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Taking an integrated and educated approach to hygiene

Aug. 25, 2016
Wendy Steward, RDH, discusses how successful outcomes are directly tied to patient education.

Successful outcomes are directly tied to patient education

As the mainstream media and health-care consumers begin to hone in on the interconnectedness of the human body, the far-reaching effects of oral health are becoming clear to everyone. The removal of a cavity or the placement of a crown is no longer a localized procedure but rather a systemic treatment that requires an integrated approach. For clinicians, successful outcomes are those in which patients get the treatment they need, along with education about how to improve or maintain their oral health in the future.

In 1993, I started working at Konikoff Dental as a hygienist. As the practice grew from one office to seven with more than 80 hygienists, it became clear we needed many things. We needed someone to ensure our hygienists and dentists were working together as a cohesive unit. We needed protocols in place to help ensure optimum patient outcomes. We needed a unified vision across our entire staff and a communication style that fostered teamwork.

As we worked through this process, we discovered that repetition was key. For patients to understand the value of in-office or at-home preventive treatments, they needed to hear clear, consistent messages from every team member during their visits.

Today, our process is working efficiently. We know that to present a unified front to our patients, hygienists and dentists need to be thoroughly educated about the products we offer. They need a deep understanding of how the products ultimately improve oral health. Mentors are assigned to new employees, who are required to complete training modules with built-in quizzes. Everyone learns our products' instructions for use and how they contribute to successful preventive regimens.

As part of our educational program, our staff learns the science behind products. We always say, "If you feel like you're selling something, you don't really understand it." Take fluoride varnishes as an example. We're not the only ones who stand behind the use of fluoride varnishes. The Centers for Disease Control and Prevention and the American Dental Association Council on Scientific Affairs recommend their use in children and adults who are at moderate or high risk for caries.1,2 Fluoride varnish provides a highly concentrated, temporary dose of fluoride to the tooth surface, allowing exposure to the enamel for an extended period of time. In our office, we use Vanish 5% Sodium Fluoride White Varnish with Tri-calcium Phosphate (3M). We tell patients that this varnish has a unique formula that contains fluoride, calcium, and phosphate, which are components naturally found in their own saliva. We think of the tri-calcium phosphate (TCP) as an intelligent material that delivers protection and helps relieve sensitivity.

At times, preventive treatments-whether in-office or part of a take-home regimen-present challenges for patient compliance. Not all treatments are covered by insurance, and there can be misinformation regarding their efficacy and importance. We make sure that our staff is ready to address any concern by using role playing exercises as part of our training process. Putting ourselves in the patient's position and practicing responses helps us feel prepared.

We've also developed handouts that review the most common objections to hygiene treatments. For example, for patients who don't want to purchase a prescription fluoride toothpaste, we educate them about what causes caries and white spot lesions. We tell them why prescription toothpaste is stronger and more effective than what they can buy on their own. We tell them, "If you're going to brush your teeth, why not do it with something that works?" For educated approach to hygiene adolescent patients, we offer fun flavors like the bubble gum version of Clinpro 5000 1.1% Sodium Fluoride Anti-cavity Toothpaste (3M).

When insurance is an obstacle, specifically insurance related to in-office fluoride treatment, we remind patients that insurance companies can't cover everything. We remind them that prevention is key. This often helps them change their perspective about treatments. Fluoride varnish application and other hygiene treatments such as dental sealants tend to be more affordable than restorative procedures, so patients save in the long run. When cost is still an object, we offer a reduced or free service depending on their needs, because we're confident that the treatment will be beneficial for their health-and ultimately, it's not about the money.

When hygienists and dentists are on the same page and thoroughly educated about hygiene protocols, they can better serve patients by offering consistent and complementing advice. This is a situation that should be in place long before a patient sits in the chair. It ensures hygienists and dentists are aware of their roles and responsibilities, and that they can have productive conversations about a patient's complete oral health while making educated recommendations based in science and practical experience. In-office treatments such as dental sealants or fluoride varnish are not just daily protocols to check off the list; they're an integral part of your patients' current and future dental health.


1. Recommendations for using fluoride to prevent and control dental caries in the United States. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm. Centers for Disease Control and Prevention website. Published August 17, 2001. Accessed July 20, 2016.

2. American Dental Association Council on Scientific Affairs. Professionally applied topical fluoride: evidence-based clinical recommendations. J Am Dent Assoc. 2006;(8)137:1151-1159.

Wendy Steward, RDH, is a 1983 graduate of Old Dominion University School of Dental Hygiene. She is the director of dental hygiene for Konikoff Dentistry, a seven-location dental corporation in Tidewater, Virginia. Wendy serves on the Old Dominion University School of Dental Hygiene Advisory Board, where she is the chair of the curriculum and education committee.

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