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ePaper created 2018-04-25, 10:58:32 | version 1.38.0
special: dental hygiene in Belgium | In 2004, I took the initiative to set up a pilot study in Lim- burg with 65 referring dentists. We used the Dutch Peri- odontal Screening Index, a screening test for periodontal status that had been introduced in the Netherlands a few years earlier. We collected data from 814 patients. The re- sults clearly showed that the screened age groups had, on the whole, periodontal problems and that there was a high need for treatment. Around the same time, Prof. Hugo De Bruyn joined the teaching staff of Ghent University’s Department of Dental Sciences. Probably thanks to my publication, he asked me to become one of his staff members. Working with Prof. De Bruyn, one is quickly involved in clinical research and so I had the opportunity to investigate, in depth, the questions that had bothered me ever since I started my career. One of these questions was the kind of oral hygiene instructions GDPs provide to their patients. Using questionnaire responses of 776 dental profession- als gathered for various postgraduate courses in Flanders, we were able to determine that, given the absence of dental hygienists in Belgium, oral health instructions and patient motivation appeared to be non-compliant with international guidelines. Though dental professionals were concerned with prevention, there were several mitigating factors work- ing against them delivering this adequately. The study mentioned lack of time, remuneration and patient interest as complicating factors for the provi- sion of preventative care. However, qualification, work experience and time are crucial for providing oral hy- giene instructions and patient motivation. Can dental hygienists be seen as a solution to these problems? It is my conviction that dental hygienists are the solu- tion to these complicating factors. Prophylactic care will be the main target of their work, since dentists are primar- ily trained for restorative care. Owing to factors such as the decreasing number of graduating dental students, the in- creasing number of retiring dentists in the next ten years, an ageing population and a higher demand for preventative care, the stress of work increases and forces dentists to manage their work time more strictly. Of course, GDPs pre- fer restorative and other more rewarding treatments. We all know how time-consuming patient motivation techniques for behaviour change can be. There is no dentist prepared to spend that time on preventative care. Generally speak- ing, dentists are used to giving a basic package of infor- mation on oral hygiene to every patient and, depending on compliance, they may want to spend more time on pa- tient guidance. Here, dental hygienists can make the dif- ference. They will be trained to insist on the importance of behavioural change and will take the time to explain and show how to perform proper home oral care. You have also published studies on implants, such as on implant design. What made you publish your study titled “Attitude of dental hygienists, general prac- titioners and periodontists towards preventive oral care: An exploratory study”? You could have just con- tinued with your research on implant systems. Indeed, the team around Prof. De Bruyn is very driven by and focused on the outcome of implant therapy. To my knowledge, the Department of Dental Sciences at Ghent University published around 40 scientific articles in 2016, the majority of which are related to implant therapy. The subject of my PhD is not implant-related, but deals with different relationships in dentistry: between the patient and the dental professional, and between primary and second- ary dental care, that is between GDPs and specialists. What were the objectives and results of this study? This second study was a step further than the first one. In the first study, we looked for an explanation for the dif- ferences in patient motivation techniques between Flemish GDPs and periodontists. In this second one, we compared our rather unique Belgian system with the Dutch system, a completely differently structured healthcare system in- cluding dental hygienists. We wanted to know if the Dutch system represented the gold standard and how we were situated in Flanders. The results showed that periodontists and dental hygien- ists shared more common viewpoints than GDPs and hy- gienists did. What was remarkable was the fact that more than 80 per cent of periodontists and dental hygienists were satisfied with their efforts in informing and motivating patients, compared with 38 per cent of GDPs. Secondly, whereas GDPs indicated nurture as the factor most con- tributing to the oral hygiene level of the patient, periodon- tists and dental hygienists focused on the influence of the dental practitioner and a patient-centred approach. In our multivariate analysis, the presence of chairside assistants seemed to be of major importance. But, as always in questionnaire-based studies, the re- sults can be biased by socially desirable answers and by the inevitable structural differences between Belgium and the Netherlands. One of these differences, for example, is the fact that providing oral hygiene instructions is not reim- bursed in the Belgian dental care system, as it is not con- sidered an autonomous activity. What should the role of the dental practitioner in the successful treatment of periodontal disease be? What does the patient need to do? The role of the dental practitioner, in particular the GDP, undoubtedly remains to keep a panoramic oversight over everything that has to do with the dental and oral health of the patient. Especially considering the introduction of den- tal hygienists in the near future in Belgium, the dentist’s role as a supervising manager is important. It is my experience that progressive problems often remain untreated until complications or even complaints surface. A trigger seems m o c . k c o t s r e t t u h S / m u l l i d d a © prevention 1 2018 43