DT News - UK - Providing thorough oral hygiene instructions in a clinical setting

Theodora Little, UK

Fri. 1 April 2016

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“ITop” stands for “individually trained oral prophylaxis”. You may argue that hygienists deliver this to their patients all the time, right? Unfortunately, with the time constraints placed upon hygienists in the UK, with 30- or 20-minute appointments and many without a nurse, the burning question is, how we are supposed to give patients the essential care, as well as effectively provide thorough oral hygiene instructions?

We mention time and time again that we strive for prevention and that this is key, but unfortunately all there is time for is a scale and polish with a little oral hygiene instruction. We are thus placed in a vicious cycle of patients returning for each appointment with the same oral hygiene as before. Habits remain unchanged. At Curaden Dental Clinic, my hygiene appointments last a minimum of 1 hour. Curaden is a Swiss company, so this is something of the norm for it. The company takes great pride in offering high-quality products and services to patients, which is also why we recommend CURAPROX products. It is not just about their vibrant colours, which initially attract attention, naturally; there is more to the products than meets the eye. CURAPROX uses CUREN filaments instead of nylon, and their manual toothbrush contains 5,460 filaments—approximately 4,500 more than the average manual toothbrush. All of this is included in iTOP, since they only use the best in their training for dental professionals.

I suppose many will say I am lucky to be able to offer hour appointments, but as a practice we want the best for our patients. Our practice focus is prevention, and it is necessary to give time to our patients to achieve this. On occasion, the whole hour is used for iTOP training only, with my main emphasis on educating the patient, starting with the basics. I will discuss products in depth with the patient, giving him or her the full knowledge to understand the benefits of these. I will also brush for the patient, not just a few teeth but all four quadrants, so he or she can feel exactly how it is supposed to feel in each area. I will of course then ask the patient to demonstrate toothbrushing to me afterwards. Usually, I will brush my teeth at the same time, as we can also learn from watching others carrying out the same task (and the patient will feel less self-conscious). With floss and interdental brushes, I do the same and will fill out the full-mouth chart for the patient to take home if more than one size interdental brush is required. Moreover, I will discuss toothpastes and mouthwashes, explaining the advantages and disadvantages, and how to gain the most benefit from them.

You may question why you need iTOP training, since surely you learnt all of these skills at university? You would think that in training to be a hygienist and therapist, the most basic training given would include correct and efficient brushing of teeth. I am somewhat ashamed to say that not once during my time at university did we have intra-oral demonstrations with a manual, electric, sonic or any other toothbrush. Certainly, we had a lecture on the different types of toothbrushing techniques used in the past and the techniques we should use now, and were then told verbally how to use these techniques. We also received slide show lectures from company representatives who left us some samples, but did anyone actually teach me how to brush effectively? How do you really know until you feel? You’re just supposed to know, right? Who taught me? My parents? And who taught them? Is it just expected that we should know this basic oral hygiene care? Is it just common knowledge? I think not, as I treat many patients young and old and they still do not know how to brush correctly. I was trained as a hygienist and therapist and I did not know, nor was I shown at university, until I completed iTOP courses.

I have now completed my iTOP beginner and advanced courses and will hopefully attend the teachers’ seminar later this year. Going through this programme, I started to realise that correct, effective and thorough toothbrushing is somewhat of an art, and it should not be dismissed so easily. It is also something that should not be rushed; great care and time do need to be taken to change a patient’s habits. Of course, many may argue that patients will not want to spend x amount to receive oral hygiene instructions and that one cannot teach an old dog new tricks. I agree to an extent; however, once one has gained a patient’s trust and he or she understands the value of this service, the patient will be more than happy to accept. We all understand how important it is to communicate well with our patients, and this combined with sufficient working time, allowing for iTOP, is one of the greatest factors. Not only are my patients satisfied, happy and grateful, they are also shocked that they have never had training on how to brush properly. As a hygienist and therapist, I too gain enormous job satisfaction and can honestly say I love what I do.

I would encourage my fellow dental colleagues not to disregard the importance of being taught how to brush correctly until you have had iTOP training. It opened my eyes and made me feel the difference, and now I can pass my oral hygiene knowledge on to my patients, because I believe my service should include more than just cleaning their teeth for them.

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