How to run your own oral health clinic

oral-hygiene-clinicI took my Oral Health Education qualification online through the British Dental Association (BDA) in 2011. I had just started working at a new practice which had a nurse who already ran an oral health education appointment book. However, she had plans to leave the practice and so I had been asked at my interview whether I would be interested in taking the qualification and continuing her work in this area when she left.

I have since moved on to another practice where there was no existing nurse with the oral health education qualification. This has meant that I have been able to run the service from the start of my post. In this article I will discuss the course, the barriers and difficulties I have encountered, and the ways in which the qualification can benefit your practice.

The course

When I began searching for a course, I decided I would like to do it in a classroom setting rather than online. I felt that a classroom setting would mean I had other nurses to talk to and gain support from if I should encounter any problems with patients. I applied for the course at two different dental hospitals and both courses were cancelled because they did not have enough applicants. I tried again the following year but experienced the same problem – with one hospital only cancelling on the day the course was supposed to begin! After that I abandoned my search for a classroom-based course and opted for an online one. The course consisted of online modules to complete in your own time. A textbook is provided to support these. There are short tests at the end of every module, both online and in the textbook. The BDA provides you with a schedule to make sure you are progressing through the modules at the rate required. 

At the end of the course there is an exam with a written part and an oral part. Before sitting the exam, there is a portfolio to complete which should include consideration of a variety of patients as well as two case studies. The patients chosen for the case studies must be seen a minimum of three times each. Obviously a lot of support is needed from your practice so that you are able to complete your portfolio. Your practice will need to ensure that you have plenty of patients in your appointment book. I found creating my portfolio to be great fun. I'm definitely a ‘people person’, and my appointments were always thirty minutes long which meant I was not rushed and had time to chat to my patients and get to know them better. However, I did not find studying the online modules to be quite so much fun! To go through them in detail and ensure I understood them took a great deal of time, and it was extremely difficult to fit this in around a full-time job. The practice I was working at did not allow me much time whilst at work to complete the course so I had to do most of the modules in my free time. It was a lot more work than I was prepared for so do bear this in mind before embarking on the course. Although I did not find the work overly difficult, I did find that there was a lot of it. You will need to set time aside regularly to complete your modules and also to plan what you are going to do with the patients you will be seeing. This is often giving practical advice on cleaning but also includes giving dietary advice, so you need to devise ways of teaching patients about caries and how to prevent it. I created diet sheets for patients to take away with them, simple ways to show the Stephan Curve, and games which explained things such as hidden sugars and how to choose good foods and drinks for in between meal times.

How to get started

When you initially begin, hopefully your practice will be well aware of the need to fill your appointment book so that you can complete your portfolio. However, this may need reinforcing throughout the time you are on the course and it is easy for staff to forget once you have completed it. If you are starting an appointment book in a practice that does not already offer this service you may find it difficult to keep reminding clinicians and receptionists. Here are a few ideas I have found helpful to me:

Hopefully your practice team meet regularly at staff meetings, so make sure to put your appointment book on the agenda. This is a great way to make the whole team aware that your appointment book is open and what it has to offer. You can also discuss which patients should be booked in with you and get your whole team on board.

Are your patients sent consent letters? We send them out to all patients at my practice and have added a paragraph at the end about an oral health education appointment. This way, even if the reception team or clinicians do not book the patients in, the patients may ask about it themselves as they are expecting that appointment at the end of their treatment.

One way I found to try and remind the team to book patients in was to go through all appointment books and find patients who should be booked in with me and then write it on their appointment. That way anyone looking at the computer screen can see it and will hopefully make the appointment. I mainly look out for patients who are having new restorations fitted.

Patients

You are likely to see a wide range of patients when offering this service. In my first practice I found that this was mainly patients with new fixed orthodontic appliances fitted. This often meant multiple visits for plaque scoring and reinforcing oral health messages. Most of these patients were teenagers and, as you can imagine, their motivation was extremely varied! I found it vital to see those with little motivation as frequently as possible, ideally at every adjustment visit. I had a laminated picture showing caries in an orthodontic patient that I found a useful motivator with many of these patients. I did plaque scoring at every appointment and made sure I discussed the results with them. 

At my current practice I mostly see patients who have had a large number of new restorations fitted, often using implants. This is more commonly older patients and a problem that can sometimes be encountered here is that some of them are not willing to change what they have been doing for a long time. It is essential to listen to them and their points of view and where possible only try to change a little at a time. You may also see patients with various disabilities. Patients with learning disabilities may find it difficult to communicate or understand your message. Patients with physical disabilities may find it difficult to carry out your instructions. Although these may seem like challenging cases, do not shy away from them as they can also be your most rewarding. I once worked with a lady who had suffered a stroke which gave her mobility problems in her right hand and arm. As she was right-handed, this gave her problems when cleaning her teeth. I remember being quite scared at first as I did not think I would be able to help her but together we made excellent progress. Work with your patients and ask their opinions and use them to guide you. In situations like this you may find you know more than you realise you do.

Barriers to filling your appointment book

Even after using the methods discussed previously, I have still found my appointment book does not get as full as I would like. I feel that the main reason for this at my current practice is simply time and space. We are looking to relocate to bigger premises as we have outgrown where we are and so I do not have a regular appointment book as there is not a surgery free on a regular basis. Although appointments for things such as dietary advice could be done in a different room, oral health instruction is much easier in the dental chair. In the past I have had to advise patients on interdental brush sizes with them sitting upright but this is not easy with me being as short as I am! How busy the practice is also has an impact on the time I am available. I currently do not have much time when I am not in surgery with a clinician and so I am not available to see patients sometimes even if there is surgery space. The problems with not having regular appointment slots are patients not being able to make the dates I am available or having to wait a long time for the next available date and so choosing not to book an appointment. Also, the reception team and clinicians are more likely to forget to book patients in. I have found that as much as I remind people, I get more patients booked in when my appointment book is open regularly as the other members of the team get used to making appointments with me.

If you are already qualified and trying to begin offering the service at a new practice, you may find that the biggest barrier is convincing your boss that it is a good idea! Below I've listed ways the service can benefit a practice so that you can discuss it with them.

Benefits to your practice

The biggest benefit I have found when delivering my oral health education sessions is that it gives me the opportunity to get to know our patients better. The oral health educator is likely to have more time to chat informally with patients than dentists and can build a rapport with patients. This makes patients feel well cared for and looked after and creates a more personalised service for them. It can help them feel more valued and like a member of staff has taken the time to listen to them and answer any questions they may have. If patients feel important and cared for they are more likely to recommend your practice to their friends and families, which will obviously generate more income for your practice. There are many other ways the oral health education service generates income. A few examples are:

Whilst neither practice I have offered this service in has charged for oral health education appointments, some practices do choose to charge a fee.

If you sell the products the oral health educator recommends, patients will often buy them from the practice so that they know they are purchasing the correct products. 

Getting to know patients creates better opportunities to discuss other treatments they may be interested in. They may then go on to book further treatments.

The oral health educator will notice any calculus or staining that can be removed by the hygienist if the practice has one and so an appointment can be made with them.

In addition, if your practice offers a guarantee on certain treatments, the practice may lose money correcting any later problems. Many issues with restorations can easily be avoided if patients are shown how to look after them well through oral health education appointments. This also means that clinicians will not lose time out of their own appointment books correcting problems that could have been avoided.

As you can see, there are many ways that offering an oral health education service can benefit a practice – but do not overlook the ways it can benefit you as a nurse. I find a lot of satisfaction in helping the patients I see and it is very rewarding. It makes me feel more valued within my workplace and gives me the opportunity to do something I really enjoy. I also find that it allows me to meet some very interesting people with some great stories to tell! 

Katie Booth, RDN

 

 

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