There is a lot of talk about non- or minimally invasive dentistry. Products such as silver diamine fluoride or Curodont Repair offer treatment options that do not require training, allowing practitioners to stop decay without simply putting a “clock” on it and waiting for the disease to progress. What if we had the same thought process in dental hygiene?
Of course, most of the treatments we offer are minimally invasive, but are we really intervening in the early stages? Do we focus on the laser when there are multiple bleeding points or a tendency to cavities? Or are we giving the same lecture on brushing and flossing, giving them their goody bag and sending them on their way – only to repeat the same thing in a few months?
What if we could prevent disease more often instead of just treating it? With few exceptions, most oral conditions are preventable with early intervention. Many physicians feel constrained by time constraints, insurance, office policies, and patient acceptance, to name a few obstacles. We could spend an entire hour just on education and never get a scaler, but what would we charge?
How can we hygienists make the most of our precious minutes with a patient and help them understand the value of prevention? These four concepts are familiar and easy to implement in your hygiene flow. When patients understand their condition, they can reverse or prevent early disease.
Also from Amanda Hill: Bulletproofing for X-rays: A thing of the past?
Papillary bleeding index (PBI)
PBI is my new favorite and a surefire way to help your patient realize that their gums are, in fact, bleeding and that it is a problem. I learned about PBI at a conference where James Hyland, DDS, BSc, owner of OraVital, was speaking. After updating the medical history, vitals, and oral and airway cancer examinations, give the patient a soft clip or a small interproximal brush and have them insert it between the teeth. Let them see in the mirror where the bleeding is and note the number of bleeding spots. You are no longer the one who makes them bleed with your pointing tools; they can see that there is inflammation for themselves.
Solution discovery
Time to go old school and grab a revealing solution. I often hear objections from hygienists to the use of this. Either they’re triggered because it was used to lower their grade in hygiene school, or they’re worried about the mess it’ll make. Like anything, you will get better with practice. If you are used to getting it on the lips of patients, use Vaseline first. Pullers are also a great tool to keep your lips away from the solution.
Using a discovery solution is an excellent teaching tool. During application, show the patient how it works. Depending on the brand, it can stain the tile different colors based on the age of the tile. New plaque is one color, plaque older than 48 hours another, and some even show acid plaque in a different shade. Gone is the excuse that they didn’t have time to wash after lunch. After applying it, sit the patient up, give him a mirror and stop talking. Let them find out where they are missing and then ask if they would like some tips on how to reach those areas. We often assume that patients know how to bathe, but they may need help. In my experience, patients are determined to see less color when they return for their next visit!
Investigate out loud
Saying depth-searching out loud is not a new concept. It’s simple and effective, but in jam-packed meetings it’s often overlooked. Voice recording search tools are improving their technology every day. If you are lucky enough to have one, use it. If it confuses you, practice. I see a lot of these gathering dust on the counter. Even if you’re scrolling back and forth to a keyboard typing the numbers yourself, say them out loud. That way, when you sit the patient down to discuss your findings, they are there for the diagnosis. It doesn’t look like it’s coming from outside.
Interdental cleaning beyond flossing
I chose the term interdental cleaning on purpose. Hygienists have gotten a bad rap for our flossing lectures. For some reason, we’ve convinced ourselves that flossing is the golden ticket to a healthy mouth. While I’m not flossing, there are other ways to clean between teeth, and it’s time we embrace them and set our patients up for success. How else are they going to manage those bleeding spots when the biofilm is busy reproducing between the teeth and they just don’t have the c-shape curve?
Feel comfortable recommending interdental brushes, water cups, and hydrogen peroxide gel tray therapy. So many of the companies that make these products offer lunch and learns and will give you samples or professional pricing.
