The mass market is dead. Long live the individual. These two statements may seem more politically than dentally related, but, there is a connection. Just think for a moment about the advice given to patients in your practice. Presumably all patients are told they should brush and floss? Good advice - but is this enough? To what extent in your practice are you tailoring what you say to the needs of the patient, in other words, the individual?
If dental health is on the agenda in your practice, a discussion probably takes place about diet followed by the best type of brush, floss, or mouthwash and whether inter-dental brushing works. Once again, ask yourself, is this enough?
To return to the theme of the vanishing mass market, most of us would agree that the growth in individual choice over the last few decades has been a good thing. Until quite recently, everything was geared to the average person, whether it was education, food or the height of car seats. This means that a significant minority was always disappointed. If you had individual needs, such as dyslexia, sensitivity to a food, or were very tall or short, you had a problem.
The area in which choice and differentiation has been most valuable is education. We now know that most of us have individual learning styles - auditory, visual, and kinesthetic –so some of us learn better by listening, others by seeing and the third group learn through touch or experience. When education is tailored so it covers all learning styles, all of us have the opportunity to benefit from what our teachers or tutors are saying.
When it comes to oral hygiene, it’s not just learning styles that must be taken into account, so must lifestyle. According to one study, patients consistently cite time limitations and interference with daily routines/habits as reasons not to carry out tooth brushing. According to surveys by the British Dental Health Foundation in 2007 and 2008, only 20 per cent of patients regularly performed acceptable flossing and only 30 per cent brushed for the required two minutes.
Professor of psychology as applied to dentistry at King’s College, London, Tim Newton, says: ‘Only by understanding each individual’s needs in the context of their lifestyle can we develop a programme that truly takes them from that place on the journey toward improved oral health. At the simplest level, consider whether their challenge is physical ability (‘I can’t do it’) or a problem of finding the time or motivation (‘I can’t find the time to do it’). Each of these calls for a different approach – what works for one will not work for the other.’
The physical abilities of the patient are another important consideration for the dental team. Manual dexterity is critical to effective dental hygiene instruction. Imagine telling a patient - Joe Bloggs - how to floss his teeth when he may find it easier to learn visually. A demonstration of oral hygiene would be much more appropriate than verbal advice. Add to this frustration poor manual dexterity and a narrow mouth and Joe Bloggs may find it very difficult to keep his mouth clean. The Bloggses of this world need advice which is tailored to them. They also need to be trying as many methods as possible to keep their mouths healthy - brushing, flossing and mouthwash, at different times, in different ways. Indeed, many dentists are recommending that Listerine mouthwash should be part of their patients’ recommended daily regime.
Its efficacy is backed by copious research. For instance, one study examined the amount of plaque reduction in patients over a six month period in response to flossing and use of Listerine mouthwash. The study showed that the addition of flossing to daily brushing reduced the amount of plaque in the mouth by 9.3 per cent while adding Listerine twice daily to bushing and flossing reduced plaque by 51.9 per cent.
Annemo Lundin, of Baytree Dental Group in Eastbourne routinely recommends Listerine to all her patients. She teaches by example - a kinesthetic experience - since every appointment ends with the patient rinsing their mouth with Listerine.
‘When the patients arrive, we pour out the Listerine into a cup and when they have finished their treatment they rinse with Listerine before they go out. So they go away with a nice fresh taste.’
The reason Listerine works is that it reaches almost 100 per cent of the mouth and penetrates deep into biofilm and kills the plaque bacteria.
Like Annemo Lundin, Robert Atkinson of the Cheshire Cat Orthodontic Practice in Macclesfield strongly recommends Listerine. As an orthodontist, his motive for recommending mouthwash is also about good risk management but the outcome for patients is equally positive.
‘Some studies have suggested that possibly 50 per cent of all cases nationally may actually have some degree of decalcification once appliances are removed. Here we like to think we have a lower incidence of problems than nationally, but it is because we take a preventive approach,’ he says.
‘It is bound to be more difficult to clean teeth with fixed appliances than without. The preventive approach comes from patient education in relation to diet and home care routines including brushing techniques, inter-dental cleaning and the use of mouthwash. We have chosen to recommend Listerine based on the fact that it has natural ingredients like menthol and eucalyptus which are essential oils which have a clinically proven advantage over comparative products. Listerine’s formulation seems to achieve the highest reduction in bacterial levels and it is a product that patients can use on a day-by-day basis.
‘Listerine does have a strong taste, but in my opinion it is the best one for anti-microbial therapy and also has fluoride (in some variants) in it which helps to harden up the surfaces of the teeth. It is not a difficult decision to go for it. We hold a stock and make it available and strongly recommend it.’
While it should never be suggested that mouthwash on its own is sufficient, its advocates say it makes a significant difference when it is an adjunct to brushing and flossing. Perhaps it is time that more practices extended their repertoire of dental health advice to include Listerine. And in the process, why not study individual needs and learning styles among your patients? It might prove to be a highly rewarding experience.
References available on request.