Dental hygienist and dental therapist Theodora Little says that she loves to educate her patients, but when it comes to interdental cleaning, even the best teacher can fail unless they can change the behaviour of their patients. In this interview, clinical manager of Curaden’s Prevention One project explains how one simple app can have a great impact on the daily routines of patients.
Do you make any recommendations to professionals for how best to use the BOB-App, or do you leave it up to them?
I recommend to use three methods I created, to support and enhance the implementation of BOB. The implementation strategy is helpful when beginning to use the BOB App in practice: The 3 methods being the BOB Interactive method, BOB Visual method and BOB Silent method.
For example, the BOB-App Interactive method, where the patient actually enters their own data on the tablet, is really engaging for them. There’s a mirror on the top, so the patient can view what the dental hygienist is doing. So we’re teaching the patient the technique of using interdental brushes whilst at the same time completing a bleeding score.
This approach is really the ultimate for me. Because they are the ones actually inputting, the patients take control of their own health. They can see they’re bleeding. They’re taking ownership of their own body, their own health, and it allows the clinician to take a step back and just guide the patient to their own answers and therefore self empowerment.
Could you tell us more about your background? How did you become a member of the Prevention One team?
I’m a dental hygienist and a dental therapist qualified from King’s College in London. After my studies, I was hired to work in the Curaden clinic in London. Curaden then approached me with a proposal to support them with their new Prevention One project.
My task was to use the BOB-App on a trial basis in the clinic with my patients. It was something completely new; I had never used technology like this before with my patients. I was testing what worked and what didn’t in the app providing feedback to the development team. It was great to be part of the team that helped refine the BOB-App to what it is today.
The BOB-App today is an application used in many countries. How has your role in the project changed?
Today I am the clinical manager for Prevention One. I still complete trials of the app and support with updates, but I also complete a variety of training to professionals in how to use the BOB-App so it can be smoothly implemented into real practices.
The main mission of Prevention One is to change behaviour, beginning with the behaviour of our dental professionals. That’s a key point for us.
We need to support our dental professionals in implementing the BOB-App in the most user-friendly way so that, when the time comes, they can feel confident and competent in using both the application and the products that support it in the dental office with the patient.
How does the whole process of launching the BOB-App unfold?
When the project is scheduled for soft launch in a certain country, I visit the dental offices to set up test sites and train the dental professionals that will be implementing it. After a set time, we return to the same country for the so-called hard launch. During this next phase, I work directly with the partner to hire Prevention One specialists who I can then train to become trainers themselves in the BOB-App. Ultimately, they will be responsible for going to the offices and training other dental professionals in how to use and implement the app.
You said that the launch of the BOB-App is always guided by educational training. Why is this so?
Through Prevention One, we are trying to develop community and education around this behavioural change for patients. But for us, the BOB-App is not just an app; it’s connected with iTop and our touch-to-teach philosophy. We don’t teach how to use BOB-App without touch-to-teach because it’s so important for professionals to be fully aware and fully confident in using the CURAPROX interdental brushes in the most effective, atraumatic and accepted way.
In how many countries have you launched the BOB-App so far?
At the moment we’ve launched in ten countries: Switzerland, UK, Brazil, Japan, South Korea, Italy, Spain, Ukraine, Germany, and South Africa.
How do you select countries for launching BOB-App?
It’s really important to have key iTop teachers and educational teams that we can involve in these countries because, without an educational team, it would be quite hard to get up and running with the BOB-app. So we like to begin with these countries that already have educational support in place because it’s the most efficient and educated way to get the app being used in practice.
What advantage does the BOB-App offer for dental professionals?
We know that using the app takes dental professionals out of their comfort zone, so we really strive to support them and offer different options for using this application. But once they can see the results – their patients coming back with lower bleeding scores and a high motivation to continue interdental cleaning – they appreciate it.
And also from a dental practice’s point of view, it’s really interesting how many referrals you can receive thanks to this interactive method. Patients talk about it because it’s so different; nothing else involves the patients in such a way. It’s definitely a talking point for people.
When you compare using the BOB app with your previous practice as a dental hygienist, what’s the difference? How does BOB-App help you?
As a dental hygienist and a dental therapist, I love educating my patients. You can teach people as much as you can, but it still doesn’t mean that they’re going to implement what you’ve taught them.
Even with great oral hygiene instructions and touch-to-teach methods, patients were still coming back with the same problems, the same lack of motivation, especially when it came to interdental cleaning. It’s a global challenge.
Interdental cleaning is a behaviour, and to be able to carry out that behaviour, you need to implement a daily habit and know the skills that are needed to create that behaviour.
The BOB-App helps my patients to have greater motivation, to actually start using interdental aids. The scores also work as emotional triggers which inform and motivate them to lower their score.
I also notice that my recall appointments are improving. Ideally I want my patients with high inflammation to come back in maybe one or two weeks’ time for a review – a purely oral hygiene coaching session without any dental treatment. That was very difficult to offer as a paying service; patients weren’t very impressed. They expected to come back and have a physical cleaning.
However, when I started using BOB, my patients had no problem coming back in one or two weeks’ time. There was a shift in mindset, and I really believe that it’s because we have that physical element in the BOB-App.
It’s a game. It’s not just me showing them how to use the interdental brushes. They have a visual aid through which they are being triggered, one that actually assigns value, both to prevention and to prevention as a service that we offer to patients. Now they receive all of their scores, their mouth maps, they get something tangible that helps them see what’s happening. And also with BOB, you can actually reward your patients.
That’s interesting. What do you mean by rewarding the patients?
BOB has four different score categories for gum inflammation: severe, moderate, mild and no inflammation. Through these scores, we can further motivate our patients and reward them for being healthy. So if patients can improve on the category scale, let’s say, from moderate inflammation to mild in a week or two, you could offer them a discount of 10 percent off their next prevention service appointment or some other reward.
And the active reward is a strong motivational factor when it comes to implementing stronger and longer daily habits because, as human beings, we all like to be rewarded! So I really make use of rewards.
So thanks to the BOB-App, I can really see the improvement in my patients’ health, and returning patients feel more confident and competent in using the interdental aids.
What’s the feedback of the patients so far? What do they tell you after they first use the BOB-App?
They keep telling me it’s fun. We also joke about it. For example, the patients will say things like “Are you bobbing me today?” or “I’ve been bobbed.” We have fun with the name BOB, which is really cool, and having a catchy word also really helps when we’re trying to build on behaviours. It’s not complicated dental terminology.
I have never actually had a negative response to this. I’ve not had one single patient say that they didn’t like it or didn’t feel comfortable.
What do the dental professionals who have already started to use the app say about it?
With regard to my colleagues as well, it’s something very different and fun for them. As a dental hygienist, you do basically the same procedures every day – perform the same dental cleanings, offer the same oral hygiene instructions, and so on. The BOB-App re-motivates the dental professional as well. It allows them to let their patients take ownership of their health, of their habits.
It’s a very professional and clinical application that tracks universal bleeding in response to interdental brushing. However, we’re making dentistry just a bit more fun. We are not saying that this is the best bleeding index and everybody has to use it. We’re saying it’s an alternative or adjunctive.
From a patient motivational aspect, and maybe for a new patient or someone who is very phobic or has a lot of inflammation, it would be nicer, kinder and more gentle to start with the bleeding on brushing index via the app instead of a scary what they believe is a sharp probe. It helps patients to gain a different perspective.
When you work so much with patients and you really want to see some improvement, it’s quite disheartening to keep having the same result. But when you get patients coming back with lower scores and with an overall improvement in their health, this is highly rewarding, especially when dental professionals know they’ve helped to motivate that improvement.
From a dental professional point of view, this app is really simple, but that’s what I love. Often, it’s the simplest things that can have the biggest impact.
Business developer of Prevention One Tom Huigen: “If you would like to set your practice apart from all the others, then the BOB-App is a wonderful tool for you”
Tom Huigen has experienced the struggles of teaching and motivating patients to practice prevention in his own dental clinic. Now, he is using his personal experience as a business developer of Prevention One and, together with Theodora Little and their team, helps dental professionals worldwide that are having the same struggles.
Tom, you’ve been involved in developing the BOB-App from the very beginning. What’s the idea behind it?
Prevention in dental care is not very popular. Prevention, to prevent something… It’s really hard to make these terms seem really concrete. Dental professionals around the world are struggling with this.
It’s always the dentist or some other dental professional who has to motivate the patients, usually by repeatedly warning them of what potential problems could arise in the future, or advising them to clean better or to start using interdental brushes.
Prevention One turns prevention into a journey by making something fun out of prevention. BOB-App is the first product of Prevention One that works as a great motivational tool for patients.
It brings a big shift into the discussion – the app shows the bleeding score changes the role of the dental hygienist. The app determines the problem, and the hygienist just shows the score generated by the app and is ready to help.
Who is the founder of Prevention One and the BOB-App?
It is a combination of different people. There’s not one mastermind. But the idea definitely originated in Curaden with a lot of input from other people like iTop teachers. Jiří Sedelmayer was the inventor of the BOB-Score and BOB-Score methods.
Then there is also the technological part developed by other people. So it’s more or less a combination of different mindsets and different ideas.
Is the BOB-App user-friendly?
From the professional side, it’s really easy to use. Maybe The BOB-App is not for every dental professional. If you are engaged with technology and if you like using apps and would like to stand out among the other practices, then BOB-App is a wonderful tool for you.
Will any extensions or updates be released for the BOB-App in future?
Yes, we are thinking about creating a BOB Implants app, especially for implantology. We also need to make the existing BOB-App as intuitive as possible. And to add new options like before-and-after pictures. There are many options that we can add there.
Interested in using the BOB-App in your own practice? Please fill out the details in this form, and we will get in touch with you as soon as possible.