Improving Oral Hygiene for Orthodontic Patients
Brief Description:
Discover how an orthodontic practice used action research to tackle oral hygiene challenges and uncover surprising findings about vaping's impact on dental health.
Summary:
This episode takes you inside an orthodontic practice where maintaining oral hygiene with braces becomes a complex challenge. We explore how one practice used action research to follow 100 patients over 8 months, revealing surprising insights about vaping, patient compliance, and the power of systematic improvement. From QR codes to waiting room videos, discover how evidence-driven changes transformed patient care and sparked a culture of continuous improvement throughout the entire practice.
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[Speaker 2]
Have you ever just felt like you're drowning in information, especially, you know, health advice. It's just a lot.
[Speaker 1]
Absolutely. It's everywhere, right?
[Speaker 2]
So today we're gonna try and cut through some of that noise focus on something specific, but really vital we're doing a deep dive into oral hygiene, specifically what it means for people with braces or you know other orthodontic stuff. And this isn't just about getting that perfect sparkly smile, it's actually a much deeper foundational health really.
[Speaker 1]
Yeah, exactly and the source material for this is, well, it's pretty unique. We're looking at an action research project, yeah done right inside an actual orthodontic practice. So the cool thing about this kind of research is it's all about spotting real problems right there in the clinic and figuring out practical ways to solve them hands-on. It's like research in action - it means we get insight straight from the, you know, the coal face, basically how things work in the real world, not just a lab.
[Speaker 2]
Okay, I like that. So our mission today is what? Understand why oral hygiene gets even more important with braces?
[Speaker 1]
That's a big part of it and also Looking at some new challenges popping up for dental professionals like what well, we'll get into that and we'll see how this one practice used data actual numbers to you know
[Speaker 2]
Adapt and improve how they care for patients and we'll figure out what this action research thing really is all about why it's
[Speaker 1]
Potentially so powerful right expect some maybe surprising facts and definitely some practical stuff you can take away.
[Speaker 2]
Okay, sounds good Let's get into it. Where do we start the basics? What's the role of?
[Speaker 1]
Dental care professionals DC peas and orthodontists during treatment, right the basics well, think of them as the the guardians really they're constantly looking out for things like gingivitis that's inflamed gums and Periodontitis, which is more serious gum disease. So diagnosing problems diagnosing yes, but also prevention a huge part of their job is making sure patients keep up with good cleaning habits and Importantly a sensible diet through the whole treatment and if patients don't what are the risks? I imagine they're pretty significant with all that hardware in your mouth Definitely the stakes are high if hygiene slips or the diets poor you can run into a whole list of issues things like Decalcification that's like the enamel weakening leaving white marks.
Yeah carries actual cavities gum inflammation Gingivitis can get worse and in really bad cases. You could even risk losing bone or teeth Wow Okay, which is why it's so so important that patients keep seeing the regular dentist their GDP throughout the orthodontic treatment Not just the orthospecialist that makes sense.
[Speaker 2]
You need those regular checkups and cleanings, too Now here's something I find fascinating the link between your mouth and the rest of your body it's often overlooked isn't it hugely overlooked, but it's incredibly important your mouth really can be like a Window into your general health.
[Speaker 1]
How so well certain systemic diseases think digestive issues or diabetes They can actually show signs inside the mouth first Yeah, and it works the other way to poor oral health can actually make conditions like diabetes obesity heart disease even respiratory problems potentially worse That's quite a connection it is and even just thinking about basics if your mouth hurts or you have infections It affects how you eat that can lead to poor nutrition which impacts everything a good reminder that it's all connected
[Speaker 2]
So given all these risks There must be requirements before someone even starts treatment.
[Speaker 1]
Absolutely It's a strict rule only patients who are considered dentally fit can begin meaning meaning no existing decalcification No broken teeth, no active gum disease and generally good oral hygiene already The orthodontic consultant does a thorough check first.
[Speaker 2]
It's about starting from a healthy place Okay, so once treatment starts the responsibility shifts quite a bit to the patient How do they learn how to keep things clean with braces on is it just a quick? Here's a toothbrush. Good luck Huh?
[Speaker 1]
No, definitely not or at least it shouldn't be it's usually a pretty detailed process. Tell me more Well, it starts with verbal instructions often They'll use models we call them typodonts to demonstrate and mirrors so patients can see their own mouth See how to get around the brackets and wires Okay visual aids exactly and involving parents or carers is really encouraged especially for kids and teens It helps reinforce the message at home.
[Speaker 2]
How long does this usually take?
[Speaker 1]
The DCPs usually spend about five maybe ten minutes really explaining technique How to use the toothbrush effectively the role of mouthwash and those little brushes for cleaning between teeth Intraproximal brushes that's them crucial for getting into tricky spots Then patients are usually asked to get a sort of starter kit What's in that typically a toothbrush those intraproximal brushes some toothpaste orthodontic wax for soreness mouthwash and
[Speaker 2]
Maybe disclosing tablets disclosing tablets the ones that stay in the plaque
[Speaker 1]
Yep So you can really see where you're missing and interestingly the toothpaste and mouthwash in those packs Often have a higher fluoride level than standard ones.
[Speaker 2]
Why is that?
[Speaker 1]
It just underlines how Aggressive the plaque can be when you've got braces providing all those extra hiding places Yeah, the standard recommendation in the UK is the bass brushing technique plus using those interdental brushes And yeah studies back up using fluoride toothpaste and topical fluoride treatments make sense But things change right new challenges emerge. You mentioned the practice in the study faced something new They did a really noticeable increase in patients, especially younger ones who were vaping Vaping it's everywhere now. Exactly.
It became so common They actually added specific questions about it to their medical history forms, which makes sense But what does the research say is there much known about vaping and orthodontics? Well, that's the interesting part until very recently there was surprisingly little research on it Especially specific to ortho treatment, but this project flagged a paper just out March 2024 So brand new findings pretty much still early days research wise but it's starting to look into vaping's effects with and without nicotine on oral health generally and
[Speaker 2]
What are those early conclusions suggesting are they worrying I'd say they're pretty striking
[Speaker 1]
Yeah the paper suggests vaping might be linked to higher rates of periodontitis that serious gum disease and also an increased risk of cavities even
[Speaker 2]
without tobacco smoke apparently so
[Speaker 1]
Vapours might also experience more gum pain and just general oral symptoms compared to non smokers still less than traditional smokers
[Speaker 2]
Thankfully, but definitely not harmless Wow, so it's not just the nicotine then are there specific problems?
[Speaker 1]
Yes, that recent paper actually identified a particular type of fungal infection Hyperplastic candidiasis as being quite common in e-cigarette users a fungal infection
[Speaker 2]
Yeah
[Speaker 1]
Found in nearly 18 percent of users in certain parts of the mouth The researchers think it's linked to pH changes caused by the chemicals in the e-liquids
[Speaker 2]
So the chemicals themselves are potentially altering the mouth's environment seems like it
[Speaker 1]
Yeah, which is concerning right a direct impact on the tissues.
[Speaker 2]
Definitely. So what's the mechanism? Why is vaping potentially bad for teeth and gums, especially with braces?
[Speaker 1]
Well one theory involves the flavourings often sweet right very sweet some of them that sweetness can coat everything teeth gums the braces themselves leave sugar behind and That sugar can kick-start decalcification Weaken the enamel and definitely ups the risk for gum disease and cavities. So the flavourings act like a constant sugar bath Potentially yeah, plus the aerosol itself isn't just water vapour and nicotine it can contain other potentially harmful things, too It's complex.
[Speaker 2]
This really does raise a flag for public health, doesn't it?
[Speaker 1]
If vaping is so widespread, especially among young people exactly the paper itself calls for better more effective public awareness campaigns People need to know about these potential oral health risks.
[Speaker 2]
It's a fast-moving target Okay, so bearing those challenges in mind, let's circle back to prevention. What are the sort of?
[Speaker 1]
Standard recommendations based on evidence, right general prevention Based on guidelines like the UK is delivering better oral health toolkit for anyone over seven Basically, it's brushed twice a day minimum with fluoride toothpaste. Yes, specifically 1350 to 1500 parts per million fluoride last thing at night is crucial and one other time and importantly Spit don't rinse afterwards. Why not rinse you want that fluoride to stay on the teeth?
Give it time to work rinsing washes it away too quickly. Got it What else reducing sugary foods and drinks frequency is key there getting professional fluoride varnish Applied twice a year helps and for people at higher risk of cavities Yes a daily fluoride mouth rinse, but and this is important use it at a different time for brushing again Maximising fluoride contact.
[Speaker 2]
Okay, and for older kids and adults cleaning between teeth Absolutely vital from age 12 up using those inner dental brushes single tuft of brushes or floss tape if the gaps are really tight Okay, clean all the surfaces right makes sense So with all that as background the importance of hygiene the risks the new challenges like vaping the standard advice How did this specific practise tackle it?
[Speaker 1]
This is where the action research comes in exactly This is where they use that systematic approach to try and improve things. Yeah, but Yeah, maybe we should first properly define action research. It's not a term.
[Speaker 2]
Everyone knows good idea What is it exactly you mentioned Kurt Lewin?
[Speaker 1]
Yeah, Kurt Lewin back in the 40s. He introduced it. Basically.
It's a process often cyclical They call it an action cycle or cycle of enquiry. Okay, it's about investigating a problem area something that needs improving But at the same time taking action to solve it so research and action hand in hand, so not just Studying something from afar not at all. It's very practical very grounded It's used loads and education and health care because it's about fixing real-world problems in their actual context It's systematic but flexible.
[Speaker 2]
How does that differ from say traditional academic research?
[Speaker 1]
Well traditional research often aims to test theories generate knowledge. That's maybe more general. Action research generates knowledge from practice making the findings often more immediately useful and sustainable in that specific setting So more practical less theoretical in a way. Yeah, it's collaborative context specific Sure formal research might be more independent aiming for broader conclusions action research is about empowering people within a system To improve their system.
[Speaker 2]
I see and you mentioned it cyclical like steps exactly four main stages that repeat first
[Speaker 1]
planning Identify the problem plan what you'll do second acting carry out those planned actions Third developing or observing Collect data see what happened analyse it and fourth reflecting Look back what worked what didn't and that reflection feeds straight back into new planning plan act observe Reflect repeat plan act observe reflect got it.
So how did the orthodontic practise apply that cycle?
[Speaker 2]
What did their project look like they set it up quite methodically? They took a hundred patients in total 20 from each of the five clinicians working there, right? And they followed these patients for eight months Patients came back every six to eight weeks for their regular appointments So they were seen maybe four or five times during the study period.
[Speaker 1]
How did they track things? They use simple data sheets and they took intraoral photos at each visit got consent for that Of course and kept everything secure GDPR compliant photos are useful Did they worry about bias like clinicians scoring differently? They did think about that So they had someone else reassess the hygiene scores just from the photos compared them to the clinician scores They found over 90% agreement, which was great.
I meant the DCPs were pretty consistent. No major retraining needed there good What were they actually measuring they use something called the oral hygiene index the OHI standard way to score plaque food debris that sort of thing Objectively measure cleanliness and the patients any particular group quite a mix actually 43% male 57% female and the age range was huge from 7 years old right up to 83 Wow 7 to 83
[Speaker 2]
Okay, and you mentioned this was a mixed methods project. What does that mean?
[Speaker 1]
Ah, yes good point mixed methods means using both quantitative and qualitative research approaches Quantitative is numbers stat exactly measuring things testing hypotheses with statistics Qualitative is more about understanding experiences meanings Usually involves words interviews observations why mix them?
[Speaker 2]
What's the benefit here?
[Speaker 1]
Well, the real power is you get a much richer more complete picture Quantitative data tells you what is happening the numbers qualitative data can tell you why it's happening the context the experiences The strengths of one approach can kind of balance out the weaknesses of the other like numbers alone might not capture the patient's perspective They're lived experience adding qualitative insights makes the findings much deeper.
[Speaker 2]
That makes a lot of sense. So, okay, they did all this What did they find? What were the main results from looking at those hundred patients over eight months?
[Speaker 1]
The main headline was pretty positive actually overall 67% so two-thirds of the patients managed to keep their oral hygiene at a good or adequate level throughout the study That's good news. It is but here's a really interesting finding especially given our earlier chat 27% of the patients reported on their forms that they either smoked or vape it over a quarter. Yes But and this was significant the study found no significant difference in how well smokers or vapours Maintain their oral hygiene compared to non smokers during this specific eight-month period no difference
[Speaker 2]
That is interesting, especially with the potential long-term risks of vaping we discussed So for the third of patients who didn't maintain good hygiene what happened then
[Speaker 1]
Right for those who fell below the acceptable threshold the practice had clear intervention steps Such as it could be a referral to a hygienist or back to their own dentist for a deep clean or they might see an in-house oral health educator if the practice had one or Simply get more intensive chairside instruction for the DCP right then and there and they followed up Oh, yes, those patients were seen more frequently maybe every four or five weeks until their hygiene improved the study actually sparked discussions about hiring an in-house hygienist because sometimes getting appointments externally took too long and
[Speaker 2]
Held up the ortho treatment practical changes emerging already So what were the big concrete changes the practice made because of doing this action research quite a few actually
[Speaker 1]
It directly led them to review and update all their patient advice sheets the post-op care instruction Clearer more up-to-date. Yeah, they also changed how they deliver information Mm-hmm started emailing it out to patients and parents cares more convenient Using tech and they put QR codes up in the clinic These links straight to official patient leaflets from the British Orthodontics Society things like guides to treatment how to care for appliances Retainers apparently those have gone down really well.
That's a great idea easy access to reliable info anything else Yeah, they installed a screen in the waiting room plays looped videos what to expect how braces are fitted OH instructions Keeping people informed while they wait exactly and they can even tailor the video content like around Easter or Halloween They might add warnings about specific sugary treats that often cause breakages, huh? Proactive that's clever and another key thing the DCPs now actively give advice on quitting smoking or vaping Guidance and support they noted there aren't BOS leaflets specifically on vaping yet But they're hoping those will come as the evidence builds
[Speaker 2]
It sounds like this project really shook things up in a positive way But I imagine it wasn't easy to run especially mixing methods were there challenges
[Speaker 1]
Oh, definitely the researchers acknowledged that the mixed methods approach did mean more work especially analysing both number data and say interview notes and potentially more
[Speaker 2]
Confounding factors to consider and personally for the person leading it
[Speaker 1]
Yeah, they mentioned the personal challenges time was a big one juggling family normal clinic work teaching commitments Meant a lot of late nights working on the research I can imagine plus GDP our rules meant they could only review the clinical photos at work So that ate into lunch breaks or meant staying late and just the sheer time involved in getting consent Verbal and written from a hundred patients and their families that required huge buy-in from colleagues, too So a big commitment massive the researcher noted that next time they definitely want to collaborate more share the load despite those hurdles
[Speaker 2]
What was the overall impact for the researcher personally and for the practice culture?
[Speaker 1]
Well personally the researcher gained a much deeper appreciation for action research and its value But maybe more importantly because it involved everyone colleagues stakeholders It built this real sense of ownership everyone got part of it exactly Commitment to the change and it's actually inspired others in the practice from nurses right up to consultants to think about their own improvement
[Speaker 2]
Projects really that's fantastic.
[Speaker 1]
Yeah, they even set up a buddy system now pairing up staff with different levels of research experience And they hold monthly meetings specifically for audit and research It's genuinely fostered a culture of you know, continuous improvement.
[Speaker 2]
That sounds like a fantastic outcome Okay, so let's just recap quickly. We've really dug into oral hygiene today, especially with orthodontics We've seen the crucial links to overall health looked at new challenges like vaping and importantly seen how one practice Use this action research approach that plan act observe reflect cycle to make real Practical improvements for their patients.
[Speaker 1]
Yeah, and I think that cyclical approach is a key takeaway that idea of planning trying something Seeing what happens reflecting and then adjusting It's not just for clinics. How do you mean what you can apply that cycle to almost any challenge right in your work in your life? It's a way to learn and adapt as you go take a practical step.
[Speaker 2]
See how it goes tweak it continuous improvement That's a great point a useful model for tackling problems generally Okay So for a final thought something to leave our listeners chewing on We heard that finding in this specific study over eight months There was no significant difference in the observed hygiene between vapour smokers and non smokers, right? That was the finding for that period So what does that make you think about the difference between what we can see right now the immediate clack levels versus the potential? Underlying longer-term health effects maybe things we can't see yet that the newer research on vaping is starting to hint at Does that finding raise more questions for you about how we educate patients and what kind of research we need next to understand those perhaps hidden impacts.