Brandi Hooker Evans is a registered dental hygienist and consultant. 

She acquired her formal education from Idaho State University, most recently earning a master's degree in health education. Hooker Evans has served the Idaho Dental Hygienists' Association as President, as well as her local Portneuf Valley Dental Hygiene Society. With nearly 2 decades of experience as a clinician in private practice, she has treasured her time as clinical dental hygiene faculty at Idaho State University and served on the ISU Dental Hygiene Advisory Board. Currently, Hooker Evans owns and operates Stellar Outcomes and Evans Dental with her husband, Dr. Eron Evans. Furthermore, she is an American Academy of Dental Hygiene accredited continuing education provider.

Brandi Hooker Evans RDH-ER, MHE, MAADH

Checking on Patient Wellness. Image credit: © Jade Maas / peopleimages.com - stock.adobe.com

Do you ever wish you could erase things in life like an Etch A Sketch? Maybe you would erase a poor choice as a teenager, an angry moment as a parent or maybe the whole dang dental hygiene appointment. I sure do. I would love to shake the red gadget and start over. Ditch the expectation to see a patient every hour and put all their care into that hour which may or may not suit them. Based on the rampant disease in our country, we know that half to three quarters of the adults we see will need something other than that typical 1-hour they are scheduled for. Grab your pencil and let’s sketch a plan to turn the average prophy appointment into an oral wellness check-up or rather a check-in.

The first thing we aren’t going to draw is an expectation about what a patient needs before they sit in our chair. It does not matter if they are new to us, new to our practice, or have been coming to us since before Hilda graduated hygiene school in 1974. We will approach each person with curiosity. That begins with their medical history. “Sarah let’s chat about your medical history.Medications and ailments have a direct effect on your oral health and vice versa.” Then allow plenty of time to explore what Sarah is working with from a total body standpoint. We may not be experts in every other system in the body, however, we are highly skilled screeners with enough information to point Sarah in a good direction if something about her health appears off.

Right after a thorough conversation about the patient’s medical history, let’s sketch in a couple of moments where we get to take blood pressure. Yes, we get to. Every time. I consider this part of the appointment such a privilege. This is not the time to be tentative about offending people. This is our chance to mitigate the effects of disease within our patient population. The care that we provide and the knowledge we share can save lives. Imagine having a conversation about hypertension with a 42-year-old Dad that went on the receive care for his silent, yet present cardiovascular disease. That care translated into a major lifestyle change that prevented said dad from an early death at age 48. Thanks to our tactful conversation, a re-found love for exercise, and some vegetables, Dad is attending his daughters’ high school graduations and going to get to walk them down the isle at their weddings. Prior to our chat, Dad had not been to a doctor for a physical since his junior year at age 17 when he was the football quarterback. In general, he felt fine and had no idea his atherosclerosis was sneaking up on him like the angel of death. Don’t you want to be the hygienist that started this cascade of events? I know I do. We never know when our words are going to powerfully impact an entire family and community. Why not do the best we can, in all the ways we can?

Side note- I co-delivered a course last night where we discussed heart disease and blood pressure. Many hygienists talked about the backlash they have received from other providers about “staying in their lane.” A few claimed that they have been discouraged from having total body wellness conversations with our patients. Y’all, we must respectfully disagree with that statement and the sentiment behind it. The periodontium is directly connected with the cardiovascular system. P

orphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Fusobacterium nucleatum (Pg, Aa, and Fn)

 are all found in atherosclerosis after having originated in the mouth. We also know that one inflammatory disease increases a person’s risk for another inflammatory disease at a minimum of 5-fold. Americans visit their dentist more than their doctor making the need for us to complete a basic screening incredibly necessary. Furthermore, if a patient has periodontal disease, an elevated blood pressure reading is excellent evidence for the case that our patient needs to address the inflammation in their body. Good thing they are here today because we will help them start with their oral inflammation that will have a direct effect on their overall inflammation. If you receive negative chatter about this topic, I invite you to share the details on cardiovascular disease as it relates to periodontal disease. Couple that with the fact that we lose 800,000 Americans every year to cardiovascular disease (150,00 to stroke, 650,000 to heart disease). Those well-intended yet inaccurate medical professionals will reconsider their stance on what our “lane” is. If we really want to sketch a brilliant care system for our patients, we will seek out those other providers and build relationships. I would love to see it become common practice for dentists, general practitioners, specialists, nurses, and the like become friends that regularly have tea and discuss the needs of our community. Imagine what a difference we could make if all the health care practitioners in the community worked together for prevention of disease, co-treatment of present disease, and well-rounded education for the population we serve……. We may have to ditch the Etch A Sketch, grab an easel, and a brilliant set of paint colors. This picture is getting more vivid and gorgeous by the minute. Alas, we must start somewhere. Together, you and I will sketch out our dental visits then revisit the other entities of health care at a later date.

Sketching in a quality oral cancer screening is our task now. What is normal for Chad? This is when we find out. As we complete the extra and intra oral exam we notice that Chad has a swollen thyroid on one side. Since about 20 million Americans have thyroid disease, we aren’t surprised to find an abnormality for Chad. He had no idea and has since gone to his doctor and found that his thyroid is not functioning properly. He doesn’t have cancer but is taking some supplements to correct the dysfunction of his thyroid. Chad is super grateful that we took the time to provide such exquisite care. His energy levels have returned to normal and because he caught the problem early, he doesn’t have to take medication. Another day saved by an RDH. Yahoo!

Now it is time to draw in the x-ray portion of the appointment. It is critical that we take high quality images that show all the information we need to make an accurate diagnosis. We need a straight on view of the interdental bone, open contacts, and the roots of all the teeth. Depending on the risk factors of each patient the timing will vary. Personally, I want to see in between the back teeth and the bone there every year, the periapical area of the anterior teeth every 2 years, and all the roots every 5 years. If there is any reason for concern, I will happily snap a new film before that time frame. We live in a digital world where the risk of radiation from dental x-rays is so minimal that it is a no brainer to just get the films and/or retakes that we need. One important reason we need these great pictures is for our patient’s ability to diagnose their own disease. If the films are poor, the contacts are closed, and the alveolar bone is missing altogether, how are we (the dental professionals) supposed to diagnose the disease? You are right. We can’t. And neither can Joan. So, let’s take great films!

As we spin the knobs on the Etch A Sketch, we arrive at my favorite part of the appointment. Here is where we draw in adequate time for recording or updating a periodontal chart. We need to allow time for measuring every tooth, every time. Our number one indicator of active disease is bleeding. Simply guessing is a mistake in my opinion. In health, checking all 6 locations of each tooth takes less than 2 minutes. When we need to record depth changes and bleeding points, it takes more time. Usually, the patient needs more care at this point and the extra time at this juncture sets the patient up to understand what their needs are and equip them with tools to address said needs. This is where a hygiene assistant comes in handy. If you don’t have an assistant there are several tools available to aid in efficient charting for your patient. The critical piece to periodontal charting is to say the numbers and bleeding points out loud. When Bob hears, “1-3 mm is normal and healthy gums don’t bleed or hurt while I am measuring.” Then proceeds to hear 4, 5, 6, and 7 with generalized bleeding, you don’t have to tell Bob he has gum disease. He figured that out all on his own, thank you very much. 

The above 5 steps of quality oral wellness check ins are non-negotiable in my opinion. The medical history, blood pressure reading, oral cancer screening, adequate x-rays, and full mouth periodontal charting are a fabulous picture of what is happening currently for our patients. In health, that entire routine takes less than 20 minutes. That leaves 25 minutes for instrumentation, polish, and varnish. Leaving the last 15 minutes available for an exam, rescheduling, and a warm hand off to the front desk administrative team. Please invite the doctor in for an exam anytime after your assessment is complete. This system creates a healthier flow for the entire practice. It also insulates your patient from having to wait for an exam should the dentist be busy at the moment you finish rinsing the polish out of their mouth. This works if excellent hygiene care is standard procedure and there is trust and mutual respect. The result makes the dentist’s need to “check our work” non-existent. When the doctor does arrive for the exam, briefly update them on what you and Jose found during the assessment. Set the conversation up for team collaboration. Give the doctor an opportunity to confirm the findings and support the game plan. This type of teamwork takes practice and time spent reading x-rays and periodontal charts together outside of the operatory. I urge us all not to skip this prep work required for team unity. A united presence with the patients is effective while differing opinions instills confusion and trepidation in Jose. We are sketching an efficient and thorough dental hygiene appointment that supports Jose taking action for his oral and overall wellness. If we confuse him, he will not proceed with care here or make modifications at home.

Should you have a picture that has all 5 of those steps already in place and would like to take this oral wellness check in to the next level, I would invite you to add in one item of interest to you. This will challenge and invigorate your RDH soul. Intra-oral pictures are a phenomenal adjunct for patient education as well as documentation. Everything from mouth sores, old fillings, recession, and bruxism can easily be recorded and monitored with precise accuracy over the course of time. I have seen skilled clinicians snap an entire mouth worth of pictures in 2 minutes. The profound information this provides is well worth the 120 seconds it takes to collect the photos.

Another emerging adjunct for amazing assessment is saliva testing. This technology is becoming more user friendly and less cost prohibitive by the year. While the information does not necessarily change the game plan for the patient’s periodontal treatment plan, it can change their motivation to care well for themselves. Learning that the bacteria in their mouth are the same strands found in clogged arteries and spinal fluid of people with Alzheimer’s disease is likely to allow you to forgo the brushing and flossing speech forever. They will not want anything to do with either one of those life destroying diseases. By the way, Costco is having a sale on a 2 pack of power toothbrushes. Our patient, Felix is planning to stop on his way home from his appointment today, purchase, and then use the power toothbrush from here on out (wink, wink)! Saliva testing as an assessment adjunct is also great for those of us that like to geek out on data. For example, yours truly. If something lights your fire for your career, the cost in time, effort, and money is well worth it. Don’t forget if you try something and don’t love it, you do not have to do it forever. Many companies with products like this offer a deal on a trial package. I encourage you to give it a go if it looks fun and/or beneficial to your patients. I have yet to see a professional become more passionate about their days at work and less good at being a hygienist. The two have a positive correlation. Why not capitalize on it?

As we complete the picture of what our assessment sketch should look like, we have brilliantly transformed a basic hygiene appointment into an oral wellness check-in. If at the end of our beautifully drawn assessment our patient needs something other than a prophylaxis, we will have the evidence to support a treatment plan that is reflective of Lanett’s needs. It also allows ample chance for Lanett to learn about her own health. No matter how great of a hygiene appointment we provide, Lanett is the one who will be caring for herself throughout her life. If Lanett were your favorite auntie, would you want her to be equipped to care well for her oral and overall health? I definitely would. For both her oral and overall health an ounce of prevention is worth a pound (maybe ten) of treatment. Let’s make a promise to ourselves and our patients to wipe the slate clean and sketch a hygiene appointment into the most beautiful, comprehensive oral (overall) wellness check in. Happy sketching!

Articles

How to turn prophy appointments into oral wellness check-ups.

Checking on Patient Wellness

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Do you ever Feel like we're trapped in a box? Does that box look like 50-minute prophies back-to-back to back-to-back?

Have you ever pondered what it could be like outside of that box? Have you ever wondered who even made the box?

While I can’t blame anyone in particular for the box or even say that it is a bad box, I can say there is so much more if we are willing to imagine life and dental hygiene outside of the prophy box.

Let's look at the traditional role of a dental hygienist in a private practice dental office. What would it be like if we took all our education, continuing education, and experience to transform the typical dental recare appointment into a wellness visit unparalleled by any other provider?

Americans see their dentist more than any other medical provider. That puts us in the prime position to make a revolutionary change to the health care system in America. Because we are trained to be health screeners for the entire body, why not give it a whirl? Recently, I have seen dental hygienists integrate total body health into their assessment and treatment plan with outstanding results. The referrals for cardiovascular and endocrine (thyroid & diabetes) evaluations are prolific. These diseases are top killers in our country. How great is it that some of our colleagues are catching them early? When I speak to “whole body” RDHs, they report feeling valuable and fulfilled in their work. Who doesn’t want that?

What about the work that we perform in that dental office? After an amazing assessment and appropriate referral (if necessary) is completed, what else can we provide for them in our office that we currently are not?

Certainly, incredible periodontal therapy is at the top of my list. In addition, there is also an insatiable market for cosmetic procedures that we are already trained and licensed to do. This will have a wide range of appeal within specific geographic markets and consumer demographics. Rural farm towns may not be a hot spot for these services but a bustling city like Phoenix might.

The caveat to the “licensed” part of that claim will vary state to state. Which is another area of potential for dental hygienists that is often overlooked. There is endless work to be done for dentistry at the legislative level in our government. With everything from hygiene scope of practice to the abysmal state of dental insurance in need of attention, our entire profession needs great men and women with our background to lobby for appropriate laws. There are states in the union that still don’t allow local anesthesia and nitrous oxide to be administered by RDHs. That is especially alarming when other professions can do all kinds of procedures without a license. For example, in Idaho, medical assistants can administer local anesthesia and there are no requirements for training and licensure for phlebotomy. I do not know what the correct answers are in all these situations are but surely there is a large measure of logic and reason we could add to the current set of laws.

Might we also challenge working in the dental office only? What if it were commonplace to consult with a dental hygienist at the pediatrician’s office? Parents all over the country seek special care for their children to offer them the best chance of living a healthy life. We know that oral health is critical from the beginning of life. Sadly, many parents have no idea how to care for those cute gummy grins and are devastated when their child is in oral pain or has dark spots across all their front teeth.

The pediatrician’s dental hygienist could have profound nutrition and hygiene discussions with the parents. They could apply fluoride varnish, place sealants such as my product of choice in any setting—GC Fuji TRIAGE®—and make sure the family had a great dentist to visit for their regular dental appointments.

Imagine if children and their parents were equipped with the knowledge and skill to avoid that first round of dental decay? How great would it be to know that the full body infections of caries and gingivitis were vastly reduced because of the support we provided at the earliest stages of life? I know you know parents who believe that apple juice in the bottle is fabulous for a little one’s health. Such a great easy way to get fruit!..... Friends, we are soooo needed in this realm. And to be clear, that was a joke. Apple juice does not count as a serving of fruit.

Expanding upon the children and their parents needing our knowledge and assistance, what about the schools? Many schools have a nurse available regularly, if not daily. I see this position as a territorial position where a dental hygienist would be hired by the school district to rotate through the buildings within the district. It seems like an oral wellness program with classes for children in pre-kindergarten through 12th grades would further help eradicate the oral health calamity of our nation.

The Oral Health in America report from 2022 shows that dental caries is still the most prevalent disease in Americans even though it is largely preventable. We are seeing that the oral disease is directly connected to gut health and the rest of the systems in our bodies which means that if we can improve oral health and dental IQ in children, we can effectively promote overall wellness in our entire future population.

This career sounds particularly fun to me. Imagine creating classes for the little babes and having candid conversations with the teenagers. The collection of experiences from that large age range would be ongoingly entertaining. This also seems like a great program to have the potential for varnish and sealant placement as well as emergency screenings for toothaches. It would be similar to going to the school nurse for a headache, but the student would be able to have a professional evaluate their ailment and refer them to the appropriate place for treatment.

In the last few decades there has been a major push for dental hygiene care in nursing homes. This idea is brilliant and, if given more attention, it has the potential to improve the quality of life for our treasured elderly population on a large scale.

Often oral health is the battle that does not get fought in facilities where people are unable to care independently for themselves. I have a patient who comes in every month for a prophy (in this case it’s my best effort with the ultrasonic as fast as possible until I can see that her tolerance is spent) to help ward off pain associated with dental neglect. The nursing home she lives in takes great care of the rest of her body but because oral health has been overlooked, her daughter seeks treatment outside the facility. She does not want her mom to end up with a mouth full of cavities and gum disease. It is not a perfect scenario but a monthly visit to our office is better than the “nothing” that happens at her residence.

It seems that if this area of care was given more interest and support, the difference we could make would be profound. There is a cost associated with having a hygienist on staff at these facilities that I believe we could build into the cost of attendance, acquire grants for, or utilize the money otherwise needed for dental emergencies that would be avoided if there was regular care present. If you would like to see how big of a difference we can make and how rewarding the work can be, check out the Geriatric Toothfairy, Sonya Dunbar on 

. The joy and help she delivers to her patients and the fulfillment her career brings is priceless.

One of the largest needs I see in our nation is for dental hygienists to become myofunctional therapists. Or at least adding myofunctional therapy skills to help with the large number of patients we see every day in need of this service. The disease that our nation is suffering from based on mouth breathing, poor sleep, tongue ties, speech impediments, and skeletal formation is prolific. We have a great education in head and neck anatomy and a huge part of oral wellness is correct breathing, eating, sleeping, and speaking patterns.

A dental hygiene license is the perfect jumping off point to gain further skill to help our patients improve their oral and overall health in this way. There is not a day that goes by when I work as a clinician that I don’t scramble to find a myofunctional therapist to refer to. I live in Idaho and my favorite is Cheryl Shafer, RDH in Maryland. Thank goodness for Zoom, and even at that, there are not enough hours in the day to take referrals from the whole country.

She has saved people from surgery, sleep apnea, ADHD, and a gamut of other diseases that otherwise “have no treatment” or “just needs a pill” or “let’s pull a few teeth” and the list goes on. I have seen her work firsthand with my daughter. A child who has had surgery for airway issues that only helped mildly for a few months. After a few short appointments and a few specific exercises for homework, this girl no longer takes allergy medication every day, sleeps through the night, does not have headaches, does not have puffy eyes all the time, and can chew her food with her mouth closed. It is literally life changing. And as a professional, Cheryl works from home, sets her own fees, sees a positive difference in her patients’ lives immediately, and has career satisfaction to one of the highest levels I have ever seen.

There are countless ways that we hygienists can expand our scope of practice. We have unlimited potential. There has never been a better time to reimagine our careers. To visualize and increase the contribution we make to the health and wellness of our country.

What it will take is getting outside of the clock in and clock out prophy box most of us have felt trapped in at one time or another. I invite every single one of us RDHs to examine and reimagine our career. Whether we feel called to elevate our private practice game, create a new position at a different venue, lobby for more appropriate laws, or expand upon geriatric or myofunctional dreams, this is our time to think bigger.

Dream without limits. Make the most profound impact we possibly can. While the task will require work, the reward is sure to be exhilarating. Cheers to our careers as RDHs, reimagined.

Reimagining the role and scope of the work done by dental hygienists.

Visualizing Dental Hygiene’s Potential

Image Credit: © Sultan / stock.adobe.com

How do you describe biofilm construction to your patients?

I often compare it to building a house. I like to illustrate that the bacteria first on scene build the foundation, then the framers show up, followed by drywallers. Last to the work site are the painters who also happen to be the most virulent microbes.

This works well because the comparison describes the process, inspires “at home” biofilm disruption, and reinforces the need for regular professional dental hygiene care. I really like multipurpose analogies, please send me a new one that has worked well for you!

For quick reference, here is a review of the more scientifically accurate description of the life cycle of biofilm:

The acquired pellicle attaches to a surface

Microbes begin to arrive and colonize the area

More plaque with microbes connect with one another (co-adhesion)

Biofilm matures and alerts the immune system

Biofilm detaches and launches into other areas of the mouth and body

The immune system realizes it has work to do and begins to respond to the invasion with a myriad of fluid, cells, and techniques

Biofilm is removed by a person with their homecare or via professional dental hygiene care

Biofilm begins to reform immediately upon removal
(Insert favorite curse word here).

What are we to do with this never-ending biofilm building process? It is like the dang laundry. It starts building up the moment it is done being removed. In college, I used to sit sans clothes for a few just so the laundry could be done for five stinking minutes. Because being naked won’t help reduce oral bacteria and isn’t appropriate to recommend to our patients, let’s jump into how we can help them mitigate this biofilm issue.

First, we must give them a clean slate at the office. This is our chance to do a stellar job with our awesome clinical skills. Recent research has shown that ultrasonic instrumentation removes fifty percent more biofilm than hand instrumentation alone. The crowd favorite response is, “That’s why we use the blended approach.” However, did you know that hand instruments remove 10 times more cementum than ultrasonic instrumentation? These two pieces of evidence have been the impetus for a complete reconstruction of my clinical routine.

 Now, I do my very best to use ultrasonic instrumentation only. I hope you will give this a go too. The increased speed, decreased tax on the hygienist’s body, increased biofilm elimination, and decreased cementum removal is incredibly enjoyable and effective.

Gaining confidence to let go of my precious hand instruments and the “blended approach” most of us learned in school was difficult. However, as the evidence kept coming into my view, I felt I had no choice but to practice Maya Angelou’s advice, “Do the best you can with what you know. Then when you know better, do better.”

Here is the recipe I use to ensure an efficient and effective prophylaxis, scale and root plane service, or periodontal maintenance:

Choose the Correct Ultrasonic Tip for the Type and Volume of Deposit Present

Test your choice by tapping and swiping that tartar! If the calculus comes off easily, you know that you have the correct combination. Ultrasonic the lower anterior teeth until you believe they are completely free of deposit. Move on to the surfaces toward, and finish with surfaces away. Rinse and repeat for the maxillary teeth. Then switch ultrasonic tips to a slim or thin attachment and proceed to use it like an explorer. If, and when you find a deposit that the first tip missed, simply activate this thinner tip. Stay with the calculus until it is completely removed. Floss the teeth as an additional round of exploration. Voila! Hygiene routine elevated and simplified!

Use at least two ultrasonic tips per patient. As more complicated conditions present themselves, use the appropriate tip styles and as many different tips as you need to complete the task well.

Wondering why I didn’t recommend a new piece of equipment or some magical product? Certainly, the very best tool (in this case the ultrasonic) is the one you already have. My only limitation to this statement is that the ultrasonic unit must be in working order with appropriate tips that are less than 50% worn.

The research regarding ultrasonic instrumentation is irrefutable and has decades backing it up. No gimmicks needed. Just great information for utilizing what we already have. Additionally, I truly have not seen anything show better, more repeatable, long-term results. Perhaps it is due to the lack of research and time on the market of the newer technologies. While many of these are showing promising signs of biofilm disruption and removal, I believe it is a mistake to avoid addressing the need to maximize our ultrasonic use.

Now that we have our part done let’s strategize how to guide our patients in between appointments. Before you recommend a tool or a technique for their home care, assess whether your words will fall upon open ears. I often find that brushing, flossing, water flossing, interdental brushing, and the like are counterproductive to recommend. Sounds crazy, I know, but hang with me for just a second.

Our wonderful patients are whole human beings, and they regularly have no idea that their oral health is connected to (i.e. the same thing as) their overall health. Ergo, I have better luck grabbing their attention and inspiring a change when I discuss anti-inflammatory living to support their gum health. More people are inspired to buy a power toothbrush (and use it) when they find out the positive effects of adding a veggie to every meal. Seems a bit disjointed, but it has been a predictably repeatable occurrence. I believe the reason this works better than recommending our favorite electric toothbrush is that it disrupts their thinking pattern. It is a conversation our patients aren’t expecting. It gains our patients’ attention and motivates them to act. Another fabulous reason to talk about overall wellness as a support to their gum health is that it shows that we care deeply about them as a whole human being.

What if they have open ears? Or better yet, what if they ask us what to use? Yee-haw! Time to have some fun. Never underestimate the power of recommending what you choose for your own mouth. The dental homecare market is incredibly robust right now. If we tell them to go research options, it is likely analysis paralysis will set in. If this happens our patient will show back up to their next recare appointment with the same routine they were using before this conversation happened. Best to give them specific recommendations.

A fantastic first place to begin is with that power toothbrush we talked about earlier. Repeatedly we see power brushes remove more plaque and biofilm than manual toothbrushes. Electric toothbrushes also cause less damage to the soft tissue. The biofilm is effectively disrupted by the mechanical action of the toothbrush. Any of the brushes that use sonic technology are extra awesome because the waves of energy emitted disrupt the outer layer of the biofilm. When the biofilm is disrupted, it must repair itself. We would rather the biofilm be working on building itself than being mature and able to detach and launch to other areas.

If your patient already has brushing down, we can move to the interdental space. I prefer floss and use “Reach Clean Burst” on myself. If asked, I share that piece of information. If I am not asked, it is useful to find out more about our patient’s daily routine. If we can figure out a habit they do every day that we could pair flossing, floss picking, soft picking, or interdental brushing with, we will be more likely to have compliance.

For example, Johnny has a 20-minute commute to work every day that he uses for his Zen time. Heavy metal blasting first thing in the morning puts him in a great headspace for a productive workday. This is our chance to say, “I love Metallica too! Reminds me of the cruise in high school. Johnny, you might love throwing some floss picks in your truck and busting them out during 

. If we can kick out the bacteria that are growing in between your teeth, we will see your gums and body heal. Talk about increasing Zen!” Did you catch what we did there? We related to him as a human, recommended something easy, and habit-paired it for optimal success potential.

All of it: Well thought out and tailored to his specific needs.

Another oral physiotherapy aid that is very effective is the water flosser. This is great for your patients with hard-to-reach areas that enjoy something new and different. Water flosser use is a fun conversation to have because we get to share that many people prefer to skip the mess and use their cordless water flosser in the shower. I think people visualize themselves doing this and it almost always produces a giggle. It is common knowledge that laughing enhances information retention, so I am all for promoting that giggle!

Water flossing is of utmost value to our patients with braces. Blasting water around brackets is an extremely helpful tool against all that extra material in the mouth for biofilm to build on. 

I swear my teenagers still have teeth because of this gem of an oral care aid. It is also highly handy if you are recommending medicaments/mouthwashes/bleach therapy to your patients. It is quite simple to have them add the solution of your recommendation to the water reservoir and complete 2 tasks at once.

Speaking of mouthwashes, the conflicting information has turned into quite a can of worms for us, hasn’t it? I am a hygienist raised on essential oil/anti-septic mouthwashes such as Listerine and antimicrobials like Chlorhexidine (CHX). However, the newest data shows that we might not want to use these rinses because they disrupt the good bacteria too.

We used to recommend 2 weeks of CHX after scaling and root planning, but there is some argument that CHX disrupts the precious fibroblasts we want to be active for quick healing of the newly treated gingival tissue. We are learning that antibiotic-resistant or “super-bugs” are being created in some of these environments. We know that treating superbugs is difficult and can become dangerous. Most often, good brushing and interdental cleaning habits seem to be adequate in achieving the desired results without adding mouthwash. The simpler we can keep a hygiene routine, the more likely our patients will be to demolish their biofilm.

Might I qualify the above recommendation to skip mouthwashes? If your patient has a specific ailment that needs addressing, a mouthwash specially designed for them can be incredibly useful. Dry mouthwashes have been instrumental in helping patients going through chemotherapy, radiation, Sjogren’s Syndrome, medication/age-related xerostomia, and the like. Additionally, pH-neutralizing rinses are showing promising results for our patients with highly acidic mouths due to internal and external factors such as GERD and their diet. Because we are focusing on biofilm removal today, it was pertinent to share that the mouthwash may not be the saving grace. However, there are many occasions where mouthwashes are very helpful.

Do you ever feel as though people are looking for a new magic wand or pill to solve their problems? They often want it to take no time and be cheap if not free. As you can imagine, we are still searching for such wands and pills. In my experience, mastering the use of the underutilized tools we already have has provided the most predictably positive results. This applies to at the office and at home when getting rid of the pesky, never-ending biofilm.

The options, technologies, and techniques for eliminating biofilm continue to expand. Let’s challenge one another to do the best we can with the tools and strategies we know work well. Let’s use our ultrasonic to the best of its capability. Let’s encourage amazing biofilm removal at home. Finally, let’s join in promoting anti-inflammatory living. Together, we can make a profound and lasting impact on the lives of our patients one well-completed hygiene appointment at a time. Cheers to great biofilm elimination in and out of the dental office.

Johnston W, Rosier BT, Artacho A, Paterson M, Piela K, Delaney C, Brown JL, Ramage G, Mira A, Culshaw S. Mechanical biofilm disruption causes microbial and immunological shifts in periodontitis patients. Sci Rep. 2021 May 7;11(1):9796. doi: 10.1038/s41598-021-89002-z. PMID: 33963212; PMCID: PMC8105330.

Ritz L, Hefti AF, Rateitschak KH. An in vitro investigation on the loss of root substance in scaling with various instruments. J Clin Periodontol. 1991 Oct;18(9):643-7. doi: 10.1111/j.1600-051x.1991.tb00104.x. PMID: 1960232.

How one hygienist is changing her approach to combating biofilm build-up in her patients.

Setting Site on Biofilm: Technologies and Techniques to Help Patients Eliminate Biofilm Buildup

Spotting Trouble: How to Spot More than Just Oral Issues Your Patients are Facing. Image: © LIGHTFIELD STUDIOS - stock.adobe.com


Here’s the thing Hygiene Team: now more than ever before, our patients need us. And sadly, our picking and scratching ain’t gonna do the whole trick. Don’t get me wrong, the hand scaling, polishing, and my personal favorite: ultrasonicking are all super important, but the superb plaque and calculus removal simply isn’t enough. We are going to have to dig deeper (poor instrumentation joke pun intended) if we want to make a true impact and help our patients finally get healthy.

For the first time in history more people are dying from chronic rather than communicable diseases worldwide (7 out of 10 deaths). In the United States of America, cardiovascular disease kills 800,000 people every year. This is our cue as health care professionals to refuse to skim over the medical history and assessment portion of the hygiene appointment.

In hygiene school we learned how to investigate every positive response on the health history. We learned how to look up medications and understand their purpose, contraindications, and drug interactions. When we exited school, many of us exited this practice as well. My friends, it is time we went back. If we want our patients to move towards health, we must pour a proverbial “cup of tea” and get to know our patients better. The excellent part of this news is that we have more knowledge and expertise to utilize than we did in school. The worst part of this news is our culture promotes chronic inflammation and disease as though they are awesome. Alas, that is a big topic for another day.

Back to the clinic. Let’s start by gathering our patient into our care from the waiting room. Walk right up to Karen and extend a hand and deliver a warm welcome. Ask ourselves silently, “Does Karen look well? How is her coloring? Does she appear to be caring for herself? Is she frazzled? Was she late? Does she seem nervous? How is her energy level?” Our goal here is to get a general feel for her state of being. I am not suggesting reading a book by her cover, I am encouraging us to utilize the incredible amount of information that this initial assessment of Karen provides.

Once seated, pop open the medical history. Explore every positive response as though we are detectives. Please do not ignore any responses that “do not pertain to us” because they all do. If Karen is struggling with her overall health, her response to any pathogenic bacteria will be exacerbated. We also know that when Karen’s immune system is playing whack-a-mole with too many ailments, its ability to a good job in the oral cavity is hindered. When Karen asks why we are being so thorough, we simply respond, “your body and mouth operate together. The more we address you as a whole human, the better our success will be.”

Side note: as our patients present with various diseases, do a little digging. The quest for more information about diseases makes showing up as an RDH more fun and rewarding. This is an excellent way to prevent or recover from burn-out. Did you know that research is showing periodontal disease contributing and even causing fatty liver disease?

 It may be fun to blame it on the alcohol, but those gram negative pathogenic oral bacteria are buggers. They are causing major destruction throughout our bodies. I would highly recommend reading the article sited below on the topic. It contains powerful information to equip ourselves and our patients. Discussing the liver’s response to periodontal bacteria that has entered the blood stream is one of my all-time favorite topics with patients. They are surprisingly interested in the liver releasing low-density lipoproteins into the body to contribute to clogged arteries. Who knew?

What about the medications Karen is taking? Is she at risk for dry mouth or periodontium destruction? Is caries prevention going to be the focal point of our efforts today? Perhaps Karen is on medication for prediabetes or diabetes, and we need to discuss blood sugar control in conjunction with periodontal disease. Quizzing Karen about the side effects she experiences with her meds is helpful in our quest to help her address her individual needs.

Does Karen have allergies? If she does, are we making sure that her appointment does not include unnecessary exposure? For example: I was at the dermatologist’s office and marked “latex allergy” on my medical history. I also discussed with the nurse my allergy because I noted both latex and nitrile gloves on the wall. At the risk of being the “annoying patient,” I had to ask the doctor and the nurse if the gloves that they were putting on to numb my skin and biopsy a suspicious lesion were latex… They were. Ugh. They of course changed them immediately, but I was completely disappointed that I had to work so hard to avoid the latex. The take home message was to pay close attention to my own patients so as not to put them in an uncomfortable or unsafe position. Ever.

Last up on the medical history is, “have you had any surgery since we met last Karen?” To our surprise, Karen has had surgery since we last saw her. A minor procedure to place a stent in one of her arteries happened 2 months ago. Hint: anti-inflammatory living and superb gum health will dominate our conversation today.

Following the discussion about positive responses to her medical history, allergies, and surgeries, it is time to discuss the blood pressure reading we acquired today. If Karen has 120/80 mmHg or lower, let’s high five her and move forward with the rest of assessment. Should her blood pressure be higher than that, have a conversation based on the reading. Ask questions such as, “Karen, when is the last time you spoke with your primary care provider about your blood pressure?” And “Do you monitor your blood pressure regularly?” Look back at previous appointments to see what her readings have been. Refer to the current American Dental Association guidelines to ensure that our recommendation matches the reading acquired today.

 It is better to have a candid conversation about the number one killer in America than to avoid the fleeting discomfort and risk a life. Our job is not to diagnose, but rather screen and refer. Many of us blood pressure taking RDHs have a story (or several) about how we helped someone avoid a cardiovascular event. Karen may not be our mom, but her kids would be grateful for our assistance in keeping her around. Let’s all be that hygienist.

Did you know that 7% or 23.5 million Americans have an autoimmune disease?

 Many first manifestations occur in the oral cavity and on the face. If diagnosed early, the treatment effectiveness and quality of life improve exponentially. Hello oral cancer screening! Thank you for your information. Let’s discuss a few of the most common diseases we can recognize early in our patients:

Sjögren's syndrome. This disease presents frequently and is noted by extreme tiredness, dry eyes, and dry mouth. The dry mouth is a real issue for us because of the critical contributions it makes to oral function and health. Xerostomia is famous for helping cavities grow, increasing infection susceptibility and severity, and hindering the eating process. While we are performing the oral cancer screening, check to see if the glands are releasing saliva correctly. If not, this is a great time to encourage Karen to seek an appointment with her primary health care provider. Catching Sjögren's early gives Karen the best chance to get rid of or at least lessen the effects. I have seen people commit to anti-inflammatory living and completely eradicate all symptoms of their autoimmune condition.

What are some effective anti-dry mouth modalities you have had good luck with? I am always on the hunt for great suggestions because not everything works for everyone. Please email me any magic tricks you have. My favorite recommendation to share is for the patient to drink milk (of any kind) with meals. The fat in the milk provides lubrication for mastication and swallowing, making eating more enjoyable or at least possible. Based on the commonness of xerostomia, this is a handy bit of info to have ready to pass along.

How about Karen’s butterfly shaped red marks on her cheeks? Does she need to be on the anti-lupus living war path? While not curable, medications such as NSAIDS, corticosteroids, anti-malarial drugs, immunosuppressants and biologics can all manage the autoimmune disease and prolong quality and quantity of life for Karen. Personally, I have seen several people with lupus. Their lifestyle was a direct indicator as to whether they were “struggling” with lupus or “not really noticing” their lupus.

Perhaps Karen has an enlarged thyroid we notice during the palpation of her neck. The thyroid is the major regulator of the body’s systems. It is also the second most common glandular disorder. If there is trouble with the thyroid, Karen can experience several frustrating symptoms. Remember we observed her energy in the waiting room? The thyroid could be the culprit of her lethargy. Let’s say that Karen already knows she has a problem with her thyroid. Both hypothyroidism and taking levothyroxine are associated with the destruction of the periodontium.

 Because of oral systemic bidirectional communication, we need to work closely with her endocrinologist to ensure the best outcome possible. In 2013, 2 of my dental professional friends discovered they had thyroid cancer. Both are here today because of early detection. I hope to never find cancer in my own practice. More importantly, I hope to never miss cancer in my own practice.

Geez, Karen is a wreck, isn’t she?! What if we back all the way up and pretend that Karen showed up looking fine with no medical history positive responses. No current medications and no elevated blood pressure. We made it through the oral cancer screening with nothing to note. Then we begin to probe... Karen has good home care with minimal calculus build up, but holy moly she is bleeding like crazy when we probe! There are 2 likely culprits here:

The virulence of her microbiota make up is excessive or

At this point more questions about her general sense of wellness are prudent. If she appears to feel well and is taking good care of herself, try an oral probiotic and ultrasonic everywhere. An exaggerated response to minimal biofilm indicates dysbiosis and taking a benign probiotic could prove incredibly helpful for both her gums and the rest of her body without the worry of negative side effects. In this situation, invite Karen to return for recare in 3 months to ensure that the homecare regimen is working. When she returns if the gingiva is still overreacting, recommend that she see her primary care provider. Functional blood work can be useful at this point but is way outside of our scope of practice. Nonetheless, if we help Karen tackle a hidden issue, her quality and quantity of life are likely to improve. Karen will love us forever and we will sleep well knowing we made a difference for her.

Isn’t it astounding how much information we have gathered and haven’t even peeked at the radiographs?! This is the last piece to our puzzle that will dictate the dental hygiene care we will provide. Hang on just a minute though. Before examining our favorite interproximal cortical bone, look at the films with an eye for abnormalities. Once we have discerned that Karen’s x-rays are normal, zoom into the interproximal spaces. Keep the perio chart open and compare every bleeding upon probing point to the films. If the periodontal ligament is widened or the crestal bone has lost density, we need to treat this active disease that is causing permanent destruction. Show Karen where the bone is gray and fuzzy rather than a thick white line. She will let us know that she needs to address the disease. We agree and offer her the options for moving forward. Karen is impressed with the exquisite care we provide. She will also leave our operatory with knowledge about her health that allows her to take charge of her own life. This is patient autonomy and health care provider collaboration at its finest.

By now you may be wondering how on earth we have time for all of this. Based on the severity, prevalence of disease, and early death due to non-communicable diseases, my question is: how do we not have time for this?

 In health, this entire process happens in a very short amount of time. It is helpful to divide the appointment into 3 segments for healthy patients. Use 20 minutes for assessment. Continue with 25 minutes for implementation. Finish with 15 minutes for exam, scheduling the next appointment, chit chat, and a fabulous hand off to the administrative staff. When Karen shows up and needs more than the above suggested time, we can schedule to meet her needs. The beautiful result of individualized care is an increase in profitability of our clinical work. It turns out that “prophy mills” may get more patients seen in a day but the quality of care and production suffer. In addition, we RDHs in these “prophy mills” often try to provide the care our patients need as fast as possible ultimately compromising our own health and sanity.

At the end of the day, we are the bridge to not only oral but total body health. If we can put the time and effort into utilizing the information each person brings to us, the impact will be profound. We are trusted, educated, and equipped to recognize issues that our patients may be facing. Another benefit to approaching care in this comprehensive format is the way that conversations become deeper. Collaboration becomes effective. Our patients, their smiles, and the health of our population are counting on us to step up and lead the way to a healthier future. This is our chance to be the Thing that makes a difference. Let’s not wait one more minute. Together, you and me, let’s be the Thing. One Karen at a time.

Sanz M, Marco Del Castillo A, Jepsen S, et al. Periodontitis and cardiovascular diseases: Consensus report. J Clin Periodontol. 2020;47(3):268-288. doi:10.1111/jcpe.13189

Kuraji R, Sekino S, Kapila Y, Numabe Y. Periodontal disease-related nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: An emerging concept of oral-liver axis. Periodontol 2000. 2021;87(1):204-240. doi:10.1111/prd.12387

Hypertension (High Blood Pressure). ADA.org. Updated November 1, 2022. Accessed July 28, 2023. https://www.ada.org/en/resources/research/science-and-research-institute/oral-health-topics/hypertension

AUTOIMMUNE DISORDERS. Mayo Clinic. Mayo.edu. Accessed July 28, 2023. https://www.mayo.edu/research/centers-programs/mayo-clinic-biobank/projects/auto-immune-disorders

Rahangdale SI, Galgali SR. Periodontal status of hypothyroid patients on thyroxine replacement therapy: A comparative cross-sectional study. J Indian Soc Periodontol. 2018;22(6):535-540. doi:10.4103/jisp.jisp_316_18

About Global NCD. Centers for Disease Control and Prevention. CDC.gov. Published December 17, 2021. Accessed July 28, 2023. https://www.cdc.gov/globalhealth/healthprotection/ncd/global-ncd-overview.html#:~:text=NCDs%20kill%2041%20million%20people,out%20of%2010%20deaths%20worldwide

In this final part of a 2-part series, we dive deep on how to spot issues beyond the mouth that your patients may be facing. 

Spotting Trouble: How to Spot More than Just Oral Issues Your Patients are Facing

This is the first article in 2-part series on spotting trouble early on during hygiene visits. 

Spotting Trouble: Best Practices for Noticing All The Things You Can See In Your Patients. Image: © Prostock-studio - stock.adobe.com


Ready, set, go! Retrieve Bob from the waiting room, get him back in the chair, pick and scratch all the tartar, have a great conversation in less than 2 minutes with the dentist, and high-five Bob on the way out. Sound familiar? Dear standard hygiene routine, you are exhausting and unfulfilling! Not to mention missing incredible opportunities to change lives.

The mouth is a treasure trove of information. Yet, when the schedule is tight, it seems quality assessment is the first to go. Perhaps it should be the only thing to stay… Bob does need to ditch the tartar, that simply isn’t the most important part of our time together. Bob might have oral cancer, be struggling with bruxism, or in love with the latest lemon water cleanse craze. In any of those cases, we have bigger fish to fry than Bob’s tartar on his lower anterior linguals, premolar line angles, and buccal of upper molars.

Let’s re-work Bob’s appointment. Rather than calling Bob like a dog from the door to the waiting room, walk right up to him with an outstretched hand and kind greeting. Gather him into our care and have a seat in the operatory. A thorough conversation about Bob’s medical history, current medications, chief concern, and today’s blood pressure reading is the most important part of the entire appointment. How the heck is Bob? We have to know at the beginning!

Today is the day that Bob is due for radiographs. We begin taking the films and decide horizontal bitewings are not going to give us quite enough information about his bone health. We elect 3 vertical bitewings on each side, 2 upper anterior periapicals, and 1 lower. As we are acquiring the films, we cannot settle for less than stellar pictures. Retakes are quick, cheap, and easy. Let’s grab them!

Next up: extra- and intraoral manifestations of trouble. “Bob, we are going to start with an oral cancer screening. Let me know if anything is sensitive or bothers you.” It is best to keep this explanation simple. It is common for hygienists to over-explain what they are doing if it is something new or something that is making us feel uncomfortable. However, our patient, “Bob”, does not care about our rationale behind this part of the appointment. If Bob does care, he will ask. In that case, it is reasonable to say, “I want to make sure that everything looks and feels normal for you. If trouble of any kind arises, catching it early is our best chance for success.”

During the oral cancer screening take note of Bob’s coloring and symmetry, check his lymph nodes and jaw. If Bob's jaw ever hurts, this is an excellent time to brainstorm about what is causing the pain and how to remedy it. Often, a simple 10-to-20-minute walk at the end of every day is helpful enough to relax Bob into a more peaceful state of mind and a more restful night’s sleep. Obviously, that is not the only way to help people with temporal mandibular jaw (TMJ) disorders, but many people just need to chill out so their TMJ will feel better. Also, in our culture taking time to let the amygdala rest, enjoy nature, and move our body is the simplest, most overlooked, highly effective medicine there is. A conversation about going for a walk after work to help Bob's jaw pain is an example of how we know a thing or 2 about whole health and that we care about Bob. Have you ever heard of the adage, “People don't care about how much you know until they know how much you care?” That is exactly why we are taking our time to do a thorough assessment.

We also want to know, how is Bob's thyroid? Out of the estimated 20 million Americans with thyroid disease, 60% of those people are unaware they have trouble, per the American Thyroid Assocation.

 For many people, we are the only health care professionals palpating their neck. It is typical for men to go decades without a health physical. Depending upon the type of healthcare provider a woman has, her primary care physician might not check her thyroid either. This is further evidence that 

 (dental professionals) must be making a thorough effort for these patients we love so much.

Once we have observed and palpated Bob’s face, jaw, and neck it is time to lay him back and take a look on the inside. Does he have petechiae on his soft palate? What do the inside of his cheeks look and feel like? Does he have white, lacy, lattice lines on his cheeks? Perhaps Bob has lichen planus that we need to help him address.

Is there anything noteworthy in his vestibule or under his tongue? Speaking of his tongue, how does it look and feel? Is there anything abnormal with the shape, color, and/or texture? Does it appear that his tongue is resting in a place that indicates trouble breathing, eating, or speaking? We are learning that the tongue tells more of the story than we originally thought.

Are Bob’s saliva glands working? How big are his tonsils? Does Bob struggle with strep throat, allergies, or sleep apnea? Maybe myofunctional therapy is the best next step for Bob’s life.

During this visual and tactile exam, we can catch trouble. The earlier the better. It is our sincerest hope that we never have to find cancer. But how would we feel if we were the healthcare professional that missed it for Bob?

Moving on to Bob’s hard tissue. Are his teeth worn down to little nubbins? Does it appear that he has scrubbed his teeth so clean that much of the supporting structure is no longer present? Or how about methamphetamine use? Does Bob have black, bombed out teeth that suggest an addiction to drugs or Mountain Dew? Are the insides of his teeth eroding, indicating GERD or even an eating disorder? And when Bob bites down on his back teeth, does his occlusion look healthy? Personally, I have had many adult patients seek orthodontic care because their occlusion was causing trauma to the hard tissue and devastation to the soft tissue. We can treat perio pockets all day long, but if we never get to the root cause of the issue, such as traumatic occlusion, we will never be successful.

The moment we have all been waiting for: the perio chart! “Hey Bob, 1-3 mm is normal and healthy gums don’t bleed or hurt while I am measuring.” Once the probe depths and bleeding points have been recorded, we need to know about recession and furcations. Does Bob have clinical attachment loss causing mobility? Let’s write that down too. While we gather this information, we must say it all out loud. If we do this, we never have to tell Bob he has periodontitis. He will tell us by the end of assessment.

After we call out the perio chart, we are going to sit Bob up and show him the radiographs. “This thick white line should go up, over, and down between each tooth.” The thick white line is his lamina dura. But Bob doesn’t need a new vocab word; he needs to know if his thick white line is intact or if the spots that were bleeding are also losing bone support. If so, Bob is going to ask us for perio therapy in just a second because bleeding and bone loss are the signs of active periodontal disease. He will tell us that he needs treatment as a prevention activity is no longer appropriate for him. He would like a healthy mouth, body, and better breath.

Super cool note: that “thick, white line” trick also applies to enamel. “Do you see that fuzzy, dark, V-shaped notch? That is where a cavity is starting.” Who knew reading x-rays was such a sinch?! 

At this point in our time together, Bob is super impressed. He feels loved and cared for. He is excited to walk after work and is thrilled we can help him heal his periodontitis (that he diagnosed all by himself). In addition to being grateful for incredible care that he has never experienced before, Bob will be loyal to us and to his health. We may not have made it to the tartar picking today, but Bob needs 4 quadrants of scaling and root planing. A bloody prophy would have harmed him more than helped today. Ergo, we saved the day and his future. Congratulations RDH! What an honor to be on the same team.

Quality assessment is the key to fulfilling clinical hygiene days. Now more than ever, our patients need us to get to the root cause of their ailments. They need to believe that we care deeply for them and are here to serve. The brilliant part of quality assessment is that: in health, this whole routine takes less than 20 minutes to complete. All 5 steps of medical history, blood pressure reading, oral cancer screening, radiographs, and full mouth periodontal chart are a breeze. That leaves 25 minutes for calculus removal, polishing, double checking our work, and 15 minutes for the exam. If what Bob needs is a prophylaxis, this system does not make us run late. If Bob needs something else, we now have the data to support the necessity of more time and more involved dental hygiene care. The result will be a healthier patient (Bob), healthier provider (you or me), and a healthier, more profitable practice (our respective clinic). My parting question is: Why not?

Cheers to spotting trouble! May quality assessment bring us all fulfillment and health.

Stay tuned in July for the next part on this 2-part series, where we will learn best practices for spotting trouble beyond the mouth. 

American Thyroid Association Press Room. Thyroid.org. Accessed June 1, 2023. https://www.thyroid.org/media-main/press-room/

Dental hygienists can often be the first line of defense in early detection of certain conditions in patients. In this first part of a 2 part series, Brandi Hooker Evans talks about best practices for spotting trouble at the start. 

Spotting Trouble: Best Practices for Noticing All The Things You Can See In Your Patients

These are exciting times for oral physiotherapy aids. Not only are there many outstanding products available, but online shopping and drop-shipping have made more of them available to more people than ever before. In addition to reviewing some of the latest and greatest, we will discuss how to educate patients about oral hygiene.

Has anyone ever told you, “It’s not what you say, it’s how you say it”? Me too. But, alas, I’ve had to learn it the hard way as a hygienist. Let’s look at 6 ways in which RDHs sabotage the success of their oral health instructions. I’m guilty of making all these mistakes, so I humbly present them, with a solution for each.

. Because we are qualified to address patients’ caries risk, periodontal disease risk, and overall health with a variety of tools and practices, I have too often given patients too much information and too many things to work on. That’s when their eyes glaze over, and I start hearing “yes ma’am.” At the next appointment, the patient has implemented nothing.

 Focus on one thing at a time. Give them one simple, attainable goal to work on. At their next recare, you will see they have succeeded and be able to build upon that foundation.

. Even if patients may have “had a lecture coming,” this is a complete turnoff that evokes neither compliance nor loyalty.

 Try celebrating that they showed up to their appointment and ask them what they want to work on in between visits.

. This is a surefire way to remove the patients’ ability to realize that a disease is affecting their entire body and they need to do something about it. There is no such thing as a little bit of bleeding. Either infection is present or it’s not. Sweeping facts under the rug may feel comfortable in the moment, but disease progression will destroy that peace in the long term.

 Nonthreatening full disclosure will allow patients to recognize, prevent, and treat dental disease. Teach them to evaluate their own x-rays and periodontal chart, then watch them take charge of their health.

Thinking you’re the only one with good ideas

. Our RDH brains are brimming with ideas for good oral home care. Sadly, if we don’t let patients choose what they want to do, they won’t do it.

 Finish the assessment and ask the patient what they think would be most helpful. If they don’t know, ask them if they would like to hear one of your ideas. When I get this opportunity, I always pick something that reduces total body inflammation. Eating veggies or walking for 10 minutes a day are excellent, attainable goals. Spoiler alert: more people will buy power brushes if you suggest they go on a walk than if you suggest they purchase a power brush. Why? People already know that brushing and flossing improves oral health. We need to show them that their body is connected to their mouth. When we do, their motivation for better oral health goes through the roof.

. If you’ve suggested a power toothbrush 6 times, don’t do it again and expect a different result.

 Recommend an anti-inflammatory strategy (more sleep, better diet and exercise, stress-reduction practices), and they’ll stop at the store on their way home for that toothbrush you mentioned last time. Connecting oral disease to the rest of their health is the best motivator I’ve yet to find.

Recommending something you don’t believe in

. Dental professionals all over the world halfheartedly recommend care and products they don’t believe in. The result? Patients often choose to pass. This happens all the time with suggestions about scaling, root planing, and recare intervals.

 You must believe in your recommendations. If you’re certain that something will work, that energy will be transferred to your patients, and they will also get excited and commit to the care you recommend.

I recently worked with a dentist who was not convinced that 3-month intervals between visits were necessary and asked whether 4-month recares would be sufficient for perio maintenance after scaling and root planing. We read the research, and he noticed that the dental bacterial biofilm matures at 12 weeks and that leaving it alone for an additional month was detrimental not only to the success of scaling and root planning but also to long-term overall health. This dentist is passionate about providing quality care and believes that his care can change lives. I agree. After discussing what was holding him back, he let it go, and his confidence about presenting a comprehensive care plan skyrocketed—and so did patient acceptance.

Do you sabotage your oral health instructions? By now, you may have guessed that too much information is my specialty. But I am guilty of all 6. Although I struggle with the solutions, I know it’s worth the effort.

Now let’s discuss 7 terrific technologies that can improve your patients’ oral health. Giving patients the opportunity to ask us what we think, rather than simply telling them what to do, allows us to share our favorite products and increases the chances that patients will purchase and use them.

1. We can all enthusiastically endorse the items we use every day, thus proving that we believe in them. In my case, that item is the Oral-B iO electric toothbrush, which produces oscillation rotations with micro-vibrations. Research shows that it is an excellent plaque removal device and doesn’t contribute to gum recession.

2. For the patient who wants to elevate oral care and keep all tools together, there is Waterpik Complete Care 9.0, which combines a sonic power toothbrush and a water flosser. Plaque, stains, and hard-to-reach areas are conquered with this space-saving tool, which is an excellent option for those on a moderate budget.

3. Have you tried BURST floss yet? It is excellent at grabbing plaque, comes in cute cases, and refills arrive every 12 weeks. It’s no coincidence that 3 months is the amount of time bacteria takes to repopulate our mouths. The floss is black to show the plaque being removed, and it expands when exposed to saliva to increase the surface of the area being covered. At $12.99 for the initial purchase and $6.99 for refills, this floss is a great option for most budgets.

Are you open to a 3.2? If so, I suggest checking out the Best of BURST package: an all-in-one option your patient can get excited about. It includes a sonic power toothbrush, a refillable floss set, a pack of white strips, and fluoride toothpaste.

4. Another terrific toothbrush for tech-loving patients is the Philips Sonicare 9900 Prestige, which boasts SenseIQ technology that evaluates pressure, motion, and coverage to improve brushing technique. Sonicare brushes are a longtime favorite of many dental professionals and consumers alike. Although it’s not a bargain at $379.96, it is a slam dunk for the bougie dental gadget seeker.

5. Something fun for everyone—those who underbrush and overbrush—is the Bäz gumline cleaner. Great for patients who want whiter teeth and are missing the apical third with the bristles, this ergonomically designed, soft-tipped product is also fantastic for those who scrub too hard and too often. The Bäz gumline cleaner is gentle on the cementum of root surfaces and will give overzealous folks a way to maintain that fresh, clean feeling without causing further recession. The startup kit is $18 on bazdental.com

6. Crest Pro-Health Densify is technology in a toothpaste that rocks. Densify uses stabilized stannous fluoride to reduce erosion up to 83% more than its competitors. Dental professionals have been battling intrinsic and extrinsic erosion forever. The more we learn about lifestyle and acid, the more important helping our patients combat the problem becomes. Available at most grocery stores for around $7, Densify is a fantastic option for any budget.

7. For patients who are hoping to go all-natural, there is the Get Mouthy oral health kit. For $45.99 at getmouthybox.com, the customer can receive a toothbrush, a travel tube, a toothbrush holder, dental floss with a refillable glass container, and tooth soap in a bamboo box. Get Mouthy boasts all-natural, eco-friendly, vegan, and remineralizing properties. A word of caution: there is not sufficient evidence to suggest that this is a good choice for cavity-prone individuals. But it can be an option for those who have plaque under control, don’t consume acidic food or drinks, and want to try a sustainable and natural system.If patients battle cavities, I suggest they continue using products with fluoride, for which we have decades of efficacy data.

Using the best techniques and technologies ensures our patients’ oral and whole-body health. Evidence shows that they are not different. Numerous studies have recently explored the relationship between oral health, inflammation, and 

. Oral bacteria can cause inflammation in the mouth and contribute to systemic inflammation if toxins or microbes leak into the bloodstream. The association between oral inflammation and systemic inflammation is fundamental to understanding the detrimental effects the former may have on a variety of organ systems and its ability to increase the risk of developing a non-oral disease.

 Dental hygienists are ideally situated to connect the dots for patients. So don’t be afraid to recommend the products you believe in. And don’t be surprised when patients come to their recare appointment singing the praises of their new power toothbrush. Cheers to whole-body health by way of a dental hygiene appointment!

Clark-Perry D, Levin L. Comparison of new formulas of stannous fluoride toothpastes with other commercially available fluoridated toothpastes: a systematic review and meta-analysis of randomised controlled trials. 

Bui FQ, Almeida-da-Silva CLC, Huynh B, et al. Association between periodontal pathogens and systemic disease. 

Here we look at ways in which hygienists sabotage the success of their oral health instructions and 7 products that can improve patients' home care routines.

 The Homecare Buzz: Advanced Techniques and Technologies for Dental Hygienists

The Next Chapter in your Dental Hygiene Career. Image courtesy of Shi/stock.adobe.com. 


Remember when you were in dental hygiene school and you thought as soon as you graduated, things were going to be great? You would have your own operatory, your own patients, and oversee your own destiny. That’s right, no more instrument pass offs or multiple-choice exams for you. Freedom with a shiny Registered Dental Hygienist license all to yourself!

How about now? Do you have anxiety on Sunday evenings? Does the mere sight of your scrubs make your middle right scapula ache? Do you believe that one more conversation about the importance of flossing is going to send you past sanity’s edge? If any of these statements make you giggle but ring a little true, read on. Today we are going to explore the road to achieving self-actualization in your career if clinical hygiene care feels gloomy.

First, make no mistake that a change of any kind brings discomfort. Underestimating the time and work it takes to travel the learning curve of a new venture is a recipe for heartache, frustration, and more curse words than you typically speak. Ask me how I know.

The prickly learning curve can also be exhilarating and exciting! The opportunities are endless. May I request a small favor? Will you please be open to the idea that if lemons are your favorite thing, you can make a profitable and fulfilling career out of them?

Here is proof: Last night my husband and I were at a concert in our small town Idahome. The evening was warm, the sunset magnificent, and the music delightful. A darling yellow truck with “Lemon Smashers” adorned its side. The business proudly boasted an unending line of people excitedly buying $5+ lemonades. The team of 3 teenagers exhibited toothy grins as they took orders, smashed the lemons, and pumped out a myriad of flavored lemonades. Due to the geeky nature of the aforementioned couple, we mapped out an entire business plan. We estimated that upon recoupment of the initial investment ($20,000 for the trailer, supplies, legal documents, and licenses), the owners of the business could easily expect a $1500 production for a 2.5-hour event. If overhead was $500 per event, a $1000 profit would be easily attainable. How many of us make $1000 a day doing clinical hygiene? I have read the data, it is, essentially: no one. A 2.5-hour lemonade event appears to be highly lucrative and a viable option if lemons make you smile. Insert overused life comparison cliché. 

The first noteworthy idea to consider is that the grass is green where we water it. Perhaps you are feeling like you are done with clinical hygiene. Burnt out. Bags are packed. O-U-T out of there. Shall we blame the monotony, stress of the team, or lack of patient compliance? Or maybe all the above? I get you. I have a box for you to pack your things in.

But what if you could transform your clinical career? What if there was a way to delete the monotony, make your team feel like a functional family, and have your patients seek the care they need from you to finally get healthy? Good news! There is a way. I watch burnt out clinicians transform into enthusiastic masters of the operatory all the time. Instead of throwing in the towel, they reevaluate their approach to dental hygiene care and discover these 4 things:

Investing in leadership and teamwork is the catalyst to a new career within the same position.

Comprehensive assessment and care as a team with the patient, hygienist, and dentist working together is the key to achieving clinical excellence and fulfillment.

A break is as good as a change. I hear Mexico is nice this time of year.

When burnt out hygienists learn how to continue their work as clinical RDHs in a way that invigorates rather than exhausts the need to leave disappears. Spoiler alert: this was the first part of my journey out of the operatory. Most of career satisfaction lies within our perception of the situation. A solid place to start your journey to a new career is to water your clinical grass before hanging up your loupes and ultrasonic tips.

Alright, you have modified your clinical life and that white picket fence is taunting you. It is time to make the jump. The first actionable step is to speak it out loud with as many people as you can. This includes looking in the mirror and having a candid conversation. In addition, talk to your family, friends, strangers, God, Allah, Buddha, and even Santa if the mood strikes you. 

A journal with good old-fashioned paper and your favorite pen is also an excellent choice for this part of the exploratory process. List the aspects of clinical care you love and will miss. Write the names of your favorite patients you will have to say goodbye to. Then write down everything that exhausts you. Pen absolutely everything that frustrates you. Make specific notes of items in your current working situation you want to avoid like the plague.Be clear and specific on this pros and cons list. The last thing any of us need is to leave that dysfunctional relationship only to immediately replicate it. Once you have spoken and written your desire for a change, evaluated what to keep, and what to kick out, we can begin to find the perfect new venue.

This seems like the logical time to share my journey out of the operatory. I love dental hygiene care with all my heart and will always seek clinical days to maintain my skill and passion in this arena. However, my operatory was not enough. As I suggested you do, I talked to myself and anyone that would listen and wrote the pros and cons list. “Yes, I wanted to stay in dentistry. No, I didn't want to sell products. Yes, I have picked up some incredibly useful tools along my way. No, I am not handy with technology. I want to find a way to help others thrive like I have in the last few years.” And so on.

When I left the operatory, I left my dream job. My patients were my people, and I loved my coworkers like family. As I explored my options, I realized that the lessons I had been given were meant to share.

There are many paths that a dental hygienist can follow in or out of the operatory. It’s about knowing the options available to you. 