Following the introduction of guided biofilm therapy into the oral health science BSc curriculum at the University of the Highlands and Islands, Leah Fraser shares with readers what led to this forward-thinking change.
What motivated the University of the Highlands and Islands to introduce guided biofilm therapy (GBT) to students?
There are a number of reasons behind this change in the curriculum.
First of all, guided biofilm therapy is very much a holistic approach and minimally invasive, and that is what we are trying to teach. To treat each patient as an individual and treat their specific needs.
We are too used to the term ‘full-mouth scale and polish’! We want to treat what is present and not cause unnecessary damage of any kind to the tooth surface, supra- or sub-gingivally!
Next, the evidence supports the use of this approach as more motivational, with an increase in patience comfort. Plus, ask any expert about the best treatment for implant maintenance and it is using an Airflow-type device.
Then there are the GDC learning outcomes for dental education, which encourage and stress providing students with different methods/equipment to treat patients.
I feel we are now providing students with the best education, giving them experience of using cavitron and piezo as a form of ultrasonic, enabling students to make up their own minds about what constitutes best practice, as I have.
Finally, we are training dental therapists for the future. We have to educate them with the most current and up-to-date methods and equipment.
This is where change really begins to filter concepts through, especially to the NHS system. This is the way forward with perio treatment for all, not just in private practice.
Given the university is a trailblazer by introducing GBT, was it a difficult decision?
Absolutely not – I’m surprised that we are the first.
However, it’s a great university to work for in that it is very forward thinking and innovative in its approach to education.
I have been in education for over 30 years, first as a secondary school teacher and now as a tutor. The University of the Highlands and Islands is the most exciting, forward-thinking establishment for which I have ever worked.
How did the university go about introducing GBT?
I put the case forward to the programme director.
Like me, she had attended many conferences and courses that explored the guided biofilm therapy concept.
At the University of the Highlands and Islands, we started the oral health science BSc just over 10 years ago now. So our equipment needed updating and replacing.
It was the perfect opportunity, since we needed to modernise anyway, and used that as a rationale for the necessary funding. Plus the evidence base was crucial to support our proposal.
What equipment have you brought in to facilitate the GBT training?
The Airflow Prophylaxis Master, which is a beautiful bit of kit.
We opted for the portable units, so we could get the most use out of them within the dental department. They can be used in clinic, for clinical skills, and the service wing can use them. We want as many people to benefit from them as possible, so they earn their keep.
Who will teach GBT and why?
We have excellent tutors at the University of the Highlands and Islands. It’s important that we are all trained to deliver any part of our course in clinical skills and clinic, so we all will.
What would you say to other dental education establishments that are yet to incorporate guided biofilm therapy into their curriculum?
To be honest, I feel that educational establishments already have a good understanding of the concept of guided biofilm therapy. We have been disclosing and using that to guide our treatment of patients as an underlying principle since I trained too many years ago!
So, I’m not going to tell educational establishments about disclosing. But what I can share with them is how to broaden their students’ experience and expand on their knowledge of professional mechanical plaque removal in terms of using manual and electric toothbrushes, interdental brushes or floss, hand instruments, ultrasonic such as cavitron, piezo, airflow, polish etc.
This is what we can use to achieve high standards when we’re educating future dental professionals.
We train our students on the different methods and the advantages and disadvantages of each based upon evidence.
As an educational establishment, are they giving their students varied and broad curriculum options, especially in terms of the methods to treat periodontal disease?
Which students/years will learn about guided biofilm therapy and why those in particular at that time in their education?
I have already built it into the first-year curriculum.
They will use this concept from the very beginning of their course. Session three of the perio module is professional mechanical plaque removal; they start with disclosing patients, move on to how to educate patients and motivate them through disclosing, and then how to remove plaque biofilm.
Their third clinical skills session is using Airflow, so it’s right at the start.
I want all years to experience it and hopefully I will build it into their clinical practice as soon as I can.
With COVID, this year it’s too much of an uphill battle to add more things to the timetable for them but I’m hoping to incorporate it very soon. The second years are already asking when, as they know the first years have used it and they want their chance, too.
What do the students think about the possibilities of learning guided biofilm therapy?
They are very, very excited about it. The first years had a great session this week. They have had to wait a whole semester before doing any clinical skills work due to COVID. You could really see their excitement, motivation and enthusiasm after their session. They can see the value, the advantages and how it motivates patients.
Students are working towards becoming healthcare professionals who can deliver the very best for their patients. They can see guided biofilm therapy is an important part of that.
Who wouldn’t be excited? I know I am!
What is guided biofilm therapy?
Guided biofilm therapy (GBT) is an evidence-based, indication-orientated, systematic, modular prevention or prophylaxis and therapy protocol for all dental applications.
It can be achieved in eight simple, pain-free steps:
- Assess – probe and screen every clinical case
- Disclose – make biofilm visible
- Motivate – raise awareness and teach
- Airflow – remove biofilm, stains and early calculus
- Perioflow – remove biofilm in >4 to 9 mm pockets
- ‘No pain’ Piezon – remove remaining calculus
- Check – make your patient smile
- Recall – a healthy patient equals a happy patient.
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