My Ortho Experience

As we celebrate Ortho Month here on Hygiene Edge, I wanted to share my experience in hopes to make braces wearing a more enjoyable experience. I have had braces TWICE. Once as an awkward adolescent and once as an awkward adult in braces.

Thanks to inheriting my father’s large teeth (thank’s Dad) and my mother’s small mouth, I was an orthodontist’s dream. As an adolescent I was severely self conscious of my buck teeth and wanted this braces thing to be over as soon as possible. After consulting with my orthodontist, it was decided that I would have 4 premolars extracted in order to make room for my teeth and to hopefully correct my class II bite. I was in braces 3 years. I hadn’t learned the discipline of wearing my rubber bands consistently and would quadruple band with a side of Advil for a week before my appointments in order to show some progress. I was not consistent, my hygiene was floss-less and I tried to make my braces as inconspicuous as possible, always wearing grey bands. I had failed at this braces thing and didn’t really know it.

The sporadic rubber band wearing backfired over time. Years later when I was working in the dental field I noticed that my bite was still class II and I had a “black triangle” between #8 and #9 that I wanted corrected. I decided to go to multiple orthodontists for evaluation. It became clear that in order to correct my bite and close that black triangle I was sentenced to jaw surgery and 2 years of braces wearing at the age of 26. This was a new opportunity to do braces right!

When I was an adolescent, my braces were a boring, awful experience. I had done braces wrong. This time I was going to enjoy this braces thing. Gratefully I was in Dental Hygiene school at the time and was introduced to the Oral B Pro 1000 mechanical toothbrush. I used the Power Tip brush and Ortho brush attachment to clean around my braces. The Power Tip brush allowed me to clean where the wire attached to the bracket without hurting my papilla. The Ortho attachment helped me clean above and below my brackets without needing any ninja moves. My teeth had never been cleaner! I also was motivated to floss knowing my fellow students would be peering at my teeth. Flossing was not my favorite pastime as it took FOREVER (I hadn’t heard about GumChucks yet) so, I added my beloved WaterPik water flosser to my hygiene arsenal. I decided that my braces needed pizazz this time and took every opportunity to change my band color to anything outrageous. I decided to have fun with them!

Looking back at my braces experience, I am glad that I was given a second chance. As a Dental Hygienist, I feel I can empathize with and inspire those unmotivated adolescents and I can also encourage those hesitant adults in getting braces. Adults with braces rock and they are much better at wearing their rubber bands consistently! Well, at least I was. I have noted my favorite products that helped me have a better braces experience. I’d love to know what products have been game changers for you and your braces wearing loved ones.

Flossing with Platypus Flosser

Wasatch Dental Hygiene Study Club

Hey, Utah Friends!

We are so excited! This Thursday, May 19th, we will be speaking about Local Anesthesia at the Wasatch Dental Hygiene Study Club Dessert and Learn! If you're local, come say HI and hang out with us! The meeting is held at Henry Schein Headquarters (1220 South 630 East in American Fork) from 7:30-8:45. If you plan on coming, please RSVP to wasatchdhsc@gmail.com.

See you on Thursday!

OrthoGami Giveaway Winner!

Congratulations Janice on winning! Please email us your information and we will get send you your GumChuck and OrthoGami prize!

The Importance of the Labial Frenum

When you see your pediatric patients, are you checking their labial frenum? I know many hygienists, including myself, always checked the tongue frenum to check for tongue tied. However, lip ties were never a concern for me. Until now.

Recently, studies have been showing the importance of releasing a lip tie. Not only will a class 4 lip tie prevent a baby from having a proper latch and prevent nursing, it can cause problems as the child gets older.

One problem that can occur is higher decay rates on the anterior teeth. With a lower frenum attachment, the lip creates a “pocket” around the anterior teeth which can trap milk and food. This allows the sugar to sit on the teeth, causing decay to begin around the gingival margin. The strong frenum between the teeth also cause problems with brushing and reaching the toothbrush bristles to the gum line, another reason for increased risk of decay. Another issue that can occur is sleep problems. If the labial frenum is too tight, the upper lip cannot reach the lower and the child is constantly breathing through their mouth. This can lead to sleep apnea in the child. It can help the child orthodontically. Regularly when the lie is released, the infants teeth will move together and have less of a diastema, This can prevent further ortho treatment needed as the child gets older.

I am very passionate about checking for labial frena attachments because it has recently happened to me.

This is my daughter Georgia. She is almost 2 years old now. Like most two year olds, she’s curious, busy and into everything in my house. However, she was very behind in her speaking and communication, which of course, as a mother, made me very worry. My dad is a dentist in Alberta, Canada and kept asking if her lip and tongue frena’s were tightly attached. Like a daughter would, I brushed it off and we started working with a speech therapist to hopefully help develop her skills. However, he looked at her first dental visit with him and he highly recommended having them released. I waited a few months to complete the treatment because I was nervous!

I scheduled a frenectomy appointment with a pedodontist that uses a diode laser and treats hundreds of lip and tongue ties a month. After a quick consultation, they preformed the surgery with topical anesthetic only. The most important part of the surgery is the post op instructions and lip stretches. While the area is healing, the frenum can reattach, so I stretched her tongue and lip 5 times/day until it healed (about 1 month) to prevent it from reattaching.

Georgia's Class 4 Labial Frenum

In my experience, the earlier this is diagnosed, the better:

1.    The earlier the child has the frenum release, the quicker it will start to nurse and eat properly.

2.    The treatment is easier to accomplish on a young baby. Since Georgia was almost 2 when it was completed, she was bigger and stronger and didn’t want to sit for our pediatric dentist during the procedure. She also was a bit aware of what was going on and seemed scared. I'm not going to lie. Since she wasn't happy during the procedure and tried to twist away, it was stressful as a mom! 

3.    The younger the patient, the less likely they will remember the appointment. We are hoping that Georgia doesn’t remember the surgery and will be doing “happy visits” at the pedodontist several times before she actually is a patient for a prophylaxis appointment.

Once a patient is a candidate for surgery, it is extremely important to explain the post op instructions to the patient. For at least 1 month after surgery, the parents or caregivers need to perform lip stretches several times a day to prevent reattachment of the frena. If these stretches are not completed, the tissue will reattach and the surgery will be unsuccessful. If you have any questions on lip stretches, contact your local Oral Myologist.

To see different photos between Class 1, 2, 3, and 4 labial frenas, this is a great paper.

Find contact an Oral Myologist, check out the IAOM.

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Sources:

The Influence of the Maxillary Frenum on the Development and Pattern of Dental Caries on Anterior Teeth in Breastfeeding Infants: Prevention, Diagnosis, and Treatment

Lawrence A. Kotlow, DDS

DDS, 340 Fuller Road, Albany, NY 12203

J Hum Lact. 26(3):304-308.

http://www.sleep.theclinics.com/article/S1556-407X(14)00025-3/abstract?cc=y= - article-footnote-

 A Novel Treatment of Pediatric Sleep-Disordered Breathing

Joy L. Moeller, BS, RDH, Licia Coceani Paskay, MS, CCC-SLP, Michael L. Gelb, DDS, MS 

Sleep Medicine Clinics 

June 2014Volume 9, Issue 2, Pages 235–243

The influence of the maxillary frenum on the development and pattern of dental caries on anterior teeth in breastfeeding infants: prevention, diagnosis, and treatment.

Eur J Paediatr Dent. 2015 Dec;16(4):262.

Kotlow LA.

Lingual frenectomy: functional evaluation and new therapeutical approach.

Eur J Paediatr Dent. 2012 Jun;13(2):101-6.

Olivi G1, Signore A, Olivi M, Genovese MD.

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One Of My Best Tips For Efficient Ortho Prophys

Remember to enter our giveaway of a complete GumChucks kit HERE

Ugh. Your 30 min child prophy just showed up, right after school lunch, with a new full set of braces. This is about the time when I USED to shed a little tear as I knew I was going be be put behind in my schedule. Now when I have this scenario, I am excited for the change of routine and can complete it in the time provided. (Feel free however to schedule extra time at the next prophy visit if needed.) Here’s is the time frame ESTIMATION by minute:

• 1m-HH
• 4m-Radiographs (if needed)
• 2m-Brush the patient's teeth/OHE
• 10m-Polish, ultrasonic, hand instrumentation
• 3m-Flossing
• 5m-Exam
• 1m-Fluoride
• 4m-Dismissal/room turnaround

One of my personal biggest time savers to stay on the above schedule on an ortho patient is to disclose, hand them a mirror, and then have the patient watch me brush their teeth. This will give you a good head start on removal of materia alba and biofilm, which these patients usually have lots of, and at the same time you are doing OHE. I love a good BOGO (Brush One Get OHE). You could have the patient brush their teeth over the sink as well but I find that they take longer and still miss those hard to reach areas.

I used to hate flossing braces, as threading the floss through each time was a killer! Some time saving tips on braces are to use an ortho flosser such as the sterilizable handle from the company GumChucks with an ORTHOgami attachment, or you could use the platypus flosser or fish floss. Find one that works best for you by requesting some samples. 

Stay tuned in over the next few weeks to come as we have some videos on how to be more proficient  with the air powder polisher, ultrasonic and hand instruments on patients with ortho. 

It's Ortho Month On Hygiene Edge

It's Ortho Month on Hygiene Edge! Watch for articles and new videos all about how to care for our patients with ortho.

Our first video in ortho month is about an amazing product from GumChucks called ORTHOgami. They make flossing braces easy both for you and for your patients. They also offer metal handles that are sterilizable to use in your practice that makes flossing patients quick and easy. 

To kick off Ortho Month, we are doing a give away! We are giving away a complete GumChucks kit for you to try at home and in your office. It includes multiple handles for kids and adults and inserts for both ortho and non ortho patients. To enter, comment below with your favorite ortho trick or products that you recommend. We will be announcing the winner here on Hygiene Edge on Tuesday!

Does Flossing Really Prevent Cavities?

I sat in a large conference room as the speaker shared that flossing is not very effective in preventing caries. Immediately, there was a tangible feeling of agitation in the air. Who does this lady think she is?  How could someone, let alone a well-known dental hygienist, say such a thing?  The speaker later shared that she has had hygienists even leave her courses over this.

Don’t we drill in our patients head brush, floss, repeat? I certainly have been guilty of being a ‘floss boss’ and telling my patients to “clean-in-between” to prevent decay.   

But, here is the thing, we say a lot of stuff in dentistry out of tradition; or because it kind of makes sense in our minds and we may not even have any research to back up. 

There was a good-sized systematic review (click here) done that showed a very weak correlation between flossing and a decrease in decay. (However, the study did show that flossing decreases gum disease). 

So how has this news changed the way I educate my patients?  If a patient has a lot of decay, and relatively healthy gingiva, I skip the floss lecture and go straight into strengthening the patient’s teeth with different products such as fluoride and eliminating known risk factors such as frequent consumption of energy drinks. 

Hygiene Edge Challenge:  Back your oral hygiene education (OHE) up with research!!

Edgimacated

This past week has been an exciting one for my as an educator. Last Friday, the school where I work graduated some of the best and brightest students, ready to take on the world one dirty tooth at a time. This week, those students finished up their local anesthesia and clinical dental hygiene boards. I was reminded of when I took those boards and still feel some residual anxiety about them and it's been 5 years! I remember being so nervous and stressed out. All of my available brain space was focusing on that exam so it's not surprising that I locked my keys in the car that day, right?! Anyway, I was reflecting on how much study, preparation, work, and money went into the letters at the end of my name, letters many don't know about. That is what I was to discuss today: educating our patients and the general public about what it mean to be a RDH, BSDH! If we remember back in 2012, a national television program called The View proclaimed to the world that is was not necessary to get a college degree to become a Dental Hygienist! Let alone the reputation we have as ditsy women thanks to other television shows. I have had many discussions with my patients about my education. More people than I'd like to admit are surprised when I tell them that I have a bachelor's degree and am licensed by the state to do my job. Imagine their surprise when I tell them I had to take 3 written exam and 2 practical exams in order to be licensed! I have 3 suggestions that I would ask you to consider in order to bring the respect that our profession deserves.

1. Hang your license AND diploma (whether it is an associate or a bachelor's degree) IN your operatory where your patients can see it. This provides you with a conversation piece and an opportunity to educate your patient on the quality of care they are receiving from a qualified individual- YOU!

2. Wear a lab coat or name tag with your name AND credentials on it. You may think it's pretentious. It is NOT. It is PROFESSIONAL.

3. Be a member of your professional organization! Without an organization, we do not have a voice. We need a voice to protect and preserve the professionalism and prestige of our profession.

How do you present yourself in a way that helps others recognize your qualifications? I'd love to know. Let's join forces and not let the stress of boards go unwarranted. Let us be a united voice in letting our patients know that educated professionals are taking care of them. We are much more than the "person that cleans my teeth."

When and How to us a Snap-A-Ray For Bitewings

Snap A Ray For Your Bitewings