HEALTH ADVICE:

SORTING IT OUT FOR

PATIENTS AND FOR YOURSELF

Elizabeth Roberts, DDS, MBA

Assistant Clinical Professor, Diagnostic
Sciences
April 10, 2019
 LEARNING OBJECTIVES

Participants will be able to:

• Define and identify claims

• Assess the value of different claims
• Use a simple 4-step communication model to answer patient questions
• Identify implications to your dental practice
INGREDIENT CONTROVERSIES
As a Dentist, you are a different
person than you were before you
• Dentistry
entered dental school Body of • Science
Knowledg • Patient Management
e

• Standards of Care
Professional • Literature Search
• Shape Policy
Skill • Science
• Sponsor Expert
Panels Association s Assessment
• Critical Thinking
s

• Teachers
• Peers • of Dentistry
Resources Languag • of Scientific
• Journals
• Text Books e Research
• White Papers
 LITERATURE ASSESSMENT TOOLKIT

PICO principle for focusing your question for a searchable inquiry

Evaluating a Study:
• Study Design (Parallel, Double
Blind, Single Blind)
• Subject Demographics (incl/excl)
• Sample Size
• Randomization
• Materials and Methods
• Has the study been reproduced?
• Are the investigators calibrated?
EVIDENCE-BASED DENTAL PRACTICE IS BASED ON
SUBSTANTIATED BELIEFS

Unsubstantiated vs Substantiated
Beliefs Beliefs

• Harmful? • Informed by
• Benign? Evidence
• Useful? • Should be
Useful
 ADA CONSUMER SURVEY – DECEMBER, 2018

Questions
Beliefs
“If you wanted to make your teeth 66 Would see a dentist
look better, what would you do?”
%
“Have you ever tried to correct a 39 Said “YES”
dental issue on your own, without %
seeking the help of a dentist or
other professional help?”

Have you ever used or would consider 40 Said they HAVE USED
using a do-it-yourself (DIY) kit for % (12%) or WOULD USE
filling a cavity? (28%) a DIY cavity-filling
kit. 6% were “Unsure”
 What are the common types of products you are
asked about? (select up to 3)

Whitening trays 54%

Aligners 52%

Charcoal products 49%

Mouthguards 39%

Oil pulling 32%

Snoring appliances 26%

Veneers 9%

Other, please specify 2%

Gap banding 1%

Source: ADA sponsored survey with dentists December 2018

WHERE DO PATIENTS GET THEIR BELIEFS?
 IT’S ALL ABOUT CLAIMS

What is a CLAIM? An assertion of truth

What is a TARGET? The audience for whom the

claim is meant
Why make a claim? To get the TARGET to
confirm or change their
belief

What is the claim To compel the TARGET to

meant to do? make a decision / take action
 CLAIMS CHALLENGE YOUR DECISIONS

After assessing the CLAIMS

• Do the claims compel you to REPLACE your

current product / regimen or ADD to the current
products / regimen that you personally use?

• As a professional, does the claim compel you to

change your recommendations to your patients?
 CLAIMS: TWO GOLDEN RULES

• Must be SUBSTANTIATED AS TRUE

• Must NOT BE MISLEADING

 OBEYING THE RULES

• Substantiate as true by using QUALIFYING

FOOTNOTES to
o Describe how the product was tested
o Provide basic information about the
product tests

• Do not mislead by
o Identifying the SPOKESPERSON
o Using “USE AS DIRECTED” statements
 HOW CLAIMS GET INTO ADVERTISEMENTS

Marketing
places the
Test with advertising
Consumers CLAIMS into
Advertising the media
Agency
Legal, writes the
Regulatory Creative
Marketing Expert, Piece
proposes the R&D
CLAIMS respond
 EXAMPLE – COLGATE TO PROFESSIONALS

https://www.colgateprofessional.com/products/total
 EXAMPLE – COLGATE TO CONSUMERS

https://www.colgate.com/en-us/products/total
 EXAMPLES OF TELEVISION COMMERICALS

https://www.youtube.com/watch?v=EwQSZuyH6ug (Dad of Dental Student)

At 0.07 “Visible differences in plaque assessed by qualified dentists one month

after a professional clean. Use of these products does not replace professional
clean.”

At 0.11“Actor portrayal of real Crest ProHealth results. Use as directed.”

https://www.youtube.com/watch?v=Wv8Nda33PE8 (Alison Crane Sales Mgr)

At 0.28 Pronamel Strong & Bright “vs. Pronamel Daily

Protection” https://www.youtube.com/watch?v=KwSurazWkh4

(Dentists)
 NOT ALL CLAIMS ARE CREATED EQUAL – 3 TYPES

Claim Type Your

Action

Health Benefits Assess the Science

Ease of Use Try It
EX: “Great Taste”, “No Mess”

Factual, but may or may not matter to Ask Yourself: Does it matter
everyone in the TARGET audience to you?
EX: Walgreens’ “Get One / Give One
vaccine promotion
 5 ELECTRIC TOOTHBRUSHES EARNED THE ADA SEAL

The ADA Council on Scientific Affairs’ acceptance of [PRODUCT NAME HERE]

is based on its finding that the product is safe and has shown efficacy in removing plaque and

helping to prevent and reduce gingivitis when used as directed.

Oral B Oscillating-Rotating-Pulsating Electric Rechargable

Toothbrush

Philips Sonicare Protective Clean Electric Toothbrush

PRO-SYS VarioSonic Powerbrush

quip Adult and Kids Electric Toothbrushes

 2 PRODUCTS’ CLAIMS ABOUT EARNING THE ADA SEAL

Source:Websites of respective products accessed 3/28/19

 TRUE for
“Every product with the Seal has been
Products scientifically evaluated by independent experts
that display to be safe and effective. In fact, to earn the
the ADA Seal, companies are often asked to meet higher
Seal standards than what is required by law. “1

BUT Not displaying the ADA Seal does not mean that

• The Product does not meet the ADA Seal standards

• The Product is not an ADA Seal product

1 https://www.mouthhealthy.org/en/ada-seal-products/what-is-the-ada-seal accessed 4/9/19

 YOUR ASSESSMENT IMPACTS YOUR DECISION

Science
Ease Supported
of
Use

Factual,
but
Subjectiv
e

REPLACE or ADD the product

to your current product(s) for use and for patient recommendations
 SIMPLE 4 -STEP COMMUNICATION MODEL

Assess the Translate the Communicate

Ask
Science Science Effectively
“Why?”

Copyright © Roberts & Roberts Consulting, LLC,

 ASK “ WHY?”

Get clarity on “why” your patient asks their question

• Why are you asking about this product?

• Why are you considering to replace the product or regimen are you using
now?

• Why do you think this product will be better than what you are using now?
 ASSESS THE SCIENCE

• Request claim support data

• Search the scientific literature
o Identify the comparator(s) (e.g. active ingredient, regimen, procedure)
o Convert search question into the PICO format
o Conduct literature search in scientific research database like PubMed
o Critically evaluate the individual studies
o Prioritize using the hierarchy pyramid of study design / scientific evidence
• Check professional associations for information from their science experts
o White papers
o Position statements
o Standards of care
 TRANSLATE THE SCIENCE

Describe in terms of a System:

• Health (How things work)
• The disease or trauma (How disease or trauma impacts how things work)
• Prevention (The behavior to maintain health)
• Treatment (The steps to restore health)

Example: Treating Cavities

 COMMUNICATE EFFECTIVELY

Everyone brings their focus to a topic regardless of

EDUCATION | FINANCES | HERITAGE | WHERE THEY LIVE | ETC.

Consider an experience familiar to your target and think of a simple analogy

EXAMPLE Mouth: an
Patients in Health /
S Incubator growing
Life Science
Plaque Biofilm

Treating Periodontal
Patients who
Disease: Building
Build, Repair or on a Sound
Mend Foundation
 COMMUNICATE EFFECTIVELY: 6 KEY POINTS

• Be respectful
• Leverage the “Why?” answers to shape your response
• Consider a concept familiar to your patient and think of an analogy
• Use plain language; avoid jargon and acronyms
• Illustrate: Draw / Use pictures / Use models
• When appropriate, ask patients to “play it back”
 SIMPLE 4 -STEP COMMUNICATIONMODEL
PUTTING IT TOGETHER

Ask Assess the Translate the Communicate

Why Science Science Effectively

• Why are you • Request claim • Consider a • Be respectful

attracted to the support data relevant • Leverage the
product (or this • PubMed metaphor “Why?” answers
idea)? Search • Explain how • Use
• Why do you • Evaluate the healthy oral simple
think this the studies system works analogies
product (or • Consider the • Explain the • Use
idea) will be impact on plain
EBD pyramid
better than health of disease language
of scientific
what you’re or trauma
evidence • Use pictures /
doing now? • Explain how
• Check with the models
ADA or other the product / • Ask patients to
professional intervention “play it back”
associations helps

Copyright © Roberts & Roberts Consulting, LLC,

 IMPLICATIONS FOR YOUR DENTAL PRACTICE

What’s in your waiting room?

What educational materials do you have?

What materials do you need?

Models
Pictures
“Chairside instructional guides”
Sketchpad and marker at chairside

What’s in your “Goody Bag”? What

do your recommend?
 GET STARTED: WHAT DO YOU USE?

Which oral hygiene products do you personally use and why?

• Toothpastes
• Toothbrushes
• Floss
• Interproximal devices
• Mouthwashes
 GET STARTED: WHAT SHOULD YOU WATCH?

• The media for oral health news, advice and products

• The professional associations for positions about oral health topics

• Product advertisements and commercials

• Listen to your patients about who they watch and follow

 FAVORITE RESOURCES

• American Dental Association (ADA) - www.ada.org

• ADA’s patient website – www.mouthhealthy.org
• American Academy of Periodontology (AAP) – www.perio.org
• AAP’s patient website – www.perio.org/consumer/patient-resources
• American Association of Endodontists (AAE) – www.aae.org
• AAE’s patient website – www.aae.org/patients/
• American Academy of Pediatric Dentistry (AAPD) – www.aapd.org
• AAPD’s patient website - www.aapd.org/resources/parent/