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

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