Uncategorized – Page 9 – Invisalign vs Braces

Caries management: Simplify product selection to improve compliance and outcome

By Pamela Maragliano-Muniz, BSDH, DMD

As dental professionals, we evaluate our patients on a routine basis and continually provide strategies to prevent dental caries. These strategies include caries risk assessment1 and individualized risk management recommendations. There is an abundance of products on the market and it can be challenging for dental professionals to hone their recommendations. In general, caries management programs receive criticism for being time consuming and complicated for private practices. It is essential to streamline and simplify2 caries management for the private practice it can be practiced routinely and indefinitely. The purpose of this article is to discuss simple strategies to get the maximum impact of caries management within the private practice.

Simplify product selection for caries risk management

Getting Started

Before implementing a caries management program, it is vital for the dental or dental hygiene practice to plan and organize as a team. A few items for consideration include:

Understanding the caries process. It is essential to become educated in the caries process so that risk assessment and risk management can be tailored for each individual practice.
Caries risk assessment. Which team member will provide risk assessment? How will risk be assessed; will a questionnaire be used or will caries risk be assessed using another method?
Caries risk management. Who will make risk management recommendations? How will this information be conveyed, verbally or via handouts?
Product recommendations. It is important to decide which products will be recommended for patients in each risk category, including toothbrushes, interdental cleaning strategies and topical pastes.
Documentation. Documenting caries risk assessment, caries risk category assignment, risk management recommendations and patient’s acceptance of your recommendations is essential. Custom documentation templates within the electronic health record are particularly useful to calibrate different members of the dental team.

The Caries Process

Historically, dental caries was thought to be the result of the interaction of a susceptible tooth, fermentable carbohydrates and time.3 Later research uncovered that the progression of dental caries is multifactorial4 is significantly more complex5. Dental caries is the result of an oral environment that is conducive to the progressive demineralization of the hard structures in the oral cavity. This net loss of tooth mineral is due, in part, to the proliferation of cariogenic bacteria that thrive in a low-pH (acidic) environment.6

Periodontal documentation: Stepping beyond ‘ordinary’ diagnosis

Karen Davis

I remember like it was yesterday, even though it was more than 25 years ago. I was attending a dental meeting in Houston with hundreds of other people, but I felt like the speaker was talking directly to me. The periodontist from New Jersey captured my attention with this statement: “If you see bleeding gums in the majority of your patients while cleaning their teeth, the problem is you.”

Certainly, I knew bleeding gums were not okay. But honestly, they had become so “ordinary” in my patients that they had lost their urgency. Then, Van Stevens, DDS, from New Jersey stepped on my toes! Fast forward to today, and I now tell my audiences that I hope they wore close-toed shoes—in case I step on their toes, intentionally.

Let’s address this elephant in the room—periodontal documentation. Already some of you know you can move on to other articles in this publication because this topic won’t apply to you. However, since thankfully I had my toes stepped on and that got my attention, I feel as though I’ve earned the right to address the subject. To have the greatest impact in your practice, dentists and dental hygienists need to read this article and discuss this topic together.

Dentists can defer to the dental hygienists for collection of the periodontal data, but in order for that to become consistent there has to be value for the time required to collect the data thoroughly, as well as explaining the significance to patients. Surprisingly, given all we know about the oral-systemic connection, thorough periodontal assessment and documentation is still an overlooked procedure. Dentists and dental hygienists settle for spot probing, periodontal charts that are outdated, bitewings that don’t show bone levels, and in some cases, no periodontal assessments at all on patients. Right now, I bet some of your toes are becoming a bit twitchy after reading that last sentence.

Gastric ulcers: What is the connection to periodontal disease?

Jannette Whisenhunt

One of the questions on your office’s health history form should ask whether the patient has had any gastric or duodenal ulcers. When a patient responds yes to this question, what follow-up questions do you ask? What concerns you about the patient’s response? Many times, we do not delve as deeply into patients’ medical histories as we should.

One 24-year research study of more than 51,000 male participants found a relationship between gastric and duodenal ulcers and periodontal disease: “In this prospective cohort of men, [the study’s authors] found that periodontal disease with bone loss was associated with an increased risk of gastric and duodenal [ulcers]. The association appeared largely consistent for gastric and duodenal ulcers as well as H. pylori–positive and H. pylori–negative ulcers. These observed associations persisted even after adjusting for putative risk factors, including smoking, alcohol intake, and regular use of aspirin and NSAIDs.”1

The study authors hypothesized that the oral microbiota changes that keep periodontal tissue from healing can also keep ulcers from healing in the GI tract.1

Another study found a possible association between poor periodontal health and H. pylori infection.2 Helicobacter pylori is a gram-negative bacterium that causes duodenal and gastric ulcerative disease. The study authors discovered that this bacteria can be found in deeper pockets of those with periodontal disease and that it can be found in those patients’ saliva and plaque biofilm.2 About 41% of the individuals who had pockets measuring 5 mm or more also tested positive for H. pylori.2 This, of course, does not mean that one causes the other, but it does suggest a link we need to study further.

How to address CNN article: ‘Fluoride exposure in utero linked to lower IQ in kids, study says’

On September 19, CNN released an article stating the fluoride exposure in utero is linked to lower IQ in children. I urge you to be ready to answer questions regarding fluoride. My fear is patients will read the article title and take the limited study out of context. Let’s review the study and equip you with the facts to be better prepared.

The study can be found here. This study shows many limitations, including the sample time, lack of information about iodine in salt, which could modify associations between fluoride and cognition, and the lack of data on fluoride content in water given that determination of fluoride content.(1) Therefore, the study has no way of knowing how much fluoride the women were exposed to via natural fluoride in their water source. Determining the source of the water is important because natural fluoride in the water source has up to 1.38 mg/L, which is double of that of the United States.(1) Furthermore, we have no idea which women drank from the water source vs. the bottled water.

The initial study is aimed to “estimate the association of prenatal exposure to fluoride with offspring neurocognitive development.”(1) The researchers report that additional studies are needed to confirm the link. Most consumers will see the title of the CNN article and assume all sources of fluoride are dangerous. We understand the benefits of fluoride in correct amounts. It is our role to educate on the importance of the therapeutic benefits of fluoride.

As dental professionals, it is important to remember that multiple factors contribute to tooth decay. Therefore, if the patient decides not to accept the fluoride recommendations, we can reinforce the importance of biofilm disruption, provide products that will help balance the pH of the mouth, and recommend diet changes to reduce the patients’ risk of tooth decay. It is important to value the patient’s personal views, while providing respectful, yet strong education to support ingredients shown to prevent decay.

Suze Orman: Save money on dental care

Dental insurance, according to Suze Orman, America’s personal financial expert, is in most cases not a wise purchase. Suze says that the best way to pay for dental services is through a dental savings plan. Haven’t heard about them? Most people haven’t, but Suze wants to change that. If you want to save 10%- 60% on dental care, and not have to worry about the restrictions, limitations and exclusions associated with traditional dental insurance, check out why Suze wants you to get a dental savings plan in this video.

Serving at the pleasure of the people: Clinical excellence does not excuse the absence of basic etiquette

By Eileen Morrissey, RDH, MS

I’ve just returned from an office visit for a checkup on my new health-care “product.” This was intended to be a short appointment, strictly a follow-up. The practitioner who treats me kept me waiting for a full hour. When she finally came to retrieve me, she called my name with a blank stare – no smile, no greeting. She turned and I watched her back as I followed her down the hall to the treatment room. This is how it goes at every visit.

Because I was following her lead (and writing this column in my head), I said nothing, sat down, and patiently waited as I’d been doing all morning. She did not acknowledge her tardiness. In fact, there was no small talk of any kind. At this point, I’m guessing we were well into her lunch hour, so she was probably annoyed and anxious to get me out. The waiting area was empty when she retrieved me. After reading my chart, her first words were: “How are they?”

I was referred to this clinician from within the practice because she was touted as a specialist. I’m told she is a legend. I was informed that she has built a following because of her conscientiousness and attention to detail.

Sigh.

If there is a take-home message, it begets these questions. RDH, are you a legend in your dental practice? And if one is a “legend,” so to speak, does that excuse the absence of basic courtesy and social skills?

I have a following in my dental practice, as does my coworker hygienist, Danielle. We are both very skilled at what we do. We are also well versed in the basics. That would be Practice Etiquette 101.

If I were ever to keep someone waiting that long – which is more than the equivalent of an entire patient appointment in our office – my doctor would take control within 11 minutes and figure out some sort of plan B. No one waits more than 7-10 minutes in our office. In fact, there is typically no wait. We take pride in valuing our patients’ time. Those who arrive late may be seen but not at the expense of those who arrive punctually for the appointments that follow.

Product Report

OmniOptic by Orascoptic

Orascoptic said the introduction of OmniOptic is an interchangeable magnification loupe that allows clinicians to select the optimal magnification power for each procedure. The four magnification powers range from 2.5x – 5.5x. The OmniOptic system also allows users to increase magnification during the course of their careers. The design features a magnetic anchor built into the carrier lens of the frame, and clinicians can upgrade magnification without having to purchase a new loupe system.

Visit Orascoptic.com

Varnish Pen by Young Dental

The Varnish Pen is an all-in-one varnish delivery system. A quick twist and easy press sends varnish right from the applicator system to the teeth, eliminating the need to double-dip, open difficult packaging, and keep track of applicator brushes. Young’s Varnish Pen contains a single-dose 5% sodium fluoride varnish made with xylitol that provides sensitivity relief. The thin, translucent no-mix formula is easy to handle without stringing or clumping, and is available in mint and assorted (mint, grape and bubblegum) flavors.

Visit VarnishPen.com

ElectroMatic by KaVo Kerr

KaVo recently launched of ElectroMatic for dental professionals transitioning to electric handpieces. The ElectroMatic motor system delivers constant speed and constant torque, allowing precise preparations at the defined speed. Easily adjust the speed on the control system display for a wide range of indications. Three distinct options in the ElectroMatic series offers the versatility to choose the right system to fit your treatment needs. The plug-and-play system connects to a standard air tubing and automatically adjusts to the air pressure of the existing dental unit.

Interactive brushing from Philips; plus, Ugly toothpastes focuses on the organic ingredients

By Kim Miller, RDH, BSDH

Sonicare DiamondClean Smart

The Sonicare DiamondClean Toothbrush, which recently launched at the California Dental Association meeting and was highlighted at RDH Under One Roof, delivers an advanced interactive brushing experience. According to Philips, this smart brush offers complete care for a healthier mouth through intuitive brushing and personalized coaching based on feedback from the radio-frequency identification brushheads. Simply download the app and sync the brush with your smart phone and begin the experience. Features from the Philips brush include:

A smart timer paces each quad for two minutes of brushing. The three intensity settings are low, medium, and high. Five modes provide different types of brushing experiences, including one for tongue care. A pressure sensor alerts the user with a pulsating handle and a light on the handle.
The smart sensor technology syncs with the cell phone. Location is tracked in facial and lingual segments.A scrubbing sensor prompts the user to use less motion.
The personalized coaching on the phone’s app provides information on needed touch-up areas, as well as areas requiring more focus. A 3D map of the mouth and a progress report is also available. In addition, there’s a brush head performance monitor.

DiamondClean Smart comes in four colors – black, pink, white, and silver. Visit sonicare.com for more information.

Ugly Toothpaste

Personal care products formulated with non-psychoactive hemp and cannabidiol oils are starting to hit the market. I recently came across one such product. Let me introduce you to Ugly by Nature, a raw, whipped toothpaste made with all organic and natural ingredients.

Ugly toothpaste was developed by Dr. Paul Herman who set out to make a nonallergenic toothpaste. Initially, Ugly consisted of three ingredients. Over a period of 18 months, the formula evolved to include 10 ingredients that Dr. Herman chose for their efficacy, consistency, and flavor: bentonite clay, purified water, coconut oil, birch xylitol, diatomaceous earth, coconut activated charcoal, hygdrogen peroxide, aloe barbadensis leaf juice, organic flavors, and hemp derived cannabidiol oil.

Intraoral camera detects inflammation: SoproCare enhances diagnostic capabilities

By Amber Auger, RDH, MPH

The roles of the dental hygienist are an educator, clinician, researcher, manager and an advocate for prevention of diseases.¹ We have the ability to address the patients’ high-risk factors for tooth decay, periodontal disease, and systemic diseases while bridging the educational gap between periodontal health and systemic health. This unique role could save the life of a patient by identifying symptoms for life-threatening conditions.

Influential patient education is essential to establishing change in the life of the patient, and an intraoral camera elevates our ability to connect the education to the patient. Acteon has created the SoproCare camera that differentiates the color of tissues to reveal inflammation.²

SoproCare was created for dental clinicians to educate during periodontal and prophylaxis treatment.² The camera offers three modes: Perio mode, Cario mode, and Daylight Mode. Each mode has been designed to engage patients and increase compliance to treatment recommendations.

Perio mode allows the clinician to provide a more complete assessment of the patient’s oral health by rapidly assessing gingival inflammation, plaque, and calculus.² Through the usage of LED lights, the camera demonstrates new plaque, which is shown as white, and the old plaque that is demonstrated in a yellow and orange shade.²

This allows patients to see the bacteria that was left behind even after their most recent brushing, which increases their need to change their oral health regime. The degree of gingival inflammation is detected with a light pink color to represent mild inflammation through a deep magenta to represent severe inflammation.²

Acteon has created the SoproCare camera that differentiates the color of tissues to reveal inflammation.

In addition, the images allow the clinician to identify specific areas for the patient to improve on, and the images can be used document current oral conditions. The initial images can serve as a baseline to track improvements or progression of disease. Clinicians can praise the patients’ enhanced home care techniques during their preventive care appointments.

Reassuring the anxious patient: Needle-free anesthetic options decrease sensitivity or pain during hygiene procedures

By Lory Laughter, RDH, MS

Every dental professional has experienced the fearful or anxious patient. The individual’s first words to you are, “I hate going to the dentist.” Dental fear or apprehension is a leading reason why appointments are not made, pain is self-treated, and why, even after all of your education efforts, patients do not return to complete care.

Six years ago, I met my first patient with real dental phobia. He didn’t tell me how much he disliked being in my presence. Instead we spent one full appointment talking about exactly what might happen in the dental chair. It took him seven tries to call and book the appointment, even though he knew some of the staff members personally.

He actually drove by the building or into the parking lot a number of times before he could come inside. This was a level of patient discomfort I had never witnessed. Thankfully, I worked in an environment where providing care was more important than production goals.

After rapport was built and the patient agreed to treat his periodontal infection, the biggest contributing factor to his fear emerged. He was worried about pain and severely afraid of needles. It has been reported that almost one-half of American adults experience dental fear of at least a moderate level. In fact, 5% to 10% of adults report avoiding dental care due to fear.¹

A quick search of online blogs and chat groups highlight two issues discussed most prominently for why people do not seek treatment for dental problems – discomfort/pain and fear of needles. We practice in an exciting time where both barriers can be addressed successfully and easily.

Even patients who may not be anxious but experience sensitivity during preventive appointments are resistant to injected anesthetic. The objections can range from numbness interfering with work or other activities to simply not wanting local anesthetic when no drilling is taking place.