How better communication drives better patient outcomes

quip: Patients frequently ask their dentist which toothbrush they should be using. From your perspective, what features actually matter most when recommending a toothbrush?
Dr. Saldua: Honestly, the best toothbrush is the one you’ll actually use correctly and consistently. This is where most patients struggle…they’re not cleaning the full mouth (especially the gum lines). Electric toothbrushes can help if your technique isn’t great, but a manual brush can work just as well when used properly. 

quip: You often emphasize the power of communication in dentistry. What is one communication shift that can dramatically improve patient trust and treatment acceptance?
Dr. Saldua: The biggest shift is moving from telling to asking. Instead of jumping straight into treatment planning mode, I start by understanding a patient’s goals. That builds trust right away. 

I also focus on bridging the communication gap by explaining things in a way patients can actually understand. Patients are smart and want to be involved in their health, so I use images, drawings, and analogies to meet them in the middle. It turns the conversation into something collaborative, and that’s what really improves trust and treatment acceptance.

quip: Saliva is often overlooked in everyday dental conversations, yet it plays a critical role in oral health. What should providers be paying closer attention to when evaluating saliva?
Dr. Saldua: Saliva is one of the most underrated factors in oral health. Saliva helps buffer acid, fight bacteria, and support remineralization, so when it’s off, everything else gets harder. I’m looking at flow, consistency, and overall quality. Is the patient dry? Is the saliva thick or foamy? That tells me how well their mouth is being protected. 

I also use context clues. If I see a lot of tiny, early cavities, that usually tells me their saliva is low in minerals. If I see heavy buildup, especially behind the lower front teeth, that often means higher mineral content. Both still point to plaque control issues, but it helps me understand what ‘problem zone’ they’re in and how to guide prevention and treatment. I’ll also look at things like medications, mouth breathing, and hydration, because those play a big role too.

quip: Sleep apnea is increasingly recognized as a whole body health issue. From your perspective, what opportunities are dentists missing when it comes to identifying patients who may be at risk?
Dr. Saldua: Dentists are in a really unique position to catch undiagnosed sleep apnea, but a lot of it gets missed because we’re only looking at teeth. I’m paying attention to airway, tongue posture, wear patterns, scalloping on the tongue, and even things like a narrow palate or recessed jaw. Those are all clues, and once you're looking for it, you'll start seeing it everywhere.
A big miss is not asking the right questions. Patients won’t always connect their fatigue, headaches, or poor sleep to their mouth unless we bring it up…  which is why it’s never been diagnosed in the first place. Even things like mouth breathing or dry mouth can be signs of some sort of sleep disordered breathing or tongue posture issue.
It doesn’t mean we’re diagnosing sleep apnea, but we can absolutely identify risk and guide patients to get the right testing. That’s a huge opportunity to impact not just oral health, but overall health.

quip: Many dentists want to bring up sleep apnea with patients but are unsure how to start the conversation. What communication strategies have you found most effective when introducing airway health in a dental setting?
Dr. Saldua: When I first meet a patient, I always review their health history form carefully. If a few things jump out that point toward airway issues, I’ll check for other signs of it with my visual exam. And if I’m suspicious of it I simply say, ‘I’m noticing some signs of sleep apnea.” My focus is on letting patients know they’re not alone and this is something I catch all the time.
Most often it’s mild/moderate cases that are missed because symptoms aren’t obvious, but even mild sleep apnea affects quality of sleep and long-term health. I also normalize it, let them know sleep apnea isn’t just for overweight people. I’ve seen it in young, petite women, and even in kids, which is often why you see heavy grinding. It’s about helping patients understand the impact without shame and encouraging them to take action before it causes chronic problems.
I also am quick to tell them they can take a test at home and it's something the medical insurance will help cover (not dental). And then I say I will review the findings with them after they get their results. This is key because I need to make sure all the dental work is done before we fit them for an appliance. 

quip: How can dentists and hygienists simplify their homecare recommendations so patients are more likely to follow through?
Dr. Saldua: The key is to make home care simple and realistic. Instead of overwhelming patients with a long list of products and steps, I focus on one or two simple adjustments – whether it's an adjusted brushing technique or adding floss into their habit by strategizing a “habit stack” with something else they do every night. Habit changing is one of the most difficult things.  
I also explain why each step matters in plain language, using visuals, analogies and even the hand mirror so they can actually see the problem. When patients understand the reason behind what they’re doing, it’s easier to implement a new habit because the motivation behind it now exists (example: changing brushing technique because of gum infection OR adding a water pick because they could lose this implant OR committing to wearing their invisalign because they can see the chipping of the teeth due to a poor bite). It's all about the correct motivator AND the ease of implementation or recognition of the trigger of the new habit. And as always, I'm respecting their intelligence by allowing them to get involved in their own health. Collaboration will solidify this much easier than dictation because you’ve created that “buy in” or “ownership” that’s necessary for true and lasting habit change.