Benjamin Tighe explores why managing gingivitis using plaque control measures is key to successful preventive care, as are personalised care plans.
As a practising dental therapist and educator, what do you think is the key to ensuring optimal patient care in today’s society?
I think optimal care comes from bespoke care. It’s that one-to-one focus, treating each patient as an individual, getting to know them, eventually understanding their lifestyle. You need to get away from this template idea, such as with twice-daily brushing.
Although it’s part of the gold standard regimen, it doesn’t fit into everyone’s lifestyle for a variety of reasons. It might eventually, but it can take time.
So, our advice and the care we give must be personalised to each individual.
If plaque management is the required focus, what are the barriers and how can dental professionals help their patients to achieve improved outcomes?
There are many potential barriers and I think it’s very nuanced in the sense that you come against what people have traditionally always done:
‘I’ve always brushed my teeth this way.’
‘Why are you telling me to change this now?’
‘I’ve been seeing the same hygienist/dentist for a number of years and they’ve never said anything, so why are you doing this now?’
So, change, understanding why a different clinician is recommending something else, is one barrier for patients.
Then, a huge issue at the moment is the financial barrier. We can’t expect all patients to be able to buy the latest electric toothbrush. Even toothpaste, interdental brushes or floss cost money that some patients won’t have.
Here, it’s about being proactive, perhaps even going to the local saver or pound shop to see what is available and whether it’s good enough for a cash-strapped patient to spend their money on.
Education is another barrier. People still don’t really understand what biofilm or plaque does, or the effects on the body. That needs to be addressed so that patients can appreciate the true impact of oral healthcare and be motivated to make a change.
Are there any adjuncts that can help patients maintain their oral health and manage plaque?
This is interesting because before I attended the Hygienist Advisory Panel and was presented with the evidence, I would probably have said ‘no’, other than, perhaps, short-term use of chlorhexidine in some circumstances.
However, having been presented with the evidence regarding mouthrinse efficacy, and then trying it for myself over a long period, I do recommend an essential oil mouthrinse for certain patients who need a little something extra to reduce plaque beyond mechanical cleaning.
The ‘spit don’t rinse’ message has been circulating for years. However, there does seem to be some confusion surrounding it. What is the confusion, why is it not being implemented correctly in some instances, and what is the correct interpretation of it?
When we’re at university, it’s drilled into us that we need to tell patients that it’s ‘spit don’t rinse’. The idea is that if you rinse, then you’re going to get rid of all that fluoride, which was going to help strengthen your teeth.
However, that advice is based off one study that looked at kids who rinsed with water after brushing their teeth. We’re basing this whole ethos and attitude around one study, which, I admit, I was guilty of doing.
It was even in earlier versions of the Delivering Better Oral Health toolkit, but now they’ve changed it to ‘spitting out after brushing rather than rinsing with water, to avoid diluting the fluoride concentration’.
The evidence demonstrates that the enamel uptake of fluoride from a fluoride-containing mouthrinse is as good as leaving residual toothpaste in the mouth. So, for some patients, an adjunctive fluoride hit offers benefits.
It isn’t unusual to come across conflicting advice when it comes to best practice. With that in mind, where should clinicians seek advice and how can they know what to implement and what to ignore?
It can certainly be tricky, as there is new information being published all the time, but not all of it is robust. You need to identify the type of evidence and consider where it comes in the hierarchy of evidence and where it fits with GRADE (Grading of Recommendations, Assessment, Development and Evaluations).
Can clinicians wait for guidance to be handed down to them from leading associations and bodies within dentistry or should they be seeking it themselves?
We are quite lucky in the UK, in that we havesome very proactive associations. I’m thinking specifically of the British Society of Periodontology (BSP)’s version of the European Federation of Periodontology (EFP) S3-level Clinical Practice Guidelines, which offers UK-specific evidence-based recommendations.
I think, had you taken the evidence directly from EFP, you would’ve been extremely confused. The BSP version is much more user-friendly. That said, it’s the clinician’s responsibility to inform themselves, to be able to challenge things should they need to. So you have to lead the way with your own skillset and knowledge, to ensure you’re offering best practice based on the current evidence base.
You will be visiting a number of dental events this year to present to practising dental team members. What information will you share with delegates?
I’ll be delving more into how the care that we provide needs to be bespoke to every individual patient and addressing the ‘spit don’t rinse’ issue to make sure we’re all clear on the evidence base. Evidence is key in everything we do, so I’m also going to run through staging and grading clinical recommendations.
I’ll also try to reduce the noise for colleagues surrounding adjunctive advice, taking it out of the social media and Google realms of confusion and back into an evidence-based reality.
Johnson & Johnson Ltd, the maker of Listerine, will be running The Dental Hygienist Roadshow throughout 2023. During the roadshow, leading speakers will discuss the benefits of dental professionals empowering themselves with the latest knowledge to help support their patients.
For further information and to sign up, click here.
