Pacific Coast Society of Orthodontists Bulletin Summer 2015 - (Page 56)
Practice Management Diary
Hygiene: A New Battle Plan
for an Old War
By Dr. Jeffrey Nichelini
American Canyon, CA
In my office, we pride ourselves on our emphasis
on good hygiene, as do most of you. Therefore,
you can imagine my embarrassment when a
pediatric dentist from a referring office (who is
also a close friend) recently called to discuss her
deep concern for a mutual patient who presented to her office with braces, abundant
plaque, caries, and bleeding gums. She further
drove the stake into my heart by reading back to
me a line from my initial exam report stating
that the "patient has poor hygiene, and will not
start comprehensive orthodontic treatment until
it improves." Argh! I reacted by defending myself;
I explained that we had only bonded the patient
after putting him on a weekly recall plan in
which he displayed his ability to keep his teeth
clean, and demonstrated that he was responsible
enough to commit to braces.
After this phone call with my friend and colleague, I fretted about where we clinicians are
going wrong. We're doing a bunch of great stuff
to minimize this problem. We're thoroughly sealing the buccal surfaces of all bonded teeth to
defend against white spots, giving away an
abundance of hygiene products including electric
toothbrushes, showing instructional videos and
providing one-on-one instructions with disclosing tablets when needed. What more can we do?
To answer this question, I reached out to friends
and scoured the Internet. I found a lot of unique
approaches to educating and incentivizing kids,
but none that addressed the underlying issue:
how does one train a teenager? With the help of
San Francisco child psychiatrist Michael Swetye,
MD, we outlined a series of steps to organize and
contextualize these approaches in a way that
might more effectively target a larger percentage
of the kids in any practice.
Step 1: Educate. This goes without saying. The
first step of any effective hygiene program is to
educate patients regarding the benefits and
techniques of good oral hygiene. Resources
abound; some of my favorites include:
56
The Grosser, More Disgusting, But Still Totally
Cool Mouth Book, by Theodore Croll, DDS.
This amazing resource gives a great pictorial
review of the consequences of poor hygiene.
It seems to really engage kids.
YouTube. Many offices around the country
have posted great hygiene tutorials. If you're
not inspired to make your own, take a few
minutes to browse those created by some of
our colleagues. You can play your favorites in
the office or email links for patients to view at
home.
"Embrace It" program by Crest. This program
offers some great printed materials to show
to and discuss with patients; there's also a
website, including videos, dedicated to maintaining good oral hygiene while in braces.
Numerous orthodontic practice software
packages come with hygiene videos.
www.bracesguide.com. Check out this awesome website. In addition to being a great
hygiene page, it provides a very comprehensive and objective discussion of many of the
components of orthodontic treatment.
Step 2: Engage. If a patient in active treatment
presents with poor hygiene, it is critical to
approach him/her with warmth and empathy.
Rather than attack the problem, be curious. Start
the conversation with, "I notice that there is
plaque on your teeth." Hand him/her a mirror
and explain your areas of concern. Have an assistant work on technique with the patient for a
few minutes to make sure he/she understands
the nuances of brushing with braces, and ensure
that the appointment does not end until all
plaque is removed from his/her teeth. Taking this
approach makes the patient part of the process,
and allows him/her to demonstrate that he/she
is capable of meeting your expectations. This
strategy also eliminates confusion.
Step 3: Understand. If the problem persists at the
next visit, again resist the temptation to scold
the patient. Ask what's going on, and try to coax
a response from the patient. If you can get
him/her to talk, you'll be more likely to discover
PCSO Bulletin Summer 2015
http://www.bracesguide.com
Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2015
Staying Connected in a Large, Diverse Orgainziation
Palm Springs: A PCSO Favorite
Trustee Report
PCSO at a Glance
PCSO Member News
AAOF Report
Special Section on CBCT
CBCT Imaging Protocols Within PCSO Residency Programs
Cone-Beam Computed Tomography in Orthodontics - Benefits of Comprehensive Visualization
Case Report Pre-Treatment
CBCT in Today's Orthodontic Practice
Case Report Post-Treatment
Differentiating Posterior Crossbites with CBCT Volumetric Images
Apps for the Orthodontist
Dr. Ib Leth Nielsen, San Francisco, CA
Dr. Robert J. Bendzak
Dr. Arthur A. Dugoni's 90th Birthday Makes for a Special Alumni Meeting in San Francisco
Preparing for the Unexpected: Your Emotional SOS Plan, Part II
Resident Spotlight
Hygiene: A New Battle for an Old War
Dr. Peter Picard, 1919-2013
Pacific Coast Society of Orthodontists Bulletin Summer 2015
https://www.nxtbook.com/allen/pcso/bulletin_summer2023
https://www.nxtbook.com/allen/pcso/95-2
https://www.nxtbook.com/allen/pcso/95-1
https://www.nxtbook.com/allen/pcso/94-4
http://www.brightcopy.net/allen/pcso/94-03
http://www.brightcopy.net/allen/pcso/94-02
http://www.brightcopy.net/allen/pcso/93-3
http://www.brightcopy.net/allen/pcso/93-2
http://www.brightcopy.net/allen/pcso/93-1
http://www.brightcopy.net/allen/pcso/92-3
http://www.brightcopy.net/allen/pcso/92-2
http://www.brightcopy.net/allen/pcso/92-1
http://www.brightcopy.net/allen/pcso/91-4
http://www.brightcopy.net/allen/pcso/91-3
http://www.brightcopy.net/allen/pcso/91-2
http://www.brightcopy.net/allen/pcso/91-1
http://www.brightcopy.net/allen/pcso/90-04
http://www.brightcopy.net/allen/pcso/90-3
http://www.brightcopy.net/allen/pcso/90-2
http://www.brightcopy.net/allen/pcso/90-1
http://www.brightcopy.net/allen/pcso/83-4
http://www.brightcopy.net/allen/pcso/89-3
http://www.brightcopy.net/allen/pcso/89-2
http://www.brightcopy.net/allen/pcso/89-1
http://www.brightcopy.net/allen/pcso/88-4
http://www.brightcopy.net/allen/pcso/88-3
http://www.brightcopy.net/allen/pcso/88-2
http://www.brightcopy.net/allen/pcso/88-1
http://www.brightcopy.net/allen/pcso/87-4
https://www.nxtbook.com/allen/pcso/87-03
https://www.nxtbook.com/allen/pcso/87-2
https://www.nxtbook.com/allen/pcso/87-1
https://www.nxtbook.com/allen/pcso/86-4
https://www.nxtbook.com/allen/pcso/86-3
https://www.nxtbook.com/allen/pcso/86-2
https://www.nxtbook.com/allen/pcso/86-1
https://www.nxtbook.com/allen/pcso/85-4
https://www.nxtbook.com/allen/pcso/85-3
https://www.nxtbook.com/allen/pcso/85-2
https://www.nxtbook.com/allen/pcso/85-1
https://www.nxtbook.com/allen/pcso/preview-program-2013
https://www.nxtbook.com/allen/pcso/84-4
https://www.nxtbook.com/allen/pcso/84-2
https://www.nxtbookmedia.com