Earlier this year, Emily Johnston attended The Dental Hygienist Roadshow – here, she shares what she took away from the day’s events.
Johnson & Johnson, the makers of Listerine, ran The Dental Hygienist Roadshow throughout 2023.
Between them, Iain Chapple, Simone Ruzario, Laura Bailey and Benjamin Tighe discussed the current impact periodontitis is having on the UK population. Additionally, why managing gingivitis using plaque control measures is key to successful preventive care. Finally, the role the dental hygienist can play in supporting patients’ behaviour change efforts.
There was also the opportunity to discuss the evidence along with current challenges in practices with the speakers in a more exclusive setting, limited to just 10 delegates at each event. One such delegate was student dental hygienist, Emily Johnston.
What are some of the key challenges the dental hygienist and dental therapist face in general practice today?
Emily Johnston (EJ): Time constraints are clearly key in practice. At the moment, as a student, I have an hour to spend with a patient. Even with that I need to speed up.
Some dental hygienists are doing 20-minute appointments without a break, and I don’t know how they do it. I also think patient management and patient compliance are challenging.
In fact, with some referrals, the patients claim not even to know why they’re with us! So, you have to start from scratch, explaining gum disease and how it can be managed. Some people become really engaged and enthusiastic and want to take control of their own oral health. Others are just going through the motions while they are in the chair.
Clearly, we’re not with our patients between appointments. It’s impossible to gain traction with their oral health care when they do not engage with us.
How can dental hygienists and therapists help to encourage positive oral health care change between appointments?
EJ: You have to try to understand what makes each patient tick. Either challenging or encouraging a patient could yield the best outcomes.
I’m also a firm believer in empathy and I would never criticise or shame anyone in my chair. You never know what is going on in a person’s life when you meet them – even if you ask the right questions.
Not everyone is forthcoming. They might be physically or emotionally unwell or have other things on their mind. Not everyone can brush for two minutes twice a day or floss. No matter how hard you work at communicating the beneficial evidence base.
So, I take the route of suggestion, such as: ‘Well, you’re doing the best. Maybe you can try this.’ The truth is, it’s never too late to start. Even a tiny step in the right direction can reap oral health benefits and habits that can be built upon.
What do you know about the S3 Treatment Guidelines for Periodontitis and what is your understanding about them?
EJ: We were taught about the guidelines from day one. It’s evidence based, and we’re following the guidelines for the best treatment outcomes for our patients.
In everyday practice, it’s more straightforward because clinicians will most likely have access to previous X-rays and full medical and dental records, so you can see changes over time. As a student practising in a university clinic, a lot of the time we don’t have all the records we would like for our patients.
However, we can still assess what is in front of us using the screening process we have learned. That single snapshot is nonetheless helpful to provide treatment and preventive advice tailored to the individual.
Has anything changed for you since you attended the forum?
EJ: When I was a dental nurse, I noticed that dentists tended to only recommend mouthwashes with chlorhexidine, or to treat a specific problem for a short period of time. Recommending daily mouthwash didn’t happen in the practices I was working in.
Now, I’m in education, classes have gone through what mouthwash is about and why we have it. It’s apparent from my clinical supervisor’s recommendations of mouthwash use that, again, it’s really only recommended in cases of a specific problem for a specific timeframe.
The breakout Q&A forum allowed me to delve deeper into the evidence base and to hear from experts about the confusion over the ‘spit don’t rinse’ message, which really needs to be ‘spit, don’t rinse with water’. Seeing the studies that support the message that a fluoridated mouthwash does not wash away the fluoride in toothpaste if used immediately after brushing is an eye opener (Duckworth et al, 2019).
With what I now know, I would recommend daily mouthwash use for some patients as an adjunct to mechanical cleaning, offering guidance on which would be best in individual circumstances.
Looking to the future, what else would you like to have a better understanding of to help to inform your recommendations and the pursuit of continuing development?
EJ: The psychology of patients, which I think is fascinating.
I’m obviously still learning, and my career is in its infancy, but a deeper understanding of psychology would help with patient management. I would also love to know more about the evidence base of the various oral health products that are available in the UK.
There are so many, and it is challenging to know which is the best, based on the evidence.
What do you think the future looks like for dental hygiene and therapy in the UK?
EJ: My view is that I hope that hygienists and therapists will help to bridge the gap for people who can’t get in to see an NHS dentist.
Cleary, access is a big issue at the moment, and it seems equally clear that, between them, dental hygienists and dental therapists have a skillset that can make a difference, if we’re allowed to do so.
Of course, there are wrinkles still to iron out, and perhaps the biggest is prescribing. But it is something that is being looked at, so there is hope for the dental hygienist and dental therapist to help the wider patient and dental communities.
Duckworth RM et al. Effects of flossing and rinsing with a fluoridated mouthwash after brushing with a fluoridated toothpaste on salivary fluoride clearance. Caries Research 2009; 43(5): 387-390.
For more information about The Dental Hygienist Roadshow: www.listerineprofessional.co.uk/roadshow2023.