Our first step should be as teachers. The art of communication and persuasion will help to navigate our patients to better home care. It isn`t easy, but the rewards are very gratifying.
Connie L. Sidder, RDH
We like to think that so much has changed in the practice of dental hygiene. When I graduated from hygiene school in 1974, electric brushes had cartoon characters on them, Cavitrons were exclusively used on very hard deposits, and soft tissue curettage was the norm. We have come a long way. I would like to take some time to examine what was emphasized during my education - education, that is. We didn`t have programs to advance the cause of periodontal disease; we had to rely on our education and motivational skills. I find that many hygienists have trouble getting their message across. Also, large companies we used to rely on for help in educating the public are more interested in marketing and profit than in education and proper technique. Hence, we now have toothbrushes designed for cross-brushing, because that is the way our patients do it anyway. Give me a break!
What is proper brushing these days? The Bass technique required a brush to be placed at a 45-degree angle to the tooth that could then be spiraled along the gumline. I`m sure many of us still rely on this method, but for how long? I don`t ever recall telling a patient to brush across the teeth, yet who hasn`t seen a patient with receded gums due to toothbrush abrasion?
There seems to be an emphasis today in identifying and treating gum disease. The public has been introduced to the meaning of plaque and gingivitis. Recently, I had a new patient tell me, "I know I have gingivitis. That`s why I still get so many cavities." Unfortunately for her, trying to broaden her education was not hitting home. We`ll have to approach her "gingivitis" from a different angle next time.
I still believe the best way to help our patients is to motivate and educate them on the best ways they can help themselves. To coin a phrase, "It is not what we can do for our patients, it is what they can do for themselves." Before I do any heroic procedures (beyond a thorough cleaning), I work with a patient about the reasoning and techniques needed for home care. This process may take a couple of visits. Trust and cooperation doesn`t always happen immediately. But, unless the disease process is showing signs of accelerating, time is on our side.
Most patients do want to take control of their home care. Hitting on the proper formula for them may take a few tries.
So, what are we teaching our patients? And how? I recently read a statement by Katherine Ortblad in the Journal of Practical Hygiene (September/October 1999 issue) that I would like to share. In her conclusion, Ortblad wrote: "Many studies have shown automated toothbrushes to be clinically superior to manual brushing in overall plaque removal, control of gingivitis, and removal of stain from tooth surfaces." Also, think how helpful it would be if we could explain the differences in electric brushes. Remember, we are the experts in preventive dentistry; show your patients that you do know more.
Every hygienist knows where the calculus typically builds up. The mandibular teeth along the lingual surfaces, especially anterior, and the maxillary molar, buccal surfaces, generally accumulate more tartar. We know this to be true through our experiences. We understand that most of our salivary ducts enter the mouth in these areas. This feeds the calcium found in our saliva directly to these areas. How many of our patients are aware of this? I find most people appreciate this little fact. Now they are brushing with more of a purpose. They have a better understanding of what they are doing when brushing. Also, instead of just hearing that their brushing could improve, by being more specific, you have educated this person and thereby empowered them to take better care.
For children, how many know why we brush our teeth? Why can?t we just rinse? We all know that plaque is sticky and if we don?t brush it off, it will continue to stick and cause problems. Let the child OfeelO the plaque, or, of course, a disclosing tablet can be used. It helps to give that child a visual memory of why we need to brush. Of course, until the age of about 10, most kids lack the dexterity to do a good job, but at least we can plant the seeds of understanding at an early age. ORemember,O I say, Oif we forget to brush upstairs, downstairs, inside, and outside, the plaque will still be there. So, do your best!O
Educating vs. lecturing is a fine distinction. Educating involves some patient participation and acceptance. Sometimes just using a mirror is at that?s necessary to hit home with a new tip. But if I hear a patient respond, OI?ll try,O I know I haven?t done my job. Until I hear, OI can do that,O I keep rewording what it is that I?m trying to get across. If they have gained a new understanding, then you have educated them successfully. You can only hope that this newfound information will be put into practice. This leads us to another component of successful teaching: trust.
Trust doesn?t come at the first visit necessarily. Often times, you may have to live down the previous hygienist?s lectures. In these cases, the least said can be the best approach.
Listening is also a vital component to learning. Listen to how your patients feel about their home care. Very often, they OconfessO up front that they don?t floss. Maybe it doesn?t matter, or maybe it?s an opening to find out why not. Is it the time of day they choose to try (there?s that word again) it? Is it where they keep the floss? Is it easily accessible? Do they need a mirror? How can we as teachers help simplify their needs? We may discover they prefer toothpicking over flossing and continue with them along that path.
We must think of ourselves as teachers first. Of all the treatments available, be it soft tissue management or chemotherapeutic agents, they will have only a limited effect without an effective home care regime. At times, we can jump into treatment before we have established rapport with the patient. I like my patients to feel I?m working with them, not just on them. Also, it would enhance our position of respect and influence if we could impart some knowledge they don?t already know. By placing the heel of the brush into the gumline, it locks the bristles into the area as opposed to bending the bristles over the gumline (like the tip of the brush does). Even the toothbrush manufacturers have it wrong!
Another easily remedied problem I see is very old orthodontic cement. Removing cement that 20-somethings still have brings much joy and instant respect. We use a Cavitron on hard calculus; why not cement that?s hard? Believe me, it works, and you will look like a genius!
Instead of treating gingivitis with pockets to 4 mm, I feel an electric toothbrush would do the job. Granted, I don?t work on commission; so my first thought is how patients can help themselves, not what I can do for patients. Isn?t that what we all want in our healthcare? Prevention, prevention, prevention. Let the patient/hygienist relationship take shape, and the reward is an easier (less scaling) day and better patient rapport. It makes for a very enjoyable day. There will always be enough new patients to make work interesting and challenging.
As a profession, our first step should be as teachers. The art of communication and persuasion will help to navigate our patients to better home care. It isn?t easy, but the rewards are very gratifying.
Connie L. Sidder, RDH, is based in Fort Collins, Colorado. She can be reached at (970) 482-4649 or [email protected]