Lichen planus: Patients are asking if amalgam removal would help

Patients are asking if amalgam removal would help

Amalgam on #14. Courtesy of Carol Perkins, RDH, BA.

Amalgam on #14. Courtesy of Carol Perkins, RDH, BA.

Your patient today is Jennifer, a patient of record who has been diagnosed with oral lichen planus confirmed through a biopsy. During your initial assessment, Jennifer asks the following question: “If I have oral lichen planus, should I remove my amalgams because of mercury leakage? I have seen postings on the internet and engaged in conversations on this subject suggesting that amalgam/mercury may be contributing to my oral lesions.”

This question is asked frequently by patients who have obtained information from various sources and are concerned about the long-term effects of mercury in the environment, particularly in their own mouths. Many patients want to know if removing amalgams will assist in improvements with oral lichen planus or their general health. Since lichen planus normally affects the adult population (mainly in age groups over 40 years of age), many patients with lichen planus also may have one or more amalgam restorations. Amalgam was the restoration of choice for many years in the United States. Many offices have stopped using amalgam mainly because better restoration materials have come on the market in the past several decades. With this said, many clinicians will tell you that amalgam is a strong material and, when properly placed, will last for decades.

Developing strong teeth during prenatal dental care

Adopt an active role in the strategic prenatal development of our youngest patients

As hygienists, we put a lot of focus on children. Dr. Alfred Fones’ original intent, after all, was for us to work with children in schools.1 We want to catch them early, train them (and their parents) in home hygiene, make sure they have fluoride available, and watch them grow into caries-free adults with healthy mouths.

But did you ever stop to consider how much we can help children toward that goal before they’re even born? Remember that deciduous teeth begin forming in utero, so a mother’s health and nutrition are vital to the proper formation of teeth. By educating mothers-to-be, we can provide their babies, who are also our patients, with the best possible start on lifelong oral health.

Presuming the mother is healthy, you might say the first step toward baby’s oral health is prenatal vitamins, which include important minerals such as folic acid, iron, iodine, and calcium.2 If the mother lacks certain vitamins during pregnancy, here’s what can happen during baby’s tooth development:

  • Vitamin A deficiency: enamel hypoplasia and defective dentin formation
  • Vitamin C deficiency: gingival hemorrhaging, improper dentin formation, and gingivitis
  • Vitamin D deficiency: loss of lamina dura, enamel hypoplasia, cavitated ECC, and white spot lesions3

A lack of minerals during pregnancy can cause these problems for the baby’s teeth:

Carly Scala, RDH, defines how dental professionals can lead the efforts to halt opioid addiction.

Dental professionals possess many resources
for spotting or limiting addiction to opioids

Dental professionals possess many resources
for spotting or limiting addiction to opioids

For decades, television has automatically plastered us with news updates about the latest drug bust. We still routinely view scandals and yet another mugshot. As television, social media, and the ability to have nearly anything and everything at our fingertips progresses, we also gain the ability to share helpful information about the current version of this disturbance across America—substance abuse.

I grew up in rural West Virginia. If you haven’t heard of our drug-umentaries, you should check them out. They are eye-opening. During my teenage and young adult years, substance abuse was on the rise in my area too. When I was in public school, it would be no big deal to see my peers drinking as barely teenagers (at high school football games, no less) or trying each other’s pills. At the time, it was called “partying.” My grown self would now like to correct my former self. What I was witnessing was “substance abuse,” and it was just the beginning of a very long and difficult journey in my community. Flash forward 10 years, in my home state of West Virginia, there is a hospital where one of every five babies spends its first days in agony. These helpless children were exposed to opioids or other drugs in the womb.

Trust for America (healthyamericans.org) released a report in 2013 of information gathered from 1999 to 2010 about all 50 states and statistics related to prescription drug abuse. Topping the list was wild and wonderful West Virginia, with 28.9 deaths by overdose per 100,000. From the low 4.1 to 100,000 ratio found in 1999, this new statistic shows a 605% increase between those 11 years. In addition to this, North Dakota ranked lowest at 3.4 per 100,000 in 2010.

Dental hygienists: Engage in a what-if conversation about the profession

The dental hygiene profession could surge forward if we imagined the possibilities

I’m not always a fan of the game, “What if?” But the game seems appropriate for our profession right now. I’m a bit weary of the old complaints over patients who won’t floss, or those who would rather have pink nails than pink gums. That isn’t the “what if” I’m after here. Instead of queries about our patients’ mouths, let’s play the game with the very real threats to our profession.

What if every RDH in every state (or providence) attended a legislative day and brought an example of one way patient health was improved through oral preventive services? Instead of arriving with toothbrushes and floss in hand, we could arrive with glucose monitors, stethoscopes, and sphygmomanometers to show our role in health care and disease prevention. Perhaps each RDH could introduce a patient whose life was saved as the direct result of a hygienist’s intervention.

Our discussions with political leaders might focus on the lifesaving role dental hygienists can provide in pediatric care. Rather than a drawn-out lecture on the benefits of fluoride varnish, a united message could center around the unnecessary deaths during sedation dentistry, attributable to the lack of appropriate preventive care. It is time for those in charge of spending the dollars to learn that RDHs are prevention specialists and not in competition with the dentists to drill and fill.

The starting point for such an important undertaking will be to educate some of our colleagues about these very facts. It is astonishing to me to hear at conventions or CE events how some hygienists view themselves. Many do believe they’re in practice only to remove stain, plaque, and calculus, and to make patients happy. Good Yelp reviews appear to have replaced great preventive care in some instances. If the RDH community as a whole views our career as one of scale and polish, there’s not much hope for the future of our profession. The role of health-care delivery is changing and we’d better be ready to jump on board.

Finding a new hygiene job after being fired

How to rally from the gut punch to your career

How to rally from the gut punch to your career

“We’re going to have to let you go.”

“We’re moving in a different direction.”

“Your services will not be needed any longer.”

As you gather your personal belongings, usually with someone watching to ensure you don’t steal anything, your heart is pounding and your head is swimming. You’ve just been fired, and you’re not alone. It seems dental hygienists are finding themselves in this situation more often than ever. Most hygienists work with the assumption that doing a good job equals job security.

I’ve spoken with many hygienists who were gobsmacked when they got fired. Their patients loved them, they met their production goals, they built up the hygiene department from nothing, and they had good relationships with their coworkers. They were professional, hardworking, and responsible. The sad truth is that someone can be the best and still get sacked. The reasons are as specific as the individual and his or her workplace.

Does the doctor have staff problems, personal problems, money problems? How many experienced RDHs have been replaced with younger graduates who will work for less money and shorter appointment times? Yes, it’s harsh, but it happens. Dismissal from work ranks in the top 10 list of stressful life events, according to the Holmes and Rahe scale.1

Proud of my op: San Francisco hygienist explains why she is proud of her operatory

Elizabeth Grillo, RDH, proudly shows us the two operatories where she practices in the San Francisco area.

Elizabeth Grillo, RDH, proudly shows us the two operatories where she practices in the San Francisco area.

Elizabeth Grillo, RDH, works in two dental offices in the San Francisco area. For almost 10 years, she has worked for Glen Park Dental for three days week. The dental office is across the street from a subway (B.A.R.T.) station just off Interstate 280 in the south part of San Francisco.

“Glen Park Dental is amazing as far as the architecture of the office. It is the only bi-level office I know of in San Francisco that has a waterfall in the office,” she said. “They have a laser, intraoral camera, digital x-rays, and they are a completely paperless office.”

She also works one day a week at the Pacific Sky Dental office in Daly City. She recently started the position at Pacific Sky, working there on Saturdays.

“It is a pretty new office with incredible equipment to use,” Grillo said. “I wanted to work on Saturdays for half a day just to pick up extra cash. I didn’t get the job initially. So I temped for them for a while. They have at least four hygienists working for them.”

Proud of your op?
Are you proud of the operatory where you treat patients? Correspond with us to share details about the great place where you work. Send an email to
MarkH@PennWell.com, and insert “Proud of my op” in the subject line. Warning: We actually enjoy looking at photos, so we’ll probably ask you to take some pictures too.

Guiding the children

Treating pediatric patients can be challenging, but it helps if you use a few child-friendly techniques

As we all know, dealing with children in a dental office can be tricky. Sometimes they are crying, scared, or generally don’t know what to expect in the dental setting. Everything is new to the child—the sights, sounds, and even the smells. Not only are children nervous, but they might be accompanied by an anxious parent, which can make managing the patient even more challenging. But by implementing a few tricks, you will be on your way to creating a positive dental experience for your youngest patients. 

First impressions matter

When you first meet your pediatric patient, you must keep in mind that you have one chance to make a positive first impression. Getting down to your patient’s level, making eye contact, and offering a big smile can do wonders for a child’s mood. Imagine being in your patient’s shoes: a new place, new people, new sounds, and being greeted by someone who is two to three times your size can definitely be intimidating to a child. 

Another thing that often helps lighten the mood is to comment on something your patients have brought in with them. Younger kids may have a toy or stuffed animal they brought with them from home.

Introduce yourself to their favorite toy and let them know that you might even be able to count the number of teeth that their teddy bear (or another stuffed animal) has! This helps children relax, and then they will usually get excited at the possibility of looking at their special stuffed animal instead of focusing on their fears. If they didn’t bring a special toy, see if you can find a character on their shirt, sparkles on their shoes, or perhaps a pretty necklace they are wearing. Find something to comment on that will make them feel special and show them that you are paying attention to them. 

Pediatric care: Introducing xrays in a patient-friendly experience

The benefits of digital radiograph system with pediatric
patients lowers everyone’s anxiety

The xray is positioned for a pediatric patient. Courtesy of Dentsply Sirona.

The xray is positioned for a pediatric patient. Courtesy of Dentsply Sirona.

When I first graduated from hygiene school, I worked full-time in a busy pediatric office. Our “open bay” layout, which included four dental chairs in a large room, was designed to allow parents, siblings, and other children to engage in the “show-tell-do” systems that ease the inexperienced patient’s anxiety. For the pediatric patient, everything involved in the dental experience is new.

The patient’s first-time experience can be overwhelming due to the sounds alone, such as the high-pitched sound of the polishing handpiece and suction. However, with the gentle touch of a skilled dental hygienist, the patient can overcome the initial fear of the unknown. The role of the pediatric dental hygienist is imperative to the patient’s future success in oral health.

Retaking X-rays

Imagine that you have a patient in your chair who is five-and-a-half years old. During the initial assessment, you notice a dark shadow on the distal of number K. The patient’s sibling is at high risk for tooth decay, the patient’s home care is poor, and her diet includes juice throughout the day.

No referral? Can hygienists be held accountable for failure to mention possible oral cancer?

After reporting lesion, hygienist is concerned about doctor’s response

Dear Dianne,

I recently had a 53-year-old woman in my chair. She related that she had never smoked and was an occasional social drinker. When I performed the oral cancer assessment, I found an odd lesion on the left lateral posterior of her tongue. The lesion was not ulcerated, but it was irregularly shaped, and 4 mm to 5 mm in size. The patient was unaware that the lesion was there and told me it had not been sore. I noted all the particulars in the chart notes, including location, size, color, and shape. I felt certain that the doctor would refer her to see an oral surgeon.

The doctor performed the periodic exam, and much to my surprise, he told the patient that he didn’t think it was anything to worry about. He ended by saying that we would check it again in six months. I was floored that he didn’t refer her for a biopsy.

After the doctor left the room, the patient asked me what I would do if that lesion was in my mouth. I had to think fast. Not wanting to contradict what the doctor had just told her, I said that she should keep an eye on the lesion and if it didn’t go away in a week or so, let us know and we’d check it again. I knew as I was saying this it would be difficult, if not impossible, for the patient to monitor the lesion since it was so far back. But in all truthfulness, if I had a lesion like that, I’d want it checked by an oral surgeon.

Now I’m worried. I keep thinking about this patient and wondering if I did the right thing. Should I have referred her anyway? Should I call her? What if the lesion is cancerous? Would I be liable even though the doctor chose not to refer?

No secrets: Pregnant dental patients should be forthcoming with their recent health history

There’s a reason why female patients should
be forthcoming when pregnant

There’s a reason why female patients should
be forthcoming when pregnant

My 33-year-old female patient told me there were no changes in her medical history when I asked about any updates at her recare visit. I told her that since we had taken radiographs at her previous appointment and there were no apparent problems, we would not take x-rays today. She replied, “Good!” This patient normally has an excellent home-care presentation, and there is very little work for me to do at her cleanings.

As I looked at her mouth, these conditions appeared consistent. However, when I probed and performed her debridement, there was definitely more bleeding than usual. Something about her tissues seemed off. I found myself thinking about her three-year-old son and wondering when or if she and her husband were going to try for a sibling for little Joey. My intuition was speaking loud and clear, and I blurted, “Linda, is there any way you could be pregnant?” She looked at me in amazement and said, “How did you know that?”

I told her it was a hunch based on the bleeding I was seeing. She divulged that she was indeed 11 weeks into her pregnancy. Her reason for not sharing the information was that she and her husband had not yet told anyone, even family. When she saw that I was not going to take radiographs, she felt that she could keep the information to herself.

I explained why it is so important that we be made aware of any changes in our patients’ health histories. I took advantage of my newfound knowledge to educate her in whatever ways I could regarding all that is important in terms of prenatal oral care. She was still reeling from my discovery. I have to say I was shocked that someone who I have been treating on and off for six years would hold back such information. Now it makes me wonder how many times this has happened before with a pregnancy, or any condition for that matter. Probably more than I imagine. The recurrent theme among patients seems to be that nothing in the mouth has any connection to their systemic health.