Very Dental: Is the Hygiene Model Broken with Dr. Jason Smithson

Feb 14, 2025

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Alan is joined once again by the one and only Dr. Jason Smithson. We've often compared how dentistry is delivered differently between the United States and the UK, but today we compare how dental hygiene is delivered differently.

Summary: Dr. Alan Mead and Dr. Jason Smithson discuss the stark differences in how dental hygiene is approached in the United States versus the UK. They explore the reasons behind these differences, including insurance models, historical practices, and the perceived value of hygiene appointments by patients. The conversation also touches upon the role of diagnosis, consent, and duty of care in dental treatment.

Key Discussion Points:

Jason's Current Activities: Dr. Smithson discusses his teaching schedule at Spear Education, including new courses on aging teeth and other advanced restorative techniques. He also mentions his work in Australia and Europe.
The Hygienist Shortage: Alan describes his difficulty in finding a hygienist due to increased pay demands and a shrinking pool of candidates. This leads into the core discussion of the episode.
US vs. UK Hygiene Models:
- US: Hygienists are often the primary point of contact for patients, with a focus on regular cleanings regardless of individual needs and disease. The system is largely insurance-driven. Patients often prioritize the cleaning over the dentist's exam.
- UK: Dentists assess patients first, determining recall intervals based on risk factors (caries, periodontal disease, wear). Hygienist appointments are prescribed by the dentist and are therapy-focused (e.g., scaling and root planing for periodontal disease). Healthy patients may not see a hygienist at all.
Value Perception: Jason argues that the US system can make hygiene seem like a cosmetic procedure, diminishing its perceived value, especially for healthy patients. The UK model ties hygiene to specific therapeutic needs, increasing its perceived value.
Insurance and Payment Models: The discussion touches on the differences between NHS (government-funded) and private dental care in the UK, as well as the impact of insurance on treatment decisions in the US. The UK has a mixed system, while Dr. Smithson's practice is entirely fee-for-service.
Direct Access Hygiene (UK): In the UK, patients can directly access hygienists without a dentist's referral. This is uncommon in the US.
Diagnosis and Consent: Jason highlights the importance of explicit diagnosis before treatment, emphasizing that informed consent cannot be obtained without a diagnosis. He suggests that the US system sometimes relies on implicit diagnoses.
Duty of Care: Jason explains the concept of duty of care in the UK, stating that dentists assume responsibility for a patient's care once treatment begins. This raises questions about the US system and potential legal implications.
Efficiency and Multitasking: The conversation explores the inefficiency of jumping between patients and procedures, including hygiene checks during restorative work. Jason cites research on the negative impact of multitasking on quality and productivity.
Patient Expectations: The discussion acknowledges that US patients have been conditioned to expect regular cleanings, even when not clinically necessary. This creates a challenge for dentists who might want to shift to a more therapy-focused model.

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