When you're just starting out, it's hard to envision where your business will be in a few years. But while your lease might seem like an afterthought now, it can carry a lot of weight if you ever decide to move, sell, or shut down your practice!
1. Navigating the Make-Good Clause in a Dental Lease
A make-good provision lays out how the landlord expects the property to be when the lease is over. If you don’t leave the space in the condition you agreed to, you’ll pay for it!
Examples of common make-good clauses include:
The tenant returns the building in its initial condition
The tenant strips the building down
A make-good clause can be bad news if your practice space is a fixer-upper and you plan to undertake major renovations. Years down the road, when it comes time for you to move on, you could be on the hook for the expenses of stripping the property or returning it to its original state.
Fortunately, there are ways to navigate this costly sticking point. Sometimes, all you need is to ask. Your best chance is if the landlord is eager to bring on a tenant long-term and you have leverage.
Of course, it won’t always be that straightforward, in which case, you’ll need to take other steps to offset those expenses.
Below is a list of actions you can take to stave off the potential pitfalls of a make-good clause if your landlord doesn’t get rid of it:
Agree to a maximum total expenditure so that you’re only paying a certain amount.
Don’t agree to undo any work you didn’t do. Make sure it’s written in the contract that you only have to pay to return the space in its original condition, not to make any additions or strip it bare.
Get a document called a “condition report” before moving in. This will document damage or changes that already exist before your tenancy begins. This way, you won’t have to pay anything that wasn’t your doing.
Be sure you're not paying your make-good provision fees months after your lease ends. Ask your landlord at the end of your term if there’s work they want you to do. Provided they answer “no,” ask them to release you from the clause.
2. Know the Difference Between Sublets and Assignments
Sublets involve transferring your lease’s rights and responsibilities to a third party (i.e., the right to access space and the responsibility to pay rent every month) without changing your original contract with your landlord. You’re responsible for any of the new tenant’s actions (e.g., if they miss rent, you’re stuck with the bill).
This option's a bit risky, but it's a whole lot easier to negotiate than an assignment. Sublets are ideal for sharing your practice space with another dentist or professional part-time, or on a temporary basis.
An assignment, on the other hand, entirely releases you from your obligations as a tenant and transfers those obligations to the new tenant. This option makes sense when you’re selling your practice or trying to move to a different location before the end of your lease. However, since you need the landlord's permission to assign your lease, you must talk to your landlord before making this arrangement with another professional.
To avoid any confusion, your lease should clearly state which scenarios allow an assignment to occur.
For example, your landlord might agree to get rid of the make-good clause because you sign a longer lease. Or, they might even end up paying for some of the improvements you make to the space.
Before signing a long lease, consider the following:
Are you confident in your practice and its long-term success?
How long do you plan on running your practice?
Does the lease require a personal guarantee?
Remember that a long lease can be rigid, so you should be 100% sure that the benefits outweigh the commitment!
Finally, know that the end of your lease doesn’t always spell the end of your business at that location. If you have a good deal on a great space, talk to your landlord about renewing the lease before the end of its term. However, renewal clauses should not be a substitute for negotiating good make-good and assignment clauses up front.
Securing a great lease from day one will help get your practice off on the right foot! Understanding these factors gives you a better idea of what to look for in a dental practice lease before you shake hands and start doing business.
Why Mouthwash Has the Potential to Reduce COVID-19 Transmissions
When people think mouthwash, they think of fresh breath and plaque removal. They don’t really think about the broader health benefits of swishing a mouthful of the minty, slightly-burning liquid.
However, the results of recent laboratory testing suggest that there are at least two types of mouthwash that could stop COVID-19 from replicating in a human cell.
The two types of mouthwash in question are Listerine and chlorhexidine. Listerine contains the active ingredients Eucalyptol (0.092%), Menthol (0.042%), Methyl salicylate (0.06%), and Thymol (0.064%). The latter, chlorhexidine, is only available in Canada and the United States by prescription.
According to the lab results, both mouthwashes only took a few seconds to disrupt the virus, even after they were diluted to resemble functional use.
Questions remain about the real-life efficacy of these findings. The study only replicated conditions found in the mouth, applying concentrations of the mouthwash and measuring the time it took to contact tissues. Real-world scenarios have yet to be tested.
For this reason, more studies are needed before anything is set in stone. However, the findings suggest a simple, straightforward method that people could use to protect themselves.
Other Mouthwashes Show Promise for Preventing COVID-19 Transmissions
Another mouthwash has the potential to help in the fight against COVID-19, that being Betadine. But unlike Listerine and chlorhexidine, this product couldn’t disrupt the virus without impacting the skin cells in the mouth, which offer a layer of protection.
Betadine contains Peroxyl and povidone-iodine, which are not found in the other two mouthwash products tested by researchers.
Mouthwashes Could Help Keep Dental Professionals Safe from COVID-19
Part of fending off COVID-19 is keeping yourself safe from the virus. While PPE and other safety standards help, they aren’t impenetrable. After all, your job revolves around being up close to your clients’ mouths day after day. Every added bit of protection is welcome.
By giving a patient (who has unknowingly caught the virus) Listerine or chlorhexidine, there’s now proof it might lessen the viral load and help offset the chances of you transmitting COVID-19.
And in keeping yourself safe, you keep your patients, staff, and surrounding community safe.
The hope is that people using these mouthwashes a few times per day would lessen transmissions. However, mouthwash alone cannot stop anyone from catching or transmitting the virus.
While other research had been performed to test other antiseptic mouthwashes’ abilities to disrupt COVID-19, these findings are unique. Previous studies only examined temporary transmission prevention, whereas the new study also examined antiseptic rinse concentrations, time of contact, and skin-cell killing traits that mirrored oral conditions.
Although Listerine and chlorhexidine aren't 100% proven to prevent transmission, it wouldn't hurt to encourage patients to use them.
As a dental professional, there’s nothing you want more than for your patients to feel at ease. A comfortable patient is a happy patient ‒ not to mention easier to work with and less likely to skip cleanings or check-ups.
Unfortunately, studies show that around half of all adults have a fear of the dentist, and up to 12% suffer from extreme dental anxiety (also known as dental phobia, odontophobia, dentophobia, or dental fear.)
This is a two-pronged problem. First, patients with dental anxiety are less likely to visit the dentist as often, missing out on important dental and overall health benefits. Not only does that harm their own oral health, but it adversely impacts your practice’s financial health!
Second, anxious patients who do attend regular check-ups tend to have negative experiences. Often, anxious patients are more worried that their dentist might try to trick them, won't take their fears seriously, or will recommend unnecessary work. An anxious patient may offer less cooperation than others, which means more resources and time are required to treat them.
Plus, having someone on edge in the dental chair can make you feel like you’re not in control.
In the end, the appointment is a negative and stressful experience for both the patient and dentist, hygienist, or dental assistant. The more you can help patients reduce their anxiety level, the better the experience will be for everyone.
Cranial electrotherapy stimulation involves administering pulsed, low-intensity current to the patient’s earlobes or scalp to activate specific groups of nerve cells in the brain.
Essentially, by altering the chemical and electrical activity of these cells, the current serves to boost activity in some areas of the brain and decrease activity in others. Devices like the Alpha-Stim harness this effect to induce feelings of calmness, relaxation, and mental sharpness, reducing stress, calming agitation, and stabilising mood.
The device itself is small and unintimidating, resembling a smartphone.
Researchers have studied the effectiveness of this technology in calming patients who experience dental anxiety. One study, conducted in Niagara, sought to compare the efficacy of CES to relaxation therapy and to a combination of both CES and relaxation therapy.
While all three approaches drastically reduced patients’ dental anxiety levels, researchers found that CES (delivered via the Alpha-Stim device) was more efficient and easier than relaxation therapy.
Years earlier, Colette had suffered a traumatic experience during a dental procedure that left her very anxious, to the point of tears, whenever she needed to see a dentist. She required sedation to get through even simple treatments like fillings, as well as somebody to distract her throughout the procedure.
These solutions were not ideal. Adding pharmaceuticals to the equation creates an array of potential complications. Throw distractions into the mix and you’ve got one stressful dental appointment.
After skipping out on necessary dental treatments for years, Colette finally sought out a new dentist, who introduced her to the Alpha-Stim. The results were immediate. No more appointments missed.
On her first experience with CES, Colette writes: “I couldn’t believe it at first; I thought the nurse was tricking me. But when she adjusted the level of microcurrents I could feel myself adjusting to my situation and actually relaxing. I wasn’t as conscious of what was going on.”
Many dentists in the UK and Ireland, as well as parts of Canada and the U.S., are embracing this technology with great enthusiasm. While there are numerous other strategies to help patients cope with anxiety, most involve factors that are out of your control: not everyone responds the same way to sedatives, and relaxation therapy takes time to learn.
CES, on the other hand, is a direct approach that appears to provide immediate, consistent results.
Running a dental practice is a blend of technical expertise, business savvy, and customer service. In this day and age, where people value the customer experience more than ever, the ability to provide a fear-free dental practice is a huge competitive edge.
And when patients aren’t anxious, neither are hygienists or dentists. Technologies like the Alpha-Stim could truly be game-changing devices for your practice.
All of us seem to intuitively recognize that authenticity is important. But it’s more than a gut feeling — studies have shown that when our outward behaviour aligns with our internal self, we experience greater well-being and satisfaction, less depression, and a higher level of engagement in our work.
There's a lot of pressure to bury your feelings and “go with the flow” to get through a day of frantic phone calls, stressful appointments, and tedious administrative work.
There are times when you have to put on a smile, times to frown, and times to just sit and nod along.
But research shows that putting up a facade like that can make us feel unsatisfied, more burnt out, and less engaged in our chosen profession.
It is worthwhile to practice authenticity as a dental professional not only for your personal well-being, but for the ways it will strengthen your connection to patients and colleagues. The process isn't easy, but it's achievable. And when you do it right, it can change your career for the better!
1. Practice Self Awareness
The only way to bring your whole self to work is to know yourself.
Knowing your values, emotions, strengths, and weaknesses, as well as how you are perceived by others, is the first step toward authenticity.
Self-aware practitioners are aware of their strengths and limitations. They take advantage of their strengths and do what’s necessary to overcome their limitations, regardless of what others might think.
The textbooks at dental school showed you perfect procedures and outcomes, leaving out real-world obstacles like material breakdowns, dental anxiety, and patients’ financial limitations.
The perfect patient does not exist. Neither do perfect illnesses or conditions. So why would there be such a thing as a perfect dentist?
Authentic professionals strive for excellence, not perfection. While they strive to go above and beyond the call of duty, they also realize that perfection is impossible and they accept their imperfections (as well as the imperfections of their patients.)
Letting go of perfectionism and revealing the real you can be a powerful boost to your resolve and your relationships with patients and colleagues.
3. Follow Your Dreams
Think: what attracted you to the dental field in the first place?
If your practice is not making you feel good, take a step back. It might be time to adjust your career to better align with why you got into dentistry and who you are.
Authenticity comes from knowing yourself, accepting your imperfections, and discovering your purpose in life. This is where it all comes together. Never lose sight of your “why” and the things that matter to you!
The Case for Authenticity
Of course, being authentic doesn't mean you’re baring your soul all the time. Nobody could keep that up and still get their job done!
Being authentic is about knowing what’s important to you and integrating those values into your practice so you can experience greater satisfaction, more engagement, and stronger relationships with the people you see every day.
Have you ever been unsure how to treat someone whose background was different than yours?
Have you had trouble communicating with a patient of a different culture?
As populations in Canada and the U.S. become more diverse, these kinds of challenges are increasingly prevalent in the dental profession.
Throughout a dentist's career, they are bound to encounter patients and colleagues from many different cultures. Not only is this true in private practice, but also in public health, academia, and research.
This is why cultural competence — the ability to communicate with people from different cultural backgrounds — is key to providing effective, appropriate dental care.
What’s more, in the aftermath of the COVID-19 pandemic, it has never been important for dental professionals to understand diversity and inclusion. As Dr. Cathy Hung highlights in her piece on dental professionals and cultural competency, a rise in xenophobia and racism has been an unfortunate side effect of society’s pandemic-induced anxiety.
The topic of cultural competency goes far beyond the scope of a single article. We encourage you to dig deeper in the subject via the sources linked throughout this post.
Let's talk about cultural competency in dentistry.
What Cultural Competency Means in Dentistry
The word culture generally refers to beliefs, values, attitudes and behaviours shared by a group. Cultural traits can be passed down through generations, or arise in response to things happening in the present.
We often think of culture as norms and traditions rooted in a person’s country of origin. While geography does play a role, sex, gender, sexual orientation, and age are also relevent in providing culturally competent care. People with different cultural backgrounds also tend to have different religious and philosophical beliefs, as well as differences in education and economic status. Each of these factors could impact how a patient is assessed and treated, as well as their health literacy.
Cultural competency is the ability to connect and communicate with people from different cultural backgrounds. To put it another way, a culturally competent dentist, dental hygienist or dental assistant is one who accepts cultural differences and responds with appropriate attitudes and behaviours to allow for effective treatment and communication.
Cultural competency also involves a degree of cultural sensitivity, making an effort to understand the cultures of your patients and colleagues.
Grow your patient base by offering culturally sensitive care to a larger, more diverse patient population
Provide better oral health care while respecting your patients' cultural beliefs and practices
Reduce errors caused by miscommunications and differences in oral health literacy
Help lessen the disparities in oral health care that exist based on race and ethnicity
Becoming a Culturally Competent Dental Professional
As a dental professional, diversity is a part of everyday life: your friends and family, colleagues, and of course, your patients. Cultural competency is vital if you are going to meet the diverse needs of a changing demographic.
However, it’s not something you can learn overnight. Developing cultural competency is a continuous process of self-reflection, education, and learning.
Fortunately, there are a number of resources available to dental assistants, hygienists and dentists to assist them with cultural competency. For example, the U.S. The Department of Health and Human Services offers an e-learning program to provide dental professionals with basic skills and knowledge related to cultural and linguistic competency.
You don’t need to hit the books to improve your cultural competency right away. As Dr. Hung recommends, you can spark change within your own dental practice day-to-day.
Get to know the people in the area you serve. If you practice in an area that's home to many people of a different cultural background, get to know their cultural beliefs and religious practices.
Ask questions instead of making assumptions. For example, if you don’t know how to pronounce a patient’s name, the best thing to do is just ask them how. If they prefer to go by a name that's not on their ID, respect that. It’s always better to ask than to guess.
Make small talk to build rapport. Building positive relationships with your patients will ensure they receive culturally sensitive and effective care. The more you know about their culture, the faster you can establish rapport with them.
Pay close attention to nonverbal communication. People communicate in a variety of ways. A big part of communication relies on body language, including facial expressions. Many nonverbal clues are still universal, even when translation is needed; but others differ greatly across different cultures.
Be mindful of personal distance. Letting a dentist or dental hygienist get right up close to examine your mouth might not be a big deal to you, but for someone else, it could be very uncomfortable. Many Asian, Southeast Asian and Middle Eastern cultures have a greater value on physical distance than in Western cultures, especially between men and women. Always ask for permission before you examine a patient, especially if you are a male practitioner working on a female patient, and explain what you are doing and why.
Acknowledge other values systems. Many dentists get frustrated when patients try to negotiate a lower fee or say they’ll seek treatment in their home country. What you may not realize is that cultural differences can produce very different views of the North American health care systems. For example, dental implants are usually offered at a significantly lower cost by dentists in Mexico and India. Instead of getting frustrated, try to educate these patients on the value of your care and the importance of continuity of care.
Remember: Culture goes beyond race or ethnicity! Although you may practice in a more ethnically homogenous area, there will always be cultural concerns to consider.
Becoming a culturally competent care is key to improving communication, broadening your patient base, and providing the best possible oral health care to patients of all cultural backgrounds.
When asked to name a physically demanding job, most people would think of something like landscaping, firefighting or construction — ‘tough’ roles that involve a lot of lifting and exercise. Dentists and dental hygienists rarely come to mind.
But it’s no secret that repetitive movement and awkward posture can be just as hard on your body as manual labour. And, in fact, dental professionals are prone to serious musculoskeletal problems.
Among dental professionals, chronic pain in the lower back, neck, hip, shoulder, and wrist is all too common a problem. These issues have spawned troubling statistics around the industry: particularly that 30% of dental workers' compensation injuries stem from musculoskeletal conditions.
This is why dentists should follow proper ergonomic practices and take preventative measures. Whether through ergonomic instruments, well-timed breaks, or exercise, you must be proactive about maintaining your musculoskeletal health and functionality.
These efforts will help ensure your career’s longevity and your overall well-being.
How 3 Simple, Easy Exercises Can Help Dental Professionals Stay Healthy
Imagine you were a rower – which requires immense back strength – but you spent all your time building your calves. It wouldn’t make much sense, would it?
Functionality is critical in every exercise you do. You need to focus on the most prone to injury areas so you can build the stability that keeps fatigue at bay.
Your psoas (hip flexor) is likely chronically tight due to all the leaning and sitting you must perform. When these muscles tighten or shorten, it pulls the lumbar spine inward, causing lower back pain after a workday.
Bending backward, use your hands to push your hips forward with the hands.
Alternatively, start from a plank position on the floor. Push through your palms with a forward-facing chest. And push the top of your feet to the ground (this movement is known as “upward-facing dog.”)
2. Stretching Your Chest
Hunching forward all day causes tightness and shortness in the sternum, ribs, clavicle and shoulder blade.) If these areas are neglected, you can develop rolled shoulders and a hunched back. Additionally, you’ll be vulnerable to nerve impingement, constricted circulation, and muscular atrophy.
Place your forearms and palms on either side of the wall at shoulder level (or as close as your flexibility allows), then inhale.
After exhaling, pull your lower abdominals into your spine.
Lean toward the wall.
Hold the position for between 5 and 30 seconds, then come back to the starting position.
This stretch shouldn’t be exhausting—only moderately challenging and without pain or discomfort. Don’t push it!
3. Strengthening Your Front Shoulders and Overall Posture
Strengthening your posture muscles through resistance training will increase your endurance and reduce pain.
Rows are a highly effective workout for every dental profession because they strengthen the mid back, shoulders, glutes and core at once. They should be part of every dental professional’s workout! While there are many variations to this movement, here’s a video that breaks down a version of the row that only requires your body weight.
It’s Time to Prioritize Your Physical Health
Dental professionals must maintain good physical and musculoskeletal health. If you start early, you can build a foundation that prevents discomfort and degenerative pain in the long run. And don’t hesitate to consult your doctor or a physical therapist before taking on a new workout routine!
Bruxism, or teeth grinding, impacts anywhere from 8% to 31% of the general population. Mild bruxism does not always require treatment, but it can cause teeth to become chipped, broken, or worn. Severe bruxism can also affect the jaw and gums.
Some patients gnash, grind, and clench their teeth while they're awake, but others do it while they're sleeping ‒ conditions known as awake bruxism and sleep bruxism, respectively. Sleep bruxism is considered a sleep-related movement disorder, and people with it are more likely to have other sleep disorders such as snoring or sleep apnea. Patients might not even be aware of it.
After the damage has been done, a dentist can restore eroded teeth and treat them to stop further damage. Treatment options for worn down teeth include composite bonding, cosmetic veneers, crowns, and (in severe cases) orthognathic surgery.
Veneers are thin porcelain or composite resin shells attached to the front part of the teeth. Porcelain veneers are generally viewed as the superior option, since they’re stronger and less likely to colour or stain. Porcelain veneers require at least two dental visits to apply, whereas composite resin only requires one appointment.
Composite resin veneers require a mild chemical to be applied to the front surface of the tooth. This will establish some roughness, allowing the composite resin to adhere to the tooth's enamel. You want a resin that matches the color of your patient's teeth, so it can blend in. When the resin's final layer hardens, the tooth is shaped and polished so it looks smooth.
Local anesthesia is usually required for porcelain veneers because a thin layer of enamel is removed from the patient's teeth to make room for the veneers. Temporary veneers are often necessary to replace the part of the tooth that was removed, and they are used until the permanent ones are ready. Temporary veneers need to be handled with care while eating and cleaning because they come loose easily.
When the patient returns for their next visit, the temporary veneers are removed, and a mild chemical is applied to the teeth to give them a rough texture. This allows the veneers to adhere better to the teeth. The veneers are then glued to the individual teeth with composite resin cement.
Caring for Dental Veneers
Patients should brush (with soft bristles) twice per day and floss once daily. They should avoid toothpastes that contain abrasive chemicals. Regular dental checkups are also a must. Coffee, tea, tobacco, and other things that will stain teeth should also be avoided.
For patients with sleep bruxism, a mouthguard can protect the veneers from the wear that damaged their natural teeth.
Bruxism and Composite Bonding
Bonding, also called bonded restoration, fixes minor breaks in teeth using a tooth-coloured composite resin. The procedure is painless, and multiple teeth can be bonded during a single visit to your practice.
The bonding resin can be matched to the teeth, shaped to fill in a gap or chip, build up teeth, or fill space between them. On top of that, it can be used to fix a broken tooth.
A protective film is first positioned between the damaged tooth and neighboring tooth. Then, a mild chemical is placed on the tooth to roughen it up and ensure the composite resin sticks. The composite resin is then layered onto the tooth, to be shaped and polished after the last application hardens so the finished tooth is smooth.
In a recent article for DentalTown called Reversing the Grind, Dr. Terry Shaw demonstrates this technique, restoring a patient’s maxillary teeth and lower incisors worn by bruxism.
Caring for Bonded Restorations
Patients should brush twice a day and floss once daily. Avoiding hard food, coffee, tobacco, and nail-biting will help. As with veneers, a mouthguard may be necessary to protect the newly bonded teeth from sleep bruxism.
Dentists and hygienists are so focused on their patients that they tend to forget about themselves.
However, even the most dedicated dental professional knows they must care for their own physical and mental health in order to provide optimal care.
Because their work is physically and mentally stressful, dentists and hygienists are more susceptible to musculoskeletal injuries and disorders (MSD’s). Dental professionals frequently suffer from back and neck pain caused by the awkward, forward hunching posture that is necessary to examine a patient's mouth.
With that in mind, it’s clear that ergonomic magnification loupes are a must-have in any dental practice.
Not All Loupes are Created Equal
Finding an ergonomic loupe may seem like an easy thing, but unfortunately, some loupes aren't ergonomic even though they claim to be.
To start, there are plenty of sub-par products on the dental equipment market. Many manufacturers sacrifice quality and standards in the name of low prices, and ergonomic magnification loupes are no exception.
Some salespeople claim that all loupes are the same, but that’s just not true.
To determine whether or not a loupe is ergonomic, you have to be 100% sure of its declination angle. This angle determines how steeply your view drops through magnification oculars. If the declination angle doesn't hold your head upright, it increases the risk of chronic neck pain.
Here's what you need to remember about ergonomic loupes:
For an ergonomic working distance and declination angle, there must be a forward head of less than 20 degrees. This is your first line of defence for staving off chronic neck pain.
A forward tilt of 20 degrees or greater will first cause you substantial discomfort and can contribute towards permanent MSD.
Neck Pain Shouldn’t Be “Part of the Job”
There is something of a toxic trend in our profession when it comes to musculoskeletal disorders.
It's believed by many dental professionals that physical discomfort (e.g., neck pain) comes with the job. Don't be fooled. Pain won't only cause your body to break down and fail you; it can also wreak havoc on your mental health too.
Recently, Dee Humphrey, RDH, BHSc wrote to DentalTown describing how using non-ergonomic loupes can shorten careers. Her own tenure as a dentist was prematurely ended due to a previous neck injury that grew worse because of a faulty product.
Humphrey offers dentists and hygienists the following advice on choosing ergonomic loupes:
Have a colleague help you assess your work posture while using a loupe. This will help ensure your current loupe is giving your neck the support it needs—if it’s not, look into another option.
Keep in mind that snazzy-looking loupes aren't a priority. Do your due diligence when it comes to ergonomic products. Ignore salespeople who focus only on aesthetics.
Don't take salespeople or marketing collateral at face value. You need to fact-check all their ergonomics claims.
Finally, be proactive in learning about ideal ergonomic posture and what it looks like. Ask someone to take a photo as you work—or take a video. This can help you make necessary postural corrections.
Humphreys urges hygienists and dentists to listen to their bodies, not salespeople or colleagues. Neck pain shouldn’t be ignored. It could be a sign you need a new loupe.
There’s no substitute for the two pillars of oral health: brushing and flossing.
But the more layers of defence against plaque, tartar, and gingivitis, the better. Mouthwash or mouth rinses can help patients to get even more out of regular brushing and flossing.
You might even call mouthwash the third pillar of oral health!
Adding mouthwash to an already-robust oral health regime has long-term benefits. It can be a crucial step in the battle against cavities, bad breath, gum disease, and dry mouth symptoms.
With that said, let’s take a deeper look at the many types of mouthwash that could help your patients achieve better oral health.
Cosmetic Mouthwash vs. Therapeutic Mouthwash: What’s the Difference?
As the term suggests, cosmetic mouthwash functions as a one-dimensional ‘band-aid’ for halitosis, or bad breath. Cosmetic mouthwash tastes pleasant enough and keeps your patients’ mouths feeling fresh for a brief time.
However, beyond temporarily freshening breath, cosmetic mouthwash has no chemical or biological function.Typically, cosmetic mouthwash does nothing to kill bacteria or address the root causes of halitosis.
Conversely, therapeutic mouthwash eats away at bacteria that cause bad breath, gingivitis, plaque, and cavities.
Therapeutic mouthwash contains active ingredients such as cetylpyridinium chloride, chlorhexidine, essential oils, fluoride, and peroxide. Cetylpyridinium chloride actively reduces bad breath, while chlorhexidine and essential oils control plaque and gingivitis. Fluoride prevents tooth decay, while peroxide is prevalent in whitening mouthwash.
Therapeutic mouthwash is available over-the-counter as well as by prescription. However, the chlorhexidine-based products can only be obtained with a prescription.
Common Clinical Applications for Therapeutic Mouthwash
Dry socket: also known as alveolar osteitis, commonly occurs after dental extraction procedures, especially extraction of the third molar. This results from a fibrin clotting that forms once a tooth is dislodged. Using chlorhexidine without antibiotics has proven effective against dry socket.
Halitosis: caused by volatile sulphur compounds that arise due to food breakdown, dental plaque, etc., can be controlled using mouthwash that contains antimicrobials. The active ingredients in antimicrobial mouthwash may include chlorhexidine, chlorine dioxide, cetylpyridinium chloride, and essential oils.
Plaque and gingivitis: when combined with daily brushing and flossing, antimicrobial mouthwash reduces plaque and gingivitis.
Tooth decay: fluoride ions cultivate remineralization and are available in some mouthwash.
Topical pain relief: local anesthetics are found in some pain-relieving mouthwash. Such anesthetics may include lidocaine, benzocaine/butamin/tetracaine hydrochloride, dyclonine hydrochloride, or phenol.
Whitening: extrinsic stain reduction can be achieved through the use of carbamide peroxide or hydrogen peroxide in mouthwash. Using 1.5-2% hydrogen peroxide-based mouthwash for 12 weeks provided similar whitening results to using 10% carbamide peroxide whitening gel for two weeks.
Dry mouth: mouthwash with fluoride helps prevent caries that stem from xerostomia, or a lack of saliva. Alcohol-free mouthwash is preferable since alcohol is a drying agent. Patients with dry mouth should use a mouthwash containing enzymes, cellulose derivatives, or animal mucins.
The Most Effective Way to Use Mouthwash
First and foremost, patients should brush before using your mouthwash, waiting longer between brushing and mouthwash if they use toothpaste containing fluoride.
It is best to use three to five teaspoons of mouthwash, which should be the volume of the mouthwash's bottle-cap or cup.
Swish, don’t swallow! Instruct your patients to swish, gargle, and rinse for 30 seconds. And voila! It's time to spit it out.
While mouthwash is best used after brushing, it can be used as a quick fix for bad breath at any point of the day.
But we live in a world with coffee, curry, tomato sauce, and other delicious foods and beverages that make the dream of a pristine smile difficult.
When brushing and flossing can’t undo discolouration, patients often request more powerful means of teeth whitening. Treatments involving hydrogen peroxide or carbamide peroxide are commonly relied upon to achieve the desired results.
Regardless of the approach, your patients’ safety should be the topmost priority. Here, we’ll explore the risks associated with some teeth whitening procedures and discuss the steps you can take as a dental hygienist to ensure your patients are safe.
Review of Common Teeth Whitening Procedures
Whitening toothpaste contains abrasives and detergents to combat surface stains. There’s no bleach in whitening toothpaste, but products may contain a small amount of carbamide peroxide or hydrogen peroxide that help lighten tooth colour. A whitening toothpaste can lighten teeth by 1-2 shades, but it cannot change the natural colour of the teeth or eliminate stains that go below the tooth's surface.
Over-the-counter whitening strips are thin, plastic trips with a thin layer of peroxide gel, shaped to fit onto the buccal surfaces of the teeth. Peroxide-based gel can also be applied directly to the surface of the teeth. With either method, it is usually recommended to apply twice daily for two weeks. Gels and strips can provide a 1-2 tooth shade improvement after treatment.
Whitening rinses contain hydrogen peroxide and other oxygen sources, reacting with the chromogens within the dentine to lighten the body colour of the teeth. Whitening rinses are meant to be used two times a day, where the patient rinses for a minute each time. Patients can expect a 1-2 tooth shade improvement in about three months.
Tray-based teeth whiteners are available over the counter or by prescription. The apparatus consists of a fitted tray with carbamide peroxide bleaching gel. Patients wear the gel between two and four hours a day or overnight. Teeth whitening trays can yield an improvement between 1 and 2 shades in just a few days.
In-office whitening procedures offer more immediate and noticeable results than over-the-counter alternatives, with higher concentrations of peroxide and the aid of UV light. Patients will notice an improvement in tooth shade after 30 minutes to one hour of treatment, and after several treatments, they will see more significant results.
What Are the Risks Associated with Whitening Procedures?
The two most common issues affecting people who use whitening treatments are tooth sensitivity and slight gingival irritation. The primary factors that impact the intensity of these side effects are:
Concentration of the peroxide bleach component;
Duration of treatment; and
Product’s non-bleach composition.
Usually, any tooth sensitivity starts during the treatment and persists for a couple of days. Irritation from the gingival tissues will last about as long, but often appears within 24 hours of the treatment.
Other reported risks associated with whitening procedures include:
Tooth mineral degradation
Increased susceptibility to demineralization
One of the best ways to protect your patients is to provide them with sound advice for their at-home whitening routines. This begins with directing them on how to apply the gel. Moderation is key. Your patients shouldn’t go too heavy on teeth whitening gels.
Your patients should also steer clear of teeth whitening procedures by unqualified individuals. Like most things related to oral health, any treatments are best left in the hands of professionals, and the equipment or compounds being used should be approved by the relevant authoritative bodies.
What’s more, not all patients are ideal candidates for teeth whitening procedures. Patients who suffer tooth decay should have that problem treated before beginning in-office whitening. The same applies to patients with cracked or broken teeth, since the gel could seep into a cavity and cause an array of issues, and with an abundance of amalgam restoration.
When it comes to treating your patient in-office, remember the advice about moderation. If more gel is applied after the initial treatment, it should be used on an as-needed basis only.
It is important to use precisely-fitted whitening trays to protect the gums and reduce the risk of spillage. Although you might worry about a patient's pain threshold, avoid using local anesthetic gels to numb the area so the patient can tell if gel is seeping into their gums.
Now, You’re Ready to Help Your Patients Get the Smile They’ve Always Wanted.
A beautiful smile is a powerful thing. However, oral health and safety are much more important. By keeping those precautions in mind, you can confidently help whiten your patients' teeth and give them the smile they've always wanted!