IFDH white paper highlights findings from 5 global surveys

The International Federation of Dental Hygienists (IFDH) released an important white paper in November 2023, summarizing the results of 5 global oral health surveys that were conducted from 2019 to 2023. These surveys were initiated by IFDH in response to a call for action from the World Health Organization (WHO), the World Dental Federation (FDI), and the United Nations (UN) for a more “health-centred prevention approach and less on a pathology-driven treatment approach”¹ to the delivery of oral health care, as well as one that focused on sustainability and cost reduction.^{2, 3} Respondents to these 5 separate global surveys were practising dental hygienists from the 34 IFDH member countries. Topics of these 5 surveys were: 1) toothpastes; 2) electric toothbrushes; 3) oral–systemic links; 4) sustainable dentistry; and 5) oral hygiene instruction practices. The aim of the IFDH white paper was to present the survey findings and identify opportunities and strategies for dental hygienists to make more impactful, evidence-based, preventive self-care recommendations focused on improving patients’ periodontal health and, in turn, positively influence overall health and contribute to sustainable dentistry.⁴

The results of these studies were somewhat surprising as, in several instances, although the majority of respondents were in agreement with the importance of prevention as well as these various preventive approaches, their reported decision making regarding patient recommendations tended not to be based on the scientific evidence. What follows are some highlights of these survey findings.

Salme E Lavigne

TOOTHPASTE SURVEY⁵

While current evidence clearly shows that stannous fluoride toothpastes offer more benefits beyond caries protection (e.g., reduction in gingivitis, plaque biofilm, erosion, dentinal hypersensitivity, and breath malodor) than other forms of fluoridated pastes, such as sodium fluoride pastes, only 18% of respondents reported recommending stannous fluoride toothpastes while 46% reported recommending sodium fluoride toothpastes to their clients. Over half the respondents believed that “all fluorides provide similar benefits.” This finding could be directly related to the respondents’ reported use of scientific journals in their clinical decision making; only 41% of respondents reported using peer-reviewed journals even though 84% stated that the evidence from the literature was important. This contradiction is clearly a gap that needs to be addressed.

ELECTRIC TOOTHBRUSH SURVEY⁶

Recommendations for the use of electric toothbrushes were more promising, as 90% of respondents agreed that patients who use an electric toothbrush have better gingival health, which is consistent with the evidence. Subsequently, 96% of respondents reported recommending them to their patients although only 16% believed that patients actually purchased them. However, there was a similar gap to that found in the toothpaste survey when it came to the use of scientific literature to guide electric toothbrush recommendations. Only 52% of respondents reported consulting peer-reviewed journals for their decisions, while the remainder reported using feedback from colleagues as the basis for their recommendations.

ORAL–SYSTEMIC LINK SURVEY⁷

Over 90% of respondents to this 2021 survey agreed with the presence of a link between oral health and diabetes as well as cardiovascular disease. Additionally, 87% strongly agreed that effective daily oral hygiene was important to reduce risks of numerous systemic conditions. A disconnect occurred, however, when only 25% reported that use of antimicrobial toothpastes was extremely important in reducing risk for systemic diseases and even fewer (16%) considered recommending mouth rinses. Thus, there appears to be a knowledge gap in the recommendation of chemical means to reduce oral–systemic disease risk.

SUSTAINABLE DENTISTRY SURVEY⁸

Results from this survey were very interesting as only 22% of respondents said they were familiar with the concept of sustainable dentistry. Moreover, those from North America were less familiar with the concept than those from Europe and other countries. However, after reading the definition of sustainability, 88% agreed that dental hygienists have a responsibility to contribute to sustainable dentistry, with 77% also agreeing that preventive oral care plays a role in reducing emissions. These beliefs could provide motivation to practitioners to further embrace prevention in their practices.

ORAL HYGIENE INSTRUCTION PRACTICES SURVEY⁹

Although 90% of hygienists who responded to this 2023 survey indicated the importance of prioritizing oral hygiene instruction as it provides long-term benefits to their patients, the average time spent on these instructions was between 5 and 10 minutes. The literature on effective behaviour change requires more complex strategies such as motivational interviewing or the COM-B model that take a lot more time. In addition, although 81% of respondents indicated the importance of making evidence-based product recommendations, only 64% said they made specific brand-name recommendations that are backed by clinical evidence.

CALL TO ACTION

In light of these survey findings, the white paper contains a “Call to Action” section that provides strategies on how to address the noted gaps. The most important gap identified from these surveys was in evidence-based decision making. The white paper reviews the evidence hierarchy and provides examples of what actions are appropriate for both mechanical, chemical, and home care recommendations based on the current literature. It also includes a table that addresses the following:

• What to recommend

• How to make recommendations

• How to find out what motivates your patient

• How you can assist your patient to continue active learning at home

I believe every dental hygienist worldwide should read this white paper, considering we are recognized oral disease prevention specialists. This paper also provides us with the opportunity to address the Global Oral Health Recommendations made by WHO and to make a difference globally in improving oral and overall health as well as environmental sustainability. This white paper can be viewed and downloaded at https://ifdh.org/wp-content/uploads/2023/10/IFDHWhite-Paper-FINAL-2023.pdf.

Evidence-based care is the gold standard for oral care. Clinicians can only provide high quality care and recommendations when examining the research and acting accordingly.

—Jill Rethman, IFDH President-Elect