Tailor-Made Home Care for Every Patient

Home care products are not one-size-fits-all. Each patient should be evaluated in terms of oral health, overall health, and personality. "You really do need to conform to the needs of your patient to help them the best you can," says Trish Smith, RDH, a dental hygienist for Generations Family Dental Care in Macomb, Michigan, who has been practicing for 27 years. "Everyone values different aspects of their mouth—esthetics, longevity, function, etc. You need to find out what they want to achieve. For example, a blanket statement about the necessity of fluoride does not meet the needs of patients who are allergic to it. Similarly, if a patient does not like the feel of electric toothbrushes, then recommending one to them may not be the best strategy."

Getting to know a patient is the key to providing useful recommendations. Smith suggests asking the patient what they want to focus on. "They expect to be asked if anything hurts, but I prefer to try to learn what makes them tick, and recommend from there," Smith says.

Below are some examples of patients who may require special considerations.

The Pediatric Patient

It has been said that we cannot depend on a child to thoroughly brush and floss alone until we know they can thoroughly wash dinner dishes. The analogy makes sense. Until then, review oral hygiene instructions with the patient and ask the parent to take a turn caring for their child's teeth as well.

The Orthodontic Patient

Floss threaders are great, but the percentage of orthodontic patients who can use them effectively is extremely low. Giving the instruction is important, but offering more realistic alternatives such as a water flosser or interdental brushes is critical. Be honest with your patients. Especially if they are young, they may not always understand the long-term consequences of poor oral hygiene unless we take the opportunity to educate them.

The Excellent Home Care Patient

Go ahead and praise this patient and encourage continued home care efforts. In this case, you can be more specific and possibly recommend a thicker floss that would frustrate a less experienced person. This patient can likely handle the higher shred risk in exchange for a more thorough clean.

The Periodontally Involved Patient

You do not want to overwhelm this patient with 10 different gadgets. This individual may be feeling some embarrassment, so be cautious. Start with the basics of toothbrushing and perhaps recommend a power brush. Consider reviewing only one item per appointment. For example, in one visit, only demonstrate interdental brushes and what brand and/or size you believe would be most effective for their blunted papillae.

The Patient With Poor Oral Hygiene

If a patient does not brush on a regular basis, then definitely avoid giving them several instructions at one time. Meter your expectations. Merely convincing this patient to brush every day is huge progress. Similarly, it is amazing how often adult patients tell hygienists that they have never been shown how to floss. Some say they floss every day; however, after inquiring further, you may discover that they floss anterior teeth only, or never insert the floss sub-gingivally. Getting a clear picture of the patient's current habits can help you prioritize which instructions to emphasize in any given visit.

The High Caries Risk Patient

A variety of factors contribute to a patient's high risk for caries, including diet, xerostomia, lack of home care, or any combination thereof. It is important to determine where the risk originates from and attack the problem based on those findings. This requires asking questions and recommending products accordingly. If a patient is opposed to fluoride options, be prepared with a non-fluoridated product list.

The Patient With Reduced Dexterity

In some cases, patients with reduced dexterity have difficulty grasping a toothbrush to perform the desired brushing motion. If grasp is an issue, helping the patient increase the circumference of a toothbrush handle can be helpful. Rubber-banding a piece of cloth around the handle of a power toothbrush or a water flosser can make brushing easier for these patients.

The Patient With a Cognitive Impairment

All patients should be treated with the utmost respect. Patients with advancing dementia, for example, may not remember the skills we are trying to reinforce but should still feel comfortable and cared for. In these cases, it is imperative to educate the patient's regular caregivers, because they are ultimately the ones who are relied on to carry out home care instructions. If caregivers cannot or do not help with home care, a more frequent recare interval can be recommended. This, at least, ensures that the patient's plaque, calculus, and biofilm are removed on a more consistent basis. When patients present with bright red, inflamed gingiva and food debris that has been irritating the tissues for a long time, they likely have been living with noticeable discomfort between visits. Our patients deserve a better quality of life if we can help them attain it.

The Dental Implant Patient

The implant patient who first comes to mind is the one wearing a fixed hybrid denture or fixed implant bridge. These implant scenarios often present a challenge. Sometimes, these patients need to be reminded that implants can fail if an infection occurs. A water flosser on a low setting is one of the best options to help prevent infection. We must also stress that the patient apply their toothbrush to the natural gingiva, not just the prosthesis. Shortening the time between hygiene appointments may also be necessary.

Today's home care options range from the tried-and-true products that keep improving, to fresh innovations. For example, electric toothbrushes continue to be a very helpful tool for many patients in their home care routines. "We have seen them on the market for decades," Void-Holmes says, "but there is a lot of current research … that is really speaking to the long-term, positive effect on oral health."¹

Water flossers continue to be a strong supplemental option for traditional flossing, though Smith emphasizes that they should not be recommended as a replacement. "Everyone wants water flossers because they can be finished in 30 seconds, but I always tell patients that there is no replacement for string floss," Smith says. "Still, if a patient who previously was not flossing at all starts to water floss, that is a positive development."

Among the newer innovations, polishers and scalers customized for home use have become available recently. These are "tools that have been modeled after the ones dental professionals use," Void-Holmes says.¹ Smith says her favorite new product is a probiotic lozenge. "You put it on your tongue and let it dissipate, and it has six strands of good bacteria that combat the bad bacteria in your mouth. It helps with tonsil stones, bad breath, bleeding gums, caries, and more. You can notice the impact immediately."

As dental hygienists, we must not take for granted that our patients need our guidance at every visit for the betterment of their oral health, although they might not always know it. "You need to accept the fact that patients will not always listen to you, and that often you will care more about their teeth than they do," Smith says. However, patients often appreciate the extra time and consideration we give them. With positive feedback and strong recommendations for home care, they can maintain excellent oral health. "I give as many compliments as possible to patients who are exceptional with their home care," Smith says. "They leave feeling great, and they are motivated to continue doing their part."

1. Void-Holmes JD. The Teeth are Still Talking: Dental Hygiene Trends You Need to Know About - Part II. Inside Dental Hygiene website. https://idh.cdeworld.com/webinars/22435-the-teeth-are-still-talking-dental-hygiene-trends-you-need-to-know-about-part-ii. Published March 2022. Accessed August 24, 2022.