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Blood and Pus

I want to introduce you to, and provide a glimpse of, a larger work we put together called THE HYGIENE FACTOR. Many of you know that I worked with multiple hygienists that produced well over $2,000,000 per year while working three days a week and one Saturday a month each. This allowed us to maximize the facility and provide consumer friendly appointment times for our patients. Most of the productivity in hygiene could be attributed to not just incredibly talented hygienists, but to a very intentional hygiene system that virtually guarantees success in both productive hygiene and case presentation. One of the most difficult areas to address is getting a patient from just wanting a cleaning to actually showing up, paying for and loving full mouth comprehensive scaling and root planing.

The trick here is what do we do with the patient who comes in wanting a cleaning, but is in need of soft tissue? You are now faced with a confrontational tipping point. How do you help them get better, while having them want the treatment they really need? It is usually compounded by that patient who walks in talking about their previous dentist, who for 40 years has taken care of this person and the last three generations of his family. He goes on to explain that good ‘ole Dr. Never Look, DDS, was a great dentist. He didn’t use those little hygienist girls. He was a real dentist and did it all. You seat him, and take one look and realize that the only thing holding in his teeth is a calculus bridge. In fact, every time he breathes the entire anterior dentition waves in the breeze. So what do you do? How can you build a bond with the patient and still move them in the direction of understanding that a “cleaning” will not and is not what they need?

This set of scripts and system is called “Blood and Pus”. I have used this system for over 15 years after hearing Walter Hailey first describe it during an intensive retreat with Planned Marketing. It goes something like this:
1. You have used the permission statement and discussed their insurance just like we discussed in “100% Case Acceptance”.
2. You have taken the x-rays and charted the mouth for existing conditions and restorations.
3. You explain about probing and show the patient the periodontal probe. You explain that the color-coded markings are in two millimeter increments, and that pocket depths of 2-3 are normal but anything deeper means the patient has a serious periodontal condition. You further tell them that any bleeding points or pus around any tooth indicates an infection.
4. Swing the monitor around and involve the patient in “co-diagnosing” their mouth. We always handed the patient the “mouse” and had them “click” it to save the probing depth while watching the monitor indicate green lines for a normal probing and red for anything over 3mm.
5. The moment you find a bleeding point, you stop and inform the patient that they have “blood and pus” around that particular tooth.
6. You take the mirror or even better, the intraoral camera, and show them the bleeding site.
7. You then ask: “How long have you had that infection”? To which they will always reply: “I didn’t know I had an infection”.
8. You then say: “We need to get the doctor in to see about this infection because you may need something other than a cleaning”.
9. I will be the doctor here so I walk in and before I say anything, the hygienist will brief me on what has occurred. “Dr. Abernathy, I called you in because Mrs. Jones has blood and pus around tooth numbers 30 and 31 on the lower right. I have not finished the entire probing for the mouth because I knew you would want to be informed immediately.”
10. I then would turn to the patient and ask: “How long have you had that infection?”
11. Just as before she will respond with: “I didn’t even know that I had an infection until a few minutes ago”. (Keep in mind that before we ever began the probing and oral exam the hygienist had taken the time to explain about normal and diseased probing along with the fact that if “blood or pus” is present they have a gum disease. We always will try to precede confrontational blockage points with explanations that preempt any push back from the patient. This insures that we don’t surprise them with anything.)
12. Then I ask: “Does it hurt?” At this point the patient leaps at the opportunity to make it very clear that it doesn’t hurt at all. They do this because like most of us, we think that if it doesn’t hurt then it’s OK.
13. I pause just a moment with a reflective, thoughtful expression and say: “That’s the problem with gum disease. It’s kind of like cancer in that it never hurts until it is too late.” The use of the words “blood and pus” and “like cancer” forms a word picture that the patient cannot ignore. They are listening and really own the problem now.
14. At this point I suggest that we take a little more time today to diagnose the disease and that we will probably need to see them a few times to clear this up. I allude to the fact that the hygienist will get her more information about her condition and as soon as we completely finish our comprehensive exam we can determine what needs to be done, how much time it will take, and what the cost will be. I always close by saying that: “We will help maximize your insurance and make sure to help fit anything that the insurance does not cover into your budget”

That’s it: Simple, quick, reproducible, and very predictable. Just imagine increasing your hygiene department by 10% or more, while having more patients demand to have more crowns and comprehensive dentistry. It’s the one two punch to knocking out low productivity and slow days. Your hygiene department will become the driving force for decreased stress and increased profitability. My hygiene department brought in millions of dollars a year to our bottom line. This report will give you all of the details and secrets that you and your hygienist need to take your practice to the next level. If you would like to know how to get this 29-page document, The Hygiene Factor, just email Max at:

Michael Abernathy, DDS
972-523-4660 cell