Caries. Gingivitis. Ulcerations. Bruxism. These are among the common ailments dental hygienists watch for in every routine dental examination. But there are some areas of inspection many hygienists overlook: namely, the oral structures of the head and neck.
Dental professionals, including hygienists, omit conducting an extraoral head and neck examination on patients on a routine basis. However, head and neck examinations can save lives, as they are key to identifying signs of oral cancer.
Importance of Extraoral Head and Neck Examinations
When oral cancer is detected and treated in its early stages, the 5-year survival rate is as high as 90%. However, because it often develops without pain or symptoms, patients rarely notice the disease until it has progressed into Stage 2 or beyond.
For this reason, dental hygienists and other professionals can greatly improve patient outcomes, or even save lives, by incorporating head and neck examinations as part of routine dental examinations.
Dental professionals conduct extraoral head and neck examinations by palpating important structures of the patient’s head and neck to assess and identify abnormal conditions. A thorough examination involves palpation of the jaw joints, parotid salivary glands, thyroid gland, masseter muscles, and various lymph nodes (submental, submandibular, cervical, supraclavicular, occipital, postauricular, and preauricular lymph nodes).
It is not necessary to perform these checks in any exact sequence, but the clinician should choose a sequence and apply it consistently to maintain awareness of abnormal versus normal conditions.
A well-practised clinician can complete this examination within four to five minutes.
How Dental Hygienists Can Perform Head and Neck Examinations to Improve Patient Outcomes
Unfortunately, many dental hygienists do not conduct thorough head and neck examinations on patients.
The Canadian Dental Hygienists Association (CDHA) identifies various barriers that stand in the way: lack of time, insufficient training or knowledge, concern about client compliance, and lack of guidelines and tools.
But the capacity of these exams to improve outcomes for patients is too great to ignore. Dental professionals can potentially detect up to 84% of new oral cancer cases in the critical early stages. And, as demonstrated by an anecdote told by TGNA Clinical Coach and guest columnist Karina Bapoo-Mohamed, these 5-minute examinations can save lives.
Bapoo-Mohamed advised her patient to see a doctor ‘sooner than later’ after discovering an abnormality. Within days, the patient was referred for treatment for stage 1 oral cancer.
“Everyone that asks how/why I had it checked,” writes the patient, “and all I say is thanks to my Dental Hygienist.”
The CDHA sets out the following steps dental hygienists can take to improve their practice when it comes to extraoral head and neck examinations:
Know the facts on oral cancer. Dental hygienists should be confident in their knowledge and ability to locate, review, and update baseline data.
Know the early signs to look for. Perform extraoral head and neck examinations in addition to other routine dental exams. Use this fact sheet from Canadian Dental Association as a starting point for educating yourself on the signs of oral cancer.
Effectively communicate findings to patients. Ensure that patients understand the urgency of identifying and treating a potential case of oral cancer in the early stages.
Refer patients appropriately. Dentists and dental hygienists should establish a process for referring patients who could have oral cancer to a doctor who can conduct a biopsy.
Medicine has long recognized the connection between a patient’s oral health and general health. While research on the precise mechanisms of this oral-system link is ongoing, we know that inflammation by oral bacterial contributes to inflammation in other parts of the body. In a recent piece for Hygienetown, RDH Shirley Gutkowski discusses an aspect of the oral-systemic link that is proving to be more significant than previously thought: airway disorders.
Complications of the airway, particularly mouth breathing and sleep apnea, are growing concerns among dental professionals. Below, we’ll examine how dentists and dental hygienists can use airway support in dentistry to help patients improve their oral and overall health.
How Airway Disorders Affect the Oral-Systemic Link
In her article, Gutkowski contextualizes the issues through the work of pediatric dentist Dr. Kevin Boyd. Dr. Boyd is a leading scholar in Darwinian Dentistry, a medical theory exploring the link between modern systemic diseases and human evolutionary changes.
Darwinian Dentistry hypothesizes that the rapid industrialization of food has spurred evolutionary changes that leave us susceptible to airway disorders. Specifically, humans have smaller midfaces and smaller sinus cavities than our ancestors, contributing to mouth breathing while awake and apnea during sleep.
The same is true about sleep apnea. Gutkowski points out the conditions associated with inflammation are nearly identical to those linked with sleep apnea, and many studies show an increase in inflammation in people who snore. In one study, seniors with abnormal pulmonary function had significantly higher incidences of gingivitis.
Airway Support in Dentistry
An increasing number of dental professionals are focusing on the airway, some even opening “sleep practices” that specialize in these disorders. Many of these dentists can provide patients with dental appliances designed to support the jaw during sleep, providing airway support to alleviate apnea symptoms.
The practice of Orofacial myofunctional therapy (OMT) is also gaining acceptance as an alternative method of treating airway disorders. OMT involves movements that strengthen the muscles involved in the airway complex. The results are impressive: OMT has been demonstrated to reduce apnea by 62% in children and 50% in adults.
There are several ways dental hygienists can play a role in airway support. It is likely that demand for these skills will increase as recognition of airway disorders in the oral-systemic link continues to grow among dental professionals.
Become an expert. Registered dental hygienists can apply for certification as an Orofacial Myologist following completion of an IAOM-approved 28-hour course.
Be breath-aware. Along with looking for signs of periodontal inflammation, hygienists can observe a patient’s breathing for potential issues. A patient who cannot breathe through the nose for 20 or more respiration cycles should receive a referral to an orofacial myology specialist.
Practice preventative treatments. Since OMT takes time, hygienists can provide patients with fluoride varnishes in the meantime, which can help to prevent oral health issues associated with apnea and mouth breathing issues.
Migraine symptoms have many potential triggers: bright light, changes in air pressure, allergies, high humidity, stress, and more. Can dental problems trigger migraines as well?
According to the American Migraine Association, migraines affect over a billion people worldwide. Over 36 million people experience migraines in the United States alone.
What many people do not realize is that their migraine symptoms could be relieved by treating common dental problems.
An article in Dentistry Today explores the link between migraines and dental issues. Some of the dental problems that can trigger migraines include:
Bruxism (tooth grinding)
Caries (tooth decay)
Periodontitis (gum disease)
How Bad Bite Causes Migraines
Loose, missing, or misaligned teeth contribute to a bad bite. Bad bite strains the jaw muscles by forcing them to work harder to chew, swallow, and even keep the mouth shut. Over time, bad bite contributes to persistent muscle inflammation that can trigger painful migraines or headaches.
Pain that begins in the temporomandibular joints, which connect the sides of the jaw to the skull, can also lead to migraines and headaches.
Migraines often develop on one side of the head, beginning around the temple and spreading to the back of the head. Dentists observe that patients who complain of having frequent “one-sided” headaches are more likely to have dental problems relating to a bad bite.
Tooth Grinding and Migraines
Bruxism, or tooth grinding, is another common dental problem that can trigger migraines. Many people who experience tooth grinding do so at night, so they do not realize they have a dental problem, but do report persistent headaches or migraines.
Other signs of tooth grinding include:
Clicking sound when opening the mouth
Difficulty opening and closing the mouth
Clenching or gnashing teeth causes inflammation in the gums and jaw muscles. As with bad bite, the inflammation caused by clenching or gnashing is a potential migraine trigger. These migraines often feel like a dull, constant headache originating around the temples behind the eyes.
Throbbing toothaches caused by tooth decay can also trigger headaches or migraine episodes.
Are Dental Problems Causing My Migraines?
There is a strong connection between headaches, migraines and untreated dental problems. Fortunately, there are usually ways to treat the underlying issue and diminish the migraine symptoms.
Dentists can correct many of the dental problems that trigger migraines through simple dental procedures, orthodontic treatment, or a mouthguard. In addition to relief from migraine pain, patients will experience the benefits of better oral health.
While there is no guarantee that treating the problem will end the migraines, dentists can help determine whether the symptoms and dental problems are linked. It is always worth asking.
Patients who experience symptoms of bad bite, tooth grinding, tooth decay, or gum disease should see a dentist regularly and ask about headaches and migraines.
There are many ways to boost patient satisfaction in your dental practice. Clear communication, good time management, friendliness, efficiency, and empathy are significant factors in a patient’s overall expectations of their dental experience.
But according to the Canadian Dental Association, one quality stands out above the rest: confidence.
A dental practitioner’s confidence, and the ways in which they demonstrate it, ranks as the #1 influencer on how patients perceive their quality of care, according to the latest Canadian Dental Association survey.
Why? Confident people attract positive attention — no secret there. It’s natural to be attracted to people with high self-esteem, whose confidence shines through their charisma, appearance, speaking, writing, and listening skills. Confidence is a sign of competence, not arrogance, in the dental practice.
To promote and maintain patient satisfaction, professional dental care providers need to keep confidence at an optimum level to ensure ongoing quality of care. Below, we’ll discuss some of the ways to grow and maintain that confidence in your practice.
Ways to Be Confident and Boost Patient Satisfaction
A person’s levels of confidence can swing up and down due to positive or negative experiences, and criticisms. We are most confident when we are performing routine and familiar tasks.
Here are ways to show your confidence as a dental practitioner or hygienist:
Be optimistic. Think positively. While it may sound cliché, there are tangible and proven benefits to adopting an air of optimism, and your positive outlook will rub off on your patients.
Focus on the present. What do you want to accomplish today? Don’t dwell on the past. Once you have acknowledged your mistakes, learn to accept them and move forward.
Accept compliments graciously. Say thank you. What may seem like minor work to you can have a profoundly positive impact on your patients’ lives, so you should always be open to their praises.
Face your fears. When you have a busy day ahead, tackle the tasks you like least first. You will face the remainder with the confidence of knowing the worst is over.
Break down large tasks into smaller sub-tasks. Knowing how to prioritize your to-dos is key to ensuring you accomplish your daily goals.
Learn and research new skills and technology. The world of dentistry is continuously advancing, and being prepared will help you keep a competitive edge.
Recognize your strengths and achievements. You have come a long way to get where you are. Remember to celebrate successes.
Manage stress. Don’t let your own wellness get lost in the daily grind. Develop effective coping strategies, and take moments to just breathe throughout your day.
Smile. Learn to laugh at yourself. Take pleasure in your daily tasks.
Believe in yourself and your team. Positive reinforcement will help everyone in the practice grow their confidence and boost patient satisfaction.
The North American opioid crisis is not only an issue for public health and law enforcement officials; it also concerns dentists and dental hygienists in private practice. In fact, dentists can play a significant role in protecting their patients from succumbing to addiction and substance abuse.
As medical professionals who prescribe opioid drugs to patients, it is imperative for dentists to understand the link between opioids and dentistry, and the steps they can take to help combat the opioid crisis.
Opioids and Dentistry
Despite great advancements in dental techniques and technology, pain is often a necessary consequence of performing dental work. Fortunately, we have also come a long way in developing effective steps to lessen patients’ discomfort, and pain management is a top priority of any dental practice.
Among the pain management tools at a dentist’s disposal are analgesics (painkillers) and other prescription drugs. In many cases, drugs like acetaminophen and anti-inflammatories are sufficient in managing a patient’s dental pain. However, there are cases where non-opioid drugs are not enough, and that is when dentists might consider prescribing an opioid analgesic like codeine or oxycodone.
All drugs carry risks, but opioids are more liable to misuse than most, and opioid abuse can result in grievous harm. In 2016, over 42,000 peopled died from overdosing on opioid drugs in the United States alone. Many people who use narcotics first developed a dependency to legally-prescribed analgesics.
It’s not to say that dentists are unaccustomed to making judgement calls; exercising professional judgement is a part of what dentists and other healthcare professionals do every day. However, with opioid abuse causing a record-number of overdose deaths in Canada and the U.S., dentists must be especially careful in weighing the potential benefits and risks of prescribing these drugs to a patient.
In a message to America’s dentists, ADA president Joseph Crowley asks dentists to take four specific steps to prevent opioid analgesics from harming patients:
1. Consider using non-narcotic pain relievers as the first line of treatment.
2. When prescribing an opioid pain reliever, consider prescribing fewer pills in accordance with state law and the latest pain management guidelines.
3. Counsel patients about the benefits and drawbacks of using opioids to relieve pain, especially the risk of addiction.
4. Learn to recognize when a patient might have a substance use disorder or be more prone than others to addiction.
The ADA also provides a free continuing education course on how to incorporate safe and effective protocols for using opioids to manage dental pain and offers a reference manual on how to manage dental pain for patients who are at risk of substance abuse.
It is with great enthusiasm that Sable Industries announces the introduction of our expanded Electric Parts series of products.
Sable now offers more key electric parts in order to help you keep repairs in house and at a great value. We have integral parts for Bein Air, Kavo and NSK electric handpieces.
Sable electric parts are compatible with leading electric handpieces which will allow you to:
Keep more repairs in house as opposed to sending back to OEM
Purchase only the key assemblies that require replacement
Contain costs for yourself and your clients
Sable is the North American leader in handpiece parts. It is our pleasure to expand our offerings into electric parts to bring our expertise and outstanding service to this under-served yet growing segment of your business. We will be adding more electric parts from other OEM manufacturers in the near future.
Please note that our Cartridge and Assembled products are warrantied for manufacturer defect for 1 year, all individual parts are not warrantied.
To order or to learn more please call us at 1.800.368.8106
With more and more people making an effort to be informed on the chemicals and materials they’re exposed to every day, many dentists are looking to reduce the number of chemicals used in their practices.
Proper cleaning and disinfection in a dental office is a legitimate concern. After all, if disinfection isn’t done properly, a patient could be harmed. Everyone in the practice is responsible for ensuring the safety of all patients that walk through its doors.
The best way to avoid making a patient sick is to make sure that any sources of infection are properly contained. Unfortunately, it’s all too common to hear that evacuation systems aren’t cleaned daily—or aren’t properly disinfected when they are cleaned.
Reasons for the lapse in cleanliness could partly be due to the work involved, but also the perceived dangers of the continuous use of chemicals every time the system is cleaned. Over the past three decades, newer and stronger chemicals have been introduced to keep surfaces, water lines, and evacuation systems clean and sterile. However, the number of chemicals can also create issues, and many are harmful on their own.
The alternative is microbiological cleaners. But what are they, and how do they work?
It was over 150 years ago that doctors figured out washing their hands before surgery drastically reduced the patient’s risk of infection. This jumpstarted the field of microbiology, or the study of microscopic organisms.
Once we started looking, we discovered bacteria everywhere.
It’s estimated that there are more bacterial cells in a human body than there are cells that make up that whole person. The sheer number of microbial organisms that constantly surround us is staggering, which is why it’s so hard to create sterile environments. We need to use intense stressors like temperature, pressure, or chemicals to eliminate microbial growth.
We simply must accept that we are, and always will be, swimming in a sea of bacteria. The good news is, though, that the clear majority of bacteria won’t make you sick. Most bacteria really do not affect us. In fact, there are plenty of microbes that actually keep us healthy. Your gut, for example, is chock full of bacteria that is helping you to remain healthy and digest your food.
The good bacteria in your gut also keeps dangerous, harmful bacteria at bay. It’s this same principle that makes microbial disinfection such a good alternative.
As an alternative to chemicals, disinfection can be done using microbial cleaning products. These products seed and jumpstart the growth of “good bugs.”
These good bugs not only help to kill harmful ones, but they also work to keep the bad bugs away. This is one clear advantage to chemical sterilization—the harmful bacteria is kept at bay for longer.
Products like Bio-Pure can keep an evacuation system clean of harmful bacteria on a continuous basis. It does this by introducing a cleaning microbe into the system. Microbial growth is exponential, which means one microbe can quickly become 10,000,000. This army of good bacteria cleans out all other microbes and creates a barrier against bad bugs.
Short of cleaning out the system before and after each use, Bio-Pure is the most effective way to keep a system clean and safe at all times. Plus, there’s no need for harmful chemicals.
Most of us chew gum, and we chew it for a variety of reasons. Whether it’s a piece before a first date, or after a particularly strong cup of coffee, many of us use the chewy stuff to keep our mouths smelling clean and fresh as we go about our day.
We see gum promoted in advertisements as something you can use not only to keep your breath smelling fresh; but to whiten and clean your teeth, improving your oral health.
Exaggerated marketing, or bona-fide fact? The answer lies in the ingredients of the gum you choose to chew.
The Potential Benefits
It comes as no surprise that if you’re chewing gum with a lot of sugar in it, it’s going to be bad for your teeth. Sugar promotes the growth of plaque bacteria, which in turn promotes the development of cavities, the decay of enamel, and other issues.
It’s because of this that many companies, such as Wrigley’s, have begun to use both aspartame and a substance known as Xylitol as a substitute for sugar in their products.
A naturally occurring compound that has been shown to prevent tooth decay, the National Centre for Biotechnology Information writes that Xylitol, “reduces the levels of mutans streptococci … in plaque and saliva by disrupting their energy production processes, leading to futile energy cycle and cell death … Consumption of xylitol chewing gum for >3 weeks leads to both long-term and short-term reduction in salivary and plaque S. mutans levels.”
Sounds pretty good, doesn’t it? Less bacteria on your teeth means less enamel-eating acid created, which means a healthier mouth. Brands like Confadent advertise and discuss their use of Xylitol as a safe alternative to aspartame, and a plaque reducer.
According to Delta Dental of California, “With xylitol use over a period of time, the types of bacteria in the mouth change and fewer decay-causing bacteria survive on tooth surfaces.”
This sounds like a big-time benefit for your pearly whites, but how do the results compare to projection? Some research shows that the evidence regarding the long term benefits of Xylitol as a dental hygiene product is still unclear.
According to a review published by the American Dental Association in 2015, while there is some evidence that Xylitol may reduce tooth decay over a period of years, the evidence is low quality.
Research published by the Cochrane Library website suggests that there just isn’t enough high quality evidence to confirm that Xylitol prevents tooth decay.
Philip Riley, M.P.H., of the School of Dentistry at the University of Manchester in the UK, is quoted as writing, “More well-conducted, randomized placebo-controlled trials that are large enough (in terms of number of randomized participants) to show a difference, if one exists, are needed.”
The Cochrane Library review stresses in its conclusions, “We found some low quality evidence to suggest that fluoride toothpaste containing xylitol may be more effective than fluoride-only toothpaste … The effect estimate should be interpreted with caution due to high risk of bias and the fact that it results from two studies that were carried out by the same authors in the same population.”
So, What to Do?
In the end, the conclusions are yours to draw based on the evidence given, but it’s safe to say that chewing gum with Xylitol is better for your teeth than its sugary counterparts. While there needs to be some more research done to better reinforce this conclusion, Xylitol has indeed been shown to reduce cavity causing bacteria in the mouth.
Still, if you want to keep your teeth healthy, at the end of the day no gum is a substitute for regular brushing and flossing. For more information on Xylitol, its benefits and drawbacks, you can check out this article from Access Dental, or this one from Delta Dental.
When concentrating on efficiency and making the best use of the available space, it can be easy to forget a dental office also must provide the right atmosphere for clients. Although many dental practitioners have done their best to reduce anxiety for clients, Ondontophobia is still all too real for many people.
While some of these individuals require therapy to manage this issue, practitioners can still do their part to reduce anxiety experienced by anyone dreading a trip to the dentist. A great way to start is by reducing a client’s apprehension before they sit in the examination chair.
Here are some things to keep in mind for dental office design that will help to generate an inviting, relaxed atmosphere for your patients.
In the old days, dental offices often had a tropical fish tank in the waiting room. These provided a gentle distraction for patients, particularly children. Many still do, but now many offices are also installing televisions.
These generally play programs and movies without the sound, but with closed captions activated so interested viewers can follow what is happening.
A TV can provide a relaxing diversion, but you need to be careful about what is on. Violent shows or ones that are particularly suspenseful will be counterproductive, as will news channels on days when the reporting is particularly negative.
Soothing Colours and Artwork
Personal preference always plays a big role when choosing colours for an office, but here are some suggestions to consider. When choosing your colour scheme, aim for hues that induce a sense of tranquility and do not have any hint of threat.
Colours able to bring about a calming energy include those people commonly enjoy in nature, such as sky blue, green/sage, and tan/brown.
White suggests cleanliness and reminds some of anti-septic, but can be triggering for some due to its hospital connotations.
Bright colours, while attractive, can actually put people on edge (red is particularly strong in this regard), so try to stay away from them.
Do not choose only a single colour; pick a main one as well as another that provides a notable contrast, but not too harsh (e.g. a darker and lighter version of the same hue). Solicit opinions from your staff, and ask what they would prefer for areas only they will use.
Artwork can also provide both decoration and visual interest. Be sure to choose art the average person can easily relate to and does not include an abundance of off-putting shades.
Plants and Furniture
Plants will help to reinforce the natural theme and suggest that your practice is a healthy and vibrant place. Be sure to regularly water and maintain them so wilted, dying leaves are never apparent. If it is apparent that everyone on staff is too busy to ensure this happens, hire an outside company to do it.
Choose chairs that look and feel comfortable, but can also hold up well to steady traffic and children. Side tables should be big enough to accommodate patient’s incidentals, but not take up so much space that it becomes awkward to move around.
Include magazine and brochure racks for those who would prefer to read.
Provide a View
If building design permits, and you are lucky enough to be in a picturesque area, provide a window view in the waiting and exam rooms.
This offers another healthy and natural way for patients to get their minds off their procedures, both before and during the process.