Category: Uncategorized

Working as a dental hygienist during pregnancy: Safety considerations and symptom management

Datevig Tegeleci, MA, RDH

For those who are trying to expand their families, or even if it comes as a surprise, pregnancy is an exciting milestone. Navigating it for the first time can be overwhelming, fun, confusing, and at times frustrating. Our bodies are going through so many changes in such a short amount of time that sometimes we feel an onslaught of uncomfortable symptoms. My pregnancy journey may be different than yours, but I hope some of this information can be useful or tailored to fit your specific needs.

Occupational hazards and pregnancy

I told my employers that I was pregnant early on, at about five to six weeks. The reason I told them so early was because I wanted to reduce occupational hazards and exposures, and so they knew the reason why I could not see certain patients. Two of the most important factors to me were not seeing patients who needed nitrous oxide gas sedation and not taking x-rays.

While nitrous oxide can be used safely in a dental office setting with proper maintenance protocols and well-maintained scavenging systems, it is still not recommended for pregnant individuals to work near it. This is because even with the best protocols in place, trace amounts of nitrous oxide gas can escape the machine, the patient’s nasal mask, or even the hose. Breathing in nitrous oxide gas can potentially be toxic. According to the Centers for Disease Control and Prevention (CDC), possible side effects can include spontaneous abortion, more commonly known as miscarriage.1 Continued exposure to nitrous oxide during pregnancy can lead to increased risk of premature delivery, congenital abnormalities, and cancer, renal, and hepatic diseases.1

Are dental practices ready for therapy animals?

By Alexis Ohrstrom, BS, Natalie Baz, BS, and Gail Aamodt, MS, RD

Pets have long played an important role in the American family. The human-animal bond is also well established in the medical field,1 but this concept is lagging behind in the dental field. This article describes the benefits of animal-assisted therapy (AAT), along with the risks and barriers of incorporating AAT into the dental office.

Research has shown that dogs can improve overall health by lowering blood pressure, providing comfort, and improving mood.1 Many of those who oppose AAT are concerned with infection control and the possibility of zoonotic diseases (infectious diseases that can be transmitted from animals to humans under normal circumstances). A survey was conducted to identify the opinions of dentists and dental hygienists regarding the use of AAT in the dental office.2

Under the Americans with Disabilities Act, state and local governments, businesses, and nonprofit organizations that serve the public generally must allow service animals to accompany people with disabilities in all areas of a facility where the public is allowed. For example, in a hospital, a service animal would be allowed in patient rooms, clinics, cafeterias, and exam rooms. However, it may be appropriate to exclude a service animal from operating rooms or burn units where the animal’s presence may compromise a sterile environment.

Based on frequency of postings on social media, health-care facilities have recently shown an increased interest in therapy animals and facility dogs. In addition to lowering blood pressure and improving mood, animal-assisted intervention programs have also been shown to delay the onset of dementia.1 AAT is currently being used in elder-care facilities, hospitals, and mental health therapy sessions, but is less common in the dental field. If employed, AAT may be able to reduce anxiety and improve the dental experience.

Take it right the first time

Tips and tricks for safer dental radiographs

By Sarah O. Ostrander, RDH, MS

As dental hygienists, we want to capture quality diagnostic radiographs on the first exposure and avoid having to retake images to protect our patients and ourselves. Technology continues to emerge in favor of the clinician, leading to less room for operator error and overexposure to the patient. Our goal when taking radiographs is to maintain the ALARA principle (As Low As Reasonably Achievable). We do not want to expose our patients to any excess radiation, so following this rule is critical. This article will review the basics of exposing radiographs, as well as tips and tricks for taking a better image.


Radiation shielding

The apron for patient shielding should be utilized any time radiographs are exposed (figure 1). Not only do the American Dental Association and Food and Drug Administration recommend appropriate patient shielding, but there are also rules and regulations specific to each state.1 Lead-free and standard lead-lined protective aprons are available. Compared to lead, lead-free options provide equal patient protection, but the aprons are much lighter. Effective patient shielding requires a minimum of 0.25 mm of lead or lead equivalent.2

Figure 1: Use an apron any time radiographs are taken.

You may wonder, “When do I use a protective apron with a thyroid collar?” The National Council on Radiation Protection and Measurements requires thyroid shielding for all children and highly recommends the same for adults for any intraoral radiographs. This recommendation is based on the radiosensitive nature of the thyroid gland.3 Studies show that protective collars reduce radiation dosage to the thyroid by 26% to 33%.4 When taking a panoramic image, an apron that protects the front and back of the patient, such as a cape or vest style, should be used. A thyroid collar is not needed when taking a panoramic image as it may obscure desired anatomical structures. With the many apron choices available, make sure you choose the style appropriate to the type of radiographic exposure.

Dr. Fones: Following his vision in 2018’s dental hygiene

The founder of dental hygiene believed in collaboration and, yes, working outside of the dental office

Christine Nathe, RDH, MS

 

It is vitally important to understand the history of something when developing a solution for an issue. Dental hygienists should always research the history of topics in which they’re engaged because this can teach so much about the process and explain the “whys.”

When planning for dental public health programs, it’s important to remember the founder of dental hygiene, Dr. Alfred Fones’ initial paradigm for the profession. This paradigm focused on a new preventive dental care provider who worked outside of the dental office with the intention of motivating people to obtain comprehensive dental care by a dentist.

A photo of Dr. Fones from Fones School of Dental Hygiene, University of Bridgeport, Bridgeport, Connecticut.

Dr. Fones saw dental hygiene as a distinct profession that would be positioned within dental public health, and he believed that dental hygienists should provide education and preventive treatment outside of the dental office. Dr. Fones envisioned dental hygienists working collaboratively with other health and social service workers to provide preventive dental care to the public.

He stated that health education should be carried out by specially trained and educated teachers, and that dental hygiene was, in fact, created for this type of service.1 He further stated that because dental disease and resultant systemic infections were almost universal maladies, trained workers for maintaining mouth health were essential. The present need of the dental profession to solve the public health problem of mouth hygiene means dental hygienists should be competent to enter public schools, dental offices, infirmaries, public clinics, factories, assisted living facilities, and other institutions to care for the mouths of the millions who need these educational services.1 (Figure 1)

A guide for dental hygienists

Author’s table visually links up systemic conditions

Jannette Whisenhunt, RDH, BS, MEd, PhD

 

For the last several months, I’ve been writing about the oral-systemic link between periodontal disease and several systemic diseases. This month, I want to provide readers with a reference guide of how these diseases link with periodontal disease and the information that can be useful for hygienists while treating their patients.

With those patients who have periodontal disease, we’ve been seeing how the inflammation of their gingival tissue can affect other systemic disease processes. Use this guide to ask more in-depth medical history questions. We need to concentrate on explaining the inflammatory process to our patients. This explanation can help patients understand how their oral health might affect the other disease processes they’re dealing with. It may be a way to encourage them to take better care of their oral health and take your suggestions more seriously.

With the US population living longer and many people keeping most of their teeth, diverse health issues and periodontal disease will be a topic we’ll be dealing with more in our practices. We need to make sure that our patients understand that their periodontal health truly does affect their overall health.

Becoming collaborative partners with other medical professionals will become increasingly more common as the medical field continues to make the link between the mouth and the rest of the body. Asking more in-depth medical history questions will help us know more about our patients’ overall health so we can better serve them. One of the tools we have at our disposal is salivary diagnostics testing. By doing in-office saliva testing, we can help decrease the inflammatory burden that many of our periodontal patients experience.

Sacramento is a nice place, I hear.

Mark Hartley

I have traveled so often to California that it’s hard to remember the destination of every visit. I don’t believe I’ve seen Sacramento, though. I think I would have remembered the Tower Bridge. I admire the engineering and architectural designs that went into older generations of bridges. The Tower Bridge has vertical lifts to enable boats on the Sacramento River to pass underneath. Two towers rise up to more than 160 feet into the air. I would have remembered Sacramento.

The offices for the California Dental Hygienists’ Association sits in a cluster of professional office buildings—pretty much similar to what you find in any city—about five miles northeast of the state capitol buildings. It’s a little ironic that the street address is Point West Way, since many significant events in dental hygiene over the last 30 years prompted the rest of us to look west, particularly within the last three years.

I’m pretty sure I’ve never driven down Point West Way, even if I’ve passed through Sacramento at some point. We all should pay a visit to the CDHA headquarters. We can also visit the Tower Bridge, Sutter Creek, Tower Bridge, Crocker Art Museum, and, of course, the capitol on the way out of town.

Don’t get me wrong. The state’s dental hygienists withdrew from the American Dental Hygienists’ Association in June 2016, and it still bothers me a bit. The importance of unity within the ADHA community is as important as it ever was. California’s absence is a shame for both financial and political reasons. It just doesn’t sound right to say the ADHA has the support of 49 states. Any outsider in a position of influence for the profession could think, “Only 49? Have you, uh, miscounted? You meant to say 50, right?”

A case for the rubber dam: How the dental dam improves treatment and patient quality of care

How a rubber dam during dental procedures improves treatment and quality of care

By Staci Violante, RDH, BSDH, MSDH

 

The rubber dam is used in dentistry mainly for endodontic, fixed prosthodontic (crowns and bridges), and restorative procedures.

A dental or rubber dam, also known as a Kofferdam, is a thin, six-inch, latex or nitrile square sheet that is used in dentistry as a shield to isolate one or more teeth from the remainder of the mouth during a dental procedure. The rubber dam is used in dentistry mainly for endodontic, fixed prosthodontic (crowns and bridges), and restorative procedures. Aside from isolating the treatment or operative site, “the purpose of the rubber dam is to prevent saliva from interfering with the dental work, such as contamination of oral microorganisms during root canal therapy, or to keep filling materials such as composite dry during placement and curing, and to prevent instruments and materials from being aspirated, swallowed, or damaging the mouth.”1 Consider this analogy: A doctor uses surgical drapes to isolate the area of the body being operated on to prevent bacterial contamination from occurring; this is the equivalent of a dentist using a rubber dam for a dental procedure where isolation is necessary.

The dental dam

The dental dam is detained over a single tooth or multiple teeth by the appropriate rubber dam clamps over the anchor tooth. The tooth crowns protrude out from the rubber dam through the individual holes made by a hole punch, isolating the tooth to be treated from the rest of the patient’s mouth. This keeps the tooth dry and reduces the risk of exposure to microorganisms. Listed below are several advantages and disadvantages of using a rubber dam during a dental procedure.2

The dental dam is detained over a single tooth or multiple teeth by the appropriate rubber dam clamps over the anchor tooth.

The advantages of using a rubber dam:

  • enhances visibility of the treatment site since the dam retracts the cheeks and lips

Implant care: Two dental hygienist team up for CE company

Seminars presented by Healy and Obrotka explain the importance of implant maintenance

Ann-Marie C. Depalma, RDH, MEd, FADIA, FAADH

With implant surgical and restorative markets forecasted to reach $12.32 billion by 2021, dental professionals will encounter patients who are either candidates for implants or have implants currently. Do you know what to expect with a patient with implants and how to decide whether the area is healthy or exhibits peri-implant disease? With the increased incidence of peri-implant diseases, implant maintenance is an important aspect of total implant care and long-term success.

Maintenance protocols vary but Shavonne Healy, RDH, BSDH, and Melissa Obrotka, RDH, BBAOM, have developed a company, RDH Innovations, that provide strategies for safe, effective implant maintenance care and information. Their programs include:

 

    • “Are You Prepared to Treat the Terminator? Caring for Patients with Advanced Implant Supported Prosthesis”

 

    • “A Dental Hygienist in Oral Surgery? Introducing the Implant Care Practitioner.”

 

The “Dental Implants Uncovered” program reviews:

– The etiology and factors associated with peri-implant diseases

– Froum and Rosen’s peri-implantitis classification system

– Implant surface characteristics and prosthetic design

– Decontamination protocols and combination therapies for the management of peri-implant diseases.

Infection prevention: Control aerosols when using an ultrasonic scaler or air polisher

Devices can help control aerosols during patient treatment

Dianne Glasscoe Watterson, RDH, BS, MBA

 

Dear Dianne,

I heard a talk about infection control recently, and the speaker described the need to control aerosols when using the power scaler and air polisher. He said the best way to accomplish that would be to have someone suction while I work. I do not have that luxury. Of course, I always use the saliva ejector to control pooling water, but I know it does little to control aerosols.

In a lecture you give, you talk about several different options for controlling airborne pathogens. Could you revisit that subject? What about my hair? Does a hairnet keep airborne pathogens out?

Brittany

Hi Brittany,

We know that pathogens come from two sources: the patient and dental unit water lines. We also know that aerosols, or tiny microdroplets, are created when we use instruments such as power scalers and air polishers. Aerosols are measured in microns. One millimeter is equal to 1,000 microns. If an aerosolized particle is 0.5 microns, 2,000 particles could fill the space of one millimeter. Particles this small can pass through a standard face mask.

In a literature review conducted by Harrell, et al., which looked at blood in aerosols and splatter found that 100% of samples collected during ultrasonic scaling contained blood.1 According to Stephen K. Harrel, DDS, blood in aerosols and splatter “may represent a surrogate marker for pathogenic organisms and thus create an infection control risk.”1 Herpes simplex viruses, hepatitis viruses, and MRSA can be present in the mouth. It is logical that these organisms will be forced into aerosols resulting from the use of an ultrasonic scaler. This explains why aerosols should be controlled to the greatest extent possible.

Toothbrushing: Infection contol in the school setting

Infection control practices, though, may be missing from the lunchroom

Noel Brandon Kelsch, RDH, RDHAP, MS

 

I walked into the school cafeteria. It looked like a plume of dust was rising. It wasn’t until I heard that familiar tune, “Well, you wake up in the morning. It’s a quarter to one and you wanna have a little fun. You brush your teeth…” that I realized what was happening. Over a 100 children who just finished lunch were brushing teeth all at once. Two boys were “dulling” toothbrush swords. Two girls declared they were trading toothbrushes; one wanted the Trolls toothbrush and the other one wanted the Minnie Mouse toothbrush.

The intention of this afternoon brushing program was noble; the action may be doing more harm than good.

I discussed the issue with the school nurse and soon found out that many times not even the school nurse is aware of the contagious nature of dental diseases. I gave the nurse the example of dental caries. I explained this is the simple most common chronic childhood disease. It is a contagious infectious disease. Family members, caregivers, and even playmates can transmit caries producing oral bacteria. This can happen by sharing a spoon, kissing, and even wiping off a pacifier that has fallen on the ground in the mouth.1,2,3 The nurse was shocked. She said she had no idea.

In the school setting, the Centers for Disease Control and Prevention takes a strong stand in this area on the need for both a protocol and a high level of supervision. They state that the likelihood of toothbrush cross-contamination in the school setting in toothbrushing activities is very high. Improper storage and children’s behavior can have a big impact. There is also a small chance exists that toothbrushes could become contaminated with blood during brushing (gingivitis, trauma, etc.).4