Oral health – is there a need for a change in ethos?

Laura Bailey considers dental hygienists’ and dental therapists’ scope of practice, as well as the significance of these in practical terms as a positive pathway for the primary care dental team.

Following the Hygienist Advisory Panel (HAP) last year, Johnson and Johnson Ltd, the makers of Listerine, followed up with four members of the group to talk more about key issues affecting dental hygienists and dental therapists

For this, Laura Bailey, Alison Edisbury, Anna Middleton, and Benjamin Tighe will be exploring important topics to shine a light on the challenges and offer support for both dental professionals and patients, including:

  • The association between inflammatory-driven diseases
  • Exploring the patient-friendly consensus
  • The human and economic cost of periodontal disease.

Here, Laura Bailey offers insight into how periodontal disease is perceived in the UK by both dental professionals and the general public, and consider why a change in ethos is needed, alongside raising awareness of elements like bleeding gums are not normal.

Evidence-based mouthwash use supported by Hygienist Advisory Panel consensus

When Johnson and Johnson Ltd. brought together a group of dental hygienists and therapists for the very first Hygienist Advisory Panel meeting, they shared their views in relation to plaque management.

They also explored the benefits and any limitations of mechanical cleaning, as well as possible adjunctive support in the form of a chemotherapeutic mouthwash.

Building on the outcomes of the earlier National Advisory Panel formed of key opinion leaders, the group agreed on the following consensus:

‘Healthy gums don’t bleed when brushed. Twice daily brushing along the gum line and cleaning in between the teeth is essential to support a healthy mouth. Fluoride mouthwashes clinically proven to reduce germs (plaque) offer additional benefit.’

Below the age of 7
‘Spit don’t rinse.’

Over the age of 7
‘For better gum health, after brushing spit and then rinse with a fluoride mouthwash that is clinically proven to reduce germs (plaque).’

For more information, visit www.listerineprofessional.co.uk

How do you think the dental profession tends to perceive periodontal disease?

Laura: I think it’s perceived as a daily frustration. It is a wholly preventable disease and, with the correct guidance and compliance, can be easily treated, yet we find ourselves in this perpetual cycle of disease and destruction due to lack of resources, time and education.

Building on that, what do you think is the general public’s view?

Laura: The general public see periodontal disease as normal. I don’t think there is any other chronic and destructive disease that is as blindly ignored and misunderstood. Especially not one that can massively affect a person’s systemic health.

What are the challenges hygienists and therapists face because of these ideas?

Laura: It is really difficult to convey the true consequences of periodontal disease to a patient. It is a complicated disease with mainly silent symptoms. How often do patients go undiagnosed after not seeing a dentist for years because they have no complaints?

Bleeding gums, one of the only ‘obvious’ symptoms to a patient, are seen as a common and harmless occurrence. It can be a challenge to ensure a patient accepts a diagnosis and what this means. It can be hard to get a patient to own their gum disease and take responsibility.

How might a change in ethos help? What would you want to see?

Laura: A change in ethos to having more patients understand that periodontal disease is not normal, it can be prevented, and the role of their home care is the most important factor in this fight.

This would not only decrease the amount of periodontal disease DCPs [dental care professionals] see but it would also reduce the cost on the NHS and economy that would normally be caused by chronic periodontitis. It would make treatment simpler and easier.

To what extent could making full use of each DCPs’ scope of practice make a difference?

Laura: I think hygienists and therapists working within direct access will hugely help with the diagnosis and treatment of periodontal disease by ensuring patients have as easy access as possible to dental care.

Being able to carry out a full perio exam, X-rays and treatment plan within our scope will increase patients taking up treatment.

On a day-to-day basis, how do you seek to overcome these ideas and change the mindset of your patients?

Laura: I always try to be positive, create an honest relationship and not ‘lecture’ patients. It is imperative we give our patients all the information and help them to understand their oral health. But we can do it in a way that is informative and motivational. I use social media to try and educate and empower the general public to improve the overall oral health.

Have you changed your position on this at any point?

Laura: Yes, I think since understanding that gingivitis is more closely linked to progressing to periodontitis than I previously thought, I have been spending more time educating those that I thought were lower risk. This will hopefully reduce the amount of people that then go on to develop periodontal disease.

How do you think using the HAP consensus can help?

Laura: From my perspective, the HAP consensus gives us a clear and concise protocol to follow to protect and support our patients based on the latest evidence.

Have you seen any positive changes after adding an adjunctive mouthwash to a patient’s at-home regimen? In what way and to what extent in terms of plaque control?

Laura: Since the Hygienist Advisory Panel, I’ve integrated a clinically proven fluoride mouthwash into my protocol for patients with whom I have previously struggled to see an improvement. Although it is early days, the prospect of further supporting my patients at home is really exciting for me. I look forward to seeing the results.

Read other articles in this series here:

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