How much is too much? Patients can feel overwhelmed by oral health information

May 25, 2016
I want to talk about just how much time should be spent on our home-care and oral health discussions with patients.


". . . As a young, exuberant hygienist, I was more than a bit extreme
I gave home-care presentations that made patients want to scream.
I couldn't seem to grasp that lives were more than oral care No one will spend hours, despite what I say at the chair!
As a mature hygienist, I've softened; Eased up on folks, and me,
I've learned to treat as whole; for some, just let them be!
The sun will rise tomorrow if my patients do not floss
I enjoy them so much more now; I'm a caregiver, not a hygiene boss . . ."

The sidebar above is an excerpt from a poem I wrote for my "Roar of Womanhood: How Life's Phases Impact Oral Health" seminar. I thought it might be timely for today's column, as I want to talk about just how much time should be spent on our home-care discussions with patients.

I went to school with a hygienist who spent her first two years post-graduation disclosing every patient at every recare appointment. She looks back on those early years as a period of time in which she was fanatical. She felt she simply was not doing her job unless she:

  • Disclosed every patient at every visit
  • Taught the very basics of brushing and flossing to every patient at every visit
  • Included whatever else might be appropriate for the patient to hear in terms of ancillary information relevant to his or her particular needs

Her commitment to her protocol was impressive. Unfortunately, the impact on patients was positive only for a minority. The reason she stopped was because her employer asked her to cut back. It seems that the majority of patients were asking not to be scheduled with her. Enough already, they said. "I know how to brush my teeth and don't need to hear the same routine repeatedly ..."

On the opposite end of the spectrum is the hygienist who is there to socialize and never educate. He or she makes the patient comfortable by distracting, but does this hygienist fall short of providing an important aspect of his or her professional role? What about the hygienist who does not talk at all? A self-described, burned-out hygienist colleague of mine labels herself a human toothpick, uninterested in any interactive dynamic whatsoever. Both these hygienists may be five-star from a technical, clinical standpoint, but it is questionable as to whether they are providing optimum care.

As I state in my poem, I went overboard in my early years. I believe I have now finally reached a balance. One thing I have learned is that if something is not broken, I don't need to fix it. If my patient has an excellent clinical presentation of teeth and tissues, is it important that they change their routine "my way" of doing it if they have found their own method that works? Of course not! My employer is notorious for saying to patients: "Keep doing whatever it is you are doing, because it is working!"

How much then, dear readers, is too much? My teaching colleague, Lois Aaronson, RDH, likes to focus on one "tip" only at each visit. There's no point in overloading, because too much information can overwhelm a person. It's very apparent when eyes are glazing over that you recognize you are losing your patient.

I like to perform a nonjudgmental gathering of data mission at the start of a recare visit. "How many times a day are you brushing? When does this take place? Are you using an automatic or a manual brush? Do you know if the brush is hard, medium, or soft? Are you using anything to clean in between your teeth? Are you using any other aids in your routine?

Are you using any mouth rinses?" As I am gathering the data, I'm documenting their responses. This is a simple fact-finding survey, akin to questions asked of me at medical wellness visits.

Responses to all of these questions provide a basis for which to facilitate a discussion with the patient. After my clinical exam, I can tie in what the patient has reported to me with what I see in the mouth; for example, inflammation, areas of toothbrush abrasion, or increases in decalcification, etc. Consider any risk factors the patient presents and you have the components of a dental hygiene diagnosis, something that is standard operating procedure for contemporary dental hygiene students. When you show a patient such findings and relate it to the personal hygiene protocols he or she has shared, it can make a lightbulb go on. Your patient will see the correlation, and it will be a "take home" that often results in a change in his or her behavior. Onward we go; it is in our hearts' core. RDH

EILEEN MORRISSEY, RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Burlington County College. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at [email protected] or 609-259-8008. Visit her website at