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Dr Martínez’ students go through iTOP—a training programme for perfect individual oral prophylaxis—learning how to coach patients to achieve better oral health. (Image: Curaden)

Interview: Correcting your own oral hygiene habits is the best way to help patients

By Kasper Mussche
May 05, 2021

Too often, dental students have to rely on textbook examples or only receive limited practical training when it comes to improving their oral hygiene skills. Dr Isabel Martínez Lizán is a professor of preventive and community dentistry at the University of Barcelona in Spain and takes her dental students through iTOP—short for individually trained oral prophylaxis. Thanks to the iTOP training programme, dental students learn the correct tools and techniques for perfect brushing through hands-on practice, so they in turn can set up their future patients for a lifetime of oral health.

Dr Martínez, why did the University of Barcelona decide to offer iTOP to its dental students?
Mechanical control of biofilm remains the main pillar of preventing inflammation and oral disease. Through iTOP, students learn the exact tools and techniques they need for perfect oral hygiene through hands-on practice. The knowledge, skills and motivation gained become an extraordinary source of resources that can be used to coach future patients.

For dental professionals, observing and correcting their own oral hygiene habits is the best way to help patients. However, too often students have to rely on theoretical textbook descriptions. This prevents them from being able to instruct patients, which only perpetuates dentistry based on disease and invasive repair.

What are some misconceptions about prevention that students have before attending iTOP?
Firstly, I would say a common misconception is that prevention can only be applied in the absence of disease, which simply isn’t the case. Mechanical biofilm control is an ongoing process, no matter what.

Secondly, students do not realise that they need to dedicate time and practice to their own oral hygiene skills. It is only during the iTOP training sessions that they find out that they too suffer from varying degrees of inflammation because this is the first time that they have used an interdental brush or interdental brushes on their own teeth.

“Health education is one of the key responsibilities of dental hygienists”

How can iTOP instil behavioural change in patients?
Health education is one of the key responsibilities of dental hygienists. By the nature of the work, dental hygiene is preventive, non-surgical and focused on promoting oral health by improving patients’ habits.

So, one of iTOP’s key concepts when it comes to changing patients’ habits is the “touch-to-teach” method. This means instructing patients in oral hygiene by taking them by the hand and practising technique. Repeated and supervised practice and follow-up stimulates constant improvement. Without iTOP, dental students learn about biofilm control largely in theoretical terms. This can become problematic once they are practising dental professionals. Dental professionals should be able to instruct patients on exactly what to do, guided by their own experience.

What about patients undergoing treatment?
Currently, patients with the highest risk of oral disease seem to be those with dental implants or orthodontic appliances. In our experience, treatment prognoses improve significantly if patients learn perfect individual prophylaxis in advance and continue to practise this during and after treatment too.

Personal instruction is essential in iTOP. (Image: Curaden)

No matter how good any oral rehabilitation or operation is—sophisticated, advanced and expensive—without good mechanical biofilm control, the prognosis of the treatment and the oral health of the patient will be seriously compromised.

Lastly, how can iTOP encourage students to be more prevention-minded?
When dental professionals have dedicated part of their training to practising and maintaining their own oral health correctly, this makes them more empathetic towards patients. They know where the difficulties for patients lie and recommend tools and techniques out of personal experience. They will understand why it is worth taking the time to instruct patients about something that they themselves have experienced. The future of oral health is based on prevention and maintenance, and within the dental practice, the dental hygienist is the person with that knowledge and skill set.

Editorial note: Dental students or practising professionals who wish to take part in an iTOP seminar can check out the dates and locations for a nearby session here.

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