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The iTOP—which stands for individually trained oral prophylaxis—training programme is for dental professionals who want to set up patients for a lifetime of oral health. In an iTOP session, dental professionals learn about the correct tools and techniques for perfect brushing and oral care through hands-on practice so that they can teach patients in turn. Dentist and iTOP trainer Dr Franka Baranović Huber explained how practical brushing skills are still lacking among dentists and how exactly patients can benefit from iTOP.
Dr Baranović Huber, is there a knowledge gap when it comes to correct brushing?
When I was studying dentistry at university, I learnt how to repair and fill teeth with composite, prepare crowns and perform root canal treatment, but we received no practical training on how to brush properly or use interdental cleaning devices. I finished my studies in Switzerland in 1991. We are in 2020 now, and nothing has changed. How are dentists supposed to instruct and motivate their patients towards good brushing and good oral health if they have never learnt to do it themselves?
Mechanical plaque control is the sine qua non for achieving and maintaining oral health over the long term. But at the same time, practical knowledge on how to maintain the health of the oral cavity is a gap in the curriculum for dental students. ITOP is there to fill this gap.
So how does iTOP help?
A dental professional who possesses in-depth practical knowledge must show each patient directly in his or her own mouth exactly where, how and with which tool the teeth should be cleaned. This knowledge is key, but in reality, most of us are autodidacts.
This is where iTOP comes in. During an iTOP session, dental professionals learn perfect, atraumatic toothbrushing with the right tools so that they in turn can teach their patients. Patients should have the opportunity to practise in the presence of a supervisor. Repeated individual instruction and practical training are key. Without these, patients cannot achieve successful primary prevention or avoid potential damage to soft tissue, interdental papillae and teeth.
Why is interdental brushing such a crucial part of iTOP?
The interdental space is crucial: it is here that caries, as well as gingival and periodontal diseases are most likely to emerge. But at the same time, the interdental space cannot be reached, let alone cleaned, by a standard toothbrush’s bristles, no matter what the design or shape is. The only cleaning devices able to pass through an intact interdental space are floss and interdental brushes.
In terms of effectivity, interdental brushes have proved to be superior to floss in the reduction of bleeding and plaque, but for optimal results, it is important that the brush maximally fills out the interdental space. During iTOP seminars, participants learn how to calibrate their own interdental spaces and determine which size of interdental brush is needed for each interdental space. Then, they learn how to use interdental brushes on themselves. I would like to stress that we are not talking about open interdental spaces displaying periodontal attachment loss. We are practicing on closed, healthy interdental spaces with an intact periodontium and papillae. The latest generation of interdental brushes was conceived especially for this purpose: primary prevention.
Lastly, what is the best way to motivate patients?
If you are going to motivate someone, you have to be living proof of what you are preaching. Before learning about iTOP, I had a hard time motivating patients. Although I was telling them to brush interdentally, I was not doing it myself regularly either! You cannot fool your patients. They can sense when you are lying. But when you, as a dental professional, can testify that you have the knowledge and that you practise what you preach, patient motivation comes from a real place. Dentists have to be a living testimony to what they tell their patients. If not, it is impossible to convince anyone.
Editorial note: Dental professionals who wish to take part in an iTOP seminar can check out the dates and locations for a nearby session here.