News feature: The challenge of dental patient compliance
 

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News feature: The challenge of dental patient compliance

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News feature: The challenge of dental patient compliance

 

News feature: The challenge of dental patient compliance

To say that patients do not always adhere to best practice in oral hygiene is an understatement. R

esearch shows that most people, on most days, do not brush and floss for the required time. This has been supported by a survey carried out in 2007 by the British Dental Health Foundation (BDHF) which found that just 30% of people brushed for the required two minutes. When it comes to flossing, a survey by BDHF in 2006 found that 40% of people admit to never flossing.

It is common knowledge that we should all brush twice a day for at least two minutes yet the evidence presented to dentists in patients' mouths suggests that this is far from being the case.

Patients consistently cite time limitations and interference with daily routines/habits as reasons for not carrying out professional advice on oral hygiene brushing[1]. It is surely no overstatement to say that patient compliance with oral hygiene advice is one of the biggest challenges faced by dental teams today.

The challenge is nothing new, of course. For decades, dentists and hygienists have been trying to get patients to understand the importance of regular, routine oral hygiene. But there are two factors which make this challenge more pressing today.

One is the growing awareness of the potentially worrying consequences to overall health and well-being of not maintaining good oral hygiene and the other is the litigious nature of today's society.

But first, let's examine the systemic link between gum health and other conditions. Recent published studies have shown that poor oral health could increase the risk of heart attack [2]
and stroke [3].  A recent study [4] published in the Canadian Journal of Diabetes (one of the fastest growing diseases in the world) noted that seventy five per cent of diabetes sufferers also have gingivitis and periodontitis. The authors predict that the interaction of the two diseases will have a growing impact on both dental and overall healthcare. 

Furthermore, poorer metabolic control in diabetes and greater risk of complications can result from poor oral health5. Conversely, periodontal therapy improves glycaemic control [6].

A study of patients with rheumatoid arthritis (RA) published in 2008 shows they are 82% more likely to have periodontitis and seropositive RA patients are 120 per cent more likely [7]. All of this suggests that patients who do not care for their gum health may also be making themselves susceptible to, or aggravating, conditions such as CHD, diabetes or RA.

The risks are not limited purely to the health of the patient. There is a secondary risk to the clinician and the practice of having a patient whose gum health deteriorates and who must be treated for periodontitis.

A third of all the highest value negligence claims against dentists relate to allegations of undiagnosed/untreated periodontal disease. These claims are amongst the fastest growing groups of claims, especially here in the UK.

If the patient is a smoker, this increases the risk factors of periodontal disease by approximately three times [8]. While all patients at risk of periodontal disease need to be made aware of the implications of the condition, extra care should be taken with smokers. Kelleher, Porter et al [9] reported that only 6% of patients seen for specialist opinion were aware of any link between smoking and periodontal disease – about the same level of awareness as for mouth cancer.

It's clear that dentists, hygienists, therapists and dental health educators need to be doing all they can to recommend to patients that they improve their home care routine, especially those with sub-optimal oral hygiene, and making a specific record in the patient's notes each time they issue an oral health warning or advice.

It is also clear that a thorough and diverse approach should be taken, so that each patient is engaged with a routine which includes, brushing, flossing and the adjunctive use of a mouthwash. In particular, those with poor dexterity should have a mouthwash strongly recommended as this is more likely to be effective in the harder to reach areas of the mouth. 

All in all, if the challenge of compliance is to be met head-on, clinicians need to be armed with the best possible resources and advice. Patients must understand the importance of a daily routine which includes regular brushing and flossing, and to achieve a broad spectrum anti-bacterial approach, the adjunctive daily use of a mouthwash should also be recommended.

For more information and free copies of patient literature, please contact Johnson & Johnson on 0800 328 0750.


References
1. Abegg C et al.  How do routines of daily activities and flexibility of daily activities affect tooth-cleaning behavior?   Journal of Public Health Dentistry 2000; 60(3): 154-8. [Quoted in ‘UCL - Periodontal Disease in Modern Day Britain' March 2008, p7.]
2. Genco R, Offenbacher S Beck J.  Periodontal disease and cardiovascular disease - epidemiology and possible mechanisms. J Am Dent Assoc 2002; 133: 14-22.
3. Tonetti MS.  Periodontitis and risk for atherosclerosis; an update on intervention trials.  J   Clin Periodont 2009; 36(Suppl 100):15-19.
4. Tenenbaum HC, Iacopino AM.  Current concept in Diabetes Management: Comprehensive interprofessional care, including oral health. Canadian Journal of Diabetes;  September 2009: 146 – 147.
5. Mealey BL.  Periodontal disease and diabetes – a two-way street.  JADA 2006; 137: 26-31.
6. Stewart JE et al. The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus.   J Clin Perio 2001; 28:306–310
7. de Pablo et al. Association of periodontal disease and tooth loss with rheumatoid arthritis in the US population.   J Rheumatol 2008 Jan; 35(1): 70 – 76. (http://www.joponline.org/doi/abs/10.1902/jop.2008.070501?cookieSet=1&journalCode=jop) www.previser.co.uk  PreViser risk assessment Autumn Newsletter 2009.
8. Johnson GK, Hill M.  Cigarette smoking and the periodontal patient.  J Periodontal 2004; 75 (2): 196 – 209.
9. Kelleher, Porter et al. Poor patient awareness of the relationship between smoking and periodontal diseases.  Br Dent J 2005 Dec 10; 199 (11): 731-7.


Richard Horner runs Scope Dental Professional Relations.

 Posted on : Wed 26th - May - 2010

 

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