To Disclose or Not to Disclose
How I fell back in love with plaque disclosing
By Tabitha Acret
When I graduated university I was like a teenager hygienist, eager to break free of university constraints, full of knowledge ready to tackle the hygiene world. I say a teenager hygienist as I was like a teenager. I had knowledge from univeristy that made me feel like I knew everything and my university lecturers were like my parents, I was ready to run away and carve my own path.
At university we learned about plaque disclosing and used it on all of our patients but once I left the training setting and went into private practice so many of the best practice steps fell to the wayside as I tackled time and production. I simply thought I no longer have 1-2 hour appointments, I have 50 minutes and I don’t have time for plaque disclosing. For many years I didn’t touch it unless it was an unruly teenager or a patient I was having trouble motivating.
When I found AIRFLOW I started my GBT journey and fell back in love with plaque disclosing. Plaque disclosing was invented in 1814, research shows that 80% of clinicians are aware of plaque disclosing but only 10 % of clinicians use it. Some of the many constraints clinicians say are the same that I used to say myself and excuses once made for not using it, but once you start again you will find its one of the most useful tools in your surgery.
Barrier 1 - It's time-consuming
I used to think the same but it actually saves time! By using plaque disclosing it is the quickest and easiest way to show patients exactly where the plaque is. It allows for chairside identification of new and mature plaque and allows the clinician to do a quick risk assessment. For many patients and clinicians it's hard to identify plaque and when a disclosing solution is used the plaque is easily identified by everyone. It allows the patient to see exactly where they need to improve and allows for easier and quicker identification of the types of plaque. It also aids for oral hygiene instructions as it breaks away the barriers for the patients resisting OHI and instead they seek advice to correct their home car techniques as they can easily see where they have been missing.
Barrier 2 - I won't get it all off
Using traditional methods for prophylaxis you probably won't but that’s all the more reason to plaque disclose and use AIRFLOW. AIRFLOW technology allows 360° access to all areas of the teeth, implants and orthodontic brackets that are almost impossible when using traditional methods. AIRFLOW is also proven to be much faster so you won’t be spending hours trying to remove the plaque disclosing in all the hard to reach areas. However, the plaque disclosing shows us how important it is for not just the patient but also to guide the cleaning for the clinician.
In a study done by Professor Basendorf from the University of Bern they had a look at two test groups. Group one had cleaned with AIRFLOW technology with no plaque disclosing and group two had cleaned using AIRFLOW with plaque disclosing first. Both test groups were then plaque disclosed and given a score. Group one had an average of 20% plaque left and group two who had used plaque disclosing had an average score of 6%. This is a significant difference and shows how much better a clinician will clean with plaque disclosing
Barrier 3 - Patients won't like it
I used to think the same, I was worried that adults would think I was treating them like children, or they would be upset if it got on their lips or gums.
- Tip 1 - Always use lip balm first so that it doesn’t stick to their lips.
- Tip 2 - You can AIRFLOW the gingiva and tongue to remove the stain and the patient doesn’t have to leave looking like they had a frozen Slurpee instead of a dental appointment on their lunch break.
I was also worried as was my boss that adult patients would feel belittled by plaque disclosing but this has not been the case. It comes down to how you describe it to your patients and the reasons why. When I have families in the chair we use it as a tool to motivate the whole family, I grade everyone in the family including mum and dad and declare a winner. It’s a great way to make it fun in the surgery and motivate everyone to want to WIN at the next appointment. But you're probably thinking this doesn’t apply to the 55-year-old investment banker in a suit who hasn’t cracked a smile in the 10 years you have been seeing him, however I have found this has been fantastic teaching, motivating tool with everyone. I explain what I am doing first that I am using the solution to assess the bacterias age and its destruction value along with using this solution to guide my cleaning so that I can treat in a minimally invasive way while still maintaining 100% plaque removal. It's also undeniable that it's needed when plaque is found everywhere.
Overall using plaque disclosing again as a standard of care in my practice has been a positive experience for everyone involved, its help motivate and build relationships with my patients and enabled me to make sure I am not missing anywhere and providing satisfaction at my appointments knowing I have provided a service to my patients where they are motivated and all bacteria has been removed.