As are many of my colleagues I am totally dedicated to our profession, and in order to give something back, I recently launched my Smile Revolution podcast to help support career development for dental hygienists and therapists around the world by providing penetrating insight into their peers’ career paths.

My podcast interviews explore the views of hygienists and therapists who are happy to share their professional journeys with others. I believe we should always share what we have learnt regarding the many exciting elements of our profession, and there is so much more to explore than the well beaten paths.

Others are so generous in sharing their insights, and, thanks to the nature of the podcast it is accessible anywhere, anytime. It is a resource that the profession can tap into and learn from while on the go. As I said, I love what I do, and 16 years after qualifying I feel so fortunate to have chosen a career that I am still so passionate about today.

Why Smile Revolution?

to read the full article click on the link…

https://www.dentalreview.news/people/58-dentistry-interviews/4673-victoria-wilson-launches-smile-revolution

The Hygiene Market in 2019 – Challenging the words Scale and Polish, Cleaning and Clean within dental hygiene.

Words really do matter …..

Abstract

The realm of communication and behaviour change in dentistry has evolved to be a topic of huge interest.  This has hence lead me to explore further the power of the words we use within dentistry, to communicate to patients and amongst the profession.

Behaviour change tools can be highly effective, in supporting behaviour change within patients oral health and their commitment to their oral care.   Despite this being an area that is supported by extensive evidence based behavioural change models.(1)  There seems to be less supporting evidence in dentistry that focuses on the choice of the words we use to communicate to our patients.

This article explores the supporting evidence for non-surgical periodontal therapy, followed by a discussion on the relevance of the words ‘scale and polish’,‘cleaning’ and ‘clean’.  These words are renowned for being associated with dental hygiene appointments and how this fits into the evidence supporting non-surgical periodontal therapy.   Some clinicians have already implemented changes in their choices of the  words they use.  Despite this being the case it would still appear that the majority of clinicians continue to be in dental settings where ‘scale and polish’,‘cleaning’ or ‘clean’ seem to be some of the most common terms used relating to hygiene treatments.

Discussion

The evidence supporting routine scale and polish for periodontal health in adults.

In summary a recent Cochrane report published in December 2018 included 1711 participants. (2) The author stated that adults without severe periodontitis, that are regular attenders in the dental practice, with routine scale and polishes, the treatment makes little or no difference to their gingivitis, probing depths or the quality of life over a 2-3 year follow up period.  There was also little or no difference in the plaque levels over these two years.  Despite a reduction of calculus with 6 monthly scale and polish appointments over a 2-3 year period the clinical importance of these small reductions was uncertain.

From this Cochrane report, a scale and polish appointment would appear to be up for debate and challenged considering there was no improvement in gingivitis, probing depths, quality of life or plaque levels.

If supra and sub gingival plaque and calculus removal takes place with hand and powered instruments, this done alone does not reduce gingivitis demonstrated in Needlmans’ research in 2015.(3)

The evidence would suggest the standard name ‘scale and polish’ ‘cleaning’ or ‘clean ‘given to hygiene treatments and the approach to treating gingivitis, needs to be challenged.  The focus spent on the obvious- oral hygiene. Hygienists and Dental Therapists are fully aware of the time required and needed for oral hygiene instruction, along with the implementation of effective behaviour change models and results.

In another study focussed on the ‘Patients’ views on periodontal disease; attitudes to oral health and expectancy of periodontal treatment’. (4.) The study was essentially an interview format asking patients about how they felt about their diagnosis prior to treatment.  In the results, patients felt they had a low degree of control over treatment, decisions and treatment outcomes.  In conclusion a degree of vulnerability after patients diagnosis was identified with an emphasis on the need for the importance of communication in dentistry.

It is widely accepted that a preventative program that stimulates patients to adhere to proper oral hygiene habits are likely to resolve gingivitis and prevent the progression of periodontal disease. (5)

Hygienists and Dental Therapists and communication

It is widely accepted that Hygienists and Dental Therapists are renowned for their communication skills within oral health, and within the dental team.  The value of the Hygiene department cannot be underestimated for the crucial role played in engaging patients with their oral health.  Despite this, there continues to be areas within communication to support the improvement of oral health that can be improved.  The implementation of evidence based behaviour change models is certainly successful.

Challenging the words used that support an oral hygiene focussed appointment.

The potential engagement in oral health will undoubtedly be affected with sub optimal communication, and the words that can truly communicate the intentions of the results we wish to achieve.

If the dental profession and dental team as a whole were to universally change the words ‘scale and polish’ and ‘cleaning’ or ‘clean’ to other words more pertinent to the hygiene treatment, is this likely to impact the patients perception and expectation of an appointment in a different way?  It may be accepted that the words scale and polish are currently being misused.

What does a ‘scale and polish’ or a ‘cleaning’ or a ‘clean’ really mean to the patients?

The choice of words are critically important if we wish to convey a clear message to the patients.

Are the words a true reflection of the meaning of the appointment?. If other words were adopted throughout the dental team, to describe the purpose of the treatment, could treatment outcomes be affected in the long term?  Would patients be more at ease and accepting to actively talk about oral hygiene for an appointment?  If patients were prepped accordingly , from all members of the team and they had not been told they needed to be booked for a scale and polish, cleaning or clean how could treatment outcomes be different?

What we say, and how we say it, is significant in the communication to the patients understanding of the significance of periodontal disease.

On speaking to a handful of colleagues that have been qualified on average over 10 years, from posting on social media, the below feedback was sent.  I received a variety of responses all in agreement that scale and polish, cleaning and clean do not support successful treatment outcomes, due to the varied challenges these words bring, and are potentially having a negative impact on our roles and delivery of treatment.

The below are just a few summaries of responses received –

• Patients clock watching, intent on receiving the full scale and polish as that is what they booked for.
• Prioritising a polish over the health of their gums or acceptance of disease
• Dissatisfied if they do not get what they consider to be a full scale and polish that they have been booked in for.
• Patients are expecting a scale and polish and can become agitated when they don’t get this.
• It makes delivering oral hygiene more challenging to deliver for one appointment if the appointment has been labelled a scale and polish, or it is ingrained in the patients head that they are attending a hygiene appointment for a scale and polish.
• A polish is infrequently indicated and it makes it challenging when it is not carried out.
• For years select polishing has been used however the term scale and polish does not reflect this.
• Patients perceive it to often be a cosmetic treatment, requesting a polish. This is not the focus of the treatment, we are treating a disease.
• ‘I’m here just for a clean’. Which undervalues the complexity and value of our role.
• Social media campaigns don’t help either. Adverts for things like charcoal toothpaste drive demand for quick cleans and immediate results and give the impression there’s nothing to it.

Despite feedback being received on these words some hygienists and dental therapists do already use other words to describe their hygiene treatments.

Change will continue to take place as we refine our skill set to continuously improve.

Based on the content of this article so far. Options of new words to use are suggested below :-

• Oral health focused appointment
• Oral health appointment.
• Oral Health tailored care.

These are mere suggestions open for debate, but by changing the words the meaning of the appointment changes. If all members of the team communicate the new choice of words.  Over time it is likely to be possible to change the patients perception and expectations of the appointment.

Ultimately the pressure to perform a scale and polish is no longer there as the appropriate treatment required for that patient, becomes the focus rather than being dictated by the appointment name.

For the purpose of this article and on reflection of the Cochrane review referred to, the results,  do not support a scale and polish.  These could arguably be strong enough grounds to support the implementation of new words to describe a hygiene appointment and what is carried out within the hygiene appointment.

The evidence potentially supports a revision in the name of the patient to be more accepting of an appointment focussed on oral hygiene especially when a Cochrane review including 1711 patients does not support a scale and polish. It is also important to consider how patients felt in the study referenced previously with a low degree of control over treatment, decisions and treatment outcomes.  If patients realised they do have a higher degree of control if they take charge of their oral hygiene affecting the treatment outcomes. Patients attitudes could change.

As with every part of ones professional career path as it evolves it is our responsibility and commitment to learn more that furthers the profession. It is important to never underestimate the value of the instruments we use.

Conclusion

From exploring the evidence supporting scale and polish treatment, additional actions need to be taken to change treatment modalities.  From supporting papers that have been included in this article, it seems a justified time to introduce the terms to accurately communicate treatments.  These terms need to be adopted by the whole team to successfully increase the patients perception and expectation of hygiene treatment.

Refining the choice of words used could be explored further, and additional articles on psychology of chosen words within medicine and dentistry need to be explored further.  There are significant areas of research that could potentially be carried out around this subject matter.

As science and technology change, so should the way in which we educate and motivate our patients through the spoken word.

Author – Victoria Wilson – Dental Therapist – BSc, Dip. DT (RCS Eng.), Dip. DH (RCS Eng.)

www.smile-revolution.net

1.Heatlh Behaviour change in the Dental Practice  – Christoph A. Ramseier and Jean E. Suvan

2. Routine scale and polish for periodontal health in adults – Lamont T, Worthington HV, Clarkson JE, Beirne P – 27^thDecember 2018

3.Professional Mechanical Plaque remobal for Prevention of Periodontal Disease – Needlman, Nibali, Di Iorio – Journal of Clinical Periodontology 2015

4. Patients’ views on periodontal disease; attitudes to oral health and expectancy of periodontal treatment: a qualitative interview study –Abrahamsson KH¹, Wennström JL, Hallberg U. – Oral Health Prev Dent.2008;6(3):209-16.
5. Axelsson P, Lindhe J. Effect of controlled oral hygiene procedures on caries and periodontal disease in adults. J Clin Periodontol .1978;5:133–51

Published in Dental Sky Magazine – https://cdn.dentalsky.com/media/catalog/pdfs/Dental%20Sky%20News%20JuneJuly%202019_Web.pdf

So happy with my six page spread in the local NCT magazine for Tunbridge Wells.

To read full article please see below – 

Victoria Wilson, Dental Therapist, founder of Baby Smile Revolution, and mummy of two baby girls shares practical tips on how best to look after your babies’ teeth.

As a dental therapist and mummy of two baby girls, Sophia aged 2 and Alice nearly 1; I am frequently asked by other parents on the do’s and don’ts for their babies’ teeth and how to maintain oral health in general. Ultimately caring for your babies’ teeth is one of the most important responsibilities as you become a parent. Being a new parent has certainly been the most wonderful thing that has ever happened to me. Yet, on speaking to other mummies, realising I am not alone it has been one of the most overwhelming things at the same time.  I decided to write an article for NCT magazine as a little resource for their Christmas edition and for other parents, as we approach the festive time of year when we are tempted with even more treats than any other time of year.  I intend for this article to be broken down into the key facts to consider, and a realistic practical resource on babies’ oral health from one parent to another who really understands the daily challenges that being a new parent can bring.

For the avoidance of doubt to clarify, a Dental Therapist is essentially a dental care professional who carries out routine preventative and restorative dental care for adults and children.

As you can imagine my professional life influences me to easily become obsessed with my daughters’ tooth brushing habits and what they eat. I am not OCD, at least I try not to be, but it is a huge priority in our house.  The irony being due to my obsession and intent to tick all the boxes on the do’s and don’ts to achieve oral health for my girls, my first daughter officially has the sweetest tooth in the world!  I certainly did not sign up for this challenge or nurture it intentionally, however it just proves each parent has their own individual trials and tribulations to overcome as we strive for optimal wellbeing for our babies.

Due to my role in my professional life and my number 1 role of being a mummy in my personal life I am now on a mission to help support other parents in the pursuit of oral health for their children.  I hope you find answers and practical solutions in what I write.

So what are the facts that parents need to know?

Why are milk teeth so important in our babies’ mouths?

Why is it so important that they are looked after?

Essentially, they maintain the space for the adult teeth to enter the mouth, as well as aiding with eating and speaking.  Since the enamel of milk teeth is thin they are more at risk from being affected by tooth decay and erosion.

What should parents do as soon as a milk tooth appears in the mouth?

• Begin brushing your babies’ teeth at least twice a day for 2 minutes, with ONLY a smear of fluoride toothpaste. Check the toothpaste has no less than 1000ppm fluoride for ages 0-3.  It is recommended to brush them last thing at night and one other time in the day.
• Book an appointment to see your dentist as soon as their milk teeth come through.
• The last thing to touch a baby’s teeth before they go to bed should be a fluoride toothpaste.
• Cut down on sugary foods and drinks.
• Sugar free medicines are recommended.
• Encourage your child to drink from a free-flowing or open top cup from 6 months of age, and from age one year feeding from a bottle should be discouraged.
• Once your baby is old enough to drink anything other than milk, water should be the only drink encouraged.

Real life practical tips

Buying the right toothpaste.  Frequently it is overwhelming when you go shopping looking for specific things for your babies.  Do be careful when buying your baby’s toothpaste as not all toothpastes contain the recommended 1000ppm of fluoride, for this reason I have devised a list of some toothpastes to look out for in the supermarket that contain exactly 1000ppm that babies can use between 0 – 3 . This list is provided as information only and is NOT endorsed by any particular brand, merely some children’s toothpastes that are available.

Asda – Protect 0 – 3 Milk teeth.

Aquafresh – Milk teeth 0 -2 years

Boots – Smile Kids 2 – 6

Colgate kids 0 – 3

Dr Fresh Thomas the tank engine

Kokomo – Hello Kitty

Sainsburys own – Kids toothpaste 0 – 3 

What does a smear of fluoride toothpaste on a tooth brush look like?

How to avoid brushing becoming a battle?

Practical tips on how best to install good tooth brushing habits.

The brushing battle becomes a topic of conversation frequently amongst friends and other parents and has been for years with patients.  So I have done my best to avoid this in my own household.

My number one tip is, always make brushing fun, and keep it as fun as possible to avoid it ever becoming a battle.  Some may say ‘easier said than done’, and this is very true as brushing before bed when the babies are tired can be a challenge.   On occasions, it has certainly turned into a battle in my house.  Yet predominantly I try to keep it as fun as possible.

Before their first teeth –

I would recommend prior to your baby’s teeth erupting you get into the habit of playing with your baby giving your baby a baby brush or a rattle with a brush in the morning and just before bedtime.  I found my girls liked chewing on the baby’s brush whilst they were teething.

This will help you and them when it comes to brushing their new teeth as they will already be familiar with the routine.  You can start to try this last thing at night before they go to bed.

Examples of first baby brushes to look out for in the shops or order online could be –

Bickiepegs Finger Toothbrush & Gum Massager

Curaprox orthodontic teething ring

Baby Banana Teething Toothbrush for Infants

BrushBaby’s chewable toothbrush

BrushBaby’s first teether

When their teeth have arrived how to get them brushing –

• Playing with their lips is always a fun game that helps with making brushing fun.
• Blowing raspberries.
• Brushing your teeth at the same time as when you brush their teeth.
• Brushing in the morning can be a challenge. It is always better to brush their teeth before eating as the process of eating produces acids in the mouth making the teeth more susceptible to erosion if brushed directly after breakfast. So brushing before breakfast is ideal. To ensure this happens I have found it helps to brush their teeth as soon as they wake up after changing their nappies.  By bringing their toothbrush to them and brushing their teeth whilst they are still lying down after changing their nappies helps ensure brushing takes place before the day becomes too hectic.
• In an ideal world, it would be preferable to always get your child into the bathroom to brush their teeth, but reality is this is not always possible so as many solutions we come up with as parents to fit the ideal, the better.  By taking the brush to my babies and brushing their teeth as I am getting them ready while they are lying on the changing table, means I get their teeth cleaned even if it’s not done in the bathroom.
• At night before witching hour it can be even more challenging so after tea we will generally play for a bit and then take certain toys to the bathroom and include the toys in the brushing regime.
• Singing a song to brushing.
• Downloading an app for brushing.
• We practice roaring like lions to help to encourage them to open their mouths wide so I am able to brush all their back teeth thoroughly.

Book an appointment to see your dentist as soon as their milk teeth come through –

Go and visit the dentist as soon as their first tooth appears.  The Chief Dental Officer for NHS England, Sara Hurley in association with the BSPD (British Society of Paediatric Dentists) has raised a campaign in support of this called ‘Dental Check by One’ DCby1.  So please go and see the dentist as soon as your baby’s teeth appear.

I would highly recommend making the trip to the dentist a fun experience.  If you have any personal reservations or phobias about the dentist, I would strongly recommend you do not share them with your babies, remain enthusiastic and aim to have fun.  It is common that parents who are nervous share their fears with their children who in turn develop anxieties about the dentist.

The poster used to promote DCby1 can be a helpful resource in first talking to your baby about going to the dentist.

Get your baby’s 1^stDental Certificate –

Practical tips on sugar free snacks for fussy eaters –

My eldest daughter is a fussy eater, so I am always trying new foods in the hope she will like them. If time allows I try and cook with her by pre-weighing out the ingredients and getting her to mix. I find by involving her in as much as possible she is more tempted by the food we cook. I focus on savoury snacks such as cheese puffs, spinach muffins, frittatas etc.  I avoid giving the girls sugar at all times between meals as sugar really has no nutritional value within their daily life.  (If you are interested in getting recipes from the sugar free foods I cook, please follow my Instagram @baby_smilerevolution)

Practical tips on what your baby should drink and what your baby should drink from.

Avoid nurturing a sweet tooth by giving your children juice to drink.Other than milk I encourage Sophia to only drink water from a free-flowing cup where possible. I found the Doidy Cup was particularly helpful as an early introduction to a free-flowing cup.  As daunting as it may seem to give your baby a free-flowing cup, there are inevitably spillages, however this does seem to be for a limited time only with the Doidy Cup with my help and guidance – in comparison to a normal cup. 5I find having multiple colours in cups for Sophia and Alice helps to entice them to drink a lot of water.  I will use straws on occasion, but I will avoid juice and squash all the time.

If you are interested to learn more on helpful tips to support your baby’s oral health please follow me on Instagram – @baby_smilerevolution.  I update my post fairly regularly including various competitions and chances to win some giveaways for your baby’s teeth.

All the facts in this article are evidence based, and my practical tips are merely what I have discovered along the way whilst being a mummy.

Email me – info@smile-revolution.com for further questions.

Resources and Influential people to follow on social media –

Delivering better oral health: an evidence-based toolkit for prevention Third edition

https://www.bspd.co.uk

Baby Smile Revolution is targeted towards supporting parents in keeping their baby’s teeth healthy.

If you are a parent that prioritises your baby’s oral health then baby smile revolution is here to help you.

From how to win a brushing battle, to options of sugar free snacks for fussy eaters and what books to read with your babies to get them engaged in oral health from a young age.  We make brush time fun and look at general life style choice, and play, that can support oral health for your babies.

Founder of Baby Smile Revolution Victoria Wilson is a Dental Therapist with 17 years experience in dentistry, and mother of 2 baby girls.  Victoria fully understand the new challenges that being a mummy can bring.  She has combined her professional and creative background with being a mummy, to provide realistic daily solutions on all challenges related to oral health for babies.

Follow Victoria Wilson on instagram @baby_smilerevolution to learn more about the realistic solutions on everything related to oral health for babies.