DSOPro: Tell us about your background and why you wanted to be a hygienist.
I was very concerned about what I was going to do for a living, even at 16 years old. I grew up on Staten Island, one of the outer boroughs of NY. I had an uncle who was a dentist who mentioned that I might like to be a dental assistant. As it turned out, the high school I went to actually offered a dental assisting program as part of the overall curriculum, so I signed up. Within a week, I fell in love with dentistry. I got a job working part-time after school and on Saturdays as a dental assistant and loved that as well.
Some of the ladies I worked with encouraged me to become a hygienist. They were all dental assistants, and I’m glad they pushed me a little bit. I decided to do it and worked really hard to get there. I practiced for two decades in the same practice in Manhattan, where I had moved in my twenties. I had a wonderful career there. The practice had a great clientele, and the doctor I worked with gave me a lot of autonomy, which was a little unusual. He would say to me, “You’re in charge,” so I was able to do things with my end of the practice to expand services over the years.
I was trained a long time ago when it was kind of the one-size-fits-all prophy situation. My eyes were opened years later when I attended one of OraPharma’s (the makers of Arestin) hygiene forums. That was where I had my epiphany. I then realized that treating a patient’s oral cavity was really about treating their overall health as I had learned the infectious nature of periodontitis and the systemic links of the disease. I went back to work the next day and convinced my dentist that we needed to implement the use of locally applied antibiotics. He agreed and I’ve been on a mission ever since.
I was such an advocate that I eventually started a part-time position with OraPharma as an educator and, eventually, a speaker. I loved that job. I was paired with a salesperson and taught her customers’ hygienists how to implement a protocol for the treatment of the periodontal infection. After 2 years, they asked me to join their sales team, so I essentially put my scalers down. I worked in sales, selling Arestin for a little over a year. In 2006, I had the opportunity to become hygiene director for a small DSO in the New York tri-state area. There were 24 practices, and I decided to take it because I thought, “This might be the wave of the future.” I couldn’t have been more accurate.
Like other hygiene leaders who have been around as long as me, we consider ourselves pioneers in this field. I came into an organization where there were no protocols, no standards, and I had to start from the ground up. This was challenging to say the least, but I’m a very persistent person when I believe in something. I persevered, built my credibility, and got my way for the betterment of the patients.
That organization was acquired by Great Expressions Dental Centers after about 6 years. I stayed on in a regional capacity for 3 years and really learned a great deal. There I experienced this larger organization with a focus on great reporting and having a lot of systems in place. I took the ball and ran with it. I did so well that they promoted me to a national position in 2015. We had about 250 practices, and I had a team of 6 regional hygiene directors. Basically, my job was to lead and train the trainers. I taught them how to implement the practices that I employed to obtain my success.
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After about 3 years, I decided it was time for a lifestyle change and took a job out west in Denver and that was definitely a leap of faith. I had been living in Manhattan for so many years. I enjoyed it for a long time but had had enough of the city life. I had heard Denver was a nice place to live, so off I went. This professional move was essentially me scaling down. I accepted a position with Perfect Teeth—a smaller DSO with 66 practices in 3 states. With my experience, I was able to jump in and make strides very quickly.
Shortly thereafter, that organization was acquired by Mid-Atlantic Dental Partners, a Northeast group that subsequently acquired Dental One Partners and Dental Works as well. I went from scaling down to being catapulted back into a national position in 2019. There I had a team of 4 hygiene leaders and stayed there for 4 years until the company was acquired by Western Dental last June. At that point, I decided to go out on my own.
I am doing consulting now. I started my company, Oral Health Solutions, in August 2022. I am focusing primarily on small to mid-size DSOs that often don’t have a hygiene infrastructure, training programs, mentors, or leadership. It’s a pleasure for me to train them and help build that infrastructure. I firmly believe that in healthcare, structure is imperative. I’m able to carry out my mission, promoting best hygiene practices with a focus on the treatment and management of periodontitis. A program employing all the preventive and interceptive care we have at our disposal. I provide guidance for everything hygiene and it is very rewarding for me. Helping hygienists, patients, and the whole organization.
I also do some speaking, some media work, and I work with other consultants on different programs. I like the variety in what I do and working with different people.
DSOPro: What are some of the structural things you consider most necessary for DSOs?
Some of it is simply following industry standards. Then, having definitive guidelines implemented for treatment based on those standards. I’m a very hands-on coach and lead by example. Everything starts with the assessment, whether it’s periodontal disease or caries risk. Interpretation of radiographs and probing calibration is part of the training as well. This is in order for the hygienist to competently co-diagnose with the doctor. Hygienist-doctor collaboration is key.
I like to take hygienists from being the “tooth cleaner” to something more comprehensive, setting up standards to proactively address patients’ conditions. The implementation of adjunctive therapies enhances basic legacy procedures for better, longer-lasting patient outcomes.
Once the hygienists are trained, identifying hygienist leaders or mentors is crucial to continued success. When I work with DSOs, I always develop leaders so that when I am no longer working with them, there is someone in place to “carry the torch.”
Lastly, having a focus on hygiene operations and structured schedule management is a part of the equation. Operationally, utilizing an assisted hygiene model can be a great benefit and help offset the current issue of industry hygienist shortages. Ultimately, if the operations are buttoned up and hygiene schedules are prioritized, patient volume improves, and it helps the whole practice.
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DSOPro: Does that impact how hygienists can contribute to increasing patient or treatment volume?
Sure! While I have such a strong clinical background and knowledge, I very much understand the business of dental hygiene. I employ a three-pronged approach that includes clinical training, clinical leadership development, and operational systems. Trained hygienists are more productive. That revenue generation will increase the EBITDA or the profitability of the whole organization. Two thirds of the hygiene production go to the bottom line. Just by having a standard of care to provide treatment that is indicated based on a patient’s condition changes a loss to a gain. With this, the patients clearly benefit as well as the organization.
All that said, some in the DSO industry still accept hygiene as a “loss leader” when dental hygiene can actually be its own enterprise with a huge impact on the success of an organization as a whole. This is especially important now given that hygiene wages are so elevated.
DSOPro: What can DSOs do to best support their hygienists?
I think recognition goes a long way. Hygiene represents the epicenter of the practice; a place from where all the dentistry will come. Being a hygienist myself, I know how hard they work. So, in my leadership career and even now as a coach I make it my business to recognize them and their performance. While most DSO’s have compensation plans that reward clinical compliance, a nominal gift card can go a long way. Bear in mind that when you look at the lifetime of a patient, 89% of the time they’ve spent in a dental practice is with the hygienist. Thus, they are very important and telling them so is paramount.
DSOPro: Any career advice or message you would like to give hygienists about becoming leaders?
I practiced clinical hygiene for many years, but I always thought I would move on from clinical practice at some point given the physicality of the work. Because of that, practicing hygiene long term can be difficult. I knew there had to be something else for me to do but I wasn’t quite sure what that could be. I was fortunate enough to be presented with other opportunities to parlay the skills I already possessed into other roles.
For hygienists who would like to have the opportunity to take on alternative roles to clinical practice, the DSO setting may have the most growth potential. Many organizations have mentor programs and other leadership field positions. Being open to training and clinical compliance will help open those doors. Of course, it is important to let the management team know that you are interested in an advanced role.
Morphing into or being promoted into leadership or training roles, that’s something you can do for a very long time.
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DSOPro: Any final words?
For DSOs, I think it’s so important to understand the value of dental hygiene, the value of training hygienists, and developing hygiene leaders. Everybody has budgets, but the cost of training pales in comparison to the revenue this will generate. Value the concept of trained hygienists and what they can do for your patients and for your organization.
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Marisa Dolce, RDH, BS, is a hygiene consultant providing strategies for effective clinical program design, hygiene operational systems, training, and leadership development as founder at Oral Health Solutions. Beginning with a formidable career in clinical hygiene, she then advanced to roles as clinical educator, dental sales, and speaker for OraPharma Inc. Marisa then transitioned into the DSO industry in hygiene leadership roles, working in a national capacity at Great Expressions Dental Centers and Mid-Atlantic Dental Partners for a period of 16 years.
Oral Health Solutions
Oral Health Solutions offers a hands-on, customized coaching approach for dental hygienists. Employing established strategies of success, prioritizing and elevating the quality of clinical care for patients yielding a high increase in revenue generation and profitability for the organization. Covering all aspects of hygiene including systems for clinical standard, business operations, and leadership development.