Billion Healthy Mouths Club

Dental hygienist Tabitha Acret from Australia: “When a patient comes in, I don’t just look at their teeth, but I try to find out why their mouth looks the way it does.”

It’s necessary for dental teams to collaborate with medical teams in order to help patients become healthier overall.

She left law behind and found her passion in preventative care. Dental hygienist Tabitha Acret is passionate about motivating, educating and instructing her patients, but also about collaborative ways of working with other medical teams in order to improve her patients’ overall health. Tabitha says that she has given herself a commitment of continuing life-long education. Read our interview with this positive and inspiring woman and learn more about her rich experiences, her passion for learning, educating and motivating others, and how – on top of all else – she still finds the time for voluntary work. 

What was your path into dentistry? How did your professional story start?

My grandfather was a dentist in Europe before he came to Australia. I spent a lot of time playing in his lab as a kid, and just being generally obsessed with teeth. He made me a set of dentures that I kept in a handbag when I was five years old, and I’d say to people: ‘Would you like to see my teeth?’, and they thought I was going to smile, but I’d whip out this set of dentures and show them to everybody (laughs). So I was quite obsessed with teeth from a small age, but then I forgot about it for a bit. 

I originally went to university to study law, and at that time I got a weekend job as a dental assistant. I quickly realised that I didn’t like law that much – I was a bit bored and just wasn’t really enjoying it, so eventually decided to leave. But at that point, I didn’t know what to do next. I told my boss I was going to miss being in the dental surgery. I liked it there, but knew I didn’t want to be a dental assistant forever. He asked me if I have ever thought about hygiene, and that was the beginning of me heading down this path. I applied and got in, and it’s been the best decision I’ve ever made. It’s something that I’ve been really passionate about since the beginning.

What education do you need to be a dental hygienist in Australia? 

We do a Bachelor of Oral Health (BOH). Then there’s a lot of different routes from there. I’ve done some postgraduate study – I’ve got a graduate certificate in public health, and I’m in the process of completing my master’s. There are a lot of hygienists in Australia who have gone on to do master’s, honours, and PhDs as well, who are going more down the academic career route. But for clinical work you only need the BOH degree. 

What does your current daily work mostly involve? 

I’m lucky that I’ve got a lot of variation in my career. I work as a clinical tutor at one of the universities and I help teach dentists how to perio probe, etc. I also give lectures at weekends on motivating patients and treating periodontal disease. I also work in a periodontal practice. 

My usual day is about treating patients who have, or have had, gum diseases. I assess them in order to see how I can help them with their oral hygiene, and then treat them throughout that course – seeing them regularly until they’re healthy. Then we return them to their general dentist. So I don’t get patients for a long time, but I get to meet lots of patients, which is nice as well. 

And what’s your favourite part of the job? 

Seeing good results is something I really enjoy. When my patients come in, they’ve got lots of inflammation, bleeding and infection. Getting them healthy – motivating them to improve their home care, getting them invested in their treatment and managing their own health, and then seeing the results – that’s truly rewarding. I get genuine happiness from seeing that huge improvement. I love being able to make that positive change in people’s lives, and meeting these patients every day. I just love the dynamics of a dental practice and how much you get to be social. 

“I love being able to make that positive change in people’s lives.”

Do you treat a lot of patients who have some kind of fear or anxiety of the dental chair? 

Yes, the majority of my patients suffer from fear – particularly because I work in a specialist practice. It’s often the case that a patient has been so scared about coming to the dentist that they put it off for too long, by which point there are a lot of problems. So we do get people with quite advanced disease of the tissues around their teeth, and anxiety as well. We have to try and help them with both issues. 

There are also a lot of patients who have never been told how to brush their teeth properly. Teaching them this is a great way to build relationships and educate these patients. There’s no shame in not knowing, but it’s very important to impart that information so they can make changes at home. We’d all love to be the star of the show, but the reality is that what the patient does at home is the most important part of everything. I can be a skilled clinician, but if the patients don’t do what they need to do, then it doesn’t matter how good my skills are.

Education and motivation plays an important role in your professional career. You’re also a host of a podcast, Disrupting Dentistry. Could you tell us a bit more about it? 

I run the podcast with Melissa Obrotka, a dental hygienist from New Jersey. We met at a course in Washington D.C. where we were both lecturing. We’ve got a lot of the same views and we really get along. In the middle of the Covid lockdown, I just messaged Melissa saying that I had some spare time and I wanted to make a podcast. And she said yes. It’s been a huge learning curve in terms of how to record, how to edit, how to upload, etc. We’re recording in our lounge rooms and the time zones can be a little difficult to sort out. But we’ve been truly happy with what we’ve been able to produce so far.

Who is this podcast for? 

It’s mainly targeted at dental hygienists, but obviously the whole dental team is more than welcome to listen. We wanted to create something that would help us all learn new things. Our aim was to create a podcast that would be informative and offer an alternative form of continual education, but also something for dental hygienists to not feel alone. Sometimes you can be the only hygienist in a practice, and you can feel quite alone as there’s no one else doing your exact job so you don’t have colleagues you can bounce ideas off or chat with in that sense. Our podcast should help dental hygienists when they feel a bit lonely at work, a bit burnt out, or like they need a new bout of motivation.

We’ve had some fantastic feedback from dental hygienists all around the world. They tell us that they enjoy listening, or how great it was to realise that they weren’t ‘the only person stressed about that’ or who ‘didn’t understand this’. And of course they say they enjoy learning new things. Our oncology episode – learning about ways we can help these patients, had very positive feedback in particular. And that’s what we want – to improve patient care, and to make dental clinicians feel part of a global team. 

Welcome to the Billion Healthy Mouths Club

Proper routines in prevention are the future of dentistry – that’s why we at Curaden launched the Billion Healthy Mouths Club – a community of dental professionals committed to the idea of having proper routines in prevention and a holistic approach to dentistry. Dental hygienist Tabitha Acret is one of those dental professionals who shares these values, and we proudly present her experience and thoughts with other like-minded people from the field. Keep reading our Gently magazine to discover more interviews with forward-thinking professionals from around the world.

From listening to the podcast I’ve learnt that you are very focused on the importance of collaboration between dental hygienists and other medical experts. How does this work, based on your experience?

That’s something both Melissa and I feel quite passionate about. The mouth isn’t separate from the body. It’s the gateway to the body. Obviously, I work with the periodontist and we talk about cases and share together. So we work as a collaborative team all the time. But what’s really important is that we’re working with the medical team as well, because when we see a patient that comes in who maybe doesn’t have as much biofilm as you’d expect compared to their level of inflammation, the ratio is clearly out of whack. 

We need to ask – do they have a vitamin deficiency? Is there an autoimmune disease? Is it stress? So we talk to our patients about their diets, what their overall health is like, what their stress levels are like. And if we’re not getting any red flags in those conversations, we send them to the general practitioner to have a full blood work to find out if everything’s ok there. 

I had a patient the other day whose gum was receding on the bottom of her teeth because she was grinding so badly. She said she’s been grinding for years. I asked why she grinds, and found out she only sleeps two to three hours a night in total because she’s got really disrupted sleep. So I referred her to ENT. 

We’re medical hygienists, we’re looking at the whole body and we’re working collaboratively with every team. So when a patient comes in, I don’t just look at their teeth, but I try to find out why their mouth looks the way it does. Sometimes it is just neglect and it’s about changing the brushing technique. And other times there are systemic diseases going on that we need to address at the same time. 

Collaboration is so important in dental surgery. We’ve become part of the big team because patients – especially those that are having oncology treatment or other chronic disease treatment – often have side effects in their mouth from their medications. So we need to work together to find solutions.

“We’re medical hygienists, we’re looking at the whole body and we’re working collaboratively with every team. So when a patient comes in, I don’t just look at their teeth, but I try to find out why their mouth looks the way it does.”

And does this collaboration work well, or does it need any improvements? 

Some of the universities are amazing. They’re starting that focus on collaboration within their training. But there’s still a lot of work to be done in educating clinicians who have already graduated about working collaboratively, and then also educating the medical team in how to work with us, and when to get us involved. It’s exciting because it’s getting more recognised and it’s changing. 

The systemic links with oral health are becoming more and more reported thanks to good research. We know that patients with periodontal disease have a higher risk of cardiovascular disease. Now it’s about working collaboratively so that a patient who goes to the cardiologist should be asked if they have been checked by their dentist and informed about the risks. When patients come to me with gum disease, I ask if they know that their risk for cardiovascular disease is high as a result. We need to make sure that the patients are aware of everything that’s going on. 

I’ve had patients before with gum disease that was just too aggressive considering their level of biofilm. I asked them some questions and recommended getting bloodwork, and then the blood tests uncovered diabetes. We were able to pick that up before it became a catastrophic event. Together we can help patients become healthier overall, and try to avoid negative outcomes.

It can be kind of tricky getting patients to give honest answers to certain questions. Do you have any tips how on to get your patients to tell you the truth about their health?

We’re very aware that patients lie. And the reason they lie is because they feel they’re being judged, or they feel ashamed. I always try to explain that I’m not asking questions because I want to judge them, I’m simply asking in order to do an accurate risk assessment. Patients need to know that we’re not going to tell them off or yell at them. 

For example, smoking. Patients often don’t want to admit to how much they’re smoking. But I just say to them, I need to know. And then I have an honest talk to them about smoking cessation, and offer referrals to people they can talk to if they are ready for change. I’m not a smoker, but I understand it’s an addiction and it’s hard. For us it’s about trying to be understanding and realising our patients are people, who have stresses and lives and biases. We need to help them and champion them, but never judge them. 

When we look at the level of oral health in your country, what are the most serious issues that need to be solved in order to improve it?

Dentistry isn’t sufficiently funded; we have publicly funded health care, but dentistry isn’t covered. Certain groups can get free dental care, but there’s a two-year wait and it’s difficult to access. The general population has to pay for dental treatment. So – dentistry has essentially become luxury health. If you can’t afford it, then you miss out on those preventative steps and then usually only go to the dentist when you’re in pain or when there’s an issue. That’s something that nearly every dental practitioner in Australia would love to change. 

When we look at the facts and figures document from 2010, it shows us that most children are experiencing decay before they are five years old. Obviously, from lower socioeconomic areas and more disadvantaged groups, we see poor oral health outcomes as well. We truly need dentistry to become more accessible and more affordable for the general public. 

“I actually didn’t want to be a dentist. For me the preventative care is what I love.”

And how about dental hygiene? Do people in Australia know what a dental hygienist does?

In Australia, dental hygiene started about 30 years ago. So it’s a relatively new profession. We have about 5,000 dental hygienists in Australia and more than 20,000 dentists. So our proportion to dentistry is still quite low. 

We’re failing to service remote and rural locations because a lot of us are focused more on metropolitan areas. A lot of patients don’t know what we are. When I say I’m a dental hygienist, many people don’t know what I do. There’s a lot of work to do in educating the public in Australia about the role of a dental hygienist, and the benefits of preventative care. 

Are there any recurring biases connected to your job?

I often get asked why I didn’t want to become a dentist. Usually, patients think that we are failed dentists (smiles). And it’s not the case. I actually didn’t want to be a dentist. For me the preventative care is what I love.

How do you stress the importance of prevention to your patients so they really understand it? 

Prevention, to me, is the most important aspect of dentistry. We want to avoid just fixing a failure and instead teach people about eating correctly, brushing properly – also between their teeth, and all the other things they can do to help protect their teeth before anything goes wrong. All dental diseases are preventable, but prevention is not the easiest sell. 

You need to know your patients. Some patients get it when you talk about systemic health, and that by reducing inflammation, we’re making our whole body healthier. Other patients will be motivated by saving money.

It’s about finding the motivation in each patient. What would be an inconvenience to them? How do we get them to relate? It’s different for every single patient. That’s why we use motivational interviewing skills. We get to know our patients so as to understand what will make sense to them, and what will make them say yes. 

You’ve already mentioned that you’re currently working on finishing your master’s degree. But are there any other ways that you work on your continuing education? 

During the pandemic I’ve been attending a lot of webinars. But I do prefer face-to-face learning. I often go to conferences. I’ve travelled to Portugal, Amsterdam, to the USA to learn. If the course is really good and they don’t offer it in Australia, then I get on a plane and I fly. 

I love learning about systemic health and motivating patients. I’m lucky to get to lecture at lots of conferences myself, so after my own lecture I can attend the rest of the conference programme and learn. I spend a lot of time on continuing education, probably about 100 hours a year. 

“Australia is a pretty privileged country, but there are many people in other countries that don’t even have access to a toothbrush.”

Besides your daily job and educating, you also do some volunteer work?

Yes. I was meant to go to Kenya last year with the Maasai Molar project. One of my amazing friends in Switzerland has started that charity, and I was supposed to go with her and a group of hygienists to do preventative work. Unfortunately, due to coronavirus, that trip was cancelled, as well as another trip to Nepal. But I’ve said to both groups that as soon as we’re allowed to travel again, count me in.

Australia is a pretty privileged country, but there are many people in other countries that don’t even have access to a toothbrush. I always volunteer with sustainable charities. A one-off visit can make a person volunteering feel good, but it doesn’t make a long-term impact to the people they’re trying to help. The charities that I’m involved with do things on a regular basis, so they can keep giving that care. 

For example, I volunteer for a long-term project in Vietnam: they treat and see specific groups of people three times a year, do studies of what they’re doing, and watch the impact they’re making on oral health. It’s possible to do charity work locally, too. I’ve just signed up to volunteer at a local homeless shelter. We bring toothbrushes and toothpaste and give oral hygiene instructions. If that’s done regularly, it’s going to make a difference.

Tabitha Acret, BOH is a dedicated award-winning dental hygienist. She studied a Bachelor of Oral Health at Newcastle University after working as a dental nurse and practice manager for 10 years. Tabitha was previously the national vice-president for the Dental Hygienists Association of Australia and has volunteered in many roles since graduation for the Association. She also has a passion for educating students, working as a clinical educator at Sydney University, and currently works as a clinical educator for implant maintenance and non-surgical periodontal therapy. She lectures and writes regularly for both industry and consumer press on motivating patients, disease prevention and periodontal therapy. She is a winner of the 2018 Leadership Award in Dental Hygiene and the 2019 Award for Clinical Excellence. Outside of her work life, Tabitha enjoys volunteering to raise awareness of the need to change the way oral health care is delivered to patients. She is also a co-host of her own podcast, Disrupting Dentistry. Follow Tabitha on Facebook or Instagram to learn more about her work.