Too Many Options
Floss, tape or ribbon? Soft, medium or hard brush? Manual or electric? Fluoride or herbal toothpaste? Whitening, double-action, triple-action or all-in-one? Mouthwash or not?
These questions are endless in the mind of a common consumer. So no wonder they rely on the advice of a dental professional. Why wouldn’t they? Us professionals have the latest information and studies. We have tested the products ourselves. We have seen them in use amongst patients with good results before we recommend them.
As some of us might have, most of us haven’t. Let me tell you how a product gets recommended.
Annual Dental Show Case
Every year dental professionals gather at dental show cases where manufacturers of dental equipments and oral health care products have set up impressive stands to lure dentists, hygienists and nurses to discuss about the new products.
Most of these professionals are not interested in what types of root canal files they have invented or the qualities of the new toothpaste.
What they are interested in (while acting as if they are listening the representative) is:
Are there any freebies?
Yes, I have seen highly paid dentists with their Louis Vuittons to run after freebies like they had no money to buy them. They sit in free 45 minute lecture sponsored by one of the leading oral hygiene product manufacturer to receive the latest model of an electric toothbrush which they already have. This new one they will either sell or give as a Christmas gift to a relative. They go from stand to stand to pick toothpaste, floss, chewing gum, sweets and reluctantly accept advertisement leaflets which will go straight into the bin when they reach home.
The most generous representatives are the ones whose product end up recommended the most.
Because they send boxes and boxes of free samples to the practices. Let’s say a dental practice receives 6 boxes of toothpaste samples, those handy travel sized ones, you know? Each box has 100 samples. So 600 tubes of toothpaste to give away. Will all of these be given to the patients? Nope.
300 of them will confiscated by the staff of the dental practice for personal use
200 of them the staff will give to the relatives and friends
And finally the rest will go to a small bowl on the side of the desk in the surgery and these samples are given one by one to a patient who has deserved it. Some might even hide them in a drawer to avoid being forced to give them to a patient that annoyed them (because it’s not good manners to say no if the patient asks for samples).
Salesmen of the Manufacturers
The leading oral hygiene manufacturers have salesmen who visit regularly the dental practices to promote their products. They are warmly welcomed to the practices but often only if they visit whilst the practice is having a lunch break. The reason for this is:
- The practice does not want to lose any profitable surgery hours.
- All dental professionals know they will bring something to go with a coffee. A cake, sweets, a swiss roll. They had better or the salesman will be faced with a grumpy audience.
When the dental professionals are happily sipping away their coffee or tea with the cake, the salesman goes through the new products. There might be a question or two but what everyone is thinking while the salesman talks is:
Are there any freebies?
We often meet quite aggressive salesmen who will defend their product to the death. Honestly, what happened to customer is always right? If you are actually listening to the salesman when he is telling you about all the impartial studies of how their pulsating electric toothbrush is better than a manual toothbrush and especially better than their competitor’s sonic toothbrush (their study actually says sonic toothbrush is as crap as the manual toothbrush – what?) you are urged to raise your hand to get a say.
You want to tell the salesman, that you are actually using the sonic toothbrush and that you have recommended it to the patients with poor oral hygiene and the results are great. If you are wise, you don’t say anything and carry on recommending the product you know is the best. But if you cannot keep quiet, you will soon learn to do so next time. The salesman starts to talk to you as if you are retarded or malpracticing when recommending something their study has shown to be ineffective.
Impartial study my arse (beg pardon my French).
Anyway, the salesman gives everyone toothpastes and promises to send samples later on. Boxes of samples. And they will. And you already know what happens then.
I must say that it amazes me how some of the dental professionals are stubbornly stuck on recommending the same electric toothbrush they are using themselves and have never tried another one. Or they might have tried it once (let’s say this leading sonic toothbrush) with incorrect technique and judge it by that. They refuse to see the good results that are clear with the patients who are using this sonic toothbrush. Where is professionalism in this?
Personalities and Professions Clash inside the Practice
The dentist is the ultimate Master of the Universe (by Universe I mean a dental practice) and if the Master has ordered certain toothbrushes, certain toothpaste, floss and interdental brushes to be sold in the practice, then the rest need to comply. Of course there will be some rebellion inside the closed surgery doors. But it needs to be done so that one does not get exposed as there will be consequences. So one must occasionally recommend the products the Master has chosen.
For some reason unknown to the writer the patients seem to consider the dentists as God. What the dentist says overwrites everything another dental professional has said, including oral hygiene recommendations. The hygienist cannot be right if the dentist said something else.
This leads me into temptation to step out of the subject for a little while as I remembered something that has puzzled me for ages and I think I might get an answer through this blog. Here it goes… Patients consider the dentists as God and bring gifts (wine, chocolate, cds etc) to them when the treatment is done and the nurses, hygienists and the rest hardworking supportive staff get nothing. TO THE DENTIST who makes gazillion amount of money compared to the supporting staff! Why o why? Dear patients, please use comment box to enlighten me in this matter!
Back to the subject.
Later on in this blog I will be writing more about the personalities and how it affects dental practice and the treatment given to the patient. But having mentioned it on the heading already I will write shortly here as well.
When a dental professional has a big ego it sometimes runs over the best interest of the patient. Lets say a dental hygienist recommended you a yellow interdental brush and she spent time and effort to get you to learn the technique by showing how to use it and by checking that you understood how and why to use it. You leave the practice happily because you learned a new skill to improve your oral hygiene.
Then you see a dentist the next week and he thinks the interdental brush is rubbish (as you lost a filling made by him when using the interdental brush) and advices you to use floss on your heavily filled teeth with wide gaps. He just casually says this without showing the technique. You try the floss as you have many times previously and it gets stuck, breaks and is difficult to use between the back teeth. You give up and stick to the toothbrush only.
Who wins? Nobody. Especially not the patient. And to be honest, you would be wasting your money anyway as the floss is not the right tool for you.
The dentist is not in the area of the best knowledge when it comes to recommending the oral hygiene products. They are far better drilling and filling the teeth. And doing all sorts of other nasty (from patient’s perspective) things that requires higher and longer academic education than hygienist’s.
Old Habits Die Hard
“I have always recommended floss and it’s been fine”
Oh, dear. Lets start from the basics of oral hygiene.
Patients are all different, our teeth and bones are different shapes. They have teeth that have no fillings, some fillings or mouth full of fillings and other restorations (crowns, bridges, implants). Some restorations are well made, some not. Patients have different motoric skills.
So you cannot recommend something out of custom.
To find out the best product to recommend to the individual patient, we should always use disclosing liquid (the one that dyes the plaque red/blue). If not used, it is impossible to tell what works and what doesn’t. You would be surprised to find out how ineffective the common floss or tape is. I do recommend floss every once in a while but only 3 certain types of certain brands (you will find out from here which they are, plus correct technique for the sonic toothbrush).
How It Should Be Done
This chapter is especially useful for the dental professionals but the patients benefit of reading this as well. You know you are in good hands when a dentist or hygienist is as thorough as I describe.
This is a short version of upcoming post about what recommendations should be based on. It is last on the list because there are not many dental professionals who are this thorough.
The most important thing is to interview the patients about their current oral hygiene habits and reasons behind them. E.g. if the patient is not cleaning between the teeth, ask why? without sounding or being judgemental. Laziness, ignorance, stress, depression, difficult life situation, too hard… there are as many reasons as there are patients.
The next you need to find out where the problem areas are in patient’s mouth and decide the right tool for the patient to use. Test it, show it to the patient and let the patient try. Remember to say, it won’t be an easy ride at first even if looks easy when I do it.
Tell the patient where she can find them and where they are the cheapest to buy (do you research).
Give leash and don’t be overenthusiastic. By this I mean you should encourage patient even if there has been only small improvement, but also same time encourage to do better next time. Change the tool if it’s not working. Small steps!
In my experience it takes 12-18 months on average until you get it right if the patient is responsive. So don’t give up after the first visit.
Also worth remembering
- the products sold in the practices are not necessarily the best ones like electric toothbrushes of certain makes and models. They are normally just the owner’s way of making more money on the counter. Use the products recommended by the experienced hygienist.
- some of the products might even be a health risk like mouthwash which contains alcohol (now this is an issue that divides dental professionals. Some agree with me, some don’t. I will be writing about this later on in this blog).
- some of the products might not be suitable for you like toothpaste containing soap if your mouth is sensitive (sodium lauryl sulfate).
- some dental professionals are not revising and open to a new information and studies about dental products. They stick to the old knowledge despite the fact that the new information is indisputable. This happens especially if the new information is delivered by the lower rank colleague in the practice.
- fillings, when well-made, do not come out with any oral hygiene product. The fault is always in the filling and in it’s maker.
It was a long post, hopefully you made through it. To sum up all 2000+ words, only two words come to my mind that defines us dental professionals these days. Greed and pride. Two out of seven of deadly sins.
But there is hope.