Perio Reports Vol. 26, No. 6
|Perio Reports provides easy-to-read research summaries on topics of specific
interest to clinicians. Perio Reports research summaries will be included in each
issue to keep you on the cutting edge of dental hygiene science.
|Is Dental Disease Preventable; What Do People Believe?
It’s a simple yes or no question—are caries and periodontal
disease preventable? According to the research, dental disease
is preventable. Oral hygiene instructions given by dental
hygienists focuses on prevention, but do clinicians and the
general public really believe dental disease is preventable? One
dental hygienist was convinced that dental disease was preventable
and that with the flood of health information today
and the detailed instructions of dental hygienists, patients and
the public would surely agree.
Several groups were asked individually the yes or no question.
While traveling internationally from California to Hong
Kong and then to Thailand, the question was asked of fellow
business class travelers, airline personnel and others encountered
over a two-week period. A simply tally was kept. Of a
total of 60 people, 45 people or 75 percent responded, no,
dental disease is not preventable.
Back in the U.S., the hygienist set up a blind tally approach
to patients in two dental practices. Patients were invited to
mark a slip of paper either yes or no and place it in a ballot box.
In a practice where the RDH had worked for 10 years and provided
extensive oral hygiene instructions and education, 47 out
of 60 (78 percent) circled no. In another practice in a more
rural area, 54 out of 55 patients (98 percent) responded no. In
a small group of five dental hygienists, five out of five said no,
citing risk factors and genetics as reasons.
Clinical Implications: It’s an interesting
question to answer yourself and ask your
family, friends, colleagues and patients what
Gordon, A.: Is Dental Disease Preventable or Inevitable? OHU Action Research 9A-
Oral Health Coaching via the Internet
According to the research, patients remember only 40-80
percent of what they are told in a clinical setting and 50 percent
of what is remembered is incorrect. Much of what dental
hygienists provide patients as oral hygiene instructions is
actually coaching. Many forms of coaching are popular
today, including athletic, academic, leadership, management
and life coaching. With each comes a price tag and the expectation
of improvement of some sort.
Oral health coaching in the traditional dental office setting
is generally cut short because of time and the coaching
is offered free of charge or included in the DH visit fee. To
achieve better oral health for her child patients and to take
more time to coach and educate, one RDH offered the parents
of these patients online coaching from their own home.
Three questions were asked of the parents pre- and postvideo
coaching. The questions were: 1. Do your children
brush their teeth regularly? 2. Do your children understand
tooth decay? and 3. Do your children think tooth decay is
preventable? Nine children from four families participated
in four coaching sessions. The first covered dry toothbrushing,
the second xylitol, the third bacterial biofilm and the
caries process and the fourth reviewed all topics and techniques.
Each session was 15 to 20 minutes. The children
seemed interested and engaged in the four coaching sessions
Pre-coaching, six believed tooth decay was not preventable,
none of them knew how a cavity formed and only one
brushed regularly. Post-coaching, nine believed tooth decay
was preventable, seven knew the cause of tooth decay and all
nine brushed regularly.
Clinical Implications: Technology provides new ways to share oral health information and coaching.
Parton, S.: Oral Health Coaching. OHU Action Research 9A-13, 2014.
Risk Assessment into
Caries management by
risk assessment (CAMBRA)
has received a great
deal of press and scientific
focus lately. Identifying
caries risk factors and
developing a therapeutic
or preventive program are
now considered the standard of care. However, implementing
this protocol into an already busy general dental practice can be
challenging. It all depends on the attitudes and willingness of
the dental team members.
It was decided by a large, national dental practice group to
implement a modified caries risk assessment into their many
practices. A dental hygienist who regularly coaches and trains
the dental teams was given the task of implementing the new
protocol and providing the education and coaching necessary
for success. Reviewing the outcomes for two of the first practices
involved showed conflicting results.
To measure success, a chart audit was performed for each
practice. The practices were similar. In one practice there were
three dentists and three RDHs. The other had two dentists and
three RDHs. Both practices received a two-hour continuing
education course on the topic and four follow-up visits. In each
practice 15 charts were audited for completed caries risk assessment
forms and evidence of preventive planning.
One practice was successful implementing the risk assessment
with 11 of the 15 charts containing the forms and treatment
plans. In the other practice, only one of the 15 charts
contained a form that was only partially completed. The first
office bought into the plan, the second one didn’t.
Clinical Implications: Implementing change is not always
quick and easy. Involve the team and ask what they each
think, want and are willing to do.
Kowalczyk, A.: What Factors Contribute to the Successful Implementation of a Caries Risk Assessment Protocol
into the General Dental Practice? OHU Action Research 1A-13, 2013.
Why Patients Don’t Schedule
In a practice near Cardiff, in Wales, a dental
hygienist was being integrated into an existing
practice. However, the patients, after
seeing the dentist for a complete exam, were
not scheduling with the RDH.
To determine why, a questionnaire was
designed to get anonymous feedback from the
patients. Forms were provided at the front
desk and a box for depositing them. After one
week, not one form was completed. The front
desk person was then asked to hand each
patient a form and request feedback. The box
was moved near the door, so they could drop
it off as they left. This was more successful in
getting patient feedback.
Through this process, the RDH listened to
how scheduling with the RDH was presented to
the patients. This appointment was left to the
patient’s discretion. The receptionist was asked
to say “the dentist recommends you schedule an
appointment with the dental hygienist. Our first
opening is this date.” This small change
increased patient acceptance significantly.
The patient feedback indicated a variety of
reasons for not scheduling: anxiety, finances,
lack of understanding what an RDH is, not
knowing there was an RDH in the practice
and lack of time. Based on this feedback, several
changes were made. Brochures were provided
to new patients and put in the reception
area explaining dental hygiene. A financial
plan was introduced that made it easier for
people to accept treatment. To deal with anxiety,
more questions were asked of patients
about their past dental experiences.
Clinical Implications: Asking patients what
they want and why they don’t accept treatment
provides opportunity to make necessary
changes to the practice.
Oakes, K.: Following a Dental Examination Why Do Patients Decline to Make
an Appointment with the Dental Hygienist. OHU Action Research 1A-13, 2013.