We all have our share of patients who’s periodontal health never improves, or improves very little, year after year.  In other words, they are in a chronic state of active disease.  And too often, we hygienists blame ourselves for failing to help these patients improve their periodontal health.  What could I have said to persuade them to improve their home care?  What product could I have researched and recommended to make it easier for them?  What product or procedure could I have used during their recall appointments?  Should I have learned hypnosis to fool these dummies into better health?  In this blog post, my goal is to help hygienists feel comfortable with this simple fact.  It’s not your fault.  It’s your patient’s fault.

Me: “It’s not your fault”

Hygienist: “I know”

Me: “No you don’t.  It’s not your fault”.

Hygienist: “I know”

Me: “It’s not your fault”

Hygienist: “Don’t fuck with me Mark!”

Me: “It’s not your fault”

Hygienist: (crying) inaudible words

What are the primary factors that drive health outcomes?
If you google the following phrase “the determinants of health” and then click on images, you will come across lists, bar graphs, pie charts etc. that break down the major categories of health determinants along with their weighted percentages.  Not all sources use the same categories or come up with the same percentages, but overall, three determinants consistently stand out; behavior, genetics, and healthcare.  The primary drivers of health outcomes are behavior (50%) and genetics (20%), and relatively little is driven by actual medical treatment (5%-10%).  So what does that mean for hygienists?  It means that your patients’ oral health is essentially in their hands, not yours.  Does that mean we should give up on trying to help our patients?  No, but it does mean you should stop blaming yourself for your patients’ poor oral health and lack of improvement.

Unfortunately, good oral health habits involve human beings
The problem with maintaining good oral health is that it requires daily action from actual human beings.  That is a major problem because people generally suck at that kind of discipline.  The daily habit of oral hygiene also involves a concept called Delayed Gratification (this concept also applies to many other areas of life).  What is it?  Delayed gratification is when we choose to experience short term pain in the present for long term gain in the future.  Examples of delayed gratification can involve both taking action or avoiding action.  “Taking action” examples include exercising, eating more vegetables, saving money, studying, flossing, etc.  “Avoiding action” examples include not drinking soda, not smoking cigarettes, not drinking alcohol, not overspending on consumer goods, etc.  I know some of you may be thinking, “C’mon, good oral hygiene only takes a few minutes a day.  It’s easy.”  That’s factually true, but it doesn’t really matter for two reasons.  One, human beings really don’t want to do it.  And two, getting started is probably the hardest part of the task, not the duration or the ability to perform it.

Is it possible to prevent all, or at least most, periodontal disease?
If daily action by individual human beings is required then the answer is no.  Significant disease prevention only comes through the implementation of technology that doesn’t require daily action by individuals.  Let’s look at a few examples.

Vaccines have essentially eradicated a whole list of diseases that plagued populations in the past like smallpox, polio, measles, etc.  Vaccines require almost no action by individuals.

Water fluoridation has put a significant dent into preventing dental caries.  Of course, dental caries are still a problem, but that’s because preventing dental caries still requires daily action by individuals.

Auto safety technology like air bags, seat belts, better tires, better brakes, crunch zones built into frames, etc. have significantly reduced highway deaths and injuries over the last century.  But like water fluoridation, the current technology has not solved the problem completely.  We still experience a lot of deaths and injuries on our roads everyday.  Like oral health, safe driving still requires daily action from individuals.  Again, that’s the problem.  Driverless car technology has the potential to be the “vaccine” that will finally eradicate this “disease”, but only time will tell.  We need a similar “vaccine” to have any real chance to eradicate dental disease too.

Should we just give up on our patients then?
No.  Some patients will actually make the change, so keep doing what you are doing, but don’t sweat the fact that most never will.  It’s not because you’re a bad hygienist.  It’s because your patients are human beings.  So the simple fact is this. It’s not your fault.  It’s your patients’ fault.

If you find yourself still feeling bad or blaming yourself for your patients poor oral health, just play this video over and over until the feeling goes away.

Mark Frias, RDH