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There’s been little improvement in the rates of Australians brushing their teeth in the past decade. The solution might start with better messaging from dentists. By John Burfitt
One of the most important lessons in preventive dentistry Associate Professor Alex Holden recalls from dental school is the Modified Bass Technique, taught to students as a fundamental best practice approach to brushing teeth.
But A/Prof Holden, a specialist in public health dentistry and the Sydney Dental Hospital’s head of Specialist Services, believes the focus on this technique might be one of the reasons why the rates of brushing teeth has shown little improvement with patients over the past decade.
The Australian Dental Association’s Oral Health Tracker 2021 survey figures revealed only 54 per cent of people brush their teeth twice a day. In 2011, it was 56 per cent, while in the middle of the past decade, it dropped to 47 per cent.
“The Modified Bass Technique, about angling the brush at a certain degree and brushing in small circular motions, is important to learn and good in principle, but the reality of explaining it is hard for patients to conceptualise and apply,” A/Prof Holden says.
“We have to do better in thinking about how we deliver our messaging about brushing rather than just repeating it again and again and hoping it eventually sinks in. These figures about the trends reveal it’s not working, and it obviously needs to be looked at in a new way.”
The survey also revealed that of those respondents who only brush once a day, 12 per cent thought brushing more often wasn’t good for their teeth, 37 per cent were certain they didn’t need to, and 29 per cent admitted they didn’t brush regularly because it caused pain and discomfort.
The Oral Health Tracker survey figures are disappointing given the range of regular campaigns run by the ADA and other agencies, like the annual Dental Health Week and World Oral Health Day, that have addressed the issue many times. All these regular initiatives are in addition to personalised clinical efforts by practitioners to educate patients about achieving better standards of oral health.
Dr Mikaela Chinotti, the ADA’s Oral Health promoter, believes a range of factors need to be addressed to increase the effectiveness of brushing teeth.
“People’s oral health literacy obviously has a lot to do with it,” Dr Chinotti explains. “There’s a large proportion of people who don’t have regular access to a dentist, possibly due to cost or location, which means those people do not have the same ability to access that education.
“Many dentists try so hard and do great advocacy work on individual levels, but it’s going to take a comprehensive, holistic approach to better educate people. It’s about getting into the community and working with other professions to solve this issue so we can figure out what is stopping people from taking action, and then motivating them to change their brushing habits.”
She believes adopting a lifespan approach is crucial, so the oral health of infants through to the elderly is addressed not only by dentists but also GP doctors, nurses, and practitioners in such sectors as childcare, indigenous communities and aged care. That way, the messaging becomes consistent.
“Oral health is still not included in Medicare-funded checks such as the over 75s health assessment, which is something the ADA is advocating for,” she says. “What we need is for the Federal Government to join in with national oral health campaigns so the messaging about brushing has a chance to make a real impact.”
So, for the time being, the onus remains with professional bodies and practitioners. A/Prof Holden believes better clinical strategies must be considered so lessons remain and are acted upon by the patient in the wake of the consultation.
“Instead of overwhelming patients with too much information, the dentist needs to think about how oral health advice can be made applicable to individuals’ particular circumstances,” he says. “This way, patients can more easily apply oral health messages and are more likely to adopt change into their everyday lives. It’s fairly safe to assume that most patients already know the general principles of oral health advice, so it’s our job to help make that applicable and actionable for them.”
Dr Tracy Le, a dentist at Sydney’s Rawson Dental, says she adopted a patient strategy about brushing teeth based on a principle in Simon Sinek’s book Start With Why, which explores how to communicate important messages so others will act upon them.
“If a patient comes in with an issue like bleeding in the mouth, you have to give them a ‘why’—as in, why this is happening and it’s usually because they’re not brushing properly,” she says.
“Once you clarify the consequence of not taking action, you get them to buy into the treatment and explain if they do take action, this issue will probably resolve. It’s making the point about how short-term inaction can have damaging long-term consequences.”
With the ‘why’ explained, Dr Le then decides on the best approach from a three-point communication strategy. This is when, she adds, attention needs to be paid to the type of patient sitting in the chair.
“This is about what sensory approach will best work for them,” she says. “If they are an auditory kind of person, then I just talk to them, explaining what’s needed with brushing,” she says. “If they’re tactile, I get them to demonstrate their brushing methods on a model and I tweak their habits with advice.
“If they are a visual person, I play a video that goes through the whole process of how they need to improve their approach. Once I have gone through an approach, I then get them to repeat it back to me so I know they understand.”
The key, she insists, is paying attention to the patient over each visit so the best tactic can be determined. “If I see their eyes glazing over as I am talking to them, that’s when I try another method that better connects with the way they learn.”