We hear what The Dental Hygienist Roadshow was all about and touch on what each of the speakers covered.
Throughout 2023, the world of dental hygiene has witnessed an exciting event – The Dental Hygienist Roadshow by Johnson & Johnson Ltd.
Visiting cities across the UK, Professor Iain Chapple, Simone Ruzario, Benjamin Tighe and Laura Bailey have covered:
- The current impact periodontitis is having on the UK population
- Why using plaque control measures, which can help to manage gingivitis, is key to successful preventive care
- The role the dental hygienist and dental therapist can play in initiating patients’ behaviour change.
During the Roadshow, the three lecturers took delegates through the very latest in periodontal research.
Here, we talk to each of the speakers, find out what the latest research is and understand how to implement this into the dental practice.
Professor Iain Chapple – director of research for the Institute of Clinical Sciences
Non-communicable diseases (NCDs) are the major cause of death in humans. The World Health Organization (WHO) has targeted reducing them by 30% by 2030!
This roadshow took a look into the future of oral healthcare and flagged the likely extended duties for a hygienist/therapist in the brave new world of ‘putting the mouth back inside the body’.
It started by sharing dramatic figures from The Economist on the economic burden of periodontitis and how shifting our focus to preventing and treating gingivitis could save billions of euros.
Behaviour change
To achieve this, however, there is a need to empower and coach patients in self-care and behaviour change.
This is a central tenet of step one of the world’s first ever S3-level clinical guideline in dentistry.
The audience was challenged by the revelation that, while mechanical plaque removal remains the bedrock of prevention and therapy, chemical agents employed as adjuncts do add benefit.
Gingivitis is frequently regarded as trivial, but new evidence is provided for its systemic health consequences, adding strength to the need to shift the paradigm towards taking gingivitis seriously.
However, the challenge of throwing out frequently non-evidence-based teachings from undergraduate days needs addressing and this requires an open mind and keeping up to date via CPD.
Equally challenging to the need to change our own behaviour is how to achieve it with our patients. Unless we succeed, prevention fails, NCDs worsen and mortality rates increase.
The roadshow also glimpses the future scope of practice of oral healthcare professionals by engaging in early case detection of systemic conditions like diabetes. Also, using saliva as a diagnostic tool outside the dental surgery.
This digital era and artificial intelligence (AI) are upon us, and the future is very exciting as a consequence. However, we all need to think outside the box and grab the opportunities that will certainly come our way, and support the WHO in their key objectives.
Benjamin Tighe – tutor dental therapist at The Eastman Dental Hospital
Where do we start?
Why is managing gingivitis using plaque control measures key to successful preventive care?
Optimal oral care comes from bespoke care. It’s that one-to-one focus, treating each patient as an individual, getting to know that patient, eventually understanding someone’s lifestyle.
We need to get away from this template idea, for example with twice-daily brushing. Although it is 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.
There are a lot of potential barriers to managing plaque, and I think it’s very nuanced in the sense that you come against what people have traditionally always done:
Understanding why a different clinician is recommending something else is one barrier for patients.
A huge issue at the moment is the financial barrier. We can’t expect all patients to be able to go out and buy the latest electric toothbrush.
Even toothpaste, interdental brushes or floss still 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 is 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 do, or the effects on the body.
That needs to be addressed so that patients can appreciate the true impact of oral health care and be motivated to make a change.
Adjuncts to plaque management
Before I attended the Hygienist Advisory Panel and was presented with the evidence, I would probably have said ‘no’ to adjuncts – 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 beyond mechanical cleaning.
When we are 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, and we’re basing this whole ethos and attitude around it.
It was even in earlier versions of the Delivering Better Oral Health Toolkit, but now they have changed it to ‘spitting out after brushing rather than rinsing with water, to avoid diluting the fluoride concentration.’
The evidence actually 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.
The latest evidence
There is new information being published all the time, but not all of it is robust.
We 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).
It’s the clinician’s responsibility to inform themselves, to be able to challenge things should they need to.
So, we have to lead the way with our own skillset and knowledge, to ensure we are offering best practice based on the current evidence base.
Laura Bailey – dental hygienist/therapist
Know your patient, change the outcome
Laura Bailey explores the role of the dental hygienist and dental therapist in creating behaviour change.
To change a person’s understanding of oral hygiene and get them to change and implement new routines, you need to understand what makes them tick. By unpicking that, you can figure out how to motivate them.
However, people are busy, they have different priorities, and it’s not my job to tell someone that flossing is a bigger priority than their new-born baby. It’s about making it easy for them to make small adaptions, ultimately leading to a bigger change.
The question is, how can we slot into their life, rather than them having to change their life for us?
Management and understanding
We know that plaque biofilm causes disease. It is intrinsically linked to systemic diseases.
We have a growing understanding that it’s not just about making sure we’ve got good oral hygiene, it’s also about making sure that we’ve got overall good health.
It can save us a lot of time and money long-term if we can prevent rather than treat diseases.
To work towards that, I focus on the importance of mechanical biofilm removal. I go over and over it until they understand that it is the gold standard.
But sometimes patients need a little bit of extra help. There are so many different reasons why someone might struggle to remove biofilm properly. In certain cases, on an individual basis, I think you can introduce something like a chemotherapeutic mouthwash to help support what they’re already doing.
Patient personality
It’s really important to understand the patient. I like to divide them into one of four personality types.
From there, I know exactly how to talk to the patient.
For example, a type A patient will be straight to the point, wants information, but for it to be short and concise.
The opposite of that is type C, for whom it’s important to be empathetic, build loads of rapport and learn about them and things they’re interested in.
When you start to understand how a patient ticks, that’s when you can really start to build trust and create a connection. It’s hard to tell someone or teach someone what to do without having that rapport in place. Then, based on that, I assess whether they are ready for change.
It’s important to keep repeating yourself. It can be in different ways, but you’ve got to repeat yourself because patients aren’t going to take in all the information that you’re giving them every single time. If you overwhelm them, then you have missed the mark.
Keeping up to date
The GDC stipulates that dental therapists and dental hygienists need to do 75 hours of Enhanced CPD in every five-year cycle.
But going further than that is really important: hygienists and therapists are often the first port of call when patients come in. We’re seeing patients more regularly than a dentist and we can be such a good first step to avoiding problems.
So, by ensuring that we’re up to date with all the information and evidence, we can utilise that to prevent patients from being in pain, from having dental diseases.
For more information about The Dental Hygienist Roadshow, visit www.listerineprofessional.co.uk/roadshow2023.
