Perio Reports Vol. 26, No. 4 |
Perio Reports provides easy-to-read research summaries on topics of specific
interest to clinicians. Perio Reports research summaries will be included in each
issue to keep you on the cutting edge of dental hygiene science.
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Motivational Interviewing Used to Introduce Dry Toothbrushing
Children and teenagers are generally not motivated to
comply with oral hygiene instr uctions. Repeated toothbrushing
instructions at dental hygiene visits are not predictive
of compliance within this age group.
Motivational interviewing focuses on what the patient is
interested in and willing to do, rather than on what the dental
hygienist wants the patient to do. It requires asking questions
and listening to the answers, engaging the patient in the
conversation rather than presenting a lecture. Together, the
patient and the clinician make a plan to improve oral health.
Following the OARS strategy, teens and preteens were
engaged in a discussion about oral hygiene and dry toothbrushing.
OARS: O—open-ended probing questions, A—affirming
or acknowledging responses, R—reflective listening and
reflecting back to the patient, and S—summarizing, asking the
patient to summarize the discussion. Having the patient summarize
the discussion and their proposed actions is valuable.
Follow-up was done with the patients and their parents via
email and phone calls. Patients targeted for motivational interviewing
rather than traditional oral hygiene instructions were
more likely to follow through with the plan agreed upon.
Parents were excited with the results and the daily commitment
to oral health demonstrated by their children.
The hygienist involved reported feeling more gratified
to be doing more for her patients. Her interactions with
patients are now more creative and rewarding. The challenge
with motivational interviewing was to avoid taking on a
directive approach, tr ying to get patients to do what the clinician
thought they needed to do rather than
what the patient is actually willing to do.
Clinical Implications: Motivational interviewing
enhances oral hygiene instructions.
Fernald, S.: The Impact of Motivational Interviewing on Dry Brushing
Compliance in Pre-Teen/Teenager Patients. OHU Action Research 8A-13, 2013.
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Professional Products to Treat Root Sensitivity
Root surface hypersensitivity is a problem patients ask
dental hygienists to treat. There are both at-home products
for patients to use daily and there are professional services
that can be provided in the dental office. Several products are
available, yet not all products work for all patients. Some
products require more time to apply, while others require a
light cure. Clinicians are looking for products that are easy to
apply and provide immediate relief for the patient.
In this clinical practice study, fluoride varnish and a
desensitizing agent were compared in a split-mouth
approach. Patients with sensitivity on both sides of their
mouths were treated on one side with fluoride varnish and
the other with a desensitizing agent. Both products are
Sunstar GUM brands: Xylitol Sweetened Rapid Fluoride
Varnish and Protect. The Protect required a pre-application
step with a conditioning acid to remove biofilm and expose
tubules, allowing access to the Protect liquid.
Clinicians evaluated patients’ sensitivity to hot, cold and
touch. They also evaluated the level of bacterial plaque associated
with the area of exposed dentin. Most of the patients
reported sensitivity to cold rather than hot or touch and
reported the pain level to be five on a scale of one to 10. Very
little plaque was associated with areas of sensitivity.
The cost benefit calculations found the per application
price for fluoride varnish to be $2.06 compared to $1.42
for Protect. Treatment fees for the clinical application of
these two products can be submitted for insurance company
reimbursement.
Clinical Implications: Both Sunstar GUM brand fluoride varnish and Protect desensitizing agent were effective in eliminating
dentinal hypersensitivity.
Thaw, M.: Reducing Dentin Hypersensitivity with the Application of Fluoride Varnish or Protect. OHU Action Research 7A-13, 2013.
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Recall Frequency and
Periodontal Health
Both daily oral hygiene and
frequent dental hygiene visits are
important for maintaining oral
health. Oral hygiene instructions
can be generalized or tailored to
each person’s needs.
This was a retrospective
evaluation of 10 patients with
periodontal disease who were
given detailed oral hygiene instructions and told they needed
to be seen every three months by the dental hygienist. It was
anticipated that frequent DH visits would be the key to
maintaining optimum oral health.
Not all the patients agreed to more frequent DH visits. Six
of the 10 patients agreed to see the RDH more frequently. The
other four decided to work harder on their daily oral hygiene
rather than visit the RDH more frequently. The periodontal
health of those with less frequent DH visits was actually better
than those who adhered to a three-month recall. Patients seeing
the dental hygienist less frequently showed significant reductions
in gingival bleeding upon probing and deposit accumulation.
They complied with the recommended brushing and
interdental cleaning recommended by the dental hygienist.
Their motivation to avoid more frequent dental hygiene visits
resulted in more attention to daily
oral hygiene.
One of the four patients focusing on oral hygiene decided
to change his diet to reduce generalized whole body inflammation,
resulting in better periodontal health. Focusing on
improving oral health reduced inflammation while those with
frequent DH visits were not as attentive to their oral hygiene.
In some cases, those with frequent DH visits showed no
improvement in oral health. Bleeding levels remained the same
and deposit levels were not reduced.
Clinical Implications: Recall intervals are important, but
what people do each day to control oral infection is more
important.
Lepak, S.: Are More Frequent Recall Appointments the Key to Periodontal Health? OHU Action Research
7A-13, 2013.
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Soft Picks Provide an Alternative to Floss
Brushing and flossing are the “gold standard”
for oral hygiene but they are not working. Studies
show an average of only 13 percent of adults report
they use dental floss daily. Despite this fact, a staggering
number of dental offices still dispense floss
to every patient. A wide variety of floss types are
available, including flavored, fluoride coated, xylitol
coated, individual flossers and floss holders. Despite
this variety, compliance does not improve.
The reasons for not flossing include pain, too
much time, gagging and not wanting to put their
fingers in their mouth. Alternatives are available
that are easier to use. A popular floss alternative is
Sunstar Butler Soft Picks, plastic picks that fit easily
between the teeth. The tiny projections effectively
disrupt bacteria biofilm from proximal surfaces.
Several clinical RDHs were invited to select
non-flossing patients, note bleeding and give them
Soft Picks to clean interdentally. Patients were then
contacted one and two weeks after their appointment
and asked about Soft Pick use and gingival
bleeding. A total of 18 patients participated with
84.5 percent of them using the Soft Picks daily.
Reduced bleeding was reported by 89 percent of the
test subjects.
These findings suggest that when something is
easy to use, patients will comply. The impact of this
could significantly reduce the accumulation of bacterial
biofilm between the teeth, leading to a reduction
in proximal dental disease. The results seem to imply
a new “gold standard” for oral hygiene instructions:
something patients are willing to follow.
Clinical Implications: Soft Picks are a viable
alternative to dental floss that are easy to use and
provide an effective plaque removal approach to
interproximal areas.
Heimbach, J.: Will using Soft Picks Create Increased Patient Compliance and Improved
Oral Hygiene in Non-Flossers? OHU Action Research 7A-13. 2013.
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Do Patients Really Want Oral Hygiene Instructions?
Dental hygienists the world over spend time and
energy giving patients oral hygiene instructions, but
rarely do they take the time to ask what the patient
wants. The education of RDHs emphasizes the
importance of giving patients
brushing and flossing instructions
at each visit. The RDH
tells the patient what they
need to do to take care of their
teeth and gums to achieve
good oral health. If patients
followed these instructions,
there would no longer be caries
or periodontal disease. Despite repeated oral hygiene
instructions, patients return time after time covered
with bacterial biofilm. Do patients even want to be
told how to brush and floss?
A dental hygienist with 13 years of experience
asked patients if they wanted oral hygiene instructions,
before embarking on the usual lecture. A
group of eight patients from 15 to 45 years of age
were asked if they wanted verbal oral hygiene
instruction, a pamphlet or no instructions. Six of the
eight said they didn’t want instructions. They had
heard it before and didn’t want to hear it again. Two
agreed to the instructions, if the RDH wanted to do
it. Four of the eight agreed to take a pamphlet with
written instructions.
By asking patients what they want, needless,
unheeded lectures can be avoided. Instead, focus on
the individual needs of each patient, finding out what
their oral health goals are and what they are willing to
do to achieve that level of health. Involve patients in
the choice of oral hygiene products and the oral
hygiene plan.
Clinical Implications: Ask patients if they want
oral hygiene instructions before embarking on the
usual lecture.
Vasquez, D.: Do Patients want Oral Hygiene Instructions and How do They Want It. OHU
Action Research 7A-13, 2013.
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Patients are Open to Flossing Alternatives
Dental floss has been available since 1815, yet more than
70 percent of the population doesn’t see the value of daily
flossing. Despite this fact, hygienists continue to be the
“flossing nag,” encouraging patients to start flossing or to
floss more often. There is a growing body of research now
available showing that alternatives to dental floss are as effective
as dental floss and easier to use.
Before being offered alternatives, a group of 15 private
practice patients were asked why they didn’t floss. Pain was
the most common reason, expressed by eight patients, followed
by three finding it awkward, two didn’t have floss and
two didn’t have time.
Another group of 17 patients was asked about alternatives
to dental floss. Everyone in the group reported that dental
product displays in stores were intimidating. Eleven of the
17 reported they had seen advertising for flossing alternatives.
Surprisingly, only six of the 17 remember being told by
a dental provider about dental floss alternatives.
Setting the traditional flossing lecture aside, and using
motivational interviewing, several flossing alternatives were
offered to non-flossing patients. They were excited to learn
there were alternatives to floss and asked for more information.
Each patient was offered alternatives: Sunstar Butler
Soft Picks, WaterFlosser or the Philips Air Flosser. Two weeks
later patients were telephoned to see if they had purchased
their choice of an alternative for dental floss. The Soft Picks
were the most likely to be purchased and used. Although
some decided to try the WaterFlosser, the purchase had not
been made.
Clinical Implications: Dental floss is not preventing dental disease because it isn’t being used, alternatives that people
want to use should be suggested.
Macron, A.: Are Patients Receptive to Flossing Alternatives? OHU Action Research 7A-13, 2013.
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