The Talking Points in Dentistry seminars, run each May by GlaxoSmithKlyne in various places in the UK, were especially relevant to Dental Hygienists this year. The first lecture was given by Graham Smart and Phillip Ower; both well known in the world of periodontics. Their philosophy is one I strongly endorse: to teach patients’ plaque control and improve periodontal health before doing any treatment.
We should be concerned with the living bacteria in the Biofilm (they didn’t want us to call it plaque), not the dead bacteria in calculus. Calculus can be removed later if it’s causing a rough surface or ledge for bacteria to adhere to but the Biofilm is the real target. We have to train our patients to do a good job each day. They recommended using an oscillating and pulsating electric toothbrush for 4 minutes and a conical, single tufted interdental brush, trimmed with scissors to a finer point, used to reach deep into the pockets.
Letting them loose
Patients are greatly encouraged when they see the improvements brought about by their efforts alone; the paler gingivae and feeling of tautness are evident signs of health and any further procedures are less painful or tender. People are surprisingly adept at the skills we try to teach them. I am amazed how good they are at using TePe brushes, providing they are taught well. The main problem is that the teaching takes time; it cannot be rushed.
The difficulty, so often, is persuading dentists of the need and worth of non-invasion when they would like to see us charging in and creating lots of blood. I had the opportunity of explaining my philosophy to the team at a practice meeting, following a ‘little chat’ with my boss. He and another dentist in the practice felt there should be scaling done at each appointment because they were sending patients for a ‘scale and polish’. I really felt I couldn’t see a new patient without giving them some instruction on prevention of disease, especially if they already had disease in their mouths.
In our new NHS practice many patients are phobic, having not seen anyone dental for a period of years rather than months. I was unwilling to put them off by doing much treatment when their gums were really inflamed, or even use Local Anaesthetic– I wanted to nurture them until their mouths were more healthy and they trusted me. Scaling would then be easier and more comfortable. Amazingly, I was listened to; several team members said how helpful they’d found my brief ‘teach-in’ at the meeting. My boss now explains what I’m going to do before he sends patients to me and one of the other dentists always sends phobic or needy patients to me. It’s great see improvement and experience the trust of patients who are happy.
So, if you feel as I do – please take heart and explain your views to someone in the team. You have a wealth of evidence based research behind you. Go for it!