Phase seven: Behavior modification
Dental hygienists are periodontal management specialists within the general practice.
by Beverly Maguire, RDH
Dental hygienists are periodontal management specialists within the general practice. Unfortunately, excellent clinical care by the periodontal therapist alone does not assure complete health for patients. Without the cooperation and co-therapy of the patient, our best efforts may produce only limited results. Effective homecare is the key to long-term periodontal success. Disrupting daily plaque is the patients' responsibility, while detoxifying pockets is our professional role. A successful partnership is essential to ensure total oral health.
The role of homecare in managing periodontal disease cannot be overstated. However, merely telling patients what to do or even demonstrating technique to them seldom produces the needed results. Many years ago, I began to work hands-on with homecare instruction. Devices were no longer in my hands, but in the hands of the patients! The myriad dental aids and devices on the market today are only as good as the effectiveness of the person using them. Too often we assume that because patients have been under our care for many years that they are adequately aware of the proper techniques. Not until I put these devices in my patients' hands did I begin to understand how ineffective my teaching techniques have been. Most patients simply cannot hold dental floss correctly, much less use it subgingivally. Powered toothbrushes are effective and gaining in popularity, but have you ever watched what many patients do with them? Most move too quickly, press too hard, and brush too high on the tooth, missing the gingiva entirely. Why do we expect good oral health when patients cannot manage these tools properly? It is our professional responsibility to teach proper technique. Dispensing instruments in our own practices with hands-on instruction is the ideal approach for our patients and our practices.
The role of "personal oral trainer" is perhaps one of our most important. Behavior modification and oral hygiene instruction simply are not the same. "Behavior modification" means that patients truly change their daily habits affecting their oral status. Several of my patients have been willing to participate in smoking cessation, a critical behavior that impacts both periodontal and general health. Two patients in my practice reported that their husbands began brushing before bedtime for the first time in over 40 years! How about the patient who swore he could never wear the night guard, in spite of the severe damage being done to his clinical crowns and supporting bone from his intense grinding and clenching while asleep? All of these patients eventually succeeded in changing their behavior and it has impacted their periodontal status and prognosis. Is it the end of the story? Unfortunately not; therefore, hygienists must continue to monitor, re-motivate, and re-train patients as they lapse, relapse, and collapse with their dental routines. Count on it, plan for it, and keep teaching hands-on. It is a never-ending process. But as more and more of your patients succeed with their co-therapy, you will see more of them each day with zero bleeding points. It is truly possible to see improvement on a daily basis; the key factor is homecare effectiveness. Until you consistently have patients walking in and out of the office with their powered brushes in tow, and you see them demonstrating various techniques to their hygienist, it's likely that not much will change.
Behavior modification plays a critical role in patient oral health; it's a lifetime management issue. Although not every patient is a success story, many of them are. It's worth the energy and time expended to address this critical link in the periodontal puzzle.
Beverly Maguire, RDH, is a practicing periodontal therapist. She is president and founder of Perio Advocates, a hygiene consulting company based in Littleton, Colo. She can be reached at (303) 730-8529 or by email at email@example.com