Fixing Overlap on Your Bitewing
I regularly would tell my students in the radiology lab and even in clinic that “radiology is an art, not a science”. Do you agree with this? Seeing students try to understand the concepts of radiology and creating a 2D image of a 3D thing is tricky, and does need practice.
We know that there is so much science involved with radiology, when it comes to exposure, KVP, waves, etc. But, there is an element of art along with it- perfecting angles, sensor placement, patient comfort, and education to have the perfect exposure of a bitewing or periapical.
One of the trickiest parts of having the perfect bitewing is definitely horizontal angulation. Knowing where to place the tubehead is critical to prevent overlap. We know that this angle is such an important part of a bitewing. Without it, we will end up having overlapping contacts and overlapping teeth that cover the height of the bone and ultimately an undiagnosed radiograph.
How can we help prevent these diagnosed radiographs from happening? Practice! With ALARA, it can definitely be hard to practice radiology on our patients, but utilizing a manikin like the Kilgore Radiology Manikin is a game changer. Having this will allow you, your students, or your coworkers to be able to practice their techniques, feel confident in their radiology skills, and to make sure we understand the techniques and tricks when it comes to taking an x ray.
To learn more about this manikin, but also some helpful tips when it comes to taking proper bitewings, both molar and premolar images, definitely check out this video from us at Hygiene Edge.
xoxo Melia, RDH
A huge thank you to Kilgore for supporting our educational efforts here at Hygiene Edge! Their goals definitely align with ours- helping clinicians feel empowered to give the best possible care to our patients and communities.
Amber Teething Necklaces: What the RDH Needs to Know.
Picture this. Your 10 am patient slumps down in your op chair, tired eyes and feeling overwhelmed. After some questioning, you get to the bottom of your patient’s body language. They have a teething baby! Nothing is harder than being over exhausted, and having a teething baby is no help when it comes to sleepful nights. Your patient looks at you and asks “What do you think about Amber Teething Necklaces?”. They are desperate to try anything to help their little one and in turn help their family. How do you answer them?
For me, I love to follow up any question that I get from patients about the current research that is being presented on a topic. Starting your response as “the research shows” or “the research now shows” is a great For this subject of amber helping with pain, there isn’t great research to support the claim. In theory, amber once warmed up against skin releases succinic acid, a compound that is believed to have pain-relieving and anti-inflammatory properties. Then once, it is released with the warm body, it is then absorbed through the skin and provides the relief. Another aspect of amber is the believed calming and soothing capabilities. When the amber is warmed from the body, energy from the amber is released and has a calming effect on the child and body, potentially reducing fussiness and irritability. Unfortunately, there is no current research on amber when it comes to energy and calmness.
Unfortunately, there is research and evidence on the harm these necklaces can have on our tiny patients. First, since it is something worn around the neck, there is always a chance of trauma or breathing issues. Second, they usually are a strand of amber beads on a string, which pose a choking or ingestion hazard if the string ends up breaking. Since the patients using and wearing these necklaces are usually 6 months-2 years old, this is the most common age for strangulation or choking on anything, let alone a necklace worn both during the day and at night.
If you have a patient ask about these necklaces, it might be good to have some suggestions about what else can work for their child instead.
Questions like these are a great reminder to keep up with the latest research in health and dentistry, and knowing how to look and read research. I totally get it- having time to read and research isn’t always feasible, but knowing how to look at studies, see who is sponsoring them, and knowing the outcomes is so helpful to our patients and shows how much of dentistry and dental hygiene treatments are science and research based. The next time you have a patient ask you about a fad or a treatment, let them know what the latest research shows, or get back to them with some research to allow them to make their best informed decision and care.
Have you had patients or family members try out amber teething necklaces? What was their opinion?
xoxo, Melia Lewis, MEd, RDH
Sharpening Stone 101- Part 2 (Updated 2023)
This is part 2 of our series called Sharpening Stone 101. Find part 1 here!
Sharpening Stone Shapes
There are several shapes of stones you can purchase for your office and instruments. And most people learn one type and go with it for their entire career. I’m part of it! I learned about regular rectangle stones in school and honestly they are still my favorite, with the update of really liking a diamond card with the same shape. Here are the main shapes you’ll see in your distributor catalog:
Cone Shape- Great for removing wire edges, good for concave edges, tapers to fit different instrument shapes.
Wedge- Perfect for the face and the edges making it an all around stone.
Rectangle- Perfect for all hand instruments with straight cutting edges, which means most of our hygiene instruments. Scoops and periostial elevators aren’t the best candidates for a rectangular stone.
Sludge Layer
The sludge layer is a thin grey layer that appears on your sharpening stone as you sharpen. It’s a good thing! It it small amounts of metal being removed from the instrument, making a new, sharp edge on your instrument. If you have a build up on the sludge layer, wipe it off with a 2x2 gauze to keep the area visual to see if you’re using the right angle.
Hand piece mounted stone
Using a special sharpening stone that attaches to a hand piece might be the perfect solution to your sharpening needs, especially if your instruments are currently dull or misshaped, if you see double hygiene and only have a few minutes to sharpen, or if you have several hygienists in your office and go through instruments quickly.
There are some disadvantages of using this technique. First, it’s not very conservative due to how fast the bur is moving and can remove more of the instrument than with traditional hand sharpening. Second, if the hand piece is moving too fast, it can make the instrument hot and warp the shape slightly. We recommend practicing a few times on old instruments to get the hang of the power driven stone the first couple times to get then hang of it.
File Sharpening
Since files have at least 3 cutting edges on their face, a special sharpening stone called a tanged file is needed to sharpen. It's highly recommended to use loupes and a light as you sharpen your files. Check out the video to see the tanged file technique.
xoxo, Melia
Sharpening Stone 101- Part 1
Ever opened your dental supply catalog and peeked at all the different sharpening stones? There are hundreds of combinations of sizes, styles, amount of abrasiveness, and price. Here on Hygiene Edge, we are breaking down this daunting task of getting a new stone to every day language.
Different Stones
Arkansas Stone- This is a natural abrasive stone that has been used since dental hygiene was invented 100 years ago. It was one of the best for dental instruments for years due to how fine the abrasive powder particle size is. It’s perfect to have such a fine grit because our instruments are so tiny. They also require some sort of lubrication while sharpening.
Ceramic- These stones are made of artificial materials. Since they are man made, they are “newer” on the market compared to the Arkansas stone. They do not require oil or water during sharpening, but it’s a good idea to soak your stone first to easily clean off shavings that accumulate.
India Stone-This stone has a large abrasiveness, which means it will take away more of your dental instrument then other stones. It is perfect for deburring or fixing the shape of an instrument. They are usually orange or brown and are more course than an Arkansas. If you do have an extremely dull instrument, start with India and then finish with Arkansas or Ceramic.
Oiling- Yes or No?
Using oil for lubrication on your sharpening stone tends to be an older technique as it has been used with traditional sharpening stones. Most stones that are used today do not require oil since most people buy ceramic stones. There are several disadvantages to using oil. First, it tends to make the stone very slippery which is great and dissipating heat, but makes sharpening go a lot slower since the instrument can just slide right over the stone. It also can suspend metal shavings from the instrument and cause scratches and defects in your instrument as you sharpen. It also can cause problems with infection control due to handling the oil container if you are sharpening instruments in the middle of an appointment and can make clean up a bit more messy.
Water-Yes or No?
Instead of using oil, water is the most common form of lubrication. Though man made stones don’t require water as a lubricant, it can prevent silver marks forming on your stone and therefore makes clean up easier.
This is part 1 of Sharpening 101. Next week, we'll discuss sharpening stone shapes, other methods to sharpen hygiene instruments and how to sharpen files!
Have any sharpening questions? Let us know in the comments!
What To Ask before Temping as a Dental Hygienist
I’ve been temping each week for the last few months. I’ve always filled in locally here and there during school breaks and when it worked out with my schedule. However, working each week in a new office has been a great experience to see what is out in my area on treatments, spaces, etc, but also learn new skills, softwares, and conversations. As I’ve been navigating this temping world (Full time temps are the real MVP), I’ve picked up a few things that I like to ask before even working there the first day to make the clinical day run a bit smoother. Here is my list of things to ask:
If they have overhead lights. Now, many new offices or rebuilds are taking out their overhead dental lights since so many providers wear a loupe and light combo. However, some still do not. If you’re temping, you’ll definitely want to know if there isn’t an overhead light available if relying on it. As a side note- if you’re thinking of temping or looking for a new job, it might be a good time to look into purchasing a headlamp even if you don’t want to wear loupes. We reviewed an Amazon light if that’s an option you’re thinking about.
What software they use. Each practice uses their own practice management software and usually loves it. Knowing before what you’re getting into will either take away the unknown anxiety of what you’re getting yourself into by confirming you already know it, or giving you time to do a bit of research on how to do simple tasks before your temp day. Bring a little notebook to write some notes as they give you directions through the software morning of.
What color they wear. Honestly, you’ll probably be okay wearing black to each temp job since so many offices wear black every day. In my experience of temping, only 1 office in the last 4 months has not worn black daily. However, some do other colors based on their brand colors and some wear specific colors each day of the week. You definitely don’t have to go out and purchase a scrub to match, but if you have the color on hand, it’s great to be part of the team by something visible like color.
The address of the office. I know that seems pretty straightforward, but actually pay attention to the address before the morning of. I worked at an office a few weeks ago that was in a new part of town and really had nothing around it. So, me planning on running out to grab some lunch wasn’t feasible, since there wasn’t anything close! If you are planning on grabbing lunch out, do a quick Map search beforehand to make sure there are options for you.
You require a full day pay. Maybe this isn’t a question, but more of a statement to let them know your expectations. I’ve had a few temp days recently that the day has “fallen apart” and my hours as the fill in have been cut. Unfortunately, I didn’t have that conversation beforehand and was planning on a full day of pay, when in actuality, I ended up getting only a few hours or a complete day off. If that conversation makes you uncomfortable (and honestly, money conversations are the worst), consider temping through an agency or an online company that sets a contract and pays you for your set hours, no matter how many hours you work.
Do you temp in your area? What are you seeing/experiencing as you temp?
Xoxo, Melia @meliardh
Rubber Cup Polishing Tips with Ultradent
In the office I work at clinically, we run 4 chairs of hygiene during the week. A few weeks ago, one of the ops were having some hand piece/cord issues and for some reason, polishing wasn’t happening anymore. With the difficulties of having to switch out all the cording and figuring out next steps with the unit, the office decided to try a cordless handpiece instead. And honestly, having one in an office is a game changer! They are light, comfortable, have the power behind them like a corded hand piece, and there isn’t cord drag like a traditional hand piece. Now, having a cordless hand piece is definitely talked about throughout the office, and ends up in other ops when that room isn’t in use.
I’ve also used a cordless hand piece in a nontraditional setting while volunteering at nursing homes in Utah. This is so helpful when patients have limited mobility or can’t sit in a traditional dental chair and lean all the day back. It has a saver for both my neck and back, plus be able to perform the best care possible for these populations who need it the most.
That’s why I was so excited when Ultradent released their own, just in time for National Dental Hygiene Month! The perfect addition to your operatory to celebrate the month. To learn more about helpful tips when it comes to polishing, check out our latest video:
I know you’re going to love a cordless hand piece in your practice! To learn more about the polisher and how to get your own, check out the Ultradent website.
xoxo, Melia, RDH
Furcations with Kilgore
I remember when I was a brand new instructor, one of my first days of being back to school I was asked to teach a group of students about instrumenting a furcation. These students have never even seen or felt a furcation before, so explaining something that was completely foreign plus by working in a small area completely blind underneath the gingiva was so hard for me. I definitely felt overwhelmed and did not explain to them as well as I should have. I wish I had the PER 1027 model by Kilgore to explain this difficult concept. The best part of teaching these subgingival concepts with this model is the translucent gingiva where you can actually see the anatomy, calculus, furcations, and bone levels. Even though we can’t see these in a natural mouth, being able to practice and visualize beforehand is key to have proper instrumentation when you can’t see subgingivally.
Another great feature about this model- it is completely customizable. Want different teeth to have calculus? Done. Want the tissues to be different colors, translucent or opaque? You can have that! Want the teeth to be able to be prepped for restorations? That can happen! It really is a helpful model for so many procedures that happen in the dental office.
To see this model in action and to learn more about how to instrument furcations, watch this video:
To learn more about the PER1027 Kilgore model, and all the Kilgore products, check out: www.kilgoreinternational.com
xoxo, Melia
Handheld Radiology Safety with Digidoc
When hand held radiograph units were introduced to the world, I’ll be the first to admit that I was a bit weary of them. We had been taught that we need to run into a completely separate room, stay behind a wall, and stay there until the radiation had been completed. Now, I’m supposed to stand in the room with the patient while holding the machine?! Definitely a tricky concept to change in my brain. However, as research has been published and these hand held devices, like the Digital Doc unit, are commonplace in dental offices all over the world, I have literally and figuratively gotten behind them. Even last week, I was in a different operatory than I normally work out of, and was asked to use the regular tube head. Making the switch back was tricky, and I honestly missed the hand held unit.
So, what is the difference between a wall mount and a handheld unit?
Design
Handheld Radiograph Unit: As the name says, a handheld radiograph unit is designed to be held by the dental professional during the exposure. It is smaller and more compact and offers greater portability and flexibility in positioning.
Tubehead Unit: A tubehead unit, on the other hand, is a stationary unit typically mounted on a wall or ceiling in a dental operatory. It consists of a tubehead housing that contains the X-ray tube and other necessary components. It is not portable and requires the patient to be positioned in front of the unit.
Beam Control:
Handheld Radiograph Unit: The handheld unit usually has a set range of exposure settings, which are pre-determined by the manufacturer. The operator activates the X-ray beam by pressing a button on the unit.
Tubehead Unit: The tubehead unit offers a wider range of exposure settings, allowing the dental professional to adjust the X-ray beam intensity, time, and other parameters based on the patient's needs. The controls, including the activation button, are typically located on the control panel of the unit outside of the opatory.
Positioning and Technique:
Handheld Radiograph Unit: With a handheld unit, you direct control over the positioning and angulation of the X-ray beam. They can move around the patient to obtain the desired angle and positioning for each radiograph, and the patient can move their body or head to get the proper angle. This is great for patients who have limited mobility or working in alternate settings.
Tubehead Unit: The tubehead unit requires the patient to be positioned in a specific location relative to the unit. The dental professional adjusts the position of the tubehead itself to align it with the desired anatomical area to be radiographed.
Both definitely have a place in dentistry and either will completely go away. We as professionals should know both methods to get the best images possible for our patients, with the minimal amount of retakes. That doesn't mean you might not have a preference on either method (I know I do), but knowing both will easily take you from one op to another and be able to expose the best possible radiographs.
A huge thank you to Digital Doc for supporting us at Hygiene Edge. To learn more about helpful tips on using a handheld unit, check out our latest video below.
Do you use a unit like this in your office?
xoxo, Melia
Dental Hygienist Spotlight with Amanda Trenerry
We have been so lucky enough to meet and get to know Amanda Trenerry, dental hygienist, entrepreneur, and mouth guard expert from Australia. Every time we chat to Amanda, we feel inspired and excited on what’s next in our profession, and how we as dental hygienist can be such a force for change in our patient’s lives. This a true testament of who she is since we usually have to meet in the middle of the night due to time zones! Learn a bit more about Amanda and what she’s doing now with her company Neomorph.
Where you went to school?
Mitcham Girls High School in South Australia, Australia.
Why did you get into dentistry?
I would love to say it was always a passion of mine yet in all honesty, I just fell into it!
In Australia, most high schools provide the opportunity to do “work experience”. This is as it sounds, you volunteer a week of your time to work at a place that interests you and see if it still appeals after you have spent some time there.
I had thought I wanted to be a Physical Education (PE) teacher working with special needs children. My sister had special needs and I loved the community that surrounded her. I also loved PE, so thought about combining the two and becoming a PE teacher for kids with special needs.
As part of this process, I had one week of work experience in a special needs school (loved it), and then the second was at my old primary school with a PE teacher. Unfortunately the PE teacher was unwell that week so as a backup they put me in the onsite dental clinic .
Despite the randomness of that, I really enjoyed it so did further work experience in a private dental practice. After 2 weeks there I was offered a dental assistant position. My boss became one of my greatest mentors. He encouraged travel and self-improvement. After a couple of years in this practice, I decided to follow his advice and worked /backpacked overseas for 2 years. When I returned home I decided to study again so applied for Dental Hygiene.
Favorite part of dental hygiene/being a dental hygienist:
Ultimately, it would be the relationships and trust I built with my patients and colleagues. I also really enjoyed the variety and autonomy.
As a veteran of over 30 years now, I have been fortunate to have worked in a variety of different specialties in both the Private and Public sectors. I was part of a team in the High Caries Unit at Adelaide Dental Hospital, I have worked in Prosthodontics, general practice and been a clinical tutor and presenter for both BOH & Dental Hygiene. While I enjoyed the variety, I really found my niche in Orthodontics and it’s here that led me on a quest to find a better mouthguard for our patients.
I suppose I could wrap that up by saying being a DH helped me discover my true calling!
What are you up to now?
I am the founder of the Neomorph Mouthguard – a triple-layered re-mouldable alternative to the dental-made mouthguard. Neomorph was designed to provide a similar custom fit, comfort and protection to that of the dental-made mouthguard yet with the convenience, price-point and mouldability of the over-the-counter “boil & bite”.
What inspired you to start something new and how did you start that?
Ultimately, it was the regular complaints I would hear from my patients about their mouth guards. I had always had a fundamental belief that we could improve moldable mouth guards and could never really understand why we hadn’t quite got there.
I tried to educate myself as much as possible on them, I read loads of research papers, papers on alternate materials, impact and other testing, standards, regulations and guidelines. I physically trialled a variety of professionally made mouthguards and every moldable mouthguard that I could find. I also did the fabricating mouthguards unit of the dental technicians' course. I gathered a "pros & cons" list for my ultimate mouthguard and then formulated a design.
Once I had a basic proof of concept (made in my kitchen), it became apparent that I would need to invest in formal research and prototyping.
Through a fortuitous discussion (at a funeral), I was introduced to the Medical Device Partnering Program (MDPP) at Flinders University in South Australia. The MDPP is an ideas incubator that offers 250 hours of grant assisted technical support with access to any speciality I needed, primarily researchers, polymer specialists, scientists, engineers and industry collaborators. This was a game-changer for me. The support I received through MDPP confirmed that the Neomorph Mouthguard could be the solution we were looking for and was worth pursuing. With that knowledge, I applied and received an Accelerating Commercialisation Grant through the Entrepreneurs Program (a co-contributor grant) to help further research, develop, and test Neomorph to ensure it performed as intended and was able to be manufactured on a commercial scale.
After 3+ years, many mistakes, failed trials and frustrations, we have now successfully realized our goal.
What would you want to tell a dental hygienist who is interested in starting their own company?
If you have a passion for something, follow it and see where it takes you. It doesn’t always mean that you need to heavily invest financially, but sometimes it does. If it does, look into what options are available to help you (there may be grants available) and more importantly grants often come with a mentor. Either way it will require dedication and perseverance. Speak to people that have inspired you as most of them will love your passion and be keen to help.
What I know about our profession is that we generally have a passion to do good things and the camaraderie that is forged from that can help you in amazing ways.
We all have a background of baggage which can hold us back, but just know that:
- You will never have all the answers but there are people that can help you with that
- There is no such thing as a stupid question - you don’t know what you don’t know…so ask away.
- You are only alone if you choose to be, there is often a mentor/helping hand closer than you think.
- Your family loves you and in most cases will have great intentions, but they will also want to protect you so they may not be your most supportive network.
- When you feel like everything is piling up, remember this phrase “How do you eat an elephant……one bite at a time!” (P.S it’s actually not OK to eat elephants!)
- There will always be “naysayers”. If you believe that what you’re doing has merit and is for the right reasons, then just accept that anything that has magnitude may attract “naysayers”. Listen, use whatever may be valuable to you, then file it wherever it belongs. This could be in a drawer or the bin. Don’t let it consume you – there is way too much to do!
Dental and Dental Hygiene Shadowing Tips
A few weeks ago, I showed up at my office and the front desk just came in to chat as I was setting up my room. After the morning niceties, she casually mentioned that someone who was applying to dental hygiene school would be there in 10 minutes to shadow me during the day. I’m not gonna lie. It took me a little bit off-guard as I was hurrying to set up my operatory for my first patient to now have someone coming in in the middle of an appointment to watch me during the day. I’m honestly not the biggest fan of shadowing days. I feel like I have to split my time between the shower and the patient, but I’ve had several people shadowing me during my career. I’ve picked up a couple helpful tips during that time as well. So, if you are looking into shadowy a dentist, dental hygienist, or a dental practice, here are a few things to do to make sure that you are the best shadow possible, you can learn the most, get the best experience, and the office will love you and ask you to come back.
1. Come dressed professionally and on time. I’ve had shadows show up in scrubs, jeans and a T-shirt, a suit, whatever. When you confirm the shadowing you could definitely ask to see if there’s something you could wear. But, black scrubs is a great option when it doubt. We want to make sure feel comfortable having an extra person there in the room especially when we’re talking about private things such as health concerns and issues, and dressing the part can help.
2. If you can, talk to the hygienist before hand. Some hygienists do not want you to talk during the appointment. Some absolutely love it, want to chat the entire time and will explain everything that’s happening. Have a conversation before hand so that you both are on the same page. I personally don’t love it when the shadow talks to me or especially talks to the patient during the entire appointment. I feel like the point of shadowing is not to chat and to get to know the patient, but to see what goes in to a dental hygienist day to see if hygiene is the career for you. But that’s just me! See what the RDH you’re shadowing prefers.
3. Keep questions until after the patient leaves. It’s so tempting to ask why the patient is bleeding so much or if something is normal. Pointing out abnormalities can definitely make patients anxious, especially in a space where they might not feel comfortable already. We love to talk about what we see, what we do, and treating disease. Keep these questionable questions until after the patient is out of the op.
4. Use this as a learning and growing experience, as well as a networking opportunity. It’s so easy to show up to a shadow day and leave with out a second thought. However, these offices you are going into could be your future place of work, a future letter of recommendation, or even a place you want to come be a patient! Be positive and helpful during these days to set yourself up for the future.
We love showing off what we do, how we help patients, and how dentistry can change a person’s life. We want you there in that conversation as well! We can definitely work together to make the shadowing day the most productive and pleasant experience for the both of us. Who knows? Maybe after you graduate, you will work or collaborate with the offices you shadowed at!
xoxo, Melia