Dental Tribune International

How to change the way South African dental professionals look at prevention

By Marc Chalupsky, DTI
August 22, 2016

JOHANNESBURG, South Africa: Elna van der Ham does not look like she will be celebrating 40 years as a professional dental hygienist next year. She is a prime example of passion for work keeping one young. A native South African, she is committed to her work as a dental hygienist at an implant clinic in Cape Town. In a country divided by income and personal wealth inequality, she aspires to educate all of her patients on how to maintain good oral health in the future before possibly retiring from her profession and dedicating her time to iTOP (individually trained oral prophylaxis). Dental Tribune Online spoke with her about her experience of iTOP and the oral health situation in South Africa.

Dental Tribune Online: How did you learn about iTOP?
Elna van der Ham: I am a registered dental hygienist in South Africa and the immediate past President of the Oral Hygienists’ Association of South Africa. I work full time in a practice specialising in periodontics and prosthodontics and I am currently the only iTOP teacher in South Africa. My discovering of iTOP was a true blessing. In 2013, the International Symposium on Dental Hygiene was held in Cape Town in South Africa. Glenda Meyer, the owner of Prime Dental, one of the largest distributors and suppliers of dental products in South Africa, was looking to train an iTOP teacher. After the conference, one of the CURAPROX representatives approached me and asked whether I would be interested in teaching iTOP in South Africa. I did not know what iTOP meant at that time. A few weeks later, I travelled to Prague in the Czech Republic for the four-day teacher-training course and have continued to attend recall courses in Lucern in Switzerland. I have so far given three iTOP courses in South Africa and will have completed another two by the end of the year. South Africa is divided into different provinces and 11 official languages, so bringing iTOP to all corners of the country is quite a task. We are planning to take iTOP to Namibia and other surrounding countries too.

What is so special about iTOP?
The best thing about iTOP was that it changed my own processes, my work in the practice and my own personal oral hygiene regime. It was indeed a lightbulb moment. I had been doing the same thing for 30 years and all of a sudden had to relook at myself and tweak the old for the better. ITOP leads to a new and healthier oral cavity and general health for everyone.

You work in a practice that focuses on implantology, one of the most important areas of restorative dentistry. Why do you place so much emphasis on prevention?
Prevention is the key to oral health. No amount of treatment is going to provide long-lasting oral health, but sustainable prevention will. The iTOP system is the only way to maintain oral health throughout one’s life. ITOP is for the whole dental team, regardless of whether one works with the patient or manages the reception. It should be implemented in every dental practice. I would recommend at least one full practice day of iTOP. We should be on the same page as and use the same language with all of our patients.

What have you encountered during your courses?
I asked a young delegate to brush her teeth with the best possible technique she normally uses, but her technique was completely incorrect. This illustrated to everyone that brushing and interdental cleaning are technique-sensitive. ITOP is about touch to teach repetition, re-demonstrating and re-emphasising correct techniques. It is easy to revert to bad habits.

Most importantly, we need to facilitate a paradigm shift in mindsets. In every iTOP training course, I have met people with their set ways of running their practice. At the last one, there was a dentist who declined to learn more about touch to teach. He wanted to stay in the waiting room, being convinced that he knew how to brush his teeth properly. He said that he had installed a screen in the waiting room for his patients on which a video explaining how to brush their teeth was shown. Such thinking is difficult to change, especially if those concerned think they have little to learn as dental professionals. For this dentist, watching a short video in the waiting room constituted teaching prevention. One cannot learn a technique from a book or pamphlet. The challenge is to change the way dental professionals look at prevention. First, one’s own behaviour needs to be modified, then the practice behaviour needs to adapt, and finally our ultimate aim is to modify the behaviour of our patients. All three steps are equally important. Dental treatment without education is unacceptable.

What is the status of dental hygiene in South Africa?
There is a dire need for dental hygiene in my country. A large part of the population has little or no access to dentistry. Very few people have access to specialised dentistry. The ratio is about 50,000 patients per hygienist, and 1,000 dental hygienists currently are registered with the Health Professions Council of South Africa. The caries rate in South Africa is tremendously high; for example, about 80 per cent of preschool children in the Western Cape have dental caries. We have to educate children from a young age in oral hygiene techniques to prevent oral disease. There are also areas with excellent dental care, but the majority of the population continues to lack access. Prevention and education in oral health issues are indeed needed in our country and remain a challenge for all in the dental profession.

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