What's in Your Caries Prevention Toolbox? Two Experienced Hygienists Share What's In Theirs

You're listening to the Phil Klein Dental Podcast. We all heard it many times, an ounce of prevention is worth a pound of cure. And although this has been repeated ad nauseum, we can't argue that there isn't a great deal of truth to it. In fact, more studies than we can possibly ever read have supported the notion that taking care of our bodies and minds with a prevention approach is the best way to stay healthy and feel good as we age. And of course, prevention absolutely applies to our oral health. So what does this mean to the dental hygienist? How does the dental hygienist play a role in caries prevention with the goal of keeping the patient's oral cavity as healthy as possible throughout their lifetime? To start, one of the most important things is to have a definitive preventative protocol. Every office needs to have it, and this would apply to the entire dental team. And with that protocol, the hygienist needs a toolbox, one that has the necessary tools to get the job done. And it goes without saying, the toolbox needs quality products and materials. But beyond that, it needs something else. It needs techniques that build trust, or might we say a partnership, where the hygienist and patient are in it together. To tell us the importance of having preventative protocol in a practice and all the nuances around building the optimal caries prevention toolbox are our guests today, Danielle Avila and Laura Betancourt. They are both registered dental hygienists with over 15 years of hygiene experience, and they are co-founders of El Diamant Dental Coaching, helping hygienists gain confidence and shine in their careers. Danielle and Laura, it's a pleasure to have you both on the show. Thank you so much for having us, Phil. Yes, Phil. I'm so happy to be here. Yeah, and hats off to both you guys for your dedication to the profession in helping a lot of offices understand the value of prevention, which we're going to be talking about today. It's a super, super important topic, and I think our audience is certainly going to benefit by a lot of your input. So before I ask you the first question, whenever we read like credible sources or listen to a reputable speaker talk about being and staying healthy the word prevention inevitably comes up we hear it all the time and at this point in time we know that doing things on a daily basis that supports good health is a far better way to live than for instance being reckless with your diet because you're young not exercising not getting quality sleep we know what that does to you and of course abusing your body with smoking drinking too much and so forth and a lot of us when we're when we're young Just think we're never going to age. That's just how we are. And there's consequences to that. And this, of course, applies to oral health. So there's no question prevention is critical in maintaining healthy teeth and gums. So as dental health care providers, and we'll start with Laura, why is it so critical not only to have a culture within a dental practice focusing on prevention, but also have definitive prevention protocols in place? Absolutely. I love that question and everything that you just said, because it's truly the whole being, the whole person, and you want the whole team to be on the same page. And as a dental hygienist, I feel as though, and I know Danielle agrees because our mission is in alignment, but we are truly prevention specialists. and as a prevention specialist you want to lead with an open heart and provide that optimal care for our patients so when you're working at an office you want that uniformity and you want to make sure that all of your team members are providing that same standard of care so when you have certain protocols in place you know that you know it's the standard and you know that's expected of you This also applies to different employees coming and going, right? If you don't have something in place and then you hire someone else and they're coming in and they don't know where to start with your prevention protocol because you don't have any, you know, you're certainly at a big disadvantage. Do you want to add anything to that, Danielle? It is so important, like you said, Phil, when you have, you know, hygienists that are coming and going out of offices, when one comes in, they need to all be on the same page and again, providing that optimal care. I agree 100% with everything you said. Yeah, I was just going to say, it's a great place to say, okay, these are where all our protocols are. If anybody has a question, they can go back to it. They can resource it and have any questions answered. So how are those protocols stored? Like, are they in a digital document? Typically, Laura, how would... A manual. I mean, a lot of places have digital now where especially larger practices will still have everything on this database where all the employees can access that. Or if it's a smaller practice, I mean, a good old handbook, you know, have these protocols in place so their team can resource it if needed. And it's important for that new employee to understand because they're coming from a different practice or they may just be at it. hygiene school and they don't have the experience but if they're coming from a different practice that has minimal interest in prevention then that that protocol being in place is so important to get that person on board quickly because you certainly don't want patients to notice that all of a sudden this new person in the office, this new hygienist is not particularly focused on prevention, which includes communication with the patient, not only doing physical things to the mouth, but also communicating to the patient and partnering with them to understand the importance of we're in this together. And we can't just do this if you're not on board. So Danielle, let me ask you this. What are some in -office tools that dental practices can utilize in order to help their patients with caries prevention? Yes, I love this question. I mean, there are just so many tools that we utilize in our toolbox on a day-to-day basis, starting from as simple as a disclosing solution. So that disclosing solution allows us to really visually show our patients and educate them on the biofilm and the removal of that biofilm. From there, we like to go in with motivational interviewing and really get to that, you know, what is it that's going to motivate this patient to want to? really incorporate these preventative tools into their routine when they leave the office because they can be so motivated. in the chair, but then once they leave the office, it's like in one ear out the other. So it's really important to ask those, you know, motivational interviewing questions to the patients and what gets them excited to, you know, implement these preventative tools. Nutritional counseling is really important. Also, we utilize fluoride varnish at the end of all our appointments. If our patients don't like fluoride, we have non-fluoride options. for the patients as well. So we just really like to tailor and really suit whatever our audience is, whoever that patient in the chair, making sure that we have our multiple tools in our toolbox that will allow and help with caries prevention. It's interesting to hear how many hygienists are using fluoride varnish as part of their preventative protocol. I know that we utilize Pro Fluoride 5% Varnish from Voco. I love their product because how it helps with hypersensitivity, especially for people with exposed roots. And a personal favorite of mine, so a personal story is my son has multiple severe allergies. And I love that the Pro Fluoride 5% Varnish, actually a lot of their products, majority of their products are allergen free. It contains no milk, no tree nuts, no gluten, no soy, shellfish, or no red dye. I mean, it's... Just a relief as a parent and as a hygienist that you don't have to worry about that. So a personal story for me, because I know my son has had reactions. And it's certainly encouraging to know that there are products out there that give you peace of mind, especially when your child is sensitive to so many different things that could cause an allergic reaction. So why not use a product that doesn't have all those additives? I agree. But even before you get to the point where you're using... on the patient. That first conversation with them is so important to build trust and also to get them to understand like what your goal is and how you can succeed in a partnership between the hygienist and the patient. So talk to us about that communication, the value of that communication, especially in that first visit. Absolutely. So I think like we were saying before, you know, asking those motivational questions to the patient and Leading with love and empathy and just trying to be on that same page as the patient. It goes a long way when they know that you're not trying to talk down to them or make them feel bad, that you're trying to help them. And so, like you said, it's important that we utilize all of the tools and all of the pieces of the puzzle. So the x-ray imaging, the periodontal charting, the disclosing solution. All of those things are some piece of the puzzle that we use to educate our patients. And once we educate our patients, they become more involved and they become more engaged in their own health. And so once we're able to get them involved and engaged in their own health and what we're seeing, they're more on board to these preventative fluoride varnishes or SDF treatments. you know, other treatments that we have in office that we utilize. They want us to help them, but they just need to understand the state of disease or health in which they're in, in order to wrap their head around why we think it's so important to remineralize the enamel. Getting them on board to understand the importance. of where they're at and where they can be if they comply. And of course, you need their participation. That brings me to a question to Laura. Talk to us about some effective strategies and tools that patients can implement at home. Because if they're not doing stuff at home, that's going to be a very difficult job for you as a hygienist to maintain their oral health. And they'll get disappointed and they'll think, well, I just can't seem to get into the spot where you want me to be. And they'll feel like a failed patient. With that implementation at home, with the right tools, it'll be a successful partnership. So how do you get them to do that successfully? This is so perfect. So I can tell you that the hygienist that I was when I first graduated, what, 16 years ago, I'm such a different hygienist than I was then. And I love that evolution because previously I used to save. education and home care and like that motivational interviewing aspect for the end of my appointment and now I I get that toothbrush out I'm like hey show me how you brush your teeth show me how you floss so that way we can truly change and help them create realistic habits that will set them up for success Some patients, they don't have the dexterity to use floss. Okay, so what other tools do we have in our toolbox? So let's talk about a water pick. Certain patients have a difficult time with certain toothpastes, and they're like, oh, no, I don't like that. It makes my tissue slough because it may contain SLS. But there's other products. I know that we recommend Voco Cream. It's Remin Pro. And it really helps our patients that have that sensitivity and are a higher caries risk because it contains that trifecta effect. It has some of our favorite products. It has the nanohydroxyapatite, xylitol, and fluoride. So all those three ingredients are so important to help our high risk. dental patients. And when they can see the difference from whether they're on a three-month or six-month recall, and they're coming in and you're working with them and you're starting to see change, you celebrate those wins with them. And that is going to continue to help with that. Do you find it challenging to switch a patient to a new toothpaste, especially if they've been using their typical favorite Crest or Colgate for many, many years? I mean, I personally haven't had a problem, especially because it tastes so great. They have different flavors and and they they love the way it makes them their mouth feel. It's very soothing and especially my high. sensitivity patients, they immediately see a difference and they can't imagine going back from that toothpaste. Like, no, I don't want to feel that sensitivity again. Yeah. So let's pivot a little bit and talk about something that's important in all phases of life, and that's trust. So we all know how important it is to develop trust between two people. That's how things get done. You have to trust your partner in life. You have to trust your friends, your teachers, your professors. Everybody you work with, people you buy things from, your car salesman, it goes on and on. Your real estate agent, when you're trying to buy a house or selling a house, without that trust factor, nothing happens. It's just you end up going into a dead end and you can't accomplish what you want to accomplish. So as a dental hygienist, you have the same challenge. You're seeing a lot of patients for the first time. These patients are essentially strangers. So how do you quickly develop trust in that first visit? And we talked about it to some extent, but there's a psychology behind it. And what are you finding, Danielle, works for you as far as building trust quickly with that new patient? Yeah, absolutely. I love that question. I think that right out the gate for me personally, it's important to find almost a common thread with that patient, whatever it may be, just kind of solely engaging and asking questions. And then really just step by step. If it's a new patient, we do new patient exams as a hygienist in the office that I work in. And from the second that patient walks in the door, they know exactly what I'm doing and why I'm doing it. And the second that I've done a portion, I'm sitting that patient up and I'm educating them. So if I'm taking x-rays, I'm educating them. If I'm doing a gum charting, I'm educating them. And then kind of from there, like we were saying before, all of those puzzle pieces, the disclosing gel and everything that we've discussed, you know, about their personal health and medications, I try to tie everything together for that patient and let them understand what I'm seeing visually as a clinician. And I'm here for them. I'm not here to, you know, you know, degrade them or make them feel bad for, you know, not being a dentist for 20 years. I'm here to help them, you know, obviously go towards that health continuum. We see a lot of patients that come in with, you know, a lot of disease and it's our job as prevention specialists to get that patient out of that neutral disease state to that, you know, state of health. And so once they realize that I'm on their side and I'm on their team and I want to keep them from the doctor's chair, they're all on board and they're willing to do whatever it takes. And they just, I don't know what it is. They just kind of immediately trust that, you know, what I'm telling them is true. And I obviously want what's best for them as the patient. I treat all of my patients as individuals and utilizing all of my different tools in my toolbox, whether that be prescription fluoride paste for them to take home or, you know, the pull fluoride varnish at the end of the appointment, whatever I deem necessary for that patient, I'm going to educate them on, you know, the need. And I allow them to make that decision. Yeah, I think the education part of what you do is so important because I know when I go to a healthcare provider, not only dentist, even if I go to my primary care physician, PCP. I want to know what he thinks of my lab tests and why he is concerned or not concerned or where the trend is compared to last year. These kinds of discussions is exactly what you're talking about. You know, you're partnering with the patient and you're feeling like the doctor is involved with you personally and you're not just a lab number and you fit into a range. You look at the whole picture because there are going to be some patients that are genetically prone to perio disease where you do a very good job, Laura and Danielle, and your prevention techniques are perfect and you have your protocol in place, but the patient comes back for the recare appointment and it still ain't that great. And they're doing a lot at home, diligently trying in good faith to do it. That's discouraging for the patient. Hopefully, that's a minority or a small percentage of patients, but it does occur. How do you deal with that? Maybe, Laura, you want to answer that question. Oh, yeah. We dig deeper. We say, all right, there's a root cause going on here. Let's figure out what that is. We offer salivary diagnostics. We talk to them about how their sleep is, what their airway looks like. It's so multifaceted. Yes. Periprotectories. Like there's so, there's so much to, to think of. And it's, I mean, really we're like investigators as hygienists, you know, sometimes trying to figure out what that root causes, but that's what we want to get to. And we, and when we're doing that, I mean, patients see that they, they feel that and they feel taken care of. And ultimately that's what we want to do. We want to treat our patients like they're our family or friends, and we want to help them. become healthy. Yeah. So the oral systemic link has been a big topic. And what you just mentioned, Laura, is really very important. Sleep apnea, for instance, could be a major cause, etiology, for recurrent gum disease and caries that are just, you're trying to get it under control, but you're just not successful. And years ago, when I was in dental school decades ago, dental hygienists did not learn anything about that kind of stuff. So are they now teaching that in the dental hygiene programs, what you just discussed, for instance, to investigate deeper and be more of a diagnostician when it comes to resistant perio problems that keep coming up, even though their home care is good and you guys are doing a fabulous job? Oh, I hope so. To be honest, I don't know the answer to that, but that's why we take continuing education courses as... right i know Danielle and i we we both are always learning and growing and discovering new ways we can help our patients and it's like once you start learning and start seeing that you can't unsee it like the connections just it's so evident and and you can really i mean put the put the puzzle pieces together And there's no question, continuing education is so important. Of course, from my perspective, having founded Viva Learning almost 25 years ago, I'm a big fan of continuing education. I made this business out of it, and I'm very happy I did that. We're disseminating information all over the world to dentists, hygienists, assistants, everybody. And it's fantastic to know that what you do... every day can be improved, especially by learning and reading peer-reviewed articles and listening to key opinion leaders and top clinicians. Everybody has something to learn. Nobody knows everything. And being open-minded about that is a great way to be and progress through your career. So with your experience, Danielle, and the CE that you've taken over the years in your education, what would you... say is important for a dental hygiene department in today's dental practice to be top of mind? That's a really great question. I think that kind of having had worked at multiple different offices, I think that a thousand percent having protocols in place is so important. When the patients are walking through the door, it shouldn't matter what hygienist they're seeing in that office. It should be the same standard of care throughout. And I think that if you can provide that same standard of care. And have everybody in that office understand the vision and the mission of that office that you work in. And, you know, once everybody on that team is on the same page, I mean, beautiful things can happen. And like Laura said, you know, we continue to educate ourselves. And I think that we're in a fantastic, exciting place as a hygienist right now. There's just so much opportunity. Like you were talking sleep and airway and myofunctional therapy. Laura and I are starting to dip our toes in all of those things. And really, again. try to get to the root cause for our patients. So I think as a, as a doctor, just really taking hold of your hygienist and, you know, co-diagnosing and being on the same page and having those protocols in place and that vision and that mission and beautiful things will happen. Yeah. Well said, well said. And I just want to ask you a last question, Laura, how important is training? Like Danielle is mentioning to get everybody on the same page. And I think that's really important because if I go to a dental office, And I don't see my favorite hygienist, I would say, on one day because she's out and another hygienist comes in. I certainly want that person to have the same standard of care and look at my mouth in the same way that my regular hygienist would do. So isn't training so important to achieve that? And how does that happen in the office? Absolutely. I mean, I think in order to have effective communication and a cohesive team, you need to set up, you know, team meetings. And I'm not just talking, you know, a five minute huddle before the day of what who needs to do what, when, where and how. But no, it's it's so much more than that. It's making sure that you understand people's personalities, you know. how you all work together, like to truly create that culture. And like Danielle said, have those protocols in place. I think everybody should want to invest in that. You know, we're working a majority of our time, of our life, right? So don't you want to be happy doing that and being in a good environment? So if you can, you know, provide and raise each other up. It's a great place to be. So absolutely. I mean, dentists, owners, whomever. Remember that and remember to create that beautiful mission and vision that you want for your practice and give back to your team because they're the ones that are providing that optimal care for our patients. Yeah, no, well said. I think both of you guys are an inspiration to the dental hygienists that are listening to this, dentists that are listening to it, because while you're going to work anyway, you could... so much more effective by doing the things that you're talking about, much more gratifying of a career, and everybody benefits, the patient, the practice, you personally. It's really nice to hear you guys have that culture. Whoever raised you two separately did a good job, and whoever trained you did a good job, so hats off to them because you're carrying the torch in a very respectable way. Have a great evening, and thank you very much for your input. Really appreciate the discussion. Thank you so much.