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Making Product Recommendations to Patients By Christine A. Hovliaras, RDH, BS, MBA, CDE and Fotinos S. Panagakos, DMD, PhD

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Making Product Recommendations to Patients
By Christine A. Hovliaras, RDH, BS, MBA, CDE and Fotinos S. Panagakos, DMD, PhD
(Professional Savvy, LLC and Colgate-Palmolive Company)

It is well understood that a dental hygienist will draw upon both objective and subjective information when making a product recommendation to a patient. What role each piece of information plays in the overall decision making progress is still not well understood. An on-line e-survey was conducted from September 24-28, 2009 on the Hygienetown web site In order to learn more about how both objective and subjective influencers impact this process. The objective of this e-survey was to gain insights from dental hygienists from across the country to determine what elements were important to them in recommending over-the-counter toothpaste products to their patients. The online e-survey was sent out to 6500 dental hygienists and 349 respondents participated in this online e-survey. The survey recipients were blinded to who sponsored the survey.

Important Elements That Influence Toothpaste Recommendations
This survey assessed both objective and subjective elements that could influence what dental hygienists recommend regarding over-the-counter (OTC) toothpaste product(s) to their patients. Table 1 summarizes the responses received for the objective elements that were asked in the survey. Respondents were asked to rank the various elements in order of importance. The results indicate that the two most important objective elements that respondents ranked as being most influential for hygienists when making an OTC toothpaste recommendation were that the product(s) provided an important benefit to patients (89.5%) and that the claims a toothpaste product(s) make are substantiated with peer reviewed published research (60.8%).

Almost half of the hygienists felt that they read the literature to ensure that clinical support and product claims regarding a toothpaste product(s) ensure the claims were valid and also validate that quality research was conducted on the product(s). Two other relatively important objective elements were that the product was manufactured by a respected company (38.5%) and that the toothpaste product should carry the ADA Seal of Approval (36.4%). Of interest is that only 16% of dental hygienists indicated that they would recommend a toothpaste product if they saw an advertisement in a professional publication.

This survey also looked at a series of subjective elements that could influence a dental hygienist’s recommendation of an OTC toothpaste product(s). The results from this part of the survey are summarized in Table 2. Personal trial was ranked the highest subjective element that could influence patient recommendations at 57%, followed closely by a recommendation made by a professional colleague at 45.9%.

More than a third of the hygienists felt that the taste of an OTC toothpaste product was important as well as a recommendation made by a speaker they heard at a continuing education course presentation. Less than 25% of hygienists felt that price was an important element, followed by seeing the OTC toothpaste product at a dental convention (18.4%), product presentation by a sales representative (15.3%) and lastly, that the patient informed the hygienist about the toothpaste (10.5%).

The Value of Clinical Claims
Almost half of hygienists in the survey indicated that they reviewed and investigated clinical claims that OTC toothpaste product(s) make in order to confirm the quality of the research and to ensure that the research supports the product claims prior to them making a recommendation. The review of product claims research support helps hygienists to address the efficacy of the product, determine if claims are valid, determine how the studies were conducted, and on what population of subjects, ultimately determining if the studies referenced in the product information substantiate the claims being made. In addition to the closed ended questions summarized above, the respondents were also provided the opportunity to answer a series of open ended questions. Below are some of the quotes taken from the returned surveys:

Why do you review/investigate the clinical claims that OTC toothpaste product(s) are making? What is important for you to know about the claims?
“Better understand the efficacy of the product.”
“Because if the claim is false the patient doesn’t benefit or is misled.”
“I don’t recommend a product without thoroughly researching it first.”
“I consider myself an educated professional and the quality of my advice to my patients relies on this. My patients trust me to tell them which products are worth the money. There are so many choices and I get overwhelmed at times, but knowing the science makes it easier to select products that aren’t just hype.”

Hygienists who reviewed and investigated the clinical claims that an OTC toothpaste product(s) make indicated that the following reasons impact their decision to recommend OTC toothpaste products to their patients:
• I need to know how the product works and the benefits it provides patients
• that it gives value to the hygienists recommendation
• the product does what it is intended to do
• that the product is intended to help certain patient types
• the product provides a benefit to patients versus other competitive products.

Some additional quotes from dental hygienists to the following question:

How do clinical claims impact your decision to recommend an OTC toothpaste product(s) to your patients?
“Because it does what it claims to do.”
“A great deal, I like to know that a product does what it says it does before I endorse it.”
“They do impact my decision to recommend a certain product over another.”
“Clinical claims and trial evaluations are extremely important to any product on the market and not just on the related drug side.”

Clinical Studies and OTC Toothpaste Product Recommendations
More than half of the respondents indicated that they would review and investigate clinical studies that are published in a professional peer reviewed publication about an OTC toothpaste product, while 35% of respondents indicated that they may review the clinical studies.

Almost 75% of the respondents reported that they have read a peer reviewed published study about an OTC toothpaste product and learned that the product benefits and claims being made about the toothpaste(s) are supported by research.

Consumer Advertising
Interestingly, only half of the respondents felt that consumer advertising might or might not influence their desire to recommend an OTC toothpaste product. Over a third of the respondents said that consumer advertising would probably not or definitely not influence their decision to recommend and we see this correlation with the objective elements previously discussed in this article. Only 13.5% of respondents felt that consumer advertising would definitely or probably influence their decision to recommend an OTC toothpaste.

Respected Companies with Best Information and Published Studies
Dental hygienists felt the top five companies who provide the best information and published studies to support their oral care product claims for the products they recommend to their patient are Colgate-Palmolive Company, Procter & Gamble/Oral-B, Philips Sonicare, Johnson and Johnson and GlaxoSmithKline. A full listing of the rank order provided by the respondents is provided in Table 3.

Conclusion
As we know, dental hygienists value the benefits that over-the-counter toothpaste products provide to their patients oral health for the prevention of oral diseases. This survey indicated that a certain set of objective and subjective elements are most influential in the decision making process. Subjective elements, such as personal trail, taste, and colleague recommendation are considered along with objective elements such as product benefits, peer reviewed research support and a review of the literature. The combination of these elements, plus the perception of the company which manufactures the product come together and provide the dental hygienist the data necessary to make an effective product recommendation for his/her patient.
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