Knowing what oral health products are available over the counter can optimize your patients’ home care.
You advise your patients to brush twice a day and clean between teeth every day. You caution patients to limit their sugar consumption and tell them why a healthy diet benefits their oral health. The American Dental Association (ADA) also recommends that you provide specific and personalized recommendations of over-the-counter (OTC) products for home care.
With so many products available, this can be challenging. We spoke to 4 dental professionals about how they handle OTC recommendations in their practices.
Know What Products Your Patients Are Using
Jeff Lineberry, DDS, FAGD, makes OTC recommendations every day in his private practice in Mooresville, North Carolina. He says that dentists need to know what their patients are using daily to provide the best consult for their oral health.
“It’s important to understand the premise behind the different products’ claims and the ins and outs of them so you can make solid recommendations for your patients,” Lineberry explains.
Cathy Stano, RDH, BS, who is a professional oral care educator for Arm & Hammer, compares the observations made by dental professionals in the operatory to being a detective who searches for a patient’s oral care needs.
“It’s up to us to educate them and recommend or prescribe products or methods that could help them achieve those good hygiene goals,” Stano explains.
Stano says that patients are prioritizing self-care more than in the past. Some ask her what they can do to improve their home care. Stano says that being prepared with specific and relevant products that are easy to find and inexpensive boosts patient adherence.
“So, it’s important for us to know what’s out there on the market when they go into these box retail stores or supermarkets,” Stano says. “There’s so much choice out there, how can I make it as easy as possible for them to be able to purchase the products they need?”
Make Recommendations Part of the Operatory Routine
Katrina Sanders, RDH, a practicing dental hygienist, dental hygiene educator, and international speaker, recommends using the time when you provide care as an opportunity to recommend products that will support patients’ best possible oral health.
“[Hygienists] spend all of this time in the operatory with a patient going over their medical history, dental history, and reviewing the potential genetic components and challenges. We also look in their mouth and evaluate the risk of oral cancer, decay, gingivitis, and periodontitis. If there is anybody in the practice who better understands the oral condition of the patient, it’s the person who just spent upwards of an hour in that patient’s mouth,” Sanders says.
“We are with that person for almost an hour at a time,” Stano agrees. “Our patients trust us and know us personally. We have a continuum of care with these folks. And if not, it’s up to us to document our charts so that the next practitioner can follow up and make sure they answer any questions they might have.”
Because hygienists are licensed dental care providers, Sanders thinks that “prescription” is a more appropriate word for OTC products they recommend. These “prescriptions” are based on that patient’s specific needs and extend the care the hygienist provides. Sanders says this extension of care is crucial.
“If you only see that patient twice a year for hygiene, that’s 363 days of the year that you have no control over what’s going on in that patient’s mouth,” Sanders explains. “If we can better manage that, it allows us to have more involvement in our patients’ care even when they are not sitting in our chair.”
Cut Through the Clutter of Marketing Claims
If there is 1 thing that consumer-facing products are excellent at doing, it’s marketing. Marketing messages highlight benefits and are designed to change patients’ behavior. However, these messages are not always promoting science-based benefits.
Lynne Slim, RDH, MS, a writer and speaker on dental hygiene, says it isn’t possible to be familiar with every OTC dental product. She recommends using scientific evidence to support recommendations. Slim does an internet search on product information when she needs to know more and to ensure her patients don’t fall prey to effective marketing.
“My focus with patients is to make sure that the OTC product is not based on unsubstantiated claims….I’m a passionate, evidence-based hygienist who’s always looking at scientific evidence to support a product,” Slim says.
For example, Slim is familiar with OTC 0.454% stannous fluoride dentifrices and their adult patients’ indications. She also is aware that these new dentifrices don’t stain. Slim is comfortable recommending them to patients, based on her research.
However, she also tells patients when there isn’t enough research on a product. For instance, if a patient asks whether they should use a toothpaste containing charcoal, she will tell them there are no reports of harm in using the dentifrice, but there’s also no research showing any advantages to that particular ingredient. This approach helps her build trust with patients, which is essential when it comes to patient adherence.
“If I explain to patients my passion for scientific evidence, and if I gain their trust, they’re more likely to listen closely and heed my suggestions,” Slim says.
When it comes to the types of products she would recommend, Slim says she relies on her research. Even though she appreciates seeing the pharmaceutical salespeople and the samples they leave for patients, she says she needs to know the science and ensure it satisfies her credibility standards.
“I am sick of junk or ‘pseudo’ science, and there seems to be plenty of that kind of science being promoted when it comes to COVID-19,” Slim says.
Toothpaste varieties run the gamut from tartar control to whitening to sensitivity control and more. Dental professionals should understand what the products’ claims are and how they work before recommending them—especially if they hear patients are using the wrong thing for their needs, Lineberry says.
“For example, some of these toothpaste formulas out there are fairly abrasive. If I have a patient [who] is having a problem with sensitivity, and I discover that they are using toothpaste for whitening and tartar control, which is abrasive, then I know it’s causing their teeth to feel more sensitive,” Lineberry says.
OTC recommendations extend beyond toothpaste and floss, however. Lineberry often recommends water flossers for patients with more space between their teeth or a history of periodontal disease. Dry-mouth medicines are another type of OTC product they often recommend in his practice. Lineberry and his team also recommend rinses, dental adhesives for dentures, and temporary cements when there is a dental emergency and patients can’t make it into the dentist’s office. Lineberry always looks for the ADA seal of approval before he makes a recommendation.
“The seal has always been representative that the product has been tested and shown to be safe and effective,” Lineberry says.
“I do, in general, like to look for the ADA seal of acceptance,” Sanders agrees. “It does provide a level of excellence. There are plenty of dental products across the market that will make claims on X, Y, and Z. Still, it’s when we get that ADA seal that we know our governing body has evaluated them for nonbiased efficacy of these products.”
In addition to the ADA seal, Sanders looks for products she knows her patients like to use. If not, patients may not follow her recommendations. If it is not possible to avoid an OTC product that can be unpleasant to use, Sanders explains that it is temporary and asks for the patient’s patience.
“I tell them that I know it is not ideal, but this is something we have to do to get them to a state of health again,” Sanders explains.
Sanders starts her advice by discussing the patient’s toothbrush. Many dental professionals ask how many times a patient brushes a day and leave it at that. However, Sanders thinks it is crucial to dig deeper. For example, Sanders wants to know if patients use a manual or electric toothbrush, how often they change the brush or brush heads, and for how long the patient brushes each time, as well as their brushing technique.
“Because if your patient is coming in and they continually present with high levels of debris saying, ‘Well, I brush twice a day,’ I need to know more information on what isn’t working,” Sanders explains.
Sanders then usually asks how patients clean between the teeth and is careful not to use the word “floss.” Instead, she wants to know what they use and how often they clean, because floss is not always the best option.
For example, if a patient has periodontitis and wide-open embrasure space, a water flosser or interdental brush might clean the area better than floss.
“That’s another layer to what our treatment prescriptions are going to be; it needs to be based on the unique needs of the patient,” Sanders says.
Stano has been a staunch supporter of Arm & Hammer products for 40 years. Baking soda is in all of Arm & Hammer’s toothpastes, comprising from 35% to 65% of the product, and it has been a natural product in toothpaste and dental powder since 1911, according to The Journal of the American Dental Association.1
Stano likes to recommend baking soda products because they are supported by science, and because baking soda is a natural ingredient.
“It’s proven. We have a lot of research backing our claims. Obviously, we are all looking at the science,” Stano says.
When making recommendations, Stano also takes into account the patient’s symptoms. For example, she often recommends that patients switch to a natural toothpaste when they present with recurring abscess, ulcers, or sores in the oral cavity. Stano says that many toothpaste brands use sodium lauryl sulfate, which can aggravate these conditions.
“The Arm & Hammer Essentials toothpaste is free of sodium lauryl sulfate, peroxide, preservatives, parabens, artificial sweeteners, and dyes,” Stano explains. “We try to keep it clean as much as possible. There are a lot of [people] here and around the country [who] want cleaner products. They want products free from all these additives.”
If a patient consumes a lot of carbonated water, soda, popsicles, sports drinks, or sugary foods, she would recommend a toothpaste with a higher pH to reduce the acidity in the oral cavity.
“The acidity is what causes dental decay and is a contributor to periodontal disease,” Stano says. “Arm & Hammer have some of the highest pHs in the market, which aid in buffering the acidity.”
Goal-Based Recommendations Can Extend Your Care Into Their Home Care
When walking down the aisle of the grocery store, Sanders says, patients see an array of products touting benefits such as whitening, sensitivity, enamel-building, antigingivitis, antiplaque, and more. She says it can be confusing for patients. It is incumbent on dental professionals to give prescriptive advice, so patients know what they need when presented with so many options, Sanders says.
“It’s more than dropping a little sample in a bag and giving it to the patient. It is intentionally saying, ‘This is the type of toothpaste that I would like to see you use because of the active ingredients that do X, Y, and Z,’” Sanders says.
These active ingredients are crucial in OTC products such as mouth rinses. Sanders might recommend fluoride rinses for patients who are caries-positive, or a rinse with medicaments that reduce halitosis for patients with gum disease
Sanders also recommends having samples or coupons in the office for products that may be useful for your patient’s home care. She also recommends offering to show them how to use products they may not be familiar with at the next appointment. Perhaps most importantly, she says, remember that your suggestions are something that patients take seriously.
“Think about how your patients are reading your ‘recommendations,’ and know that they matter and patients do listen,” Sanders says. “It’s our opportunity to help guide them through what they don’t know and truly extend our reach beyond simply what we do in the dental chair.”