During interviews, participants shared their stories at length – they had a clear understanding of what the process of becoming a regular user of TMP entailed and provided a detailed narrative of such process. Participants’ narrative revealed three distinct periods of their lives: before, during and after becoming a regular user of TMP (Table 7).
Participants described their experiences of oral disease before becoming a regular user of TMP and how they felt about it, physically and emotionally. Before TMP, signs and symptoms of oral disease were very familiar to them. Individuals were living with vulnerable teeth which were brittle, painful, and/or sensitive; some had a dry mouth which led to more discomfort. Participants visited a dental practice once to twice a year; they anticipated a restoration at every appointment and feared paying soaring fees for it (Table 8). It was not a happy life and the simple thought that life could be different did not even cross their minds. On the other hand, after becoming regular users of TMP, they recognized the enormous disparity between life as they knew it (before TMP) and life after becoming a regular user of TMP (Table 9). This change was described by all participants in the study. Historical, biological, financial, psychosocial, and habitual dimensions of their experiences were identified (Table 9).
Experiences of oral disease before becoming a regular user of TMP
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 relevant: family history, personal history, and history of oral disease. Having a damaged mouth with vulnerable teeth, dry mouth and sensitivity was explained by historical, biological, and financial elements (Table 8). For example, participants who had grown up without having access to a dentist or who were not encouraged during childhood to take care of their teeth, revealed disappointment about “not doing enough tooth brushing” (ID10, female, 55-64 years old, dental caries) and requiring restorative treatment when they eventually visited a dentist. According to them, having a damaged mouth affected their chewing ability as reported by a participant: “I couldn’t chew anything without a bit breaking off” (ID4, female, 55-64 years old, brittle teeth and sensitivity). Participants believed it was common to have teeth drilled and filled every time they visited a dentist. They were also familiar with the replacement of failed tooth restorations. However, a common finding among their narratives was the fact that they were unable to afford restorative care. This was a major cause of concern and reflected the financial burden participants were facing.
Barriers to changing daily routines
When TMP was first recommended to participants, despite not being pleased with the possibility of keep losing teeth, incorporating an additional step into their oral hygiene routine was not straightforward (Table 7) - as it is expected with any change of habit. However, they knew something had to shift if they sincerely wanted to keep their teeth. Feelings such as anxiety, uncertainty, determination, confidence, and reassurance were part of such process. Participants spoke about three main barriers: (a) being difficult to apply TMP daily, (b) TMP not being available at chemist/pharmacy and (c) TMP being an expensive product.
The difficulty of starting a new habit was evident for all participants, but among the various reasons one stood out, life itself and its unexpected events including illness, divorce and death of a loved one:
“My TMP use was sporadic for about two months. I wouldn’t use it for one week, the next week I’d use it once, and in the following week I might use it two or three times. Suddenly, I became a patient [oral and throat cancer] and I’ve never been sick in my life, so it was like “Why me?” Yeah, so difficult initially to get into the routine, then also my mother passed away, my marriage broke down and I became deeply depressed. It was tough. So, to be honest, to put something extra on the routine was a pain. It became another chore; extra mouth hygiene became annoying. It was hard, and only when the depression started to lift, I saw the importance of looking after my teeth again” (ID14, male, 45-54 years old, dry mouth).
Participants also talked about where they purchased TMP (e.g. at dental practices or from online dealers) and how much they paid for it at different locations. Cost was clearly defined as a barrier:
“I used TMP very sporadically because I thought it was a bit expensive, and then probably it wasn’t until about five years after that, I started using it regularly” (ID4, female, 55-64 years old, brittle teeth and sensitivity).
“Obviously, the cost is something that most people, including myself, find it difficult” (ID11, male, 65 years or older, sensitivity and dry mouth).
Few participants were happy to purchase TMP from their dental practice; others shifted to online purchase given the price difference between the two settings. While some participants wished they could purchase TMP from a nearby chemist, not being able to do so was also defined as a barrier:
“It would be so much easier if you could buy it at a chemist” (ID12, female, 55-64 years old, Sjogren's syndrome).
“The fact that you could only buy it from the dentist sort of made it a hassle to acquire” (ID7, female, 65 years or older, dry mouth).
The process of becoming a regular user of TMP
Despite encountering 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 (Table 7). This process led to a fundamental lifestyle change with five types of outcomes: historical, biological, financial, psychosocial and habitual. 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”. (ID4, female, 55-64 years old, brittle teeth and sensitivity)
Facilitators for changing daily routines
During this process of change, participants identified key facilitators for changing daily routines to include TMP application. These included: (a) seeing the long-term positive effects of TMP, (b) seeing research evidence, (c) TMP being endorsed by their dentist, (d) being educated by the dentist/dental team on how to apply the product and (e) having the support of a family member.
Participants were drawn to the product because it gave them an option apart from restorative care. Seeing concrete long-term positive effects of TMP in their mouths was a revelation, which positively reinforced daily application of TMP.
“Seriously, for the first time in my life, after about two years of using it [TMP], I sort of realised that I hadn’t had a new cavity, a broken tooth, for two years.” (ID4, female, 55-64 years old, brittle teeth and sensitivity)
Participants reported that seeing research evidence was important to believe in the product and to start applying it.
“The community health dental team were the ones who convinced me that it [TMP] worked. They showed me a lot of research evidence, which showed how well TMP worked and everything, so that was it then; I was sold”. (ID4, female, 55-64 years old, brittle teeth and sensitivity)
Equally important was to have dentists and dental team advocating the product and educating participants on how to use it:
“My teeth were just on the verge of breaking and he [dentist] said to take this TMP; he explained the
chemistry behind it and how it can rebuild your enamel, and how to apply it. I took that tube, I
brushed my teeth normally, then I applied TMP every day for almost a year. And then when I went
back to the dentist, my enamel was all healed and stronger. So, I swear by the stuff [TMP]. So,
even though my teeth are strong now, I go to the oral hygienist once a year and because my teeth
are so good, he says he doesn’t need to see me, but I go to the oral hygienist just to get my teeth cleaned,
and that is when I buy my TMP.” (ID3, female, 45-54 years old, sensitivity)
For one participant, it took a while to become a regular user of TMP but having her husband’s support made it happen.
“My husband has encouraged me - he’s taken an interest there. And that is nice, you know. He
understands that I need to spend the money and spend the time”. (ID10, female, 55-64 years old,
For other participant, it was about his parents taking the time to find a different kind of dentist, who would not only fix teeth, but who was dedicated to help him reach a status of having a comfortable mouth with strong teeth. This different kind of dentist took the time, showed, and explained TMP research findings and how the chemistry behind TMP works – these were effective facilitators of change.
“When I was younger, I went to the dentist near where I live but, about ten years ago, my parents found
a different dentist: he was good. He was kind of different from other dentists; he would not just fix your
teeth. He was more about looking at how to prevent deterioration in your mouth. At that time,
he said take this product [TMP] to rebuild your enamel” (ID9, male, 25-34 years old, dental caries).
Experiences of oral health after becoming a regular user of TMP
After becoming a regular user of TMP, participants no longer felt that their fate was to have a vulnerable mouth (and all its consequences), as they were able to achieve tangible lifestyle changes. The dimensions shown on Table 8, which had a deteriorating effect in participants’ life, were altered and reinforcing outcomes started to be noticed (Table 9). Participants realised that their dental history had changed: their teeth were stronger, less sensitive and did not require frequent restorations.
When for the first time during a dental appointment, restorative treatment was not necessary, individuals were astonished by it. They suddenly realised it was a consequence of becoming a regular user of TMP. It was their accountable daily actions that made it possible. From that moment on, TMP effectiveness was cemented in their consciousness. Hence, experiencing tangible results in their mouths was crucial for truly believing in TMP. Participants described themselves as being responsible for this highly valued status of having a more comfortable mouth. They felt empowered by the sense that they would be able to keep their teeth for life. For example, participants spoke about a newly and invigorating emotional status of feeling complete. Feeling complete or being complete simply meant their body was whole and healthy; a body in which teeth could be maintained. Being complete enabled participants to enjoy life and smile again. Participants stated that applying TMP is “tooth protection” that one can do at home (ID11, male, 65 years or older, sensitivity and dry mouth). Thus, applying TMP became part of their life and it was comparable to daily exercise and eating healthy meals. While reflecting about the reinforcing outcomes noted after becoming a regular user of TMP, participants referred to TMP as being an essential part of their life as reported by a dry mouth sufferer: “I wouldn’t be without it [TMP] … there’s no other product that I’ve found that is good … I use mouthwash that’s supposed to improve saliva, you can get gels for a dry mouth, none of them are nice to use, so I think it’s just an essential – it’s an essential part of my life now. I would never be without Tooth Mousse” (ID1, female, 65 years or older, dry mouth).