3 Tone Plaque Disclosing
Clinical Application Strategy
Patient Communication Techniques
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode, this week brought to you by GC America.
Hey, y’all. It’s Michelle here with a TIPisode. You don’t usually hear me on these TIPisodes, and it’s been a minute since I brought you one. But I saw that the topic was going to be Tri Plaque Gel from GC America, and I was like, “Oh. No. I got this one,” because I love my disclosing solution, which is Tri Plaque Gel from GC America.
You know I love the science. I’m not going to bore you. You guys, stay with me. Don’t worry, I’m not going to redo an entire study like I have done in the past for Storytimes with Michelle. However, I wanted to tell you this one study that I — when I was looking up things about disclosing solution for a presentation, I came across this one from 2015. It is from the Contemporary Clinical Dentistry journal, and it’s “Efficacy of the three-tone disclosing agent as an adjunct in caries risk assessment.”
And so it — just a quick background. It says, “Today, most approaches to caries viewed that catastrophic change in normal plaque biofilm is responsible for the disease, and the behavior and composition of the biofilm are a reflection of the oral environment, and the caries is a reflection of adverse changes occurring in that environment.” Of course I was like, “Yeah. Duh. Got that. We all get that.”
And, in the conclusion, it said the three-tone plaque disclosing agent was effective in identifying pathological plaque and can be used as one of the chairside adjunctives in caries risk assessment, to which again I was like, “Yeah. Duh.”
So I wanted to tell y’all about some of the clinical applications and stories of using disclosing agents. And, you know — I know we think about products sometimes, but it’s always the patient’s stories that keep us loyal to some of these products, right? Or unless they make our lives easier. But I started — okay. So I used disclosing solution in school. I think we all did, right? And even as a adjunct facul — or an adjunct faculty member, I used it as a way to grade my students. And, honestly, this was me just not seeing the real purpose of disclosing solution. I used it as a way to grade and be graded.
And, when I got — and, also, let me just tell you guys. I’m klutzy. I am such a klutz. So I would get disclosing solution everywhere. I mean, scrub — pairs of scrubs upon pairs of scrubs gone. Just ruined with disclosing solution. And so I just was like “once I’m done, I’m not — I’m out of school, I’m not using this stuff.” Like, it just wasn’t on my radar. It took me 12 years as a hygienist to get back to using disclosing solution. And someone once said that it was a diagnostic solution, and that’s when I was like, “Oh. I get it now.”
So one of the reasons that I like Tri Plaque Gel, the — well, there’s many. The first reason is because it’s a gel. So, calling back to my klutziness, it’s not a liquid, so it doesn’t spill [laughing]. So if it were — my Dappen Dish were to tilt over, it wouldn’t just, like, go all over the place. Because it’s a gel, it kind of stays in that Dappen Dish, which is fantastic.
And then it is tricolored. So it’s Tri Plaque Gel, tricolored. So the reason that — and when I was in hygiene school, I only had one color. It was just red. And then there was a two-colored one that came out, and then we got this three-colored. And so what’s fun is that while I’m applying it to the patient’s mouth and especially if it’s their first time, I’m always like, “Okay. We’re going to see three colors. I really honestly hope we only see one color, if any.”
If it’s pink, it’s been there for less than 24 hours. If it’s a darker blue — I’m sorry, a darker purple, it’s like a deeper purple, it will be there for more than 48 hours. And, if it’s light blue, that makes me a little concerned because it tells me it’s a more acidic bacteria, and we are going to talk about pH control and other factors that might be causing a light blue color or this bacteria to, like, fire off and be light blue and super acidic. However, it depends on who I’m talking to how I put it, but that’s usually my little, you know, spiel to them.
So I wanted to give more information about my clinical application. I think everyone that I’ve talked to has really done it differently. I’ve heard anywhere from, like, literally dropping it from the tube into their mouth. I don’t really think that’s a great idea for infection control purposes, but I mean, if you can maybe do it in a clean way? I feel like just that’s a no go. So let’s just take that one out of the equations. But I’ve heard of it.
Then it’s, you know, using the Dappen Dish with a cotton tip applicator and just kind of smearing it on the tongue side, the cheek side. I don’t do this now because I do find that I don’t get it to spread as well. Not because anything — because it’s a cotton tip, and it soaks it up [laughing]. And I think back of the — all the times that I did it with anything else, and I’m like, “Well, that was kind of ridiculous.” Now, I use, personally, a toothbrush because I’m going to go over home care. It’s very rare that I don’t need to show them a spot and sit them up and let them practice usually the lower linguals in the posterior or the max posterior. Those are usually the common places. But I almost always have my toothbrush out to go through home care instructions. I spend a lot of time on home care.
So I have that toothbrush out. I use that toothbrush, and I spread it around their mouth, tongue side, cheek side, and then I have them take their tongue and kind of smush it around — [laughing] that’s the technical term — kind of move it around, and then I rinse and have the — and I suction. So that’s kind of, like, the way that I apply it.
Some of the questions I get is “can I swallow this?” I’m like, “Don’t worry, I’m going to suction this out. But a little bit, yeah, not a problem at all.” And a lot of — well, I would say almost 90 percent, especially since I’m in a newer practice that has not done this with their patients prior to this, they — if I had to paint a picture for you — was it Bugs Bunny or was it Roger Rabbit? I think it was Roger Rabbit that, like, their eyeballs popped out of their head. God I hope, I hope some people are not too young [laughing] for that reference listening. But, like, their eyes, like, pop out of their head. They just cannot believe that they’re seeing all of that in their mouth.
And so this was the turning point for me because for so many years, y’all, so many years of my career, I was having the same conversation over and over and over with my patients. I was telling them about the biofilm and how it is — you know, what’s going on in their mouth and, you know, thinking I was making science-y things — putting it into layman’s terms. And the reality was I was not painting a picture for them. The disclosing solution literally paints a picture for them [laughing]. They literally see it. And so this is the turning point in my career where I now disclose every single patient without question.
And the one time that I was like, “I’m on the right track here,” I had a very stoic patient. You know, doesn’t say much, sits in the chair. Not mean, not rude, just very — I wouldn’t even say aloof. Just very stoic, quiet, doesn’t say much. You know, sits in the — with the ehmm grunt kind of getting settled in. I know you all can all visualize that one patient. And he says to me, “I hope I don’t see any of that purple this time because I’ve been working really hard.” And I was like, “Oh, my gosh!”
I have been saying — I have been giving brushing instructions to this gentleman for years. He was a three month recall in my perio practice. I was seeing him all of the time trying to come up with new ways to encourage him and motivate him, and it was because he hadn’t seen it. I was using words that did not compute in his brain. Not because he wasn’t smart and not because I wasn’t trying to switch it up, but because it just did — he couldn’t see it. In my mind, I’m looking at, like — I’m thinking of all the spirochetes and the, you know, bacteria kind of moving in this biofilm, and I don’t care how I said it to him, it did not paint the picture until I put the disclosing solution.
So I am a huge, huge advocate. You can probably hear it in my voice. I think we should all go back to using this solution at the top of the appointment. I think we should get ahead of it. Like, let’s show them what’s there. And then also it helps me do a much better job at removing as much biofilm as I can, really kind of focusing in on the areas that might have a lot of purple. Like, I’m really going to lavage those areas.
And I personally love using erythritol air powder procedures, but not everybody is doing that across the country. And, quite frankly, we’ve got a pandemic right now, so aerosols are a little hard to manage depending on where you’re at and what you’re doing and what kind of products you have and suctions and vacuums and all that jazz.
So, if you are doing prophy paste, then you can really kind of concentrate those areas and make sure you’re disrupting all of that, like, very aggressive bacteria that is — has been there for more than 48 hours according to the disclosing solution.
And the other thing that I do with this is I take a ton of intraoral pictures. I don’t care how great I think I am at writing up my clinical notes. A picture paints a thousand words for me. And so I can actually just snap those pictures, say in my notes “see intraoral pictures for areas of hygiene or home care concerns.”
And I’ve had even the patient take pictures with their cell phone or even a video while I’m going through home care instructions so that they can remember what I’m saying and where they were missing because Lord knows they get back and they’re like, “was it the inside or the outside? I can’t remember now.” Well, now they just go to look back at their phone, and it’s there.
So I hope this helps somebody out there. I cannot tell you enough — and I’m sure — I know I’ve said it multiple times already, but disclosing solution, it needs to come back. It needs to be a standard of care for us, and especially for home care instructions.
So I highly encourage you to go check out GC America’s Tri Plaque Gel. It’s so amazing. It’s very different. If you haven’t used disclosing solutions in a few years, then you’re going to be just blown away by this.
And I just want to say thank you to GC America for sponsoring this. But I’ll tell you right now, it didn’t take me any pushing and, like, “hey, Michelle, can you talk about this?” I was like, “No. I got this,” because I love it that much.
So I hope everybody has a great week. Let me know if you have any questions. I love chatting with you.
Thanks for listening to another TIPisode, and thank you to GC America for sponsoring this week’s episode. You can find out more about their great products at gcamerica.com.
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