Dental hygienists are the gateway where clients are "enrolled" into the mindset of esthetic or comprehensive treatment programs. With that in mind, the prediagnostic evaluation and subsequent post-esthetic hygiene management sessions should dedicate an appropriate amount of focus on the what, why, how, and how much of oral home-service products. Naturally, proper care of esthetic restorations depends on the combined efforts of the oral health team and the client. The hygiene appointments occurring before the smile design represent an opportunity for the dental hygienist to document and discuss a client's current self-care program.
Establishing a clear and precise understanding of current product usage is the first step in educating and creating a home-service program that will be in alignment with a patient's new smile. Possible areas that should be covered include the usage of:
- Smile brushes (manual/automatic)
- Smile polishes
- Interproximal smile cleaning devices
- Smile rinses
- Tongue gels or sprays
- Tongue de-plaquers
- Smile fluorides
- Powered cleaning or irrigation devices
- Fresh breath products (gum, sprays, mints, etc.)
The client must be proficient in maintaining healthy gingival tissue, and the emphasis is placed on the importance of daily elimination of plaque. These goals must be achieved without provoking self-harm to the restorative dentistry. So, the second step in outlining a care plan surrounding home-service products is a series of questions:
- Why did you choose this product?
- How do you use this product?
- How many times a day/week/month do you use this product?
Pre-treatment demonstrations may begin with smile-brushing methods. After all, improper brushing techniques - such as scrubbing, excessive speed or pressure, and/or ineffective plaque removal - may affect the longevity of esthetic restorations and irritate gingival margins. A post-treatment demonstration may involve ensuring that the client can remove interproximal bacteria without the interproximal aid catching or getting stuck between the restorations.
How often a client uses a smile brush, breath mint, smile rinse, etc., will give the dental hygienist a clearer perspective about what type of guidance is needed. A client's excessive cleaning with a product, for example, signals an aggressive preoccupation with a restored smile. This information, when recorded, may help derail potential challenges brought on by excessive cleaning. These challenges include gingival irritation/migration and/or scouring the restoration as opposed to gently cleaning it.
Lastly, a crystal-clear understanding of the why clients use certain products often tells us who clients listen to in regard to oral health care. Did the recommendation for the product originate from one of your practice's team members, a previous dental hygienist, a neighbor, the sales clerk, or a glamorous model appearing in a television infomercial?
Thorough and legible documentation of all answers (with computerized forms and charts, for example) allows for seamless consistency of care between various providers in a practice. If the details from the first home-service conversation are written or recorded, then the clinical provider at the next session can easily continue the educational process without asking the same questions again. If a client sees various providers in an office, it is important that he or she notices the "seamless consistency." What clients will see is that the previous dental hygienist valued the discussion enough to record it, and the current hygienist took the time to study the chart and become familiar with the client's values, oral health wants, and self-care history.
Once the initial record of the self-care history has been acquired, the hygienist may need to recommend changes to the routine. Beyond proper techniques, another area that may need to be covered is recommendations for new products. This information should be supported by how many times a day the product should be effectively implemented and why the recommendation is being made. Advising the client why you are suggesting a product builds value into the product recommendation. Esthetic hygiene should sustain the theory that certain products will better serve and prolong the longevity of the treatment, safeguarding against premature wear or breakdown.
Each hygienist and team member will have his or her favorite products, and the reasons can range from scientific to anecdotal. The specific product is not as important as the consistency among team members in understanding and learning why one product is recommended over others in the same category. "Knowledge sessions" scheduled for the staff members help solidify the practice's home-care message. Everyone, including dental assistants and administrative team members, mirrors the message. Complete awareness and support from all team members further guarantees the clients' education about product recommendations.
Generalized product guidelines for esthetic dentistry take into account:
Smile brushes - Soft bristle, automatic rather than sonic
Smile polishes - Nonabrasive, nontartar control
Interproximal devices - Appropriate to the client's dexterity - manual or automatic
Smile rinses - Pleasant tasting, light in color, zinc chloride, chlorine dioxide, alcohol-free, nonirritating/nonburning
Tongue gels or sprays - Alcohol-free
Tongue deplaquers - Plastic, various colors for multiple family members
Smile fluorides - Sodium fluoride
Fresh breath products - Sugar-free, nonalcoholic
Home-service product solutions are an important aspect in the pre-diagnostic hygiene sessions and follow-up management sessions. Suitable time, energy, documentation, and record auditing/retrieval ensures that the client is being heard and the clinician is able to match the desired smile outcomes with appropriate smile products.
Kristine A. Hodsdon, RDH, BS, presents seminars nationally about esthetic hygiene. She also has developed Pre-D Systems, a pre-diagnostic esthetic enrollment software for oral health professionals. She can be contacted through www.pre-d.com.