Thyroid conditions present oral and systemic manifestations that can challenge even the most seasoned dental professionals. Up to 15% of the general population has some form of thyroid abnormality, and many people have never been properly diagnosed - which makes treating them all the more complicated.
As a registered dental hygienist, there are ways you can help to identify and manage the oral manifestations of thyroid diseases. Here, we’ll discuss two of the most common thyroid diseases you’ll see in your practice: hypothyroidism and hyperthyroidism.
Many people who have hypothyroidism present only a few or very mild symptoms. However, those with severe hypothyroidism can experience numerous symptoms including slow metabolism, weight gain, lethargy, sensitivity to cold, and puffiness of the face.
When treating a dental patient with hypothyroidism, you may notice one or more of the following common oral manifestations:
Salivary gland enlargement
Compromised periodontal health
Glossitis, or inflammation of the tongue marked by soreness, swelling and change in colour
People who experience severe hypothyroidism as a child may present long-term dental and craniofacial manifestations in adulthood, such as:
Micrognathia, or undersized jaw
Macroglossia, or oversized tongue
Oral Manifestations of Hyperthyroidism
Hyperthyroidism, also called overactive thyroid, is the unregulated production of thyroid hormones. It is most often called by an immune system disorder called Grave’s Disease and usually affects women under 40, but it can occur in people of all ages.
Many of the symptoms of hyperthyroidism mirror hypothyroidism in reverse - sensitivity to heat, weight loss, increased cardiac output are common. It can also cause emotional instability, tremors, abnormal heart rate and hypertension.
A dental patient who has hyperthyroidism may present the following oral manifestations:
Increased susceptibility to periodontal disease and dental caries
Enlarged extraglandular thyroid tissue (mainly in the lateral posterior tongue)
Treating Dental Patients Who Have a Thyroid Disease
As a registered dental hygienist, it is important to understand how thyroid dysfunction could affect your patient care.
First, you are well-positioned to notice the symptoms of hypo- or hyperthyroidism and aid in early diagnosis. Your keen eye could be what points a patient in the right direction to receiving treatment for their condition.
For patients who have confirmed thyroid disease, it’s also important that you and your colleagues deliver care that will help, not harm. Complications can occur from improperly treating dental patients with thyroid disorders.
Rebecca Marie Friend, BS, RDH demonstrates this perfectly in a recent column for Today’s RDH. When an elderly patient came in presenting with hypothyroidism, Rebecca took the time to carefully review the patient’s health history and discuss the patient’s medications, including over-the-counter remedies. Not only did this discussion reveal an important oversight by the patient’s doctor, but Rebecca was able to provide the patient with a better understanding of the condition.
Rebecca also provides the following recommendations to hygienists and other dental professionals in treating dental patients who present with thyroid disorders.
Establish communication with the patient’s endocrinologist and other healthcare providers. This will ensure that you are kept up to date with the patient’s medications and the rest of the healthcare team is aware of the patient’s oral manifestations.
Plan treatment in a way that limits stress and infection. Patients with hypothyroidism are at greater risk of infection due to increased bleeding and delayed wound healing.
Treat the oral manifestations of hypothyroidism and hyperthyroidism as needed, including periodontal disease, caries and xerostomia.
Conduct an extraoral head and neck examination at each appointment. This will help you detect changes to the patient’s thyroid region.
Be sure to always use a thyroid collar when taking patient X-rays. The thyroid gland is very sensitive to radiation, and excessive exposure is a known risk factor for thyroid conditions.
Help the patient feel comfortable in the chair. People who have hypothyroidism could use a blanket to help keep their legs warm, while those with hyperthyroidism might appreciate you turning the thermostat down a few extra degrees.
Dental handpieces are the bread and butter of any dental office.
Imagine a violinist without a violin or a painter without a paintbrush. That is what dental handpieces are to dentists and hygienists.
Without them, a dentist couldn’t fully function safely and easily.
Every dentist has their own personal preferences to which handpieces they use. The speed, and size and just overall feel of the equipment allows us to feel comfortable in delivering the best possible experience and quality for any patient.
But like most things, everyday use can wear down the machinery. Handpieces are investments and so their repairs shouldn’t be brushed aside.
What should you ask when your handpieces are wearing down and it’s time to get them repaired?
1. Do All Repairs Come With A Warranty?
Handpieces are investments to your overall business. You need a guarantee that it will work.
The tools you use in your office, are extensions of yourself and your business. If something goes wrong because of a faulty repair, you’re liable for that patient’s safety.
A warranty is a silent indicator that the company is confident in their services to ensure your tools with a failsafe. Not only that but if something does happen, you’re covered.
Typically, the average repair service warranty is 3-6 months, depending on the handpiece and the type of repair. You’ll want a company that carries out quality repairs with a guarantee that it will work well.
If a repair service lacks a warranty, it’s probably best to avoid their services. They may have an inexpensive price tag, but you’ll get what you pay for. There’s a reason they are cheap.
Imagine yourself bringing your car in to get new brakes on your car. The technician says they’ll be covered under warranty for the next year. This is a necessary investment to ensure that you’ll be safe on the road, not only to those around you but also yourself.
Handpiece repair warranties are similar to car warranties. They are necessary investments to perform your daily tasks safely.
2. What Kind Of Parts Are Being Used?
Like we said before, handpieces are investments to the success of your business.
The last thing you’ll ever want is to replace your high-quality handpiece parts with cheap, poor quality parts. You wouldn’t replace violin strings with yarn, so why would you expect anything less than high-quality parts for every repair?
Sadly, if you end up with poor quality parts in your tools, not only is it not going to last as long but it may also damage your tools beyond repair.
One of the best things you can do is find out what others recommend. Personal recommendations are huge because they know how the product actually turned out.
No one should ever take expensive equipment to someone they don’t know!
3. Does The Company Provide High-Quality Customer Service?
What does that look like? Someone that honours the promises they make. If they are charging you for a quick turnaround, they make sure they are delivering their work on time.
If you don’t get a good feeling around them, or your personalities clash, then don’t entrust them with your repairs.
Some of the best repair services are the ones that let you speak directly with one that’s handling your equipment. They have the knowledge on what needs to be done.
An indication of a good repair company is if they offer you a free no obligation quote. You need someone to tell you if your tools are just beyond repair. Someone who won’t waste your time trying to fix something that can’t be.
Giving you an estimate or advice, means that you can trust their knowledge and they have your best interest in mind.
Extending the lifespan of your handpieces can allow you to save money. But you need someone who will tell you like it is, when things are beyond repair. Talk to us about our handpieces and how we can help you!
In any business, there are customers that we like and customers that test our patience. The same goes for the patients that visit the dentist’s office.
And sometimes, it’s hard to handle them so that they have the best experience and you can do your job.
Here are 4 types of patients that can be difficult and how to manage them.
1. The Google Expert
We all know that one patient.
They know all the latest and greatest medical news and can’t wait to share with the dental hygienist. Instead of giving them a cleaning, we’re bombarded with questions that have taken four years of dentistry school to learn.
“Why didn’t you use this treatment?’
“Shouldn’t you be doing this?”
It can be exhausting.
It’s wonderful that the patient is enthusiastic about getting involved with the process, but it can hinder dental hygienists’ trying to do their job and sometimes even be harmful to the patient.
It’s 3:50. Their appointment was at 3:30. At this point, we’re assuming they just aren’t coming.
That’s when they stroll on in. The only thing more frustrating than that is if it happens on the regular.
Lateness has a domino effect. Regardless if all the next patients are on time, there’s no way to get back that 20 minutes. The worst part is making other patients wait just because someone has chronic tardiness. It isn’t good for anyone.
The best way to manage lateness is to incorporate a late policy. And stick to it.
Anyone that is more than 15-20 minutes late to their appointment, cannot be seen that day and will have to reschedule.
Generally, patients will respect the set appointment time and it will reduce the amount of late arrivers.
As dental hygienists, no one wants to see a patient cringe and tense as we recline the chair or pull back their cheeks. But no matter what we try to do to calm them, nothing works.
Sometimes, their discomfort and tension can radiate onto us, making us nervous too.
The best advice is to stay calm yourself. This is much easier said than done but often times what you put out into the world you get back in return.
It may be beneficial to open up the floor to a discussion about what is causing the anxiety and how we, as hygienists, can ease that discomfort. By knowing what makes them the most worried, you can avoid or minimize that factor.
In extreme cases, the patient may need to consult their doctor for anti-anxiety medication to take before appointments.
4. The Chatty Cathy
You love them, but at the same time they can be quite frustrating.
These are the types that will get to know you, ask about the kids or about upcoming vacations. They are often the sweetest patients you’ll get!
As much as they make the workday go by faster, they can eat into the appointment through their conversations and suddenly we’re behind schedule!
It can be challenging when managing a Chatty Cathy because we don’t want to be rude in any way but we also have to get the job done on time. But like any skill, managing chatty patients comes with time and experience.
Focus the conversations towards the beginning and end of the appointment as well as during the period of time before the patient is seen by the doctor. These time zones are optimal for conversations because they don’t interrupt your job but also give the patient a chance to socialize.
Not only that but it will also build a better relationship with the patient!
While these four types of difficult patients can pose a challenge, there’s nothing we, as dental hygienists, can’t handle.
When someone smiles, what is the first thing you look at? For many dental hygienists, and the public, it is the person’s teeth, particularly if they are brilliantly white or if there is something stuck in them. In addition to maintaining appearances, oral hygiene is essential to preventing gum disease, cavities, et cetera, which have a significant effect on oral health.
As you are aware, diet plays an important role in oral hygiene and health. While dental hygienists know the specifics behind which foods are good and bad for their teeth, many patients forget and require reminding. This is why we have compiled some of the information regarding two of the worst types of food for teeth as well as two of the best, including examples. Be sure to review this information with patients regularly. Their oral health will skyrocket if you do!
Sugary and Chewy Food
The sugar in food, especially refined sugar, is prime fodder for bad bacteria. The sugars often become acid, which is how cavities in your teeth get started. Some sugary drinks, such as pop, are your teeth’s worst enemy, particularly when it comes to eroding the enamel.
Chewy food, on the other hand, is not good for your patient’s teeth because of how pieces are more likely to stick to them for longer. This makes eating gummy candy even worse for you, since the longer food sticks around in your mouth, the higher the potential for cavities becomes.
Be sure to remind patients of the effects of refined sugar and chewy food like gummy candy on their enamel and overall oral health. Of course, not everyone will be able to avoid them entirely. Thus, review best practices for oral hygiene, such as how to brush/floss and how often clients should floss) with each patient.
As a dental hygienist, you are aware how highly acidic foods, such as lemons and pickles and drinks like alcohol and coffee, are among the worst for your teeth if you are not careful when consuming them. Remind patients about the effects beyond discolouration, which many are aware of. Put particular emphasis on sensitivity, cavities, and tooth decay. After all, stopping the issues as soon as possible helps prevent serious issues down the line.
As a dental hygienist, you have likely told your patients drinking milk helps their teeth grow. Most people know the calcium helps make their bones strong, but many may not be aware the benefits go beyond that, particularly for their teeth. Inform patients about the mineral hydroxyapatite, of which calcium is a major part, since it helps to build up the strength of their enamel. This also goes for casein, a common protein found in dairy products such as cheese. Are your patients consuming food not so healthy for their teeth? Reminding them of the benefits of dairy, in addition to best oral hygiene practices, is a great way to counteract the effects.
High Fiber Food
Many individuals know high fiber food helps maintain healthy cholesterol levels and increases good digestion. But they may not be aware of what dental hygienists already know: the benefits they provide teeth. Review how the amount of chewing required to consume fiber-rich food increases the saliva in their mouth, which helps provide some natural cleaning. But make sure your patients do not forget to brush their teeth regularly too!
If your patient is stuck on what food they can consume with a high fiber content, popular suggestions include spinach and other leafy greens, beans, and whole wheat pasta.
Share your extensive oral health knowledge with your patients, and remind them of the effect both good and bad food has on their teeth!
Think back to your days as a dental hygiene student. How did you picture your future career as a dental hygienist? If you dreamed of working in a fancy dental office with the latest and greatest in high-tech gadgets, you have something in common with hygienist Casandra Smith.
In an article for Hygienetown Magazine, Smith admits she was once a fresh dental hygiene student who hoped to spend her career as a dental hygienist within the confines of a comfortable office. But her outlook changed when she began seeing patients in her college’s clinic.
“During my time at the clinic, I treated many patients from underserved communities,” Smith writes. “They all came from different walks of life, but they had one common thread — limited access to care.”
Each of Smith’s patients had a story. All had tried and failed to receive dental treatment in the past. They faced obstacles like lack of insurance or transportation, disabilities, and language barriers. When these patients finally received treatment, they showered her with hugs, gratitude, and even a few tears of joy.
From that point on, Casandra Smith dedicated her career as a dental hygienist to the field of public health.
Role of Dental Hygiene in Public Health
Today, Casandra Smith works as a dental hygienist both in private practice and in a public health organization. She works with the Dental Sealant Program in Maricopa County, Arizona, travelling to elementary schools to place dental sealants on the teeth of students in need of care.
“Every school year, I see children with abscesses, rampant decay, and poor oral hygiene,” she writes. “Since most of these children have no dental insurance, I know that every dental sealant placed is very important.”
With an estimated 108 million Americans lacking insurance coverage for dental care, there is an urgent need for public health services in the United States. Public health organizations can help these people receive the hygiene treatment they need, and dental hygienists can make valuable contributions to the cause.
How Dental Hygienists Can Help
Casandra Smith wants dental hygienists to know being a clinician is not the only way to work in public health. “There are actually many ways a hygienist can overcome access-to-care issues and help the public receive hygiene treatment.”
For example, hygienists can create their own public health programs aimed at improving oral health in underserved areas. They can also advocate for change in public policy, and lobby for public health funding.
“No matter what role a dental hygienist plays in public health, it is a significant one,” Smith concludes. “Each role helps to grow public health, but when all the roles work together, the boundaries of public health can be transcended.”