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Serve up OHI with a dose of augmented reality. Wait, what?

April 5, 2018
Patients, usually understandably, can struggle to remember all that you tell them during an appointment. This is an ongoing struggle for dental hygienists and other dental professionals. But in giving oral health instruction (OHI), augmented reality apps can be an excellent tool that helps your patients stay engaged with their oral health and gives them more chances to learn. Hear from one hygienist experienced with using such an app, HP Reveal, in this article.

Have you ever wondered how your patients are doing with their oral hygiene after they leave your office? After all, you spent a good five minutes going over flossing—demonstrating, explaining, watching them practice while you corrected and modified. How do you know that they will remember everything you taught them? Chances are, they may not remember much.

You may have heard that people only remember about one tenth of what they read, and half of what they see and hear. These learning retention percentages are based on Edgar Dale’s learning cone, which has been used in education for decades. (1) However, these percentages were never attributed by Dale, but by an unknown person who added these percentages to Dale’s cone. (2) The percentages are not backed by research, and there is so little research done in the area of learning retention that we have no good data to support that any percentages can be attributed to different modes of learning. (2) Despite all this, as clinicians, we know that our patients don’t always remember what we tell them.

Put yourself in a patient’s shoes for a minute. You’ve been talking to her about periodontal disease or gingivitis, and pointing out areas where her gingiva is inflamed. You’ve been taking intraoral pictures of faulty restorations, and explaining to her that she will need two fillings or a new crown. After you’re finished with the prophy and some oral health instruction (OHI), the dentist comes in and gives her some more information. She walks up to the front desk with a bag full of goodies and pamphlets, and the receptionist starts talking to her about their treatment plan. They discuss insurance benefits, cost, and when to schedule. Your patient has been bombarded with a ton of information in only an hour. She may not completely understand everything she has been told.

As hygienists, we are educators. We know that patient education and good oral hygiene are paramount to good oral health. On many occasions, I have entertained ideas to keep my patients motivated and on track with oral hygiene. I have wanted to be an oral hygiene coach, but seeing patients every three to six months doesn’t seem often enough. I can’t count the number of times I have heard patients say, “Well, I was really good about flossing for the first couple weeks,” or something along those lines.

In August, I finished my master’s in education with a focus in digital learning. My goal was to become a more effective teacher, using technology in the classroom for my millennial learners. I was playing around with a new app for the classroom when it dawned on me that it could be a powerful tool for delivering OHI to patients at home. It’s called HP Reveal (formerly known as Aurasma), and it’s an augmented reality program. Using the HP Reveal app, you can become a patient’s personal daily OHI coach.

Give it a try right now. Download the free HP Reveal app on your phone, create an account, and then follow me at NCruz (later, when you create your own, you’ll have your patients follow you instead). You can do this by typing NCruz in the search bar at the top of the screen, click on my picture, and then tap “follow.” Here are instructions on sharing content on HP Reveal.

Now, scan the image below that reads “Floss Like a Boss” using the app. You should see a video on proper flossing. This is called an aura, a video overlay connected to an image. If the image isn’t tracking well, try scanning the same image on

You can make your own videos, which I recommend because it will personalize the experience for your patients. You can also use videos that already exist on YouTube or other sites. To download videos from YouTube to your laptop, you can use a website called Then you can upload it to HP Reveal when you’re ready to create an aura. If you’re not comfortable making videos or auras, you are welcome to use mine. For a tutorial on creating auras, click here.

It’s easy to use, but I ran into issues that I learned to fix after playing around with the app. Here are some tips. Create your auras on a laptop or desktop, make sure your auras are public (not private). If you get messages about your trigger images when you’re creating the aura, try a different picture, as the image may not be good enough for tracking. Also, use black and white images unless you are planning on giving your patients color copies. I like to print my images on stickers, but they have to be large enough for the app to track. I found that a 1” by 1.5” image works well. Before dispensing to patients, practice scanning the image to ensure it is working correctly.

Here is how this can work for you in your practice: Put stickers with your trigger images on the floss that you dispense to patients. You can do the same thing with toothbrushes or adjunctive aids that you select. Or, you can make OHI pamphlets with your trigger images on the paper and give it to your patients. Help your patients find and download the HP Reveal app and have them follow you. Now, when a patient is ready to floss at home, he can scan your trigger image and watch your video. You can even change your video periodically to keep things interesting for your patients, so they’ll want to keep scanning and learning.

OHI is the most valuable gift you can give your patients. Using an app like HP Reveal, delivering OHI at home continuously to them can be a reality. Your patients will be impressed that you took the time to do this for them, and the novelty of the app might keep them interested enough to get them flossing every day for more than two weeks! I encourage you to make your own auras and image stickers, but if you would like to use mine, visit and click on “OHI.”

Editor's note: This article first appeared in RDH eVillage. Click here to subscribe.

1. Anderson HA. Dale’s Cone of Experience.
2. Janoska L. What really is the cone of experience? eLearning Industry website. Published August 28, 2017.

Nicole Cruz, RDH, BSDH, MEd, graduated from Lamar University with a master’s in education with an emphasis in digital learning and leading. She completed her BSDH at Northern Arizona University after obtaining her ASDH from Southwestern College in 2003. She is currently a full-time professor of dental hygiene at Concorde Career College in San Antonio, TX. She teaches dental radiology, oral embryology and histology, law and ethics for the dental hygienist, oral pathology, periodontology, and board review. She can be reached at [email protected] or by visiting her website,