iTOP, or individually trained oral prophylaxis, gives dental professionals a framework of prevention, and guides them in choosing the right tools and technique for each patient to help them master their oral care. Dr Lucie Sedelmayer takes us on a deep dive into the benefits of iTOP and the indispensable role it plays in the dentistry of the future.
iTOP is built on three core principles which are acceptance, effectiveness, and atraumatic nature. What do these principles mean for you?
These principles were first suggested by my husband Jiří Sedelmayer in order to create a system of prevention. Prevention in dentistry used to be a chaos. To streamline the selection of dental tools or approaches he created three criteria they all should meet: Acceptance, effectiveness, and atraumatic nature. But meeting them is not so easy.
The patient needs to accept the respective tool or technique, and they need to be motivated to use it. It also needs to effectively help with oral care, while not causing harm or trauma. If even one of the three criteria is absent, it all falls apart.
The most important criterium for me is that the tool or technique must be motivational for the patient. If we can’t motivate the patient to use it, then it is of no use. We have to make sure they understand the reasons for brushing their teeth. We can’t just hand them a toothbrush and tell them to do everything differently. We have to foster a relationship with our patients, through love and mutual trust. In a sense, we should become their motivational “dental coaches”.
Has iTOP evolved in any way since its inception?
iTOP has evolved tremendously. Its beginnings were in the spirit of total improvisation. We didn’t even have the right tools for proper biofilm management and teaching prevention. Step by step – and with the help of Curaden – we got our hands on interdental brushes and other tools that allowed iTOP to flourish. That was the first big leap forward.
Our techniques evolved as well. We saw what motivates people and how they use the tools we give them. By analysing our work, we were able to tweak our approaches and update iTOP. But throughout these changes one thing remained the same: the core philosophy of acceptance, effectiveness, and atraumatic nature.
Another key aspect of iTOP is the individual approach. How do you align the individuality of each patient with the necessity to adhere to precise brushing techniques?
We really have to be sensitive to the individuality of each patient. The condition of their mouth is the first thing we look at, along with their capabilities and motivations. Based on that we can chose how to talk to them about proper biofilm control.
We can’t dump everything on them all at once. If we were to teach them all the right techniques at once, they’d run away from us as fast as possible. We have to choose what suits each patient and what will have the greatest benefit for them. Every oral cavity is different, and every individual patient is different. By recognizing their different needs and abilities, we can approach them in a way that is the best for them. That’s what makes iTOP so successful.
How does the individual approach look in practice?
Let’s take interdental brushing. I always start with it – whether I’m teaching students, dentists, or patients, because it can be a source of great motivation.
A lot of people don’t brush their interdental spaces at all and have no idea what kinds of problems are hiding in there. It is only when we probe their interdental spaces and they start bleeding that they realise they have a problem. That is the first step. Then, when I have their attention, I can tell them what the bleeding means and what causes it.
Afterwards, I give them a suitable toothbrush, that fits their interdental spaces nicely, and teach them how to use it. Within two or three days, they’ll see an improvement – no blood, no pain, all thanks to brushing. That has an amazing motivational effect.
That is when they start to trust me. They see that I’m not just trying to sell them a new toothbrush to make quick money off of them. The trust crates a basis for a relationship which allows me to teach them further techniques.
How do you teach proper biofilm management techniques?
The basis of iTOP is Touch to Teach. I can’t just put a movie on for the patient or hand them an educational book. They need to have a tactile experience with the tools. Through these means they can then understand the right position of the toothbrush, the right pressure, and the right movements. Oftentimes, I even tell them to close their eyes to get a better feeling for it.
What are the most common mistakes people make regarding their oral care?
I wouldn’t necessarily call it a mistake, but general lack of knowledge about proper oral care and tools is a big problem. Even though the level of knowledge has been improving significantly thanks to the work of my husband and I. When we were starting out, no one even knew about interdental brushes. In fact, my husband brought the first interdental brush to the Czech Republic in 1994.
But when it comes to mistakes patients often make, these include putting too much pressure on the toothbrush and not cleaning their sulcus properly. The sulcus is actually the most important place to brush, because it is the gateway to the whole body.
Interestingly, another common mistake is that patients don’t know how to do circles with their toothbrush. You’d think that making a circle is a terribly easy movement, but when you take into account all the nooks and crannies of our mouths, it can really give the patients a hard time.
We try to fix it through playing. For example: we have children draw big circles in the air, then smaller ones on paper, before transitioning to the mouth. Touch to Teach also plays a big role in teaching patients how to move their toothbrush correctly.
How often do you go over the correct technique with your patients?
It’s not that simple. When I’m starting with a new patient, I need to see them at least once a week. If I don’t see them within a week of the first meeting, they will start making mistakes and forgetting many of the things I’ve taught them. If we meet a couple of days after the first session, we can recalibrate their technique.
Only when they are comfortable with one technique or tool can we start adding others. That means several very intensive weeks or months at the begging of our working relationship. Only then can we gradually start spacing them out.
I see some patients only once a year – when I see that they are well versed in the techniques and motivated. Again, it is very individual. It depends on the patient’s willingness to cooperate, their skills, their oral health, their motivation…
And how often should dental professionals recalibrate their biofilm management skills?
We doctors are also only human and we need to refresh our knowledge on a regular basis. That’s why we regularly organise iTOP seminars or the Week of Clean Teeth in Czech Republic, where we work intensively with dental professionals for a couple of days.
During those events they can attend lectures, get to know the latest techniques or tools, refresh their skills, get the latest news on prevention and more. These events are a great source of motivation for all dental professionals who attend them.
But is there a fraction of dentists who are afraid that teaching their patients about prevention might lose them profits?
I wouldn’t say that they’re afraid, I would say that they’re disdainful. Some of them feel that teaching patients is below them, that is should be someone else’s responsibility. I think that’s a shame, because I’ve had the privilege of getting to know and teach three generations of my patients and we have great and rewarding relationships.
My patients are like my second family. They are the kind of people we don’t just shake hands with. We hug, and they say:“Doctor, why didn’t I meet you sooner? I could have kept more of my teeth”. It is a wonderful thing to experience. My colleagues who don’t teach their patients and who don’t build this relationship don’t get to experience these kinds of connections – which I think is a real shame.
But when it comes to the fear of losing profits, it’s all about understanding that my time as a professional has value. When you teach dance classes or give driving lessons, people are happy to pay for them. And it’s the same with iTOP. Naturally, implants are more expensive and quicker, but iTOP can really create a lasting change in your patients’ lives.
Considering how useful iTOP is for dental professionals, it surely has a place in the modern university curriculum. Is that the case, or is iTOP rarely taught at universities?
As you know, iTOP was started by my husband at a university in Hamburg. From there, it eventually spread to dozens of universities all over the world, for example in France, Austria, Serbia, Spain, Vietnam, Ecuador, Brazil, Australia, or here in the Czech Republic. Our goal was – and still is – to have teams of iTOP instructors all around the world who can teach iTOP and spread its popularity.
For example: ten years ago, we were approached by the students from the Prague Charles University Faculty of Medicine to bring iTOP to their university. We created an intensive programme with six 2-hour lectures and a practical module in which students could practice their technique. At the end of the course, they took an exam in which they demonstrated the iTOP approaches and showed that they fully understand them. In Prague we really created a top-notch programme.
It is extremely important to me that iTOP is taught at universities – because it is better to teach people the correct techniques at the begging of their professional careers, rather than having to reteach them in later life.
How do you see the future of dentistry and iTOP – especially now that more and more prevention-minded dentists are entering the workforce?
Dentistry is evolving tremendously – both in terms of know-how and in terms of tools and materials. There is an ever-present need to stay informed and to keep up with the latest trends in order to be able to make the right decisions for patients. And that’s not always easy. This is where iTOP is indispensable and what makes it – in my opinion – immortal.
I think iTOP will speak to any generation – especially if you experience it yourself and feel the difference in your mouth. I see firsthand its power when working with young people at the university. After the course is over, they bring me flowers to say thanks – because they realise the iTOP course taught them something new and useful. And they can then teach it to their friends, families, and patients. Seeing the change it can bring is the greatest satisfaction.
It’s about beautiful feedback and beautiful relationships with the patients. It’s about a greater joy of work. iTOP will help make your work better and give you more enjoyment from it. And I wish that for everyone.
Dr Lucie Sedelmayer has been a Preventive Dentistry Teacher at Charles University in Prague since 2014, actively contributing to dental professionals’ education. She graduated in 1990 from Charles University, Prague. She did a postgraduate courses in Hamburg, Munich, and Frankfurt (1991–1993) enhancing her skills. In 1994, she established a private dental office in Prague, showcasing entrepreneurial spirit. She has been the iTOP Chief Instructor since 2000, and is a Teacher of Preventive dentistry at Charles University. Dr Lucie Sedelmayer is one of the founders of the Czech preventive association, was its vice chairman for seven years, and was elected president of the association in April 2023.
