Morag Powell explains how her team of four hygienists and therapists changed their practice’s approach to dentistry.
Morag Powell is one of four hygienists and therapists at the well-renowned Fergus and Glover practice in Aberdeen. Focusing on private cosmetic and implant dentistry, the award winning practice is one of the most recognisable brands in Scottish dental care. Here, the team’s dedication to delivering gold standards of care is clear to see and is the result of a ‘nuts and bolts’ review and redevelopment of all aspects of the hygiene and therapy department.
Their journey to the elevated standards delivered today began back in 2008. With the total backing of the practice owners, the hygiene and therapy team were given autonomy to revolutionise the department. The aim was to develop and implement a preventive practice policy that would deliver gold oral health care standards as a prerequisite to all restorative and implant treatment carried out within the clinic. The results of their hard work have been profound. Morag explains the team’s approach to prevention and how they seek to embed behaviour change in their patients; an approach that won the team the DH&T Best Preventive Practice Award in 2012.
The team’s approach to prevention
‘All our hygiene and therapy appointments are one hour, much longer than the average hygienist appointment. This is so we can take time in each appointment to review the patient’s homecare routine and make any modifications. Every patient is disclosed and their plaque and bleeding scores are monitored. The introduction of the Oral-B Test Drive with single use demonstrator heads and hygiene sheaths has really enhanced this for the patients. This enables us to fully cover the TIPPS (talk, instruct, practise, plan, support) behaviour change strategy, allowing patients to receive instruction in their mouth and then practise whilst they are still in the surgery. Educational video clips on the iPad are routinely used to give patients additional information on the systemic effects of periodontal disease, which works well in increasing the importance and value of their homecare routine.
‘As a practice we recommend the Oral-B Braun 2000-6500 range of power brushes. Our implant patients find the interspace brush head very good and easy to use. This, combined with the Oral-B Pro-Expert toothpaste (which has the benefit of stabilised stannous fluoride), we believe is a contributing factor in the positive feedback we receive, and more importantly the improved oral hygiene we observe.’
The whole team at Fergus and Glover see co-diagnosis as an integral part of their prevention strategy. Significant effort is put into educating patients with concise information about disease processes prior to screening. Using this approach the team has seen greatly increased acceptance by the patient if oral health issues become apparent. Morag outlines: ‘We start by explaining to the patient verbally and with the aid of diagrams and digital videos on the surgery iPads, that pocket depths of 3mm and below are areas of health and pocket depths of 4mm and above are areas of inflammation, which will require treatment.
‘Using a full-mouth pocket chart, the depth of each pocket is heard by the patient and recorded. This allows the patient to start to realise that they have inflammation present, and when this is then discussed with the patient, the patient is in a frame of mind to ask for solutions.’
Education of the team
In addition, one of the most significant changes to be implemented in the practice in recent years has been the education of the team in understanding different patient personalities using the DISC (dominance, influence, steadiness and conscientiousness) profiling system. This has allowed them to tailor their oral health messages in the most receptive format for each patient. Morag is positive about the results, which have seen a significant improvement in the understanding, uptake and success of treatments.
Goal setting with patients is another integral part of the team’s oral health. This is achieved by ensuring that patients have a comprehensive understanding of their bacterial and inflammation levels. Morag explains: ‘We talk through what the healthy parameters are and what they need to work at to achieve health. This empowers the patients to take responsibility for their own oral health. All goals are set within SMART parameters – specific, measurable, achievable, realistic and time bound. An example of this would be to set a realistic and achievable goal for a patient who presented with a plaque/bacterial level of 80%. To set a goal of 10% for this patient would be unrealistic and ambitious. A more realistic approach would be to set a goal of 40% for the next appointment, which would be scheduled in approximately two weeks time. If this goal is achieved, positive reinforcement will be given to motivate the patient towards achieving the next goal, which would be 20% etc.’
It’s a widely shared view that motivating patients to take ownership of their dental health is key to achieving long-term behaviour change. This is certainly borne out by Morag’s team’s experience. Here, the effective deployment of techniques that help them understand their patients’ motivations has enabled them to deliver outstanding results.