Interview: Bleeding gingivae are not normal
Dental care continues to be a topic of much debate in Canada. Around 75 percent of Canadians have periodontal disease of varying severity. Dental care in the country is mostly privately funded, despite public healthcare and company insurance plans. Gisèle Choquette is an established dental hygienist from Quebec and a trainer for individually trained oral prophylaxis (iTOP). She asserts that it is not acceptable for financial obstacles to lead to poor oral hygiene, as this results in nutritional, mental health and cardiovascular problems. Canadian dental hygienists can learn to effectively communicate with their patients, thereby increasing the number of visits while reducing the dental treatment costs for patients.
Dental Tribune Online: Ms Choquette, what is your background and how did you learn about the iTOP educational program?
Gisèle Choquette: I graduated as a dental hygienist in 1989. I knew that I wanted to work in oral hygiene and communication. I like to help. After that, I took further courses to become a teacher at a dental hygiene college. I worked for dental companies and dental clinics for many years and taught dental hygiene. Right now, I give courses twice a year at the International Dental Institute. I have been with iTOP since 2009, after meeting Curaden in 2008 in Quebec.
Back then, I was already convinced that, besides proper training, one needs to have intelligent products that allow for accurate measurement and treatment of the interdental spaces. For example, when I was teaching laser dentistry to my students, I found that, although the laser was good, patients continued to have poor oral hygiene. Interdental brushes were not used frequently because my students did not educate patients on using them correctly. That is why I introduced iTOP to my training. I immediately wanted to become a teacher and completed the advanced and top level courses. It was definitely a great decision.
You already had about 20 years of experience in dental hygiene when you started with iTOP.
Over time, any job can become boring—patient after patient, hour after hour—so I wanted to change the way I practise. Now when I see dental plaque, I start with the disclosure and explain how it forms and its effects. I then schedule another appointment and make sure that proper oral hygiene is being practised. It is more educational for the patient. The goal for me is to help patients understand that, for example, bleeding gingivae are not normal. It is an indication of an inflammatory disease that can affect other parts of the body. ITOP has taught me how to explain this to them correctly.
What is the status of oral hygiene in Canada?
Only 50–55 percent of Canadians go to the dentist twice a year. About 30 percent do not have any kind of dental insurance and many Canadians avoid going to the dentist because of the costs. However, the greatest part of the Canadian population has cavities and ongoing mouth pain. I work in a dental office in a rather affluent neighborhood. The issue there is that teenagers consume a lot of sugary drinks, leading to decay. We have to educate them that interdental cleaning should remain a top priority in their daily tooth cleaning routine.
I have to agree with my patients that dental treatment can become very expensive for patients. Some of them try to manage the costs through their dental insurance, which means that they can only come every nine months. However, having a healthy mouth should not be reliant on a particular time period. The most important thing is to follow the treatment, and if that requires a three-monthly or biannual visit, there has to be a way to bring the patients to your office. ITOP helps with that. By that, I do not only mean effective recall management. We teach our patients that a visit to the dental office about every six months will reduce costs and the possibility of a painful mouth.
What do you like most about iTOP?
Definitely the motivation. The aspect of motivation changed my philosophy as a dental hygienist. I was very bored after years of working the same way every day. ITOP gave me a new sense of enthusiasm. The most important thing is to speak to patients in simple terms. Throughout my career, I became increasingly knowledgeable about dental hygiene, but without the language to express this simply, my patients sometimes could not understand what I meant. Now it is so simple: iTOP gives easy examples that patients will comprehend. What I also learned is that one has to repeat the same messages for patients every time. Dental hygienists have to train and coach their patients, and we have to find a way to give them the objectives and motivation they need to maintain their oral health. At the same time, patients have to recognise that we care for them. Dental hygiene is a business that involves trust. When one asks one’s patient to come every three months, he or she has to trust one that any bleeding will stop and that the investment makes sense.
Please could you describe the iTOP courses in Canada and the benefits for dental hygienists who attend the program?
In Canada, I only teach the one-day courses—three hours of theory, followed by practical steps in the afternoon. In the morning, we discuss clinical cases, communication strategies and different techniques. The practical part involves high-quality products and effective ways to teach your patients how to use these products. We focus on evidence-based oral hygiene. The one-day course, in combination with free products, is a great offer for dental hygienists, but one day is definitely not enough. My students are all professionals, but teaching the proper brushing technique and strategies for patient interaction requires at least one recall session. We try to repeat the training as much as possible to also teach them the aspects of communication and motivation. In addition, we focus on patients in residence or hospitals who have reduced mobility and need assistance with their dental hygiene. Future hygienists should be able to treat them and we teach them how to do it.
How would you describe the future of dental hygiene in Canada?
The future for dental hygienists will be good as long as we become independent. In Quebec, we are not independent right now. I want to work in my own office, regardless of the presence of a dentist. There is the concern within dentistry that dental hygienists will take away patients from dentists, but the opposite is the case. We all just want to improve oral health in Canada.
Thank you for the interview.