The first manifestation of recession in a general dental practice can be a gappy book for the hygienist. In fact a dentist emailed me overnight to ask “what should I do?” The solution to getting a hygienists book full is always the same around the country: 1. get the patients on a membership scheme, so that they don’t cancel because they are busy or broke. Make the hygiene visit an essential part of the brand and the benefits of membership; 2. make sure there is an effective reminder system – preferably SMS text messages; 3. make sure that every member of the team – staff and dentists – re-inforces the aspect of dental health that the hygienist delivers.; 4. insist that, if an appointment is cancelled, then unless it’s a genuine emergency, there will be a cancellation fee and there will be no “carry over” if there’s a scheme or plan in place. Patients don’t miss or cancel hygiene appointments because they don’t want healthy teeth and gums or because they are scared of the treatment/hygienist (in the main). They cancel because they don’t see it as important. That is always because the principal or the team haven’t made it important. Its no good if the dentist says “now that we have finished, why don’t you JUST POP UPSTAIRS FOR A POLISH” or words to that effect – and I continue to be amazed at how often that happens.