Is your ‘scale and polish’ mindset costing you patients?

Beyond 'scale and polish': Claire-Louise Berry reveals why systemic health should be at the heart of your business right now.

Beyond ‘scale and polish’: Claire-Louise Berry reveals why systemic health should be at the heart of your business right now.

There’s been a notable shift towards recognising the crucial link between systemic and oral health. However, regrettably, only a minority of dental clinics actively embrace this connection. This isn’t merely a passing trend; it underscores the profound reality that the mouth’s condition reflects the body’s broader health.

Every clinician must commit to reconsidering traditional practices to truly integrate systemic and oral health. However, initiating and implementing change in the practice’s language, narrative and mindset is difficult. So, we often get stuck in the comfort of just continuing to do what we always did.

Another reason for failing to embrace what can be a profitable shift in approach to dental care is a lack of understanding of the links between oral health and systemic health or a lack of confidence in discussing them. Even with the right knowledge, changing current practice comes with its own challenges that most won’t want to take on.

For example, it might mean making investments and increasing appointment times. Increasing the conversation to include systemic health takes time, and patients have questions because it’s a really interesting topic. With limited treatment time, this can be seen as another stressor in an already full appointment.

Biofilm business model

However, many dental practices recognise that incorporating systemic health is a vital component of a hygiene visit and will allow the hygienist time to ensure this is done effectively. In the long run, this means increased recalls and added value to the appointment, potentially justifying an increase in the cost per visit. Preventing hygienists from integrating this as part of our treatment is incredibly short-sighted and possibly harmful to business, especially as our patient base becomes more aware of these concepts.

So, how do we transition to a different business model to keep patients on side and a dental business profitable? My model centres entirely around biofilm and its role in disease and potential to initiate systemic inflammation. The first change you need to make is the language you use. By using terminology like ‘scale and polish’, you are pinning the hygienist down to treating the patient with a scale and polish, which deals with things that don’t cause disease (calculus and stain).

Patient recall

Scale and polish also sounds like a stand-alone treatment – it is done once it is done! The patient feels they only need to return when the stain and calculus return, leaving them to believe it is up to them to decide if or when that will be.

Biofilm, however, is what causes disease, and it starts to accumulate minutes after its removal. Within weeks, it can initiate disease if left to mature, which will be in the nooks and crannies patients cannot access. If the appointment concerns health and biofilm, the control is back in the clinician’s hands. We determine a recall based on individual risk of disease and their level of biofilm control at home.

It’s not that we don’t trust patients to do a good job, it’s just that biofilm is so complex to remove from all the hard-to-reach areas that patients need us for professional prophylaxis (the prevention and control of disease).

A better experience

Does discussing these systemic health factors help dental clinics create a better patient experience? And will patients appreciate this?

In my experience, dental patients are much more informed now, especially post- COVID-19, when health and wellness were hot topics. In 2024, patients are increasingly aware of optimising oral health for general wellbeing. Contemporary practice means integrating these concepts into our treatment, which adds value to the health and hygiene department.

Believe it or not, patients enjoy discussing systemic health factors, and, in my opinion, this has really improved the overall patient experience.

The big four

Some of the conversations may be challenging or are considered taboo by specific demographics, such as erectile dysfunction (ED) and HPV. So, how can a practice ensure the whole team uses the best approach to communicate any risks with patients?

Firstly, I’d never advocate starting a conversation about ED with a patient outright. That’s a difficult one to navigate. I’d recommend a subtle approach. For example, you could have information on a TV in the waiting areas or patient leaflets. Have a conversation about how systemic inflammation can initiate endothelial dysfunction in minor and major blood vessels, but maybe don’t mention the penis!

Using waiting room material can spark interest and hit a nerve with the taboo subjects we may not feel comfortable raising and then keep face-to-face conversation for the more appropriate discussions. I often talk to patients about what I call the ‘big four’ – diabetes, heart disease, pregnancy/fertility and Alzheimer’s.

We should always ensure inclusivity in patient education and make it part of an entire discussion. The health belief model suggests that patients won’t change their behaviour if they don’t believe they are susceptible to disease, which makes sense, as behaviour change is hard. If it were easy, every one of us would be flossing daily.

So, how can we expect patients to change?

It is crucial to empower them with the knowledge of what happens in the disease process, what biofilm is and how this is related to disease. Teaching them about their susceptibility to some form of biofilmrelated disease so that they can make more informed decisions about their oral health is doubly important. This often leads to a ‘penny drop’ moment and then behaviour change. I think it’s more than necessary; it’s imperative.

By addressing systemic health factors such as diabetes, cardiovascular disease and autoimmune disorders, clinics also reduce the risk of oral complications and improve treatment efficacy. Systemic and oral health are often intrinsically linked; sometimes, there is a bidirectional correlation.

This is especially recognised in the case of diabetes. Teaching our patients how diabetes can impact their perio risk and disease process and then explaining how this plays into a vicious circle to affect their diabetes can help them see how we need to control both systemic and oral health factors to benefit the stability of both. Collaborating with other healthcare practitioners can improve treatment efficacy outcomes and reduce oral health complications.

Marketing advantages

So, are there marketing advantages to this change in approach? As health-related topics become more widely discussed in mainstream media, we can leverage this and incorporate it into the patient experience, making visiting the hygienist a whole new concept. Creating appointments where patients can learn so much more about themselves and how to prevent severe health conditions can be a vital marketing tool in the practice armoury.

Not all practices have this mindset, so adopting it will set you apart. You’ll be seen as being ahead of the curve and empowering the health and hygiene department to push what they can offer. Being a trendsetter and an early adopter of these new ideas of what a health department can offer is a fantastic marketing opportunity.

A robust referral system that supports the model is key, and collaboration with the relevant outside agencies is essential. At the very least, having protocols in place for referring, if needed, to the right healthcare professionals is necessary. You can’t have these systemic health discussions and finish by shrugging your shoulders if a patient asks: ‘What next?’

Important role

Being an oral health expert and having the confidence to incorporate systemic health conversation into your practice also means knowing the steps a patient may need to take to escalate what you have taught them. It’s worth looking into what local private practices, centres and hospital services are around you. If you carry out health-related checks, like blood pressure, have referral templates if you spot anomalies in results. We cannot diagnose, but we can spot an anomaly and refer.

Dental clinics improve community health outcomes by addressing systemic health, potentially reducing the overall burden on healthcare systems. The average person in the UK sees a dentist a lot more frequently than they would see a GP. Post-COVID-19, seeing a GP is much more difficult, too. We could reduce the burden on the NHS by spotting health anomalies sooner and getting patients referred earlier. This is particularly important for things like blood pressure and diabetes risk.

Also, by helping prevent systemic inflammatory markers chronically circulating for years caused by issues like periodontitis, we can prevent them from causing systemic disease in other areas. We play an important role in optimising general health.

Ahead of the curve

With an increasing emphasis on integrated healthcare and patientcentred approaches, dental clinics must incorporate systemic health as a significant part of their patient experience. This also ticks boxes in meeting patient expectations and being ahead of the curve in delivering high-end dental care.

When the hygiene profession started 70-plus years ago, we introduced scale and polish. Roll on to 2024 and many practices still use the same mindset and tools. This way of treating patients is becoming progressively more archaic. We know more about periodontal disease, biofilm and how systemic disease links with the mouth. We know we need to focus our attention in the clinic on biofilm control for professional prophylaxis and good home care. In addition, we understand this benefits the body and prevents dental disease and tooth loss.

High-end dentistry means a premium comes with a commitment to maintaining high levels of knowledge and understanding and heavy investment in technology to bring our patients the highest levels of care based on contemporary practice and justify the prices we set to deliver this level of care. This is also what a patient expects. Therefore, incorporating systemic whole-body health and integrated healthcare into our practice meets that expectation.

I know I’m biased because I am genuinely passionate about this topic, but I think it must become integral to performing oral health optimisation.

This article first appeared in Private Dentistry magazine. To receive a copy, sign up to Dentistry Club.

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