How to tailor dental hygiene appointments for young orthodontic patients

Addressing the oral care challenges posed by braces

Braces, braces, braces—I don’t know about you, but I used to cringe when I got these patients in my chair. I knew that my appointment was going to be filled with poor oral hygiene and floss threaders galore. Now I welcome the changeup and don’t mind treating these patients, because I have finally found great resources and tools for both the patient and myself. As you know, orthodontics is an expensive process and it’s important for us to be able to educate parents and patients on all its aspects, from oral hygiene to nutrition.

Here’s a short overview of my recommendations: Always use an ultrasonic scaler; recommend the GumChucks flossing tool (OralWise, Inc.), a water flosser, and an electric toothbrush; provide education on a floss threader and Super Floss; and fluoride varnish at a recall appointment.

My must-have products for these appointments (with a little overlap with the suggestions I just mentioned) are: GumChucks, the Cavitron (Dentsply), 2pro disposable prophy angles (Premier Dental), Vera Advanced Bright prophy paste (Young Dental), and the Varnish Pen (Young Dental). These products help make appointments painless for the patient and provider.

If you use GumChucks during your appointments, not only are you introducing them to the parent and child during the visit by using it to floss, but you can also use it for oral health instruction and recommend this product for use at home. The company makes autoclavable handles for hygienists to use chairside; the consumer packages come with plastic handles.

Namaste in my op: Stress management and mindfulness for dental hygienists

 

Tips for balancing the physical and emotional toll of clinical practice

It is no secret that dental hygienists are very proud and resilient individuals. We conduct ourselves with the utmost professionalism and confidence, even in the many stressful situations that may cause us to imagine a very different response. While we would never purposefully be unprofessional, it is true that our kill-them-with-kindness façade is typically used to placate the source of these stressors. In the end, we are rewarding the stressor and causing ourselves to compartmentalize the negative emotions, all while maintaining our professional and confident stature without skipping a beat.

The “Big B”

We have all experienced days that bring us to our breaking point. We are tired, broken, and have nothing left to give. Our tank is empty. Working in a profession where we are forced to give 100% of ourselves, all of our emotional and physical energy, every minute of every day, and then compartmentalize our emotions, we will always be at risk for the “Big B.” Just as the “Big C” is used to discuss cancer without ever saying the word that so many are ashamed or afraid to speak, the “Big B” can be used the same way to describe burnout. In our profession, it seems shameful to admit being burned out, causing us to force those feelings away and pretend that we always love our jobs and are happy 100% of the time.

The expansion of teledentistry offers a different view of dental hygiene practice settings

Mobile dentistry is a good fit for teledentistry.

 

How teledentistry is expanding and energizing practice settings

It’s vacation time! Spending time in the Big Apple has been on your bucket list for years. Now you’re standing right in the middle of the fabled Times Square. People of all sizes, ages, and nationalities are moving through the famous area. Some are old; others are young. Some are living on the streets; others live very comfortable lives. Some appear to be very healthy; others look frail and sickly. Times Square is a beehive of humanity.

The looming crisis

It takes a few minutes to soak in all the sights and smells. Glancing upward, your eye catches The Zipper, the famous New York Times news ticker. Headline after headline streams across the screen. The Zipper has been alerting crowds to breaking news headlines since 1928. Today is no exception. This moment’s visual sound bites are about oral health: Looming crisis—Lack of quality, affordable dental health affects millions in the US…Dental care: highest financial barrier of all health services…51 million lost school hours due to dental issues…Severe periodontitis associated with increased risk: stroke, heart disease, diabetes, chronic respiratory illness…50% of children age 5 to 9 have had one area of decay…RDH magazine reports Utah dental hygienist, Staci Stout, develops a sustainable business model that provides quality dental services to at-risk children and seniors. Stout works outside of a traditional dental office, harnessing the power of portable equipment and tele-dentistry communication platforms…

Tips for purchasing magnification and illumination devices in the dental hygiene operatory

Everything is illuminated

 

Tips for purchasing magnification and illumination devices in the dental hygiene operatory

On various dental hygiene social media groups, questions about loupes are often posed. Who wears loupes? Which brands of loupes are best? What power is best? What headlamp is best?

I usually am one of the first to respond to these posts, as I am a firm believer in the use of loupes, illumination and the purchasing of your own equipment. I began my profession with no loupes, illumination, goggles, masks or gloves. How in the world I ever worked for 20+ years without protective wear is beyond my comprehension! This will not be an article of which brand is best (although I do have my favorite), or which power is best. The objective with this article is to make you an educated consumer.

This article was inspired through a collaborative effort with the Facebook Group, Trapped in an Op

This article was inspired through a collaborative effort with the Facebook Group, Trapped in an Op

Your own pair

My first suggestion to these posts is buy your own equipment. If and when you leave your current employer, this enables you to take your loupes with you to the next facility you work. I do volunteer work and take my loupes with me to the location in which I am volunteering. A few manufacturers sell directly to hygienists—seek them out. When attending either your local or national convention, go to the vendors. When reps come into your office, ask them questions. They want to talk to hygienists! Companies selling loupes may have a payment plan—ask!

Many factors are considered when purchasing loupes, including cost. Don’t let cost be the deciding factor. Remember, you get what you pay for! The other factors are: resolution, field width, field depth, weight, magnification power and the angle of declination. These are fancy terms, but they are terms you should make yourself familiar with:

  • Resolution enables us to visualize small structures, and is set by the quality of the optical design and a clinician’s use of loupes.

The oral-systemic practice: A pediatric patient’s oral health and misbehavior lead to obstructive sleep apnea concerns

 

Adding orthodontic, orofacial therapy evaluations for challenging kids

At the morning huddle, I learned a family was up for a quick in-and-out visit—prophy, fluoride, exam—boom! Addison came in with her mother and little brother in tow. Her smile was disrupted by six missing front teeth, but she didn’t seem bothered. As if she worked there, Addison confidently led the way down the hall to treatment room No. 8. Each step she took was measured to get the most bounce out of her corkscrew curls, her arms moving to get the best swish out of her skirt with its tulle scaffolding. On her feet were sparkling ruby red Mary Janes.

Addison is a big girl of six, and her brother, Mason, is four years old and challenging. In sharp contrast to his big sister, the chart notes for Mason commented repeatedly on behavior, even charging out behavior management codes. He smelled of diaper, his mouth hung open, he exhibited adenoid facies, his lips were fire-engine red from licking, and when he wasn’t a tornado (for example, sitting on his mother’s lap), he looked comatose. Caroline, the children’s mother, looked exhausted. Fortunately, imaging was not on the schedule.

As expected, Addison’s mouth was a shining example of good dental hygiene. The six-year molars were in, sealants would be indicated in six months, and—“Mason, please don’t shake the dental chair.” Why isn’t this mother managing this kid? He dropped like a sack of potatoes and wailed.

NHANES: A CDC tool for improving a dental hygienist’s community’s oral health

Public Health
 

The National Health and Nutrition Examination Survey (NHANES), which is conducted by the Centers for Disease Control and Prevention (CDC), was recently published. The survey, authorized by the National Health Survey Act of 1956, has been conducted since the 1960s.1 Americans of all ages are interviewed in their homes regarding health, disease, nutrition, risk factors for disease, and health care utilization.1 The self-reported information is followed by a clinical examination, which is completed in a mobile unit.1

The NHANES population includes all demographics in the United States, except military members or institutionalized populations.1 The NHANES is designed to help health providers and administrators assess disease, risk factors, and health care and dental care utilization.1 Additionally, demographics are stratified for assessments in relation to race, ethnicity, age, and income level.1 This data helps paint a picture of Americans’ health status, nutritional habits, trends in disease, and risk factors for disease.

This can be an effective tool for dental hygienists interested in providing assessments as part of an overall initiative to improve the community’s oral health.

Periodontal recording: Dental hygienists should be talking aloud

Periodontal Charting
 

Increasing the volume during probing also increases awareness

A hygienist I know (let’s call her Partima) works in a practice a half day a week, where she’s been employed for 18 months. The practice also has a full-time hygienist (let’s call her Fultima). Their doctor requests that all patients be comprehensively probed annually. Periodontal screening and recording (PSR) or general perusal of the tissues is performed at all other recare visits. The practice uses a software system that allows for periodontal charting; however, the numbers have to be keyed into the computer by the clinician or another party.

The front desk administrator makes herself available as needed to assist the hygienist, and Partima told me she takes full advantage of this offer to help. Conversely, Fultima probes and then keys in the numbers herself.

Partima told me about an interesting phenomenon. Anytime she sees a recall patient that has been seen previously by Fultima, something strange happens. After Partima performs the periodontal assessment, the patient asks her what function is taking place and for what reason? There’s no question that the documentation has taken place in the past, as the numbers are keyed in. What’s interesting is that the patient has no awareness that the periodontal recording has happened. (You’re probably wondering where I’m going with this.)

Tough to recover: Preparing to recover from a natural disaster

Disaster Preparation
 

The recent natural disasters have challenged residents in affected areas to plan more thoroughly for events

For the past two decades, my work has involved a lot of travel for presenting continuing education programs, attending dental and dental hygiene conferences, and spending time with students at colleges and universities all over North America. It’s a thrill to see how people come together to create communities and work together. It is also interesting to see the regional differences that often reflect the physical landscape of the area.

On August 31, I flew to Wichita, Kansas. My hotel room faced west, overlooking the Arkansas River. The water was so still it looked like glass. Dozens of people in kayaks and paddleboards leisurely glided past the colorful artwork floating in the middle of the waterway. The sculpture is a huge strand of DNA depicting the vital interaction of human genetic material and water. The Wichita Wingnuts baseball team was playing in the brightly lit stadium on the other side of the river. The sound of the Star-Spangled Banner filled the air. As darkness fell, the Labor Day weekend celebrations commenced with a huge firework display on the river’s edge that punctuated the night sky. It was a quintessential portrait of Midwestern America.

While this Norman Rockwell moment was soothing, my mind and heart were totally pre-occupied with the damage Hurricane Harvey was creating for my friends, colleagues, and neighbors in Texas and Louisiana. Two high-pressure cells kept Harvey parked over a large portion of southeast Texas. The Houston area averages 50 inches of rain a year. Many parts of Houston got 50 inches in three days.

Voice recognition: Charting software increases dental patient engagement

Periodontal Charting
 

Verbal charting increases patient engagement

Hygienists are often faced with the challenge of completing a comprehensive periodontal charting on our own. Many of us have struggled to keep barriers on while we turn from patient to computer. The data we need to document seems impossible to obtain in a timely manner. Some dentists recognize the importance of a hygiene assistant. However, the majority of hygienists are left running behind or neglecting the ADHA recommendations for a comprehensive periodontal evaluation by only charting 5 mm and above. Voice recognition software is a solution to avoid compromising clinical treatment, and to identify areas of disease early.

The ADHA recommends comprehensive periodontal charting to be performed at a minimum of once per year, and at every maintenance appointment for periodontally involved patients. To be deemed comprehensive, the charting must include “six-points-per-tooth pocket depths, recession, areas of mobility, bleeding points, purulent discharge, attachment loss, [radiographs] and/or periodontal diagnosis.”1 Therefore, periodontal examinations without this are considered incomplete, as each area of data and radiographs are needed to properly diagnose the patient.

Water flossing: ‘Tips’ to pass along to dental hygiene patients

Education tips for patients who are considering a water flossing device for their oral health needs

True confession: I use my Water Flosser on the #10 setting. When I tell this to other dental hygienists, I often hear, “But I heard that was dangerous,” or “My doctor (or the periodontist that we refer to) says it drives bacteria into the pocket and causes deeper pockets.”

It is difficult to know how this message got started or on what basis. In many cases, it seems to have emanated from an instructor or colleague. No one ever seems to be able to cite or locate a study or even know the specific patient case.

The truth is the Water Flosser is safe to use at any setting including high. This year, the Waterpik Water Flosser earned the ADA Seal of Acceptance as the first powered interdental cleaner. The seal ensures professionals and patients that a product is safe and effective. The Waterpik Water Flosser earned the Seal of Acceptance for the removal of plaque between teeth and below the gumline and for the prevention and reduction of gingivitis.

Let’s look at the evidence on the safety and efficacy of the Water Flosser.

Penetration of bacteria: In 1988 at the University of Missouri Kansas City, a periodontal researcher, Dr. Charles Cobb, conducted a safety study on the Water Flosser. His team looked at patients who needed extractions due to periodontitis. Some of the deep pockets were irrigated with a Water Flosser at the 60 psi setting; other pockets were not irrigated.

Any first-time user should always start on low so they can acclimate to the device.