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.
Carrie Ibbetson: Hello from sunny Southern California. My name is Carrie Ibbetson, and for those of you who don’t know who I am, I’m a dental hygienist by trade, but my focus over the last 15 years has been really understanding what it takes to help patients motivate themselves to getting better results at home and how they can also test at home to see if the efforts that they are putting in are getting them the results that they’d hope for.
I want to give a special thank you to GC America for not only having me on today but also their research and development of products that help to test and buffer the pH levels in the mouth.
Today, I want to talk about MI Paste and how to really utilize that to create a win-win situation in your operatory, but I can’t really do that without talking about the Tri Plaque ID Gel because I strongly believe in the power of disclosing each and every patient.
Now, this is a TIPisode, so my time is a little bit limited today. So, instead of trying to get all the information to you, I’m going to direct you to some really good information available on A Tale of Two Hygienists because, again, thank you to GC America for sponsoring some great speakers and influencers in past TIPisodes.
The first one to check out is by Susan Wingrove. She talks about the science behind biofilm and pH testing, and she explains that when you use MI products, you can have elevated biofilm pH levels for 48 to 96 hours.
Dr. Pam has a great TIPisode where she breaks down the differences between MI, MI Plus, and MI ONE.
Amber Auger comes in with a great one about convenience and compliance with the MI ONE because it’s an all-in-one instead of a two-step process.
And then, lastly, my girl Michelle Strange comes in with “paint a picture for your patients” with GC America’s Tri Plaque ID Gel. Let me tell you with the tri colors, that blue is a game changer for your patients and really can help create such an amazing visual to how well they’re doing or areas that they could really use some extra help.
So I want to give you just a quick breakdown of the MI products. They are topical application products that are used at home to replace the vital nutrients of the teeth. We all know how important it is to get the right nutrients for our body to stay healthy, and the same holds true for our teeth. We really need those calcium and phosphate minerals to help protect our teeth, and typically, saliva helps to provide these essential minerals that strengthen. However, there are various activities that can create an acidic imbalance, and that makes it difficult to produce the saliva and these protective minerals. That’s where the MI family of products can help.
MI products contain Recaldent, which is amorphous calcium phosphate bound by a casein phosphopeptide. So what does that mean? Basically, it’s a calcium and phosphate stabilized in a milk protein. So why a milk-based protein you might ask? And that’s because milk-based proteins are structurally similar to the proteins that exist in nature.
Another great benefit of Recaldent is that it suppresses the growth of strep mutans and encourages the growth of beneficial bacteria, so it acts as a prebiotic as well. And I want to give a special thank you to Dr. Pam for sharing that in her TIPisode.
Now, the MI family are contraindicated for patients that have a true milk allergy, but they are safe for patients who have a lactose intolerant [sic].
Okay. So, now that we know a little bit about the MI products, let’s talk about how to create a win-win situation with these products in your operatory. So, typically when I am seeing a patient, there are three specific questions that I’m going to ask in the beginning. And I do this because what I have found over the years is if I have questions and I pose them differently for patients, the way that they respond and react to me is different, and it piques their interest so that they want to learn a little bit more.
Those three questions are “Mr. and Mrs. Jones, what changes have you had in your medical history?” And the reason that I’m going to ask what changes that they’ve had is because I’m going to assume that they’ve already had changes, and so instead of asking if they’ve had changes, I’m going to ask what the changes are so that they automatically have to think about what the changes are.
Then I’m always going to ask do they have any likes or dislikes about hygiene appointment [sic]. They’re going to tell you right then maybe they have some sensitivity. Maybe they have a strong gag reflex. Maybe they want to hold onto that suction tip. That gives them the opportunity to think, “Hey, this person that’s working with me really cares about how I feel.”
And the last thing that I ask is “Mr. and Mrs. Jones, when I am working with you today, if I’m seeing something that’s a home-care-related issue, is it like — is it something you’d like to know about?” And you have to pause, and you have to wait for them to actually respond to you because they’re not used to really hearing that. But then that also really lowers that barrier for them quite often. They’re going to say, “Yeah. Absolutely.” Or they’re going to say, “You know what? Today is a really bad day. My mom went into an elder care today.” Or “My dog died.” Or “I’ve just been having a really tough day.” Maybe today isn’t the best day, and that’s okay.
In dental hygiene appointments, sometimes we feel that there’s so much that we have to do that we have to do everything all at once, and that doesn’t often work for really getting patients motivated. So that last question really invites the home-care-related issue.
Okay. So we’ve gotten our magic questions out of the way. Now, we’re going to go ahead and lean our patient back, and we’re going to take intraoral photos initially as they present because we want to be able to show patients how they look without us touching any gum tissue, without doing any probing and causing any bleeding. We want to have photos exactly how they came in.
We’re going to take our photos, we’re going to gather any other information that we need as far as our probing, anything else, and then we’re going to go ahead and disclose. And, once we disclose, we’re going to identify — you can kind of take the mouth and break it into halves or into quarters. And, when you find an area that has that blue, which means that acidic biofilm, we’re going to go ahead and take the MI paste, and we’re going to apply it onto those few teeth. But, again, we’re just doing a quarter of the mouth because the other areas of the mouth we’re going to utilize for OHI.
And OHI in the beginning is kind of like pre-polishing. It gives you the opportunity to really break up that biofilm. But what it really does is it gives the patient the feeling of what it feels like to brush or to clean in specific areas because once you have started the cleaning process, once you polish them, once you’re scaling, the feeling in their mouth changes, and they don’t feel the OHI the same way. So I’m always going to do my OHI in the beginning. And, remember, we’ve put some MI paste on some of the blue areas.
So the other areas — the other half of the mouth we’re going to do our OHI with, and we’re going to let that MI paste sit on that area that’s showing the acidic disclosing area. So, once we’ve done our OHI and everything else, we’re going to then talk about that area that has the MI paste. We’re going to wipe it away, and then we’re going to disclose again just really quickly. And, again, I know this might sound like some extra steps, but once you’ve done this once or twice with your patient, you won’t have to continually do it.
Sometimes when we’re in practice, we feel like there’s so many things that we have to do at once. We try and do everything all at once. But the end result with that is the patient doesn’t really know what they need to do when they leave there because we’ve given them too many things to do. So I say stick with two things. The two things would be a disclosing and a brushing or a disclosing and an interdental care.
Whatever you want to do, get that patient to understand how they can get better results if they have a different tweak or a different stance on their brushing. But always try and elevate them by showing them how good they’re doing in a place and then utilizing either the technique or the tool, meaning the toothbrush that they’re using or the way that they’re using it. That’s the bad guy.
They’re not the bad guy because they’re doing something wrong. The bad guy is either the tool or the technique that they’re using. And what that does with you and your patient is it creates an ally. Now you guys are on a team. You and the patient are working against the tool or technique to show them how they can do a better job. It just makes for a much better situation with your patient, and it really gives them the motivation to see how much control they have over the disease process.
Now, when you’ve gone back and you’ve left that MI paste for a little bit and you’ve wiped it off and then you re-disclose, what you’re going to find is there’s going to be a difference in that color of the disclosing solution. And, again, that’s a great opportunity to visualize for that patient why it’s so important to use a product like this that can help elevate the pH so that we’re getting much better results.
As you’re working through this process, a great thing to do is keep a running list in your chart so that you know what you focused on at each visit, and you can go back and have those conversations instead of having to start over every time. That running list will really help you feel like you’re getting your patient closer to the needle of health when you’re just able to focus on little steps at a time instead of feeling like you have to do it all at once.
Once you’ve finished your OHI, then you can go through and do your pre-polishing. And, with your pre-polishing, if your patients are able to watch you in a mirror, you can really show them how tucking underneath that gum with their bristles — with their toothbrush bristles at home — show them what it feels like before you get in and start doing all your scaling. If you show them with the rest of the mouth with that handpiece, not only will you get your pre-polishing done to really remove that biofilm, but you’ll also be able to show them what it feels like in their mouth.
So there you have it. I hope that is helpful for you. The more photos that you can take and the more that you can do in the beginning with your OHI and your pre-polishing really does help paint the picture for your patient, and it really helps engage them in a way that shows them how much they can do at home in a positive manner so that they really want to do it.
And, if you can find disclosing products that you can take home — that you can send home with your patients, that’s going to be awesome. As of right now, the Tri Plaque ID Gel only comes in packaging for the operatory use. You can’t send it home with your patients. If I had a magic wand, that would be the one thing, GC America, that I would ask of you is get this in single-portion sizes so that patients can be using it at home. But, as of right now, that’s not available.
There are two-tone solutions and tablets that you can use, so try incorporating those into your practice as well. Get them in your goody bags. Get them in your patient’s hands. Show them how to use them. Ask them to use them and then take pictures at home and bring them into their next appointment. They get really excited about showing you when it’s positive praises and when they have just a small thing that they could work on that can deliver great results, which is brushing techniques. A lot of us just don’t — haven’t taken the opportunity to really share what it feels like in a patient’s mouth before we do our instrumentation or before we do our polishing to really make a difference in the way that our patients understand what their role is when they leave our operatories and when they’re at home.
I hope that’s helpful for you, and I look forward to hearing how this works for you.
Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at [email protected], and keep listening for more awesome content from your unofficial dental hygiene podcast.