'Floss every day? Really?' Part 2: Breaking the barriers

Now that you understand the barriers, here's how you break them.

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Why is it that most patients will happily make recall appointments, but seem to never be able to commit to flossing? (And why is it that although we know this, we still approach the issue the same way at the end of each appointment?) I began to examine this question in part 1 of this article, “'Floss every day? Really?' Part 1: Understanding the barriers.”

If you have read part 1, then hopefully you have thought of ways to share your understanding in meaningful ways with clients so you can be instrumental in their success to better oral and overall health. If you struggled with ways to communicate with your clients, don’t worry—we all do. This article is here to give you ideas on how you can change the dialogue for their next visit.

If you have not read part 1, I encourage you to read it first to fully understand and benefit from this article. It has the background to why we always “lecture” the same information. My last article provides the basis for client compliance or lack there of.

So, here lies my answer, and it may not be perfect, but I have noticed such a profound impact from using these strategies that I thought it important enough to share my secrets!

Breaking barrier No. 1: Education

I base my education on the severity of the client’s situation. If he or she cannot remove plaque adequately, and has never flossed before, well, I start with only educating on the brushing technique. Why stress flossing and set a client up to fail every visit? Instead, make baby steps. Here are some steps to accomplish little goals and carry your patients further with every visit. You do not have to follow the steps in any particular order, as you will choose based on your client’s needs and situation:

  1. Proper brushing technique (this can be with or without a power brush)
  2. Interdental brushes
  3. End-tuft brush to access hard-to-reach areas
  4. Floss picks (right-angled ones, of course) or floss handles
  5. Water flosser
  6. Flossing (woo-hoo—you got this far!)

Teaching the patient the technique is one part of the equation. Now, explaining why to do it is equally as important. This is when the mirror is really impactful.

I have been using a lake or fish tank as an metaphor for the mouth, and then carry that into how it impacts the whole body. I demonstrate the flossing technique and take time to show the patient the sulcus area. I explain how if we don’t open that area, there is no oxygen, and good things need oxygen to survive. Without the oxygen, the bad bacteria will start to take over, and if not disturbed by the mechanical aspect of flossing, the bad stuff will multiply. This is like the difference between a flowing healthy lake and a stagnant swamp. Then, the body recognizes the swamp-like area and tries to fix the issue. That is when we see swelling, redness, and bleeding. The problem however, is bigger than just preventing cavities. Once this happens, our bodies don’t know how to effectively kill the bad stuff, and in turn, it starts attacking our own gums and jaw bones in the process, and it allows for the bacteria in our mouth to flow into the body through the passageway that the blood comes out of! We then have the bacteria affecting our heart, brain, lungs, and joints. It is now a whole body issue.

So, now that patients can understand why we care so much about them keeping up optimal oral health care, we need to personalize it to them. Have them value it based on where they are right now.

Breaking barrier No. 2: Value

Of course we tell a patient that he or she needs to brush and floss, and hopefully now you understand why we need to show and explain why also. But, do we create stories like the example above to help the patient understand? Do we make an impact on his or her perception of its value?

I always give my clients a hand mirror, and I encourage them to see the “before picture,” pointing out areas of concern, and at the end, they watch me floss as I explain my rationale for flossing. So, what do I tell them? Well, it depends on the person, but here are some examples:

Kids: “If you don’t want cavities, you have to brush and floss the plaque bugs away. Otherwise they will build little cities around your teeth and start digging into them, like they are digging for treasure. But, because your teeth are alive—yeah, they are alive which is pretty cool—they can get hurt, and then you start to feel the pain.

Teenagers: “You now have all of your adult teeth, teeth that need to last you 100 years. We eat a lot of sweet treats and drink pop or energy drinks at this age of life, and that really starts to impact our teeth in negative ways. It can take a little bit of time before cavities actually appear on your teeth, and you might not be so lucky as to have dental insurance when this happens. So, you don’t have your parents to pay for the fillings, and they cost hundreds of dollars. You might be stuck having to pay to fix your teeth instead of going out with friends or putting gas in your car!” (Or, you could go a different route and talk about dating—how there could be a girl or boy they like, but if they have bad breath, that might be the factor keeping you as “just friends”!)

Adults: “You are here in order to maintain a healthy mouth and avoid cavities or associated dental pain. What I do is only a temporary step to the bigger picture. If you were to try to lose weight, you would not eat healthy only twice a year and expect to see results. Just like that, you canott expect me offer my services twice a year and be able to stay healthy. It is what you do every day that makes you succeed, that helps you avoid disease and what helps you age gracefully.

Parents: You might have heard, “Well, my mom lost all her teeth at 40 years, so it’s not surprising I have the same issues.” Nope. Although there are factors such as physiology and anatomy at play, cavities are not hereditary. We transfer our bacteria to our babies and kids through daily activities. So, if we clean a pacifier by sucking it, share utensils, chew or even blow on their hot food, you are introducing these bacteria to your baby’s otherwise clean mouth. We introduce the bacteria that causes cavities, the most prevalent and accepted disease.  

We can come up with stories or examples based on our own experiences, and since we all learn differently, we can share our examples with others to increase our ability to reach our clients. With that, we might even be more successful with compliance, because the next barrier might be the hardest challenge in today’s busy world.

Breaking barrier No. 3: Time

As I mentioned above, we all only have 24 hours per day to work with, and hopefully out of that we are spending at least 8 hours sleeping. We are expected to spend half of the leftover 16 hours at work. We then have to factor in the time for commuting, eating, showering, and using the restroom—yes, those things take a lot of time and cannot be outsourced, and we also need to cook, clean, do homework, and care for children and their activities. When all is said and done, we then expect patients to floss their teeth. Their physiotherapist expects them to stretch, their optometrist expects them to exercise their eyes, and their physician expects them to take their medications at specific times of the day. How exactly will we find the time for all of that? And why exactly do we have the right to judge the client or make them feel guilty for not flossing? So, my approach comes with this perspective. That we all have to balance what is right for us at this moment in time. For example, have you ever wondered why one sibling has a ton of cavities, but under the same circumstances, the other has none? Well, we are all unique, and flossing could be more advantageous to one person than another. One person may be more susceptible to periodontitis, where another person is more susceptible to diabetes or heart disease. Each person than has to weigh out their overall risk factors and choose their lifestyle and practices accordingly.

We need to keep an open mind on how we communicate with our clients, how we respect their decisions, and how we build trust with them. Because, at the end of the day, it really doesn’t matter to us what they do with this advice. But from my standpoint, if I don’t share my knowledge in a supportive way, then it will not be received, and then I am going against my professional ethical duty to make an impact on their oral health.


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.

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