Hygiene exam

A hygiene exam is the part of a hygiene appointment where the dentist leaves their own chair, examines the patient and confirms a diagnosis. Done badly, it is the tap on the shoulder in the middle of a crown prep that puts the whole day behind. Done well, Ryan's target is five minutes or less in the room, with more dentistry diagnosed, not less.

The exam starts before the dentist walks in. The hygienist has new x-rays, perio charting and intraoral photos of anything suspicious on the screen; the doctor takes a minute away from the patient to review them; and a fifteen-second handoff at the door covers what the hygienist is worried about. In the room the doctor confirms rather than hunts, explains findings without jargon, hands the patient back to the hygienist in front of them, and leaves. Cutting an average exam from nine minutes to five across twelve exams a day gives back 48 minutes.

When the exam load itself is the problem, the options are structural: moving low-risk patients in a stable practice to a yearly exam while they keep a six-month cleaning (only if production goals are already being met, since much of a practice's diagnosed treatment starts in hygiene), or a "two-and-one" model where a third hygiene chair runs procedures that need no exam.