Dialogue, not monologue

Practice owner Daniel Smith’s approach to dentistry is founded on co-diagnosis to develop the highest levels of oral hygiene

Daniel Smith’s implementation of an oral health promotional approach within his first practice was ‘a big step’. Patients were used to a certain pattern of care during the 30 years of reign of the previous owners, and were sceptical of seeing a hygienist and discussing their perio levels.

Daniel explains: ‘The first practice we took over was very “old school”. Most patients had never seen a hygienist and, despite being affluent and generally educated, the patients remained uneducated about their oral health.’

It was a major change of mindset for patients and, as Daniel says, ‘we had to do it as diplomatically and sympathetically as possible’. This practice in the market town of Hertford in Hertfordshire laid the foundations for Daniel’s new practice situated in Mill Hill in North West London. Now, at Ecladent, all patients have a full pocket depth chart and are referred to the hygienist for the appropriate appointment length and recall interval – ‘this is key to our practice’ he says. Daniel has tried hard to keep it simple so patients are given a 20-, 40- or 60-minute hygiene appointment, depending on requirements and how they present.

One to one

This assessment is based on:

• Restorative status of teeth

• Gum health and vulnerability

• General health.

The practice runs a maintenance scheme that is simplified into three categories:

1. 2 x 20 minute hygiene appointments a year

2. 2 x 40 minutes appointments a year

3. 4 x 40 minute hygiene appointments a year

And 60-minute hygienists appointments are generally booked for new patients and those requiring periodontal therapy such as quadrant root planing and use of adjuncts.

The practice offers a five-year guarantee with its dental treatments, on which Daniel is more than happy that his team can deliver – ‘we need to be confident in our quality of work’ he says.

In the past, Daniel had previously relied on video patient education systems but argues nothing beats good old-fashioned one-to-one communication. He says: ‘I know how to communicate effectively to the patient. They like the interaction, and compliance is a lot higher if there is a dialogue rather than a monologue.’

With his first practice in Hertford, it was a battle, initially, to address the need for most patients to improve their periodontal health; this after many years of patients having a basic scaling. But, having ‘repeated the conversation over a thousand times now’, it is much easier to communicate this effectively to even the most hardened of cynical patients. ‘We can communicate effectively and report back to them their oral health and education them how best to tackle any problems.’

A patient writes…‘The price of many years of poor diet, scruffy dental hygiene and smoking was bouts of severe toothache and a smile guaranteed to frighten the grandchildren. My bad lifestyle habits are now in the past but obviously the damage to my teeth is not self-healing. Fortunately, thanks to some good dental work, the situation has been recovered – to some extent. Regular visits to the hygienist has halted decay and some bridgework and whitening treatment has improved the appearance of my teeth beyond all recognition.’


‘I love it’

With more than 90% of his patient base still using manual brushes when he took on the practice, Daniel took to strongly recommending Oral-B’s oscillating-rotating electric brush. The practice had such a high take up rate that now fewer than 10% are using a manual brush. These tend to be patients who already achieve a very high level of oral hygiene without the extra help an electric brush offers. After reading the 2003 Cochrane Review: Manual versus Powered toothbrushes1 that concluded ‘brushes with a rotation oscillation action reduced plaque and gingivitis more than those with a side to side action in the short term (4 to 12 weeks)’. Daniel was committed.

Don’t forget! It’s important to give patients samples of oral health products. There are plenty of samples of Oral-B’s Pro-Expert toothpaste at www.dentalcare.com. All you have to do is register and request your samples!    

He says: ‘I love it. It claims a lot of great things and I recommend it to patients.’ When he opened the doors of Ecladent for an open day one weekend, it was with a bag full of oral health goodies that potential patients were greeted, including samples of Oral-B’s Pro-Expert toothpaste and leaflets featuring ‘before and after’ pictures. The proof is in the bag, it could be said. However, Daniel maintains that it is the joint effect of education and correct brushing along with these oral health innovations that makes the difference. He is an advocate of co-diagnosis with patients and believes it is this that is the secret his success rate with patients’ perio levels. DH&T


1. Manual versus powered toothbrushes: the Cochrane review. Niederman R; ADA Council on Scientific Affairs; ADA Division of Science; Journal of the American Dental Association. J Am Dent Assoc.

2003 Sep;134(9):1240-4.

All about me

Award-winning dentist Daniel Smith has trained extensively in many specialist areas of dentistry with particular emphasis in the fields of endodontics, implantology and occlusion. He focuses on treating nervous patients and those who are in need of major dental treatment. Daniel was the youngest practice owner to attain the role of vocational trainer.

Website www.eladent.co.uk

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