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Too much of a good thing?

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  Posted by: The Probe      3rd April 2020

Author Kimberley Lloyd-Rees


You may remember a TV advert that first appeared a few years ago: “I just want a coffee”, says a despairing customer, gazing at a wall of options in a hipster café. At the end, he’s seen leaving with his takeaway, purchased from the fast-food outlet who made the ad, while a voiceover tells us that good coffee can be “simple”.

The ad is partly about the “problem” of having too much choice (and partly about how buying a coffee can be an expensive, complicated business). In 2004, psychologist Barry Schwartz wrote a book called “The Paradox of Choice: Why More is Less”. In it, he writes “the fact that some choice is good doesn’t necessarily mean that more choice is better,” and explores how, for consumers, having too many options can be anxiety inducing and may discourage buying.[i]

Most of us can relate to sometimes feeling so overwhelmed by choice, that we decide not to bother. In a supermarket, when faced with a decision between X and Y, you may ask yourself, “Do I pick the cheapest/the branded version/the value pack/the healthiest?”. If you can’t answer these questions, if/when they apply, this will probably be the point at which you walk away.

On the other hand, choice is great! For coffee lovers, a coffee shop is a world of possibilities. Monday might be a flat-white with extra shot kind of day, but by Friday you could be in the mood for something with caramel syrup and whipped cream (occasionally of course, think of all that sugar…).

The dental choice conundrum

Do dental patients face too much choice? In any article about NHS dentistry, the word “crisis” gets used a lot. Access to NHS dental services must be improved across the UK, to support better oral and general health. The wider focus on preventive care has to be supported by access and choice; there is anecdotal evidence of patients who went to their GP, A&E, or – worse – found a DIY solution because they couldn’t get a dental appointment[ii]and felt they didn’t have another choice. 

In the robust private dental sector, the picture is different. Choice has been a key driver for increased demand, especially for procedures such as regular hygiene maintenance, cosmetic work and orthodontics. If a patient is thinking about investing in treatments like these, the internet will give them various options of where to go. Patient expectations have never been higher and their final choice will be based on all sorts of criteria, such as testimonials, convenience and cost. Practices have to meet these expectations if they want people to recommend them and/or choose them again.

Patients also have a choice about what to use to clean their mouth between appointments. The oral care product market in the UK has grown massively and people are understanding how maintaining a healthy, attractive smile is something well worth spending their money on.[iii] But what products should they be choosing? Manufacturers make all kinds of claims, particularly with the increased crossover in the dental/beauty markets – toothpastes that promise a whiter smile are an obvious example.

Dental practitioners are perfectly placed to help patients make the correct decisions. Giving patients the right information about an oral hygiene aid can help them evaluate it and feel positive that they are making a good choice. A good toothbrush should be easy to hold and manipulate, to reach all the areas of the mouth. It should be soft, to remove plaque and food debris without causing trauma to soft tissues or damaging enamel. It should be high quality, flexible and robust. Some patients, post-surgery or after implant therapy, might need something even softer.

Interdental brushes as an alternative to string floss are another choice; the new generation of brushes are functional, effective and easy to master. One size does not fit all, either. Danish company TANDEX is helping practitioners and patients understand which size brush is most suitable by adding international standard ISO and PHD (passage hole diameter) numbers to the packaging of certain products, including its FLEXI™ interdental brushes. The ISO defines what PHD interval the brush can be squeezed into without deformation. PHD is based on the number of filaments per cm, nylon thickness per mm and how hard the brush is twined. Quality brushes are at the heart of the oral health message and will help patients improve their brushing technique; good tools and good technique go hand in hand for the best results.

Choice is good, but choice must be informed in order to lead to positive decisions. Dental practitioners who help people make informed choices will not only be supporting their oral health, but will be strengthening the relationship between patient and practice. An effective prevention message needs to be coherent. Giving patients clear, consistent direction in what oral care products to buy and how to use them, can also increase the odds that they’ll choose to return to the practice for ongoing maintenance.


For more information on Tandex’s range of products,
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[i] Barry Schwartz. The Paradox of Choice: Why More is Less, Harper Perennial, 2004.

[ii] Patients resort to DIY dentistry as NHS options disappear. The Guardian, 5 February 2019. Link: (accessed February 2020).

[iii] Euromonitor International. Oral Care in the United Kingdom. June 2019. Link: (accessed February 2020).

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