Preventive services are at the forefront of medical, fitness, and nutritional research. Everyone talks about prevention, but very few people adhere to it long-term, and that is what really counts in all preventive programs. It is easy to fall off the wagon and get discouraged. There are many causes why prevention eventually fails, but the main cause is the lack of motivation and good information. For example, for prevention in nutrition, the nutrition pyramid and guidelines have completely changed from several years ago. Foods such as coffee were considered detrimental to good health but may now be deemed beneficial by some. Medical advice changes and varies between doctors with different medical philosophies. Prevention must be specific to that particular patients’ personal needs, not just generalities such as get enough sleep and don’t smoke or drink alcohol.
The advantage that nutritional, medical, and fitness programs have is that they can all be easily quantified. Dental preventive programs and immediate goals are difficult to quantify and measure to see if they are effective. Brush three times a day and don’t eat carbohydrates is not a preventive program. The fitness activities like aerobic or resistance training can be measured by the patient’s success or failure if they adhere to the program. In resistance training you can measure the benefits almost immediately, such as in low weight and high repetition exercises, or high weight and low repetitions exercises. You can easily see the results for yourself and see yourself get stronger. Aerobic exercise, long distance, or speed running can be measured in time or distance covered, and you can perceive results in a short time. Thus, the program must be tailored to the individual’s needs, perception and goals. You may need to correct mid-stream and be flexible to achieve results.
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Some people ignore prevention until there is a problem, i.e. heart attack, obesity, rampant dental caries. The public can be divided into three categories: Those who do not care or just pay lip service to prevention, people who run into urgent life changing problems and after treatment need advice on how to prevent a recurrence of the situation, or the health-conscious individuals who are looking for the best practices and information on how to prevent problems in healthcare. However, these individuals can be misled by the amount of false information on the internet, social media, or from friends or following fads. You must not just provide information but tailor it to their specific needs, and coach and educate and motivate them accordingly. In order to do this, you must first assess their problems and offer specific solutions and explanations, and see if they can comply. If a regiment is not followed for whatever reason, it will not work for that individual. If a person shows low amount of interest, let them go, as you need a motivated individual to succeed. Let them know that you are available if the situation changes. When a patient has an awakening and now seeks preventive advice, the preventive program is more likely to succeed with a now motivated individual. These patients not only need information but also new techniques and how to best apply the knowledge that applies to their specific problem. In addition, you must motivate them for the long-term, by following up on their success. How many times do you see yo-yo dieting and fitness programs that are followed for about a month. Thus, you must make the program fit their lifestyles.
Yes, there will be up and downs. You may wish to involve a family member or significant other, so as not to sabotage the program. If they tried a preventive program that didn’t work, you must show them where they were led astray. Not all diets are the same, and not all people will respond the same way. So, in medical, nutritional, and fitness programs you are able to measure short term changes to measure progress and get positive feedback or lack of any progress. In medicine, if the blood pressure doesn’t respond to the medication, the doctor can adjust the dose. In fitness, activities can be changed if results are not forth coming. In nutrition, we expect to see weight loss if the diet is succeeding. Results are easily quantified, just step on a scale. Dental prevention is much more difficult to quantify short term because it is difficult to see short-term results. If you do not brush effectively for one month, you will not see dental caries; however, you may get a gingivitis that the patient is unaware of. How many times do you meet people with minimal oral hygiene and claim to have good oral health. Your idea of good oral health and theirs may differ. Their idea of good dental health may just be an absence of symptoms. Although they may not present any obvious problems, a thorough examination may reveal potential problems and incipient lesions.
Most people think dental prevention is easy—brush three times a day and don’t eat sweets. The problem may have been there many years but was not addressed because it was asymptomatic. Thus, you must set up goals and standards that they can see and measure. In addition, you must compliment them and reward them for a job well done. This is especially important for kids and young adults and their parents. Fortunately, young parents and kids are the most receptive patients. Therefore, you must define goals in absolute terms. Then proceed to show them the preventive program and how it works. You must expect some setbacks but use long-term follow up. Gear the preventive program to the patients’ needs and understanding. Do not make it too complicated or time consuming.
In starting a preventive program, you should take a step-by-step approach, starting with the easiest application and then add features as mastery and compliance continues. For a young child, for example, simple scrub brushing for one minute back and forth is a good start. As the child gets older, changes in brushing technique are indicated once they mastered the fundamentals. When brushing is now adequate in the young teens, you can add flossing to the repertoire.
The goals of the program should be “caries free for life.” You need to stress the importance of regular visits to see if any problems are starting. In addition to regular check-ups, you would need to take periodic radiographs to find possible incipient lesions, as well as check gingival health. You should use disclosing solutions to clearly identify and show neglected areas and possible future problems. In children, compliment and encourage them at each appointment. You can set up an online preventive club with many chapters. You can have a 6-month, 1-year, 2-year caries free club and graduate annually until you reach the 5-years cavity free club. Or for the 5-year club you can offer a certificate or small prize, or special prizes for most improvement.
Thus, to set up a successful preventive program you need to have criteria that can be seen and measured, short and long term. The cost of failure is both financial and emotional distress. Communication is the key. Make sure you are on the same page as your patient and remember to ask about their well-being, as other problems in life may interfere and cause a temporary setback. If the child gets new caries, converse with the parent to see the likely cause. Remember there will always be ups and downs. A successful preventive program means a happier patient and a more fulfilling career. You matter too.
About the author
Originally from Montreal, having taken his dental education at University of Montreal (in French), Dr. Maltz moved to Toronto in 1973. He practiced for 5 years and obtained his diploma in Paediatric Dentistry from U of T in 1979. He lectured for hygiene at Niagara College for two years and also served as head of the dental department at Peel Memorial hospital, and started the paediatric division at Etobicoke General Hospital. As a two-term president of Ontario Society of Paediatric dentistry, he did a presentation at Queens Park on dental care. In addition to being a clinical instructor and lecturer at U of T, Dr. Maltz wrote numerous articles for the professional and lay press, including a book for the public, “We Treat Children Not Teeth”. He is happily married for 35 years with three kids and three grandkids. Hobbies and pastimes include traveling, swimming, hiking, fishing, reading good books, and enjoying fine food and fine wines.
