by Carol Jahn, RDH, MS
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Dental hygiene listserves have become an increasingly popular way of sharing information, expertise, and support with colleagues from around the country and the world. Topics range from daily workplace frustrations to the implementation of new technology. Answers vary from "It's just my opinion" to comments based on scientific research. There are many popular listserves for dental professionals. Some listserves are even geared specifically toward dental hygienists. Most are free. Even though some individuals prefer "lurking" to "posting," listserves can provide something for everyone — an opportunity to learn.
The following takes place between 10 p.m. and 11 p.m. on the listserve, "HygienistHotline," somewhere out in cyberspace.
From: [email protected]
Subject: My patients won't floss
Hi there. My name is Peg and I've been lurking on this listserve for a while. You guys really make my day — but sometimes I feel like I must be a failure. You are all so ... well ... enthusiastic and knowledgeable and capable. I have this secret I just have to get off my back. Most of my patients won't floss. Am I the only one? What am I doing wrong? Please help! Peg
From: [email protected]
Subject: My patients won't floss
Oh, Peg, I do speak up a lot on this list — I feel like most of you are my friends — even though we've never met in person. But don't let my name fool you. I, too, have patients that don't floss. In fact, I work in a large group practice with five other RDHs, and we all complain about this. I do have a couple of suggestions for you. Have you tried different types of floss? Some types are more helpful for getting through the contact than others. We also give floss holders to people who really struggle with wrapping the floss correctly in their hands. They seem to work out pretty well and our patients like them. I don't know how long you've been in practice, but when I started out, I thought EVERYBODY had to learn how to floss. But now after 20 years, I really just want my patients to have healthy tissue any way they can get it. Flo
From: [email protected]
Subject: My patients won't floss
I empathize with you, Peg, but hold your ground and keep at it. That is your job. NOTHING works better than dental floss. Certainly not those floss holders or any of these new picks and power gadgets and what-not that is springing up all over. Remember, for effective flossing, the floss MUST curve around the tooth in a C shape. And it has to pass through the contact point to prevent decay. Hannah
From: [email protected]
Subject: My patients won't floss and passing through the contact point
Not to get off the subject, but I really think that preventing and arresting decay has more to do with the use of fluorides than dental floss. The CDC has a new paper on fluorides and decay that is worth checking out at www.cdc.gov. Pat
From: [email protected]
Subject: Flossing, contact points and fluoride
Pat, what you are saying makes sense to me. In fact, I used to go round and round with the doctor I work with over this. When he would come in to do the exam on children, he'd say: "You got all the plaque off before you applied that fluoride, didn't you?" Well, when I told him that I learned in school that plaque actually can be a reservoir for fluoride and some plaque left on the tooth is not going to interfere with fluoride uptake, I thought he'd fire me on the spot. So I brought in my Wilkins textbook and showed him where it said that a rubber cup polishing isn't routinely necessary before a fluoride treatment. He hasn't questioned me about plaque removal since then. Nan
From: [email protected]
Subject: Gosh, Nan, you were listening
Oh, Nan, I'm so proud of you! You were listening during those fluoride lectures. And I'm also proud of the way you problem-solved this with your employer. I've been teaching for nearly 30 years, and yes, when I first started we certainly made students polish and disclose the teeth until we were sure all the plaque was off before the fluoride could be applied. Today, we know that's no longer necessary. That's why staying current is so important. Not only is it vital for your patients but it can even simplify your day! Terri
From: [email protected]
Subject: Wrapping the floss around the tooth
No one has commented on wrapping the floss around the tooth. I thought the reason we had the patient wrap the floss around the tooth was so they didn't get floss cuts in the gingiva. I also thought the most important part of flossing was to get at the area beneath the contact — I think it's called the kawl. Lana
From: [email protected]
Subject: The col
You're right, Lana, the col is an important area and the only way to clean it is with floss or some other interdental aid. Tooth brushing can't reach it. In fact, for some patients, such as those with bone loss from periodontal disease, where the embrasure area is larger or more open, the benefits of flossing can be limited and a proxabrush or tufted floss may be the preferred way to access the col area. The reason the col is such a vulnerable area is because it is not keratinized and has a concave center. This concavity allows it to harbor bacteria. That is why this area is generally the first place that gingival infections start. Barb
From: [email protected]
Subject: Perio patients and flossing
Barb, I am so glad you brought this up. I work in a perio office and flossing just doesn't cut it for many of these patients. It doesn't reach deep enough to access the subgingival biofilm. And some people have so many exposed roots and large embrasures that they need something else to help clean these areas. We, too, are very successful with proxabrushes. I also like triangular wooden sticks. Patients who like toothpicks often like these. Sometimes, for people who insist on using a toothpick, we give them a toothpick holder. I think it helps them access the lingual and palatal better. We do still try to encourage them to floss — at least it helps them keep the healthy areas healthy. But like someone already said, I've been at this long enough to know that not everyone is going to floss, and sometimes it's easier to find an alternative. We all know that old adage about insanity, right? Doing the same thing over and over again and expecting a different result. I think that applies to patients and flossing pretty well. Jean
Click here to view 'Sampling of interdental aids' table
From: [email protected]
Subject: Power flossers
Good points, you guys. But I was wondering if anyone recommends a power flosser? My patient brought one in to show me a couple of years ago. He always said his fingers were too big to get in his mouth. He bought the flosser because he loves gadgets. He had been using it for about a month when he came in and I was impressed with how it had helped him. I checked it out at a dental meeting a few weeks later and then started recommending it to patients who wouldn't or couldn't floss. Kids like it too — it's great for orthodontics. We just started giving them out complementary to patients who get a bridge because we weren't having much success with floss threaders. Tom
From: [email protected]
Subject: Power flossers
Glad you like the flosser, Tom. My company makes that product, so if anyone has any questions or wants to see the research on the product, let me know. Connie
From: [email protected]
Subject: Something other than floss???
I'm reading all this and I just can't imagine not telling my patients they have to floss. It is so much of who we are as dental hygienists. Someone even gave me a T-shirt once that said Floss Queen. I would feel like a heretic if I recommend some of these other things. A power flosser — I saw it once in a magazine ad, but I just blew it off because I believe it's best if the patient learns to use floss. But I respect you guys, so I have to admit, these listings tonight have really made me think. You know me, though — I have to have the "real" stuff before I'll believe. So, I can buy what you are saying, but is there any research to back these products up? Does anyone know? Sally
From: [email protected]
Subject: Product research
Wow — sometimes I really do believe that there are no coincidences. I'm new to the group — this is only the second posting I've read. ANYWAY, I am writing a chapter on interdental aids for a dental hygiene textbook. And I'm excited to share with you some of the things that I have learned. First, let me say, you guys are so on target. Lot's of other things have been tested and shown to be as effective as dental floss — interdental brushes, wooden sticks, power flossers. There are probably many things that work as well as floss, but most haven't been formally evaluated yet. So that is really where your experience comes in. For instance, if someone comes in and they are using one of those little plastic dental swords (that we all hate) but the tissue has improved, there is less bleeding, and they are not hurting themselves — then why switch what they are doing?
But I do understand how some of you feel about flossing. It is somehow inexplicably tied to dental hygiene. I think what all of us really want is for our patients to have good oral health. Maybe if we stay focused on that outcome, it will be easier to be more open to other products.
I'm working on a chart for the chapter. It lists some interdental aids, what they are good for, the research outcomes on the product, and other things to consider. I've pasted it into this email. I haven't submitted it yet, so please feel free to give me any feedback. Thanks for listening and letting me be a part of this group. Ellie
From: [email protected]
Subject: Something other than floss???
Welcome Ellie! And thanks! I just want to say that I often get asked how I have managed to stay in hygiene for 30 years and still love it. Two things — I'm flexible and I'm curious. Both of those qualities apply when thinking about floss and its alternatives. I have found that it is a lot easier to get compliance if you focus on the patient rather than insisting they do it your way. Especially when it comes to flossing — let's face it, less than half of the population flosses.
I think if you experiment with offering your patients some of these other things, like interdental brushes or power flossers, not only will you find that they work, but your patients will appreciate it, so your relationship with them will be enhanced. Second — be curious about new things. Some of the best advice I ever got was to not be the first on the bandwagon — new doesn't always mean better — but don't be the last either. Good grief, if I continued to only do what I did in school, I'd still be using a porte polisher. Vera
Another thought-provoking day on the Hygienist Hotline comes to a close.
Suggested readings on interproximal devices
• Brothwell, D. J., Jutai, D. K. G., Hawkins, R. J.: An Update of Mechanical Oral Hygiene Practices: Evidence-Based Recommendations for Disease Prevention, J Can Dent Assoc 1998; 64: 295.
• Lang, N. P., Attström, R., and Löe, H.: Proceedings of the European Workshop on Mechanical Plaque Control, Chicago, Quintessence, 1998.
• Warren, P. R., Chater, B. V.: An Overview of Established Interdental Cleaning Methods, J Clin Dent 1996; 7(Special issue):65.
Carol Jahn, RDH, MS is the educational programs manager for Waterpik Technologies where she designs multimedia educational programs for dental professionals. She provides continuing education programs in the areas of periodontics and patient compliance. Carol may be reached by phone at (800) 525-2020 or by e-mail at [email protected].
