Caries Risk Assessment
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.
Andrew Johnston: Hello, everyone. My name is Andrew Johnston. I am a dental hygienist, and I am honored to be taught by GC America to speak to you all today. And it’s on a topic that I myself have had a long, educational journey on. We’re talking about sealants. I think that we’ve all had enough discussion about how to place a sealant properly, so for today’s TIPisode, I’m going to take a little bit different of a course. I want to tell you about my experiences in the space — the areas that have I failed at, where I was successful. I’m hoping that many of you in the busy practices who just do not have any spare seconds can relate to what I have to say and maybe take something from it so that you can implement it into your own op.
So my personal background in sealants is probably similar to many of you. We had our initial education in school during our prevention class, and likely that was probably the first quarter. And then we learned the clinical application of it and started placing them on every child that walked through the doors that came into our chair. We also probably had requirements to place X number of sealants in one of our — maybe our first or second term. So, essentially, that was my educational part of it.
But then after school, I worked for a clinic for a short time that was generally pediatric with state-pay insurance, and we did dozens and sometimes several dozens of sealants as a company each day. It was a standard to place sealants on all occlusal surfaces and buccal and lingual surfaces as needed for every patient that walked through that door. It made sense based on my education. Kids get sealants. So bonus perk, though: the state always paid for them, so there was never an out-of-pocket expense for the parents, and so it was an easy thing to do.
When I moved to private practice — and that was mostly with adults — my education was further reinforced that kids get sealants, but we never talked about it for adults. Insurance wouldn’t pay for it, so why spend the time talking about it? So, because of this mentality, it was never on my brain to actually do, and I spent several years in this type of system. Does that sound familiar so far for most of you? Because then I started learning about caries risk, and this is where my conflict with sealants and the education that I had about them occurred. And I’m sad to say that for years I was anti-sealant because of this faulty logic that I’m about ready to explain to you.
When I was learning about caries risk assessments, it always seemed very linear, very direct. You’re not allowed to bend the rule, just kind of unyielding for circumstances that were outside of this caries risk assessment.
So, if you are not familiar with what a caries risk assessment is, essentially you have a form that you check off the boxes yes or no regarding the different habits, behaviors, dental conditions. Anything that could impact one’s chances for getting decay is usually listed out, and you mark off yes or no for these things. Depending on what the answers are, you classify them on low risk, moderate risk, high risk, and in some models, they even have extreme risk categories. So, if they didn’t have enough yeses in their responses to satisfy an increase in the caries risk, they were technically low risk.
If a patient was “low risk” according to the people who taught me their system, then there was not a reason to do sealants. There are so many issues with this train of thought. In my opinion, caries risk assessments still are our most valuable objective tool in determining a need for dental sealants. Anyone moderate risk or above absolutely needs a sealant in all of the grooves, pits, and fissures. Now, having said that, not every caries risk assessment form is created equal, and your place of practice might have adopted practices or policies to make the process easier or streamlined, and by doing so, they probably omitted key risk factors on their forms.
It would be difficult to have a list of every factor that ever increased one’s risk levels. We just don’t have the time to get through a list like that. And, additionally, when we create lists like these — which again are really amazing tools when they’re used correctly — we sometimes forget about the overall goal as dental hygienists, and that is to prevent disease.
So, essentially, when I was taught to use a caries risk assessment as my sole reason for determining a sealant’s needs, that logic was faulty. It didn’t allow for expansion of outside of these parameters. But I am responsible to prevent disease in all of my patients, and there is just no way I could possibly understand each and every unique lifestyle from a questionnaire. And our patients aren’t always reporting to me the truth on that questionnaire.
So the moral of the story is this: we know that sealants work. We know that when we seal up the areas that bacteria can be hiding, we are reducing the bacterial load in the mouth. We know that we need to place more sealants for our populations, both kids and adults. We need to keep learning past our entry-level basic school education and trust the professional groups that have been doing endless research on this topic, and every major organization we follow in dentistry agrees with this. The ADA, the ADHA, the AAP, even the World Health Organization, even the CDC has a place for it on its website. It’s about prevention, and there really isn’t a need for a reason beyond that.
So now I want to shift into another topic, and that is time management. So I have been in those offices where it’s go, go, go, and there wasn’t much time even for a glass of water. So I get it. But one of the things about this that concerns me is that when we are so rushed on time, we do one of two things, right? We reappoint the patient for a sealant appointment, or we rush through the job, and we do it poorly. And a poorly placed resin-based sealant is not helping the patient, and reappointing the patient is not helping them or us.
So let’s reframe it. How would you like it if you took your child in for a medical checkup and once they were done they say, “Hey, fantastic checkup, but please come back next week so that we can do your child’s temperature or take their weight and their height,” um, things that could have been done during the initial appointment? I myself as a dad, I would be just furious. I’d be like, “Well, I made time in my busy schedule to do this appointment to completion. I don’t have time. I can’t get next week off of work. The kids are in school.” Like, whatever the things might be, I would be just absolutely livid.
So bringing them back for another appointment is really just not logical. So the solution to solving the time problem is, in my opinion, product selection. You need a product that isn’t going to fail even if a little bit of moisture is present. You need a product that even if a piece chips off or comes out that there’s an ongoing benefit to the tooth from the little bit of portion that is retained. You need a product that doesn’t require more than one person to place it properly, am I right? Because we don’t always have an assistant. We don’t always have the tools that we need to place it properly.
So, for me, this is where Fuji TRIAGE comes in. Fuji TRIAGE — and they have a newer version of this called Fuji TRIAGE EP, and the “EP” means “extra protection” because it has incorporated the recaldent technology.
So a side note. You might remember recaldent from the hygiene favorite MI Paste. Sound familiar? Okay. So, with Fuji TRIAGE EP, there is no isolation or bonding. It works in a moist field. It has six times more fluoride than any other sealant. It also releases the fluoride for up to 24 months after placement. It inhibits biofilm formation, which at the end of the day is the name of the game, right? It’s fast. It’s easy. So, if your struggle is time, make sure whoever does your ordering adds this to the list to try.
One more thing I want to touch on, and it’s a personal passion of mine. That’s the business aspect of what we do as hygienists. And I know that many of you are going to be rolling your eyes right now being like, “Andrew, you always try and slide in some business in this.” Before you turn this off [laughing], please — I’m not going to make it very long. Just listen to the very end of this. It’s really important. I promise.
So the fact is that we all work for a company or a practice, and the primary purpose of this company, the whole reason why it was created in the first place, which, yes, patient care, but also it’s to support the practice owner. They took a big chunk out of their life to go and get educated to become a dentist, and then they invested a bunch of their money, additional time, they put all of their blood, sweat and tears and their emotions into this — into building this practice that we get to be a part of. So we are really there to be there to support them, and in return, it gives us individually the means to earn money doing something that we love so that we can then enjoy the lifestyle that we want, right? So I think we’re all on the same page there that that’s what the business is about.
There have been some interesting numbers lately coming out about the outlook for dentistry and for offices that are able to stay open or not stay open or are acquired or merged or all of these different things. And I am not one to talk about the fearmongering of offices opening or closing or being able to financially stay open, but what we do know is that there has been definitely a change in the dental industry because of the pandemic.
One thing that hasn’t changed even with the pandemic is that the backbone of any practice truly is the hygiene department. Not only is our department profitable, but a large percentage of the operative work comes out of our chair as well. It is our responsibility to take control of the production coming out of our chair, and sealants are just such an easy way to increase the production without adding a bunch of work for us to do or doing any sort of product sales. No one loves to do product sales, and so this is such an easy thing you can do that will take the place of that or in addition to that if you love doing product sales.
If you could apply just a few sealants each day, you could add a couple thousand dollars each month in your hygiene production, and this will help your office be able to keep the doors open while adding true value to your patients as a prevention specialist. There’s no reason that I can think of of why we can’t have both.
So I want to take this last minute — I wanted to wish our friend over at GC America, Michele Petre — many of you know Michele. I wanted to wish her a happy birthday this past week. We hope you had a great and wonderful day.
Thank you, everyone, for letting me chat with you all and share my experiences. I hope that you’ve learned something. I hope that you’ll be able to take some of this information and put it into your daily practice. It’s all about prevention and doing better for the patient that is in your chair.
If you have any questions or thoughts about any of this, be sure to check out the show notes for links to products. You can also contact your local sales reps to order these products. If you want to reach out to me personally, I can be reached via email. Send them to [email protected] Take care, everyone. Have a great week.
Michelle Strange: 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.
And don’t forget to hit the “subscribe” button in your podcast app, follow us on Facebook or Instagram, and head over to our website, ataleoftwohygienists.com, to sign up for our newsletter. We always appreciate ratings and reviews. Thanks again for listening to your unofficial dental hygiene podcast.