What, No Toothpaste?!?

Before you have a heart attack, you can add toothpaste, just not in the way we were taught in hygiene school.  

Am I the only one that squirms when a patient asks about toothpaste ingredients?  The patient starts rambling off ingredients that you're pretty sure you recognize from hygiene school, but the recall is not there.  Thank heavens we are "able" (required) to take Continuing Education classes.  

Apparently its not only the ingredients we should be worried about but WHEN the patient brushes.  

I recently took a course from Spear Education from one of my FAVORITE hygienist-Trisha O'heir. The course was called, "The Toothpaste Secret: Helping Patients Develop Effective Toothbrushing Habits."  The course was short and it was fascinating.  She shared that in the 70's before there were strict laws on recording people without their consent,  researchers put up secret cameras to watch people brush their teeth.

As hygienist we already know what the research confirmed- patients brush sporadically-they start on the facials and barely touch the lingual side of their mouth, they don't brush very long and aren't very effective.

Her remedy was to have them brush WITHOUT toothpaste, starting on the lower right linguals for right-handed patients and lower left linguals for left-handed patients.   This is called "dry brushing."  When dry brushing is done the research shows that patients brush longer and more effectively!  

Genius!!  it makes perfect sense to have patients start brushing where they brush the least. And because toothpaste numbs senses, without toothpaste the patient can feel if his/her mouth is actually clean or not.  After the patient's mouth feels clean, advise him/her to add toothpaste and brush again. 

We still want our patients to use toothpaste but WHEN the patients uses it is very important.  

As far as patient ingredients:  O'Heir advises against any kinds of toothpaste containing microbeads. Proctor and Gamble has been working on getting the little pieces out of toothpaste but definitely look before you recommend any brand.  Also, O'Heir strongly advises against Sodium-laurel sulfate (the ingredient that causes toothpaste to foam) because of its increased risk of aphthous ulcers.  

Hygiene Edge Advice:  If you have a patient with a lot of plaque- teach them how to dry brush (we included a handout for you below).  Patients trust your opinion so be a detective and research toothpaste ingredients before you recommend a toothpaste.  

Here is a handout for you to give to your patients all about dry brushing :) 

Dry Brushing Directions

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Oral Hygiene Education Kit How To

Remember back in Dental Hygiene school and your assignment of making an oral hygiene education kit full of handouts and samples? Remember how you made it and never used it? Well, I’m going to encourage you to either pull it out or make up a new one! Especially if you temp regularly or are looking for a new job or your first job. Here are a few reasons why to brush off the dust off your old portfolio:

If you ever talk to Candi, she ALWAYS takes her OHE kit with her to temp days. I actually started to use mine again because of her! She would always get compliments from offices about how she took the time and cared for patients by bringing extra little things to give them. They definitely notice that you care for patients and aren’t there just to get through another day. She, and now I, have had several job offers from temp days by just showing we have cared about patients and their oral and overall health.

Patients notice and love stuff. When you go to a convention or an appointment, do you love getting samples? It’s human nature to love free things to try out. Your patients love it too. Giving them something physical to take home and try out will help remind them of the education you talked about during the appointment as well.

What does an OHE Kit look like?

It’s hard to stay exactly what it should look like. A system that works for you is definifely the best! I persoanlly have mine in an occordian style folder, with dividers to organize papers and producits in sections, such as Diabetes, Children, Pregnency, etc. I’ve also seen binders with page protectors to organize papers, as well as a file folder box with divided areas. Whatever you have space for or can carry is the best for you!

Now that you’re ready to remake your portofio, what should you have it in? First, look at your population that you serve. If you work in pediactrics, obviously your hand outs and products should be taylored to your little ones. If you work in a high caries risk area, make sure you have several sampeles and flyers all about decreasing caries and fluoride recommendations. Here are a few general idea you could add into your kit:

1. Xylitol Lollipops- These are my favorite to have on hand! They’re perfect to open a conversation about xylitol to parents (and have our Hygiene Edge handout to give to parents if they have any questions). They’re also amazing to have when parents bring their children to their appointment, especially when temping since a temp day is already stressful! Once they start to get wiggly, I’ll pull them out to give to the child to help them make it through the hour. I personally like the flavors of Xyloburst's lollipops.

2. Brushing/Flossing Calendars- These are always a fun motivator for both adults and children. Not many people hand them out, so talking about brushing habits and enforcing the habit with a calendar can make an impression on patients.

3. Plain Blank Index Cards- If I’m temping, I love to have some blank cards on me to make notes for the patient about OHE recommendations that we talked about during the appointment. They’re ok looking, and a lot more professional than a Post It Note. If you work at an office every week, look into having a simple paper made up with your office logo at the top. Slip this paper into the patient OHE bag to help reinforce habits at home.

4. Samples from Conventions- Floss, brushes, denture cleaner tablets, anything! It is definitely temping to use all the samples from a convention yourself (and I’m not going to lie- I use and test out most of them!) but saving them for patients is always nice. Slip them into a pocket of your OHE folder to give out to patients in practice at a later date.

5. Coupons- Again, having something tangible of a product you recommended is always great to remind the patient what exactly it was you talked about. Knowing and talking about which stores in your area that they product can be purchased at it always helpful as well.

Where to find OHE Materials to Add to your Kit

1. Colgate has some great resources for kids. These are also great to have on hand to give and chat to kids both when they’re your patient in your dental care or if they come along with their parent or grandparents appointment.

2. Listerine has some great facts sheet about how diabetes and oral health are connected. 

3. Of course, our Hygiene Edge Shop has many free downloads of hand outs for both you and your patients. Plus, we try to regularly add new ones, so keep an eye out!

4. RDH Companion is an online resource for hygienists. For a small monthly fee, you can download and print lots of OHE resources. 

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Let us know how it goes! What works for you with highlighting the importance of home care? What is your favorite way to organize your OHE materials?

Spear Education: Trade the Lecture for Oral Health Coaching

Here at Hygiene Edge, we are collaborating with Spear Education for our continuing education. You can see from my screenshot below that I was watching Trish O'Hare's lecture called, "Trade the Lecture for Oral Health Coaching." 

I loved the tips she gave on how to get patients to better their oral hygiene by changing your interviewing techniques. I certainly have some work to do on asking open-ended question.

I also appreciated her words about being a coach, who wants the patient to win at their home care, versus a lecturer who can easily over-educate.

She said that we as dental professionals are oral health coaches. Which is a new label that I could get used to!

Spear Education is very interactive, as you can assign lessons to other staff members and join discussion about the topic with other dental professionals. You can take quizzes at the end of the courses that will count towards your CE's. 

How to Start a Caries Remineralization Program- Part 1

I remember as a new grad sitting there perplexed (sound familiar?) as a female patient with immaculate oral hygiene in the chair with a mouth full of caries.  She was understandably frustrated.  I tried remembering what I learned in hygiene school and couldn't come up with anything beyond brush-floss-rinse&repeat.

I even pulled the other hygienist aside and asked her what I should do.  She said "some people just have soft teeth."  I couldn't accept this.  

I went home and read and read.  I learned about the role bacteria plays in caries. I learned about a natural sweetener found in fruits, vegetables and even you body makes it- it's called xylitol.  There are over 2000 studies done and it decreases caries substantially. 

The office I worked at started a caries remineralization program with xylitol.  The kits flew off the shelf.  The only problem was- I was the only person (at the beginning) that could confidently discuss xylitol.  I want you to be able to confidently share this product with your patients.

Here is a video I made with ABC 4 in Utah discussing Xylitol.  

Coming up soon:

Part 1:  What is xylitol
Part 2:  How to explain xylitol to patients
Part 3: How to get xylitol in your office

"Does Flossing Really Work?"

As I’m sure you’ve read, seen, and been told about, news stations all over the county reporting that flossing is no longer needed, per the Dietary Guidelines for Americans by the U.S. departments of Health and Human Services and Agriculture. We’ve seen it and our patients have seen it. Tonight on a walk around my neighborhood, 2 people stopped me and asked if the reports were true. If people are asking on the streets, it is guaranteed that you’ll be asked several times a day for the next month or so by patients in your operatory chair.

So, how should you answer patients when they ask, “Does flossing really work?”

First, explain that the Cochrane review used for the research in the new guidelines reviewed only 12 short term trials. These trials only lasted 1-3 months, where periodontal disease can more than 3 months to manifest. Some of these studies did show a decrease in bleeding gums or gingivitis, but not a decrease in caries. Again, caries can take more than 3 months to manifest intraorally. Unfortunately, long term studies take money and not many people are willing to pay for a study to span several years.

Second, explain that from your personal experience with patients, you do see regular flossing and brushing improve oral health. It can help break up biofilms, which are live microorganisms, that can harm both your gums and your overall health.

Third, show your patient the proper way to floss in a mirror with the show, tell, do method right when they ask the question, even if it is before you begin anything. When a patient actually sees biofilm removed interproximally, it can be a big learning tool to the important of interproximal cleaning. I personally like using blue Cocoa Floss or black POH Floss since the color of the floss highlights the biofilm removal. Or, if your patient shouldn’t even be using floss due to large embrasure spaces, educate them on something else that will help with the biofilm break up. Softpicks by Gum have new curved handles, making it easier for patients to use in posterior teeth.

Finally, show the patient how much you care about their overall and oral health by explaining flossing instead of lecturing. Patients are looking for any excuse not to floss, and this news is the perfect out for them. Keep this is mind with your explanation, and hope that it will all be forgotten in a few weeks and they will be back to their regular oral hygiene routine.

How are you fielding the questions about flossing from recent news articles?

How to Teach Your Patients To Clean Their Lower Anteriors More Effectively

I do a lot of oral hygiene education. I do it for my patients to live a healthier life, aaannnd because I'm kind of lazy, I don't want to clean as much when I see my patient in six months ;).

If a patient uses a manual tooth brush they should be dry brushing starting on the lower right linguals.  Research shows patients brush more effectively and longer. In addition to dry brushing I have my patients use many different directions on the LA- vertical, horizontal and oblique. I read an article in a hygiene magazine years ago (I can't remember the magazine) and I have been astonished how much more effective patients are at keeping the lower anterior teeth clean.

I always tell my patients that I want to "adjust" his or her technique to make him or her more effective.  I actually take the toothbrush out of the packaging and demonstrate in the patients mouth- showing the bass technique and where I want the patient to start.  After I've demonstrated, I put the tooth brush back in the packaging and in the patients bag.  

Patients have been VERY receptive and grateful, and I usually have a lot less to clean in 6 months ;) 

What to know more about how I teach this skill? Check out me educating a patient on dry brushing HERE.

Hygiene Edge Weekly Challenge:   Educate a Patient on Dry Brushing 

One Of My Best Tips For Efficient Ortho Prophys

Remember to enter our giveaway of a complete GumChucks kit HERE

Ugh. Your 30 min child prophy just showed up, right after school lunch, with a new full set of braces. This is about the time when I USED to shed a little tear as I knew I was going be be put behind in my schedule. Now when I have this scenario, I am excited for the change of routine and can complete it in the time provided. (Feel free however to schedule extra time at the next prophy visit if needed.) Here’s is the time frame ESTIMATION by minute:

• 1m-HH
• 4m-Radiographs (if needed)
• 2m-Brush the patient's teeth/OHE
• 10m-Polish, ultrasonic, hand instrumentation
• 3m-Flossing
• 5m-Exam
• 1m-Fluoride
• 4m-Dismissal/room turnaround

One of my personal biggest time savers to stay on the above schedule on an ortho patient is to disclose, hand them a mirror, and then have the patient watch me brush their teeth. This will give you a good head start on removal of materia alba and biofilm, which these patients usually have lots of, and at the same time you are doing OHE. I love a good BOGO (Brush One Get OHE). You could have the patient brush their teeth over the sink as well but I find that they take longer and still miss those hard to reach areas.

I used to hate flossing braces, as threading the floss through each time was a killer! Some time saving tips on braces are to use an ortho flosser such as the sterilizable handle from the company GumChucks with an ORTHOgami attachment, or you could use the platypus flosser or fish floss. Find one that works best for you by requesting some samples. 

Stay tuned in over the next few weeks to come as we have some videos on how to be more proficient  with the air powder polisher, ultrasonic and hand instruments on patients with ortho. 

Does Flossing Really Prevent Cavities?

I sat in a large conference room as the speaker shared that flossing is not very effective in preventing caries. Immediately, there was a tangible feeling of agitation in the air. Who does this lady think she is?  How could someone, let alone a well-known dental hygienist, say such a thing?  The speaker later shared that she has had hygienists even leave her courses over this.

Don’t we drill in our patients head brush, floss, repeat? I certainly have been guilty of being a ‘floss boss’ and telling my patients to “clean-in-between” to prevent decay.   

But, here is the thing, we say a lot of stuff in dentistry out of tradition; or because it kind of makes sense in our minds and we may not even have any research to back up. 

There was a good-sized systematic review (click here) done that showed a very weak correlation between flossing and a decrease in decay. (However, the study did show that flossing decreases gum disease). 

So how has this news changed the way I educate my patients?  If a patient has a lot of decay, and relatively healthy gingiva, I skip the floss lecture and go straight into strengthening the patient’s teeth with different products such as fluoride and eliminating known risk factors such as frequent consumption of energy drinks. 

Hygiene Edge Challenge:  Back your oral hygiene education (OHE) up with research!!

Building an Office Anti-Caries Protocol With Xylitol

I graduated hygiene school with all of the enthusiasm in the world!  I really felt like I was going to save Americans from this horrible oral health crisis. Then I started working in the real world.  I began to see patients that asked me questions that I had NO idea how to answer. I felt panicky, confused and frustrated.  I had little knowledge beyond brush, floss, and fluoride.

I remember one time in particular I had a patient with excellent oral hygiene.  She had great probe readings, little plaque and LOTS of cavities. She did not have any of the typical causes of decay (heavy soda drinking, etc.)  She was so frustrated, and I was too.   I went to another hygienist and presented her with my findings, she replied, “she must just have weak teeth.”  The patient had no trace of congenital problems with teeth formation and I couldn’t accept the idea of “it must just be the way it is for her.”

I went home and began to research everything I could from dental journals, books and hygiene message boards.  That is when I really started learning about the benefits of xylitol. There are actually over 2000 studies that have been conducted. It has the ability to drastically reduce decay (around 70 percent) and cut down plaque (50 percent,) which is more than patients usually remove by brushing.

I learned about how other countries use it in their schools but we are a little bit behind in the U.S. I also learned that when mothers had enough exposures to xylitol their babies had a huge reduction in decay because cavity-causing bacteria were not being passed.

I was so excited about xylitol and found my patients really shared my enthusiasm.  I had great compliance and saw great results. I find that hygienist are not offering xylitol to their patients because of various barriers. Below are a few solutions to those barriers. 

Lack of Knowledge:  A lot of hygienist don’t feel confident talking about a product that they don’t know a lot about.  I would recommend brushing up on the topic. I love Trisha O’heirs writing on the subject. Check out her article in dental town HERE. 

Also, a xylitol company called Xlear does lunch-in-learns over Skype. You can also check out another amazing xylitol company called Xyloburst that has an awesome website full of information.   

Here at Hygiene Edge we have also created a FREE informational handout for to give to your patients as well HERE.

Accessibility: I’ve heard from hygienists that they don’t like having to send their patients to the health food store or on online to get xylitol.  A resolution to this is do what my office does and carry the product in-office.  It was hard to keep on the shelves!  We mostly sold the Spry 30 day system from Xlear.  I’ve also personally been really impressed with Xyloburst’s selection of products; especially the suckers for kids!

Exposures:  One barrier for hygienists is that the patients have to get five exposures throughout the day.  This sounds like a lot but think of the concept of simply replacing out their existing gum/candy habit.  A lot of already snack and chew gum so simply swap it out with the products they are using.   I tell my patients to “Strive For Five”!

Expense:  The beauty of having xylitol in your office is that you can lower the price a little bit.  Xylitol is definitely more expensive than gum with sorbitol and other sugars but it’s a LOT cheaper than a cavity and precious tooth structure.  I always let my patients decide and most are willing and grateful to try something “new.”

It will take some work but you too can create an anti-cavity protocol for your office that will benefit your patients long term. 

Oral Hygiene Education Week- When Does OHE Start?

One of the questions that often gets brought up is when oral hygiene education should be started. Should it begin after the probe depths are recorded, after the diagnosis has been made, or after the prophy appointment is almost complete?

Our answer to this question is:

OHE starts in the waiting room!

What does this mean? From the very first second that you meet your patient, OHE has technically started. The patient determines from the first few minutes of meeting you if you are trustworthy and educated, or if you are just there to "polish" their teeth. This first few introduction minutes are critical to gain credibility with the patient. So make those minutes count! Make sure you are wearing clean scrubs, clean shoes, and your hair is off your face. Make sure jewelry minimal. And make sure you are wearing a white lab jacket! We'll talk more about lab jackets this week, but they can make a huge impression on patients. Second, no cattle calling in the waiting room. Treat the patient like a person. If you have never met a patient before, look up their photo or their birthday so you know generally who you will be looking for in the waiting room. Approach them, smile, and shake their hand. Direct them back to your operatory instead of running away from them and hoping they follow you along.

These little steps will help your oral hygiene education and will show your patient that what you are educating them on will help their health.

Do YOU have a favorite method of bringing patients from the waiting room to the op? Let us know below!

Stay tuned for more OHE tips throughout the week!