Sometimes in a busy dental practice, it can feel like you barely have time to grab a bite to eat, let alone fit more patients into the schedule. However, if you take a closer look at some common practices, you will find opportunities to save on wasted time and energy.
Skip the lecture
Save appointment time by cutting out oral hygiene instructions. I know this sounds sacrilegious, but most patients don’t want to hear the lecture anyway. They’ve heard it how many times before? If you don’t believe me, start asking patients if they want oral hygiene instructions before you start your lecture. I think you’ll find that most people don’t want to hear it and others, to be polite, will say, “Only if you want to do it.”
Instead, ask open ended questions, the answers to which you do not know. This leads to a conversation and to identification of the patient’s strengths and desires for their own oral health. As dental hygienists we have a desire to fix what is wrong. We want to make things right with oral hygiene, correct mistakes. However, our idea of right may not match that of the patient. More listening and less talking will help us determine what each patient wants and is willing to do to achieve their oral health goal. If we never ask, we’ll never know.
Here are some helpful questions to get the conversation going:
- What do you do each day to clean your teeth?
- What do you do to clean between your teeth?
- On a scale of 1 to 10, how healthy do you think your teeth and gums are right now?
- On a scale of 1 to 10, how healthy do you want your mouth to be?
- How much time are you willing to spend taking care of your teeth and gums?
- What things have you found helpful for cleaning your teeth?
- Tell me about your diet and the foods and drinks you eat containing sugar.
Traditional oral hygiene lectures tend to focus on what’s wrong and what needs to be improved. Often, patients feel they are being scolded for bad behavior. Listening to patients will provide insight into what patients are currently doing for their own oral health. Rather than pointing out flaws, try affirming the strengths patients exhibit in their efforts to achieve oral health.
(Click this link for more on co-diagnosis with dental patients.)
Clinicians tend to make the decision for the patient about what toothbrush or interdental aid they should be using. Along with open-ended questions and affirmations of their current efforts, allow patients to design their own oral hygiene program. Offer choices rather than making choices for them. Offer patients a manual and a power toothbrush and see what they want to use. Offer two choices for interdental cleaning and let them tell you which one they are more likely to use daily. To wrap up the conversation and the decisions made to improve oral health, summarize for the patient what you both agreed upon.
Creating a coaching relationship with your patients utilizes one aspect of Motivational Interviewing. Remember the acronym OARS: Open-ended questions, Affirmations, Reflective listening and Summarizing. This comes easily to some while others may need to keep a list of open-ended questions handy until they’re more comfortable with an OARS conversation.
When you skip the lecture and begin asking questions and listening to patients, you’ll feel more refreshed at the end of the day. It’s exhausting giving one-sided lectures to uninterested patients all day long. From now on, you have my permission to skip the lecture. From now on, you are an oral health coach to your patients.
Toss the floss
Instead of asking “Do you floss?” when you already know they don’t, try this: “Tell me what you do to clean between your teeth.”
The yes-or-no question about flossing puts them on the spot. They know they should, but they don’t. They’re not alone: 87 percent of the population doesn’t floss daily, despite our lectures about it every time we see them. Let’s face it, most patients lie to their dentists and dental hygienists about flossing. The commentators on the Today Show recently admitted they all lie about flossing.
Why are we still pushing floss, when the evidence is clear that people don’t floss and if they do, most are not effective with it? Despite the evidence, both the ADA and the ADHA still insist that “brush, floss and fluoride” are the standard of care for oral hygiene. This is the message on their websites to both the profession and to consumers.
Don’t get me wrong, cleaning between the teeth daily is still important, but not with floss. For the few people who are effective with daily flossing, encourage them to continue. For the majority of people who can’t or won’t floss, there are so many other alternatives: sticks, picks, interdental brushes, and flossing with water.
It’s hard giving up the string floss message when it’s been drummed into our heads since dental/hygiene school and continues to be touted by professional organizations. However, something is better than nothing when it comes to cleaning between the teeth.
The dental profession assumes that string floss is the choice for everyone, without even asking. People want choices. Not too many, just two: chocolate or vanilla. That’s an easy choice for most. Add a third choice, strawberry, and it’s tougher. Offer patients a choice between two interdental alternatives to floss. The research confirms that interdental brushes are an effective alternative to string floss. Other good alternatives are sticks, picks and water flossing. As I said, something is better than nothing. Let them make the choice and see how many times they choose the opposite of what you anticipated. Listen to your patients. Let them make the decisions.
(Click this link to learn more about overwhelming dental patients with choices.)
By asking open-ended questions rather than lecturing, and letting patients choose their own interdental cleaning tool, you’ll save time and, in the future, they will return with healthy interdental tissue.
Hold off on toothpaste
If patients come in with little to no lingual calculus to be removed, it would reduce your instrumentation time. Without giving a lecture on improved tooth brushing, simply ask patients, “Do you enjoy all the scraping it takes to remove the buildup from the inside of your lower front teeth?” Chances are, most people don’t like this and will tell you so. Simply reply, “I know a secret that will prevent all that scraping in the future, are you interested?”
(Click this link to see how dentists can unintentionally offend patients.)
The secret is simple. Start brushing on the inside of the bottom teeth first, without toothpaste. Most people start brushing maxillary teeth and end up brushing mandibular lingual surfaces last, when their brush is soft and ineffective. Or, they never brush lingual surfaces at all. Simply changing the tooth-brushing pattern helps.
The real key is brushing without toothpaste. Toothpaste flavor and wetting agents will numb the tongue so people think their teeth are slippery and clean when they are still covered with plaque. The sodium laurel sulphate in popular toothpastes creates so many bubbles that toothbrushing time is closer to 30 seconds than two minutes. The toothpaste foam also makes it impossible to see where the toothbrush is placed.
The bottomline: Toothpaste prevents effective plaque removal. Brushing without toothpaste encourages people to feel with their tongue and continue brushing until the teeth feel clean and taste clean. Brushing without toothpaste allows people to measure their tooth-brushing effectiveness.
Try this experiment yourself. Brush your teeth without toothpaste or water. Just use a dry brush, starting on the lingual of the lower anterior teeth. Brush all your teeth until they feel clean and taste clean. If you want, you can then brush toothpaste around for the flavor or to deliver an ingredient you want on your teeth.
Researchers have measured the ineffectiveness of daily tooth brushing with toothpaste. A recent systematic review showed tooth brushing with toothpaste rarely removes even half the plaque on the teeth. Here is where logic fails the researchers. They assume that since people aren’t effectively tooth brushing, more chemicals should be added to toothpastes, rather than having people brush without toothpaste, to achieve plaque removal. After the plaque is removed, then decide what ingredients you want each patient to deliver to their teeth in a toothpaste.
By sharing “The Toothpaste Secret” – to brush without toothpaste – with patients, your future appointments with them will be much easier, with much less lingual calculus to remove.
Trisha O'Hehir, RDH, MS