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The Overall Health and Wellness Model of Dental Hygiene
Practice
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Latest research has recognized that oral infection, especially periodontitis, may
affect the course and pathogenesis of a number of systemic diseases, including:
1. Cardiovascular Disease
2. Bacterial Pneumonia
3. Diabetes Mellitus
4. Low Birth Weight
5. Kidney Disease
6. Pancreatic Cancer
7. Brain Tissue Degeneration
8. Stroke
TRANSLATION:
 As dental health care providers we have an obligation to educate and
emphasize to patients the risks associated with periodontal diseases. If
we don’t tell them, who will?
Periodontal infections are associated with complex microfloras with more than
500 species having been encountered. These infections are predominantly
anaerobic with gram-negative rods being the most common. The anatomic
closeness of these microorganisms to the bloodstream facilitates the systemic
spread of bacterial products, components and immunocomplexes.
TRANSLATION:

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 It is the responsibility of the Dental Hygiene Department to ensure their
patients understand the urgency of periodontal treatment and the serious
risks to their overall health if it is delayed or declined. CREATE A SENSE
OF URGENCY.
 We treat patients much sooner now that we understand there is a Link
between the overall health and the health of the oral cavity.
 The YOUNGER the patient the more serious the periodontal issues are
because of long term exposure of bacterial products over their lifespan.
 Children and Teens with Gingivitis are HIGH RISK patients.
 Our mandate is to maintain patients in a healthy state, not a disease
state.
With normal oral health and dental care, only small numbers of mostly
innocuous bacterial species gain access to the bloodstream. However, with
poor oral hygiene, the number of bacteria colonizing the teeth, especially
SUPRAGINGIVALLY, could increase 2- to 10-fold and thus introduce more
bacteria into the bloodstream, leading to exposure to bacterial products.
TRANSLATION: The body reacts to gingivitis the same way it reacts to advanced
periodontal disease.
There is no such thing as “a little bit of infection”
*MICROORGANISMS THAT ARE RELEASED INTO THE BLOODSTREAM REACH THE
HEART, LUNG AND PERIPHERAL BLOOD CAPILLARY SYSTEM IN LESS THAN 1
MINUTE*
Release of Microorganisms Can Occur Upon

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Brushing
Flossing
Mastication
TRANSLATION: Reaching and maintaining oral health is a requirement of
good overall
Health. This is the Primary Purpose of the Dental Hygiene
Department.
In May of 2000, the first-ever Surgeon General’s Report on Oral Health was
released. It stated, in part, as follows:
“The intent of this first-ever Surgeon General's Report on Oral Health is to
alert Americans to the full meaning of oral health and its importance to
generalhealth and well-being. Great progress has been made in reducing
the extent and severity of common oral diseases….
….The terms oral health and general health should not be interpreted as
separate entities. Oral health is integral to general health; this report
provides important reminders that oral health means more than healthy teeth
and that you cannot be healthy without oral health.”
EDUCATE
MOTIVATE
ADVOCATE
“The older I get, the more wisdom I find in the ancient rule o f putting first things first-- a
process which reduces the most complex human problem to manageable proportion.”
Dwight D. Eisenhower

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EDUCATE -- Visual Aids, Visual Aids, Visual
Aids!
It is essential that our patients have a basic understanding of the Periodontium
BEFORE we present disease etiology. This simple step is extremely important in
the patient’s acceptance of their problem. The patient needs to be aware of
what they had before they can appreciate the loss of it and the consequences
that come with that loss.
Verbal Skills
“To keep your teeth
for a lifetime, you
need 3 things…..
1. GUMS
2. JAWBONE
3. LIGAMENTS
(these attach your
tooth to your bone).”

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Once the patient understands what they NEED to have we can begin to explain
the etiology behind the loss of things.
“Do you know what plaque is?”
“Every tooth in a man’s head is more valuable than a diamond.”
Miguel de Cervantes, Don Quixote, 1605
Presenting Disease Etiology following the “First Things First” Rule means we are
ABSOLUTELY CERTAIN that the patient understands our “dental language”.
Never assume that the patient understands even the simplest of words or ideas.
How do we confirm that our patient understands?
1. We ask them.
2. We listen to their answer.
3. We protect them from embarrassment if they do not understand.
(“Everybody thinks that plaque is left-over food! Actually, it’s BACTERIA”)

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Verbal Skills
Establish that plaque is
BACTERIA.
Let the patient know that
EVERYBODY has this
bacteria.
“Bacteria causes Infection of
the gums & is called
Gingivitis.”
Create a sense of URGENCY
using our knowledge of the
oral-systemic link.
“Your BODY reacts to gingivitis the same way it
react to Advanced Periodontal Disease!”
“It’s important that we get this taken care of
right away.”

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Educate – The Progression of Periodontal
Disease
Before proceeding with education on attachment loss, the
patient must understand:
1. The 3 things needed to keep their teeth for a
lifetime.
2. That the PDL attaches the tooth to their body.
3. That plaque is BACTERIA which causes INFECTION.
4. That Oral Infection causes Diseases of the Body.
“If this situation…”
“…lasts too long, the first thing that
happens is the loss of the
PERIODONTAL LIGAMENT…”

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“…allowing the gums
fall away from the teeth
and the bacteria
migrate below the
gumline…”
“Now the bacteria is BEYOND
THE REACH OF YOUR BRUSH
AND FLOSS!”
Educate -- The Difference between Plaque and
Calculus
Once the PDL is lost, the patient is no longer able to clean their teeth by
themselves because the bacteria is BEYOND THE REACH OF THEIR BRUSH AND
FLOSS.

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Verbal Skills
“Do you know the difference between Plaque and Calculus?”
Establish that Plaque is bacteria that is soft and removable with a toothbrush.
Then establish that Calculus (aka Tartar) is hard and firmly attached to the
tooth and MUST BE REMOVED BY A PROFESSIONAL.
Educate – How Plaque Becomes Calculus
“When the soft plaque lies below the gumline, beyond the reach of your brush
and floss, your saliva washes over it.”
“There are minerals in our saliva that are very hard – calcium and phosphorus –
that’s what our bones are made of.”
“As your saliva washes over the soft plaque, the
minerals settle into it and turn it hard, cementing the
bacteria to your tooth.”
“I just want my free cleaning.”

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When a patient states “I just want
my free cleaning” what they are
reallly saying to you is “I don’t
understand you yet”.
Verbal Skills
“When you come in for your “regular cleaning” that is a PREVENTATIVE cleaning,
designed to prevent periodontal diseases from occuring. You have arrived
today WITH Periodontal Treatment. There is nothing to prevent.”
“The end result of UNTREATED Periodontal Disease is, 100% of the time, tooth
loss AND Illness.” (Oral Systemic Link)

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Educate – Advanced
Periodontal Disease
Verbal Skills
“Because the bacteria is beyond the reach
of your brush and floss you are not able
to clean this area of your teeth. As time
passes the INFECTION spreads further
into you jaw bone.”
“There is no cure for bone loss – once it’s
gone, it’s gone.”
“Have you noticed you that you feel
fatigued lately? Low-grade fevers? Bad
taste? Under a lot of stress lately? Medications?”
“This is a systemic infection, your whole body is taxed by Periodontal Disease.”
“It’s important that we get this taken care of right away.”
“People become really quite remarkable when they start thinking that they can do things. When
they believe in themselves, they have the first secret of success.”
Norman Vincent Peale

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Motivate – The Art and Science of Health
Promotion
Our purpose as health promoters is defined as: the art and science of helping
people change their lifestyle to move towards a state of optimum health. We
are selling Health Care Education. Our goal is Patient “buys” needed
Treatment.
Art …….creative communication.
Science…….establishing objective, verifiable facts.
Systems are only as effective as our ability to communicate
Lifestyle diseases are the result of behavior. Changes in behavior can often
alter the Lifestye disease in a positive way. To MOTIVATE patients to choose to
change behaviors, we must combine Art (sucsessful communication) and
Science (EDUCATE on objective facts).
Communication is made of two parts: The Speaker and The
Listener.

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The Speaker
The Three Modes of Persuasion
Aristotle (384 – 322BC) was a seminal thinker, philosopher and polymath, of
Ancient Greece. He was a student of Plato, and a teacher of Alexander the
Great. He conceived many great ideas and theories about many things. One of
them was a model for effective communication. These principles are still the
basis of all teaching/selling methods that we use today. We know we have
effectively communicated when a patient chooses to accept needed treatment.
The essential elements are as follows:
1. Ethos – The integrity of the communicator.
2. Pathos – The emotional effect (of communicator &
message)
3. Logos – The relevance and strength of the
message content.

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Each of these elements is consiously and unconsciously assessed by the
Receiver according to multiple factors, signals and indicators.
Ethos – The Integrity of the Communicator
 Vocal Style, Body Language, Passion and Enthusiasm
When selling Dental Health Care Education to a Patients it is important that we
believe in the treatment, deliver our message with confidence and are
enthusiastic about the “product”.
 Humility, Modesty, Empathy, Sensitivity and Concern
Ultimately, the patients teeth are the property of the patient. THEY are entitled
to make their own choices free of our judgements on those choices. Listen
carefully to the wants and needs of the patients. (“Active Listening” insert page
number here.)
 Trustworthiness, Experience, Reputation and Credibility
Many patients arrive at the office with a general distrust of dentistry. Today,
social media is largely responsible for the patients perception of the office with
regard to trust, experience, reputation and credibility. It is important that we
are routine about asking for positive social media reviews from our patients.
 Qualification, Evidence of Claims, Rewards for Communicator
Patients will want to feel that we are Trained Professionals. Professional attire,
posted Digrees and Licences, Name Tags stating Credential all send
subconcious messages. Including etiology in our presentation, using visual
aids and communicating Evidenced Based Science will create acceptance of
recommended treatment. Lastly, out patients will be thinking, “is this treatment
paying for the Doctors new Mercedes?”

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Pathos – Emotional Effect on the Listener
 Engages, Involves and Interests
The message should not be delivered in a way that communicates we have said
the same thing to all patients a millioin times before. Be up-beat and
enthusiastic. As the patient questions and listen to the answers. Again, visual
aids keep the patient interested.
 Smile, Be Happy, Avoid Conflict
Everyone has bad days, but we must leave our personal issues at the door and
put on a smile. Patients have bad days too. We avoid conflict and do our best
to remember, “the customer is always right”.
 Builds Desire, Invites Action, Make it Easy to Act
Presenting our message in a way the brings the Patient to there own
conclusions (First-Things-First Rule) facilitates their acceptance of their
periodontal needs. Treating patients on the same day, making flexible payment
arrangements, accepting their insurance makes it easy for patients to “buy”
treatment TODAY, not next week.
Logos – Relevance and Strength of Message Content
 Logical, Structured and In Language the Listener Understands
Follow the First-thing-First model of presentation of Periodontal Disease.

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 Cause & Effect, Measurable Positive Outcomes, Justify the Time, Effort &
Cost
Completion of a thorough Periodontal Assesment with 6-point probing depths
recorded to measure patients improvement over time. Starting your
presentation with, “To keep your teeth for a lifetime……: will justify the time
and cost of Treatment Acceptance.
The Listener
Concious Competence Learning Model
The Four Stages of Learning
The Concious Competence Model of Learning is a very simple and helpful
explanation of how Patients learn (and ultimately accept needed treatment).
This Model, essentially, shows that Patients need to be trained in STAGES.
(First-Things-First).
Stage 1 Unconcious Incompetence
“I just want my free cleaning”.

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Stage 2 Concious Incompetence
“What do I need to do to treat my Periodontal Disease?”
Stage 3 Concious Competence
Completes Treatment and Improves Oral Hygiene
Stage 4 Unconcious Competence
Oral Hygiene and Perio Maintenance Appointments become habits.
Compliant Vs Commited Patients
The difference between a good Hygiene Program and a
GREAT Hygiene Program is the ability of the Team to elicit

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COMMITMENT from Patients. Patients committed to their
heath, continue to return to the Practice year after year,
bringing family members and other referals. This type of
patient allows the Practice to reduce it’s fiscal dependence
on New Patient flow.
New Patients are expensive for the Practice to attract, create
non-productive work hours in the form of paperwork and
non-billable documentation and take more time in our
schedules with no guarentee of Treatment Acceptance.
Committed patients form the core foundation of the
practice and allow the practice to reduce dependance on
the New Patient, who may or maynot materialize.
The committed Perio Maintenance patient is the key
to practice building.
Definitions
Compliant – obedient, docile, meek, submissive
Committed – dedicated, devoted, pledged, faithful

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The long term success of establishing periodontal health is
dependent upon the commitment of, not the compliance of,
the patient.