Christina Chatfield 16 x 9


Christina Chatfield, Dental Hygienist, UK

As a hygienist, who owns a dental business that has just celebrated 10 years on Brighton High Street, I revisit my original vision of having 4 hygiene chairs alongside a growing Dental business. I know that having a driven, passionate, committed, thriving, hygiene team is the core that influences the overall success of the practice as it underpins our values of prevention and patient care.

Not only are hygiene services important to overall patient health, they are equally important to the growth of the practice both financially and in patient numbers. New patient recommendations from our existing client base are the best form of marketing and a real accolade to the delivery of care. Subsequently more motivated and empowered hygiene patients are then referred in house to our dentists, looking for the next step to health and beauty (let’s not forget how important the patients wants are alongside what they clinically need).

 Our recall systems need to be optimised and we need to stay ahead of the game so that the retention of our clients is as important as the new clients that walk through the door. The Patient Experience is reliant of our skills, knowledge, staff, coominication, clinic, the tools we use and the atmosphere. We need to move with the times on how we interact with the patients through digital and mobile media to make booking and attending appointments easier and more fluid.

As clinicians we have all seen a real sea of change in our knowledge, evidence and understanding in the area of overall health, especially in relation to diabetes, heart disease and systemic health. By 2020 it is predicated that 1 in 4 of the population will be over 65. How many of the dental profession are adapting and making changes in the delivery of care so that the health of our aging patients improves?

We need to provide care ‘From the cradle to the grave’ so what of our children? The main reason a child under 5 has a general anaesthetic is for tooth extraction due to caries, a totally preventable disease.  We need to take a pro active approach and educate our children early, not wait for the schools to teach them to brush when they are 8. Bad habits have been learned well before then and many teeth lost.  A visit to the dental clinic should become an ongoing journey based on prevention with minimal intervention so it can become a pain free enjoyable experience throughout life, our blue sky dream for oral health care.

Patient’s awareness is increasingly driven by media, advertising by healthcare companies like Philips, Colgate, Oral B on television, in magazines, newspapers and social media. Google search engine provides a library of knowledge and some misinformation which means our patients are fuelled with more knowledge about what is available and what they want. As a result of advertising, we must manage our patient’s expectations to ensure that they are not expecting miracles, especially if they do not take ownership of their problem themselves.

But we are still in the “If only they knew what we knew, saw what we saw” mind frame. The amount of times I say to my clients “if only we had met 20-30 years ago”, with the knowledge and the tools we have as clinicians today we could have a very different outcome.

The days of plaque being called plaque are long gone. People are totally unaware, blind to this slimy substance on their teeth, Biofilm, a highly organised community of microbes with its own delivery, waste disposal, communication and defence systems.  Explaining to patients that this forms on any hard surface where there are fluids with nutrients so our mouth is a great habitat., I tell them to think of the slime on the inside of a vase, around your bath taps, explaining this is biofilm. The very nature of what it is means that in can be very destructive and in some cases life threatening, the research is still in its infancy, but the evidence continues to grow.

On July 21st 1976 the American Legion had its annual 3 day conference in Philadelphia, more than 2,000 Legionnaires attended the conference, over the course of the week following the convention over 130 people, between the ages of 39 and 82 who attended the convention were hospitalised and 25 died. The Centre for Disease control finally isolated the bacterium, which was later named Legionella Pneumophila, and had been traced back to the hotel air conditioning systems.

This is why we have to manage water supplies, air conditioning units and hot tubs. Biofilms, the environmental playground of Legionella pnuemophila, are found in your mouth, no where else in your body. These bacterium communicate with each other, known as “quorum sensing“, and therefore become resistant to antibiotics. Consequently mechanical cleaning and removal of biofilm at home and with your hygienist remains key to the health of the mouth.

Can we communicate that in a better way to improve oral health? The health of the mouth is often seen as a separate issue from that of our general health but by optimising dental health we can make significant impact on our well being. If our patients could see Biofilm and really understand what it was, what it did, they would want to do something about it.

 Having moderate gum disease is like having an ulcer the size of a 50 pence piece constantly exposed, imagine that somewhere else on your body? If we talk about the blood supply around the mouth and how the bacteria from the biofilm can get into the bloodstream it becomes easier to visualise and understand.

In the UK 47% of our adult population have moderate to severe gum disease, nearly 30 million people unaware of this ulcer as the gateway into their bodies. If they were aware would they ignore it or seek out help?

From a business point of view, and more specifically the business of hygiene, that is a sizable opportunity for the growth of the practice and the revenue. Added to the fact that there has been limited access to dental health care professionals like hygienists which has been fairly restricted until Direct Access came into effect May 2013, and even then it works out on average 1 DCP for every 3,800 patients with disease, so there is plenty of work out there, much of it undiagnosed, many still not putting their foot through the door due to fear of cost, fear of pain or fear of being told off.

When I opened Dental Health Spa in 2007 I wanted to market something different to the Brighton consumer that other dental practices were not offering to their hygiene patients, so I invested in 2 air polishing units. It was not new technology, it had been around for 30 years, so about all of my clinical life. In fact way back in 1999 I had one in my practice where I had a nurse all the time but I knew nothing about it other than it tasted foul and it was a nightmare to maintain (or so I had heard). No one had shown me how to use it, I had never been taught anything about it during my training at dental school, my boss did not tell me, or show me why I had one. Yet it’s the same unit that I have used to build my practice at the start and I found a USP that no one else was marketing. I took to the radio to advertise it as new and different.

Like everything, technology evolves, from twin tubs to automatics washing machines, manual toothbrushes to the first electric, to the all singing oscillating, pulsating and sonic technology we have today. Things improve because research shows us where we want/need more as clinicians for health, from a consumer /customer view it’s about use, comfort, aesthetics, health and feel.

Move forward 30 years with EMS and look at how the powders have evolved, enhancing comfort, and efficacy, ease of use and more importantly removal of biofilm. After a visit to Euro Perio in Vienna 2012 I sat listening to the lectures on Erythritol, for management of perio mucositis and peri implantitis with the new Air Flow Master. I was sold, I came back and made the investment immediately, with additional training through the Swiss Dental Academy, it has changed my working life and my patients certainly noticed the difference. Over the last 4 years my patients show it by choosing their appointments with me and the AirFlow.

Some of my clients say that their teeth are sensitive, the sensitivity they commonly refer to is when using the ultrasonic. I am not only referring to patients who need non surgical root surface debridement, I am referring to our recall maintenance patients. So initially we thought of air polishers just for stain removal. With the newer powders, they move away from the abrasive salty larger grain of bicarbonate at 65 microns to Erythritol extra fine only 14 microns, which makes it great to use on the soft tissues, including the tongue and in the pockets, disrupting and killing biofilm and removing lighter stains. This can be used on both dentine and composites too.

4 years on its now 2018, I have just spent 3 days in Geneva at the Swiss Dental Academy and the EMS factory learning all there is to know about the new Air Flow Master  and Guided Biofilm Therapy. The EMS technology, machinery and the treatment protocol, GBT brings everything together so that we will deliver on all that I have written about. The new machine uses less powder, at a higher intensity, with warmer water improving patient comfort, removal of biofilm and soft calculus and no more bicarbonate needed for stain removal as it removes heavier stain, without any damage to enamel, dentine, crowns, veneers, composite fillings, implants and soft tissues. No more hand polishing either as Erythritol will leave the tooth smooth and biofilm free. So one powder that cleans does everything, no changing of powder or chambers and the machine maintenance is easier.

Appointments become easier, it is quicker and patients love it. Now the time has really come to change, out with the old and in with the new and an expanded hygiene team as the demand continues to increase.

The Swiss Dental Academy will be running courses throughout the UK from June 2018. Hands on courses are essential to understand how in practical terms to both use and maintain the equipment. Sharing experiences with other colleagues will help you develop skills and ideas as to how to market them and up sell to your existing clients.