Jennie Haywood-Hull, a hygienist, discusses how she’s helping people achieve their preventative goals with some "small, easy wins".
In June 2022, a dental charity warned that we were on the cusp of a nationwide oral health crisis.
A study by the Oral Health Foundation revealed that 82 per cent of adults in the UK had made sacrifices in their spending habits. Falling victim to their cutbacks included all-essential oral hygiene products, with 25 per cent saying they’d reduced their purchasing of toothpaste, mouthwash and interdental brushes.
The research, which explored the link between the rising cost of living and a decline in oral health, also found the financial crisis was the reason 31 per cent of people had not been to the dentist in more than two years.
The charity’s chief executive, Nigel Carter, has previously called on the government to address the "postcode lottery" of the inequalities in access to dental care.
Professor Avijit Banerjee, Professor of Cariology and Operative Dentistry at King’s College London, also added voice to growing concerns, saying, "We have access issues, social and demographic inequalities and of course, these impact on the quality of dental health, which has declined over the past two years. We need to move away from just treating diseases to preventing them."
Inevitably this has implications for the profession. With access to NHS dentistry problematic and spiralling food and energy costs affecting every household, it is more important than ever for those in dentistry to ensure every patient understands the best ways to keep their mouths healthy and prevent oral disease.
Oral health education that includes dietary advice and explaining the risks to mouth health of smoking and alcohol consumption are all very much part of the remit of dental hygienists. But supporting patients in their behaviour change can often be lengthy and challenging.
The Delivering better oral health toolkit is designed to support dental teams in improving their patient’s oral and general health. It notes the common challenges clinicians often face – and this includes socio-economic influences. The guidance states, "A patient’s ability to change their behaviour is influenced by an array of individual, social and environmental factors, with socio-economic circumstances being a major influence. This explains why multiple unhealthy behaviours, such as smoking, alcohol misuse, and lack of tooth brushing, may cluster together in particular groups of people."
Jennie Haywood-Hull has an interest in treating patients with periodontal disease. She practises at The Wessex Specialist Centre in Fareham, Hampshire, supporting a cohort of patients who either have advanced periodontal dental implants or other prosthodontics or require advanced restorative assistance. They come to her as private patients or via referrals. An award-winning hygienist, Jennie is also a tutor at a dental school.
The cost-of-living crisis has brought many challenges for dentistry, so how does she support her patients during these times?
Jennie says, "Preventative goals are currently even more important because the NHS is under such extreme stress. From smoking cessation to the bi-directional relationship between oral health and diabetes, it is important that we take time to educate. Everything we do as hygienists extends beyond dental health education. It is important to acknowledge the impact of oral disease on systemic health and to educate to prevent disease and support our patients’ overall wellbeing."
New guidance published in January by NHS England means dental therapists and dental hygienists can now open a course of NHS treatment, enabling them to work to their full scope of practice within the system.
But Jennie echoes the cautionary words of representative bodies, the British Society of Dental Hygiene & Therapy and the British Association of Dental Therapists.
She commented, "A shift in the ethos in the NHS is helpful. Full utilisation of our roles has the potential to make a massive difference. After all, our general approach is of a preventative nature. But, although steps have been taken towards change, there remain limitations.
"Utilising our role more efficiently in the NHS may help from a grassroots preventative perspective. Hygienists and therapists should be supported to gradually build their competency and confidence in these areas as some haven’t used some of their skills since qualifying. What the system needs is real change – unfortunately, many of us continue to fix problems rather than prevent them."
But, she says, what all hygienists and therapists do share is the placement of prevention at the forefront of their clinical care. And this inevitably is led by patient education. "As accomplished hygienists, we never want to be scaling machines," Jennie said, "And whilst it can feel like an overwhelming task for patients to keep on top of their dental health, it ultimately saves me hours of treatment which can also have a financial benefit to the patient as well as improving access to treatment for other patients."
Jennie is aware that patients have a variety of attitudes and understanding of treatment options. She explained, "There are those who have been on a journey, ended up in pain or discomfort and cannot access NHS services easily or have had a negative experience, so have decided to invest in private treatment. They have often made huge personal investments and, as a result, are motivated to do the right things.
"Sometimes, however, I have to engage with patients to make them aware that it is their role to maintain their health. Taking a social history in terms of background can shape how you manage them going forward. I use different analogies based on what I understand from their social history. I’ll tell them a classic car doesn’t service itself, for example, or being a good golfer relies on time on the driving range, not just on a course. These can help change behavioural attitudes. Others arrive in the chair with no preconceptions, which gives me a clean slate. For these patients, every bit of information is new and helpful, with no requirement for me to re-programme expectations.
"I am a kinetic learner and connect as an educator in this style. Occasionally, I might find a video or image that appeals to a patient’s learning style, but I prefer a tell-show-do approach."
The Oral-B iO Test Drive, which she uses to demonstrate brushing technique, is a key part of this approach. Jennie explains, "I initially spend at least a quarter of my time investing in educating patients which includes using the Test Drive and then reinforce messaging and correcting techniques if necessary at subsequent appointments. Utilising the Test Drive in a show-tell-do capacity enables small, easy wins. I work in a specialist practice and am fully aware that I am speaking from a privileged position where I have 45 minutes for appointments, or even an hour for some patients, but it is important to make every minute count."
And because the cost-of-living crisis has an impact, Jennie tailors her advice accordingly. She says, “There is the pre-conception that patients attending a private practice have deep pockets and not just of the periodontal kind! But some patients are here because they have been on a journey and cannot access support any other way.
"I very much emphasise that oral disease is beaten in the bathroom. Do your homework and you will need me less and less. I am there simply to play a supportive role.
"We discuss the Oral-B range of iO toothbrushes, giving patients with different budgets every option available to them. We give them an Oral-B coupon which gives them two free brush heads with every purchase (so six-months’ worth). Combined with the Test Drive head and the one head they get with their brush, this gives them a full year’s supply. Any savings made can make a significant difference at the moment.’
She adds, "Patient autonomy can be a gift. It takes the pressure off in a cost-of-living crisis and, if they don’t have to pay to come to me so frequently, ensuring they have that self-awareness that they can do the work at home pays off