Oral Hygiene Coaching 1 GN PDF

Oral Hygiene Coaching 1 Julie Watson and Rhona Mann Founda:ons in Clinical Skills and Prac:ce Year 1 GDC Learning Outcomes 1.1.1 1.7.1 1.11.2 1.1.2 1.7.3 1.11.3 1.1.4 1.7.8 1.11.4 1.1.11 1.9.1 1.11.5 1.2.1 1.10.2 3.2 1.2.2 1.10.3 6.3 1.2....

Oral Hygiene Coaching 1 Julie Watson and Rhona Mann Founda:ons in Clinical Skills and Prac:ce Year 1 GDC Learning Outcomes 1.1.1 1.7.1 1.11.2 1.1.2 1.7.3 1.11.3 1.1.4 1.7.8 1.11.4 1.1.11 1.9.1 1.11.5 1.2.1 1.10.2 3.2 1.2.2 1.10.3 6.3 1.2.3 1.10.4 10.1 1.2.4 1.10.5 1.5.3 1.11.1 Intended Learning Outcomes By the end of this session, you will be able to: Explain why Oral Hygiene Coaching is needed Explain the principles of a Preventa:ve Programme Demonstrate the delivery of appropriate Oral Hygiene advice, including tooth brushing techniques and Interdental Cleaning Tailor techniques and advice to adapt to diverse pa:ents’ needs Outline Session 1: To give an overview of why Oral hygiene coaching is important within our role Review what products are available to use to do this, how do we use them and what advice we need to give to our paLents. Session 2: PracLcal Case studies reviewing how to adapt approach? Assessment Forma:ve Summa:ve DemonstraLons in acLviLes Year 1 OSCE Year 1, 2, 3 Clinical placements Future career: ESecLveness as dental hygienist and therapist. Why? Flaticon.com It is recognised that dental bioNlm is directly involved in the pathogenicity of both dental caries and periodontal disease, increasing the risk of both. Therefore, its eOec:ve and regular removal is of the upmost importance in the preven:on of these diseases and maintenance of oral health. Castleandcosta.co.uk  Aim for 10% or less in plaque/bleeding score — inform patients Calculus retains biofilm — harbours plaque (If patients have 80% plaque score on first visit, the aim for the second appointment would be for the plaque to reduce by half or more) — gradual approach Researchgate.net Kmod.iheart.com  Prevent development of oral disease/conditions Measures to prevent disease completely Primary Prevention advice - tooth brushing etc. Establishing healthy habits. Three phases Preven:on of preven:on Diagnose and treat oral diseases as early as possible Ter:ary Secondary Regular check ups Applying sealants or fillings Link to Preven:on Preven:on Make easier for patient to clean Limit extent of oral diseases that have already occurred Chapter 8 More complex actions may be required — unlikely to be reversed at this stage Delivering Limit disease and make it manageable for patient. MAJORITY Better Oral Health Toolkit  Spoke in dental terms that patient didn’t understand Why wouldn’t OH advice work for patient = Didn’t tailor OH to patient Didn’t motivate patient Poor delivery of advice Steps in a Preven:ve Program Patient not receptive to information given Patient not ready or wanting to change behaviour Cultural/language barriers Patients unable to care for themselves — disabilities/medical conditions Purpose: Enable paLent to remove plaque eSecLvely through self-care 1. Gather all information to prevent and reduce risk of oral disease. 2. Gather new information Apply behaviour change approach: Raise the issue, build moLvaLon 3. Provide coaching for self-care Assess readiness for change 4. Evaluate changes in oral Support paLents next steps health Bad breath = Ask nurse to leave room, sit patient up, “I do have to inform you you have bad breath, most likely due to …..” Steps in a preventa,ve programme 1. Gather all informa,on 2. Gather new informa,on Referred from which department? Iden%fy presence and severity of Previous treatment and outcomes disease Pa%ent percep%on of needs – is it Iden%fy risk factors a priority right now? Carry out baseline char%ng; BPE, 6PPC, Verbal history from the pa%ent BS% PS% Radiographic evidence EVERY APPOINTMENT 3. Provide coaching for self care Iden%fy current OH rou%ne Don’t give too much informa%on at any one %me Ask pa%ent to demonstrate current techniques Keep message simple Iden%fy what/if anything needs Ask pa%ent to demonstrate what correc%ng – raise the issue, build they have just learnt mo,va,on, assess readiness for Adjust as required change Show pa%ent how to self evaluate Select appropriate preventa%ve – support next steps measures 4. Evaluate Changes in Oral health Ask the pa%ent how they feel Complete new indices & compare things have gone to previous Tndings Support and correct Evaluate gingival condi%on Provide further advice Set down new goals Add further OH devices if Set new review date necessary Discuss treatment progression Check ID brush sizes (may well have changed) How? Fla%con.com  Manual - lower 3-3 use circular and side to side motion Recommended sensodyne 3.5 manual brush Tooth Brushing Electric - 1-2 teeth at a time Look in mirror Slow technique down 45 degree angle to gingival margin assess recession/abrasion Check size of head Battery brushes not recommended Ny%mes.com Wired.co.uk Evaluate by disclosing Manual VS Electric? Both are eYec%ve if used appropriately (Grender et al 2020) Adapt to pa%ents’ needs.  Brushing alone will not remove plaque from interproximal areas Ensure brush is a snug fit with slight resistance - feel on both medial and distal surfaces Interdental Cleaning  3 times in same area — plaque sticky so might miss areas or deposit Flossing 1cm to go down between teeth ASK PATIENT TO DEMONSTRATE THEIR FLOSSING FIRST TO SEE HOW THEYRE USING IT WATCH OUT FOR SAWING TECHNIQUE Used interdentally Place as subgingivally as possible Use 1xdaily Wipe up and down approx. 3 Place small piece of %ghtened %mes `oss between contact points Remove from contact point Wrap round tooth in a C shape Reassure pa%ent about bleeding Slide down between tooth and gum Toothbrush not able to get below gum line  Require reasonable manual dexterity Patients need to be shown bridge in mirror and how it works — they aren’t always aware Give demo to patient in mouth with mirror SuperLoss Grasp on lingual/palatal side Single units- pull 1 piece out Work towards gingivae Daily use Wipe under pon%c Used under Bridges Once back & forth Around Implants Pull out Around Orthodon%c appliances Reassure if gums bleed/feel sore Push s%Yened end through Normally from buccal side  Show patient colours, types and how to resize them No more than 3 brushes each patient Interdental Brushes Dental specific - Green, purple, grey, black Gently back & forth approx. 3 Used interdentally %mes Use 1xdaily Reassure pa%ent if gums bleed Used in larger gaps Inform need to rinse brush Need to be sized correctly Can re use Need snug Tt without causing Explain sizing trauma Explain where to buy Push between teeth at gum level Explain diYerent manufactures Usually from buccal side have diYerent colour coding  Par%ally erupted teeth Single TuMed Brush Ader surgery Pa%ents with gag re`ex Very versa%le Inexpensive to buy Use around implants Long las%ng Distal to last molar May need to run under hot tap to Around Orthodon%c appliances soden Single standing teeth Awkward areas Inclined teeth Orthodontics Impacted wisdom teeth Single standing teeth Tooth with recession Gag reflex Into pockets  How not to Loss! Colgate.com Other devices pa,ents might use Tongue scrapers ASK PATIENTS TO BRING IN WHAT THEY ARE USING SO YOU CAN SEE Disclosing tablets  Removable Retainers & Appliances Do we need to keep these clean? The answer is yes, they can harbour bacteria, food & bio Tlm https://www.polident.com/en-gb/products/proguard-anti- bacterial-daily-cleanser/ https://www.polident.com/en-gb/removables/living-with-a- removable-appliance/how-to-care-for-retainer-aligner- nightguard/ https://www.gskhealthpartner.com/en-hk/oral-health/ conditions/guard-and-retainer-care/overview/ Theorthodon%cclinc.co.uk How To Do It: Use a sod toothbrush, denture Clean over a basin of water, or brush or similar brush to clean place a clean facecloth or towel in the appliance. Make sure that the the bohom of the sink in case the bristles can reach every surface. appliance is dropped You can use an appliance cleaning DO NOT use toothpaste to clean tablet to soak the appliance in your appliance – too abrasive Trst. This will loosen debris. Rinse Clean the Ting surface that goes (follow manufacturer’s against the teeth and sod %ssues instruc%ons). Then brush. of your mouth thoroughly – When to adapt advice? Will the same method be used for children as adults? When to adapt advice? Addi%onal needs? Co-morbidi%es? Carer involvement? Adapt to pa%ents’ needs Summary Why OH coaching is necessary Steps involved in a preventive program How to demonstrate for different products The need to adapt techniques to tailor to patients’ diverse needs  Final Thoughts Preventa%ve den%stry is the eYort to promote, restore and maintain the oral health of the individual. A programme of preven%on is composed of the collabora%ve steps taken by the pa,ent and operator, in order to preserve the natural den%%on and suppor%ng structures by preven%ng the onset, progression and reoccurrence of the disease Good Luck! NEXT TIME…… Please bring your tooth brushes with you! Please be dressed for a clinical session  Thank You for your a\en,on! Theteenagertoday.com References Grender J, Adam R, Zou Y. The e4ects of oscillating-rotating powered toothbrushes on plaque and gingival health: A meta- analysis. American Journal of Dentistry. 2020;33(1):3-11. Essen,al reading: Chapter 8: Oral Hygiene in Delivering beher oral health: an evidence-based toolkit for preven%on 4th Edi%on hhps://www.gov.uk/government/publica%ons/deliveri ng-beher-oral-health-an-evidence-based-toolkit-for-pr even%on/chapter-3-behaviour-change Essen,al reading: Chapter 8: Oral Hygiene in Delivering beher oral health: an evidence-based toolkit for preven%on 4th Edi%on hhps://www.gov.uk/government/publica%ons/delivering-beher-oral-health-an-evid ence-based-toolkit-for-preven%on/chapter-3-behaviour-change