Sales and MarketingIn This Issue, page 1

June 2012

Perio Reports Vol. 24 No. 6page 2

Message Board

Interesting Marketing Ideaspage 11

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»Inside This Section2 Perio Reports7 Profile in Oral Health: Communicating in Sound Bites11 Message Board: Interesting Marketing Ideas

Sales and Marketing

by Trisha E. O’Hehir, RDH, MSHygienetown Editorial Director

You might not think of yourself as a sales person, but weare all selling something. Sales go beyond commodities formoney. Sometimes the sale depends on compliance or cooper-ation, not money. Kids sell their parents on the ideas of stay-ing up later, having more dessert or playing more video games.Two people in a relationship are “selling” the continuation ofthe relationship with each other.

Sales is an intricate part of many aspects of dentistry.Selling restorative dentistry procedures is obvious because

money changes hands, but selling goes on in the practice onmany levels. Reaching out to new patients is part of sales.You want them to “buy” the idea of being a patient of recordin your practice. Keeping current patients also requires “sell-ing” them on that idea.

Successful selling results in buying with money, commit-ment or compliance. Marketing is what you do to get patientsto buy anything from restorative treatment to daily oral hygieneat home. We often market with science and logic, selling thescientific reasons for dentistry and good oral health. We canlearn from those in the marketing and advertising industryand use sound bites to convey scientific messages or give

something away that the buyer wants.Effective marketing taps into emotion, and then follows

it up with science and logic. A logical emotional tie for den-tistry is kissability or fresh breath. Simply add an emotionalhook before each sound bite – “To be more kissable, (insertsound bite)” or “To have fresh breath, (insert sound bite).”

Giving away a desirable commodity, like whitening, isanother way to successfully “sell” your practice to potentialpatients. There’s no denying it, we are all sales people, sohave fun with it, learn from your colleagues and the adver-tising experts and increase your sales. �

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Clinical Implications: The AAPD sup-ports the use of xylitol as part of a pre-ventive strategy. �

AAPD Council on Clinical Affairs. Policy on the use of xylitol in Caries

Prevention. Pediatr Dent 33: 6, 42-22, 2010.

The American Academy of Pediatric Dentistry (AAPD)recognizes the caries preventive benefits of xylitol. Its policy,based on current scientific research, assists dental profession-als in making informed decisions on the use of xylitol prod-ucts for caries prevention. The original xylitol policy wasadopted in 2006, with this update in 2010.

A total of 240 articles were reviewed pertaining specifi-cally to xylitol use for caries prevention, with 25 reviewedfor the 2010 update.

The dental benefits of xylitol were first recognized inFinland in 1970. In 1975, the first xylitol-sweetened chew-ing gum was developed. The Turku Sugar Studies were thefirst xylitol studies in humans showing a relationshipbetween dental plaque and xylitol. Early studies comparingsucrose-sweetened to xylitol-sweetened chewing gumreported caries rates one-third as high in the xylitol groupcompared to the sucrose group.

A long-term study published in 1995 comparing xylitol,sorbitol and sucrose consumption revealed lower plaquescores and lower levels of salivary bacteria in the xylitol group.

Studies suggest xylitol consistently produces positiveresults with 4-10 grams per day divided into three toseven exposures. Higher daily intake doesn’t provideadvantages, while frequency of less than three exposuresprovides no benefit.

Benefits of daily xylitol consumption include reducedplaque formation, reduced bacterial adherence and preven-tion of enamel demineralization. Long-term effects demon-strated benefits at five years after xylitol-sweetened chewinggum. Xylitol currently is available in many forms: gums,mints, chewable tablets, lozenges, toothpastes, mouth-washes, cough mixtures and nutraceutical products. Otherxylitol products are being studied.

Xylitol Prevents Transmission of Bacteria from Mother to Child

Xylitol is a five-carbon, natural sugar that does not con-tribute to caries. Daily oral consumption of xylitol appears tointerfere with the adhesion properties of Mutans streptococci(MS) bacteria. In other words, MS sheds easily from plaqueinto saliva.

Researchers in Finland compared 169 mother-child pairsto determine if the transmission of MS mothers to infantscould be prevented with the mothers’ daily consumption ofxylitol. The mothers were assigned to one of three groups:xylitol chewing gum three times daily, chlorhexidine varnishor fluoride varnish. The varnishes were applied every sixmonths over the two-year study period.

Baseline data was taken during pregnancy and all mothersshowed high salivary levels of MS. The 106 mothers in the xyl-itol group began chewing xylitol-sweetened gum three monthsafter delivery of their babies. There were 66 women in the twovarnish groups. The children received no treatment. MS weremeasured in the mothers’ saliva every six months for two years.

The mothers’ salivary MS levels remained high amongthe three study groups throughout the study. At two years ofage, the MS transmission from mothers to children was low-est in the xylitol group, 9.7 percent of children had MS insaliva, compared to 29 percent in the chlorhexidine varnishgroup and 49 percent in the fluoride varnish group.

Clinical Implications: A mother’s use of xylitol chewing gum during the first two years of their child’s life will reduceMS transmission to the child’s mouth. �

Söderling, E., Isokangas, P., Pienikäkkinen, K., Tenovuo, J.: Influence of Maternal Xylitol Consumption on Acquisition of Mutans Streptococci by Infants. J Dent Res, 79:3, 882-887, 2000.

Perio Reports Vol. 24, No. 6Perio Reports provides easy-to-read research summaries on topics of specificinterest to clinicians. Perio Reports research summaries will be included in eachissue to keep you on the cutting edge of dental hygiene science.

Health Benefits of Xylitol Recognized by AAPD

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Oral Probiotics Reduce Cariogenic Bacteria in Children

Two over-the-counter oral probiotics are now availableto control cariogenic bacteria: PerioBalance by SunstarButler and EvoraKids by Oragenics. PerioBalanceuses Lactobacilli reuteri and EvoraKids usesProBiora3, a blend of Streptococcus oralis,Streptococcus uberis and Streptococcus rattus.

Researchers at Children’s Memorial Hospitalin Chicago, Illinois, tested PerioBalance andEvoraKids on children found to be at moderateto high caries risk using a caries risk assessmentsystem (CAMBRA). The 60 children involved inthis study were ages six to 12. The oral probioticlozenges were taken daily for 28 days.

Baseline saliva samples were collected and theCaries Risk Test (CRT) from Ivoclar was used to measureStrep mutans (SM) and Lactobacilli. The process of the CRTincubates saliva samples applied to two agar carriers placedin an incubator for 48 hours. SM grow blue colonies on theagar carrier and Lactobacilli grow white colonies. The CRTwas repeated at six to eight weeks.

Both test groups showed significant reductions in thenumber of colony-forming units of oral bacteria from base-line to end of study. PerioBalance SM values were reduced-6.78 and Lactobacilli -5.762. EvoraKids SM values werereduced -7.33 and Lactobacilli -2.952.

Clinical Implications: Over-the-counter oral probioticsare effective in decreasing cariogenic bacteria in chil-dren found to be at moderate to high risk of caries. �

Cannon, M., Walsh, B., Vorachek, A., Kramer, S., Esterly, R.: DNA-PCR and CRT Results in Children

After Probiotic Use. J Dent Res, Abstract 9, 2012.

Oral Probiotics and Experimental Gingivitis

Oral probiotics in the form of mints or chew-ing gums introduce healthy bacteria to the oralcavity. The goal is to change the balance of theoral flora to one of health. Lactobacillus reuteri(L. reuteri) colonizes the intestines of healthyhumans. It was isolated in the 1960 by microbiol-ogist Gerhard Reuter, after whom it was laternamed. L. Reuteri produces an antibiotic sub-stance that can kill harmful oral bacteria causingcaries or periodontitis.

Researchers at the University of Texas inHouston wanted to know if introducing an oral probi-otic when subjects performed no oral hygiene wouldprevent experimental gingivitis. A group of 53 adultsparticipated in this study. Baseline data included gingi-val index, plaque index and unstimulated saliva to testfor bacteria. All subjects received a prophylaxis and wereinstructed to refrain from all oral hygiene for two weeksand chew their assigned gum once daily. The test groupof 26 subjects was given chewing gum containing L.reuteri, and the control group of 27 subjects was giventhe placebo chewing gum. Both subjects and examinerswere blinded to group assignments.

At two weeks and four weeks both groups showedsignificantly increased plaque levels and gingivitis scores.There were no differences between groups for these clin-ical indices. Saliva samples from all subjects in the con-trol group tested negative for the presence of L. Reuteri.In the test group, 40 percent of saliva samples testedpositive for the presence of L. reuteri.

Clinical Implications: A probiotic chewing gumcan introduce and promote colonization of goodbacteria, but once daily is not enough to preventexperimental gingivitis. �

Tran, L., Flaitz, C., Rigney, T., Tribble, G., Katancik, J.: The Effects of the Probiotic,

Lactobacillus reuteri, on Experimental Gingivitis. J Dent Res, Abstract 1533, 2012.

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Clinical Implications: The Water Flosser is moreeffective for plaque removal and reducing gin-givitis than the Air Flosser. �

Sharma, N., Lyle, D., Qaqish, J., Schuller, R.: Comparison of two power interdental clean-

ing devices on the reduction of gingivitis. J Clin Dent 23:1, 22-26, 2012.

New alternatives are needed for cleaningbetween the teeth, since compliance with dentalflossing with string floss is so low. Flossing with

water has been available for manydecades from WaterPik and a newinterdental cleaning device is nowavailable from Philips Sonicare,the Air Floss. This device com-bines a puff of air with a smallamount of water directed betweenthe teeth.

Researchers at BioSci Researchin Canada compared the WaterPikWater Flosser and the PhilipsSonicare Air Floss in a group of 82 subjects over four weeks. Allsubjects used a manual toothbrushplus their assigned irrigation

device. Instructions were both written and verbaland were repeated at two weeks. Gingivitis, bleeding

and plaque scores were recorded at baseline, twoweeks and four weeks.

At two weeks and four weeks, both groupsshowed significant clinical improvement comparedto baseline. Those using the Water Flosser demon-strated significantly more effective reductions inboth plaque and gingivitis at week two and weekfour in all areas measured. At the end of the study,gingivitis was reduced more in the Water Flossergroup compared to the Air Floss group. At fourweeks, full-mouth plaque levels were 51 percent inthe Air Floss group compared to 30 percent in theWater Floss group. For the air floss group, plaquelevels were higher on approximal surfaces, 77 per-cent compared to 48 percent, and 53 percent onfacial surfaces compared to 36 percent.

Comparison of Water Flosser and Air Floss

Tongue Cleaning Reduces Bad Breath

Everyone has bad breath sometimes, and some peoplehave chronic bad breath all the time, from 25 to 50 percent,depending on the population. Morning bad breath is due toovernight dryness when saliva flow is at it lowest, enhancingthe growth of oral bacteria. Bacterial biofilm accumulates onand around the teeth, and is also part of tongue coating,especially on the dorsum of the tongue. Eating and drinkingin the morning tends to eliminate overnight bad breath, butsometimes it is a chronic problem.

Ninety percent of bad breath can be attributed to oralcauses including caries, periodontal disease, poor oralhygiene and tongue coating. The gold standard of measuringbad breath is organoleptic testing or smelling the person’s

breath. It is also measured by the level of unpleasant-smelling volatile sulfur compounds (VSC) in the mouth air.

Researchers at three universities in The Netherlandsreviewed the research to determine if tongue cleaning with ascraper or toothbrush in addition to regular oral hygienewould reduce oral malodor. Of the 405 studies and abstractstheir search produced, 22 full-text articles were read and 17of these were excluded as they didn’t match the establishedcriteria they were looking for in the studies. The five studiesthat did fit all criteria were evaluated and compared, show-ing that tongue scraping or brushing does reduce oral mal-odor. These studies did not evaluate chronic bad breath.

Clinical Implications: Results of this systematic review suggest that cleaning the dorsum of the tongue with a scraperor brush will reduce oral malodor. �

Van der Sleen, M., Slot, D., Van Trijffel, E., Winkel, E., Van der Weijden, G.: Effectiveness of Mechanical Tongue Cleaning on Breath Odour and Tongue Coating: A Systemic Review. Int J Dent Hygiene 8:

258-268, 2010.

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Communicating with Sound 7

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Do you ever feel like a science professor talking to yourpatients? The more research you read, the more you know aboutinfection, inflammation, pH and the oral-systemic link, thelonger your discussions with patients take; the story just getslonger and longer.

According to communications expert Joan Horbiak, theaverage person can only process three messages at one time andremembers less than 10 percent of the information received.Television audiences are bombarded with repeated messages.Advertisers know that it takes seven to 15 times for a message tohit home with a listener. We only see our patients a few timeseach year, and our messages are often buried deep in the tangleof information we feel obligated to share. No wonder dental dis-ease is still prevalent. The prevention message is getting lost. Ifpatients are only remembering 10 percent of what we tell them,is it the 10 percent we want them to remember?

We need a new strategy to get the important, bottom-line mes-sages across to patients during busy, time-constrained appointments.Marketing experts get their messages across using sound bites. Theyshrink the messages to just a few words and repeat often.

Mark Twain talked about the idea of sound bites before theterm was coined. He said, “a minimum of sound to a maximumof sense.” By isolating a short phrase that is easy to remember, ithelps the phrase better stick out in a person’s memory.

Many sound bites stand the test of time, being recognizeddecades later. Some include:

“Just do it!” –Nike“Brings good things to life.” –GE“We try harder.” –Avis“Don’t leave home without it.” –American Express“Think Different” –Apple“I’m lovin’ it.” –McDonald’s“Melts in your mouth, not in your hand.” –M&M’s“A little dab’ll do ya.” –Brylcreem“The Few. The Proud.” –U.S. Marines

Learning from successful advertisers, we can sculpt messagesand repeat them during dental visits, thus competing withtoday’s overload of mass media messaging. Sound bite messagesare perfect for communicating oral health messages.

Sound bites need to be positive, clear, simple, brief, ask forspecific actions and be repeated several times during the visit tohave the greatest chance of being remembered. One of my favoritesound bites is “start cleaning in between.” Last month’s Profile inOral Health discussed toothbrushing and how the interproximal

surfaces are at greater risk of disease than brushing surfaces. Basedon this scientific information, our first message to patients shouldbe to clean between the teeth before toothbrushing.

Let’s check to see if this sound bite “start cleaning inbetween” fits the rules for an effective marketing message. Themessage is positive and clear. It’s simple, and brief, only fourwords. The message also asks for a specific action: to start thecleaning process between the teeth, not with toothbrushing.

You can use sound bites to present oral health advice, caries riskassessment findings, periodontal disease information and a varietyof treatment options. Keep it simple, short and a positive call toaction. Here are a few of my favorite oral health sound bites.

Strive for Five Xylitol Exposures Each DayXylitol is a natural sugar produced in small amounts in our

bodies every day as part of glucose metabolism. It was first har-vested from the bark of trees and is currently extracted fromcorncobs and corn stalks, but not from the corn itself. It tastesjust like sucrose, has fewer calories and a slight cooling sensationthat stimulates salivation.

Adding at least five grams of xylitol, five times daily is a goodidea for everyone, not just those at risk of caries. It makes sensefor people who want to reduce the bacterial biofilm in theirmouth and sinuses. Daily xylitol consumption after meals andsnacks will prevent acid production by oral bacteria and thusreduce plaque biofilm accumulation. Preventing the first cariouslesion begins with changes in the oral health of mothers, whopass their oral flora to infants through saliva. Research by Dr.Eva Söderling and summarized in Perio Reports this month con-firms this important primary preventive strategy.

Finland was the leader in endorsing and supporting the useof xylitol 30 years ago. Since then, many dental and dentalhygiene associations around the world have endorsed the pre-ventive benefits of xylitol. Recently the American Academy ofPediatric Dentistry joined this movement. For more details onthis, read the summary in Perio Reports this month.

Eat Bacteria Twice a Day – in an Oral Probiotic MintProbiotics are live micro-organisms that confer beneficial

effects on the balance of bacteria, not just in the intestines, butalso in the mouth. Some strains of the good bacteria produceantibiotics that destroy the bacteria responsible for caries andperiodontal disease. Probiotics provide the potential for easy,effective ways to prevent dental disease that also taste good.

Bites by Trisha E. O’Hehir, RDH, MS

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Over-the-counter products come in many forms: mints,lozenges or chewing gums. Probiotics contain one or morestrains of good oral bacteria. Evora products use ProBiora3 containing S uberis KJ2, S oralis KJ3 and S rattus JH145.PerioBalance uses Lactobacillus reuteri Prodentis from BioGaia, aSwedish biotechnology company. BLIS K12, developed by aresearcher in New Zealand, is used in several products focusedon preventing throat infections. Recent abstracts on the topic ofprobiotics that were presented at the American Association forDental Research meeting in March areincluded in this issue’s Perio Reports sec-tion. Probiotics for oral health provide anew and exciting approach to balancingoral bacteria and promoting oral disease.

Start Cleaning in BetweenThe smooth tooth surfaces at greatest

risk for caries and periodontal disease arethe surfaces between the teeth, not facialand lingual where the toothbrush reaches.Despite this fact, toothbrushing receives more focus than cleaningin between the teeth. Simply changing the focus from tooth-brushing to cleaning in between the teeth will send an importantmessage to patients that proximal surfaces need daily attention.Making this transition goes against the long-held tradition oftoothbrushing being the primary focus of oral hygiene. To getpatients’ attention, tell them to “skip brushing and start cleaningin between” the teeth. No patient ever expects to be told by a den-tal professional to skip toothbrushing. Just saying this will gettheir attention. Whatever you say next, they will hear, so use theopportunity to change the focus to interproximal surfaces.

Floss with WaterString floss isn’t very popular and those who report daily

flossing aren’t very effective at removing plaque biofilm. Theprofession’s belief that everyone should floss with string floss isnot based on scientific evidence. We keep telling people to floss,but patients continue to ignore that message. An alternative isflossing with water. Rather than using string, flossing with waterin an oral irrigator is an effective way to remove plaque biofilm.Research over many decades shows the effectiveness of theWaterPik Water Flosser to reduce interproximal plaque, bleed-ing and probing depths. Recently Philips Sonicare introducedthe Air Floss as an alternative to string floss, with forced air andwater. A comparison of these two alternatives to string floss ispresented in Perio Reports this month. The water flosser wasmore effective at removing plaque and reducing gingivitis.

Dry Brush Inside FirstAsk any hygienist where the most calculus forms and you’ll

hear mandibular linguals. Ask patients and they’ll tell you the

most “digging” goes on behind the lower front teeth. Despitethe best efforts of dentists and hygienists to convince people tofollow a systematic approach to brushing that cover all surfacesequally, people follow an erratic rather than methodical brush-ing pattern. This toothbrushing pattern rarely includes lingualsurfaces and if it does, only a few seconds are spent there.Printed toothbrushing instructions begin with images on maxil-lary facial surfaces and leave lingual surfaces to last. Since calcu-lus builds up so quickly on the inside of the lower anterior teeth,

simply change the brushing routine toreflect that. Starting the brushing on themandibular linguals will remove the plaquebiofilm before it has a chance to calcify intocalculus. Brushing first without toothpasteallows the person to feel with their tongueto make sure all the plaque biofilm has been removed before adding toothpaste.Toothpaste flavors and bubbles make effec-tive plaque removal more difficult. Drybrushing inside first was tested with 125

adults and found to be an effective way to reduce lingual calcu-lus and gingival bleeding. (O’Hehir, JADA, 1998).

Clean Your TonguePlaque biofilm accumulating on the tongue is a source of

bad breath. In addition to cleaning in between the teeth, per-haps flossing with water, dry brushing inside first, striving forfive xylitol exposures each day and eating bacteria, cleaning thetongue is important to ensure fresh breath. Cleaning the tonguealso reduces the overall amount of bacteria in the mouth. A vari-ety of tongue scrapers are available for tongue cleaning. TheWater Flosser has a tongue cleaner tip to flush and scrape thetongue at the same time. Many people simply use their regulartoothbrush, a spoon or a washcloth. While some studies reportthe tongue scraper superior to the toothbrush, other studies findthe toothbrush superior. An evaluation of several tongue clean-ing studies confirms that cleaning the tongue reduces badbreath, but it doesn’t report either the scraper or toothbrush bet-ter than the other. Simply cleaning the tongue makes a differ-ence. This review article is included in Perio Reports this month.

These are just a few of the sound bites you can use to com-municate your message to patients. Before you see your nextpatient, decide on the sound bite you want them to rememberwhen they leave your office. Remember to repeat the sound biteseveral times throughout the visit. You’ll feel silly doing this, buthow many times have you been introduced to someone and 30seconds later you’ve forgotten their name? Repeating the soundbite message makes it easier for the patient to remember it longafter the visit. Shorten your conversations with patients and tar-get your messages by using sound bites. Have fun creating yourown favorite sound bites. �

Sound Bites

Strive for Five Xylitol Exposures Eat Bacteria Twice a Day (Oral Probiotics)Start Cleaning in BetweenFloss with WaterDry Brush Inside FirstClean your Tongue

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»Hygienetown Message Board > Business of Dental Hygiene > Marketing > Interesting Marketing Ideas ▼

Interesting Marketing IdeasNeed some fresh new ideas for marketing a practice? Check out these successful strategies tested out by other Townies.

Our practice has recently extended an invitation to the specialty offices we work with forcomplimentary dental hygiene visits, exams and X-rays, for specialists and their team mem-bers. We think this will be an excellent opportunity for them to familiarize themselves withour office and the services we provide. We decided to offer this service after an orthodontistin our area provided treatment for our team members free of charge. We are constantly try-ing to send referrals his way – not to mention we are now walking billboards! I would loveto hear of any different marketing ideas. ■

A few years back the doctor offered a free whitening to all of the beauticians inour town. His thinking was for them to be a billboard for our office. It worked prettywell too. ■

I love the idea of the free whitening. I talked to the doctors about it this morning andthey want to give it a try. Thank you so much of the idea! ■

A simple marketing idea is providing business cards for members of the team sothey can tell friends, family and people they meet in the community about the greatoffice where they work. How often do people ask you if you know a good dentist orgood dental office? ■

A dentist I’ve subbed for has referral cards that his patients can give their friendsand family. Once the new patient completes a dental hygiene visit, new patient examand FMX, he or she receives free whitening. I’m not sure, but I believe the patient whodid the referring also gets free whitening. ■

We offer complimentary home whitening to all of our new patients (after compexam, dental hygiene visit and FMX). It’s relatively inexpensive and patients love it!

We also have an incentive program called “Care to Share,” which basically statesthat with each referral (non-family) your friend receives a $25 credit to his or heraccount and the existing patient also receives $25 to his or her account. This is also very pop-ular with patients and gets them motivated to tell all their friends about their great experi-ence at our office. I remember one patient who referred so many patients it essentiallybought her NTI appliance! ■

At our office, all patients leave with a follow-up card (basically just a card with post-opinstructions and our contact info). On the other side of the card is a note encouraging

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patients to tell their friends about the great treatment they have received, and informationabout new patient exams. The DDS offers a free electric toothbrush (Oral-B) to new patients(but only new patients who were referred by existing patients). She also gives gift certificatesfor a night out at the movies to patients who have referred friends. A dentist that I used towork for had a bridal shop right next to his office. He put business cards in the bridal shop,offering free whitening to brides who heard about him from the dress shop. ■

My dental office does what is called Free Whitening For Life. Basically, as long as you area patient and always keep your regular six-month dental hygiene appointments you will gettwo free tubes of whitening gel at those visits. When you first sign up for it, we make yourtrays free of charge and give you the models to take home too, in case something happens toone of your trays, then you have the models to have a new one made. The office does ortho,so for a Christmas promotion last year we offered a free iPod Touch (or $300 off ) for start-ing ortho treatment. ■

Yes, the free whitening to new patients (and White for Life) has taken over themarket in many cities. In Vancouver it is so common that saturation has drasticallyreduced its marketing effectiveness. Here we are one of the first to try it and it is stillworking well. We are also offering half-off Zoom to new patients. One concern is that

many patients are not suitable or don’t want whitening, but feel they are missing out, so Iam thinking of giving them Vitality Sonic electric brushes. Trouble is, the brushes at $17,cost me more than the whitening! Another thing we plan to try is working with a few otherbusinesses on a “makeover team” contest promo, where an individual is selected to receivefree cosmetic dental work, clothes, hair, makeup and Botox from various participating busi-nesses and the story is published and broadcast on local TV. ■

An office in Madison, Wisconsin, does some really great marketing. They work with GirlScouts to get them badges, give out apples on Johnny Appleseed Day and give out roses onValentine’s Day – all getting local media coverage. ■

Dr. James Michaels buys two boxes of Girl Scout cookies from every Girl Scoutwho comes by his office selling them. He then sends the cookies, through “OperationGratitude” to the troops overseas. This gets local media coverage too. ■

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