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Learn how to support your patients in developing the habit of using interdental brushes daily with the help of experienced dental hygienists Theodora Little, RDH, RDT and Silvia Kokindová, DiS.
According to Theodora Little, cleaning teeth is a behaviour. And if it was as easy as everyone believed it to be, then, well, half the world’s population wouldn’t be suffering with oral diseases. “How did you learn to swim, or ride a bike? Did you watch a video? Did somebody do the activity while you watched them? I think not. So first things first. To be able to regularly carry out any behaviour ourselves, we have to start by learning the necessary skills to be able to perform that behaviour.”
As a dental professional, you have to become an expert in how to use the interdental brush, and how to ensure both you and your patients are using the right size brushes.
“The more we practise on ourselves, the better we can teach the best techniques to our patients. When educating our patients on how to clean between their teeth, we first have to ensure we are recommending the right size of interdental brush, and then we need to help them learn the skills necessary to carry out that behaviour,” adds Little.
Mastering the fine technique of interdental brushing can be a difficult process for many patients, but with a little patience anyone can master it. Using a hands-on approach can help patients get the hang of it fast. Don’t just describe the correct technique for using interdental brushes, but also demonstrate it.
Start on yourself, show patients where and how to insert the interdental brushes, and then have them repeat the process. If they don’t succeed on the first try, help them master the technique by guiding their hand.
“A trick I teach my patients is the vibration technique – lightly circling the interdental brush to allow the wire to pass easily through the interdental space. Then they try it on their own. If they are unsuccessful, I guide their hand. This has proven to be the best method,” explains Silvia Kokindová.
Little adds: “A deeper learning experience is created when the patient can feel what they should be doing. Teaching learning skills on a mouth model just isn’t going to cut it. For patients to fully learn, we have to touch to teach.”
Little emphasises the importance of the form of education. For it to be effective, it can not be boring or too academic. “Please don’t just show your patients what they need to do via a diagram or flip chart. We also have other capabilities, such as using a Bleeding on Interdental Brushing Index (BOIB). Now, by completing this index, not only are you creating a valuable record, you are also starting the process of showing the patient the techniques needed to use the interdental brushes effectively.”
It is also beneficial to let patients know that improving their dental care will lead not only to healthier oral cavity but also the whole body.
“It is important to teach patients that a healthy dentition doesn’t just mean fewer problems with their teeth, but with their entire body. Explain to them that the goal of improving dental care is to reduce the overall burden on the body. Oral cavity is not isolated from the rest of the body. Pathogens and bacteria we have in our mouths can spread through the bloodstream to our other organs, most commonly the lungs, kidneys, bladder and heart,” says Kokindová.
According to Little, true empowerment comes from finding our own answers. Empowerment is a self-motivational tool, so motivational interviewing skills are a great tool to use with your patients.
“This is a huge subject in itself, but the key is leaving open-ended questions that guide the patient into finding their own answer as to why they want to do something, instead of being told they should do something. ‘Should’ and ‘want’ create a very different emotion and people are more likely to carry out behaviours in which they ‘want to’ instead of them feeling they ‘have to’.”
Kokindová explains that the best motivation for a patient is to see a before and after photo after they have improved their dental habits. Benefits like less bleeding, less discomfort on the gums, smaller pressure in the interdental space caused by tartar or uncleaned food debris, and a brighter smile are all tangible proofs that they are doing something right. Of course, the best motivator is not having long-term difficulties.
If intrinsic motivation is not enough for your patients to pick and stick to good interdental brushing habits, introducing rewards may be in order. “For example, you may wish to reward your patient with a free toothbrush on their next appointment if their bleeding-on-brushing score improves by e.g. 10 percent,” explains Little.
The best way to make sure that patients pick up a new habit is to let them insert it into their dental care routine on their own terms. Let them use interdental brushes before or after brushing their teeth, whichever suits them better. When they want to use other aids besides interdental brushes, such as flossing, show them how to do it.
And if they happen to drop regular interdental brushing once in a while, help them get back on track. “Occasionally, patients can experience a difficult period in their lives, during which they stop using an interdental toothbrush,” explains Kokindová. “If that happens, I help them get back on track and together we restart their quality dental care.”
