Merry Christmas from Hygiene Edge

Since 1964 Dentistry has been linked to Christmas thanks to a brave little elf named Hermey. In the animated movie Rudolph the Red-Nosed Reindeer Hermey declares that he wants to be a dentist. I grew up watching this movie and loving the story of Hermey, loving that he and I shared a love of Dentistry . Here at Hygiene Edge we have a love for the Holidays, a love for dental professionals and a love of cartoons. We wish you Happy Holidays and hope you enjoy these dental themed cartoons that celebrate the Holidays. I think Hermey would be proud.

Hygiene Spotlight-Jasmin Haley, RDH, BSDH, CDA, From Beyond The Prophy

Jasmin Haley, RDH, BSDH, CDA

School:

1. Allegany College of Maryland, AAS, 2007

2. University of Maryland, School of Dentistry, BSDH, 2008

3. Fones School of Dental Hygiene, MSDH(c), Expected graduation 2018

Hygiene Edge Interview

1. Where do you currently practice/what type of dental hygiene practice?

I am a PRN hygienist at a Federally Qualified Healthcare Center (FQHC) in Baltimore.  I have always loved educating and previously I spent 4 years teaching full-time at a community college. In Spring 2017, I will be joining a dental hygiene program as an adjunct instructor.

I am the founder of Beyond the Prophy LLC, through BTP I empower and inspire hygienists to provide the best patient-centered care and to explore career options that promote excellence. I am also the Co-founder of MOMgienists LLC, through Momgienists my friend Christie and I talk about everything except the kitchen sink and support other mothers through our podcast and Facebook support group.

2. What interested you in dental hygiene as a career?

My fascination with teeth started at age 13 because I had severe crowding and I was teased about my smile.  I was accepted to a specialized high school in NYC that had a dental assisting program. After the dental assistant program, I knew my journey in dentistry was not over. I wanted to pursue dental school and decided I would attend dental hygiene school to financially support myself through dental school. Low and behold! I have stuck with dental hygiene for 9 years and it has provided amazing opportunities in my professional career.  Many of my opportunities came through my involvement with the American Dental Hygienists' Association and my state constituent. As one my friends, Shavonne Healy, states "ADHA is your professional lifeline." My membership has meant more to me than I could have ever imagined as a student and I am so grateful. It has helped me unleash my potential and now the opportunities that await me are boundless!

3. What is your favorite thing about dental hygiene?

I enjoy connecting with my patients, students, or course attendees. Dental hygienists have a special role in building relationships with their patients and the opportunity to impact their lives every day.

4. What is one piece of advice that you'd give yourself as a dental hygiene student?

Have more fun! I was blessed to make lifelong friendships in dental hygiene school. Although, I went to the BEST program in Maryland, I could have had more fun! As SADHA Class president, I filled my time up with my responsibilities and school work. I didn’t make enough time for myself. I am thankful to my study partner and two women in my class from Ocean City, Maryland, who persistently asked me to hang out with them. I felt that I never had time for fun. However, when they took me out for karaoke it was the best decision I made! It was my Friday outlet that helped me to let out some steam and rejuvenate myself for the upcoming weeks before graduation. I still karaoke till this day!

5. Any funny or favorite stories from your career?

My first temp job out of dental hygiene school was very interesting. I was an awkward mess because of my nerves. My first patient of the day needed to take a full mouth set of radiographs and provide a prophylaxis in 45 minutes!  The pressure was overwhelming and I thought I was going to pass out on the spot. The gentleman that I was providing treatment for was very kind as I fumbled along gathering my equipment. Unfortunately, while assembling the XCP holders I didn’t realize I grabbed a defective set. I successfully took the anterior periapical and bitewing radiographs. I was almost finished until I was unable to remove the ring from the posterior periapical XCP to prepare for my final quadrant. I kept tugging and tugging until it finally released --and my hand hit the patient right upside his head! My hand was balled in a fist while I was tugging and I basically punched him in the face! He slumped down in the chair, head down into his chest and didn’t move. He then opened one eye and smiled at me. I was mortified! We both laughed it off and I survived that day. I often thought of him while teaching radiology lab. I remember where I once stood as a budding future dental hygienist.

Final takeaway for the future dental hygienist: It's okay to be a ball of nerves, anxious for your first day as a licensed hygienist -- EMBRACE it and REMEMBER don't stand too close to the patient's face when putting the XCP together! Ha!

Dental Service

It’s that wonderful time of year to spread joy, love and to help those in need. This time of year always get me thinking about those that so desperately need the services that we provide, but can’t afford it. I have decided to make this post about a few suggestions that you can do to give back to those in need, whether it is during the holidays or a New Year's resolution of yours.

Serve in your own office

Ask your employer if donating services to someone in need. Within HIPPA guidelines, write about it on your office social media page or website.

Another option is doing a free dental service day for those in need.

Check locally to see if there is a community health clinic that you can serve at

An example of this is a community in Utah has set up Community Health Connect which acts as a liaison between professionals and patients in need. They go around and ask for dental/medical offices to provide services to 1-2 patients per year.

Look into a state level service to see if there is a clinic that helps those in need

Check with your local state dental and dental hygiene associations to see

Nationwide service is also an option. Even though we have the best healthcare available right here in America, there are so many that don’t have access to care.

One national organization is called Dental Lifeline. They run a national nonprofit organization that provides access to dental care and education for people who cannot afford it. You can click on your state and see how you can get involved.

Consider International Service

In school, I knew of a group going to Honduras called Smiles for Central America. I would have loved to go, but being a poor college student, it wasn’t the right time. So instead, I helped hold a drive to gather stuffed animals. At the time, their mission was to send every child home with dental care and a stuffed animal.

If something like this is not affordable, you can always look around for sponsors for your trip.

There are so many ways to get involved.  Whether big or small, our services are needed. Below are several other service resources I found that may also be an option for you.

ADA International Volunteers

Have you served with your dental hygiene expertise? Let us all know what you have done, how it went, and if you would recommend it to another dental hygienist.

Arestin Placement

Top 10 Advancements in Dental Technology You Should Tell Your Patients You Are Using!

Patients want to know that the office that they choose is on the cutting edge of dentistry, and that they are getting the best care out there. If you are using any of the advancements listed below in your office consider telling your patients more about it in an office news letter or on your office social media sites. We want to thank Dr. Amruta Patel for putting together the information below! 

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Dental technology has been growing by leaps and bounds, with systems designed to improve dentist and patient comfort, reduce treatment times and enhance oral health.

Here are 10 examples of systems that are changing the way we work:

1. High-Tech X-Rays – Digital X-rays reduce radiation exposure for both doctors and patients, are faster as well as more sensitive, efficient and convenient than conventional film. Today, digital radiography is used for locating cavities, inspecting bone structure, root canals, implants, etc.

2. Caries Detection Solution – Quite similar to plaque disclosing tablets (which draw attention to any areas of teeth not cleaned thoroughly while brushing), dental care professionals apply this liquid red dye over your teeth to check if decay has been completely removed during treatment.

3. Composite Resin Materials – These materials are commonly used in restorative procedures like veneers, crowns and bondings. They replicate the look and feel of your natural teeth, and can be applied directly to the tooth surface. They cure quickly, hold their shape better and are far more durable than traditional materials.

4. CAD/CAM Technology – CAD (computer-assisted design) and CAM (computer-assisted manufacture) technology speeds up restorative dental treatment. With a computer-generated image used in place of a mold and temporary restoration, bridges, crowns, veneers and inlays can be created and fitted in one visit.

5. Digital Photography – Digital photographs can be adapted to offer you a “preview” of your post-treatment appearance. These are especially helpful for cosmetic dentistry and complex reconstructions, since treatment can be customized based on the patient’s expectations and requirements.

6. Dental Lasers – Today, diode lasers are used to locate cavities in your teeth, in addition to their use in dental care procedures. Lasers can help locate cavities earlier, and are often used alongside high-tech x-rays to detect decay between and inside teeth or for teeth that have previously been filled.

7. Intra-Oral Cameras – These small and lightweight cameras produce highly accurate images of your teeth and their supporting structure. They allow dentists, technicians and even patients to see defects, helping to detect and prevent oral health issues.

8. VELscope – This new FDA-approved oral cancer screening system allows dentists and oral surgeons to locate defects that may not be visible to the naked eye. The system uses incandescent light to help identify abnormalities, or define appropriate margins for surgical procedures (e.g. excision of diseased tissue around a lesion).

9. The Wand – This computerized tool is used to deliver anesthetic liquid in a gradual and methodic manner, reducing the pain caused by pressure from traditional injections. The small delivery holder makes it easy to use, and patients are more comfortable with the painless delivery of anesthesia.

10. Desensitizers – For patients with sensitive teeth, desensitizers are a godsend which improve your comfort during any dental procedure. Dentists or dental hygienists can use them alone or combine them with other relief methods for pain and anxiety (e.g. local anesthetic/sedation dentistry).

With newer advancements in dental technology, treatment is becoming faster, safer and more effective than ever before. We at All About Smiles always stay abreast of any advances in dental technology, call and let us help you clear your doubts.

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Author: Dr Amruta Patel is a warm and compassionate dentist caring for the community of San Antonio, TX. She practices at All About Smiles, where she provides cosmetic braces, endodontic treatments, implants, and veneers, as well as basic general dental services. Outside of practicing dentistry, Dr. Patel enjoys spending time with her husband and two dogs. 

The Formula to Happier Patients

"My hygienist wasn't that great. She only used the water." - My Aunt

"My hygienist was super lazy. She didn't even use the water." - My Sister

"My hygienist said I need shots in my mouth and all this stuff... I don't know why. I think she was just confused with all the bleeding." - My Friend

"My dentist wants me to come back after the root canal to get a crown, instead of having the endodontist do the crown. He is definitely trying to get my money." - Another Sister

Yes, there will be some patients that are NEVER happy. But, I think you'll see an increase in satisfaction and compliance among your patients by following the formula below.

State Observation + What you're going to do and why + "Let me know"

Here is an example for a patient that has generalized gingivitis.

Observation: You have 10 areas in your mouth with an active bacterial infection. We used to not be as aggressive treating gingivitis. However, studies are finding a strong link between your body and your overall health. I'm going to do everything I can here and then "adjust" your brushing slightly so you'll be more effective at home.

Procedure/Why: Research shows a mix between this water instrument and hand instruments are the most effective way for removing the harmful bacteria.

"Let me know": If you experience any discomfort, please let me know.

Hygiene Edge Challenge: Follow the above formula for 2 procedures per patient.

Selective Polishing or Polish Selection?

Remember learning about selective polishing when you were in hygiene school? Has selective polishing come to be just asking your patients to select what flavor of polish they would like you to use?

If it has, you are not alone. I took an impromptu poll of my hygienist friends asking them if they find themselves coronal polishing  every tooth on every patient. The most frequent answer was “yes” with few stipulations like “not gold crowns” or “only along the margins of crowns”.  So, while there were stipulations I don’t think they would qualify as the “selective” your  instructor and text books taught you.

While working as a Dental Assistant the words “prophy” and “polish” was synonymous. You can imagine my surprise when I learned the truth!  Maybe our patients will feel the same when they learn that same truth. Polishing is only and aesthetic treatment meant only to remove the extrinsic staining on the teeth. Polishing does not qualify as a therapeutic service, meaning that it doesn’t help treat disease or sustain health.

Selective polishing indicates that we as dental professionals are evaluating the present stain and choosing appropriate polish grit to remove the stain efficiently without injuring the tooth structure. This requires us to be educated on what abrasive particles and other additives are found in the polish is available to us.

Next time we reaching for the coarse paste, knowing that it will take anything off (including tooth structure,) we can use the time that saved us to read the manufacturer's instructions that come with our prophy paste.

Not all patients are in need of this aesthetic service but all seem to expect it. I choose not to polish the same day that I debride (SRP) as to not irritate the tissue (polish past gingivitis is a thing!) and I cannot count how many times my patients express distress at the thought of not getting polished. I have found that when I preface the scaling and root debridement with EDUCATION the distress is greatly reduced.  It also gives them an incentive to come back for their re-eval when their tissue have healed to be polished. What kinds of things can you do in your practice to educate your patients?

Trish Jones RDH, BSDH shared some valuable information in her article, Selective Polishing: An Approach to Comprehensive Polishing. “As the dental health-care provider, it is important to let the patient know the thought process behind selective polishing prior to performing the procedure. This in turn enhances the patient’s experience, adding value to the procedure. This is called pre-framing, a term used in the psychology of behavioral science. In this case, pre-framing involves explaining the procedure to the patient before and after it is completed to ensure they have a complete understanding. For example, when the patient is in the chair, the hygienist can let the patient know the purpose of abrasive type pastes and cleansing pastes. These include why the paste is splatter-free, why it rinses very quickly and minimizes the gritty feel (flash rinsing), and how the product can remove stain so a beautiful smile can be maintained. Patient concerns can also be addressed at this time.”

She went on to give great examples of how to approach that conversation:

“In order to preserve the investment in your smile, we are going to use a specialized paste that not only removes stain, but also polishes the teeth to a lustrous shine.”

“Research has now shown us . . .”

“Because I know white teeth are important to you . . .”

“I know you love the feeling of smooth teeth and fresh breath . . .”

“So we can reduce the gritty feeling when I am done . . .”

“Because you told me your teeth are sensitive, I have a special technique . . .”

“Because I noticed this about your smile, I am implementing a procedure and have chosen a product just for you that will ...”

As we educate our patients they feel that we care about them. So next time, think twice before offering that delicious grape flavored coarse paste to the lady with light stain and recession. Instead, explain the benefits of that mild mint desensitizing polish that will help with her hypersensitivity. She and her teeth will be grateful.

Holiday Dental Gift Ideas

November is already half way over. Can you believe it? Now is the time to start thinking all things Holiday, especially gifts for your dentist, office manager, dental assistant, or even your dental hygiene school bestie. 

We've searched all over for some of the most unique dental gifts for any dental enthusiast. 

Dental Tie Clip

If you dentist or office manager wears a tie regularly, this is the perfect dental accessory.

Tooth Pin

Enamel pins are a perfect way to jazz up a white lab coat. Plus, they can be wiped down at the end of a long SRP day.

Tooth Blanket

If your dentist is a big movie or baseball fan, wrap this gift with a Redbox gift certificate and some movie treats, or baseball tickets to a local team.

Tooth Bag

Fill this bag with their favorite treats, or wrap it with a gift certificate to their favorite store or to your mall.

Tooth Magnets

So cute tooth magnets (or could also be pins) from Lilac Paper Company. This is a perfect stocking stuffer if you have a dental professional in your family.

Dentalopoly

Why not get this dental game for office team building? Based of Monopoly, this game of full of dental humor, plus the proceeds help support free dental clinics.

Hopefully this list of dental gifts can help alleviate some holiday shopping stress as December gets closer! We are always looking for new gift ideas for the dental people in our lives! What are your dental gift ideas this year? Let us know!

How To Use The New Code D4346

Code Number:

D4346

CDT Nomenclature:

Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation.

Description:

The removal of plaque, calculus and stains from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. Should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures

Facts/When To Bill:

• D4346 is Therapeutic (Not preventive like 1110.)

• Not age or dentition base (can be done on children, consider ortho patients diagnosis).

• Full mouth procedure (not billed in quadrants like 4341/2).

• Available to start billing January, 2017 (It may take a few months for insurance to recognize payment).

• Generalized=30% of the mouth must have generalized moderate OR severe gingivitis. Not based on the amount of calculus.

When NOT To Bill:

1. If you have localized moderate-severe gingivitis the code to use is still D1110.

2. If you have generalized slight gingivitis use the code D1110.

3. If periodontitis is present on 1+ teeth use D4241/2.

What Treatment Is Next:

“The dentist is in the best position to determine when the patient can assume a regular preventive regimen that includes oral prophylaxis.” -ADA

Interpretation- Determine with the dentist when the patient should be seen next.

Options include:

1- Perform the initial D4346 procedure then wait 2-6 weeks for a re-eval and at the re-eval do a D1110 prophy. Then reappoint for the regular maintenance care from 4-6 months.

2- Perform the initial D4346 procedure then reappoint in 4-6 months for the regular maintenance care.

Set up a protocol on what is best for your office and patients with the dentist.

Insurance Coverage:

Unknown at this time. Since it is a therapeutic procedure, it may be covered just like the other 4341/2 codes at a percent with a deductible.

We shouldn’t base treatment on insurance coverage. If the patient has generalized moderate-severe gingivitis then this code should be billed.

Evidence of the disease should be documented with full mouth probe depths including bleeding points and the diagnosis. Consider sending intra-oral photos as well. You may have to update your protocol on when to probe children/adolecense. In many office it is at the age of 18 but since this code is not age specific it may be necessary on our younger patients. 

Verbiage With The Patient:

We (with your assessment and the dentist's diagnosis) found today that you (or your child) have generalized moderate/severe gingivitis. The good news is that this is reversible. I will give you a few actions at home you need to be doing. I will also need to do a therapy on your gums to get the healing process started today.

NOTE: It would be helpful to show the patient evidence of the disease by taking intra-oral photos and their probe depths with bleeding points.

Treatment Planning:

• D1330 Perform oral hygiene education as per the patient's needs.

• D4346 Perform the scaling in presence of gingivitis therapy.

• D9630 Consider chlorhexidine rinse as needed.

References:

The above information was summarized from the ADA publication below. http://www.ada.org/~/media/ADA/Publications/Files/D4346EducationGuidelines_Final2016May17.pdf?la=en

If you want more information I would recommend the following resource as well.

http://dentalcodeology.com/

Yoga For the Dental Hygienist

If you've ever come home from a day of hygiene feeling "stiff"  raise your hand!   

Willi went form having hygiene work related injuries to being able to joyfully handle hours and hours of hygiene a week.  She attributes much of her stamina in hygiene to specific yoga exercise.  You can read more about her experience here. 

We suggest bookmarking this video and doing these specific yoga exercise to kick off your hygiene day or as a relaxing way to unwind.