The Dental Billing Podcast

Raising Perio Performance with Ed Faton RDH (The Hygiene Coach) Part One

• Ericka Aguilar

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If your perio percentage hovers around 15% while half your hygiene notes mention bleeding, you don’t have a production problem—you have a calibration problem. We sit down with Ed, a clinician-turned-hygiene coach with a billing background, to unpack how teams move from prophy habit to complete health care without losing trust or momentum. The through-line is simple: document what you see, code what you do, and speak with one voice so patients understand why it matters.

We start with measurement. Ed breaks down perio performance percentage and why healthy practices often land between 30 and 40 percent depending on demographics. From there, we map practical calibration: agreeing on diagnostic thresholds, choosing plain language that patients can repeat back, and separating clinical conversations from benefits talk. You’ll hear how co-diagnosis works when the dentist frames whole-body health and the hygienist details the treatment sequence, intervals, and home protocols.

Technology becomes a teaching tool rather than a crutch. CBCT helps illustrate bone changes, intraoral photos make bleeding undeniable, and saliva testing like OralDNA turns bacteria into a color-coded story patients can follow. We also explore Perio Protect and how reducing inflammatory load lets the body “recharge,” improving healing and even sleep. The hardest part—converting long-time prophy patients—gets easier with “show, do, tell” scripts, honest framing about updated standards of care, and seed planting that respects patient pace while protecting outcomes.

If you’re ready to raise perio performance with integrity, this conversation gives you the metrics, scripts, and workflows to get there. Subscribe, share with your hygiene lead, and leave a review telling us which change you’ll implement first.

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Email Ericka:
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Email Jen:

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Email Ed:

ed@dentalbillingdoneright.com

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Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)


Delta Dental Locum Tenens Form:

https://www1.deltadentalins.com/content/dam/ddins/en/pdf/dentists/locum-tenens-form.pdf





SPEAKER_01:

Ed, welcome to the podcast.

SPEAKER_00:

Thank you. Thank you.

SPEAKER_01:

I don't know that the audience needs to know this, but I really wish that we could have recorded our conversation that we had this morning. Because this wasn't really planned. I mean, it was planned, but it wasn't really planned. Like we're just kind of like, hey, you want to hop on at 12 and do a podcast? And so here we are. And uh I want to invite everyone into our world and let them hear how we geek out on hygiene and billing and teams and all the things. So I first want to introduce you to the audience. Why don't you tell them a little bit about yourself and your background? Because you have a very, very interesting background in dentistry. And so tell them what you do with fortune and what you do outside of fortune. All the stuff.

SPEAKER_00:

Yeah, so I've kind of been started out as a dental hygienist. Prior to that, I am actually a foreign-trained dentist. I work, I have an active practice out in Dubai. I still kind of go back and forth. Hygiene kind of came onto my lap, if we want to say that, by me creating a dental product about gosh, it's been about 15 years now. Um, there's something now, the product that's out and about is called Playbrush. And essentially, they needed somebody here, or I needed somebody here in the US to have some sort of credentialing to be able to talk to dental offices, and that's uh hygiene was kind of the fastest pass. Obviously, now recently I'm I'm working with you and I'm working with the company. We're doing billing, we're doing hygiene coaching, and then on my and then here in San Diego, which is where I'm from, pretty much doing the same thing here, but on a smaller level.

SPEAKER_01:

So yeah, you have a very, very different background in dentistry. But what I love about your background is that you've trained more teams specifically. Trying to not say that, but yes, you definitely downplayed your experience, that's for sure. But I I love your coaching style. I'm sure the audience can hear that you're pretty laid back, but you coach hygiene teams and front office teams to have this certain cohesiveness among around hygiene, right? Yeah, for sure. And I have a background in billing, and with the billing company, I identify a lot of patterns. I think we were talking about that this morning. One of which, because I just think that there's so much opportunity billing-wise in the hygiene department that just we don't code for what we're actually doing. We're actually undercoding interactions with patients because I I don't believe that a lot of clinical staff doesn't understand how to document so that we can maximize on reimbursement. But that's a whole other that's a whole other podcast episode. Yeah, for sure. But one of the one of the key metrics that we look at as a billing company, which kind of leads into why we ended up with hygiene uh coaching, is I saw a lot of underperformance with uh perio percentage. Perio performance percentage is what we call it in the analysis that we do. Yeah. A lot of offices that we would run this analysis on would end up in like the 15%, 10% range and be in shock that their period performance percentage was so low. And I know you see a lot of that in as you hygiene.

SPEAKER_00:

Oh, yeah. I mean, so kind of taking it a step back. So, what is a period percentage? Uh, I mean, I know the way that I kind of try to explain it is essentially it's period, specifically maintenance and deep cleanings and gingival scaling, and then that person that amount, and then underneath it would be the everything else that like all that plus the profies. And I think like a lot of people don't realize that a healthy practice, I mean, I would say 30% is kind of where I would start. Optimum, where you're practicing at the highest part of your license, if you want to call it, would be right at 40%. Now, I recently read somewhere that if you are at about 42 and above, you're probably using something that you know, unless you have patients that are that are that their demographic is like over 60 or 65, you're gonna get kind of kind of recalibrate. You know, so like that's okay. We can talk about all aspects. And I think a lot of people, at least for me, and I try not to say this too much, but in a predominantly female field, when I talk to as a coach or as a regional hygiene manager or as a hygiene director of some of these DSOs that I've been a part of, I have to be very trying to choose my words, very strategic in how I place things because the end of the day, it's about patient care, right? So we can look at a practice and we say, oh my gosh, they're doing great, and then they hit that other threshold, we're beyond it. And it's like, hey, you know what? Let's dial it back, let's let's let's calibrate and figure out why some of these things are happening. And I I have recently had deal with that, which I mean, which was great. It was a good learning experience because essentially what we figured out what it was is just a lot of changes scaling. And so that that's totally fine. So we can be on the verge of stuff. I think one of the biggest takeaways that I have learned in all of this is we should not, which I mean, I think I've heard you say this on the past on the podcast multiple times. Um we should not let insurance dictate our interactions with patients and how we treat patients.

SPEAKER_01:

So that's that's I do say that. I live by that. Like, don't let insurance dictate the standard of care. And, you know, a lot of people don't even know. I don't know if you you know this, but the ADA really doesn't have a guideline on how often a patient should have a cleaning. They really do encourage the doctor to implement their own standard of care. But why do we have a six-month recall? Because insurance covers cleanings every six months. And by cleaning, I mean Profi. So, you know, like we do allow insurance to dictate that the standard of care in most offices. I do see that. It's very rare that I see in offices as we our doctor says that our patients should be coming in every four months for a cleaning as opposed to every six. So, I mean, that's that's a biggie for me. So the reason why I wanted to kind of touch on like why I brought you and people like Jen, who's also a hygienist, on board to help coach offices is because prior to having you on the team, it was me, the biller, the the non-clinical person telling offices your perio performance percentage is 11%. And it should be a lot higher, which means you're not treating as much period as you think you are, you know, and and we would break down by code, you know, you did 3,000 profies over the last 18 months. And, you know, when we look at the clinical documentation, a lot of them had moderate bleeding attached to profi. And so I'm not a clinician, and you know, the doctor would say, Well, you need to talk to my hygienist. Well, when I met with a hygienist, I would get the meeting of rolling of ice, people walking out, because you know, to them, I'm the money grab girl, you know, you're just the insurance girl. You're the you're just all you care about is getting more money, more dollars. And and yes, that is my role and responsibility when I work with an office is to make sure that you make more money. But I would want someone like me in in my corner too. But, you know, I I thought about it and I thought, okay, how can we make uh help the hygienist to become more receptive to the reality of you know, the fact that we need more period conversions in the office as opposed to just continuing to do what we've always done. We talked about it this morning. I talked about how back in the day, Dr. Charles Blair, before 4346 was out, he would encourage offices to go to put in their practice management system D1110.

SPEAKER_00:

Yeah, yeah, yeah.

SPEAKER_01:

And then you'd have D1110.b for the difficult bloody profit, which is now which is now a gingivitis cleaning, right?

SPEAKER_00:

So you made a good point this morning when you said that, you know, what were you saying that they used to break it up into different um so they would do they would do one, two, and three basically the first profile, and then they would bring them back in about four weeks for a second profit profile. So it's like it's it's insane. Like so basically in three months, these patients got three cleanings, and it, and they're not, I think there's a like the practices that I've been kind of a part of that I've seen do that. The patients don't even understand why that's being that's happening. And they they're just like, oh, the bull, you know, they just told me I need to do a little bit more here or there. And I'm like, well, you know, do we have to kind of dial it back and talk about complete health dentistry and talk about why this is what's going on. I think, I think that's the big shift and the big thing that you and I have have talked about multiple times, where if we come from a stand or a place of help and a place of having unity in in regards to their overall health, then there's none of this in-between stuff. Before we got on to the uh podcast, I was just trying to think about something that is new from all the hours of out and hours of us talking.

SPEAKER_01:

Our phone calls go on and on, and we're like, okay, we got to get back to work. It's been two hours. Yeah, yeah.

SPEAKER_00:

You know, I think like we keep hearing these buzzwords of AI, we keep hearing these buzzwords of C B C T scans. You know, everybody's using that now instead of a piano or asking for those things because they're looking at airway and they're looking if there's reinfection of root canals and making sure their avalar bone or the structure around their current teeth is stable. Well, you can still use a CBT scan to initially be able to show the patient, or the the dentist, of course, because they're the first ones that should be seeing the patient in an in an ideal world, uh, especially if it's like a new patient. You can show them that on that scan that their avalar bone is starting to deteriorate and starting to have issues. And the hygienist is going to confirm and be able to let us know the extension how extensive that is. So you're actually being able to notice bone loss in a different way prior to taking these bite wing x-rays. So I guess I guess, like all in all, what I'm trying to say is everything is interconnected together. So I don't have to wait for a bite wing x-ray to know what's going on in a patient's mouth. Or I don't have to just probe. If we're if the doctor is saying something and we get the doctors to be on board, to be on the same page, then everyone's saying the same thing. Consistency is what creates trust.

SPEAKER_01:

Yes, yes. So I want to go back to what you just mentioned right now, because you do talk a lot about this in the coaching sessions with the clients as well. Um, you talk about complete health. Um, so talk to us a little bit more about your approach to that.

SPEAKER_00:

Okay, so there is something there, there's a San Diego chapter called basically the coalition of complete health. And there's about 50, 50 to 40 members here in San Diego. It's not just dental healthcare professionals, there's dental hygienists, there's dentists, there is oral surgeons, there is PCs, there's just good old normal doctors, uh, there's there's ER nurse who's on there. And essentially, what we have set up. Sorry, essentially, what has been set up is to have a standard. And that standard of care is helping to bridge the gap between what's going on inside them in the mouth and how that manifests to the rest of the body, right? So we break down basically how we look at a patient into four parts. The first part is going to be their medical history and the medications that they're on. Their second part is going to be their bite, their third part is gonna be their teeth, and then the fourth part is gonna be hygiene and oral care. I won't touch too much about the other stuff unless you want me to, but I can definitely talk about hygiene and hygiene to just put it plain and simple terms. We want the patients to have less than 20% of bleeding, less than 20% of bone loss, and then less than 20% of calculus inside the mouth. And again, this is what we're communicating to the patients. If we want to talk in a clinical or more of scientific terms, you know, that those constitute two other things. This is why we do the parisharting, this is why we uh assess with photos, and this is why we assess with x-rays. And once we get them to once we say that to them, then we go into okay, well, why is this important? If you have two out of the three, well, you've essentially kind of increased your probability, or we believe that you do have periodontal disease. And then we talk about why and how that's that could potentially affect the rest of your body. And basically, number one is we mention heart disease, number two, we mentioned blood blood pressure, number three, we mentioned cancers, and then based on we go into their medical history and look if there's anything that we can link it to, which nine out of ten patients, if they do have periodontal disease, there's some systemic inflammation that's gonna be kind of the tag word that is going on that is manifesting, manifesting from the mouse to the rest of the body.

SPEAKER_01:

Wow, that's very comprehensive. I I'm I mean that's that's very comprehensive. So I know I I've sat in on a couple of coaching sessions with you, and you are a big fan of a couple of products, one of which is oral DNA.

SPEAKER_00:

Yes.

SPEAKER_01:

Um, talk to us a little bit about why you are such a big fan of that and why you think all hygienists should be doing that.

SPEAKER_00:

Well, so bacteria, bacteria inside the mouth. We want to figure out what's gram positive, what is gram negative, what is what what bacteria is under the gums, what what bacteria we can help prevent to have to decrease inside the mouth and be able to put patients on the proper way, if you want to call it, to where they can help themselves, help us by them helping them themselves at home. So saliva testing essentially can help with HPV. There are markers that that with the cotton swab. So it's pretty easy. They literally do a cotton swab, it gets sent out to the lab. The patient is involved in the process itself, meaning they we use their email or we use a QR code and they get an email slash text message, however, that they signed up. Hey, we have your specimen. Hey, it's been assessed. Go ahead and go here and look at it. It's very extensive. It breaks things down in a way that patients can understand, and then we also get something in the office that we more, it's more science, scientific of what's going on inside the mouth, and it's graded based on numbers, numbers, and colors. And so when a patient comes back in, we're able to actually show them hey, you know, you're in this red and purple. We want to be in this green and yellow. And so these are the things that we have to do to help you move over to this. It tells us what bacteria is in the mouth that's caused that's causing gingivitis. It tells us what what bacteria is in the mouth is causing periodontitis. It's telling us telling us what bacteria is in the mouth that's causing the the decay. And there is, and then it kind of goes into a mixture of those two bacterias, maybe is starting to cause multiple other things. There's I remember pretty recently seeing something where there was so much plaque and tartar buildup that that the bacteria that was growing there started to have the patient start having, I would say, what they they named it a bunch of different stuff, but essentially what they were talking about is that they they started to have a a sore throat, and then when they did the con soif for the for the sore throat, because it wasn't going away, their throat was was inflamed, and they were starting to basically get into the early the early times of them getting out. And so, like, if we can catch things early, yeah. So, I mean, if we can catch things early, you know, obviously this person cared about their health, so they followed up.

SPEAKER_01:

Right, right. That's interesting.

SPEAKER_00:

Yeah, you know, and then another another another product that I really like, and and it's been around for a long time. I know some people just haven't read the science behind it, is uh PeriProtect, essentially hydrogen peroxide in a in a formulae form with a certain percentage. This guy definitely helps patients reduce the inflammatory bodies that's inside the mouth, helping us get it to a manageable manageable space. I heard somewhere on one of the podcasts, I don't remember which one, but they they talk about our bodies as a battery. So it needs to be recharged. If the battery is constantly fighting the bacteria, it's not able to recharge itself. The periprotect or yeah, the the piprotect is something that's external that can get inside the mouth that can help reduce that, allowing the body to recharge so it can fight it, and the body can fight that bacteria in the mouth.

SPEAKER_01:

Right, right. That makes sense. That makes a lot of sense. So shifting gears just a little bit.

SPEAKER_00:

No, no, you're fine.

SPEAKER_01:

So this all is great knowledge to have, right? But I don't want to say I hate saying butt because I know butt takes away from a conversation, but I think it is appropriate to use butt here.

SPEAKER_00:

Yeah.

SPEAKER_01:

Hygienist struggle with the conversation around shifting a patient from a profy, because now we're talking overall health, right?

SPEAKER_00:

So of course, of course.

SPEAKER_01:

Getting more comprehensive, and that's what you're coaching people to do is learn how to look at the body as a whole, don't just look at the mouth, and we're gonna we you just talked about that. Okay, so now I have all this knowledge. How do I introduce all of this to the patient I've been treating for six years and doing a bloody profion? You know, like I think the biggest part of the or the hardest part of the hardest part, yeah, I think implementing perioconversion, the perioconversions is the conversation around that. And then taking it a step further, we'll dive, we'll talk a little bit more about the financial aspect of this, not the financial gains, but the financial conversation around you know, a patient who's been a profi for six years, and and now we've learned about this new code 4346, and we're like, oh wow, there is a code that more accurately describes what we are doing, the type of cleaning that the patient is receiving. However, I don't think the patient's gonna go for it. And if the patient ends up with a copay, I'm not talking to the patient about it, you know. So this is what I hear and see a lot of, and where offices fail to implement this code, and we'll talk about that in a second, as far as how it how insurance impacts and and all of that. Yeah. So when you're coaching a hygienist who is experienced, I mean the the people kind of know about this code because it's been around since been in hygiene, but the older hygienists, you know, those are the ones that typically struggle with perio conversion and converting a bloody profy patient to a gingivitis patient or a period, right?

SPEAKER_00:

So what is your I mean, I I think so. This is what I do, and this is just the simplest way to put it. I tell I tell people, you need to be frank and honest. So guess what? Hey Sandy, this this weekend we went to a course, we learned something new, we're like shifting things in our practice. We're basically uh trying to and wanting to treat patients from a complete health perspective. And then we kind of go into that. I personally, when I go into practices and I kind of do the show-do tell with hygienists, first thing I do when I bring a patient back, I take the blood pressure cuff, I tell them to uncross their legs, and I take their blood pressure. 99.9% of hygienists don't do that. We're just doing a uh cleaning. Well, Sandy, we went to a course that actually we are wanting to make sure that your blood pressure is under control and that you're not taking any new medications. Why you ask? Because these two things can affect and will affect the inflammation inside your body. We want to make sure, you know, I was looking at your parachart from three, four weeks ago or three, four months ago. There was a couple of fours with a a bleeding point here and there. And then they're gonna ask, oh, well, they never told me that, which that's kind of the other thing, right? So we say, okay, well, I I understand that. This is why we're going over it today, and I'm going to recheck it and see how it is. The conversation does not mean it's gonna get converted today, but at least it's happened. So you have to plant seeds. So, how do you plant an actual seed? You plant the seed with you being in it, meaning I went to something, I we are changing things in our practice, we are practicing at the highest level of our license. And the only way for you to practice at the highest level of your license is to sorry to say this, open your mouth and tell patients what you see.

SPEAKER_01:

100%. And that's where the breakdown starts.

SPEAKER_00:

Exactly.

SPEAKER_01:

I love that phrase, practice at the highest level of your license. So what that looks like is talking to the patient about what those bleeding points mean, what those numbers mean, the, you know, how that affects your blood pressure, how that affects everything. I love the battery recharge example because that resonates with me as a non-clinical person. It's like, you're right. If my body is constantly fighting a bacteria and losing, then how am I supposed to get total rest at night? How am I supposed to get proper sleep if I'm not able to recharge? Because it, you know. So I I really love those concepts. And I I think that this is probably where the rubber meets the road. It's really, like you said, planting those seeds and having the right conversations with the patients and periol conversions, like I it doesn't happen overnight. You know, we're not going to bait and switch the patient. We're not saying, you know, to break it to the patient and tell them, oh, guess what? You've had periol for the past six years. We've just been giving you a free cleaning, you know, to your benefit. But more along the lines of letting them know what you're seeing in the mouth and helping them, as Jen phrases it, she always says it's important to help the patient take responsibility for what's going on in the mouth, which is affecting their overall health. So, with that being said, do you have any tips or tricks outside of what you just shared with us? How can a hygienist who is, you know, wanting to have these conversations but afraid to lose their patient?

SPEAKER_00:

So I mean, there's there's so many different types of personalities with patient with patients and with hygienists kind of dealing with things with different patients. I mean, I would say the easiest way is to do what's called show do tell. If I can show it, then I will speak about it. If I cannot show it, then I will not speak about it. I personally will not show a patient a bunch of numbers. And every hygienist that's listening to this will definitely understand what I'm talking about. A period chart does not mean anything to the common person, right? You know, and so what I will show though is a picture of, or after I clean their teeth, there's an area that's still bleeding. I will show a picture of that, I will do a scan with whatever, you know, a scanner that we have out there and show the patients what it is. Those are that those are the tips that I would give people. I think take away from kind of all of this stuff is take one step forward, don't be scared, and have a real conversation with your patients. I think a lot of people are so scared, and most hygienists want to, are people pleasers and want to please the patients that's in front of them and forget that the conversations is supposed to be about their health, not about their kids or mom or the vacation they just went through or things of that nature. I think a lot of practices are, especially now because hygienists are so highly paid, which is kind of an unfortunate conversation to have because they definitely deserve their their pay if they're able to earn their keep. I I personally coach practices to the personal stuff, is the doctor is the one talking with the patient about it. And then the actual like dental stuff is being talked about with the hygienist, which is very kind of it's it's reversed, but that's how you co diagnose because then it's coming. Comes in, asks about the kids, asked about the summer, asks about vacation. Oh, hey, you know, we see a leaking filling here, or there's a crown here, that there's an open margin. So, you know, I'm gonna bring you back and have that done. And then they, you know, they're did you have any questions? No, okay. And then they leave. Now they're stuck with the hygienist, or they're in the chair with the hygienist. The hygienist, if it's a good hygienist, or should I sorry to say good, but if it's a seasoned hygienist, they're going to ask the patient again if they have any questions. And they're gonna reiterate what the doctor said, and then they're going to literally talk about what that is and why it's important for them to do it. I know we're kind of deviating away from from period, but that's great stuff.

SPEAKER_01:

I mean, this is I mean, this all goes into the program and how you're able to help hygienists, I don't know, deliver on better results as far as explaining to the patient, you know, what they need in terms of the type of cleaning that they need, supporting the doctor on with the restorative work, and you know, encouraging the patient to get those those that treatment done for that leaking filling and what that means to your health, you know, exactly protecting it.

SPEAKER_00:

Exactly. Exactly.

SPEAKER_01:

You know, if I could, if I were, I would use that battery analysis, you know. I would use that battery analysis. But, you know, okay, so so we're talking about perioconversion and how to like kick start that conversation, how to get this going in a practice. But now let's shift over to insurance. Okay. I have heard you say this, and I know I've heard Jen say this as well. Hygienists should not be talking about benefits, should not be talking about financials. But so many do. So many hygienists. I I hear this a lot. I will hear a hygienist look at the routing slip. I'm sorry, I won't hear them look at the routing slip, but I see them look at the routing slip, and then the next words out of their mouth is well, Florida's not covered this visit. Did you want to go ahead and do it anyways, or did you want to wait until it's covered?

SPEAKER_00:

Such a negative like connotation of saying something.

SPEAKER_01:

I've heard that.

SPEAKER_00:

No, I know, I know.

SPEAKER_01:

So, so like I'm sorry.

SPEAKER_00:

I mean, I

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