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Perio Reports  Vol. 26, No. 6
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.
Is Dental Disease Preventable; What Do People Believe?

It’s a simple yes or no question—are caries and periodontal disease preventable? According to the research, dental disease is preventable. Oral hygiene instructions given by dental hygienists focuses on prevention, but do clinicians and the general public really believe dental disease is preventable? One dental hygienist was convinced that dental disease was preventable and that with the flood of health information today and the detailed instructions of dental hygienists, patients and the public would surely agree.

Several groups were asked individually the yes or no question. While traveling internationally from California to Hong Kong and then to Thailand, the question was asked of fellow business class travelers, airline personnel and others encountered over a two-week period. A simply tally was kept. Of a total of 60 people, 45 people or 75 percent responded, no, dental disease is not preventable.

Back in the U.S., the hygienist set up a blind tally approach to patients in two dental practices. Patients were invited to mark a slip of paper either yes or no and place it in a ballot box. In a practice where the RDH had worked for 10 years and provided extensive oral hygiene instructions and education, 47 out of 60 (78 percent) circled no. In another practice in a more rural area, 54 out of 55 patients (98 percent) responded no. In a small group of five dental hygienists, five out of five said no, citing risk factors and genetics as reasons.

Clinical Implications: It’s an interesting question to answer yourself and ask your family, friends, colleagues and patients what they believe.

Gordon, A.: Is Dental Disease Preventable or Inevitable? OHU Action Research 9A- 13, 2014.

Oral Health Coaching via the Internet

According to the research, patients remember only 40-80 percent of what they are told in a clinical setting and 50 percent of what is remembered is incorrect. Much of what dental hygienists provide patients as oral hygiene instructions is actually coaching. Many forms of coaching are popular today, including athletic, academic, leadership, management and life coaching. With each comes a price tag and the expectation of improvement of some sort.

Oral health coaching in the traditional dental office setting is generally cut short because of time and the coaching is offered free of charge or included in the DH visit fee. To achieve better oral health for her child patients and to take more time to coach and educate, one RDH offered the parents of these patients online coaching from their own home. Three questions were asked of the parents pre- and postvideo coaching. The questions were: 1. Do your children brush their teeth regularly? 2. Do your children understand tooth decay? and 3. Do your children think tooth decay is preventable? Nine children from four families participated in four coaching sessions. The first covered dry toothbrushing, the second xylitol, the third bacterial biofilm and the caries process and the fourth reviewed all topics and techniques. Each session was 15 to 20 minutes. The children seemed interested and engaged in the four coaching sessions and topics.

Pre-coaching, six believed tooth decay was not preventable, none of them knew how a cavity formed and only one brushed regularly. Post-coaching, nine believed tooth decay was preventable, seven knew the cause of tooth decay and all nine brushed regularly.

Clinical Implications: Technology provides new ways to share oral health information and coaching.

Parton, S.: Oral Health Coaching. OHU Action Research 9A-13, 2014.
Implementing Caries Risk Assessment into Clinical Practice

Caries management by risk assessment (CAMBRA) has received a great deal of press and scientific focus lately. Identifying caries risk factors and developing a therapeutic or preventive program are now considered the standard of care. However, implementing this protocol into an already busy general dental practice can be challenging. It all depends on the attitudes and willingness of the dental team members.

It was decided by a large, national dental practice group to implement a modified caries risk assessment into their many practices. A dental hygienist who regularly coaches and trains the dental teams was given the task of implementing the new protocol and providing the education and coaching necessary for success. Reviewing the outcomes for two of the first practices involved showed conflicting results.

To measure success, a chart audit was performed for each practice. The practices were similar. In one practice there were three dentists and three RDHs. The other had two dentists and three RDHs. Both practices received a two-hour continuing education course on the topic and four follow-up visits. In each practice 15 charts were audited for completed caries risk assessment forms and evidence of preventive planning.

One practice was successful implementing the risk assessment with 11 of the 15 charts containing the forms and treatment plans. In the other practice, only one of the 15 charts contained a form that was only partially completed. The first office bought into the plan, the second one didn’t.

Clinical Implications: Implementing change is not always quick and easy. Involve the team and ask what they each think, want and are willing to do.

Kowalczyk, A.: What Factors Contribute to the Successful Implementation of a Caries Risk Assessment Protocol into the General Dental Practice? OHU Action Research 1A-13, 2013.

Why Patients Don’t Schedule Needed Treatment

In a practice near Cardiff, in Wales, a dental hygienist was being integrated into an existing practice. However, the patients, after seeing the dentist for a complete exam, were not scheduling with the RDH.

To determine why, a questionnaire was designed to get anonymous feedback from the patients. Forms were provided at the front desk and a box for depositing them. After one week, not one form was completed. The front desk person was then asked to hand each patient a form and request feedback. The box was moved near the door, so they could drop it off as they left. This was more successful in getting patient feedback.

Through this process, the RDH listened to how scheduling with the RDH was presented to the patients. This appointment was left to the patient’s discretion. The receptionist was asked to say “the dentist recommends you schedule an appointment with the dental hygienist. Our first opening is this date.” This small change increased patient acceptance significantly.

The patient feedback indicated a variety of reasons for not scheduling: anxiety, finances, lack of understanding what an RDH is, not knowing there was an RDH in the practice and lack of time. Based on this feedback, several changes were made. Brochures were provided to new patients and put in the reception area explaining dental hygiene. A financial plan was introduced that made it easier for people to accept treatment. To deal with anxiety, more questions were asked of patients about their past dental experiences.

Clinical Implications: Asking patients what they want and why they don’t accept treatment provides opportunity to make necessary changes to the practice.

Oakes, K.: Following a Dental Examination Why Do Patients Decline to Make an Appointment with the Dental Hygienist. OHU Action Research 1A-13, 2013.

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