Sunstar Conversations

HIGHLIGHTS – Sunstar Conversations PRO – Oral hygiene during orthodontic treatment

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How to make it attractive for teenagers?

Each month, we discuss oral health challenges through different life stages, starting with pregnancy in March, followed by childhood in April. On May 4, 2021, we hosted the third edition of the SUNSTAR Conversations PRO webinar series, tackling the teenage life stage. Together with Ms. Kristy Menage Bernie, RDH, MS, RYT and Dr. Mário Rui Araújo, RDH, we aimed to unravel how we can overcome both fundamental and behavioral challenges of orthodontic treatment in teenagers by turning them into an opportunity.

Fundamentals of orthodontic treatment

Kristy starts the conversation by setting the stage, highlighting the fundamentals of successful orthodontic treatment: “Earlier, the focus was hard tissue health, because there’s nothing more devastating than biofilm accumulating around the brackets, causing white spot lesions and demineralization”. Soon however, she came to the realization that periodontal health is equally important: “We know that teeth move quicker when soft tissue has health and resilience”. In that light, any kind of gingivitis or inflammation can cause problems for your orthodontic treatment. Mário completely agrees: “Healthy tissue is the main point. In our dental school, we always say to our students: do not think about cleaning per se, think about health. Think about how to maintain tissue health, that’s the main point”. Although cleaning techniques are important to achieve healthy tissue, Mário sees another fundamental aspect: “I think 80% of the success of orthodontic treatment is determined by cooperation, it is the teamwork in what we call a three-fold relationship between parents, professionals, and the patient”. That teamwork is crucial to achieve compliance, or – as the speakers prefer – collaboration. “Collaboration sounds like a mutual process, whereas compliance implies that I need to force you to do something, or else you’re not going to be well. And that approach, regardless of age, is going to create resistance”.

three fold relationship

teeth move quicker in healthy soft tissue

Orthodontics as an opportunity

Talking about how important a healthy life is in orthodontics, Mário sees an opportunity: “When we talk with our patients about nutrition, sports, those kinds of things, it can be a struggle because sometimes, they are so tired of listening to this. The amazing thing about orthodontics is, that it can be an opportunity, because taking care of general health is part of a treatment they want themselves. And they want it to go well”. What helps here, is that the negative image orthodontic treatment used to have in the past, has largely disappeared. “Nowadays, everyone likes it, kids like it. They cry when we say ‘you do not need orthodontics’ because they want the brackets. So, we have this open door to show them the importance of eating well, exercising, controlling gingival health. It’s amazing to see the opportunities that orthodontics offers to help general health”. Kristy agrees: “the stigma associated with metal mouth, brace face, that doesn’t exist today anymore. It’s a huge paradigm shift and one that we can take advantage of”.

Orthodontic treatment opens the door to talk about the importance of healthy lifestyle habits

Teenagers as a unique patient group

Teenagers are seen by the speakers as a mix between adults and children, which is what makes them so special. It is an age of change, and teens are like a piece of clay who want to mold themselves, but we can help. Mário about a paper he recently read: “It said teenagers have seven important needs: trust, dialogue, security, autonomy, responsibility, affection and hope. And the funny thing is: we have all those tools in our office”. Orthodontic treatment in a way reflects the process of growing up. It involves responsibility and patience, and by building a relationship based on trust, you can help a teenager in this process. And that involves dialogue: listening to what the patient wants, making this voyage together, it really helps the process of establishing a collaborative process. In terms of autonomy, it means deciding together with your patients what is good for them, and what they feel helps them to better control a problem, making it part of a teenager’s self-awareness, and we know that is very important for them. Kristy also mentions: “Instead of the term challenges, let’s look for opportunities, and use that type of dialogue consistently, meaning positive reinforcement”. Mário agrees: “It’s the idea of giving them responsibility that enables you to build bridges”.

teenagers have seven important needs: trust, dialogue, security, autonomy, responsibility, affection and hope

What can you do as oral care professional?

Kristy: “I am a big fan of anything we can do for the patient while they’re there. That is going to have an impact when they leave. Say to your patient: you have made an investment; well, we are going to make an investment back, and this is how we are going to do it. So, build that relationship, show that we are invested, and get creative”. Mário agrees on the creative part: “Curiosity creates involvement. Sometimes for a patient, visiting the dentist or dental hygienist is the same over and over. So, if you change the game, if you create some curiosity, patients will say wow, that is completely different. And we have the techniques for that, like intra-oral cameras, mobile apps, etc.”.

Continuing the topic of technological developments, Kristy has some specific ideas on oral hygiene: “For hard tissue, think of air polishing, use of chlorhexidine and fluoride varnish, etc. Then there are also app-connected power toothbrushes that are safe to use during orthodontic treatment. And when it comes to soft tissue, can we just “toss the floss” for this population? The obvious winners here are interdental brushes”. Mário nods in agreement: “I completely agree, that’s the trend. And in a technical way, it helps to create an alliance between you and your patient. And remember people, it is not about the importance of cleaning between the teeth, that we already know since 1940. The point is how to do it. Do it!

Behavioral interventions

One specific model for behavioral change is used as an example for orthodontic treatment, which involves goal setting, planning and self-monitoring, or GPS in short. Mário: “In terms of goal setting, it is important that the teenagers are involved, giving them responsibility and autonomy as we talked about before”. The unique opportunity that orthodontic treatment offers here, is that in most cases, you and your patient share the same goal, in contrary to other treatments where there is a discrepancy between what you think is important, and what the patient thinks is important. Planning involves discussing with your patient what results we should expect from the treatment, and how we get there, creating this therapeutic alliance. Discuss what we should achieve, provide feedback on the next appointment (the self-monitoring aspect of GPS), and adjust the plan if necessary. “These three things, goal setting, planning, and self-monitoring, are probably the three most important techniques to be able to change behavior”.

a powerful behavioral tool for orthodontic treatment is GPS: goal setting, planning and self-monitoring

If you are interested in learning more about this topic, you can re-watch the entire webinar on YouTube. Simply click here or scan the QR code below. Make sure not to miss any episode of the SUNSTAR Conversations PRO series by subscribing to our Channel. Registration for the upcoming one through this link. Catch you all there!