Bridging the Dentist-Hygienist Gap: Comprehensive Care Starts in the Hygiene Chair

This is where the business end of dentistry and the care end of dentistry have got to come together. We cannot be short-sighted because you will 100% not find things that you don't look for. Welcome to Austin, Texas, and welcome to the Phil Klein Dental Podcast. In this episode, we're turning the spotlight on why it's time for hygienists to level up, especially when it comes to comprehensive clinical assessments. When hygienists are empowered to fully use their expertise to perform airway screenings, laser therapy, nutritional counseling, oral cancer exams, and more, it's not just the patients who benefit. Practices grow. Treatment acceptance increases. and new revenue streams are created. Today we'll explore how forward-thinking practices are creating a culture that supports a high-functioning hygiene department where the hygienist is seen as a key provider, not just an employee. We'll talk about how to find the right practice that values this model and what it takes to build this kind of empowered environment. So if you're a hygienist looking to grow or a dentist ready to unlock your hygiene department's full potential, stay with us and you'll enjoy this episode. Our guest is Katrina Klein, a registered dental hygienist for over 16 years. She's a national speaker, author, competitive bodybuilder, certified personal trainer, and certified ergonomic assessment specialist. Ergo Fit Life, where ergonomics and fitness are a lifestyle to prevent, reduce, or eliminate pain. And by the way, she has a great website, ergofitlife.com. I've been on it many times. Check it out. You'll see a lot of stuff, a lot of videos that will help you prolong your career by taking the advice of someone who really knows what she's talking about. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases and our entire production team will really appreciate it. Katrina, it's great to have you on the show. Thanks for having me as always. Yeah, and as I mentioned on previous podcast episodes, your engagement on our podcast episodes are great and the completion rate is off the charts, which means people that are listening to your podcast or our podcast when we do it together are listening to the whole thing for the most part. They're not dropping off, which is... So they either love you, love me, or love both of us. Probably you. That's probably what it is. Oh, I bet you it's a team thing. Yeah, it's a team thing. So today we're going to be talking about the hygiene department. And one of the things that we talked about on previous episodes and we've talked about offline is that there's a real value in the hygiene department that's often unrealized. Tell us about that value and how that whole thing works. So, you know, I feel like that the hygiene department, the real value in what we do as hygienists is we play detective. We spend four years of educational time learning how to find the problems. You know, the assessments that we do are just a matter of. finding the issues. And so that's where not just the profit comes from, but that's where the patient care comes from, because we can't possibly diagnose perio on a patient that we're not probing. We can't possibly, you know, diagnose an airway issue on a patient that we're not doing an oral cancer screening and an airway screening for. If we don't get into their health history, we can't possibly figure out. what's going on with the inflammatory condition that has a complete lack of bio burden. So there's so much more that what we can do and bring to the office, not just on a relationship status. Yes, we do that. You know, we're the relationship glue of the office. The patients trust us and we do a really good job at building that up. But that's a personality thing. We're talking about skills. We're talking about what we bring to the hygiene department and the room and to the office that can help co-diagnose not just restorative issues, restorative treatment and whatnot, but also how we can fully use our scope of practice that we have. And at that point, once we do that, maybe talk about expanding that to help the office even farther. And if we don't get to do the assessments and we don't get to... we don't have the time to do anything but just scrape, scrape, scrape, then we're being very short-sighted in our abilities. It's no wonder why assistants are being told that they can scale. What you're saying makes total sense and it's a great use of the hygiene team, but I was under the impression that these assessments were being done anyway. I realized the bulk of the responsibility of a hygienist is SRP, but I assumed full probing, identifying. more advanced perio disease? Not necessarily. The more that the hygiene model becomes where we are shrinking the time that we have with patients or we are pressing upon the hygienist to do other administrative type things, for example, it is much more profitable for an office to have the front. the front business team deal with insurance things case presentations all of these sorts of things so it's much more profitable for us to do the things that we were trained to do um do i think we should be scheduling our own appointments sure yes that's great but really if i can make sure that i do a true thorough you know periodontal assessment charting the recession and the bleeding on probing. And I'm able to track that and I'm able to actually discuss that with a patient. Bring the screen up in front of the patient. Look at all of the green or red arrows or whatever software you use. Look at what we're seeing. Have a discussion with them. Bring them in so they can own their mouth. They become more invested. They're going to be more inspired to then want to do more. in their mouth and we can explain to them why because patients we talk over their heads a lot if we don't do that we can actually get more of them to do what we want them to do so what you're saying katrina is you want to utilize the hygienist in a much more proactive way as far as being a detective and assessing the patient's dental health even though the dentist of the practice may have already assessed this patient in the initial visit Oftentimes the patient is seeing the hygienist first and then the doctor will come at the end of the appointment after all of the assessments have been done and say, okay, here's what we're seeing, blah, blah, blah, blah, blah. And they're really, dentists are relying on the hygienist to do these assessments in order to have a true quality, comprehensive examination. And that may or may not include having them in on the doctor's side, but if it is, um to where they're just they're seeing the hygienist first and they're getting all of the assessments done then the hygienist really should be able to set up the doctor with all of the previous assessments done have the doctor come in and say oh okay doctor here's what i see and then the doctor looks at things and says yep that's what i see too this was great and now the doctor has an opportunity to make friends with the patient, have those good conversations that we all want to have in the hygiene room. And, and then they can bond and they can make sure that all the treatment is accepted in the room. At least the education is provided. Is there anything that Sandy didn't cover that I need that, you know, do you have any questions, blah, blah, blah, and then go about their way doing the things that they do best. But what we do best is the assessments. What we do best is the digging. We are the investigative department of. of the office and if we don't have time to do anything besides just bio burden removal how much assessments do you get to do And as our appointment times get shortened and shortened, it's not helping the bottom line, whether that bottom line for a practice owner means money or the patient means good care or the provider meaning, you know, I had the autonomy to decide, okay, this patient needs this or this patient needs that or what have you. So I assume, Katrina, that the first appointment, either a new patient or they haven't been there for a long time, that... hygiene appointment is longer, I would assume, so that that would allow the hygienist to do more detective work and be more comprehensive with their assessments. And then I assume subsequent visits with that same patient may get shorter because of scheduling constraints. Ideally, it is longer. And I would say that a fair number of... offices do make that initial appointment longer, but more and more we're seeing them not. And then even after that first patient, so if a patient hasn't, you know, isn't there on their first time, does that mean we stopped doing assessments? You know, in my operatory, every patient gets an oral cancer screening every single time, no matter what, because what can happen in three or six months? A lot. Right. People are on medications. I can tell you that with 88 percent of the population being metabolically unhealthy, there is a ton of very colorful health history discussions that are happening in our operatories. And if we're not having those conversations and we don't know that suddenly this person is on a statin or suddenly this person now has OSA and they they need a sleep device and no wonder why your mouth is dry all the time. You know, these are conversations that we have to have. But if it's just come and sit down, let me scrape it out. That's not happening. Come and sit down, scrape it out. Yeah, I mean, ultimately, this is where the business end of dentistry and the care end of dentistry have got to come together. We cannot be short-sighted because you will 100% not find things that you don't look for. Before we jump back to our guest, I want to take a moment to thank our sponsor, EMS, the company behind Guided Biofilm Therapy, or GBT. If you haven't heard of it, GBT was developed with leading universities and clinicians, and it's quickly becoming the gold standard for managing biofilm. What makes it so effective is the minimally invasive, evidence-based approach. With airflow, perioflow, and piezon technologies, GBT gently removes biofilm, stains, and calculus with impressive precision. Patients really notice the comfort and speed, and hygienists love how efficient the workflow becomes. No surprise that thousands of practices worldwide are already seeing great results. And EMS makes it easy to bring GBT into your practice with clinical guidance, marketing support, and a clear plan for implementation. So check out the GBT-ready practice setup at gbt-shop.us. So when you go to a CE course and they're talking about all the things that a dental hygienist can find and they spend an entire hour on airway and you're thinking to yourself, wow, I know so many hygienists that aren't even thinking in this realm. They're just going in there and they're doing their scraping and they're counting the next patient, how many more patients they have until the end of the day, and then they go home exhausted. And then you're saying this negatively affects the bottom line of the practice by not going through the day being a detective. Because if you're not being a detective, you're never going to find things that exist. You won't even know what you don't know. So during your continued education experience, you're realizing that there's a whole treasure trove of stuff down there that needs to be found. And not so much for the money, although that's not a bad thing. Dentistry is a business. But obviously, it's beneficial to the patient. So tell us about airway. Airway is a huge topic right now. And we're noticing more and more how airway is kind of causing patients to be in this infinite loop of dental care. They get the restorative work done. Two or three years later, they start to have recurrent decay. And we're noticing that this dry mouth syndrome and all this other stuff is because of airway obstruction. It doesn't have to be OSA necessarily, but it could be some form of airway condition. How does the dental hygienist play into all this? Oh my gosh, it's huge. And actually, I'll tell you, whenever I teach my longevity course, I talk a lot about oxygen and the importance of breathing and forward head posture and all of those things. And, you know, I share a story about a patient that I had that was... had chronic perio, you know, was super, feeling super defeated about the condition that they were in. I've been certified for oral hygiene, sleep apnea certification. And so I look for it. And in my office that I was in, we did the pharyngometer and we looked at the airway and we, and the doctor made dental devices, you know, the different devices that are made. Even in this other office that I worked in that didn't have it, I had a patient, I looked in his mouth and I said, listen, if you were my dad, I would take you to the doctor right now to get a sleep study. I don't I don't know if they will charge you for it because it's not your medical insurance. But I can tell you you're on all of these medications. I can tell you that you have this many risk factors that contribute to it. Blah, blah, blah, blah, blah, blah, blah. And this was, you know, while I was doing his SRP. And what happens? This was the second SRP appointment. He comes in three months later for his first periodontal maintenance appointment afterwards. And he won't sit down in the chair until he's talked to my doctor. And I was like, oh, my gosh, because the first time I saw him was for his SRP. And so the doctor comes in and he's been a longtime patient at this office. And he says, Dr. Patel, I need you to know this girl saved my life. I will never leave this practice as long as she's here. So he had 88 disruptions an hour. and was then on a sleep device. And yes, he's a lifelong patient and he was already a long-term patient, but he's like really a lifetime patient now, right? And then in addition to that, he started doing all of the things that I was recommending because that trust factor, that not quantitative trust factor. was there he did not miss his three-month appointments he started water picking he started he did all the things and his oral condition improved and he felt more confident he lost a bunch of weight how is that not good for the bottom line that's an amazing success success story i think what not only did you build the trust but he didn't want to disappoint you because he knew you were taking care of him and you you were taking care of his periodontal health and everything else and his systemic health through the airway diagnosis or the airway recommendation that led to a diagnosis. But he didn't want to disappoint you. He felt like, you know, you're looking after him and you probably put him on a pretty nice home compliance protocol to maintain his periodontal tissue and everything else. And that's how you get success. And my doctor allowed me the autonomy to practice that way. And that's where that comes from. Because if I didn't have the ability to make that decision and have that conversation with him, even though this particular doctor did not do sleep dentistry, he wasn't involved with that. So who did you refer him to? I referred him to a sleep doctor. And the physician put him through a sleep study. They determined that he had 88 times per hour that he was waking up. And they gave him a CPAP. He didn't qualify for a dental device, this particular patient. But the reality is I had the time to have that conversation and it did improve his... oral health because like you were talking about his decay rate went way down because he wasn't sitting here dealing with all this dry mouth all you know from breathing through his mouth he lost weight his periodontal condition improved the restorative needs decreased because he was you know and he's loyal and refers every single one of his friends yeah i mean it's a boom for the practice there's no question about it did you get did you get the owner dentist your boss to give you more time for these visits so that you could do these kinds of comprehensive assessments? No, I had an hour, but he never took away from that hour and he never required that I did more in that hour than I could. And so if that meant that maybe a patient was taking longer, had more need, then maybe the front desk would do the scheduling of the next appointment or what happened. So there was never a production quota and saying, you know, they never said to you, Katrina. you got an hour but in an hour you got to produce a certain amount of billing because you know we got to pay you that that was never discussed nope nope we didn't talk about that we talked about how can we serve our patients the best and this also by the way is a doctor that didn't zero marketing and he had more patients than he could ever possibly take on. And he had a waiting list of people trying to get into the office. Yeah. So he sounds like a super nice guy that's really genuinely interested in patient care, what's best for the patient and not necessarily the best businessman in the world, maybe. I don't know. Maybe it turns out he is indirectly, right? He is. Yeah. I take that back. I take that back. It may not be ideal for every doctor owner, but he also was very well off, I can assure you. Put his daughter through vet school. It certainly sounds like the kind of dentist I'd want to go to. So I can totally see how his practice really exploded on the upside from word of mouth. I mean, that's what patients are looking for. It's that kind of care. So let me ask you this. You talk a lot about value. hygiene care could bring a huge value to the practice. And this has to do with communication with the patient. Talk to us about that. We'll be getting right back to our guest in a second. But first, if you're listening to this podcast, chances are you're always looking for ways to take your restorative and aesthetic dentistry to the next level. And it really all starts with great dental photography. And the right camera can be the difference between getting the photos you need and actually using them to boost case acceptance. That's why so many practices choose the iSpecial digital dental camera from Shofu. It's designed specifically for dentistry, making clinical photography fast, easy, and incredibly consistent. So there's no guesswork and no frustration for your team. With high-res images, simple one-touch operation, a lightweight design, and a large touchscreen you can use even with gloves on, the iSpecial fits seamlessly into your workflow. And those clear, compelling before and after photos? They make treatment conversations easier and help patients say yes. Bottom line, this is a camera that pays for itself in no time. So check out the iSpecial digital camera from Shofu. You'll be glad you did. Visit Shofu.com and use the code Viva for a special offer. To practice comprehensive hygiene means that we are not just doing everything in our scope, right? We are practicing to the full capacity of our scope. It means we're also... telling the patient what we're doing. So I don't just go in there and do an oral cancer examination, for example. I tell them, I'm going to do an oral cancer screening. I'm looking for lumps and bumps and anything that might appear abnormal. That tells them and they hear with my words what I'm doing, why I'm doing it. And every time that I say, I don't see anything today that looks scary, I'm using it on words that they can understand. And that gives them value. They're like, oh, thank you. I cannot tell you how many times I've had a patient say, thank you. No one's ever done that before. And I say, you know, people have probably done that before. They just probably didn't tell you. And that's part of creating that value. If a hygienist is doing all these assessments, we should be telling the patient while we're doing them. what we're doing, why we're doing it, what we're seeing. I mean, what is the point of doing a periodontal assessment if we're not going to discuss the results with the patient? Yeah, communication, patient communication, it's huge. Yeah, it's huge. Right. I mean, this is how you bring this value. Right. If you don't tell them you're doing it, you can't assume that they know what you're doing behind the scenes. So the $6 million question here, Katrina, is how do you transform a traditional dental hygiene department, which is primarily srp um and some dental hygiene instruction and then the patient's gone and they come back for their re-care appointments and it goes on and on how do you transform that into a more comprehensive approach like you're talking about today without spending a lot of money so so my first thing would be so comprehensive hygiene is a doing the assessments feeding the patient the value and then you have to apply it so then you have to do the thing And if you've been operating or if you are not a fee-for-service office, start with what you have. Use the tools you have. Do you have an intraoral camera? If you have one, use it. Anything that you have in your disposal, use it. Do you have disclosing solution? Use it. So you don't have to spend a ton of money in order to become this top 10% comprehensive hygienist. you can use the tools at your advantage what we have to do is we have to stop cutting away at our time you know because time is money and it's not just the amount of profis you can fit in it's that time that 10 minutes of time can be used doing these extra things we could do um silver diamine therapy we can do laser we can do um you know we can help out with the doctor we can anesthetize for the doctor all the extra things that we can do in the hygiene appointment with the patient using the tools that you have um and also i would i would say that if a hygienist doesn't set up their cassettes and this this might get the hygienist hating me so you had the dentist hating you in one of the other episodes we did this one the hygienist might hate me i'm going to say hygienist don't set yourself up for failure and by that i mean if you have a cassette of instruments that are for an srp appointment or for periodontal maintenance in your prophy appointment, and you find subgingival tartar because you're going to find it, and they really probably should have periodontal therapy, and you've got the instrument, you're probably just going to do it. Not only is that not serving your patient because you're not addressing that they actually have periodontal needs, you're not helping your practice by not getting that periodontal therapy build out. You're not helping yourself because ergonomically you're doing harder things. you're not helping anybody by volunteering as tribute. And you're also, if you're doing a procedure on a patient, not telling them, that's not okay. So don't put your subgingival scalers into your prophy appointments that are going to be for getting down into a six millimeter pocket. You know, we want to make sure that we set ourselves up for success. Is that common? Does that happen quite readily where a hygienist will go beyond the pale and say, hey, in their mind, they're not going to tell the patient, but in their mind, I know this is a prophy, appointment but i have a scalar here that i can go right underneath number 22 and get that whole bit of calculus out even though there's a six millimeter pocket there yes i will tell you that the term bloody prophy is is kind of what we see that's interesting yeah if your patient is having a bloody pro for every time a prophy should be you know removing bio burden on a healthy patient not periodontally um you know involved patients and so if we are doing periodontal therapy and you know honestly hygienists are givers we just want to help people and you know how It's so easy for us to just grab that sub-G calculus, and we want to. We want to help them. And maybe we know these patients for decades, and we know that they are financially not in a position to do the thing that we know that they need. And I know I've seen dentists do it too. We're all guilty. We're all givers. We all want to help people. But you just can't do that because you're not helping anybody by not making them aware of their condition. and not allowing them to own it so that because what will happen if we go do periodontal maintenance or we do a free srp on a patient that is being labeled as a 37 pro fee because we think they can't afford it or we know they can't afford it what's going to happen they're going to come back in six months or whatever and they're going to be in the same place because we did it for free i didn't educate them that they're losing bone We didn't educate them that they now have, you know, anaerobic bacteria in their mouth that systemically is going into their bloodstream that could potentially be a factor for hypertension or all of the things that periodontal conditions are involved systemically wise. Like, where are we serving our patients by doing that? No question, Katrina, you can't be doing that behind the scenes. You have to tell the patient what you're doing because you never know. They may have resources that you're not aware of. You know, if you think a patient is economically strapped, you may be right, but you don't know. You have to tell the patient. We've got to tell the patient. We'll be right back with Katrina in a second. But first, for the optimal bond between zirconia and your resin cement, check out Bisco's Z Prime Plus. Rated best in class by thousands of top clinicians, Z-Prime Plus, featuring MDP, creates a strong, reliable bond to zirconia, metal, and alumina substrates. And nothing could be simpler. It comes in a single bottle, and it's 100% compatible with both light-cured and dual-cured resin-luting cements. It's time you get the most out of your zirconia restorations. To learn more about Z-Prime Plus and the entire Bisco adhesive product line, visit bisco.com. And then, you know, we talk about how can you implement things without spending a ton of money. One of the least expensive things that a practice can do is make sure that every one of their hygiene rooms are outfitted with a camera. And I happen to know that there's a mouthwatch camera out there that is, I think they're less than $200 for one of these cameras. And a picture is worth a bazillion words, not a thousand, a bazillion words. And, you know, you can have a picture up. on a screen so that you or show a patient what's going on in their own mouth the case acceptance goes way up that's not a ton of money making sure that you have adjuncts in the office as you grow allow some of those profits to go back into your business by getting i don't know a laser if your laser your hygiene department can do lasers if that's in their scope um sending them to ce again together so that they can come back and talk about how they're going to implement said ce doing it as a team all of these things can contribute to not only the practice's bottom line or the provider's fulfillment, it can also retain your employees and make your patients get the best care. And maybe at some point you can be a fee-for-service office because you're making enough money that you don't have to be, you know, hanging out with the insurance companies all the time. But I think it's also important to mention, Katrina, that the dental hygienist working in that practice that wants to go beyond the traditional role needs to corroborate this. initiative with the dentist the boss the owner of the practice because they have to be on the same page so i tell hygienists um when you're in that interview that is the time i mean you're you're literally on a first date you know you're not going to get married to somebody without having a conversation and so it's really really important that's fine yeah i hope i hope that that's true yeah i mean i would like to believe that okay you don't just like show up and hey i like your outfit you like my outfit you're pretty cute i'm pretty cute let's do this no it's you know what do you want to have children do you want to As a hygienist. Do you have a job? Yeah. Do you live with your folks? These are all questions that we ask in our dating life. Why would we not do that professionally? And it's really sometimes very difficult to have these tough conversations with people because as a dentist, you need a body in that chair to service your patients, right? As a hygienist, we need a job right now. With the shortages, I hate that word, but the perceived shortages that we have, that's a little scary because the hygienists right now are like, I should be interviewing them to make sure that we are in alignment. Versus when I graduated in 07, it was the other way around. There were no jobs available. So, you know, the conversation can sometimes go both ways, but we ultimately have to make sure that we're aligned in our philosophies and the treatment that we want to give and not give and the wording that we want to use. What kind of verbiage do we want to say to these people? Hey, doctor, when I say this, this is what I mean by that, because I'm not going to say the same thing to the doctor in their office that I'm going to say in front of a patient. And so for me. I want to have these really tough conversations right up front, you know, in the interview. How do you feel about me using laser for your patients and not just during SRP? How do you feel about adult orthodontia? How do you feel about blah, blah, blah? What is your airway? Airway is a big thing, too. Yeah. Yeah. Your airway. Do you know where do you want to take your practice? What is your your five year practice goals look like? Because if that doctor says to me. Um, you know, actually I really don't recommend adult orthodontia. I really just reserve it for kids. I know right then and there, you're not getting a second date. Um, yeah, no, that's really, this is really important. This is great information, uh, for the hygienists out there that are looking to be hired. I mean, and we talked about that on a previous podcast. I mentioned, I said, you really have to interview the dentist, especially it's a, it's a buyer's market right now. So when I say buyer's market, yeah, yeah, no, it's not. It will or won't. It will. With the way that the economy works and the way that the job markets work, it's always cyclic. Things happen. And at some point, and this is what I tell people in my longevity course, is that if you are always bringing massive value, you will always have a job. And that's all you have to worry about. Just bring massive, massive value in a practice that you're aligned with. Right. Well, that's the key thing is the alignment. And that's the responsibility of the hygienist who's looking for the job. They need to make sure that they're getting involved from the get-go. Like you said, it's a first date. You don't want to, as a woman who's looking for a man and vice versa, you want to make sure that you're in alignment early on. Otherwise, nobody wants to invest a lot of time into something that is destined to fail. So the same thing applies to a dental practice. a dentist and a hygienist. So the hygienist is in the driver's seat. They need to really look. Now, again, if you're in a small town, if you're rural and you have three dental practices to choose from, it's a little bit different, right? You're limited because the next dentist is 60 miles away. It depends where you are, right? If you're working in an area where there's tons of dentists, you have lots to choose from. And maybe you don't want to work in a high volume practice. You could have a high productivity practice. but not a high volume practice. Yeah, absolutely. And that's why I say it doesn't have to be like a fee-for-service situation. And one thing for me, particularly as a progressive hygienist that wants to do all the things, not every office is necessarily up to where I want to be. And what I will tell people is take one thing at a time, introduce one new concept, bring the science, bring the research, bring the studies, come prepared, have the conversation. Hey, I'm interested in this. What are your thoughts about it? Can we do this? If I want to introduce this to the patients, how can we make this happen? Is there a step that we can take towards this direction? And accomplish that before you say, okay, I want to bring in lasers. I want to do orthodontia. I want to talk about airway. I want to do all the things. That's overwhelming. So one thing at a time. Have a discussion, see how you can implement it within your community. If you are one dentist in a 60-mile radius practice, it's going to take a little bit longer more than likely to make change. What do you think, Katrina, about a hygienist approaching the dentist and saying, hey, there's a CE program that I want to go to on lasers, and I've been noticing that a lot of patients could benefit from laser treatment. Can I take this CE program? And the question is, will the dentist pay for it? I guess that has to be worked out between the hygienist and the dentist. Absolutely. Bringing up the approach of, hey, there's a good course. Doctor, what do you think about this? Are you willing to have me go to this course and report back and show you how I can implement it? Or if they say, no, that's not in the budget, whatever, can we earn it? Can I earn that course? How about we split it 50-50? I'm a big proponent that you need to be invested in your... own education and so i was very fortunate that that several of my certifications were covered by the dentists that i worked for because they wanted to implement those changes that i then later got to have the joy of that but um you know the laser course was something i wanted to do and so therefore partnered with my doctor and said hey why don't we split this i'm going to benefit from it you're going to benefit from it let's do this um and and that's how it worked if i was a dentist and i had a hygienist like you who was in my practice, I wouldn't hesitate for a second to pay for it. To get someone who's excited about doing treatment beyond what's expected, you know, traditionally of a dental hygienist and bring in that extra revenue and inspire the rest of the team based on the continuing education efforts that you're putting in, I'd pay for that in a second. You know, I recommend the same thing with ergonomic training. You know, there's so many of us that are in pain, you know, hygienists and dentists and everybody. I have many hygienists that say, oh, I'd love to have you come train me, but my doctor will never pay for it. And I'm like, why don't you ask them if I do X number of fluorides or I do X number, I meet my goal for this many months. will you cover the cost of me getting some ergonomic training? It can do the same thing with anything, whether it be laser courses or airway courses or anything that you want to expand that's going to benefit the practice. I mean, ergonomics clearly benefits the practice because they don't have to rehire a hygienist that's injured or pay for time off or hire a temp or whatever. Same way that a laser certified or in Texas now, maybe those... doctors who are willing to pay for the local anesthetic class for their hygienist, you know, that's a great asset to a practice. So yeah, do that. Earn it. Help them. The course that you took on lasers, that was $2,500. Was that a lot of hands-on stuff? A lot. It was a three-day, very intense, hands-on course. How many people were in the class? 20? Oh, that's a lot. 25? Yeah, that's a lot. Yeah, probably 20. Yeah. So it was, but this was California. This was also 15 years ago. Okay. Did you, when you left that class, that course, did you feel like you were ready to go? Oh, yeah. I was so fired up. I was so excited. That's amazing. Well, listen, that's what it takes. 100% of the time, we have to be thinking about continuing education. We can never stop learning. That's the way the profession's going. I mean, the advancements in dentistry in the last five years have been just astounding. It's just remarkable to me how things have changed, especially CBCT. The diagnostic capabilities, the AI that comes with these CBCT machines that color map things on the screen for the patients to see. Hygienists could use all that stuff. Absolutely. And these are things that a practice can market and use in their social media. You know, if you say, hey, our hygienists are now laser certified. That's something that you can talk about on social media. You can now advertise in your community. You know, there are so many ways to make the ROI of investing in your team and in the education and excellence of your team so worthwhile. And that's the thing. And I would just encourage that we try not to focus on the minutia. Don't throw away a dollar to pick up a dime. And by focusing so much on, okay, we're going to have to do assisted hygiene where we see, you know, we blow out our hygienist's hands in five years. which she now has to have or he now has to have a disability claim for, which makes our workers comp claims go up. And now we have to find another person because we build out 16 D110s and didn't even still cover the cost of the hygienist wages for the day. So as we wrap up this podcast very shortly, Katrina, what do you think has been the most profitable service that you've brought to the table for the practice based on your assessments and your comprehensive treatment of? your patients as a dental hygienist oh that's really hard um would you say it's arrow airway or or that you send out so airway doesn't fall into that because that's kind of referred would it be orthodontics um the in one office the doctor was a sleep dentist so she created dental devices for osi osa and so that was very profitable for her um in other offices i i would actually just say that it's It's the co-diagnosing, you know, to talk about Invisalign or aligners in some manner. I think that that's incredibly important to periodontal health. And I also pair it. There's so many adjuncts. That's the thing is, is it's not just one thing. It's the comprehensive total of. all of the things that I do, whether it be through pharmacological medicaments, whether it be through, you know, putting a patient on a more frequent recall, putting a patient into oral probiotics. There are so many ways that we can help to be profitable that have nothing to do with insurance. But it's only because of my education. No question. Knowledge is power. And with the knowledge that you're getting from your continued education, In your career development, you'll be able to continue to recommend new services that come up down the road, which will expand the services of that practice. Really phenomenal stuff. You're like the ambassador of the office, connecting in a very trustworthy and positive way the patient to the practice services. And it's only because of the delicate nature that... is autonomy. You know, we have to trust one another. We have to stop fighting amongst ourselves in our own profession and see the benefits that we each bring to the table so that we can together elevate. Because there are things that we do in hygiene that are... profitable that are personable that are procedural there's all these different things but if i don't have as a hygienist the autonomy to make those decisions and i have no control over my schedule And I've just got an office manager there telling me, we've got to get out. We've got to get out one more thing. Okay, listen, you don't know what you don't know. And it's just like me going in and telling a doctor, here's how you have to do a root canal. We certainly can talk about this for hours on end. We are running out of time though. So I want to thank you, Katrina, for your time. Thank you so much for being on the show. And we'll see you soon on another podcast episode. Oh, I'd love to. Thank you so much as always. It's been a great time.