today we're going to show you how to give some
elite oral hygiene instructions using evidence-based behavior change techniques
welcome back guys if you're new here my name is zoh i'm a foundation dentist working here
in london and my name is ali and i'm a final year dental student studying at newcastle
one of the first treatments you'll ever do as a student is given ohi
and you'll do this countless times in your first clinical year alone
so that's only more reason to be doing it properly from day one i think it's really
important not to lose sight of the impact of teaching good prevention to your patients and
this is something that definitely shouldn't be done quickly or be squeezed in i'm prouder of
the fact that i have a patient who reduced their black score by 85 percent than i am of most of my
direct restorations and that's honestly because if you think about it i saved this person from a
deteriorating oral health status which would have led to perio bone loss and eventually no teeth
so in this video we'll be taking you through our five step technique on how to give good oral
hygiene instructions and our timestamps below for each of the five steps let's get started
step one is to gather information before you start to teach the patient on how to look
after their oral health you need to establish how much they already know as mentioned in our video
on how to take a history we like to include asking the patient about their oral health
regime in the past dental history section where we'd find out the type of brush they use
the type of toothpaste they use when and how often they brush and for how long
and finally if they use any interdental cleaning aids
the second step involves further investigating the state of their oral health by assessing how much
plaque they have on the surfaces of their teeth there are different ways of doing this and one
example is by using a turesky plaque scoring index which is the one we use that bristol at newcastle
we use a plaque disclosing tablet for patients above a certain age and record the percentage of
surfaces with heavy plaque deposits this gives you an idea of the status of the patient's oral health
and tells you which areas the patient's missing when they brush and you can use this information
to tailor your advice the black score can be used as a guide to judge how much the patients improved
since the last time you saw them and gives you a huge opportunity to get positive reinforcement
and encourage behavior change before we mention step 3 i really want to talk about how to drive
your patient to change their behavior in the most scientifically effective way it's a common
misconception that the most effective way to motivate a patient is by scaring them with the
consequences of neglecting the change that they're trying to drive so for example if my patient had
periodontitis and you wanted them to improve their oral health one approach would be to tell them if
they continue to neglect brushing their teeth they'll lose all their teeth and potentially
live a miserable life well the problem with that approach is that the brain doesn't react as well
to negative information as it does to positive information and negative information and fear
usually induces inaction and wherever there is an impact it's usually limited and temporary
while positive information tends to induce action towards the change in behavior that you're trying
to drive the logic behind this is that because positive information makes you feel good you chase
it and because negative information makes you feel bad you avoid it the most scientifically effective
approach to inducing behavior change for a longer period of time is split into three categories that
the brain craves and react positively too so the first is social incentive and that's the
response to other people's opinions of you and is usually demonstrated by copying and wanting
to be better than other people the second thing that drives a person to change their behavior
is an immediate reward and that's because we value something which we're sure we'll get now
over something that we may or may not get in the future if you reward your patient for something
they've done now they're more likely to conform to the positive action and this effect can last up
to six months and usually is enough time for your patient to form a habit and the third thing which
can drive change is progress monitoring and this is because the average brain is better at coding
positive information about the future than it is at coding negative information about the future
and a plaque score can integrate all three of these it can act as a social incentive since the
patient won't want to disappoint or feel judged by the dentist the next time they come in and get a
black score it's the same reason people heavily brush their teeth just before they're going to
see the dentist secondly it can provide immediate reward when the patient improves their score or
reaches their target score and when they receive positive reinforcement from the dentist and lastly
it allows you and the patient to monitor the progress since it's quantifiable and you can
set targets for the patient having said all this that doesn't mean we shouldn't communicate the
risks of neglecting their oral hygiene it just means that we should be smart about the way
that we deliver this information to the patient so that we can encourage a change in behavior
so step three is delivering the relevant information to the patient let's say you have
a patient who brushes their teeth once in the morning for two minutes with a non-fluoridated
toothpaste the oh i would give would sound something like this if you don't brush your teeth
plaque will build up where the gum meets the tooth and the plaque is that sticky stuff that you can
scrape off with your fingernail and there's a lot of bacteria in there this bacteria irrigates the
gums and causes them to become red and swollen and this is what causes gum disease gum disease breaks
down the bone which holds the teeth in place and eventually if enough bone breaks down the teeth
become wobbly and make it hard for you to eat and talk this bacteria can also use sugar to make acid
and can cause tooth decay now the way to stop this plaque from building up is by brushing for two
minutes every day which i know you've told me you do already so well done and keep that up now let's
see if we can improve that plaque score which we talked about before by brushing before you sleep
as well i know you've told me that you've been using toothpaste without fluoride inside and a
really simple swap that would improve the strength of your teeth a lot and protect them from decay is
using a toothpaste with 1450 parts per million fluoride which can be found on the back of the
tube and also i'm not sure if you've been doing this or not but a lot of people don't know that
you should spit the toothpaste out after you brush but not rinse with water after so that
the fluoride can stay on the tube for longer and finally you should also swap out your toothbrush
every two to three months now looking at your plaque score percentage it's actually pretty
good but i think we can reduce it if we show you on the model how you could remove this plaque more
effectively then i would demonstrate the modified bass technique to make sure that they're brushing
their outer surface the inner surface and the biting surface in a systematic order towards
where the gum and the teeth meet so the order that i like to use is to divide the mouth into
four quadrants so i tell the patient you should be brushing each quadrant for 30 seconds if they have
an electric toothbrush that's quite convenient because they have 30 second timers and if they
don't i just tell them to have a timer on their phone every 30 seconds they should be brushing one
quadrant again making sure that they're brushing all the surfaces so they start with one quadrant
after 30 seconds then move on to the next then the next then the next it doesn't really matter
which quadrant they start as long as they make sure they do each and every single quadrant
step four is to get them to practice what you've just taught them you should ask them to get in
front of a sink and a mirror as they would at home and ask them to show you if they are able to do
what you've just taught them you want to make sure they're going in a systematic order brushing all
the surfaces and if they're using a good brushing technique for their toothbrush type their age and
their dexterity if they aren't then you should stop and correct them until they can do it if
they're a capable adult using a manual toothbrush i would want them to be brushing with a vibrating
motion covering one or two teeth at a time if they're using an electric toothbrush which if
they're not i would recommend i would want them to keep the round head still at a 45 degree angle
towards the pocket of one tooth at a time for about two seconds and then move on to the next
tooth working their way around all the surfaces if it's a child or someone who lacks the ability
to brush with a proper technique i'd be okay with them using the scrubbing technique where they just
go back and forth but i still teach them to go in a systematic order so that they're covering
all the surfaces i'd also advise someone who supervises their brushing to redo it for them
to a higher standard for children who are under 10 i would involve the parent and explain that
they're not able to do a detailed enough job so finally step five involves helping the patient
make plaque removal a habit and supporting the improvement of their oral health over a longer
period of time now this involves constant positive reinforcement and progress monitoring with plaque
scores making a plan on when is a good time to fit this in the day and tailoring the advice
you give to your patient has proven to increase compliance it's important to ask your patient
on returning visits about how well they've been sticking to the plan and eventually when it's
appropriate you can start to include incidental cleaning aid to the oral hygiene regime i've
definitely made that mistake of trying to make my patients do too much too soon that would present
saying that they brush their teeth once every few days and i'll be telling about flossing
and using teepees and they'll be thinking this guy's just so extra i'm not bothered to do any
of that so you just need to be smart about how much information you give them in one session
finally when you give ohi especially to younger patients make sure you consult the dboh for
specific age-related advice like prescribing mouthwash once a day at a different time to
brushing from eight years old if necessary or like prescribing 2800 per million fluoride to
a patient who's over 10 or 5 000 past million fluoride to a patient who's over 16. it's also
important to know that flossing and interdental brushes should be used once a day before brushing
so just to recap all the five steps for you guys step one is gathering all the information step two
is plaque score and behavior change step three is educating the patient step four is practice
and step five is maintenance okay guys so that's pretty much it on giving ohi and we hope you guys
found it useful if you did we'd really appreciate if you gave us a like and subscribe you might also
enjoy some of the other videos that we have on the channel so feel free to check out some of
the suggestions here and also if you guys noticed anything that we might have missed out just throw
that in the comments below and we can all learn together see you guys in the next video peace