Preventive dental hygiene: Are we really doing all we can to disrupt dental disease?

There’s lots of talk about non- or minimally invasive dentistry. Products such as silver diamine fluoride or Curodont Repair offer treatment options that don’t require a drill, allowing practitioners to arrest decay without simply putting a “watch” on it and waiting for disease to progress. What if we had the same thought process in dental hygiene?

Sure, most of the treatments we provide are minimally invasive, but are we truly intervening in the early stages? Are we getting laser-focused when there are multiple bleeding spots or a trend in cavities? Or are we giving the same brush and floss lecture, handing them their goodie bag, and sending them up front—only repeat the same thing in a few months?

What if we could prevent disease more often instead of just treating it? With a few exceptions, most oral conditions are preventable with early intervention. Many clinicians feel limited by time constraints, insurance, office policies, and patient buy-in, to name a few barriers. We could spend an entire hour on just education and never pick up a scaler, but what would we bill?

How can we hygienists make the most of our precious minutes with a patient and help them see the value of prevention? These four concepts are familiar and easy to implement into your hygiene flow. When patients understand their condition, they can reverse or prevent early disease.

Also by Amanda Hill: Lead shielding for x-rays: A thing of the past?

Papillary bleeding index (PBI)

PBI is my new favorite and a surefire way to help your patient see that their gums do, in fact, bleed and that it’s a problem. I learned about PBI at a conference where James Hyland, DDS, BSc, owner of OraVital, was lecturing. After the medical history update, vitals, and oral cancer and airway screenings, hand the patient a soft pick or a small interproximal brush and have them insert it between their teeth. Let them see in the mirror where it bleeds and note the number of bleeding spots. No longer are you the one making them bleed with your pointing tools; they can see that there is inflammation for themselves.

Disclosing solution

Time to go old school and grab some disclosing solution. I often hear objections from hygienists about using this. Either they are triggered because it was used to lower their grade in hygiene school, or they’re worried about the mess it will make. Like anything, you'll get better at it with practice. If you’re in the habit of getting it on patients’ lips, use Vaseline first. Retractors are also an excellent tool for keeping the lips away from the solution.

Using a disclosing solution is an excellent teaching tool. While applying it, let the patient know how it works. Depending on the brand, it might stain plaque in different colors based on the age of the plaque. New plaque is one color, plaque older than 48 hours another, and some even show acidic plaque in a different shade. Gone is the excuse that they didn’t have time to brush after lunch. After applying it, sit the patient up, give them a mirror, and stop talking. Let them discover where they’re missing and then ask if they’d like some tips on how to reach those areas. We often assume patients know how to brush, but they might need some help. In my experience, patients are determined to see fewer colors when they return for their next visit!

Probe out loud

Saying probing depths out loud is not a new concept. It’s simple and effective, yet during jam-packed appointments is frequently skipped. Voice-recording probing tools are improving their technology every day. If you are lucky enough to have one, use it. If it confuses you, get training. I see way too many of these collecting dust on the counter. Even if you are rolling back and forth to a keyboard punching in numbers yourself, say them out loud. That way, when you sit the patient up to discuss your findings, they are there for the diagnosis. It doesn’t seem like it’s coming from out of the blue.

Interdental cleaning beyond floss

I chose the term interdental cleaning on purpose. Hygienists have gotten a bad rap for our flossing lectures. For some reason, we’ve convinced ourselves that flossing is the golden ticket to a healthy mouth. While I’m not discounting floss, there are other ways to clean in between the teeth, and it’s time we embrace them and set our patients up for success. How else will they manage those bleeding spots when the biofilm is busy replicating between their teeth and they just don’t have the c-shape curve right?

Get comfortable recommending interdental brushes, water flossers, and tray therapy with hydrogen peroxide gel. So many of the companies that manufacture these products offer lunch and learns and will give you samples or professional pricing.