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    How to convince teens to care about oral hygiene

    Most teens aren’t paying attention to self-care, so sometimes hygienists have to think outside the box.

    Decades ago, I recall reading about the epidemiological surveys conducted by the World Health Organization on periodontal disease in Asia, Africa and other parts of the world. It became clear that gingivitis could develop into periodontitis from about the age of 15.1 That information stuck with me and continues to be confirmed. Not all patients with gingivitis develop periodontitis, but we know that managing gingivitis is a primary prevention strategy for periodontitis and a secondary prevention strategy for recurrent periodontitis.2

    We have at our disposal an array of mechanical and adjunctive agents for successful periodontal disease management, but I sometimes think we’re doing only a fair job of recommending them, especially in children and adolescents who present with generalized bleeding on probing and heavy plaque/biofilm. Why do we get a poor grade in private practice when it comes to the prevention of gingivitis in patients before they reach the age of 15? For me, I’ve noticed that I stopped disclosing and scoring plaque and inflammation and oftentimes parents aren’t included in the prevention efforts. I keep the two-tone disclosing solution on the counter, but I don’t pick it up as often as I should. I need to do better and score the teen’s plaque and gingival health with the appropriate index. Time with my patients is always an issue and sometimes 50-minute recare intervals for teens become 30 minutes and I make my displeasure known to the front desk. Parents are usually too busy to accompany teens to the appointment, but when they do, it makes me happy and I invite them into my operatory. 

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    Teens are a group of patients I find most challenging. Recently, one in particular sat waiting for me in the reception room and I cringe to see her name on the schedule. Arriving with purple/green unwashed hair with nasal and mouth piercings, I cringe when asking her to “open wide,” fearing her teeth will be the same color and consistency as her hair.

    This patient always presents with moderate chronic gingivitis and generalized early demineralization. To avoid “yes” and “no” answers, I asked her how she was using the prescription fluoride toothpaste and powered toothbrush we negotiated on during the last recare visit, and all she said was that she was using the same toothpaste her mother uses. I’m well aware that she drinks Coke on a regular basis and we’ve tried to implement CAMBRA, but she isn’t interested. This teen patient loves to shut me down during the beginning of her visit, but I’ve found another way to reach her. After dismissing her this time, I talked to the receptionist up front and she revealed that the patient has finally opened up to her, so she’s going to follow up from now on and I’ll just keep my mouth zipped. Sometimes a comprising approach is the only way so that the receptionist and I can work up a suitable plan. Tough love in dentistry is just as hard as it is in our personal lives. 

    RDHs already understand the importance of daily biofilm disruption, and we know that consistent recare debridement and polish are important to preventing bacteria from anchoring themselves more permanently. We know that within 24 hours of discontinuing oral hygiene self-care (i.e., toothbrushing), biofilm begins to form and within 10 to 21 days, gingivitis develops.3

    Once the bacteria undergo a phenotypical change, they coalesce and secrete the extracellular polymeric substance called plaque/biofilm. Plaque/biofilm forms a barrier around the bacterial community, making it very hard for the body’s protective cells (white blood cells and even antibiotics and oxygen) to penetrate. Biofilm is a tough competitor against our body’s immune system, and it makes the biofilm community up to 1,000 times more resistant to antiseptics and antibiotics.4

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