Leslie Neveu, RDH

	The absence of recommended toothbrushes and dental supplies in the marketplace can lead to frustration for patients.

 recommend a small-headed (size 30 to 35) soft 

 to lessen the assault on the cemento-enamel junction. A regularly used toothbrush should be replaced at regular three-month intervals, but, being difficult to find, are often used much longer. However, patients are seeing other, more easily obtainable and rarely recommended items in the marketplace, including size 40-60 toothbrushes, hard bristles and battery-operated toothbrushes – all of which can strip tissue off the cortical plate with a few uses.

Part one of this series: A size 35 soft toothbrush: Missing in action (Part 1)

, I made some recommendations for ways hygienists could enhance patient shopping success when looking for recommended items. Here are some techniques to take this a few steps further and ultimately put those select and valuable hygiene items into your practice’s stock room.

Given the difficulty patients experience locating size 30 or 35 soft toothbrushes, hygienists can proactively visit the nearby grocer or drugstore and request special orders. If numerous requests for a particular dental item are made, the store will start to carry them regularly. Tell your patients which stores carry the items you recommend. My aunt loved the EZ Thru floss holder but could not find them anywhere until she visited a store on the advice of her dental office. At that store, she was able to order an entire box of them, ensuring she wouldn’t run out of her favorite dental tool.

Another difficulty for patients is locating and operating recommended automatic toothbrushes. Hygienists are aware of the technology and science of high-quality automatic toothbrushes, but finding the most cost-effective or specific recommended model is challenging for patients. I once worked in an office as a temporary fill-in hygienist that stocked the lowest-priced travel edition of the Oral B Braun automatic toothbrush. When a recommendation was made for the need for better oral hygiene and the patient was willing to pay the nominal fee for the Braun, we were able to unwrap the brush and give on-the-spot instruction for optimal use. Hands-on instruction at the time of recommendation was vastly more effective than sending the patient to a store to balk at the steep prices and get confused by a large selection of brushes. Large warehouse stores often carry these low-end forms of the best automatic toothbrushes on the market. This dentist bought them by the crate. This really set the bar in patient customer service for me. It also alleviated two problems for patients: Locating the brushes and using them correctly.

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A common practice in many offices is the inclusion of a premium automatic toothbrush in a package plan for patients who have been diagnosed with disease and need full-mouth periodontal therapy. Consider stocking lower-cost automatic toothbrushes and recommend them to patients that desire or need better oral hygiene. This recommendation may seem like an expensive undertaking, especially if you have difficulties with hygiene products expiring on the shelves, or the inability to locate products. Traditionally, a non-hygiene member of the team has managed hygiene supply ordering, but responsibility and management of this aspect of the practice may create a new role for a hygienist in your practice. Goals for this new hygiene responsibility would be to remain at or under budget for hygiene supplies and ensure that prescription products are being recommended and sold in a timely manner.

For missing-in-action products, be proactive and make that trip to a local store to order some size 35 soft toothbrushes, stock automatic toothbrushes for the utmost in customer service and consider growing your practice by giving a hygienist some management duties. Your patients and the dentist’s accountant will thank you!

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 The absence of recommended toothbrushes and dental supplies in the marketplace can lead to frustration for patients.

A size 35 soft toothbrush: Missing in action (Part 2)

	Over the past 30 years, I have often been thwarted in my attempts to locate a size 35 soft toothbrush in a grocery or drug store, so I can imagine the frustration patients feel trying to follow my home care recommendations at home. 

 do exist, but for patients they are missing in action; available in the marketplace somewhere, but not where they actually shop. It’s no wonder they look so forward to the goody bag at appointment’s end.

Additionally, I have faced difficulty supplying each patient with the exact products for their individualized home care, as stocking the supply room with the plethora of choices can be financially challenging for any dental practice. Adding to the challenge are individual state’s regulations that do not allow dental offices to stock prescription hygiene products, stock in bulk or sell products such as 

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Many hygienists have been stymied trying to steer patients in the right direction for 

. Rather than allowing the marketplace to dictate your patients’ oral hygiene care, be assertive in your search for oral hygiene products you provide or recommend to patients: 

, paying particular attention to articles that discuss the science of home care and prescription products; ask dental supply sales representatives to share samples of products that benefit your patients; and attend dental conventions and search out vendors with product samples available. 

It is wise to sample products so that you can give first-hand advice on their use and palatability. It is helpful to have firsthand knowledge of products before passing on products or recommendations to patients and dentists, as an unpleasant taste or smell may stop a patient from using a product more than once.  

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Finding the elusive toothbrush (and other hard-to-find products) may require an active search of your community resources. To get started, create goals that involve reconnaissance at the local grocer, drug and warehouse stores as well as online searches. Check the grocer and drug stores nearest your practice for toothbrushes, toothpaste, floss and additional adjunctive home care products and check the dental supplies at warehouse stores for automatic toothbrush specials.

Rarely will these searches yield an actual size 35 soft brush but knowledge of what is stocked is invaluable and as a side benefit it is possible that, if asked, your local retailers can special order products. Many of the best OTC products are found online but research involving cost and availability will be necessary to encourage patients to purchase and use the most effective products.

The last step in loading your dental hygiene product arsenal is to create a catalog of resources for your hygiene department. Your catalog should list websites, specialty stores, grocers and drug and warehouse stores that carry recommended favorite home care products. Consider gathering and regularly updating this information to alleviate the frustrations of both patients and dental care providers who find so many recommendations missing in action.

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 Over the past 30 years, I have often been thwarted in my attempts to locate a size 35 soft toothbrush in a grocery or drug store, so I can imagine the frustration patients feel trying to follow my home care recommendations at home. 

A size 35 soft toothbrush: Missing in action (Part 1)

The most common objection to providing additional services in the hygiene department is, "I don't have enough time to do more." That’s understandable. As the dental hygienists in the office, we are the direct line to patients, spending the most one-on-one time with them. As we all know, the list of required duties for a dental hygiene appointment is long and it includes talking.

Of course, talking for the purpose of educating and creating good relationships is a major duty of all dental hygienists. Usually this communication has to be made in-between, during, or on top of all clinical duties. Additionally, this direct contact with patients may become part of a "visit," which is a culture many offices have fostered. Although friendliness is welcome and necessary, I describe a "visit" as a dental appointment that focuses on an assumption that hygienists' primary duty is to discuss the kids, the latest vacation, the big game, or the state of the union.

Although creating an atmosphere of comfort and empathy is vital to trust, a dental appointment that centers on improving the health and well being of the patient is paramount. For instance, the identification of potential oral cancer, testing for periodontal pathogens, and/or remineralization of white spot lesions can literally change patients’ lives. These services can be life-saving, keeping teeth viable to chew and improving digestion or saving thousands of dollars by staying the inevitability of full-blown caries. In fact, the list of new and additional services that can be offered during the hygiene appointment is overwhelming, especially if the idea of implementing a comprehensive oral cancer evaluation is enough to create a time crunch.

One sure way to find more time during your patients’ appointments is to reduce "visiting." The best advice I ever received was delivered to me by my aunt, a saint on earth and long-time dental aficionado (who attended her 3-month recare appointments like clockwork from age 25). And I quote, “I guess I look like I am interested in my hygienist's life, but I really want her to please quit talking and get her work done so I can go on with my day."

What a shock to have heard this! I had been under the impression that it was a hygienist's duty to nurture, listen to stories, empathize, and ultimately talk for the entire hour to help patients feel comfortable. I could not believe how much less time it took to clean a patient’s teeth when I stopped chatting through the whole appointment.

Also, how many times have we heard jokes and comments about asking our patient’s questions while he or she is laying back in a somewhat compromised position? Is this an effective way to educate a patient? While I understand the notion that multitasking is the answer for time management concerns, examine that picture again. This should be a conversation with opportunity to question and respond. Upon discovery of a problem, use a handheld mirror and show your patients the area you will discuss at the end of the appointment while they are sitting up. Finish your task, sit them up, take off your mask, look them in the eyes, and deliver your oral hygiene instruction. You may discover some needed clinical time during your hour when you spend 5 intense minutes at the end of the appointment.

Consider these recommendations for finding precious minutes for every patient as the list of new services will no doubt continue to expand. I discovered I could offer more services, feel less stressed, and truly impact my patients from a professional aspect when I stopped talking when I should not.

Leslie Pope Neveu, RDH has worked in the dental profession for 30 years. She worked as a dental hygienist in New Mexico, Switzerland, and Colorado. Most recently, Leslie advised dental practices as a clinical coach specializing in the Dental Hygiene department. Leslie can be reached via e-mail at 