminates boredom. Get excited about new technology! Dental hygiene practice is very different from how we were providing care, 25, 10, or even 5 years ago. Re-create yourself. Do something differently or learn something new on a regular basis. That helps us grow!

Thanks so much, Shannon, for your time and for helping our profession grow and evolve!