Alif Moosajee shares with us the background to his thinking and approach at Oakdale Dental.
I have been privileged enough to find myself working in practices for a considerable length of time, often between four and five years and it’s very interesting to see the work that you do that succeeds, and the work that you do that fails as well. My observation is that the critical determinant of success is how well dental work is maintained. That is why I have made it my business to work out how to get patients to clean well and how we can keep their mouths clean.
Given the complex nature of the treatments we carry out at Oakdale Dental, high standards of oral health are critical. When I was a dental student I was taught that the six-monthly clean and polish was all that patients needed to maintain their oral health. I soon realised that this is important but cannot be relied on completely.
At my practice, even patients who attend at three-monthly intervals know that it is what they do at home that makes all the difference. If we are expecting patients to maintain their oral health at home then we as the professionals need to think of ourselves as coaches: able to instil long term behavioural change that will help them to do this. This means that we are tasked with helping to educate and to motivate people so that they are able to do the right things at home.
I think of periodontal disease as being very similar to diabetes, in that there is no pill that the patient can take to cure it. In fact I do not think the label ‘disease’ should be used when talking about perio. Instead I think it should be termed a ‘periodontal condition’ so that patients understand that the best that we and they can do is manage it and that it is something that they will have to live with.
When I see a patient who has periodontal disease with bone loss or pocketing, the first thing I do is to explain what I can see. Whenever I examine a new patient and explain that I’m going to do a gum health check, I explain that I am going to shout some numbers out to my nurse that will range between zero and four, with zero being the best and four being the worst. If this means I end up shouting out three and four predominantly, already the patient is primed.
More often they ask ‘What does that mean?’ So you are then able to sit the patient up and discuss with them exactly what your findings mean and what impact this will have on their life. Already the onus is now on the patient. They will own the disease and also be more invested in the treatment and maintenance of it as well.
It is very important to explain how best to brush the teeth and to show patients with the aid of models. To assist this I have created a video that can be seen on my website www.smilingdentist.co.uk. This allows patients unlimited access to that demonstration so that they are able to watch it again and again until it makes sense to them.
The other thing that has been a revelation at my practice is the dentist or hygienist brushing the patients’ teeth. Giving patients the ability to feel how it should feel when the teeth are properly brushed is so important. If they can feel the way the bristles are being angled and the pressure that’s being exerted then they really have a much better and thorough understanding of what is expected from them at home.
We use the Oral-B Test Drive system with its disposable hygiene sheaths, together with Oral-B Pro Expert paste. This gives the hygienist the opportunity to brush the patient’s teeth with the electric toothbrush and paste that we would recommend they use for their daily cleaning. I believe the two go together in the same way the mechanical action of a good washing machine requires the chemical action of a good detergent to get the best results.
I’m a big fan of the oscillating-rotating electric toothbrush and think they are far superior to manual brushes. My own personal experience, which I happily share with my patients, is that when I use a manual toothbrush my teeth never feel anywhere near as clean as they do with this type of electric brush. I recommend these brushes to my friends and family and if it’s good enough for them then it’s good enough for my patients. I also feel reassured by the endorsement of the Cochrane Collaboration for this type of technology.
Oakdale dental is committed to children’s dentistry and we have recently introduced our Kids’ Days where we examine children’s teeth, but also run fun activities throughout the day including face painting, colouring competitions, stories, demonstrations and games; all promoting a good oral health message.
For our theme day last Christmas I dressed up as Santa and many of the team dressed up as elves! Our oral health educators also go out to schools in the area and show the children how to brush properly, how to eat well and how to disclose their teeth. They are usually amazed at how much plaque is missed if teeth are not brushed properly.
I firmly believe that showing children the importance of good oral health can never start too young.