This article by Amanda Gallie highlights the need for preventive care in orthodontic patients and looks at delivering effective oral health instruction.


The oral hygiene instruction is an essential step in ensuring that patients are empowered with the skills and knowledge necessary for them to maintain optimal oral health at home.

Caries and periodontal related complications associated with orthodontics can be prevented by showing patients what they need to do, when and why. Most commonly this advice is given post bond-up, so here are my Top 10 suggestions for effective patient instruction:

  1. Advanced notice

Done comprehensively, a new patient induction will take between 15-20 minutes, so make sure that patients are made aware of this in advance and are not in a hurry to get away. We need them to be relaxed and a willing participant so it is important that patients are notified at the treatment commencement visit that following bond-up they will be sitting down with a team member to run through oral hygiene during treatment.

  1. Environment

If you have the space in your practice, create an oral hygiene room where it is quiet and comfortable, a nice temperature and as far away from the surgery environment as possible. This creates a more relaxed and informal atmosphere for education.

  1. Seating

Seating position is very important. Sit opposite the patient at the same level of eye-line and sit with your desk or table top at the side. There should be no physical barriers between you and the patient. If you are teaching OH in the surgery get the patient to sit on your chair and you sit in the patient chair. This reverses the power and creates equal ownership of the space. Not every patient gets to sit in the operating seat do they?

  1. Props

Be prepared. Make sure that you have some models of teeth with braces to hand, pictures of healthy and disease stages of gum inflammation and decay; and your collection of oral hygiene aids including a lightweight mirror for the patient to use.

  1. Set the scene

The goal of these sessions is to ensure that patients leave the practice following bond-up with a comprehensive understanding of the importance of oral hygiene to their treatment. And also that they know what their daily routine ought to look like.

Start by explaining the role of dental plaque in promoting tooth decay and gum disease, followed by an explanation as to how the brace makes it difficult to clean effectively. It is essential that patients understand these aspects before you move on to products and techniques.

  1. Product demonstration

Show the products in turn, encouraging them to sample mouthwashes and paste if they would like to. Try to create logical flow when demonstrating products and my suggestion would be to take the patient through each component on your recommended daily routine step by step. For further guidance on this I would recommend that you take a look at my instruction video that can be found by entering ‘VITIS Orthodontic’ in to YouTube.

  1. Touch to teach

Then take the patient on a journey through the process of cleaning. If you are demonstrating in the mouth use the touch to teach approach. With this model of education you demonstrate on yourself, or a model, with the patient copying what you do. This is the most effective technique that I have ever come across and provides the opportunity for any difficulties or errors with technique to be rectified before they become habit. If you need to correct the position of your patient’s hand or put your fingers in their mouth ask them first. It shows respect and helps the patient to relax.

  1. Style and approach

Speak slowly and allow time for questions and repeat if needed. Keep your eye contact up but with little breaks to allow for personal space and processing of information. Keep a friendly tone and keep the language light and informative in content. Be prepared to make some compromises; if you can see that the patient is struggling to keep up it may be better to strip it back to the bare essentials and set aside time at each subsequent appointment to review their progress, providing further instruction once you are comfortable that they are ready to progress.

  1. Time waits for no man/ woman

Try and adhere to your time parameters and allow time for questions. If products are not included in the treatment ask the patient if they want to take the products home now. Believe it or not, research has shown that people like to be sold to so don’t be afraid to ask and facilitate the process.

  1. Summarise learning

Repeat a small summary of the daily regime to ensure that the patient clearly understands what is expected of them. It is highly advisable to arrange some time to sit down with the patient at their next adjustment appointment to see how they are progressing and answer any questions they may have. It is really important to pick up on any problems before the consequences become irreversible. Finally the biggest tip of all, thank the patient for coming and say you look forward to the next time…this works wonders!