A dental hygienist's perspective: Fighting caries with customized care

November 14, 2014



After more than 22 years in the dental field, I have coached numerous patients in their fight against dental disease. Preventive care is the cornerstone of a hygiene practice, and it’s something we focus on at every appointment.

While patients may think of their time with us as “just getting a cleaning,” we know that there is much more to it. In our time with patients, we are focused not just on the prophy, but also on providing education and motivation to help them ward off dental disease.

Teaching patients about oral health

With today’s tools, educating patients - whether pediatric or adults - about their own personal dental issues can go way beyond a verbal explanation. It’s much more impactful to show patients the exact situation in their mouth. With a simple hand mirror or the technology that we have available to us, in forms of an intraoral camera or a radiograph, you can do just that.

For patients that present with caries, I try to drive the point home to educate the patient, both clinically and radiographically, by comparing decayed tooth structures with healthy tooth structure in their own mouth. For example, often I will use an explorer to show patients how it “sticks” in caries versus how it does not “stick” in a healthy area. This is an elementary tool that makes a big impact in that patients can easily feel and see the difference for themselves.

When patients are diagnosed as high caries risk, this requires additional education beyond the basics. Many times high caries rate is hereditary, so when children are diagnosed with caries it is always important to re-educate the parents as well.  Specifically, dietary and homecare habits need adjusting and a fluoride protocol is warranted. In counseling patients, I make it a point not only to explain the caries process and the steps we recommend to stop it, but also to evaluate the compliance level that patients are willing to partake in. I know that I can recommend the best products possible, but if patients are not likely to follow through on extra hygiene steps, then perhaps I can adjust my recommendations to better fit what they are willing to do. It’s vital to talk with caries-prone patients to get an honest picture of how hard they are willing to work to treat their condition. This helps healthcare clinicians make the most fitting product recommendations. It’s also important to emphasize that our work together is a partnership. The patient needs to want to be healthy and be willing to take an active role in maintaining their oral health as much as I want to provide the best care that I can for them.

An effective family of products

When it comes to selecting products to help stop caries, I frequently turn to the 3M ESPE Preventive Care family of products. 3M™ ESPE™ Clinpro™ 5000 1.1% Sodium Fluoride Anti-Cavity Toothpaste is my first choice for a prescription toothpaste, as it helps strengthen enamel and arrest or reverse decalcification lesions. This product is convenient for most patients because brushing is already a part of their daily routines. I have seen excellent caries reduction for patients who use this product, with many showing arrested lesions and/or no new lesions after six months of use. We reinforce and continue to educate the patients to keep using the toothpaste after restorations are placed in order to help strengthen and prevent new lesions from forming. Patients are typically happy to comply because by that time they have experienced how effective it is.

For in-office treatments, I use 3M™ ESPE™ Vanish™ 5% Sodium Fluoride White Varnish with Tri-Calcium Phosphate (which is actually indicated only for treating hypersensitivity, but we have found it to be useful for caries as well). This varnish combines calcium and phosphate, and flows better to get into interproximal and hard-to-reach areas. Patients like this product because it is very easy to apply, and they do not have to do anything differently at home to maintain it.

With this combination of products, we are combating caries from all angles, both inside and outside of the office. I explain to my patients that if they don’t spend the time on good home care, these products won’t work all on their own. However, when patients are compliant, I usually see results from using these products within a six-month period, either with the number of lesions reduced, or the progression of existing lesions being halted. 

RELATED VIDEO: How 3M ESPE cements help make restorative dentistry easier for one dental practice

A combination approach

With these effective preventive products, good education, and a commitment from patients, I work to help prevent and halt caries as well as put patients on a healthier course. I also keep using the “show and tell” approach to help patients see and appreciate the progress they make at each visit, which motivates them to continue on the path to better oral health.

Jenna Hebert, RDH is a 1999 graduate of Northeastern University and Forsyth School for Dental Hygiene. She currently works full time in two general private practices and volunteers at Yankee Dental Conference.

After more than 22 years in the dental field, I have coached numerous patients in their fight against dental disease. Preventive care is the cornerstone of a hygiene practice, and it’s something we focus on at every appointment.

While patients may think of their time with us as “just getting a cleaning,” we know that there is much more to it. In our time with patients, we are focused not just on the prophy, but also on providing education and motivation to help them ward off dental disease.

Teaching patients about oral health

With today’s tools, educating patients - whether pediatric or adults - about their own personal dental issues can go way beyond a verbal explanation. It’s much more impactful to show patients the exact situation in their mouth. With a simple hand mirror or the technology that we have available to us, in forms of an intraoral camera or a radiograph, you can do just that.

For patients that present with caries, I try to drive the point home to educate the patient, both clinically and radiographically, by comparing decayed tooth structures with healthy tooth structure in their own mouth. For example, often I will use an explorer to show patients how it “sticks” in caries versus how it does not “stick” in a healthy area. This is an elementary tool that makes a big impact in that patients can easily feel and see the difference for themselves.

When patients are diagnosed as high caries risk, this requires additional education beyond the basics. Many times high caries rate is hereditary, so when children are diagnosed with caries it is always important to re-educate the parents as well.  Specifically, dietary and homecare habits need adjusting and a fluoride protocol is warranted. In counseling patients, I make it a point not only to explain the caries process and the steps we recommend to stop it, but also to evaluate the compliance level that patients are willing to partake in. I know that I can recommend the best products possible, but if patients are not likely to follow through on extra hygiene steps, then perhaps I can adjust my recommendations to better fit what they are willing to do. It’s vital to talk with caries-prone patients to get an honest picture of how hard they are willing to work to treat their condition. This helps healthcare clinicians make the most fitting product recommendations. It’s also important to emphasize that our work together is a partnership. The patient needs to want to be healthy and be willing to take an active role in maintaining their oral health as much as I want to provide the best care that I can for them.

An effective family of products

When it comes to selecting products to help stop caries, I frequently turn to the 3M ESPE Preventive Care family of products. 3M™ ESPE™ Clinpro™ 5000 1.1% Sodium Fluoride Anti-Cavity Toothpaste is my first choice for a prescription toothpaste, as it helps strengthen enamel and arrest or reverse decalcification lesions. This product is convenient for most patients because brushing is already a part of their daily routines. I have seen excellent caries reduction for patients who use this product, with many showing arrested lesions and/or no new lesions after six months of use. We reinforce and continue to educate the patients to keep using the toothpaste after restorations are placed in order to help strengthen and prevent new lesions from forming. Patients are typically happy to comply because by that time they have experienced how effective it is.

For in-office treatments, I use 3M™ ESPE™ Vanish™ 5% Sodium Fluoride White Varnish with Tri-Calcium Phosphate (which is actually indicated only for treating hypersensitivity, but we have found it to be useful for caries as well). This varnish combines calcium and phosphate, and flows better to get into interproximal and hard-to-reach areas. Patients like this product because it is very easy to apply, and they do not have to do anything differently at home to maintain it.

With this combination of products, we are combating caries from all angles, both inside and outside of the office. I explain to my patients that if they don’t spend the time on good home care, these products won’t work all on their own. However, when patients are compliant, I usually see results from using these products within a six-month period, either with the number of lesions reduced, or the progression of existing lesions being halted. 

RELATED VIDEO: How 3M ESPE cements help make restorative dentistry easier for one dental practice

A combination approach

With these effective preventive products, good education, and a commitment from patients, I work to help prevent and halt caries as well as put patients on a healthier course. I also keep using the “show and tell” approach to help patients see and appreciate the progress they make at each visit, which motivates them to continue on the path to better oral health.

Jenna Hebert, RDH is a 1999 graduate of Northeastern University and Forsyth School for Dental Hygiene. She currently works full time in two general private practices and volunteers at Yankee Dental Conference.