Improve oral hygiene for your ortho patients

How are your ortho patients doing at keeping their teeth clean? When it’s time to remove the braces, are you admiring a beautiful smile – or are you looking at red, puffy gums and discolored teeth?

One of the ways you can improve quality in your dental practice is to improve the oral health of your ortho patients.

Recently, we paired up our hygienists and our orthodontic team to meet and talk through our approaches to work together to help our ortho patients keep their teeth clean. If you are a general dentist with hygienists that see ortho patients, perhaps this is an opportunity to meet with your orthodontist to talk about how you can best coordinate to improve the dental health of these patients. If you are an orthodontist, you could use this as an opportunity to reach out to the hygienists of your referring dentists to increase communication and perhaps even increase future referrals?

Meet together

Schedule a meeting for your hygienists and orthodontic team to meet and talk. Prepare an agenda for the person that will be leading this meeting. During this meeting, the leader’s job is to gather ideas and comments from every single person in the room. Clinical staff are often uncomfortable in a meeting like this – and can feel like they are “being shot at” if their patients aren’t doing a good job with their oral health habits. The leader must constantly reinforce that we are meeting together ┬áto help our patients improve their health and the more we know what each team is doing, the better we can work together for the benefit of the patient.

Hygienists bring the tools you like

Make part of the meeting a show and tell where the hygienists bring a model of teeth and their favorite teeth-cleaning tools, such as proxy brushes, flossers, etc. Have one of the hygienists show the ortho team how they coach their patients in braces to clean around the brackets and bands. This helps the ortho team discover new products and approaches that they can use when they see patients that are not cleaning their mouths well. Pass around the model and the products so each person can do their own hands-on practice.

Improve documentation

The ortho team most likely is already documenting patent oral hygiene – however, it may simply be a rating of “good, fair or poor”. That’s just not enough information when the hygienist is with a teenage girl who recently had her braces removed and had to inform her that the general dentist found several areas of cavities and that she has significant gingivitis. We had this exact situation occur in our group. This teenage girl and her mother had been told at almost every ortho visit that her home care was poor – and for 2 years this patient never even had her teeth cleaned! So, after the braces were removed, they end up in a hygienist’s chair who has to deliver the bad news. Of course, this pair denies ever hearing anything about poor oral hygiene habits and the girl is in tears! This was our motivation to schedule a meeting to get everyone back on the same page.

Our plan to improve documentation so that hygienists and the ortho team know what has been communicated to the patient include several new ideas:

  • Take a photo of the poor oral hygiene so the patient and parent can see the red, puffy gums. This photo should be saved in the chart or the document center.
  • When oral habits are deemed poor or fair, then more detail is required – document what the clinical staff person told the patient (and the parent!).
  • Create a new template for documentation of oral hygiene – with a clickable template, the ortho team can document in more detail their observations.

Establish consequences

Another idea we discussed was to create a ‘muck mouth letter’ that we could give to patients that clearly shows and tells the consequences of poor oral hygiene for patients with braces. Our first draft includes a few ugly photos of overgrown gums that are fire-red along with a letter that clearly states what can occur if you don’t clean your teeth during orthodontic treatment.

It’s the patient’s choice

Throughout our meeting with our hygienists and the orthodontic team, I was constantly on the lookout to maintain a positive tone. It seemed like the ortho team was feeling responsible for their patients poor hygiene habits and they also felt frustrated that even though they told their patients what was going on – the patients still weren’t improving! This puts the orthodontic assistants into a rotten position – they have no control over the patient’s behavior but feel like they are responsible for the result!

I encouraged the ortho team to focus on giving patients choices – the patients get to choose poor oral hygiene. If that is their choice, then our job is simply to communicate the consequences. On the other hand, they also can choose to have a healthy, clean mouth – and we can also communicate the rewards of this approach. In our group, we are big believers in behavioural coaching – meaning that we spend time talking with the patients to find out their motivations. Why does this teenager want braces? Not the parent – the teen. Whatever the reason given, whether they want straight teeth or they want a beautiful smile for school, then every oral hygiene discussion should tie right back to their motivation. Everyone knows that it takes some time and energy to take care of teeth – but when you are motivated, it doesn’t seem so difficult to accomplish.

Coordinating between teams is just one way to run a successful dental practice. If you’re interested in new ideas on running a dental practice, please subscribe to my weekly blog:



One of the biggest challenges to managing a dental practice is managing dental insurance. With dental insurance handled, then dental marketing for new patients becomes a primary focus. In today’s day of online reviews, handling patient complaints well is essential. As your practice grows, hiring dental staff becomes more important. With 16+ years of dental practice management experience, I’m open to your questions to help you run a successful dental office.

Feel free to email me.

AUTHOR: Jill Nesbitt
jill@dentalpracticecoaching.com
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