New Dental Terminology You Need to Know
Dentistry is always adapting and changing. Now that I have lots of experience under my belt it is fun to say, “when I first started working _____________was a thing.” I find it fascinating when seasoned hygienists tell me that they once didn’t wear gloves for procedures or that they had to wear dresses to work/ school. It makes me grateful for the progress that we have made. Therefore I made a short list of some of the terminology updates that we have recently seen. Just as we have changed plaque to biofilm, and pyorrhea to periodontitis we will adapt to this terminology as well. What changes have you seen over the years?
1 https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.16-06422 https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.17-0733Biolase Epic Hygiene Laser and Laser Bacteria Reduction
I’m not going to lie. When Biolase reached out to us about using their Epic Hygiene Laser and learning more about the technology, we were thrilled. This was a dream for us! I’ve been laser certified for years, and have used the laser on and off over my career as a dental hygienist. I even did my research poster on lasers and periodontal disease back when I was a 2nd year dental hygiene student years ago. Let’s just say the poster didn’t win anything since there wasn’t much to be found about lasers in dentistry, but now after the years, there has been such an improvement in how often they are used, how they work, and how seamlessly we as dental hygienists can integrate and utilize them every day and with every patient. Laser bacteria reduction is one of those functions that we can utilize as dental hygienists to increase health in most of our patients, to increase the standard of care.
Laser Bacteria Reduction (LBR) is so handy for us as RDHs as it takes only 5 minutes to complete, which we all know a hygiene appointment can be tight for time. It can be used on patients with localized to generalized gingivitis to help increase healing and decrease pocketing in these inflamed and infected areas. Along with home care, you’ll find better results with your patients that have inflammation.
A couple key points about LBR:
1. The Biolase Epic Hygiene Laser is the only hygiene-only device that has FDA clearance to perform this procedure. If you decide to start using this procedure, make sure you’re using the right unit, and that it has preset settings specific to the safe operation of Laser Bacterial Reduction, like Epic Hygiene does.
2. LBR can be used preprocedurally to help decrease aerosols compared to traditional ultrasonic methods, help prevent cross contamination of bacteria, and improve healing results in patients.
3. Each state or province has different laws when it comes to lasers, what can be performed, and what dental hygienists can do with lasers. Make sure you check with your state professional association and your practice act before using a laser to make sure you legally can!
If you’re interested in learning a bit more about lasers, what they can do, and how they can help your dental hygiene practice, definitely check out the new Biolase Hygiene Academy website for all the latest information. Biolase has launched a Hygiene Academy to bring together a community of like-minded hygienists sharing tips and tricks! Come “Spill the Tea” and join me on the forums!
Simple Ways to Make it Through the Week
How are you feeling this week. No really. Like how are you feeling? If you’re like me, you’re probably a bit burnt out. For some reason, the toll of the last almost 2 years has been catching up, and trying to stay on top of all the things is tricky! Patients are overdue and presenting with more calculus or disease than ever before (not to mention their stress levels and change in daily schedules has completely switched up their home care routines). Offices are either busy busy busy or completely dead with last minute cancellations due to illness and exposures. Public schools are going back and forth from in person learning to online learning, which we know as educated moms get the brunt of the homework help. It’s a lot! We as dental hygienists aren’t the only ones feeling the impact of all the changes, but there are simple things we CAN do during the day to make our hygiene day a little bit better.
Take a CE Course. I know, I know. Sometimes the last thing you need is something else dental related on your plate. But, learning something new could help inspire you to change up how you practice or help your next patient you see in your chair. I have loved learning about airway the past few years. The best part of learning about airway was 1 pedo patient that was having a hard time with sleep and learning at school and the caregiver was out of options as they’ve tested him for everything. However, after a simple airway test through our recommendation, they found out that he was having sleep apnea at night, got his tonsils removed, had ortho and oral myology, and was now thriving in school. With some simple suggestions and referrals that went along with my personal research, it was able to change someone's life. That definitely makes being a dental hygienist worth it.
Take it one day at a time. I’ve noticed these last few years that the more I look into the future, see how much I can’t plan for and control, the more anxious I get. So, taking it one day at a time and planning on accomplishing 1 thing a day instead of 10 has helped a lot. Have I not accomplished as much as I’d like? Yes. But, practicing this self care has been helpful for my mind.
Get a new pair of scrubs or lab jacket. Nothing is better than a new something to wear, even if it's just to work. It’s always nice to have something new and fresh to wear.
Get some sleep. Make sure you turn off your phone at a decent hour to make sure you can get some sleep. Heck, maybe make a charging station outside of your bedroom to keep the scrolling temptation at bay in the evening. Getting a great amount of rest will help recharge the batteries for the next clinical day.
You got this, RDH! This is as crazy time of life with lots of changes, but we can get through this together, one day at a time.
What are you doing to get through each day as a dental hygienist?
Simple Dental Implant Tips for the RDH
With dental implants becoming more common in our world, you’ll definitely come across one (or hundreds) in your office each week. Even though they are becoming more common placed within our patient base, that doesn’t mean they are the easiest thing to assess and treat in our clinical chair. And now, with full mouth reconstruction with implants and having full arches full of implants, we as dental hygienists need to feel confident treating and educating this patient population. Here are a few helpful tips to follow as you enter into the implant world.
The neck is a perfect circle, while natural teeth are not. Lucky for us, we can critically think through adaption and angulation when it comes to a different shape. When you come to these implants, make sure you’re adapting differently, and usually more than you would a normal tooth because of the shape.
Different instruments are needed. Implants are made of titanium, which is a softer metal than our stainless steel instruments. Using stainless steel can potentially scratch the implant, which allows more surface area on a once smooth surface and attracts bacteria and biofilm. And we all know, more biofilm is not good news. Let’s keep these implants as smooth as possible, and use implant specific instruments and air powder polishing units to keep them bacteria free.
Stay away from plastic instruments. Research shows that the plastic from these instruments or shielded implant ultrasonic tips is flaking off and staying around the implant, causing irritation in the tissue. It has also shown that some threads from floss has been getting caught around implants, which causes irritation as well. Better keep those very fibrous flosses, the ones that I personally really like for natural teeth, away from implants.
When it doubt, refer it out. Implants can be finicky. Every year, they are changing their designs, materials, how they’re placed, etc. If you’re concerned about a patient’s implant, if the gingiva is inflamed around it, if there’s an open contact between the implant crown and the natural teeth, you’ll want to jump on those before it gets too late. Refer the implant back to whoever placed it to have it assessed, fixed, the crown replaced, whatever is needed to keep it back in health. The last thing we want is us as professions watch an implant get infected or mobile.
Don’t forget to stage and grade each implant. With the “new” AAP classifications, there’s a section that includes periimplantitis , and how to classify each implant to make sure they’re staying in a healthy stage. Make sure you keep your eye out for a new and improved AAP cheat sheet to download and keep in your operatory to help stage and grade not only implant patients, but any patient.
Home care recommendations. One of the most important parts of implant maintenance? Great home care! Of course. Instead of traditional floss, recommend interproximal brushes to help work under the crown and to get around the abutment as much as possible. We like the Tepe Interproximal brushes as they can be custom fit to your patient’s gingiva and implants, and can easily be purchased online.
Do you see implants in your office? Does your dentist place them? What is your protocol when it comes to maintaining dental implants?
Extrinsic Stain Removal Tips and Tricks
Last week, I had a patient come into my operatory and before sitting down in the patient chair, turned around and looked me in the eyes. She said “I’ve noticed a bit of black stain on my teeth that I’ve never had off before. I’m excited to have it all off and them looking white again.” I instantly froze. Where did this black stain come from? How bad was it? How tenacious was it? Would I be able to get it off in the short time frame I had during the appointment with the instruments I had? Would the patient be happy with the results with her high expectations? It instantly brought back memories of when I was a brand new dental hygienist and I had an extremely difficult, heavy stain patient and I was definitely in over my head. I did as much as I could in the hour appointment, then sent the patient on his way. 6 months later, he came back and was in my chair. He must not have remembered me, because after this second appointment was completed, he immediately stood up to check out his teeth in the mirror hanging in the corner of the operatory. After a few seconds of an up close look, he turned around and said “this was much better than last time.” I was sweating that entire appointment.
My patient last week laid down in the chair, put in her AirPods, and was ready to have the stain removed. It was definitely a tricky case with 6 months of home brewed raspberry kombucha stain, but I felt more comfortable than I did so many years ago. Here are a few helpful tips I’ve learned throughout the year with stain removal.
Triple Bend Ultrasonic Insert. Stain is above the gingival margin, on the lingual, and usually on enamel. Since it’s on this harder surface, don’t be shy to use a triple bend tip with a high power. If the stain is on the dentin, keep your power a bit lower as the high power can make the tooth pretty sensitive after treatment.
Air Powder Polishing. Of course, this is the gold standard when it comes to removing stains. We love using the air powder polisher as it’s a gentle and quick way for removal, but with the newer guidelines of reducing aerosol production in operatories, we haven’t been using it as much. Hopefully, we can go back to using it more regularly soon! Another big part of using the APP is management of the powder. Check out this video to help keep powder out of your patient’s face, eyes, and nose, and make the procedure a bit more comfortable for both you and your patient.
Vera Advanced Bright Prophy Paste. Have you found that sometimes prophy paste works great on one patient, and then doesn’t budge the stain with the next? It’s so hard to gauge if prophy paste will actually be an effective treatment option. The best one we’ve used is the Vera Advanced Bright. The active ingredient is baking soda, which when combined with water, other minerals, and the small amount of abrasiveness tends to work a bit better on stain. I keep a box in my op, and pull them out on patients with stain instead of using them on everyone. Regularly I’ll polish first with this paste to see how much or how little stain will be removed, and then move onto a different treatment based on how much stain is left over.
Recommend 3 month recalls instead of every 6. I tell my patients that come in for appointments with heavy stain and they know where it’s coming from, like from diet, to come in more regularly. They don’t have to have an exam and radiographs at that appointment, but use it as an in between cosmetic prophy to keep the stain at bay. Do you do Zoom whitening at your office? You could totally add that one and complete both treatments at that 1 appointment to remove the stain and whiten up the teeth in general.
Even though this heavy stained patient threw me a bit off last week, I definitely know it isn’t the last patient I’ll have with this same situation.
What do you use for stain removal with your patients?
Aerosol Suppression with Aerosol Assist
Aerosols, aerosols, aerosols. It has been the buzz word for the last two years in dentistry as everyone has been looking for solutions to suppression of those microbe containing aerosols. One company created a product called The Aersosol Assist as a solution to the problem. It has many features including:
Aersosol Reduction with a 35mm wide opening to the HVE
Autoclavable and easy to clean
Backflow prevention
One size fits all.
Watch our latest short video below to see it in action and visit https://www.aerosolassist.com/for more information on ordering.
Hygiene Edge's Favorite Things 2021
Anyone else having a year? It’s been a bit crazy both in the operatory and out with life, patients, etc. Being a dental hygienist doesn’t only happen from 8-5 in your office. Dental hygiene is definitely a full life career. We think about, take, and organize CE credits, we help keep our profession growing, we plan and focus on nutrition to keep our bodies going, we stretch and exercise to keep our body working to serve patients, we’re helping and teaching our families, we volunteer in our communities, and so much more. Dental Hygienists are one of the most amazing groups of people, and we’re so lucky to work with, hang out with, and associate with you each day! Let’s celebrate by chatting about some of our favorite products this year that made our lives easier.
CE Zoom YTP Membership- Looking for an easy way to find CE classes and then track your credits after? Look no further than CE Zoom! This is a handy way to have access to world renown speakers and get all your credits for renewal in your state. Plus, we speak with them every quarter, so hopefully you’ll be able to attend one of the upcoming classes we present!
ADHA Membership- Honestly, one of the best things we’ve done for our careers is being a member of the American Dental Hygienists’ Association. We’ve met so many amazing dental hygienists through the association, grown in different leadership positions, been involved in legislative processes and helped change our profession right here in our home state and in the USA. We totally know no organization is perfect (heck- we’re people and many are volunteering their time to keep it running!), but being together in an organized and collective group makes such a difference, especially in a legislative and government setting.
Stoggles- If you haven’t seen these safety glasses, you need to get yourself a pair. We ordered some when they were on Kickstarter and saw it as an answer to our safety goggle prayers that don’t scratch easily, don’t fog, and weren’t purchased at a Home Depot. They come in several colors and shapes to fit your face, and we love having them for when we don’t need loupes, like during radiographs, giving injections, etc. They’re comfortable, look great, and are light on your face.
G2G Protein Bars- We have these all over the place- at our house, school, office. They’re local to us in Utah, and taste great. They’re perfect for a quick lunch (because we all know we miss them on busy days), they aren’t dry, and are kept in the fridge so they’re definitely more fresh than a shelf stable bar. Plus the different flavors can’t be beat.
Zirc Mirrors- We’re going to be honest, we didn’t think much about our mirrors until we started using Zirc Mirrors. Once you get them in your hands and compare them to your current mirror, you’ll totally see the difference in how bright the teeth look, how light the mirrors are, and how much more clear they are. Just like any mirror, they can get scratched, so you’ll want to keep them in a cassette to prevent wear during sterilization.
Oral B iO- We’ve been using this brush for over a year and have really loved all the technology changes in this brush. It is so much quieter than other Oral B electric brushes, the pressure sensor on the handle is life changing, and the timer screen right on the handle is very handy to keep an eye on the length of how long you or your patient is brushing. Definitely reach out to your Oral B Rep to give you a bit more information about this brush, and it’s time to make the switch if you’re still using the Genius.
These have been a few of our favorite things this year! What would be on your list that has made your hygiene life a bit easier?
Make sure you attend our Instagram Live Event on Monday, December 6th! We’ll be talking about these favorite things, and giving them all away to our friends!
5 Helpful Tips to Make the Ultrasonic Use Comfortable for You and the Patient
This last 18 months has been a whirlwind, right? From closing offices to preventative treatments, to patients delaying treatments for over a year, to people’s home care routines completely changing due to their life routines changing. With all these changes, have you noticed your patients are presenting with much more inflammation, calculus, and stain? You may or may not be using the ultrasonic now, but I’m sure you have plenty of patients that could benefit from using it. If you have decided to use it on occasion for these overdue patients, here are a few helpful tips to make it a bit more comfortable for both the patient and for you.
1. Instrument Selection
There are several different design characteristics of an ultrasonic insert that can affect the use of the instrument. First off, the diameter, when you’re working on cementum and there aren't large deposits, the thinnest tip will be the best and most comfortable for your patient. A thick tip on biofilm removal will cause tooth sensitivity due to how much power the instrument is putting out and putting into the tooth surface. It will also help preserve the tooth surface but not using a higher power that minimal calculus doesn’t need. Once you’ve removed the moderate to heavy calculus with the thicker ultrasonic insert, switch tips to something thinner to get the fine calculus, biofilm and diseased epithelium removed.
Second, the cross section. Use a circle cross section instead of a diamond if there isn’t heavy calculus. When there’s a diamond shape, all the power goes into the corners of the shape, and transfers the power to the tooth and calculus. Use the diamond cross section tips on heavy deposits and not straight on the tooth.
2. Check out the tip for wear.
If your tip is 50% worn down, they need to be replaced. At that point, they’re no longer effective to remove anything. You’ll find soon that you’ll have to instrument the teeth longer or find yourself putting more pressure with the ultrasonic, which can in turn make the teeth sensitive.
3. Manage their expectations.
Before the procedure even begins, let the patient know what they’ll expect, especially if it is the first time they’ve experienced the ultrasonic. Let them know about the water, suction, pressure they could feel, etc. Let them know that if there is any pain, have them give feedback right away.
4. Don’t shy away from topical anesthesia.
There are lots of great options on the market today, and they’re easy and quick to apply. It’s a great option for localized inflammation and sensitivity in the gingiva. If the teeth or roots are sensitive, you’ll want to explore other options for local anesthesia. Get feedback from your patient to see how to proceed.
5. Visit Curved Tips.
Left and right ultrasonic tips are great for deeper pockets. They curve and hug the tooth anatomy, which can be more comfortable for the patient. We’ll have some videos coming up about these tips, how to use them, where to use them, and how they can be more comfortable for your patient and more ergonomic for you.
Next time you have a patient that you need to use the ultrasonic on, make sure you manage the appointment and their pain by reviewing these simple steps. You got this!
Dental Fads That Need to Go
We all know that fads come and go in our lives. Doc Martins? Scrunchies? Certain clothing items? We’ve all them and loved them, the dropped them so fast. Dentistry is no difference. We are constantly having new “findings” and “research” presented from social media, and patients will be asking about them in your operatory. We’ll break down a few current dental trends that your patients may have tried or will be asking you about.
DIY Braces
There are several ways that patients can perform an at home orthodontic treatment. One way is wrapping an elastic, string, or piece of floss around their two anterior teeth, 8 and 9, if they have a diastema. There are so many YouTube videos on this method. And it can work for a bit! The teeth will move, but will probably move back because there’s a space there for a reason. There’s also a high chance of bacteria being caught around the at home aid, causing inflection in the gingiva and bone. Another way is to make your own Invisalign trays with plastic from the craft store. You warm up the plastic beads, make a U shaped that’s a similar size to your teeth, and bite into the plastic when it’s not super hot. Then, before it fully sets, you’ll remove the tray and adjust the teeth that you want to move. And this works too! Not recommended however, because the plastic isn’t medical grade and probably it’s smart to be putting into your mouth during the day or night and constantly sucking on it.
Tooth Filing
You may have seen this on Tik Tok, but you can use a nile file to shape your teeth. Have 8 and 9 that are slightly different lengths? You can use a nail file from the drug store to make them shorter. Nail files and the files we use in the dental office are very similar (we usually use a smaller/less course grit however), and you can totally removal enamel with them. But, definitely not recommended since removal of the hard outer shell of the tooth makes it susceptible to sensitivity, decay, pain and more. Make sure you’re keeping an eye on the insial edges of your patients that are on social media (aka everyone). You never know who will be removing tooth structure for a quick cosmetic fix.
Tooth Gems
These have come and go over time, especially as celebraties like to try out new jewelry for the red carpet. These metal, diamond, or jeweled gems can be purchased anywhere (we actually bought ourselves a few different ones to try from Ali Express), and come with etch and bond to adhere it to the tooth. This definitely can be damaging to the tooth, since a patient with no real dental knowledge can be placing these. We’ve even seen some hair and nail salons adversing this service of them adhering a small decal to an anterior tooth.
What dental trends have you been seeing and what ones have your patients been asking out?