There are numerous post-qualification options available to dental nurses, one of which is the Oral Health Education qualification. This is a great qualification to undertake, and it can increase the value to patients of attending your practice.
This article discusses some of the things an oral health educator can do to promote both their practice and good oral health. There are many possible approaches, and these will vary with individual nurses and practices – so do not limit yourself to the ideas suggested here. Achieving this qualification offers dental nurses a chance to be creative, both in the methods and resources they use to teach patients and in the ways they choose to get good oral hygiene messages across to their patients.
The Oral Health Educator and Direct Access
First, let's discuss what direct access is. According to the General Dental Council (GDC) (2017):
'Direct access’ means giving patients the option to see a dental care professional (DCP) without having to see a dentist first and without a prescription from a dentist.
So what does this mean for an oral health educator? The GDC puts this quite simply, stating that dental nurses can take part in: ‘preventative programmes without the patient having to see a dentist first’ (GDC, 2017). However, you must still work within your scope of practice and only carry out treatment for which you are "trained and competent" (GDC, 2017). Although many dental nurses are likely to feel confident in delivering oral health education to their patients, it is therefore preferable to have extra training in this area to develop your own understanding of oral health messages and ways to deliver them. The oral health educator course will equip registered dental nurses with this information, helping them to carry out this work to the best of their ability. The course builds on the knowledge that dental nurses gain through their initial qualification, deepening their knowledge and understanding of dental disease and preventative measures. The course offers practical ideas on how to pass information to our patients, and it also touches on psychology and behaviour change. It is important when adopting a teaching role that we understand something of behaviour change so that we can help our patients to adopt new ideas and techniques. I am currently undertaking a teaching course and have developed my understanding of this area greatly. This has had a positive impact on the ways I think about communicating oral health messages. You will know yourself that there are different learning styles, so it is important to develop resources which will engage your patients.
So how can direct access help patients? Some patients may be too anxious to attend appointments with a dentist, and seeing an oral health educator first may help them build their confidence in the dental chair so that they are able to book further dental appointments for treatment. Oral health educators could also go out into their local communities and take their oral health messages to members of the public rather than only delivering those messages to patients at the practice. We could visit local schools and community and activity groups to do this. As we will be better-trained in promoting oral health messages, we could also design posters or leaflets to be distributed to these places and possibly to local magazines or newspapers.
For more information on direct access, visit the GDC website at: https://archive.gdc-uk.org/Dentalprofessionals/Standards/Pages/directaccessqas.aspx
For more information on your scope of practice, visit the GDC website at: https://archive.gdc-uk.org/Newsandpublications/Publications/Publications/Scope%20of%20Practice%20September%202013.pdf
Being Involved in Oral Health Days
Dental nurses and oral health educators should be aware of oral health campaigns throughout the year. These include World Oral Health Day, National Smile Month, Stoptober, and Oral Cancer Action Month. These campaigns help to educate patients in how to take care of their own mouths, and they also provide messages promoting good oral health. Why should we get involved? Put simply, we should all share the aims of these campaigns. We should want to improve the oral health of our patients (and of the general public) where possible. I have discussed all these events in more detail in a previous article, which also included ways that your practice can be involved and promote them. This, however, is not limited to just the dental practice. You can take messages out into your local community, as discussed above.
Do you have regular staff meetings? If you do, adding oral health days to the agenda can bring your team together to discuss ideas of how to be involved. If you are the person with sole responsibility for making the arrangements, it gives you a way to communicate your plans to the whole practice team so that everybody is aware what is happening, how to support you, and what they can do to help.
Are there any barriers to being involved? There are often barriers to the things we want to do, but that does not mean that we should not make suggestions and try. When I have tried to go ahead with ideas to promote oral health days in the past, I have met barriers. The biggest is often having an unwilling practice owner or practice manager. They can reject ideas of posters or displays and leaflets as they do not want their waiting rooms to look untidy. A way of overcoming this could be to present them with different options and designs. These, again, can be discussed at staff meetings, and the whole team can input their ideas. If a waiting room display is definitely not an option, you could try and design goody bags for your patients which can be stored discreetly in surgeries or behind the reception desk. Leaflets and promotional materials for the campaign can be given to patients in this way, along with other items of your choosing. Some of the campaigns have online shops, so you could include their items but adapt what you offer to fit in with your own brand. Remember to discuss your ideas with the whole team – if more people are willing to be involved, your ideas are more likely to be considered.
Benefits of Having an Oral Health Educator
So how could having an oral health educator benefit your practice? There are many ways this is possible. If you are attempting to convince your principal dentist to support you in undertaking the oral health education qualification, it can help to show how an oral health educator can increase the income of the practice. An appointment with an oral health educator could be a chargeable appointment, bringing more income to your practice in itself. Oral hygiene aids are likely to be recommended at these appointments, and so sales of these will increase – most patients will buy recommended products from the practice rather than risk looking elsewhere and being unable to find them or buying the wrong items. The oral health educator would also be able to promote treatment options available at the practice and increase income in that way. I often find myself advising patients to book for examination appointments or visits to the hygienist. I like to keep my sessions relaxed and informal, and this can provide patients with an opportunity to discuss matters they do not feel they have time to discuss with their dentist or treatments you offer that they are not aware of. For example, they may tell you that they are unhappy with the shade of their teeth or the margins of an old crown but have not felt they had time to discus this with their dentist. You can then have a conversation about the options that may be available to them to help them feel happier and more confident with their smile.
An oral health educator can add value for existing patients as well as new patients, building rapport with them and helping them to feel cared-for and looked after. Appointments with an oral health educator can help to create space in dentists’ and hygienists’ appointment books, allowing them more time to see other patients.
Helping Patients with Periodontal Disease
In my current practice, we have a specialist periodontist. This means that a large number of patients registered with us have periodontal disease. So what is the role of the oral health educator here? Before our patients are offered treatment for their periodontal disease, we must ensure their oral hygiene routine is carried out effectively at home. In my practice, we aim for a patient’s plaque score to be under 20% before carrying out periodontal treatment. There are reasons that a patient may not be able to achieve this, and these patients are not denied treatment but are made aware that having a plaque score of under 20% helps their treatment to be more successful and effective. Most commonly, periodontal treatment consists of two appointments for a course of root surface debridement under local anaesthetic, with periodontal surgery being offered at a later date if required. Prior to their root surface debridement appointments, patients attend two appointments which focus on oral hygiene instruction. Currently, my practice is extremely busy, and we are unable to offer regular oral health education appointments, so patients see the hygienist for these initial appointments. Ideally, all periodontal patients would be offered appointments with me as an oral health educator instead. As an oral health educator, I can speak to them about what their current oral hygiene routine is and help them to improve it. Patients are asked to bring their own oral hygiene aids to these appointments to aid this. The most common things I see are patients using very small interdental brushes in spaces where a larger brush is required. I often see patients using red or pink brushes, and I move them on to the very large sizes such as purple or grey. When patients bring in their own toothbrushes, the bristles are often splayed and the brushes are ready for replacing. This occurs with both electric and manual toothbrushes. An alarming number of patients have never been shown how to care for their mouths, and so providing advice and demonstrations tailored to their needs can make a great difference. Patients are often unaware of how much control they can have over the progression of their disease, and so it is vital for us to communicate with them that we are aiming for their plaque score to be under 20% to help the treatment we carry out to be successful. We also need to stress to patients that this must continue after they have had periodontal treatment to keep the disease from progressing.
Effective oral hygiene methods are key to helping patients with periodontal disease, and teaching patients how to clean their mouths is something many dentists simply do not have the time for. Supporting a registered dental nurse through the oral health educator course is a simple way they can help their patients without taking time out from their regular appointments.
Helping Patients with Implant Restorations
In my current practice, we also offer implant restorations. We are primarily an implant practice, and so our treatment options here range from a single implant with a crown through to implant retained dentures or to full upper and lower arch implant restorations. Excellent oral hygiene is vital to patients with implant restorations, and we discuss this with all our patients before they make a decision about having treatment. Ideally, all implant patients should see a hygienist before their implant surgery to ensure their mouth is clean and their oral hygiene routine is effective. Patients should also be seen once their restoration has been completed to ensure they know how to clean it. The complexity of cleaning their new restoration will depend on the complexity of their restoration and will often include the use of new oral hygiene aids they are not aware of. It may be preferable for larger cases still to be seen by a hygienist, but smaller cases need not take up space in their appointment book. There are two hygienists working in my practice at present, and both are always fully booked quite far in advance. If you find this in your own practice, you should be able to point out to your practice manager how beneficial it would be to have an oral health educator seeing some of these patients. When you first begin seeing patients with implant restorations, try to spend some time with the hygienist so that you can see what advice they offer and what cleaning aids they recommend. From what I recall from my oral health education course, there was not much discussion about cleaning implant restorations, so work with your hygienist to make sure you are offering correct advice. In the past, I have seen patients who have not cleaned their implants because they did not know they needed to – this can lead to serious problems with implants, including the treatment being unsuccessful and the patient losing their implant(s). Most patients in my practice who attend for implant restorations have more than one implant, so suitable products need to be recommended. Many of our patients use Superfloss, which is manufactured by Oral B. You are highly likely to be aware of this product. A newer product, X-Floss, is also available (in two different sizes). It is similar to Superfloss, but we have found that some of our patients find it easier to use. Superfloss has a pointed end so it can be threaded into spaces such as underneath a pontic for a bridge. We have found that the pointed end on the X-Floss is slightly stiffer and so can be easier to thread into these spaces. A product we sometimes recommend to use around implant restorations is called an implant brush. Manufactured by TePe, this is a manual toothbrush which has a few bristles horizontally across the brush, making cleaning lingual and palatal surfaces easier. We do not recommend this brush to all our patients with implants, but some do find that it makes cleaning these surfaces easier. Interdental brushes are recommended for use in the same way as they would be used around natural teeth, but it is always worth checking which size is best around a new restoration, as the interdental spaces can change.
Dental nurses who take the oral health education qualification can make a real difference to the oral health of the patients within their practices. There are many reasons this is a good qualification to have. It can benefit both patients and the practice and can increase job satisfaction for the dental nurse. The qualification and delivering effective oral hygiene messages relies on the oral health educator having excellent communication skills, so it is essential that a dental nurse is a good communicator. Dental nurses who can help patients feel relaxed and at ease will enjoy carrying out this job role. As I said at the beginning of this article, allow yourself to be creative, and enjoy working with your patients if you choose to undertake the oral health education course.
Author: Katie Booth RDN, OHE, CTLLS
GDC. (2017). Direct Access Q&As. Available at: https://archive.gdc-uk.org/Dentalprofessionals/Standards/Pages/directaccessqas.aspx (accessed on 21/1/17).