'Floss every day? Really?' Part 1: Understanding the barriers

I am writing this article because over the past year, I have been working in different environments with different protocols for patient care. Regardless of how innovative and thorough some practices have been, I conclusively get the following responses from clients when discussing flossing: “I have never been shown that before," “No one has ever explained that before,” or “Wow! That makes so much sense. I didn’t even think of that."

Now, I am not throwing anyone under the bus here. We have all been in situations where time has been limited or doing something different may be discouraged. I am, however, throwing a bone here!

We are in a time where we are getting sicker as a population and busier and more stressed. Unfortunately, even though information is free, we just do not have the time to spend finding everything that we are looking for, so we tend to fall into a one-size-fits-all paradigm and just trust that "this drug will solve my problem." To add to that, most people are not really giving thought to their bleeding gums. Because let's face it, gingivitis is normal. Or so people think!

So, the 45 minutes we have one-on-one with our patients is an opportunity to really help them move forward in improving their health with very little time exerted and very much impact available.

Here is the question that I propose: Why is it that a person regularly schedules his or her recall visits as directed and without much hesitation? But every time we start an appointment, we hear the answer to “Have you been flossing?” as either “Well…I started doing it every day for like two weeks after my last visit, but then it kind of stopped,” or, “Not as much as I should be.” Yet we finish every appointment with, “Here is a new toothbrush and some floss. Make sure that you start flossing daily so that in six months when you come back, there will be no bleeding and less discomfort...”?

It comes down to a few reasons that I believe are very important to consider. These are things that I now look for in my practice daily with patients:

• Their understanding
• Their value
• Their time

Let's consider these ideas individually.  

Barrier No. 1: Their understanding

As dental hygienists, we have been educated on the importance of flossing. We understand the impact it can make on our overall health, and we know exactly how it should be used. We then try to convince the client to do it daily because we know it should be done. But consider these questions:

• What if a client does not understand how bacteria create a host response?
• What if they do not know there is a sulcus?
• What if they do not know that bleeding gums signal inflammation that can lead to chronic disease?
• And what if they straight up do not even know how to floss?

I challenge you to consider how you can remove this barrier for your clients.

Barrier 2: Their value

As hygienists, we tend to have the inclination to be meticulous. We are cognizant towards the cleanliness of our environment, and we care for our bodies in terms of nutrition, movement, and self care. However, the majority of the population is sick because of its lack of attention to these aspects of health. People can value many things, and that is perfectly their right, but how can we assume that it  should be their priority too! So, for someone who gets comfort in sugary food or security from falling asleep in bed, how can we say that they should instead be getting out of bed to floss or skipping the dessert because they are high risk for cavities? If they do not value flossing, they will not floss regularly. And because we don’t know what we don’t know—they may never value it!

I challenge you to figure out why they do not prioritize it.

Barrier 3: Their time

As a hygienists, we  understand the importance of flossing. But I will be honest, I have forgotten to floss. It's maybe just one day sometimes, but I have also slipped to probably as long as two weeks. (Whaaaat...?! Truth!)

We have so many demands on our time now, that everything we do is a cost to our time. I do not have kids to tend to daily, so thumbs up to all of you that have found balance with that. But I have filled my time with other pursuits and made serious time commitments. We all only have 24 hours a day.

So, when we expect our clients to floss before bed every night, even though it only takes one minute, have we really considered what else they have to give up in order to do that?

I challenge you to consider ways to make flossing timeless.

Tiffany Ludwicki, RDH, RHC, is a dental hygienist and wellness coach. She started Mind Body Mouth to educate and support the public on achieving optimal health and to encourage health-care professionals to collaborate more holistically. She volunteers with both her provincial and national associations in different capacities, and has been an advocate for policy change at multiple levels of government. Find her online at facebook.com/mindbodymouthcoach and mindbodymouth.net.