Trisha E. O`Hehir, RDH
When I graduated from dental hy-giene nearly three decades ago, oral hygiene instructions consisted of brushing and flossing. The prevention of dental caries was our primary focus. Our goal was simply keeping the teeth clean in order to prevent decay and the eventual buildup of calculus. Calculus was then considered the cause of periodontal disease. The concept of a bacterial infection was discussed, but it certainly was not our focus.
Since that time, our responsibilities in the area of oral hygiene instructions have changed dramatically. We now know a great deal more about periodontal disease and how to control it. Being an expert in preventive oral health-care products today requires knowledge, skills, and even a financial investment. We are the primary preventive specialist in the office - not merely the provider of oral hygiene instructions.
A change means trying new things
The change becomes evident by taking just one look at the shelves of your local drug store. In addition to dozens of new products, we also have volumes of research to support the importance of disease control by the patient in order to control bacterial infection. Primary prevention encompasses identifying oral health and providing the necessary instructions, tools, and advice to maintain health.
Secondary prevention deals with halting disease progress and preventing further disease progression. For dental caries, that includes restorative procedures as well as fluoride, sealants, and disease control by the patient. For periodontal disease, secondary prevention includes debridement therapy, surgical procedures, maintenance care, and disease control by the patient.
To maintain our position as the preventive specialist in the office, we must be sure our skills and knowledge are up-to-date. We need to be knowledgeable about all the products currently available today, and we must be familiar with proper use as well as product limitations. That means actually trying out the products ourselves.
Thirty years ago, we only had a few toothbrushes to choose from, and the biggest concerns back then were natural vs. nylon bristles and the color of the handle. Our challenge at that time was to convince patients to change from hard bristle brushes to soft bristle brushes. We also persuaded patients to give up the roll technique and try the new sulcular or Bass tooth brushing method.
Mechanical brushes which imitated manual brushing were available, but they were only suggested for handicapped, arthritic, or lazy patients. Three kinds of dental floss were available - waxed, unwaxed, and tape. Controversy existed about the correct technique to use. Some said up-and-down. Others were strong supporters of the back-and-forth motion. As I recall, dental floss was important for patients to use, but it was not something dental hygienists themselves needed to use! We also knew that oral irrigation was not effective in removing visible plaque. So we discouraged its use, except for those undergoing orthodontic treatment and those with bridgework trapping food.
Today, this field has grown and changed to encompass not only new manual brush designs, but also new power brush technologies. Both powered and manual interproximal tools are available as well as a wide array of antimicrobial products. Research findings have turned our thinking around about irrigation.
Share your evaluations
As experts in this area, we pass our information on to the patients, as well as the dentist and all the staff members. Through periodic staff evaluations of new products, the team is regularly updated. A well-informed staff becomes our office support system.
As technology and information increase in this area, we often look to outside sources for advice. Seeking information is an ongoing process, but we must remember to trust our own instincts and experience. Combining product information, clinical research findings, and our own experience are essential to maintaining our position as expert.
One step in this process is acquiring a complete collection of available tools and products. Acquisition of these products may be for your own evaluation and use. Or if you have the space in your office, it may be the start of an oral health-care products center for the practice, offering health-care products for sale. A center of this type would provide patients the opportunity to browse, test, and seek advice from the expert all in one convenient place.
How many times have you discussed a new toothbrush or interproximal device with a patient only to find out at their next visit that they never bothered to go to the store to buy the product? This business endeavor can provide a much needed service for the patients. Demonstrating your commitment to oral health and your expertise in this area would also increase income figures for the dental hygiene department within the office, resulting in increased profits for the practice.
Before purchasing items, request samples from the companies as well as product information and current research findings. For companies which do not provide samples, ask for professional prices. To be successful, the entire staff needs to be involved, led by the preventive expert in the office - you!
Get the dental team together to discuss the various products. Find out what they are currently using and why. What do they use interproximally and how frequently? Teach your team members to perform an oral health self-assessment using the Eastman Inter-dental Bleeding Index. It`s simple. All you need is a hand mirror for each person and either the Johnson & Johnson Stim-U-Dents or the thinner, double-ended Oral B Interdental Wooden Sticks. The triangular wooden stick is simply inserted four times into each interproximal area and the papilla evaluated for hemorrhage. Ask the team members which areas bled most often?
The patients constitute our primary focus, but we sometimes overlook the periodontal health of the entire dental team. The self-assessment bleeding index will provide a stimulus for exchanging ideas about patient self-care, leading to discussions and demonstrations of effective brushing techniques and selection of the most appropriate interproximal tools for each staff member.
Team members will become supporters of your dental hygiene care. Establish your position as the primary preventive specialist in your practice by sharing your expertise with both the staff and the patients.
Trisha E. O`Hehir, RDH, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics.
