The Overall Health and Wellness Model of Dental Hygiene Practice

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Latest research has recognized that oral infection, especially periodontitis, may affect the course and pathogenesis of a number of systemic diseases, including:

1. Cardiovascular Disease2. Bacterial Pneumonia3. Diabetes Mellitus4. Low Birth Weight5. Kidney Disease6. Pancreatic Cancer7. Brain Tissue Degeneration8. Stroke

TRANSLATION:

As dental health care providers we have an obligation to educate and emphasize to patients the risks associated with periodontal diseases. If we don’t tell them, who will?

Periodontal infections are associated with complex microfloras with more than 500 species having been encountered. These infections are predominantly anaerobic with gram-negative rods being the most common. The anatomic closeness of these microorganisms to the bloodstream facilitates the systemic spread of bacterial products, components and immunocomplexes.

TRANSLATION:

It is the responsibility of the Dental Hygiene Department to ensure their patients understand the urgency of periodontal treatment and the serious risks to their overall health if it is delayed or declined. CREATE A SENSE OF URGENCY.

We treat patients much sooner now that we understand there is a Link between the overall health and the health of the oral cavity.

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The YOUNGER the patient the more serious the periodontal issues are because of long term exposure of bacterial products over their lifespan.

Children and Teens with Gingivitis are HIGH RISK patients.

Our mandate is to maintain patients in a healthy state, not a disease state.

With normal oral health and dental care, only small numbers of mostly innocuous bacterial species gain access to the bloodstream. However, with poor oral hygiene, the number of bacteria colonizing the teeth, especially SUPRAGINGIVALLY, could increase 2- to 10-fold and thus introduce more bacteria into the bloodstream, leading to exposure to bacterial products.

TRANSLATION: The body reacts to gingivitis the same way it reacts to advanced periodontal disease.

There is no such thing as “a little bit of infection”

*MICROORGANISMS THAT ARE RELEASED INTO THE BLOODSTREAM REACH THE HEART, LUNG AND PERIPHERAL BLOOD CAPILLARY SYSTEM IN LESS THAN 1 MINUTE*

Release of Microorganisms Can Occur Upon

Brushing

Flossing

Mastication

TRANSLATION: Reaching and maintaining oral health is a requirement of good overall Health. This is the Primary Purpose of the Dental Hygiene Department.

In May of 2000, the first-ever Surgeon General’s Report on Oral Health was released. It stated, in part, as follows:

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“The intent of this first-ever Surgeon General's Report on Oral Health is to alert Americans to the full meaning of oral health and its importance to general health and well-being. Great progress has been made in reducing the extent and severity of common oral diseases…. ….The terms oral health and general health should not be interpreted as separate entities. Oral health is integral to general health; this report provides important reminders that oral health means more than healthy teeth and that you cannot be healthy without oral health.”

EDUCATEMOTIVATEADVOCATE

“The older I get, the more wisdom I find in the ancient rule of putting first things first-- a process which reduces the most complex human problem to manageable

proportion.”Dwight D. Eisenhower

EDUCATE -- Visual Aids, Visual Aids, Visual Aids!

It is essential that our patients have a basic understanding of the Periodontium BEFORE we present disease etiology. This simple step is extremely important in the patient’s acceptance of their problem. The patient needs to be aware of what they had before they can appreciate the loss of it and the consequences that come with that loss.

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Verbal Skills

“To keep your teeth for a lifetime, you need 3 things…..

1. GUMS2. JAWBONE3. LIGAMENTS

(these attach your tooth to your bone).”

Once the patient understands what they NEED to have we can begin to explain the etiology behind the loss of things.

“Do you know what plaque is?”“Every tooth in a man’s head is more valuable than a diamond.”

Miguel de Cervantes, Don Quixote, 1605

Presenting Disease Etiology following the “First Things First” Rule means we are ABSOLUTELY CERTAIN that the patient understands our “dental language”. Never assume that the patient understands even the simplest of words or ideas. How do we confirm that our patient understands?

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1. We ask them.2. We listen to their answer.3. We protect them from embarrassment if they do not understand.

(“Everybody thinks that plaque is left-over food! Actually, it’s BACTERIA”)

Verbal SkillsEstablish that plaque is BACTERIA.Let the patient know that EVERYBODY has this bacteria.

“Bacteria causes Infection of the gums & is called Gingivitis.”

Create a sense of URGENCY using our knowledge of the oral-systemic link.

“Your BODY reacts to gingivitis

the same way it react to Advanced Periodontal Disease!”

“It’s important that we get this taken care of right away.”

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Educate – The Progression of Periodontal Disease

Before proceeding with education on attachment loss, the patient must understand:

1. The 3 things needed to keep their teeth for a lifetime.

2. That the PDL attaches the tooth to their body.3. That plaque is BACTERIA which causes INFECTION.

4. That Oral Infection causes Diseases of the Body.

“If this situation…”

“…lasts too long, the first thing that happens is the loss of the PERIODONTAL LIGAMENT…”

“…allowing the gums fall away from the teeth and the bacteria migrate below the gumline…”

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“Now the bacteria is BEYOND THE REACH OF YOUR BRUSH AND

FLOSS!”

Educate -- The Difference between Plaque and

Calculus

Once the PDL is lost, the patient is no longer able to clean their teeth by themselves because the bacteria is BEYOND THE REACH OF THEIR BRUSH AND FLOSS.

Verbal Skills

“Do you know the difference between Plaque and Calculus?”

Establish that Plaque is bacteria that is soft and removable with a toothbrush.

Then establish that Calculus (aka Tartar) is hard and firmly attached to the tooth and MUST BE REMOVED BY A PROFESSIONAL.

Educate – How Plaque Becomes Calculus

“When the soft plaque lies below the gumline, beyond the reach of your brush and floss, your saliva washes over it.”

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“There are minerals in our saliva that are very hard – calcium and phosphorus – that’s what our bones are made of.”

“As your saliva washes over the soft plaque, the minerals settle into it and turn it hard, cementing the bacteria to your tooth.”

“I just want my free cleaning.”When a patient states “I just want my free cleaning” what they are reallly saying to you is “I don’t understand you yet”.

Verbal Skills

“When you come in for your “regular cleaning” that is a PREVENTATIVE cleaning, designed to prevent periodontal diseases from occuring. You have arrived today WITH Periodontal Treatment. There is nothing to prevent.”

“The end result of UNTREATED Periodontal Disease is, 100% of the time, tooth loss AND Illness.” (Oral Systemic Link)

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Educate – Advanced Periodontal Disease

Verbal Skills

“Because the bacteria is beyond the reach of your brush and floss you are not able to clean this area of your teeth. As time passes the INFECTION spreads further into you jaw bone.”

“There is no cure for bone loss – once it’s gone, it’s gone.”

“Have you noticed you that you feel fatigued lately? Low-grade fevers? Bad taste? Under a lot of stress lately? Medications?”

“This is a systemic infection, your whole body is taxed by Periodontal Disease.”

“It’s important that we get this taken care of right away.”

“People become really quite remarkable when they start thinking that they can do things. When they believe in themselves, they have the first secret of

success.”Norman Vincent Peale

Motivate – The Art and Science of Health PromotionOur purpose as health promoters is defined as: the art and science of helping people change their lifestyle to move towards a state of optimum health. We are selling Health Care Education. Our goal is Patient “buys” needed Treatment.

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Art …….creative communication.

Science…….establishing objective, verifiable facts.

Systems are only as effective as our ability to communicate

Lifestyle diseases are the result of behavior. Changes in behavior can often alter the Lifestye disease in a positive way. To MOTIVATE patients to choose to change behaviors, we must combine Art (sucsessful communication) and Science (EDUCATE on objective facts).

Communication is made of two parts: The Speaker and The Listener.

The Speaker

The Three Modes of PersuasionAristotle (384 – 322BC) was a seminal thinker, philosopher and polymath, of Ancient Greece. He was a student of Plato, and a teacher of Alexander the

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Great. He conceived many great ideas and theories about many things. One of them was a model for effective communication. These principles are still the basis of all teaching/selling methods that we use today. We know we have effectively communicated when a patient chooses to accept needed treatment. The essential elements are as follows:

1.Ethos – The integrity of the communicator.2.Pathos – The emotional effect (of

communicator & message)3.Logos – The relevance and strength of the

message content.

Each of these elements is consiously and unconsciously assessed by the Receiver according to multiple factors, signals and indicators.

Ethos – The Integrity of the Communicator

Vocal Style, Body Language, Passion and Enthusiasm

When selling Dental Health Care Education to a Patients it is important that we believe in the treatment, deliver our message with confidence and are enthusiastic about the “product”.

Humility, Modesty, Empathy, Sensitivity and Concern

Ultimately, the patients teeth are the property of the patient. THEY are entitled to make their own choices free of our judgements on those choices. Listen carefully to the wants and needs of the patients. (“Active Listening” insert page number here.)

Trustworthiness, Experience, Reputation and Credibility

Many patients arrive at the office with a general distrust of dentistry. Today, social media is largely responsible for the patients perception of the office with regard to trust, experience, reputation and credibility. It is important that we are routine about asking for positive social media reviews from our patients.

Qualification, Evidence of Claims, Rewards for Communicator

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Patients will want to feel that we are Trained Professionals. Professional attire, posted Digrees and Licences, Name Tags stating Credential all send subconcious messages. Including etiology in our presentation, using visual aids and communicating Evidenced Based Science will create acceptance of recommended treatment. Lastly, out patients will be thinking, “is this treatment paying for the Doctors new Mercedes?”

Pathos – Emotional Effect on the Listener

Engages, Involves and Interests

The message should not be delivered in a way that communicates we have said the same thing to all patients a millioin times before. Be up-beat and enthusiastic. As the patient questions and listen to the answers. Again, visual aids keep the patient interested.

Smile, Be Happy, Avoid Conflict

Everyone has bad days, but we must leave our personal issues at the door and put on a smile. Patients have bad days too. We avoid conflict and do our best to remember, “the customer is always right”.

Builds Desire, Invites Action, Make it Easy to Act

Presenting our message in a way the brings the Patient to there own conclusions (First-Things-First Rule) facilitates their acceptance of their periodontal needs. Treating patients on the same day, making flexible payment arrangements, accepting their insurance makes it easy for patients to “buy” treatment TODAY, not next week.

Logos – Relevance and Strength of Message Content

Logical, Structured and In Language the Listener Understands

Follow the First-thing-First model of presentation of Periodontal Disease.

Cause & Effect, Measurable Positive Outcomes, Justify the Time, Effort & Cost

Completion of a thorough Periodontal Assesment with 6-point probing depths recorded to measure patients improvement over time. Starting your

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presentation with, “To keep your teeth for a lifetime……: will justify the time and cost of Treatment Acceptance.

The Listener

Concious Competence Learning ModelThe Four Stages of Learning

The Concious Competence Model of Learning is a very simple and helpful explanation of how Patients learn (and ultimately accept needed treatment). This Model, essentially, shows that Patients need to be trained in STAGES. (First-Things-First).

Stage 1 Unconcious Incompetence

“I just want my free cleaning”.

Stage 2 Concious Incompetence

“What do I need to do to treat my Periodontal Disease?”

Stage 3 Concious Competence

Completes Treatment and Improves Oral Hygiene

Stage 4 Unconcious Competence

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Oral Hygiene and Perio Maintenance Appointments become habits.

Compliant Vs Commited Patients

The difference between a good Hygiene Program and a GREAT Hygiene Program is the ability of the Team to elicit COMMITMENT from Patients. Patients committed to their heath, continue to return to the Practice year after year, bringing family members and other referals. This type of patient allows the Practice to reduce it’s fiscal dependence on New Patient flow.

New Patients are expensive for the Practice to attract, create non-productive work hours in the form of paperwork and non-billable documentation and take more time in our schedules with no guarentee of Treatment Acceptance.

Committed patients form the core foundation of the practice and allow the practice to reduce dependance on the New Patient, who may or maynot materialize.

The committed Perio Maintenance patient is the key to practice building.

Definitions

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Compliant – obedient, docile, meek, submissive

Committed – dedicated, devoted, pledged, faithful

The long term success of establishing periodontal health is dependent upon the commitment of, not

the compliance of, the patient.

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