With shoes, one size does not fit all, and home-care aids are no different. Dental clinicians recommend a variety of home-care routines and products to help patients improve and maintain oral and systemic health. What might work well for one patient might not be the best choice for another due to compliance, dexterity, and simply adaptation of the aid.
The gold standard is no longer simply brushing and flossing alone to maintain oral health. Individuals have different oral conditions and different needs. Many patients have interproximal restorations, and if there are rough margins, overhangs, or anything that is not ideal to the restoration, patients may be better served with something other than brushing and flossing alone.
Finding the right home-care aids
With many choices on the market, it may take more than one attempt to find something the patient is willing to use, which is the most crucial step. If they don’t like it, or if it is too difficult to use, then it won’t get used at all. We can arm a patient with an arsenal of home-care aids, but if they just sit in a drawer, they are not effective. We need to educate patients on how and why they should use the product we are recommending. Providing encouragement of what they stand to gain or avoid by using a specific aid is crucial for compliance. When I demonstrate the correct adaptation of interproximal brushes or picks to patients as they look in a mirror, many state that they never knew how to use it or they weren’t doing it right and it hurt. Knowledge is power. If patients choose to be in your office, then usually they are invested in their oral care to some degree.
Most of our society does not brush long enough to be thorough. It has been my experience that patients are more effective with power toothbrushes, no matter which brand they choose. The technology does a better job than a manual brush and should be recommended to most patients. The ability of a power toothbrush to adapt in areas that are difficult to reach may influence the choice of a power toothbrush. I usually warn patients that a power brush will take a little getting used to, but if they stick with it, they will soon see results.
Tricks and tips
I have learned great tricks and tips throughout the years while working in both periodontal and general offices. I share these tips with patients to help increase compliance. One of the best tools I have found for the 47% of Americans with periodontal disease,1 and for the increasing number of patients with dental implants, is an oral irrigator. The oral irrigator is a standard recommendation for all of my patients with periodontal disease. According to the American Academy of Periodontology, over 64 million adults in the US have some form of periodontal disease, and in adults over 65 years of age, 70% are affected by it.1 Many patients with periodontal disease do not have optimal home care, and education is the key to success. Simply recommending an oral irrigator without instructions on how to use it sets the patient up for failure. My recommendations include using warm water. It is a simple suggestion; however, it increases patient comfort greatly. Review the adaptation of the tip toward the gum line and encourage the patient to stick with the routine, as it can take weeks to create a new habit.
Like a muscle, the gingival tissue gets stronger when it is “worked.” Sometimes brushing, oral irrigating, and flossing are not the only answers. It can take trial and error for patients to find the best aids. Use of an interproximal brush may be the answer for some individuals. There are many brush sizes and handles to choose from. Whether it is a short-handled Go-Between or a long-handled retracting ParoSlider, dexterity and desire of the patient must be considered. Stimulation of the gingival tissue along with plaque and debris removal around rough anatomy and restorations with an interproximal brush may be more effective than floss for many patients.
Medications are a common cause of xerostomia in our society, often accompanied by undesirable oral effects. Over 400 medications on the market contribute to dry mouth, and medications are implicated in over 90% of dry mouth cases.2,3 Many elderly patients are on multiple medications and are often unaware that the resulting xerostomia can be treated with over-the-counter products. There is a variety of saliva stimulating rinses and toothpastes on the market. Products such as SalivaMax or Colgate Hydris are good options to help decrease the discomfort and caries risk of xerostomia.
It’s how you say it that matters
Always remember to teach and not preach to your patients, as it is human nature to become defensive when feeling criticized. It’s not what you say; it’s how you say it that will be most effective. Discussing home-care products with patients and finding out what they like or don’t like not only aids in communication and trust with your patients, but also allows you to make professional recommendations based on individual needs. For many individuals, it will take multiple discussions and trial and error before making changes in home care. Remember, when it comes to home care, one size does not fit all!
- American Academy of Periodontology. CDC: Half of American adults have periodontal disease. Perio.org website. https://www.perio.org/consumer/cdc-study.htm
- Center for Scientific Information, ADA Science Institute. Oral health topics: xerostomia. Updated July 8, 2019. https://www.ada.org/en/member-center/oral-health-topics/xerostomia
Jamie Collins, RDH, is a clinical practicing hygienist in Idaho and Washington states. She has been in the dental field for nearly 20 years, both as an assistant and hygienist. With a passion for patient care, especially those with higher risk factors, Collins enjoys sharing the tips and tricks of dental profession through speaking and writing. In addition to clinical practice, Collins is an educator, has contributed to multiple textbooks and curriculum development, and contributes as a key opinion leader. She can be contacted at [email protected].