A Clinicians Reflection in Changing Behaviour and Guided Biofilm Therapy
Tim Ives RDH, BSc (Hons), MA Med Ed, FHEA.
“Everyone wants to change the world, but nobody want to change themselves” Leo Tolstoy.
Change is not easy. People like routine. My name is Tim and I like routine.
I have always considered myself to be an ‘early adopter’ being prepared to try new things and constantly on the lookout for different strategies. I teach behaviour change to undergraduates and lead them through research, which involves qualitative analysis in this particular field. I understand the complexities of changing behaviour.
So, why did I find it so difficult to change?
Several years ago I obtained an EMS Master Piezon Unit. For those of you who have not seen this piece of equipment, it has a Piezo on one side and an AirFlow/Perioflow on the other and is a great design.
This new EMS Piezo with a light was a great addition to my practice, which I appreciated immediately, however, the AirFlow/PerioFlow was redundant for over a year. Occasionally, I would look at it and think that I should really start using it. There were a lot of conflicting discussions regarding air polishing and my only previous experience was a very messy one. I knew there were new powders made from glycine that were less messy, less abrasive and had benefits when used sub-gingivally but I still did not start using it.
Clinical practice is a busy business and it takes a lot of time and effort to start doing something completely different, especially when our patients are happy with the status quo. It is easer not to change, so I still did not start using the AirFlow or PerioFlow.
None of my colleagues were carrying out air polishing. I receive referrals from Periodontal Specialists and Dentists with a Specialty in Implantology. None of them asked me to use the AirFlow or PerioFlow, so I still did not start using it.
A year later EMS brought out a new powder made from erythritol. One of my interests is sugar alcohols. I have been researching and writing and talking about the benefits of xylitol and erythritol on bacterial biofilms for a few years, so this really piqued my interest. I ordered some of the powder and tried it out on a dental colleague. The outcome was really good, her feedback was good and there was no mess.
So, as per Mr Tolstoy, I finally stopped trying to change everyone else and decided to change myself.
Jump forward a few years and the vast majority of my patients receive an Erythritol AirFlow as part of a Guided Biofilm Therapy (GBT) appointment and my periodontal maintenance patients, the PerioFlow. It has been a revelation but it has not been easy. Patients just like their clinicians, like routine and find it difficultly to accept change and it takes time to explain the reasons for a new therapy. Some also, have had unpleasant experiences with technology involving water and do not understand the complexities of the equipment we use. Convincing these patients that this new technology when used correctly is pain free, can be a long discussion and requires patience and perseverance. The positive reaction and positive comments from these patients, post treatment make it really worth while, especially when I know that I have used the best possible mode of treatment for them.
Some people will never change and some take a long time to change. I have learned to accept that and need to temper my frustration with the understanding that change is complex. Interestingly, these people are now becoming a rare commodity in my clinic because my appointment book has become so full with people wanting GBT that I now have to send some of these ‘non-changers’ to other clinicians who do not practice air polishing or GBT. I am now receiving referrals from orthodontists and implantologists from other dental practices in my area. The word is out.
I am really excited to be teaching GBT for the Swiss Dental Academy and I am considered to be an early adopter but as you have been reading, I am not really. For me, it was less of a revolution and more of an evolution. I am now passionate about GBT because I have seen some amazing results and my patients love to be treated this way. This article is not about the clinical benefits. That particular subject and how I use GBT in practice will be coming soon, but I am now wondering about my effectiveness prior to utilizing GBT and the prospect of returning to my previous equipment and methods of treating patients would be a return to the dark ages. I am now completely dependent on my EMS Master Piezon and its powders.
An outcome I had not considered, is that treating people this way is much less demanding physically on my hands and wrists, so changing my practice has not only re-ignited my passion but it may see me looking into mouths for a few more years.
My advice to any clinicians reading this is jump on board as soon as you can. Try it out at an organized Swiss Dental Academy course, which will give you the confidence and skills you need to get going with GBT.
Please do not get left too far behind as the train has already left the station and the ‘passengers’ want to ‘feel good’ and be treated the GBT way.
Tim Ives RDH, BSc (Hons), MA Med Ed, FHEA.