Oral Hygiene Instructions
This is a piece written for our ASDA Newsletter, "The Occlusal Record". I was asked to write about how oral hygiene intructions should be given. Instead of a directive, or how-to, it ended up as a narative describing the challenges I've faced in giving OH instructions successfully.
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We sophomores have been completing exams and prophies for two semesters now, and I think that it is fair to say that we are becoming more comfortable in our roles in the doctor-patient relationship. Many of us have our routines, now. We know exactly how much time it will take us to prepare the cube, get our supplies, take a complete history, etc. We also know that when we are finished with the appointment, we have given the patient a service. Their teeth are perfectly clean when they leave the clinic. How do we know? We know because it is measurable.
So, the patient leaves with their teeth bright and shiny, did the patient also leave with a better understanding of their oral hygiene? I’m not so sure that my patients have. Many of them lie regarding their habits to begin with, and most have not been excited to have a discussion about it, either. In addition, I haven’t developed any routine for giving oral hygiene instructions. Therefore, with these two obstacles, I can guarantee that I have fallen short, more than once, in my quest to educate patients. Sure, there have been times when I have a patient that acts interested, and nods his or her head after everything I say. And, as a reward for being so attentive? These patients get a full-blown lecture on the finer points of the Bass technique. But, do they retain any of it?
It is our responsibility to give our patients good information, and reminders, regarding brushing and flossing habits. That includes teaching our patients the correct way to brush and floss. How can we measure, or control, the quality of our instruction? One of the first step is to have a script or, what may be more useful, a checklist. This helps to remind you, the doctor, to cover all aspects of oral hygiene, and to cover them equally for all of your patients. Frequency, technique, and reminders to brush all tooth surfaces as well as the tongue, are important topics. Teaching good flossing technique may make it easier for the patient, and increase compliance. The amount of floss to use, what finger to wrap it around, and showing the patient to adapt the floss to the shape of the tooth may make this task easier for them to accomplish.
Finding time to give this education during the appointment is also a challenge. It doesn’t take much time, however. To avoid rushing through it, try giving the instructions immediately after you take the patients history or plaque score. Other good opportunities may be while waiting for a start check from a resident.
Determining the level of understanding a patient has regarding his or her own oral health is an important part of the success our instruction. Giving ourselves adequate time during the appointment to address this topic will make it easier to evaluate exactly where the patient is, and give instructions in an appropriate manner. It may also help to use other resources. The ADA website contains many animations in both English and Spanish. Using our tablet PC’s to go through these animations, or looking at illustrations with our patients gives them a chance to ask questions and they may leave their appointment having a better understanding of good oral hygiene.
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