Touch to Teach: Proper oral hygiene has its proper technique

Brushing teeth may seem like the most basic skill, but mastering the technique is crucial – even for dentists, who must pass this knowledge on to their patients. 

Unfortunately, many dental professionals and students aren’t always equipped with the latest evidence-based methods to teach optimal techniques of biofilm management to their patients. The iTOP programme aims to change that – one dental student and professional at a time. 

Knowing how to instruct, coach, and guide patients towards adopting the correct techniques of biofilm management is crucial for every dental professional who wishes to be more than just a repairer of caries for their patients.

These basic biofilm management techniques should form a sturdy foundation upon which they can build a successful oral care habit. If the foundations are not strong, the rest of the oral care will also be lacking.  

Curaden’s iTOP programme fosters prevention and elevates oral hygiene to a bona fide academic discipline – by creating a pragmatic way for dental self-care.

It enriches the curricula of universities by providing dental students with hands-on instruction. It creates dental professionals who possess not only the theoretical knowledge that proper oral care is the key to a healthy mouth but also the practical skill of imparting the knowledge of proper biofilm management techniques onto their patients. 

Start at the basics

The whole idea of iTOP was born at the University of Hamburg in the early1990s. Dr Jiří Sedelmayer, the father of iTOP, was unhappy about the state of oral health of his patients. Countless people came knocking on the door of the university clinic where he was practising – with pain or swelling – no matter their age, gender or socio-economic background. Their pathologies were caused by dental plaque, as a consequence of an insufficient or inadequate oral care routine.

He questioned his own work and the profession itself and thought about how to improve the oral health of his patients once and for all. Also, his students were a huge motivation for him – many of them had perfect results in difficult clinical subjects but they still were victims of caries and gum bleeding themselves. 

Dr Sedelmayer conducted small empirical research and asked his own students to prepare and show him the Bass Technique in the upcoming class. The result was shocking but somewhat expected – ten different techniques were presented, as each dental student described something different to each other.

Remembering that class, Dr Sedelmayer said: “Of course we couldn’t ask Dr Bass about which technique is the right one because he was already dead.” He went deeper into the research just to conclude that unlike other areas of dentistry, prevention doesn’t have clearly defined principles and criteria on which proper biofilm management is based. For him, this was a sign. He decided to create a unique teaching method, based on clear criteria and empirical data.  

The courses he developed began at Hamburg University as a non-compulsory after-school activity. When Dr Sedelmayer retired and returned to his hometown of Prague, the then-rector of Charles University wanted Dr Sedelmayer to officially implement his concept. This resulted in a veritable cascade: Dr Sedelmayer’s own iTOP students went on to implement the concept in places around the world where they taught. 

The beginning of Touch to Teach

Dr Sedelmayer developed a programme to teach his students optimal oral hygiene techniques – a programme that would take its final form in 2006, when it became iTOP. The difference between iTOP and other programmes was the Touch to Teach component – all the techniques were practised hands-on, in the mouth, like in any other area of dentistry.

He taught the students new approaches to prevention education and then engaged them in interesting practical examinations. Students would have to teach their colleagues optimal oral hygiene techniques and then the ‘patient’ would demonstrate what they had learned. If the technique was correctly demonstrated, the student who taught their colleague would pass the exam. 

Dr Sedelmayer became known not only in Hamburg but also in his own motherland. He was invited regularly to the Czech Republic to teach in dental congresses and lead practical courses.

In 1995, Curaden CEO Ueli Breitschmid attended a lecture by Dr Sedelmayer in Prague at his invitation. More than 400 people followed the lecture breathlessly, laughed often and applauded feverishly in the end. In this single moment, Ueli said that he came to under-stand that he was dealing with a special person and decided for himself that,“ This man can change the world – and I want to go this way with him.” 

After their meeting in Prague, the topics of prophylaxis, dental hygiene and oral hygiene gained renewed importance for both protagonists. “Health begins in the mouth” – this claim became the guiding principle of the iTOP prevention programme developed by Dr Sedelmayer, with which Curaden has been training dental professionals in proper biofilm management with the optimal instruments for decades, worldwide on all continents.

The declared credo behind it: prevention instead of cure. The guiding principle: through a healthy mouth, a healthy person. 

New perspective of interdental cleaning 

Dr Sedelmayer was not just committed to the development of optimal oral health habits. He also understood the need for effective oral care devices. After diagnosing his own student with interproximal caries – who reported to have regularly used both floss and a toothbrush – he started his research.  

He became more interested in de-vices to take care of interdental spaces and this is where he started his research with interdental brushes, especially their usage on people with closed interdental spaces.

This led Dr Sedelmayer to develop the first generation of CPS Prime(interdental brushes for closed inter-dental spaces) brushes, the Interdental Access Probe and a bleeding index that was a modification of the Eastman index – instead of a toothpick, one would use an interdental brush to initiate interdental bleeding. Later, Dr D. Hofer introduced this index within the literature. 

During his time at university, Dr Sedelmayer included 600 students in practical research about their own BOIB – bleeding on interdental brushing – index (now adapted into the BOB score). Upon first measuring, 85 percent of bleeding spaces overall were found. After the first week of regular usage of interdental brushes, this result reduced to 42 percent, then to 19 percent the second week. After the third week, the BOIB index was only 3 percent.

These results showed that the bleeding reduced after regular usage of calibrated interdental brushes. His students and followers confirmed the thesis in their own research. 

Dr Sedelmayer did not stop there. The need for practical tools to achieve perfect biofilm removal was still there. Observing some oral health habits in different cultures motivated him to develop the single brush and solo technique, which is described today in Color Atlas of Dental Medicine: Periodontology by Rateitschak.

Oral hygiene is, first and foremost, a technique

Dr Tihana Divnic-Resnik is a senior lecturer and coordinator at the University of Sydney Dental School and one of the worldwide disseminators of Dr Sedelmayer’s basic idea. She coordinates the Department of Periodontics at the Sydney Dental School. For a periodontist, Dr Divnic-Resnik said, a well-designed and structured programme of oral prophylaxis is of utmost importance. Mechanical plaque control is the be-all and end-all of any successful periodontal therapy, she said. 

Dr Divnic-Resnik has introduced iTOP at the university to ensure that both her students and their future patients benefit. Efficient, atraumatic instruments and techniques play a crucial role. For Dr Divnic-Resnik, individual prophylaxis is the real cornerstone of good oral health.

However, the correct handling of biofilm must be learned in practice. This is necessary to enable dental students to pass on this practical knowledge. Only those who have a perfect practical understanding of proper biofilm management can pass the knowledge on to their patients. 

Dental students learn how to drill and fill teeth in many practical courses. However, when it comes to hygiene techniques, practical training is largely absent. Learners are expected to be able to instruct patients on their own. This is unlikely to be possible without hands-on training, in part because such techniques tend to be underappreciated. “Can you learn to ride a bicycle by reading a textbook?” asks Dr Divnic-Resnik rhetorically.

The same logic applies to learning efficient oral hygiene techniques, she adds. Proper mechanical control of plaque is complex and requires practice. To that end, Touch to Teach (T2T) is a unique approach based on literally taking learners by the hand and teaching them prevention techniques through practice. Says Dr Divnic-Resnik, “How else are they going to teach others later if they can’t do oral hygiene correctly themselves?” 

Dental medicine is constantly evolving. Still, both students and experienced dentists are often convinced they know everything there is to know about prevention and mechanical plaque removal – until they attend an iTOP course.

This experience first shakes and then rebuilds their confidence through hands-on relearning of the basics of proper oral care. Students appreciate being confident in the tools and techniques they can recommend based on the latest scientific evidence. Oral health and prophylactic thinking definitely have a place at universities.