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Perio Reports

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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.
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.

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.

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.

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.

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.

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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