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Study: Dental Amalgam Boasts Superior Contamination Resistance Than Other Materials

If you’ve been going back and forth on amalgam and whether you should continue using it in your practice, the findings of a new study could provide some clarity.

 

For two full years, five undergraduate students at Loma Linda University examined the impact of extreme contaminations on amalgam fillings during condensation. The goal of these dedicated research design students was to determine the shear-strength degradation effects on dental amalgam.

 

The researchers assessed the reaction of amalgam to gross contamination during condensation under the following elements:

  • Water
  • Saliva
  • Blood
  • Handpiece lubrication oil

The results, published under the title, “Amalgam Strength Resistance to Various Contaminants,”  demonstrated that amalgam is capable of withstanding “worst-case-scenario” levels of contamination equally or better than its alternatives, including resin-modified glass ionomer.

 

Just How Well Does Amalgam Retain Its Strength?

To summarize, here’s a breakdown of the findings discovered in the research discussed above:

  • Amalgam strength wasn’t reduced to a significantly statistical extent (p= 0.05) by water contamination.
  • Compared to water and blood-contaminated water, saliva reduced in between both.
  • In saliva, the final remaining strength was the same or more than the uncontaminated strengths recorded in the available literature for other restorable materials (e.g., composite resin, resin-modified glass ionomer, glass ionomer.)
  • Amalgam strength degradation was at its most significant – at around 50% – when fully immersed in handpiece lubrication oil during condensation. However, contamination from handpiece lubrication oil was proven to be highly unlikely in practice.
  • Still, the oil contamination resulted in amalgam strengths were the same or more than other available restorative materials while exceeding the minimum compressive strength of 35,000 pounds per square inch

How Do the Alternatives Compare to Dental Amalgam?

The results above already indicate the dental amalgam can withstand contaminative circumstances better than many alternatives.

 

Let’s look closer at the alternatives and see how they stack up.

 

1. Composite Resin Fillings

As the most regularly used alternative to dental amalgam, composite resin fillings are tooth-coloured and white. Acrylic resin is the primary material used in the making of these fillings—and they’re reinforced with powdered glass filler.

 

It’s common for composite resin colours to be customized to match surrounding teeth. They’re also often light-cured by blue light in layers to lead into the last restoration.

 

Yes, there’s no doubting the strength and blending capabilities of these fillings. Also, they don’t need much removal of healthy tooth structure for placement.

 

But they come up short in other aspects.

 

First and foremost, the composite resin is harder to place than amalgam—plus, they’re infinitely more expensive. Lastly, while they are strong, these fillings appear to be less durable than amalgam.

 

2. Glass Ionomer Cement Fillings

Organic acids (such as eugenol), bases (such as zinc oxide), and potentially acrylic resins can be found in glass ionomer cement.

 

Glass ionomer fillings are tooth-coloured like composite resin, and its properties seem most ideal for more meagre restorations.

 

These fillings cure on their own and don’t necessitate a blue light for the setting process.

 

While ease of use and quality of appearances are definite plusses with glass ionomer cement, they’re not particularly useful for more significant restorations.

 

Is Amalgam Usage Long for this World?

Of course, we can’t forget that these findings are only part of a bigger picture on the use of dental amalgam.

 

The material’s mercury content makes dental amalgam a public health and ecological risk, particularly after its removal. On July 14, 2017, the Environmental Protection Agency (EPA) finalized regulation specifically targeting the use and disposal of dental amalgam. In Canada, dentists must use amalgam traps and filters to collect amalgam waste and recycle it appropriately.

 

As such, many dentists – as a protective measure – are opting to use alternatives to amalgam for health, safety and ecological reasons.

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Wisdom Tooth Extraction and Alternatives - Important Facts to Know

 

Are you experiencing discomfort in your back molars or your gums at the back of your mouth? Do you have trouble opening and closing your jaws, bad breath or a low-grade fever? You may need a wisdom tooth extraction to remove an impacted third molar and prevent further discomfort and infection. Before you have your tooth removed, there are some critical facts you need to know about wisdom tooth extraction and the alternatives.

 

Alternatives to Wisdom Tooth Removal

Extraction is often recommended for wisdom teeth as a preventative measure to minimize misalignment, eliminate overcrowding, or when the tooth is infected. However, in some cases, you may not need to have your wisdom teeth removed.

 

Coronectomy

A coronectomy is an alternative to wisdom tooth extraction and is recommended for patients when the wisdom tooth is impacted and presses on the lingual nerve or inferior alveolar nerve. These nerves control the sensation in your tongue, lips, and chin and can affect speech and chewing.

 

A coronectomy removes the crown of the tooth, leaving the roots in place. If the wisdom tooth root is not infected, a coronectomy may be an ideal alternative to wisdom tooth removal.

 

Operculectomy

An operculectomy removes the gum tissue that can develop over a partially erupted wisdom tooth. Debris and bacteria can get caught in this tissue, causing painful infections and inflammation. Removal of the operculum reduces the risk of bacteria build-up and may prevent the need for a wisdom tooth extraction.

 

Bring a Chaperone to Your Appointment

Whether you have a wisdom tooth removal, operculectomy or coronectomy, your dentist will still administer anesthesia to make you more comfortable during the procedure. In most cases, the site will be numbed using a local anesthetic. However, for complex wisdom tooth extractions or if you suffer from dental anxiety, you may need to be sedated.  

 

The side effects of sedation can take some time to wear off, so it is essential to bring someone along with you to drive you home after the procedure.

 

Rest with Your Head Raised

Your body’s natural reaction to tooth extraction is inflammation and swelling. However, uncontrolled swelling can lead to infection. To keep the swelling under control, rest with your head slightly elevated to drain fluid away from the area. You can also apply cold compresses to the side of your face and take over the counter anti-inflammatory medication.

 

Skip the Toothbrush

Avoiding brushing isn’t advice that you’ll usually hear from your dentist; however, you need to avoid using your toothbrush near the extraction site for the first 24 hours after surgery.

 

Also avoid spitting and rinsing, as well as drinking through a straw. The reason for this is that the blood vessels inside the empty tooth socket form a clot that seals the socket and prevents infection.

 

If the clot becomes dislodged, you are at risk of developing a condition called dry socket where the nerves of the tooth are exposed.

 

Stock Up on Soft Foods

Hard and chewy foods can aggravate the wound site, causing discomfort. Some nutritious foods for post-surgery recovery include yogurt, oatmeal, fruit and vegetable purees, eggs, and smoothies. Cold and tepid foods can also help to alleviate post-surgery swelling.

 

Bleeding Is Normal After Surgery

Although you may have stitches in the tooth socket, it is normal to experience some bleeding after surgery. Your dentist packs the empty socket with gauze which you should hold firmly in place for 30 minutes. Repeat until the bleeding abates. If the bleeding is excessive, call your dentist immediately.

 

Symptoms that you shouldn’t ignore include fever, numbness, increased swelling, pus from the wound or nose, and trouble swallowing or breathing. Any of these symptoms could indicate infection or nerve damage and need to be assessed by your dentist immediately.

 

Keep Your Wound Clean

There are several ways you can keep your mouth clean and hygienic. Rinsing with a saltwater solution helps to eliminate bacteria, clear debris from around the extraction site, and reduce discomfort after surgery.

 

Combine one cup of warm water with ½ a teaspoon of salt and gently swish the solution around your mouth for 20-30 seconds. Instead of spitting out the rinse, tip your head over the sink and open your mouth to expel the water gently.

 

Final Thoughts

Wisdom tooth extraction is a standard procedure to prevent impacted wisdom teeth from affecting your remaining teeth and jawbone. However, it isn’t always necessary to have your tooth extracted.

 

If you have your wisdom teeth extracted, follow your dentist's post-surgical care instructions carefully to ensure a speedy and comfortable recovery.

 

About the author

Dr. Fadi Swaida first graduated from the University of Western Ontario with an Honors BSc in Biology before graduating from the University of Manitoba’s Faculty of Dentistry. He is an active member of his church and enjoys football and being by the water! His outgoing personality and fun-loving character will ensure you always feel welcome at Dentist North York.

 

 

 

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Botox Has Become an Unconventional but Effective Treatment for TMJ

 

As a dental professional, you’re no doubt well aware of the negatives of temporomandibular joint syndrome or TMJ.

 

The temporomandibular joint connects the mandible (or lower jaw) to the temporal bone (or skull) in front of the ear. Other specific facial muscles that connect to the lower jaw are responsible for chewing.

 

When the pain of TMJ has been too much for over-the-counter pain meds, it’s been known for dentists to prescribe strong pain relievers such as prescription-strength ibuprofen. Patients have also been treated with low doses of tricyclic antidepressants like amitriptyline to relieve pain symptoms, but also to control bruxism and sleeplessness. 

 

Furthermore, it’s not uncommon for patients to be offered muscle relaxants for their TMJ-related issues.

 

Then there is an array of therapies, like oral splints and even physical therapy used to treat the condition. If the patient is suffering enough, there’s also a mandibular or multi-joint surgery that can be performed. Really though, this list of treatments is only scratching the surface.

 

In fact, recently, Botox injections have been utilized to treat TMJ syndrome ‒ with a great deal of success.

 

How Useful Are TMJ Treatments?

A small anecdotal study involving 26 patients from 2012 discovered that Botox could substantially decrease the pain associated with TMJ for up to three months. It also could increase mouth movements.

 

There were two other studies, published respectively in 2003 and 2008, that revealed similar results.

 

Of the participants in the 2003 study, 90% displayed symptom relief after failing to respond to more conventional treatment methods.

 

As is the case with most experimental treatments, these small sample sizes aren’t enough for most experts to offer their 100% stamp of approval. Yes, the results are undoubtedly encouraging.

 

Still, to endorse the full effectiveness of Botox treatments for TMJ disorders, experts need to investigate the results of further studies.

 

Are There Any Side Effects to Botox Treatments for TMJ?

Despite the potential for positive results, Botox treatments for TMJ do come with side effects.

 

Pain, redness at the injection site, muscle weakness, and bruising at the injection site is common in the first week after treatment. More serious side effects include headache, respiratory infection, flu-like illness, nausea, and temporary eyelid droop.

 

Then there’s a chance that your patients might experience a fixed smile for up to 6 to 8 weeks. This condition is a result of the paralyzing effect that’s brought upon by Botox treatments.

 

A Breakdown of the Procedure

One of the primary benefits of Botox treatments for TMJ disorder is that it’s a nonsurgical, outpatient procedure. Meaning, it’s non-invasive. It’s performed right in the dental office and only lasts from anywhere between 10 to 30 minutes.

Commonly, there are at least 3 injection sessions that span throughout a several-month period. The number of injections required depends on your patient’s needs and the severity of their condition.

 

Botox can be injected in a patient’s forehead, temple, jaw muscles, or anywhere else in the face/head area where there are pain symptoms. Resulting pain from the injection itself is minimal. It resembles a bug bite, and a cold pack or numbing cream can help to ease any discomfort.

 

Patients will generally experience improvements several days after the treatment. Though they can return to regular activities immediately after leaving your office.

 

When Should Botox Be Used to Treat TMJ?

While this treatment is more synonymous with cosmetic enhancement, it’s increasingly being used in the dental industry therapeutically.

 

Botox injections treat the symptoms of TMJ instead of the syndrome itself. Meaning, it’s meant to soothe the jaw tension, teeth grinding-induced headaches and lockjaw that can result from TMJ syndrome.

 

Still, at this point, Botox treatments for TMJ disorder are only experimental. It’s considered to be an off-label approach that has yet to be approved by the Food and Drug Administration. As such, these injections are currently only an alternative when more traditionally successful methods haven’t been able to give patients relief.

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6 Myths You Shouldn’t Believe About Air Polishing

If you’re a dental professional, it will serve you well to read this Hygiene Town article that recently caught our eye.

 

The article highlights the many positive features of air polishing and the fact that, despite scientific evidence demonstrating its value, it has yet to become widely accepted among many registered dental hygienists.

 

Air polishing has proven to be successful with plaque and stain removal. In fact, it’s shown to be three times faster than rubber cup polishing! So, why aren’t more of us using it?

 

The truth is that air polishing, for whatever reason, has been riddled with naysaying...and these myths are part of the reason it hasn’t seen widespread use.

 

Let’s look at the facts about air polishing!

 

Myth #1: Air Polishing is Too Messy

This myth is based on what used to be the truth. In generations past, air polishers sprayed all over the place. However, in recent years, things have changed.

 

Older air polishing devices could only be used at full power. They also clogged too quickly, and many practitioners didn’t have the knowledge and experience to shield their patients from the abundance of overspray.

 

Nowadays, air polishers offer far more control and precision.

 

Myth #2: Patients Dislike the Taste

Similar to the above myth, the taste factor of air polishers did use to be a legitimate gripe of patients and hygienists alike.

 

Initially, the powder being used was a salty sodium bicarbonate that revolted both children and adults.

 

Fortunately, most models now include a non-sodium option.

 

There’s also a substance known as Sylc therapeutic prophy powder being utilized in air polishing systems. It’s a calcium sodium phosphosilicate or bioactive glass.

 

Although the Sylc does possess 450 mg sodium, this is far milder than the 2,000 to 3,000 mg found in a sodium bicarbonate—a staple of the old method.

 

Myth #3: It’s Less Effective at Cleaning Teeth

Marilynn Rothen, MS, RDH, states that air polishing is superior to rubber cup polishing when cleaning the tooth surface before etching for sealant placement.

 

Further studies, however, indicate similar results between cleaning methods. Regardless, air polishing has never been proven to be less effective at cleaning teeth when compared to other treatments!

 

Myth #4: Air Polishing Makes Teeth Overly Sensitive

This myth, unlike a few of the other ones, isn’t rooted in facts at all. The reality is that this myth couldn’t be any further from the truth!

 

Air polishing will offer comfort to your patients with even the most sensitive teeth. It’s an extremely gentle method that necessitates no heat or pressure being placed on tooth surfaces.

 

Furthermore, due to the acclaimed gentleness of air polishing, it’s an ideal technique to use when cleaning around delicate implants.

 

Myth #5: The Aerosol Spreads Bacteria

Dental professionals perform an array of procedures, including air polishing, that requires hand tools that produce an influx of particles and splattering. They can contain microorganisms (aerosols) from the oral cavity of the patients, which are believed to possess bacteria and fungi. It’s feared that this can lead to cross-infection for dentists and dental hygienists.

 

Yes, you do have to adhere to prevention methods to keep safe—but it’s no different from any other treatment. Furthermore, studies have proven that aerosol exposure is not a significant occupational hazard.

 

Myth #6: Air Polishing Equipment is Too Expensive

Unfortunately, many dental professionals do consider air-polishing equipment to be too expensive.

 

But this assumption doesn’t consider the return on your investment.

 

Even if you’re paying for a more expensive polisher, your patients will appreciate the results and keep coming back to you as their trusted dentist or dental hygienist.

 

After debunking these myths, we hope that you’re more open to air polishing. It’s an undoubtedly affordable, safe, and effective teeth-cleaning method that will help your patients achieve optimal oral health!

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How to Win Over Millennials and Keep Them Coming to Your Dental Practice

 

It’s a fact: millennials are now the single biggest generation in both Canada and the U.S. There are over 83.1 million American millennials and about 10 million to the north.

 

So, why aren’t you seeing more of them in your practice?

 

You’re not alone if you’ve had difficulty bringing this generation of potential patients on board. Sure, you’ll see them in for the occasional extraction or filling...but when it’s time for a regular cleaning, millennials aren’t inclined to call back.

 

It’s not that Gen Y doesn’t want or need dental care ‒ but they often require a different tact than you’d take to recruit and retain your usual patients. 


Why Gen Y Isn’t Always An Easy Win

In a recent article for HygieneTown, RDH Katrina Sanders lays out a few of the things that make the millennial generation (people born between 1983 and 1997) different when it comes to their approach to dental care.

  • First, many millennials experienced divorce in their families growing up. Because of this, they tend to wait longer to marry and have children (if they do at all.)
  • Older millennials took on significant student loans and graduated at the height of the Great Recession, leading many to unstable career and financial situations. Many work part-time, multiple jobs or flexible hours.
  • Millennials also saw their parents and grandparents, many of whom committed decades of service to their employers, suffer job loss during the Recession.

What does this all mean for you as a dental professional? Well, as Sanders explains, these tendencies affect Gen Y’s attitude about going to the dentist. Understanding these traits can go a long way in helping you attract more millennial patients and keep them coming back after the initial treatment!

 

1. Involve Millennials in Their Dental Care

Back in university or hygiene school, you might’ve learned to look at a patient’s involvement in their healthcare through scales like the Health Belief Model or Dental IQ.
But millennials don’t always fit the book. 
 
Although they are often highly educated and concerned about their health, millennials are also notorious for scrutinizing the ins and outs of anything they spend their money on. They need to truly believe in what they’re ‘buying’, even when it comes to oral healthcare.

 

Involving these patients through a co-discovery process helps by making them part of the solution to their own dental needs.


2. Make Booking Appointments a Breeze

You’d be hard-pressed to find a millennial who doesn’t carry a smartphone, but that doesn’t make it any easier to get in touch with these patients by phone. Why?

 

Truth is, phone calls are becoming a thing of the past. One survey showed that 80% of Generation Y would be willing to trade the ability to place phone calls for an unlimited data plan. 

 

Further, 61% said they would consider switching dentists just for the ability to book appointments quickly.

 

In other words, it no longer makes sense to conduct your bookings solely over the phone! Millennials are busy, and so they’re not as willing to spend time tracking down your number or waiting on hold. 

 

If you’re still only taking appointments by phone it’s time to start looking at ways to let patients book online. 


3. Stay Open Later

Speaking of busy...research has shown that millennials place a lot of value on extended evening and weekend hours. In fact, nearly 40% say they’d keep coming back to a dentist who can offer those extended hours.

 

Unfortunately, many millennials simply don’t consider regular dental checkups or teeth cleanings worth missing a day of work. Taking time off is tricky when you’ve got multiple employers and family obligations packed into one schedule.


Any practice that can offer weekend or evening appointments has a huge advantage when it comes to winning over this generation of patients.


4. Offer Financing Options

For better or worse, millennials are willing to shop around for a dentist, especially when they’re on a tight budget. As Sanders illustrates in her HygieneTown piece, most

millennials will respond to a proposed dental treatment in one of three ways:

 

  • Agree to have the treatment, but request several monthly payments broken up over an extended period.
  • Look for another dentist that can provide the same treatment at a discount.
  • Ask you to dull the pain, but not cure the problem.

Fact is, fewer millennials have insurance coverage than previous generations, and we know that those without insurance are more likely to avoid getting proper dental care due to cost. But if you can offer an alternative to paying out-of-pocket, it will win over millennials who are likely to become long-term patients and a great referral source.


5. Keep In Touch

But it’s not always an aversion to phone calls or dental bills that keeps millennials out of the chair. 

 

Between a growing career, a young family and a world of constant distraction, sometimes dental care just falls off the radar. 

 

This is where it helps to reach out to patients outside office hours. To start, following up after the appointment by text or email is an incredibly simple way to make a connection and remind them you care. You can continue fostering that connection via social media, sharing blogs, videos and resources.

 

Remember: millennials aren’t your enemy! They have all the same needs as your other patients, and they’re a valuable source of business ‒ especially as the older ones are settling down and starting families. A bit of flexibility on your part can go a long way in winning them over as dental patients.

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5 Phone Tips That’ll Help You Turn More Prospects into Dental Patients

 

 

Have you welcomed many new clients lately?

 

You’ve got a talented team, but you need patients to fill their chairs in order to keep the practice growing! The second you get complacent is when you fall into a rut.

 

While not every incoming phone inquiry leads to new patients, fine-tuning that aspect of your practice management will do wonders for your patient acquisition. The following tips will help you turn more phone prospects in patients at your dental practice.

 

1. Don’t Hold Out on Insurance Details

 

Put yourself in your potential patients’ shoes. Of course, many of them are nervous about their appointment – but on top of that, they’re worried about finances and insurance.

 

People tend to avoid treatment when they’re worried about their insurance coverage. So, be sure that you make clear what is available on any given patient’s specific policy. 

 

Delve into as much detail as possible over the phone so there’s no room for confusion. It’s integral to let prospective patients know that your practice has a relationship with most providers.

 

2. Stay Alert in Case of Urgent Appointments

 

You could miss out on a lot of potential business if you close the door on last-minute bookings. Flexible appointment options are a major draw to patients who don’t already have a regular dentist.

 

Consider leaving enough time open in your schedule for patients who need to see you immediately. If someone just cracked a tooth and can’t find an appointment, they’ll be eternally grateful if your dentistry was the one that saved the day. And voila! You now have a patient for life.

 

3. Provide Two Distinct Appointment Options

 

Your schedule comes first, of course, but you want to do your best to work with your patients’ schedules as well. One simple way to do this is to offer two potential appointment times over the phone.

 

First, ask the prospective patient whether they would prefer an earlier or later timeslot. From there, offer two potential time slots in that period (e.g., morning, afternoon, evening). The prospect feels less pressured to settle for an inconvenient time and empowered by the freedom to choose a time that works for them.

 

The quicker you can sort out a time, the less the patient can hum and haw over their personal schedule!

 

4. Be Transparent

 

Treat every phone call with care. In fact, treat each phone call with the same attention to detail you apply to cleanings and fillings! 

 

When your patients ask how long the appointment will take, it’s not necessarily about the seconds on the clock. Really, they’re trying to gauge the seriousness and intensiveness of the work being done.

 

Give your potential patients a reason to trust you by walking them through their treatment during the initial call. Giving them a step-by-step breakdown of everything from the initial check-in process to the X-rays, cleaning, and billing will go a long way.

 

Remember to ask for a cellphone number so you can text the patient to send them a reminder for their upcoming visit!

 

5. Be Upfront About Pricing

 

We get it – money is always a touchy subject in this profession. That’s exactly why it’s important to get ahead of the subject and speak confidently and transparently about your payment options.

 

Start at the low-end of the price range where appropriate and emphasize that the needs of each patient will vary. It’s fair to state that while every crown starts at a certain cost, you’d need to see the patient’s teeth first to provide a more accurate price assessment.  

 

Some patients will always be difficult to satisfy, but it still pays to be transparent in this regard. Better to lose an impossible prospect over the phone than to argue with one in the dentist’s chair!

 

 

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Should Chairside Saliva Tests Be Part of Your Dental Practice?

 

 

As dental professionals, we’re constantly looking for ways to help patients feel safe and comfortable under our care.

 

Unfortunately, there’s little we can do to change the fact that dentistry is, by nature, quite invasive. We still have a ways to go when it comes to finding less invasive means to diagnose and treat our patients.

 

One promising solution in this area is saliva testing ‒ a fast, cost-effective diagnostic tool which requires no painful pokes or scrapes. Saliva tests are increasingly utilized as a noninvasive way to monitor oral health status, disease onset and progression, and treatment.

 

Here, we’ll look at the reasons why more and more dentists are welcoming saliva test kits into their practices.

 

Why Use Saliva Testing in Dental Practice?

 

Saliva is a truly flexible fluid. Yes, it helps us eat, speak and maintain good oral health ‒ but it also contains a wealth of biochemicals that can tell us a great deal about a person’s overall health.

 

Oral fluid can be analyzed for proteins and related molecules, nucleic acid components (e.g., human and microbial DNA, mRNA and microRNA), and endogenous and exogenous metabolites. Saliva tests can help dentists assess a patient’s risk of caries and periodontal inflammation by analyzing cariogenic bacteria, acidity, blood, leukocytes, protein and ammonia.

 

In addition to oral health conditions, trace amounts of proteins and other substances linked to other systemic diseases can filter into saliva from blood serum. These salivary biomarkers have been investigated for detection and monitoring of diseases such as:

  • Human papillomavirus (HPV)
  • Autoimmune diseases, including Sjögren’s syndrome
  • Cystic fibrosis
  • Various cancers, including oral squamous cell carcinoma
  • Herpes simplex virus 1 or 2
  • Chlamydia trachomatis and Neisseria gonorrhoeae

Unlike a blood sample, saliva (along with secretions from specific oral glands, mucosal transudate and gingival crevicular fluid) is painless and readily available to collect from patients for analysis.

 

In many cases, it is possible to collect and test saliva samples right there in the dental office using portable, rapid test kits. When laboratory analysis is required, saliva samples have greater stability than blood in transportation.

 

Applications for Saliva Testing in Dentistry

 

In an article for Dental Economics, Dr. Richard Nagelberg illustrates how saliva testing could be used to help dentists and hygienists provide evidence-based treatment for periodontal disease.

 

Suppose a patient comes to you with telltale signs of inflammation: painful, bleeding gums and the early stages of gum recession. You don’t need a saliva test to tell you that this patient is likely suffering from gingivitis. However, the results test could inform an individualized treatment approach that could provide the best possible outcome for them.

 

As Dr. Nagelberg explains, a salivary test report would specifically indicate which antibiotics are indicated for each type of bacteria found in the saliva sample. A patient who is dealing with high-risk, highly pathogenic bacteria such as Porphyromonas gingivalis and Tannerella forsythia would benefit from a treatment plan that is based on their increased risk of periodontal disease.

 

Efforts are underway to further the development of rapid, point-of-care tests to evaluate oral fluids. Ongoing research indicates that saliva could eventually be used to detect heart disease, diabetes, cancers and other conditions. Refinement of oral fluid tests may shed further light on our understanding of the oral-systemic link.

 

Imagine using a simple, chairside test to detect all manner of oral and systemic diseases. This could be the future of diagnosing periodontal disease, assessing cavity risk and more!

 

The Future of Saliva Testing in Dentistry

 

The development of salivary testing for the dental practice is still in its early stages.

 

Currently, there is still no established, uniform criteria for collecting human saliva in the dental practice. Although oral fluid testing by clinical laboratories is regulated to ensure test results are accurate, the regulations do not address the validity of the test. Additionally, to date, there are no FDA-approved salivary diagnostic tests for evaluating the risk of periodontal disease or dental caries.

 

Still, saliva testing for oral and systemic disease holds many advantages that make it ideal for use in dentistry. Surveys show that these types of chairside tests are appealing to dentists and patients alike.

 

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How Time Pressure Can Affect a Dentist’s Judgement

 

I don’t need to tell you how stressful a dental office can be on any given day! However, new research from the University of Plymouth indicates that this time pressure can lead to results much more dangerous than a missed lunch or reduced time for mental breaks throughout the day.

 

In fact, we know now that dentists are much more liable to miss crucial details when reviewing patient x-rays if they’re crunched for time.

 

What the Research Says

Despite dentistry’s infamy as a stressful field, very little research has been done to examine the effects of stress on a dentist’s performance.

 

In March 2019, researchers asked forty dentists to interpret x-rays with and without the addition of time pressure. Afterward, these dentists were also asked to rate their stress levels during their session with a time crunch versus their diagnostic session without time pressure.

 

Understandably, the dentists in the study reported feeling much more stressed when working under time constraints. Additionally, their performance was significantly hindered when pressured for time.

 

In other words, time pressure meant that dentists were more likely to make diagnostic errors and overlook potential warning signs offered by x-rays ‒ a devastating effect that has the potential to put patients in danger of missed diagnoses and worsening health.

 

Of course, I’d be remiss not to mention the potential legal complications of missed diagnoses for any practice, too!

 

Addressing the Problem

The risks documented in this study may land more personally than you expect. Instead of discarding this poignant research as something which could never happen in your own office, take some time to learn and implement a few tools to create a lower-stress environment within your practice.

 

1. Don’t allow stress to be contagious.

The cold, hard facts are that most people don’t enjoy their dental visits and, in fact, many patients downright fear the dental chair.

 

Whether you realize it or not, it’s easy for the fear and tension of your patients to seep into your own conscience while you’re working.

 

Avoid this by being perceptive of your patients’ anxiety, showing empathy and understanding to patients who are stressed out by their visit, and encouraging them to take a couple of long, deep breaths.

 

Not only will this improve your quality of care and improve the patient experience, but it will reduce your stress, too!

 

2. Exercise self-care at work.

Whether this means taking a quick break to enjoy your favourite tea, meditating during lunch, or simply showing compassion for yourself while you’re on the clock, make sure that self-care practices don’t stay at home during the day. Drink plenty of water, stretch, and consume well-balanced food during breaks and lunch.

 

If your body feels better, your mind will feel better, too.

 

3. Pinpoint what’s stressing you out.

Before you can reduce stress, you must work to identify the sources of stress.

 

Need some help? The top five causes of stress in the field of dentistry are: running behind schedule, excessive workload, causing a patient pain, caring for anxious patients, and treating patients who don’t show up on time.

 

Once you have a better idea of what’s stressing you out, you can take more targeted steps to adjust and relax.

 

4. Be positive.

Attitude is everything. Even if you’re not feeling positive, search for the humour in the day’s situations and put a smile on your face.

 

Not only will patients value this positive attitude, but it will also keep stress and burnout at bay!

 

It’s a Team Effort

One final note! It may be tempting to discard this research and these strategies if your role within your dental practice doesn’t involve the diagnosis of patients or x-ray review. However, don’t think for a moment that it’s not important for every member of a functioning dental practice to learn stress management in the workplace!

 

While the study discussed above specifically investigated x-ray diagnoses by dentists, dental hygienists and assistants are equally susceptible to making mistakes or sacrificing thorough care when office stress gets high.

 

I want to emphasize that the tips I’ve offered above apply not just to dentists, but to everyone.

 

Embrace them as you work to improve your practice’s environment, eliminate stress, and prioritize the best possible patient care.

 

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8 Fun Dental History Facts You Didn't Learn in Hygiene School

 

Dentistry is as noble a profession as it gets, filled with some of the most caring people on earth. Still...it’s always taken a special kind of human to look someone in the eye, tell them to open wide and then courageously yank their teeth out! 

 

Visiting the dentist is no longer something most people lose sleep over...however, the same cannot be said of decades gone by. The age-old practice of the tooth has changed so much thanks to modern medicine and state of the art machinery. Dentistry has not always been so painless!

 

Let’s dig in to the long, rich and occasionally painful history of dentistry, including a few fun facts you probably didn’t learn in hygiene school.

 

1. Barbers Used to Double as Dentists

These gentlemen were known as barber-surgeons. It may seem quite barbaric to have the local barber extracting teeth and bloodletting, but it made sense in the medieval times, since it left more doctors available to attend to the war wounded.

 

Nothing quite like getting your wisdom teeth carved out with the same blade you were just shaved with!

 

2. Ornamenting Teeth Was All the Rage

The ancient Mayans used to bejewel their teeth by chipping at them and embedding small gemstones with glue. Although the outcome would be a dazzling and mesmerizing smile, the process was certainly not for the faint of heart.

 

In the industry today, this ancient practice by the Mayans isn’t too far from the modern practice of bejeweling your teeth...without the gruesome chipping part, of course. Nowadays, they’re called tooth gems, which some people use to give an extra shine to their smile.

 

3. Ever Wondered Where Toothbrushes Came From?

The need to maintain dental hygiene is not a 21st century phenomenon. In ancient times, people would snap a supple twig and chew the edges to spread out the fibers. Even today, some people prefer the twig toothbrush over the conventional toothbrush.

 

The Europeans used a rag and salt or soot for brushing their teeth until the English inventor William Addis invented toothbrush. This was in 1780 but by 1498, Chinese artisans had invented the toothbrush as we know it by using animal hair as bristles.

 

If you’re feeling naturally inclined to use a twig toothbrush, then you can consider trying a twig from the toothbrush tree.

 

4. Anesthesia Was Gross and Ineffective

Archigenes was a tooth doctor back in 15 A.D Rome. His idea of anesthesia for dental works was ointment made from hair-raising ingredients including roasted earthworms, spikenard and spider's crushed eggs. He would drill into your tooth then apply the ointment to relieve pain.

 

It’s hard to imagine that ointment would actually reduce pain, yet it was widely used ‒ maybe the sheer shock of having dead spider babies smeared on your gums was enough to kill the pain?

 

5. The Electric Chair and Teeth Have a Lot in Common

What does an electric chair have to do with teeth? Well, luckily not much...other than the fact that the inventor of the electric chair was also a dentist by profession and a professor who taught dental medicine at the then-University of Buffalo School of dental medicine in New York. 

 

The good news is that he invented the electric chair in the mid 1800s specifically for the purpose of execution and not dentistry. It’s a mild relief knowing that Southwick had no intention of experimenting the efficacy of electric current on tooth cavities.

 

6. Dentist Power Drills Were Powered By Feet

You might know that the dentist attending to the first president of the United States, George Washington, invented a foot engine to power his dentist's drill.

 

What you might not have known is that he used his mother’s spinning wheel making it into a torque to power the drill!

 

7. Dentistry Was a Lonely Profession

Until the year 1960, dentists were expected to do everything while attending to their patients. They would handle every procedure and tool on their own with no assistance! The result was weary and lonely dentists. 

 

This continued until four-handed dentistry was introduced, providing two extra hands (and a lot of camaraderie!) to help.

 

8. Tooth Decay Was Caused By Worms!

...Just kidding! Of course that was never true. But for a time, that’s what people really believed. 

 

After all, worms drill holes, and tooth decay is characterized by holes in teeth. This was a logical conclusion at the time. This old explanation for tooth decay was so believable it carried on in many cultures until the 1900s.

 

Today, we’re thankful for miracles like Novacaine and other tools and treatments that make your life (and the lives of your patients) easier. But we should also be thankful reflecting back on the dentists of old. Though they may have been misguided at times, they’re the ones who made it possible for us to offer the quality of care we can today!

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Treating Patients with Thyroid Disease as a Dental Hygienist

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.

 

Oral Manifestations of Hypothyroidism

 

Hypothyroidism, also called underactive or low thyroid, is a decrease in the hormone production and functioning of the thyroid gland. Hypothyroidism most often affects women from middle age onward, but it can occur in people of any age.

 

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:

  • Enamel hypoplasia
  • Micrognathia, or undersized jaw
  • Mouth breathing
  • Thick lips
  • 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)
  • Burning mouth syndrome
  • Xerostomia or dry mouth caused by Sjogren's syndrome

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.

 

  1. 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.
  2. 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.
  3. Treat the oral manifestations of hypothyroidism and hyperthyroidism as needed, including periodontal disease, caries and xerostomia.
  4. Conduct an extraoral head and neck examination at each appointment. This will help you detect changes to the patient’s thyroid region.
  5. 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.
  6. 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.
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