Alison Edisbury shares her perspective on some of the dental hygiene issues discussed during The Dental Hygienist Roadshow.
In your opinion, what are some of the key challenges many dental hygienists and dental therapists face in general practice today?
Alison Edisbury (AE): It’s always going to come down to time, I think. But I also think it’s good to look beyond that and consider what you can prioritise in the time you do have, to consider if you should be directing the focus somewhere else.
Of course, that creates another challenge. We know that while the professional clean is important, oral hygiene education and motivation are key to success, too.
If a patient is with you as a result of a dentist’s referral, which is normally because they want to do some form of treatment down the line and get the mouth in the best possible condition for that, you can see there are lots of factors competing for your time. It’s a balancing act between providing what the patient wants with the expectations of the dentist and the hygienist or therapist within the timeframe.
What has been your experience in terms of whether patients appreciate and have an awareness of the importance of the dental hygiene appointment?
AE: From my experience, people are more aware in the sense that many do appreciate they’ve been referred to the hygienist to get their gums healthy.
That said, I still think there’s a missing element, where they do not fully understand that we can’t do everything, and the ball is in their court between appointments, so we need to work on that.
Does the ‘spit don’t rinse’ message form part of that?
AE: I often see written in the patient notes, ‘Discussed with patient using mouthwash, spit, don’t rinse, use at a different time to brushing.’
We need to look at the guidelines properly to see what the evidence-based message is around mouthwash recommendation and use. As the latest version of the Delivering Oral Health Toolkit states, the recommendation is to spit toothpaste out after brushing rather than rinsing with water, to avoid diluting the fluoride concentration (Department of Health and Social Care, 2021).
Certainly, the evidence suggests that for some people there may be an advantage to using a fluoridated mouthwash straight after brushing (Duckworth et al, 2009), so we need to make sure we are getting the message right for each patient, depending on their specific needs.
Do you recommend daily-use mouthwash to your patients?
AE: There is a place for mouthwash, but it’s just got to be the right mouthwash for the right patient at the right time.
Also, if a patient came to me and said that they were using a mouthwash, I would never discourage that. But I would make sure they had sourced the best one for them and encourage it to be used as an adjunct to mechanical cleaning as far as possible.
What do you know about the S3 Treatment Guidelines for Periodontitis and what is your understanding about them?
AE: So, my understanding is that you’ve got to get each patient engaged. That is the crux of it. We know from the research that if a person is not engaged with their treatment protocol, it is not going to work as well as it might over the long term.
What’s clear about the S3 guidelines is that need to get a patient engaged before you can do the treatment. I felt that was one of the messages that came out of the forum that I went to, with Iain Chapple talking about the Avoidance of Doubt document (NHS England, 2018).
It is there to support dental professionals working within the NHS and to clarify where it might be appropriate to provide phased treatment spanning over several courses of treatment, in part covering the need for patient engagement before you move onto a further treatment step (NHS England, 2018).
How can dental hygienists and therapists help their patients, to encourage positive oral hygiene change between appointments?
AE: You need to get to know each patient as an individual and find out what their routine consists of at the time of the appointment.
I’ve never been one to change somebody’s routine completely. I’ve always tried to build on what they’re already doing. If they’re using a manual toothbrush and they’re doing a decent job with it, I personally don’t change them over to an electric toothbrush. Because if something’s working, don’t change it.
Positive reinforcement is important, as is building on the foundation that is already established. I have a patient who said he is unlikely ever to floss or use interdental brushes, but he did ask me about mouthwash.
Although it’s not the ideal situation, I did tell him I would rather he be doing something than nothing, and if mouthwash was his preferred choice, then that’s what we’ll go with. And maybe further down the line we can build on that.
What do you think the future looks like for dental hygiene and therapy in the UK?
AE: I think we’re at a point now where it’s going to flourish. Within the profession, people have a much better understanding of the role of dental hygienists and dental therapists than they did previously.
Patients are asking to see hygienists and therapists in the first instance. They’re learning that it doesn’t necessarily have to be an initial appointment with the dentist, and I think that awareness is going to grow.
Also, it’s good to see therapists who are really pushing the boundaries and using their full skillset. On that note, I’d love to see the creation of opportunities for dental therapists to specialise. You can go on various postgraduate courses but there’s no professional recognition, whereas dentists can get on a specialist register with the right qualifications.
I think that change will come, but it is going to take a long time. Utilising everyone in the best possible way within dentistry just makes sense for the future of dentistry in the UK.
For more information about The Dental Hygienist Roadshow, visit www.listerineprofessional.co.uk/roadshow2023.
