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Profile in Oral Health by Trisha E. O’Hehir, RDH, MS

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by Trisha E. O’Hehir, RDH, MS

Do you ever feel like a science professor talking to your patients? The more research you read, the more you know about infection, inflammation, pH and the oral-systemic link, the longer your discussions with patients take; the story just gets longer and longer.

According to communications expert Joan Horbiak, the average person can only process three messages at one time and remembers less than 10 percent of the information received. Television audiences are bombarded with repeated messages. Advertisers know that it takes seven to 15 times for a message to hit home with a listener. We only see our patients a few times each year, and our messages are often buried deep in the tangle of information we feel obligated to share. No wonder dental disease is still prevalent. The prevention message is getting lost. If patients are only remembering 10 percent of what we tell them, is it the 10 percent we want them to remember?

We need a new strategy to get the important, bottom-line messages across to patients during busy, time-constrained appointments. Marketing experts get their messages across using sound bites. They shrink the messages to just a few words and repeat often.

Mark Twain talked about the idea of sound bites before the term was coined. He said, “a minimum of sound to a maximum of sense.” By isolating a short phrase that is easy to remember, it helps the phrase better stick out in a person’s memory.

Many sound bites stand the test of time, being recognized decades later. Some include:
“Just do it!” –Nike
“Brings good things to life.” –GE
“We try harder.” –Avis
“Don’t leave home without it.” –American Express
“Think Different” –Apple
“I’m lovin’ it.” –McDonald’s
“Melts in your mouth, not in your hand.” –M&M’s
“A little dab’ll do ya.” –Brylcreem
“The Few. The Proud.” –U.S. Marines

Learning from successful advertisers, we can sculpt messages and repeat them during dental visits, thus competing with today’s overload of mass media messaging. Sound bite messages are perfect for communicating oral health messages.

Sound bites need to be positive, clear, simple, brief, ask for specific actions and be repeated several times during the visit to have the greatest chance of being remembered. One of my favorite sound bites is “start cleaning in between.” Last month’s Profile in Oral Health discussed toothbrushing and how the interproximal surfaces are at greater risk of disease than brushing surfaces. Based on this scientific information, our first message to patients should be to clean between the teeth before toothbrushing.

Let’s check to see if this sound bite “start cleaning in between” fits the rules for an effective marketing message. The message is positive and clear. It’s simple, and brief, only four words. The message also asks for a specific action: to start the cleaning process between the teeth, not with toothbrushing.

You can use sound bites to present oral health advice, caries risk assessment findings, periodontal disease information and a variety of treatment options. Keep it simple, short and a positive call to action. Here are a few of my favorite oral health sound bites.

Strive for Five Xylitol Exposures Each Day
Xylitol is a natural sugar produced in small amounts in our bodies every day as part of glucose metabolism. It was first harvested from the bark of trees and is currently extracted from corncobs and corn stalks, but not from the corn itself. It tastes just like sucrose, has fewer calories and a slight cooling sensation that stimulates salivation.

Adding at least five grams of xylitol, five times daily is a good idea for everyone, not just those at risk of caries. It makes sense for people who want to reduce the bacterial biofilm in their mouth and sinuses. Daily xylitol consumption after meals and snacks will prevent acid production by oral bacteria and thus reduce plaque biofilm accumulation. Preventing the first carious lesion begins with changes in the oral health of mothers, who pass their oral flora to infants through saliva. Research by Dr. Eva Söderling and summarized in Perio Reports this month confirms this important primary preventive strategy.

Finland was the leader in endorsing and supporting the use of xylitol 30 years ago. Since then, many dental and dental hygiene associations around the world have endorsed the preventive benefits of xylitol. Recently the American Academy of Pediatric Dentistry joined this movement. For more details on this, read the summary in Perio Reports this month.

Eat Bacteria Twice a Day – in an Oral Probiotic Mint
Probiotics are live micro-organisms that confer beneficial effects on the balance of bacteria, not just in the intestines, but also in the mouth. Some strains of the good bacteria produce antibiotics that destroy the bacteria responsible for caries and periodontal disease. Probiotics provide the potential for easy, effective ways to prevent dental disease that also taste good.

Over-the-counter products come in many forms: mints, lozenges or chewing gums. Probiotics contain one or more strains of good oral bacteria. Evora products use ProBiora3 containing S uberis KJ2, S oralis KJ3 and S rattus JH145. PerioBalance uses Lactobacillus reuteri Prodentis from BioGaia, a Swedish biotechnology company. BLIS K12, developed by a researcher in New Zealand, is used in several products focused on preventing throat infections. Recent abstracts on the topic of probiotics that were presented at the American Association for Dental Research meeting in March are included in this issue’s Perio Reports section. Probiotics for oral health provide a new and exciting approach to balancing oral bacteria and promoting oral disease.

Start Cleaning in Between
The smooth tooth surfaces at greatest risk for caries and periodontal disease are the surfaces between the teeth, not facial and lingual where the toothbrush reaches. Despite this fact, toothbrushing receives more focus than cleaning in between the teeth. Simply changing the focus from toothbrushing to cleaning in between the teeth will send an important message to patients that proximal surfaces need daily attention. Making this transition goes against the long-held tradition of toothbrushing being the primary focus of oral hygiene. To get patients’ attention, tell them to “skip brushing and start cleaning in between” the teeth. No patient ever expects to be told by a dental professional to skip toothbrushing. Just saying this will get their attention. Whatever you say next, they will hear, so use the opportunity to change the focus to interproximal surfaces.

Floss with Water
String floss isn’t very popular and those who report daily flossing aren’t very effective at removing plaque biofilm. The profession’s belief that everyone should floss with string floss is not based on scientific evidence. We keep telling people to floss, but patients continue to ignore that message. An alternative is flossing with water. Rather than using string, flossing with water in an oral irrigator is an effective way to remove plaque biofilm. Research over many decades shows the effectiveness of the WaterPik Water Flosser to reduce interproximal plaque, bleeding and probing depths. Recently Philips Sonicare introduced the Air Floss as an alternative to string floss, with forced air and water. A comparison of these two alternatives to string floss is presented in Perio Reports this month. The water flosser was more effective at removing plaque and reducing gingivitis.

Dry Brush Inside First
Ask any hygienist where the most calculus forms and you’ll hear mandibular linguals. Ask patients and they’ll tell you the most “digging” goes on behind the lower front teeth. Despite the best efforts of dentists and hygienists to convince people to follow a systematic approach to brushing that cover all surfaces equally, people follow an erratic rather than methodical brushing pattern. This toothbrushing pattern rarely includes lingual surfaces and if it does, only a few seconds are spent there. Printed toothbrushing instructions begin with images on maxillary facial surfaces and leave lingual surfaces to last. Since calculus builds up so quickly on the inside of the lower anterior teeth, simply change the brushing routine to reflect that. Starting the brushing on the mandibular linguals will remove the plaque biofilm before it has a chance to calcify into calculus. Brushing first without toothpaste allows the person to feel with their tongue to make sure all the plaque biofilm has been removed before adding toothpaste. Toothpaste flavors and bubbles make effective plaque removal more difficult. Dry brushing inside first was tested with 125 adults and found to be an effective way to reduce lingual calculus and gingival bleeding. (O’Hehir, JADA, 1998).

Clean Your Tongue
Plaque biofilm accumulating on the tongue is a source of bad breath. In addition to cleaning in between the teeth, perhaps flossing with water, dry brushing inside first, striving for five xylitol exposures each day and eating bacteria, cleaning the tongue is important to ensure fresh breath. Cleaning the tongue also reduces the overall amount of bacteria in the mouth. A variety of tongue scrapers are available for tongue cleaning. The Water Flosser has a tongue cleaner tip to flush and scrape the tongue at the same time. Many people simply use their regular toothbrush, a spoon or a washcloth. While some studies report the tongue scraper superior to the toothbrush, other studies find the toothbrush superior. An evaluation of several tongue cleaning studies confirms that cleaning the tongue reduces bad breath, but it doesn’t report either the scraper or toothbrush better than the other. Simply cleaning the tongue makes a difference. This review article is included in Perio Reports this month.

These are just a few of the sound bites you can use to communicate your message to patients. Before you see your next patient, decide on the sound bite you want them to remember when they leave your office. Remember to repeat the sound bite several times throughout the visit. You’ll feel silly doing this, but how many times have you been introduced to someone and 30 seconds later you’ve forgotten their name? Repeating the sound bite message makes it easier for the patient to remember it long after the visit. Shorten your conversations with patients and target your messages by using sound bites. Have fun creating your own favorite sound bites.
Dentaltown Magazine
April 2024
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