Handpieces are the most important (and often most expensive) tools in your dental practice. Know how to sterilize handpieces properly so that their lifespan can be extended and cross-infection can be prevented.
1. Always Autoclave Between Patients
Several studies show that non-autoclaved high and low speed handpieces can cause cross-contamination.
One study in particular performed 160 tests with two handpiece types where the prophy angle experienced contamination. This resulted in the motor being contaminated 20% of the time.
Then, when the other motor was contaminated, 47% of the 160 samples saw microbes transmitted to the prophy angle.
Another study assessed 20 subjects where 3-quarters of the 420 samples gathered from low-speed handpiece systems were contaminated with oral flora.
The primary takeaway here is to never reuse a handpiece without autoclaving.
Following this advice keeps your practice clean and your patient’s/staff safe.
2. Ensure Your Handpiece is Sterilization-Friendly
Ensure your handpiece is autoclavable. More specifically, it should have a smooth, sleek design that doesn’t retain debris or bacteria.
Know that a titanium finish can handle sterilization chemicals long-term, whereas a chrome plate won’t hold up over time.
Lastly, the finish on your handpiece should be seamless, without any gap between outer casings.
3. Know How to Sterilize Your Handpieces
Follow these steps in order when sterilizing your handpiece:
Cleaning the surface:
Remove contaminants from the internal water line by flushing water through the handpiece inside the operatory for 30 seconds.
Clean off any bioburden in the sterilization area. Do so using a brush under running water with a mild detergent.
Dry the handpiece:
This is 100% necessary when using a chemiclave sterilizer since excess water causes oxidation in the chamber, leading to corrosion.
Spray oil into the drive airline with the proper lubricating tip, spraying until oil expels from the handpiece head.
Get rid of excess oil:
When you’re done lubricating the handpiece, run it to evenly distribute the oil through the bearing. This process also gets rid of excess oil.
Run the handpiece for 20 seconds after installing a bur in the chuck. And DO NOT use bur blanks.
Ensure fibre-optic surfaces are clean:
Remove excess oil and debris from fibre-optic surfaces with alcohol and a Q-Tip.
Put the handpiece in a paper/plastic combination bag.
It’s finally time to sterilize:
When autoclaving your handpiece, manufacturer guidelines must be followed to the letter.
The sterilizer must process entirely through the dry cycle.
Drying your handpiece:
Place the bag (now with a handpiece inside) paper-side up atop the sterilizer, so it dries completely.
Other Handpiece Maintenance Tips
Maintenance and sterilization tend to overlap, but this section will highlight aspects of handpiece care that will help it last longer.
Considerations during cleaning and sterilization:
Soft bristle brushes won’t damage the product.
Hot water can cause blood coagulation inside the instrument, leading to bearing/clamp blockage. So, only use cold or lukewarm water.
Chemicals or abrasives will damage the handpiece’s outer surface, potentially removing the inner layer of lubrication.
Instruments shouldn’t be immersed in disinfectant liquids since these corrode mechanical parts almost immediately.
Disinfectant wipes and alcohol will cause steam to penetrate through the holes inside your instruments, leading to near-instant damage.
Considerations for lubrication:
100% synthetic aerosol oils are a must, and they need to be of high quality.
With the correct oil, you’ll extend the lifespan of your handpiece, all at a price no greater than what you’ll pay for standard mineral oils.
Follow the manufacturer guidelines when it comes to air pressure, and don’t exceed the suggested amount. Heeding these instructions prevents damage to your turbine.
Only use manufacturer-approved tools when your handpiece needs tweaks or quick fixes. Or, just send your handpiece to the manufacturer for repairs.
Before sterilizing, remove the bur and release chuck levers to prevent spring or lever compression. This will defend against damage that shortens the life of the handpiece.
A chuck needs its own specific care. Manually and directly applying lubricant should work.
Get the Most Out of Your Equipment
With these tips, you’ll keep your practice clean and safe while maximizing the value of your handpiece by extending its overall performance and lifespan.
At first, it might take some adjusting to remember all these tips. But you’ll quickly find these are relatively small efforts that lead to massive improvements in the quality of dental care you provide!
The nature of dental work leaves everyone, whether patient or practitioner, more vulnerable to inhaling airborne particles, bacteria, and germs. And during the age of COVID-19, this reality puts a lot of weight on the shoulders of dental practices – financially and emotionally.
You need your patients to feel safe in a time when their anxiety is sky-high about COVID-19. Soothing these anxieties will require heightened focus and efficiency.
In fact, the ADA has suggested hand instrumentation for dental practices to protect patients from aerosols.
However, hand instrumentation takes longer than ultrasonic scaling, meaning more hours spent in the chair, putting further strain on your musculoskeletal structure. Also, filling in for colleagues, given COVID-related challenges (e.g., schools shutting down, getting sick), has led to increased time at work and a heightened toll on your body.
The current landscape might seem like a lot to contend with, but the answer lies in one word: ergonomics.
Sharpened Instruments are Half the Battle
A shift to hand instruments requires some adjustments, the first being the need to sharpen them.
Frequently sharpening your hand instrument prevents you from the following ergonomic pitfalls:
Gripping too tight
Using more lateral pressure
Maneuvering your wrist away from a neutral position
Avoiding these stresses protects your body from breaking down during extended hours on the chair.
But the benefits of sharpened instruments also impact the patient experience. When your ergonomics are sound, patients will benefit by receiving care from a happier, healthier, more alert provider.
Still, the real difference-maker is the time you’ll save. Think about it. COVID-19 has wreaked havoc on your patients’ mental health. Nowadays, when you take too long between patients, those waiting too long would prefer bailing on their appointment than sitting around any longer.
Whereas sharpened instruments speed up time between patients, reducing the anxieties stemming from being in a place of business during COVID.
A Deeper Dive into Ergonomics in Dentistry
More than 60% of dentists claim to suffer some type of musculoskeletal ailment throughout their careers. Back pain, shoulder pain, and hand/wrist pain were frequently cited as recurring issues.
The bulk of these musculoskeletal conditions stem from practitioners using awkward and overstrained back postures while treating patients.
Plus, the repetitive movements in dentistry that impact the shoulders and neck are conducive to these disorders.
Long story short, the dental industry isn’t easy on your body at the best of times. But for the foreseeable future, due to COVID, it could be even more punishing with the prevalence of hand instrumentation and extended hours.
Exploring Sound Ergonomics for Dental Professionals
Your primary weapon against chronic musculoskeletal disorders is mindfulness of placing too much strain on your back, shoulders, neck, and remaining core muscles. This stress results from a hunched-over posture that bends your upper spine into a kyphosis (or rounded upper back).
Of course, it’s tough to avoid a kyphotic position in dentistry, but you can take some practical, preventative measures.
You’ll reduce lots of neck and shoulder stress by using a double articulating headrest. Just ensure that you cushion the headrest for patient comfort.
Furthermore, work with an appropriately sized chair so you’re close enough to your patient’s mouth to do your work. Too small a chair will make you lean too far forward, causing awkwardness in your posture, leading to the chronic muscle problems we’ve discussed.
A loupe will ensure you don’t sit on the edge of your seat to see better. Heat-mounted lights are a good alternative when your overhead light casts too many shadows or is too dim.
Your Ideal Posture When Treating Patients: a Point-Form Breakdown
Your spine must be neutral and erect. Don’t lean over the patient or bend forward.
Move your seat as close to the patient as is possible. This prevents both your arms and back from overextending.
Your feet should be flat on the floor or on your footrest. Adjust your seat (whether stool or chair) so your thighs slope downward slightly. Always sit for clinical procedures. Don’t stand.
Wrists should be held in a neutral position to limit wrist movement.
Keep a relaxed grip on hand instruments.
Better Ergonomics Results in Better Outcomes
During COVID-19, when mental and physical health are under global duress, sound ergonomics will ensure healthy and happy experiences at your practice for patients and practitioners alike. You and your patients will benefit tremendously by really keying into ergonomics and ensuring you’re doing everything possible to protect your body from breaking down.
Sanitary procedures have always been of the utmost importance in your practice.
First and foremost, these efforts protect patients and staff from potential infections. It also reflects your overall professionalism as a healthcare provider. And it gives you peace of mind in knowing you’re doing things the right way.
But with changing times come new standards and expectations. The pandemic has made many industry professionals ramp up their cleaning and sterilization efforts, whether with mechanical equipment or PPE.
One example of these crucial in-practice safety/sanitary procedures is sterilizing and maintaining your face shield. As of 2021, face shields are a necessity for dental practitioners, and they require specialized cleaning and sterilization protocols.
Why Face Shields are a Priority
Better Coverage than Standard PPE
Face shields go beyond the limitations of masks and goggles because they cover your eyes, nose, and mouth all at once.
These clear plastic visors increase comfort while you work because there’s space between your face and the shield. As a result, less facial heat is retained, dermal irritation is reduced, and you won’t feel claustrophobic.
Won’t Disrupt Work
Other pieces of facial PPE tend to disrupt your other work, whereas face shields allow you to speak and breathe with relative ease.
Seamless Cleaning Process
Facial shields are also easy to put on and remove. As such, they prevent the spread of germs, allowing for easier disinfecting between patients.
Blends Easily with Other PPE
While face shields protect you from body fluids being splashed on you, they don’t create an airtight seal around your mouth, meaning they still allow you to inhale airborne particles. However, face shields combine seamlessly with N95 masks, respirators, and other PPEs to add one more line of defense against germs and bacteria.
Provides Safety in High-Risk Areas and Stop Community Spread of COVID-19 A recent report in JAMA notes that face shields are beneficial in high risk areas and can play a vital role in stopping the community spread of COVID-19.
Before the pandemic, not much was known about face shield sterilization because not many dentists wore them. So, in response to this new industry standard, DentistryIQ established some best practices so face shields can be used safely and maintained for long-term usage:
Submerging the face shield in warm water will loosen particulate material, helping avoid surface scratches.
Adding a mild liquid dish cleaner to the warm water will lessen surface tension. This also ensures the even dispersal of soapy water across the surface.
Experts recommend using a sponge or soft cloth to clean the shield gently, then rinsing it in clear, non-soapy water before drying with a microfiber cloth or soft cotton towel.
While disinfectant wipes or sprays will disinfect and sterilize, the residue left behind is visible and requires removal.
Follow the specific instructions of whatever disinfectant you use, including the contact time. Wet contact time can be anywhere between 30 seconds and 4 minutes.
Another option for disinfecting your facial shield, while keeping it clear, is a 70% alcohol wipe. Be mindful when using this method that you must remove the bioburden before disinfecting.
What Cleaners SHOULDN’T You Use to Sterilize Your Face-Shield?
DentistryIQ also points out that all ammonia-based household cleaners should be avoided. Similarly, don’t use glass-cleaning products.
The types of cleaners mentioned above damage the plastic on your shield, causing the unremovable clouding of surfaces.
Toothpaste and other commercial cleaners that contain grit will cause damage to the shield as well. Moreover, paper towels cause microscopic scratches and should be avoided.
Run a compatibility test to ensure a disinfectant won’t cause damage by applying a small amount of the cleaner at the edge of the face shield. You can test somewhere else on the shield; just ensure it isn’t in your line of sight.
High-Quality Face Shields for Dental Professionals
Most generic, consumer-grade face shields aren’t designed to meet a dentist professional’s needs. They have a thin piece of plastic, attached to a headband, that hangs in front of the face. Unfortunately, this allows droplets to escape and breach the area between the shield and face.
High-quality face shields like the Canadian Shield face shield ensures these gaps are covered, using a flanged perimeter traveling ear-to-ear, over the forehead, and beneath the chin. The all-plastic construction of the Canadian Shield makes it easy to sanitize and reuse. It is designed to be both comfortable and compatible with other personal protective equipment, such as N95 masks and safety goggles.
Contact us to learn more about the Canadian Shield and other PPE solutions for your dental office.
No dental practice can function without establishing protocols for efficiently cleaning and sterilizing equipment.
As you’re likely aware, the right cleaning formula can make all the difference. If you're not happy with what you’re using now, or you’re looking to make a change, it’s worth taking a look at enzymatic cleaners.
Here's a guide describing how enzymatic cleaners can offer efficiencies to your dental practice, and how to choose the product for you.
What is an Enzymatic Cleaner?
A staple of many healthcare facilities, enzymatic cleaners are a key ingredient in the cleaning and decontamination of medical equipment, utensils, and devices.
When used in a cleaner, enzymes break down contaminants at a neutral pH, usually between 6 and 8. Enzymatic cleaners are useful as a detergent in endoscopic and sterile processing settings since the cleaner — powered by surfactants — can lift soil from devices.
The most common types of enzymes you might find in these cleaners include:
These are all proteins, made up of molecules built from amino acids linked together by peptide bonds. Due to their complex structure, enzymes don’t need to expend much energy when breaking down contaminants.
A good analogy is tunnelling one’s way through a mountain instead of trying to climb up it. You can reach the top of the mountain either way, but tunnelling is a lot more efficient!
Similarly, the contaminants on equipment and devices will break down with or without the enzymatic cleaner. But the breakdown occurs after using less energy and at a much faster pace — a reaction known as catalysis. In other words, the enzymes are catalysts for these sped-up, energy-efficient reactions.
What are the Main Benefits of Using Enzymatic Cleaners?
Enzymatic cleaners play a crucial role in breaking down and getting rid of organic contaminants at a neutral pH while reducing bioburden.
Furthermore, enzymatic cleaners decrease the mechanical actions required in tough-to-reach spots.
And, when compared to cleaners with alkaline chemistries, enzymatic cleaners are more compatible with delicate instruments.
Lastly, enzymatic cleaners can be placed into smaller, more ergonomic packaging. This is because the components are higher functioning at lower concentrations and colder temperatures than most detergents.
Factors to Consider with Enzymatic Cleaner?
The type of contaminant (e.g., blood, serum, tissue) and the amount are the first factors to consider when choosing an enzymatic cleaner.
Another factor is avoiding mechanical action when using the enzymes, which allows them to do the work themselves.
Moreover, be mindful of temperatures. For instance, the protease enzymes function best at 100 to 130° F (38 - 54° C).
You then must be aware of the type of water used during cleaning and the pH level of the product and soil. But note that enzymatic products work best when the pH ranges between 6 and 8. Here, good activity mixes with materials compatibility.
How to Handle an Enzymatic Cleaner
Step 1: Point of Use Within the Procedure Room
Point-of-use products keep contaminants from drying, so they remain easier to clean after being transported to the processing area.
Follow manufacturer’s instructions for usage to avoid staff/patient injuries.
Know that enzymes break down proteins in living organisms, so they can be inhaled. Be cautious when spraying/aerosolizing products containing enzymes.
Step 2: Entering the Processing Area
Instrument trays or endoscopes are manually cleaned once they arrive at the processing area.
2 to 3 bay sinks with pre-soak, clean, and rinse phases are needed.
Tap water will work during pre-soaking and rinsing--but, ideally, these phases include enzymatic detergent.
Surgical contaminants are broken down by the enzymes, and an SPD technician cleans the instruments manually. They’ll use a brush or something similar.
After this process, all devices and instruments are taken to an ultrasonic washer or automated washer/disinfector.
Step 3: The Washing Phases
With ultrasonic washing, enzymatic cleaners are used throughout the cleaning cycle. Medical devices are more thoroughly cleaned this way.
Automated washers and disinfectors are used when ultrasonic washing isn’t necessary.
After pre-washing, enzymatic detergents are used in the first wash phase, breaking down the soils still sticking to the equipment and devices.
During the second phase, a neutral/alkaline detergent breaks down organic and inorganic soils. A rinse should follow.
Thermal disinfection is provided by an automated washer, thus making the device clean, sterile, and safe.
Finding the Right Enzymatic Cleaner For You
Don’t just take our word for it. If you are in the market for enzyme cleaners, we recommend you conduct your own research according to your requirements and needs.
One of the products we do recommend is Bio-Pure: a dual-purpose enzymatic and microbial cleaner designed to save your practice time and money.
Bio-Pure Ultrasonic 3-in-1 Presoak & Cleaner formula contains both enzymes and microbes that work in tandem to break down and digest solids where sulfur-producing bacteria normally thrive. This unique, proprietary, environmentally-friendly formula safely removes blood, tissue, proteins and contaminants from instruments, burs, dentures, handpieces, aspirator tips, metal parts, bridges, diamonds, orthodontic appliances, gold work, porcelain, crowns, ultrasonic tips and much more.
Bio-Pure is also available as an evacuation system cleaner, where it works 24/7 digesting organic waste through the entire system. What the microbes and enzymes cannot digest is loosened and easily flushed through. Bio-Pure will restore your pipes, and with continued use of Bio-Pure your vacuum suction will perform at full pump capacity.
With Bio-Pure, you’ll find that unclogging suction lines is headache-free. You’ll also notice that instruments come out of the washer noticeably cleaner, extending their shelf-life and reducing maintenance time.
Enzymatic cleaners are great, but the combination of enzymes and microbes is worlds better than enzymes alone!
When your patient’s gums attach at 4mm below the gum line, scaling helps prevent plaque from fallings inside the pockets. This technique is crucial to combating gum disease and improving the long-term oral health of your patient.
While the power scaler has typically been a go-to in treating patients with plaque problems, COVID-19 has changed the current landscape. More specifically, many regulators and employers have insisted that dental professionals stop using power scalers.
However, COVID-19 limitations and safety practices don’t eliminate scaling altogether — which brings us to hand scaling.
The shift to hand scaling is necessary, but it doesn’t make it easier for dentists who have strictly been power scaling. It’s a significant adjustment for many throughout the field.
Fortunately, as a passionate practitioner, you have the skills to adapt! We’re here to help you do it with these helpful hand scaling tips.
Hand Scaling Tip 1: Diversify Your Instruments
Would you ever play basketball in dress shoes? We’ll assume the answer is ‘no.’
The same mentality applies to hand-held instruments for scaling!
While universal tools exist, they generally don’t hold a candle to mastering specific instruments for all manners of periodontal work. For instance, longer shank scaling devices (After Fives) with smaller working ends (Minis) give you better access to pocketing. Furcation areas also make a massive difference with accessing pockets.
Alternatively, rigid shanks are necessary for heavier calculus. These won’t flex against deposits and don’t put as much pressure on your hand.
We’ll point out that universal instruments do work for some dentists. But provided you can efficiently adapt a universal manual device to all types of patients, be mindful of good ergonomics.
Moreover, you’ll require the correct mix of curettes and sickles to help you access different areas without adding too much trauma to surrounding tissues.
Hand Scaling Tip 2: Know the Value of Finger Placement
When it comes to hand scaling, each of your fingers has a specific job. How you place each finger dictates how precisely you control the instrument’s working end.
The better your grasp, the more power and less repetitive stress in your hands, keeping you protected from long-term injuries.
Want to ensure your grasp is firm and powerful? Here are the basics of finger placement:
Lightly rest your index finger and thumb opposite each other on the handle.
Ensure there’s a space between your thumb and index finger so you can easily roll the instrument and not split your fingers. This helps you maintain control.
Alongside the nail of your middle finger is the side of the finger pad. It should rest on the functional shank. The other side of the pad of your middle finger can overlap with your ring finger.
Stabilize your ring finger, giving you a firmly planted fulcrum point. You’ll steady your hand, preventing any slipping and giving you more control.
Your pinky should remain close to your ring finger, staying neutral.
Hand Scaling Tip 3: Prevent Too Much Pinch Force
Pinching too hard on your instrument can contribute to long-term repetitive stress injuries.
Follow these suggestions to reduce your pinch force:
Keep your fingers relaxed between each stroke.
Use as little pressure as possible.
Switch between tougher and easier-to-reach areas, giving you continual breaks during the scaling process.
Put pressure on your fulcrum when you need to add power. This will give you more force without increasing the firmness of your pinching.
Well-maintained, correctly sharpened instruments preserve their original design while reducing the pressure and the number of strokes needed for removal.
Look for round handles instead of octagonal ones. The handle should be at least 10mm thick in diameter and no more than 15 grams in weight.
Prominent knurls on the handle help with texturing and offer more friction, so you won’t need to pinch as hard.
Hand Scaling Tip 4: Hone Your Edge Technique to Reduce Pressure on Your Grip
Apply the leading third edge of your hand scaling instrument to the tooth. Don’t apply the full working end because it’ll cause discomfort (or even trauma) for the patient.
You can be effective with the instrument by directing pressure to the leading third without applying as much overall pressure.
Properly locking your cutting edge into the tooth also lessens pressure while maintaining effectiveness. Try to use a Gracey curette. It has a sloped cutting edge, offering the ideal angulation where the terminal shank remains parallel with the tooth surface.
Do you not have a Gracey curette to work with?
Then note that sickles, universal curettes, and other instruments without sloped working ends require a 60-70 degree angle between the tooth and instrument face.
Use These Techniques to Keep Your Patients Safe While Still Providing a High Level of Care
Power scaling instruments help you be more efficient with deep teeth cleaning. Unfortunately, COVID-19 has made it a non-option for many dentists.
So, by following the above tips and mastering hand scaling, dentists can continue to provide high-level care without putting themselves, their patients, and their staff at risk to COVID-19.
Any business that wants to thrive in 2021 needs a social media account.
Your dental practice is no exception.
What started out as a way to meet and connect people has grown into a commercial force that has the power to make or break your businesses. It’s as essential to the health of your business as brushing is to your teeth!
Here, we’ll explore 7 reasons why your dental practice needs to use social media.
1. An Affordable Way to Market Your Dental Practice
You aren’t Nike or Wal-Mart, but there's a lot you can learn from them about getting your dental practice noticed! Although they have plenty of money to spend on ads, they still invest a lot of time and energy into creating content for free social media channels.
Sure, you could buy a local television spot or a newspaper ad, but they're more expensive than the zero dollars it costs to open a social media account.
Facebook and Instagram are the current social hubs for people of all ages, with billions of worldwide users. It’s likely that 90%-plus of the people in your community have accounts on one or both of those platforms.
Social media has become the new battleground for businesses thanks to its reach and influence. If you don't use it to attract people to your practice, you're missing out on a huge opportunity.
2. Bring in New Patients and Establish Yourself as a Leading Expert
Social media lets your target audience know you're around. Take it a step further and you can build your reputation as a local expert by providing tips and advice (e.g. which toothpaste is best.)
If you create engaging and informative content, you'll stand out to your target audience as a trustworthy practitioner.
On top of that, you can let people know about specials and prices, which also bring you new clients.
3. Patient Interactions Can Attract New Customers
Responding to comments on your social media posts, particularly shows that you have a good rapport with your patients.
You know who might end up reading those interactions? Prospective patients who are still on the fence. Seeing positive interactions with existing patients might encourage new people to book an appointment.
Having people like your page will not automatically bring new patients to your office, but the ongoing outreach and engagement will. When people continually see their friends interacting with your practice in comment threads, it paints a positive picture and keeps your name top of mind.
Listen out for statements like, “I found you on Facebook,” or, “My friend Karen says you’re great.” It’s a sign that your social media posts are working, and the interactions are reaching a bigger audience.
Facebook, for instance, has review sections where your patients can leave you public feedback for all to see.
When it comes to oral health, people are much likelier to put in their due diligence. In fact, 90%-plus of potential patients look through online reviews when selecting a dentist!
5. You Can Measure Your Results
With traditional forms of marketing, like billboards and signs, it’s almost impossible to figure out if campaigns are actually making a difference.
Whereas social media offers an array of tracking tools, both free and paid, that let you know how your posts are performing. You’ll have insights on volume, reach, engagement, and influence, which will help you adjust and fine-tune your messaging.
6. Make Your Practice More Accessible to Everyday People
Even the most kind-hearted dentist might come across as intimidating to patients. After all, it can be hard to feel warm and fuzzy about the person giving you a root canal.
Social media lets you go the extra mile in adding the human touch to your practice.
For example, post photos and videos of you and your staff interacting and having fun with one another. Also, use these visuals to convey your team’s dedication to your patients and their oral health.
You could host an ask-me-anything (AMA) session on your social media account. These lend themselves to more prying questions, letting you show a different, more personal side of yourself.
7. Keeping Ahead of the Competition
Your fiercest competitors will be as successful at social media as they are at dentistry. It’s how they keep attracting new customers.
Therefore, you must find your voice on social media and figure out how to gain a competitive edge.
Even better is if your competition isn’t on social media. You’ll have an enormous leg up just by being consistent with your posts!
You may not have enough time on your hands as a dental professional to give it the attention it deserves, and that's fine. However, this does not mean you should ignore social media marketing and its benefits altogether.
Looking for ideas? Check out Sable Industries Inc. on Facebook, LinkedIn, and Instagram. You’ll get dental industry news, inspiration, and tips for getting the most out of your favourite dental handpieces and tools.
Let's look at the research and discuss key takeaways.
Link Between Oral Health, Migraines and Headaches
Migraines and headaches impact 2.7 million Canadians, all of whom could benefit from knowing that better oral health can help with their symptoms.
Although they’re two different entities, migraines and headaches have similar triggers, such as too much caffeine (or withdrawal from caffeine), alcohol, stress, and bright sunlight. And that only scratches the surface ‒ weather changes, blood sugar fluctuations, and dehydration also play a role.
The research shows that you can add the following oral health issues to the list of factors connected with migraines and headaches.
1. Misaligned, Loose, or Missing Teeth
When teeth are loose, missing, or misaligned, the jaw muscles must work harder to swallow, keep the mouth closed, and bring the teeth together. As a result, your patients might experience continual muscle inflammation that can result in migraines or headaches.
2. Jaw Clenching and Tooth Grinding
Patients that grind their teeth and clench their jaw are vulnerable to inflammation in the muscles and gums.
Stress, bad bites, and teeth misalignments can all lead to grinding and clenching.
We will then note that many of your patients won’t know they’re grinding their teeth since it occurs unconsciously or during sleep.
Therefore, you must educate your patients on signs to look for that can suggest a severe grinding/clenching habit, such as:
Sore jaw muscles
‘Click’ sound when opening their mouths
Ongoing dull headaches felt behind the eyes or around the temples
Problems when trying to close and open their mouth
A toothache that results from decay can trigger migraines and headaches.
The trigeminal nerve regulates the sensation in the mouth and face functions. This is often irritated by toothaches that lead to migraines.
Oral health problems such as tooth decay, gum disease, and misaligned teeth are what cause toothaches.
4. Temporomandibular Disorders (TMDs)
TMDs and migraine research has not been presented in a way for experts to understand which develops first for their patients.
In other words, TMDs might cause migraines. But it could also be vice versa, in that a migraine can trigger pain in the jaw and teeth when TMD flares up.
With that said, research indicates that treating the oral health-based issue can offset the severity of related headaches and migraines. Dental treatments can also reduce how often headaches and migraines occur.
5. Wisdom Teeth
The last adult teeth to come into the mouth (wisdom teeth) can become impacted, causing pain and damage to other teeth. It can also lead to other dental issues such as triggering severe headaches.
In most instances, removing a patient’s wisdom teeth solves this problem.
Dentists Can Help Patients with Headaches and Migraines
While the oral health conditions discussed above can (and should) be treated by dentists, patients experiencing head pain should speak with their primary physician as well. That notion rings doubly true if headaches or migraines are new, frequent, or severe.
When patients communicate these issues with their doctors, they can grasp an understanding of what is causing the pain and figure out a treatment plan.
Once doctors acknowledge that oral health plays a role in migraines/headaches, they’ll refer patients to dental head-pain specialists.
The Need to Be Proactive and Preventative
Another crucial point is the need for proactive, preventative care.
Yes, it’s possible for dentists to treat related oral issues to help offset headaches and migraines. However, frequent dental checkups will catch these problems before they grow into something more serious, even stopping pain before it can start.
Healthcare and dental care function best as preventative measures instead of being reactive to overwhelming symptoms.
So, even if patients aren’t reporting headaches and migraines, they should be educated on their connection with dental problems. This way, they’ll be more motivated to stay on top of their oral health and schedule frequent dental checkups.
Given how common Alzheimer’s is in the senior community, and how devastating the disease can be, dental professionals must heed these results. Any chance to offset the issue can drastically improve your patients’ quality of life.
This article will take a deeper dive into the research and what it means for your practice and your patients:
Summarizing the University Medical Center Greifswald’s Research
Dr. Christian Schwann is part of Greifswald’s Polyclinic for Dental Prosthetics, Geriatric Dentistry, and Medical Materials Science. Schwann explained that it’s always been tough to do quality research that delves into periodontal disease, gum disease’s more severe form.
Elaborating further, Schwann explained that relevant statistical models are a recent development.
This introduction has made it possible to mirror a controlled clinical study by mixing the data from untreated and treated patients.
Studies of Dental Diseases Effects on People’s General Health Go Back Decades
Travel all the way back to 1997, and you’ll find the beginnings of a long-term research initiative known as the Study of Health in Pomerania/Life and Health in Western Pomerania (SHIP).
The study’s objective was to examine the influence of dental disease on the general health of people. Its findings showed that 15% to 45% of people were affected by inflammatory gum disease, depending on age.
This would be the first indication of a possible link between the onset of Alzheimer’s and gum disease treatment (or lack thereof).
SHIP results have been combined with Greifswald’s 177 treated patients. More specifically, 409 untreated patients from SHIP were used as a basis for comparison.
The researchers flagged the onset of Alzheimer’s disease using magnetic resonance imaging (MRI) data. After comparing this data to findings from the U.S. Alzheimer’s Disease Neuroimaging Initiative, the Greifswald team was able to individually measure the brain substance loss associated with Alzheimer’s.
When periodontitis treatments were applied to patients, there was a positive effect on moderate to severe brain matter loss.
Dr. Schwann clarifies that the work is far from done concerning links between Alzheimer’s and gum disease. There will be a continued need for observational studies involving simulated controlled clinical trials.
Takeaways for Dental Professionals
Professor Thomas Kocher is the head of periodontology, restorative dentistry, periodontology, endodontology, and pediatric and preventive dentistry at Greifswald. He explains that prevention and timely treatment of gum disease - something triggered by mass amounts of germs - is the main focus of the team’s approach.
Being more proactive will help prevent the onset of Alzheimer’s well in advance.
Vigilance and hyper-awareness of potential symptoms of gum disease are musts for dentists who want their patients to lead happy and healthy lives.
Also, be mindful that this focus on gum disease prevention must start early. The research didn’t only revolve around seniors. These types of issues can have long-lasting impacts from a younger age that span into old age. At no point are any signs of gum disease anything to downplay.
Ensuring that your patients are coming in for regular visits so you can stay on top of warning signs allows you to offset potential issues before they start.
Oral Health Can Save Lives
As dentists, we know that poor oral health is linked to a number of conditions, chronic illnesses, and diseases in the body. The results from Greifswald’s research sheds further light on the importance of our patients’ overall healthcare and how we can help save lives.
A crucial takeaway from this research is the need for sound oral health and how it helps older adults maintain cognitive function.
But first, let's examine the study that links tooth loss with cognitive impairment and dementia.
Researchers Link Tooth Loss to Cognitive Impairment and Dementia
The team at NYU studied tooth loss’s relationship to cognitive impairment via a meta-analysis of 14 studies made up of 34,074 adults. These studies included nearly 4,700 instances of people dealing with worsening cognitive function.
The analysis revealed that adults who lost more teeth were 1.48 times likelier to face cognitive impairment, and 1.28 times likelier to receive a dementia diagnosis.
What’s more, dementia and cognitive impairment risks still exist after controlling for other factors.
Dentures Can Play a Crucial Role in Preventing Cognitive Decline Linked to Tooth Loss
It’s also worth noting how dentures appear to play a role in preventing cognitive impairment; specifically, those without dentures had a 23.8% likelihood of cognitive impairment after losing a tooth compared to those who receive dentures after tooth loss (16.8%).
After even more analysis, the team discovered any links between tooth loss and cognitive impairment were less significant when patients had dentures.
Each Lost Tooth Heightens Cognitive Impairment and Dementia Risks
The NYU team’s research also included a meta-analysis involving 8 studies to determine if there was a “dose-response” relationship between cognitive impairment and tooth loss.
With the above analysis, it was made clear that the more missing teeth there were, the risk for cognitive decline increased. There was a 1.4% boost to cognitive impairment risk for each missing tooth, on top of a 1.1% increased risk of dementia diagnosis.
According to the NYU study, missing teeth leads to problems with chewing, which in turn can cause poor nutrition, which could trigger brain-related changes. Further research shows a connection between gum disease and cognitive decline. This shouldn’t come as much of a surprise since gum disease is a leading cause of tooth loss.
Furthermore, tooth loss could reflect a lifetime’s worth of socioeconomic disadvantages linked to cognitive decline.
What Does This Mean for Dentists?
Can dentists and their teams use this information to provide improved care to their patients?
Any way you can help stave off and prevent these issues can make a massively positive difference in your elderly patient’s quality of life.
So, where should you start?
As per the results of NYU’s research, much of your treatment strategy can revolve around dentures. Even at a glance, it makes sense. Dentures help those who’ve lost teeth chew their food, so they can absorb the nutrients they need to keep their brains functioning effectively.
We’ll then point out that this isn’t the first bit of research highlighting the importance of dentures. Studies from back in 2010 came up with similar results; brain function activity was increased by both the improvement of complete dentures and the wearing of partial dentures. Furthermore, these improvements occurred in patients who were at risk of diminished brain activity.
A proactive approach to dentures might be the answer, or at the very least, vigilance with older patients about receiving their dentures.
You have all the reasons in the world to ensure your patients receive treatment when they lose their teeth.
For one thing, a lost tooth isn’t something to be left alone from the potential for infections to aesthetic reasons.
NYU’s research has given you another reason to help your elderly patients who’ve lost teeth, helping prevent Alzheimer’s and cognitive decline.
You already know the correct type of treatment for missing teeth in elderly patients: dentures.
But you now know how much more urgent it is to ensure you perform the procedures nearly right away. After all, it’s a simple, everyday type of procedure that can make all the difference in the world to someone in need.
Stats from the CDC show that 47.2% of adults 30 and older suffer from periodontal disease. And since periodontal disease worsens with age, a whopping 70.1% of adults 65 and older have periodontal disease.
Although periodontal diseases are common, care providers often have to play a guessing game when it comes to determining the stage and severity of any given case.
With this issue in mind, in 2017, the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) updated the system that classifies the stage and grade of periodontal diseases. The previous classification of periodontal disease was published in 1999.
The AAP and EFP set out to evolve the system through an evidence-based approach that detailed the advancements made in understanding periodontitis and implant-related conditions.
There's no doubt that the revised classification is valuable. It’s a massive step in the right direction.
However, despite these positive changes, it remains difficult to determine the stage and grade of many periodontal diseases.
In Brief Review: What is Staging? What is Grading?
Staging a periodontal disease involves classifying the severity and extent of the patient’s condition. The process includes assessing measurable amounts of tissue that’s been damaged or destroyed by periodontitis. It also examines specific factors that might help with case management over the long term.
At first, clinical attachment loss (CAL) should be used to assess the stage, but it’s not always available. In which case, radiographic bone loss (RBL) is the next most reliable option.
Note that tooth loss caused by periodontitis changes the staging process. Also, when there are one or more complexity factors, the stage could reach a higher level.
Grading is the process in which you rate the periodontitis’s progression in a patient and how it’s responding to therapies and treatments. Moreover, grading deals with the effects that periodontitis can have on overall health.
Initially, the care provider should give a grade of B disease. They’ll then determine whether other factors exist to change the status to an A or C.
What Are the Three Stages Used in Staging and Grading?
Stage 1: Initial Case Overview
This stage includes screening with full mouth-probing depths and radiographs of the whole mouth. You’ll also need to look for missing teeth.
Generally, you’ll find that Stage III or Stage II can be applied to moderate periodontitis. Alternatively, Stage III and Stage IV are appropriate for severe to very severe periodontitis.
Stage 2: Establishing the Stage
Stage I and II periodontitis require that you confirm CAL and rule out causes outside of periodontitis (e.g., cavities, root fractures).
From there, you must determine the maximum CAL or RBL, then confirm potential RBL patterns.
When dealing with Stage III and IV periodontitis, you need to adhere to the above methods. But you also must assess tooth loss due to periodontitis and evaluate complexity factors.
Stage 3: Establishing the Grade
You need to divide the RBL (percentage of root-length multiplied by 100) by age. Then you must assess whether the patient has related risk factors such as smoking or diabetes.
Patient responses to scaling, root planing, and plaque control should be measured while the expected rate of bone loss is assessed.
Conduct a thorough risk assessment and keep medical/systemic inflammatory considerations in mind.
But Wait...The Ground Rules for Assessing Grade of Periodontal Diseases Have Changed
There are new rules for how you should assess the grade of a patient’s periodontitis, as highlighted below.
First and foremost, you’ll define your grade primarily on the observed or inferred rate of periodontitis progression. Heavily weigh the presence (or lack thereof) of control or risk factors that could impact treatment outcomes and further disease progression.
After therapy, the grade can be dropped to a lower level, provided the patient’s risk profile improves enough. Note that these improvements should be sustainable.
Using a B-grade is your go-to when you’re unsure, as it suggests a moderate rate of progression. Afterward, you can make the necessary changes to the grade when the risk profile and its elements make themselves more evident.
Dealing with the Abstract Nature of Periodontitis
Unfortunately, in the world of periodontics, you can’t punch a bunch of numbers in a calculator or type a Google search and get the black-and-white answer you seek.
No, the “right” answer is more abstract when it comes to periodontal disease, existing within an endless number of shades of grey.
Correctly using this upgraded system whenever it’s appropriate will improve your judgement as a periodontist. This way, you can ensure your patients receive the best available care. That notion will hold true even when their current condition is confusing, and you don’t have immediate answers.