Before, During and After Becoming a Regular User of GC Tooth Mousse Plus
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Sbaraini et al. BMC Oral Health (2021) 21:14 https://doi.org/10.1186/s12903-020-01360-8 RESEARCH ARTICLE Open Access Experiences of oral health: before, during and after becoming a regular user of GC Tooth Mousse Plus® Alexandra Sbaraini* , Geofrey G. Adams and Eric C. Reynolds Abstract Background: Clinical trials and laboratory studies from around the world have shown that GC Tooth Mousse Plus ® (TMP) is efective in protecting teeth from tooth decay and erosion, bufering dental plaque pH, remineralising white spot lesions and reducing dentine hypersensitivity. However, no other study has assessed the experiences of oral health, before, during and after individuals becoming regular users of TMP. The aim of this study was to identify how participants’ oral health status changed after introducing TMP into their oral hygiene routine. Methods: A qualitative study using Charmaz’s grounded theory methodology was conducted. Fifteen purposively sampled regular users of TMP were interviewed. Transcripts were analysed after each interview. Data analysis con- sisted of transcript coding, detailed memo writing, and data interpretation. Results: Participants described their experiences of oral health and disease, before, during and after introducing TMP into their daily oral hygiene routine, together with the historical, biological, fnancial, psychosocial, and habitual dimensions of their experiences. Before becoming a regular user of TMP, participants described themselves as having a damaged mouth with vulnerable teeth, dry mouth, and sensitivity. Various aspects of participants’ histories were rel- evant, such as, family history and history of oral disease. Having a damaged mouth with vulnerable teeth, dry mouth and sensitivity was explained by those elements. Despite some initial barriers, once being prescribed TMP by a dental professional, a three-fold process of change was initiated: starting a new oral hygiene routine, persevering daily, and experiencing reinforcing outcomes. This process led to a fundamental lifestyle change. Participants transitioned from having a damaged mouth with vulnerable teeth to having a comfortable mouth with strong teeth; at the same time participants felt empowered by this newly found status of being able to keep their teeth for life. Barriers and facilita- tors for incorporating TMP on daily oral hygiene routine were also identifed. Conclusions: Participants valued having a comfortable mouth with strong teeth, which did not require repeated res- torations. Seeing concrete results in their mouths and experiencing a more comfortable mouth boosted adherence to daily applications of TMP, which was maintained over time. Keywords: Tooth mousse plus, Qualitative research, Grounded theory, Compliance, Adherence, Oral hygiene Background The context of this study: adult Australians who were prescribed GC Tooth Mousse Plus® by a dental professional *Correspondence: [email protected] Tis study was designed to understand how everyday Oral Health Cooperative Research Centre, Melbourne Dental School, adult Australians became regular users of GC Tooth Bio21 Institute, The University of Melbourne, Melbourne, VIC 3010, Mousse Plus® (TMP). To the best of our knowledge, Australia © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Sbaraini et al. BMC Oral Health (2021) 21:14 Page 2 of 17 there is no detailed data on the characteristics of regu- What do we know about the product? lar users of TMP; hence the context of this study is based Te product has been available in the Australian market on data from oral health population surveys, as described since 2006. TMP is distributed globally by GC Corpora- below. tion and GC America. In Japan, Europe, the United States In Australia, around 51% of adults brush their teeth of America, and South America, TMP is known as MI twice a day, with brushing habits declining as people Paste Plus®. TMP contains a milk-derived protein called age [1]. Most people pay for their own dental treatments RECALDENT® with incorporated fuoride (CPP-ACPF: (including home care recommended products) or pay for Casein Phosphopeptide-Amorphous Calcium Phosphate the private health insurance that partly covers the cost of Fluoride). Te level of fuoride in TMP is 900 ppm. dental care [2]. Most adults visit a private general den- RECALDENT® or Casein Phosphopeptide-Amor- tal practice for a check-up at least once a year on aver- phous Calcium Phosphate (CPP-ACP) is a unique ingre- age; residents outside capital cities visit less frequently dient derived from naturally occurring protein found in [2–4]. Most individuals visit the same private dental cow’s milk. RECALDENT® is exported worldwide and practitioner on a long-term basis [3, 4]. Financial bur- used as ingredient in various functional foods and dental den is often cited as a reason why people do not visit a products. Te CPP-ACP technology is the result of many dental practice regularly or comply with proposed treat- years of research at the University of Melbourne into the ments [4]. Hence, based on population surveys and for anticariogenic properties of milk. Tere is a high-level the purpose of this study, an average adult Australian of evidence supporting the ability of CPP-ACP to rem- would be someone who (a) performs oral hygiene once ineralise early caries lesions and prevent their progres- to twice a day and (b) visits a dental practice at least once sion [10–14]. Tere are now twelve published systematic a year for a review appointment. In addition, our target meta-analyses of these clinical studies to support the population had a particularity: individuals who were pre- use of CPP-ACP to lower caries risk [11–22]. In addi- scribed TMP by their dental professional (e.g. a dental tion, CPP-ACP efectiveness has also been demonstrated professional being a dentist, a dental hygienist, a dental in relation to the reduction of cariogenic bacteria and therapist, or an oral health therapist) and became regular increased colonization of commensal microorganisms, users. Tat is, this study focused on TMP regular users and the reduction of dentine hypersensitivity [23–26]. functioning in a typical Australian context in relation to In brief, calcium, phosphate, and fuoride within TMP dental treatment and home care. are available in a soluble form—this means the product provides extra protection for teeth, bufers dental plaque What do we know about oral health care compliance acid from bacteria in the mouth and protects teeth and how does it relate to this study? from acidic foods and drinks. A dental professional can Te term “compliance” is commonly used in dentistry to advise on how often and for how long one should apply describe a patient’s readiness and commitment to follow TMP. Application should occur after brushing teeth. It recommendations and instructions [5, 6]. Compliance is important to acknowledge that TMP does not replace can be expected in relation to treatment provided in the the use of fuoride toothpaste. TMP is available in straw- dental practice or to oral health care instructions to be berry, vanilla, and mint favours (Fig. 1). ensued at home. Wilson described compliance as “the extent to which a person’s behaviour coincides with med- What do we know about consumers’ expectations ical or health advice” [7]. However, it is well known from when applying GC Tooth Mousse Plus®? the dental literature that people frequently “perceive oral While the efectiveness of RECALDENT® (CPP-ACP) is health care instructions as difcult to follow and time- well-established in the dental literature, it is not under- consuming” [8]. Terefore, at the beginning of this study stood how regular users experience incorporating TMP we assumed that individuals’ compliance would be key into daily oral hygiene routines. For example, what hur- to reach the desired outcome of incorporating TMP into dles they might encounter when asked to change their their daily oral hygiene routines. We also assumed that routines and what is important and valued by them dur- we could identify reasons for non-compliance, such as ing such process. socio-economic factors, uncertainty about the product, In this paper, we report on fndings from a qualitative competing priorities and existing habits as previously study of TMP regular users’ experiences while adding the mentioned in a study looking at compliance to preventive product into daily oral hygiene routines, guided by the protocols [9]. below research questions: Sbaraini et al. BMC Oral Health (2021) 21:14 Page 3 of 17 Fig. 1 GC Tooth Mousse Plus® 1. What was participants’ experience of oral health Methods before starting to apply TMP? Study design 2. What was participants’ experience of oral health after Te design of this study was based on an established sys- starting to apply TMP? tematic methodology: grounded theory procedures [27]. Grounded theory uses a methodically applied set of pro- a. How has participants’ oral status changed? cesses to generate rather than test theory [28].