Does oral rinse REALLY matter?

April 28, 2017

Hygienists weigh in on rinse use-and what you should tell your patients.

Chances are, your patients don’t think much about oral rinses and the many benefits they provide. Sure, they might swish with their go-to rinse for a few seconds after they brush, but if they’re not using the right rinse for their oral condition for the proper amount of time, it isn’t doing them much good. 

While popular over-the-counter options might be enough for some of your patients, others need rinses that address specific health conditions such as rampant caries and dry mouth. That’s where you come in. Asking the right questions and assessing your patients’ health will help you determine the best rinse to recommend, and educating them about why they need that rinse will make them much more likely to comply.

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“It’s all based on the patient’s needs,” says Tina Clarke, RDH. “Look at health history, do a risk assessment and talk with patients to find out what they’re experiencing. Find out what their issues are and talk to them about why they’re having those issues, whether it’s because of medication they’re taking, their diet, their genetic makeup or a systemic disease. Then, let them know there’s a rinse that can help them relieve that issue.”

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Of course, it’s important to make sure patients understand that rinses, while they offer many benefits including plaque reduction and fresher breath, aren’t all they need to keep their mouth healthy. Oral rinses are part of a wellness package kit that also includes brushing, flossing/interdental brushing and chewing gum, notes Anastasia Turchetta, RDH. When they understand the role these products play and the importance of including the right rinse in their home care routine, your patients’ oral health will start to improve.  

Finding the right rinse

Oral rinses aren’t one size fits all, Turchetta says. They come in many varieties and offer different benefits, which is important for everyone on the dental team to understand. To determine the best rinse for patients, address their current state of oral health. Understand what the ultimate goal is and how the rinse will help them get there. Think about their caries risk, find out if they’re dealing with hyper sensitivity, ask if halitosis is a concern, determine their risk for gum disease and ask them what medications they’re taking.

Once you determine the rinse that’s best for their condition, educate patients on the benefits they can expect when they use that rinse. Sarah Thiel, RDH, CEO and co-founder of CE Zoom, likes to recommend a general rinse and tells patients about its ability to kill the bacteria that causes plaque buildup. There are also fluoride rinses, both over-the-counter and prescription, for patients who are cavity prone, have a lot of decay or have an acidic diet.

When treating patients with periodontal disease, Thiel often reaches for an antiseptic oral rinse, which, when used in conjunction with scaling and root planing, helps kill bad bacteria.

There are also antimicrobial rinses that fight infection and reduce inflammation, Clarke notes. These come in over-the-counter options and prescription versions such as chlorhexidine gluconate. They also work well as pre-procedural mouth rinses to reduce patient bacterial load and infectious aerosol particles in the dental operatory.

Finally, there are rinses for patients experiencing dry mouth caused by health conditions or medications they’re taking. Ethel Hagans, RDH, recommends this type of rinse to some of her patients. There are many options out there, Clarke says, and all of them work to relieve the symptoms of dry mouth and prevent the problems the condition causes, including decay.

“I need to get the patient fit, so it’s like I’m the coach at the gym,” Turchetta notes about choosing the right rinse for her patients. “They want to get from point A to point B. I need to get them into an oral fitness regimen with the right kit. They might want to use a whitening mouth wash as an adjunct, and that’s great, but I might tell them they need to use chlorhexidine gluconate first and here’s why.”

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Know your patients

Finding the right rinse for your patients goes beyond determining their condition and what might work best; it’s also important to find a rinse patients will actually use, Turchetta says. If a rinse doesn’t taste good or contains ingredients patients are leery of, such as alcohol, they’re not going to use that rinse once they get home. Know the ingredients in the rinses you routinely recommend and be prepared to answer common patient questions, such as how long do I need to use the rinse, how long should I swish with the rinse, how long should I wait to eat after using the rinse, what flavors does it come in and does it contain fluoride.

“Look at it from their world, not our world,” Turchetta says. “Think about the benefits for the patient. They want to know if it’s it easy to use, is it going to taste good, can they use it even if they don’t have dexterity and what it’s going to help them with. It’s a different story from what we think is the benefit and what our patients will see as the benefit.”

Focus on education

At the end of every appointment, Thiel spends about 15 minutes educating patients about what she found during the exam. She talks about the benefits of rinses during this time, but also makes sure patients understand rinsing alone simply isn’t enough.

“After you brush and floss, there’s still bacteria floating around in the mouth. The oral rinse kills it,” Thiel observes. “A lot of people don’t understand how many bugs live in their mouth. If they did, they would want to rinse every day to clear that out. I make sure patients understand that and then I talk with them about different types of mouth rinse based on their situation.”

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Hygienists should be the ones educating patients about oral rinses, Turchetta says, not pharmacists, which seems to be happening more and more. Talk to patients about their oral fitness and encourage other team members to do the same. When you get everyone on the team involved, patients will have much better results.  

“I’m big on co-diagnosis and knowing what products are recommended in your office,” Turchetta says. “For example, many hygienists don’t see a lot of implant cases until they’re done. I prefer to sit down with the assistant and say ‘Hey, this patient has active gum disease and this is what I would use to control it. If you could relay that message we’ll have better success with the implant.’”

It’s also a good idea to give out free samples if you can, Hagans says, especially when you’re recommending over-the-counter rinses. Patients can feel overwhelmed by all the options in the mouth rinse aisle and might forget which one you recommended. If you give patients a sample to take home, they’ll have a chance to use the rinse before they buy it, and can even bring it with them when they go shopping.

With the right education, Hagans notes most patients are open to using rinse to improve their oral health. And if the hygienist is excited about the product and the benefits it provides, patients are more likely to follow through.

“If patients know what the problem is and why the problem exists, I have found nine times out of 10 they want to address it,” Clarke says. “But if you tell them to use something and they don’t understand why you’re recommending it, your patient acceptance rate goes way down.”

Seeing the benefits

When patients add the right oral rinse to their home care regime, you’ll notice the difference during their next exam, Clarke says. During that visit, be sure to talk with patients about their progress and how the rinse is working for them. Point out the positive results and encourage them to continue the good habits they’ve developed. Reinforce why rinsing matters and continue to deliver that message during every appointment.

“You want to have a good conversation with your patients. They need to use the rinse regularly for it to make a difference, so follow-up is important,” Clarke notes. “And these rinses really do help. I’ve seen a huge difference in gum tissue after patients have started using an antimicrobial rinse. It’s not a cure-all, but it’s an adjunctive therapy that assists in reducing gingival inflammation. Rinses are a really nice way to help patients get their mouth back to healthy.”