Products to see at the Chicago Midwinter Meeting

Headed to the exhibit hall? Here are some highlights of the many products that will be featured on the show floor.

Booth 4644

BURST sonic toothbrush

BURST is proven to be the best brush at removing plaque. At 33,000 vibrations per minute, BURST has the highest rate of sonic vibrations. BURST has charcoal embedded, multilength, interdental bristles that are super soft and easy on your gums and enamel. Get rewarded and offer your patients a more than 40% discount on the BURST brush by becoming a BURST Ambassador. Sign up today at burstambassadors.com or visit us at the Chicago Midwinter Meeting booth 4644. To learn more, visit burstoralcare.com or call 1-833-BURSTUS.

Booth 4216

OPTIM 1 disinfectant (SciCan)

With a 1-minute broad-spectrum contact time, OPTIM 1 is one of the fastest and most effective cleaner and intermediate level disinfectants. It is also listed as a category IV, the EPA’s lowest toxicity category. OPTIM 1 provides the confidence that you are compliant and protecting your patients, staff, and the environment without compromise—the perfect balance. To learn more, visit bit.ly/2CztWwc.

Practice Changers: Gingicaine

When it comes to scaling, I am burnished calculus’s worst nightmare. I find few things as rewarding as removing calculus that has been hiding under the patient’s gums. As dental professionals, we know that the burnished calculus can lead to periodontal disease. Over the last few years, I have found an increasing amount of residual subgingival calculus that is often burnished. I attribute this to improper technique, neglecting to implement an 11/12 explorer, improper working ends, reduced clinical time, and well-intentioned concern for patient comfort. With the intention of not becoming the “mean hygienist” in the office, I began my pursuit of finding a topical anesthetic. My research led me to Gingicaine, an anesthetic gel that works quickly, tastes great, and patients love.

Overview

• Active ingredient: 20% benzocaine gel

• Uses: Reduce pain or discomfort caused by minor dental procedures, minor gum injuries, canker sores, and minor mouth or gum irritations caused by dentures or orthodontic appliances.1

• Contraindications: Should not be used in patients with history of hypersensitivity to ester-like anesthetics, or on severely traumatized mucosal areas that are infected. Do not use on patients who are allergic to “-caine” anesthetics or FD&C Red 40.1

• Ordering: Gingicaine can be ordered through major distributors and comes in a strawberry-flavored gel. Gingicaine gel syringes are available in kits containing 20 syringes each with 1.2 mL of benzocaine gel and 40 micro needle tips.

Time to celebrate National Children’s Dental Health Month

National Children’s Dental Health Month (NCDHM) is celebrated each February to raise awareness of the importance of oral health care in children. The campaign, now in its 63rd year, is observed by dental professionals and dental companies alike. As Colgate notes on its website, NCDHM “brings together thousands of dedicated dental professionals, health-care providers, and others to promote the benefits of good oral health to children and adults, caregivers, teachers, and many others.”1

This year’s catchy slogan is “Brush and clean in between to build a healthy smile.”2 It focuses on oral hygiene practices and draws attention to safe and effective preventive measures that can be practiced at home.

To date, tooth decay is still the most prevalent disease in children, with 42% of children ages 2–11 developing one or more cavities in their primary teeth.1 As hygienists and health professionals, we are at the forefront to provide oral health education. We can prevent the spread of tooth decay in our pediatric patients because we are fortunate enough to have the resources to prevent oral disease and provide access to care.

The American Dental Association, which sponsors and promotes NCDHM each year, notes that “developing good habits at an early age and scheduling regular dental visits helps children get a good start on a lifetime of healthy teeth and gums.”2 NCDHM has many other supporters, such as ones who provide free health education materials. These materials include activities for all ages, teaching guides, videos, and presentations.

In this month’s issue, there are four articles that will help shape your perspective of children’s oral health. Kory Nieuwkoop looks at tethered oral tissues (p. 20), which can have profound effects on children’s oral health. Colleen Roy explains how CBCT is being used in pediatric dentistry (p. 24). Alyssa Delgado presents her favorite products for kids (p. 30). Finally, Nancy Burkhart gives tips on how to teach oral health care to children (p. 33).

Finding the right dry mouth fit

Dental professionals, particularly hygienists, bond with patients quickly—often during the first visit. That is what happened with Connie and me. She was a health-aware person, diagnosed with multiple sclerosis 25 years before her first visit. Connie shared that her dry mouth was one of her biggest challenges. She said sometimes she didn’t have enough saliva to chew her food. By the end of the visit, she took my hands and said, “God is taking my legs—can you help me keep my teeth?” What an honor! What a challenge.

Based on her risk and to maintain her quality of life, Connie saw me every two to three months. At every visit there was a complete evaluation and discussion of her dry mouth needs. Why? Because every time Connie came into the office, she was different than she had been at the last visit . . . just like all of our patients.

© Photomall – Dreamstime.com

A dry mouth condition is not static. Evaluation is needed at every visit to create the best comfort and preventive care plan. There are many arrows in the quiver of product choices. Care must be taken to recommend products that are safe, effective, and the right fit for each individual.

At least 30% of your patients are afflicted

Many of us take saliva for granted, but when this natural function is diminished or stops, the quality of life can drastically change. Connie described her dryness as her tongue and palate feeling like halves of Velcro.

The effects of dull hygiene instruments on hygiene production

The hygiene appointment is known throughout the industry to be an important source of production and overall practice health. Though the exact figure varies, most industry experts suggest that hygiene production as a percentage of overall production should be about 30%.1

This means that the tools hygienists have to work with directly affect the financial fate of a practice. In the August 2016 issue of Dental Economics, Chris Salierno, DDS, wrote that “Your hygiene systems are arguably the most important in your practice. We must keep a healthy supply of patients flowing into our practice, give them an outstanding experience, diagnose any disease that is present, and correctly bill for the services provided. There are a lot of moving parts here and a critical failure at any step can cost you lost revenue and, even worse, lost patients.”2

One moving part—literally—is the scraping of a scaler against enamel, doing the all-important job of removing calculus. Though judging from the survey comments, many dentists see sharpening as either a hygienist’s “problem” or a waste of time altogether. Why? Arguably it’s a lack of understanding of how dull instruments impact their practices, and with this last article, I’d like to take a more bird’s-eye view of the importance of sharp instruments. Some of the previous articles in this series have briefly touched on these points, and we’ll dive into them further here.

Patients—through no fault of their own—are usually not qualified to judge the quality of care they receive at an appointment.3 They are often only left with how dental professionals made them feel, whether emotionally or physically. And what is the first sustained point of contact a patient usually makes with a practice? The hygiene appointment. The hygienist continues to be the face of the practice for most patients, and their experience of the prophy is their only yardstick for judging other potential procedures.

Dental unit waterline safety: The science and what dental professionals need to know

The science of waterlines and what dental professionals need to know

In many areas of dentistry, outcomes are determined by the dental health-care professional’s (DHCP) level of ethics, standard of care, and ability to stay up to date. Dentistry is not static; being aware of current findings and embracing them ethically can protect both the patient and DHCP from disease. Dental unit waterlines are one of these areas. When new findings and regulations come forward, finding out if you are in compliance can be daunting—like opening a can of worms. Finding out you have an issue and addressing it can be a defining moment.

What do we know?

Recently, there has been a focus on water safety in dentistry. Dental unit waterline systems (DUWS) have long been known as a harbor for high concentrations of potentially pathogenic bacteria.1 The small tubing has proven a haven for specific pathogenic bacteria,2 including Pseudomonas spp., Legionella spp., and nontuberculosis mycobacteria.3 Most microorganisms detected in DUWS come from public water supply and do not pose a risk for healthy patients. Until recently, it was assumed infection was possible only in immunocompromised patients. But infection outbreaks involving at least 90 healthy patients in Anaheim, California, and Atlanta, Georgia, suggest otherwise. There are now documented cases of direct transmission of disease from DUWS.4–10


Recent cases of disease acquisition from dental waterlines involving healthy children have also brought the topic to the forefront in dentistry and the media.11,12 DHCPs may also be put at risk by exposure to water spray and aerosols from devices that use DUWS.

Pediatric oral care: How dental hygienists can assist parents and children in oral care

Many oral diseases, such as dental caries, are public health concerns that are preventable. Dental professionals can facilitate prevention of these diseases in children by presenting home care education, encouraging skill development, and fostering self-efficacy techniques. Additionally, by assisting parents in developing values of total health for their children, long-term health goals can be achieved.

© Kiriill Ryzhov | Dreamstime.com

Oral care is vital to the well-being of children, both in the short term and for their entire lives. This includes brushing, flossing, and acquiring key knowledge related to nutrition. Dental hygienists, in particular, are vital to promoting a total health concept and assisting parents in teaching the best oral health practices for their children.

Figures 1 and 2 are examples of potential damage by children. In Figure 1, the damage is related to pressure applied by a power toothbrush over time to a specific area of the mouth. Very young children are sometimes given toothbrushes and allowed to “play” with them, potentially keeping brushes in their mouths for long periods of time. For example, power toothbrushes are sometimes given to children while they watch television shows. Children may hold power toothbrushs in one area or on one tooth for an extended period of time, such as is seen in Figure 2.

Figure 1: A child was allowed to “play” with a manual toothbrush throughout the day. Note the recession and the tissue trauma on all anterior teeth.

Using Piaget’s theory of cognitive development to make pediatric product recommendations

Child development has been studied and researched since 1936 when Jean Piaget became the first psychologist to theorize the stages of cognitive development. Piaget “regarded cognitive development as a process which occurs due to biologic maturation and interaction with the environment.”1,2 His theory can give health-care providers insight into pediatric patients’ development based on age.

It is important for children to develop healthy habits starting at a very early age to promote future health and well-being. This can be accomplished through imitation of healthy habits and introduction to products and routines that promote a healthy lifestyle.3 Using Piaget’s stages of cognitive development (table 1), dental hygienists can recommend products and routines appropriate to pediatric patients’ development.1,2


The first stage of cognitive development is the sensorimotor stage, which typically occurs from birth to two years of age. During this stage of cognitive development, the child explores the world by looking, hearing, touching, and mouthing.2 Children under the age of two love to explore the world by putting things in their mouths, so introducing brushing at this developmental stage can increase the likelihood that they will maintain this healthy habit later on.

Children will repeat behaviors with positive associations.1 It is recommended to begin oral hygiene behaviors by stimulating the child’s gum tissue, even before tooth eruption occurs and as early as four weeks old. Parents or caregivers can introduce brushing in a positive manner by using finger brushes in fun colors and characters, such as the Brushies finger puppets (figure 1).i Each finger-puppet toothbrush comes with a storybook to engage the child and provide tips to parents or caregivers on introducing a brushing routine.

You earn respect by giving respect: An interview with Sarah Tarara, RDH

It was a cloudy and drizzly late August morning, and I sat in a coffee shop having the most delightful conversation with a bright ray of sunshine.

Sarah Tarara, at the young age of 83, still practices dental hygiene. That’s right—you read that correctly. It’s not often I meet someone with twenty years more experience than I have (me being at 37 years). But here she was, right in front of me.

Sarah was a wealth of information, and she had an intense kindness that showed through so strongly right from the start of our conversation.

I learned about Sarah through Tracy McConnell, RDH, a fellow Illinois Dental Hygienists’ Association member. Tracy mentioned that Sarah had reached out to her about renewing her dental hygiene license. Sarah was going to let it lapse and retire from the two days a week she worked, but she changed her mind and decided she really wanted to continue working. Well, I just had to meet this woman, and I am so glad I did. As you’ll see from reading the interview, Sarah was ahead of the curve—and still is in many respects.

Interview with Sarah Tarara, RDH

Jensen: Tell me about your family background and childhood growing up in Rockford, Illinois.

Tarara: My parents came to the United States from Italy after they were married in 1926. I was one of four girls. I have two older sisters. One is 91 now and living with Alzheimer’s. The other, who would have been 92, died from natural causes. My younger sister is 75. I was kind of an “only middle child.” My mother and father were very, very protective of their daughters.

Jensen: Can you elaborate on that?

Tarara: For everything we would do, we had to be so careful. We might get hurt! I never rode a bike. I would wear one roller skate and skate downhill near our house. That way I could stop easily. It was quite a sight to see.

Confronting eating disorders in the dental chair: Advice from an eating disorder survivor

As dental professionals, you are placed in an awkward situation when you notice a patient with the clinical signs of an eating disorder. You may be unsure about how best to approach the issue without offending or scaring off your patient from your practice. You may also be hesitant to treat the patient until he or she has admitted to having a problem.

Regardless of how you are feeling, direct and honest communication is key. I can attest to this as someone who suffered from an undetected eating disorder for 15 years, from ages 12 to 27. As a result of my disorder, I suffered severe and irreversible damage to my teeth from purging.

Although I am not a dental professional, I believe that my experience from a patient’s perspective during my 15-year struggle with an eating disorder could be helpful to dental professionals who are likely to encounter patients like me at some point in their practices. I was fortunate to find an extremely skilled and knowledgeable dental professional to help restore my smile, but it took several years, a lot of dental work, and a lot of money to get to a place where I can finally say I am free from pain and confident about my smile.

There were times throughout my eating disorder journey when I encountered dental professionals who were ill-prepared to have a patient with an eating disorder in their dental chair. I say this not to criticize these dentists, but because I believe dentistry suffers from a lack of standard and effective protocol for confronting eating disorders, which leaves clinicians unprepared and unclear about how best to help their patients. As a result, some patients have fallen through the cracks—like I did—such that their teeth are irreversibly damaged.

Most importantly, I believe it is essential that the dental professional use direct communication and clear language to confront patients in a gentle way about the unusual damage eating disorders inflict on their teeth. When talking to patients, directly mention an eating disorder as a possible cause for the damage. Avoid terms such as bulimic or anorexic, because these words may make the patient feel stigmatized or defined by his or her eating disorder. Direct communication is so important, because you may be the only medical professional who notices the symptoms that are indicative of an eating disorder.