TePe for Dental Professionals Blog

5 Routine Things We Do in the Dental Profession That Do Not Make Sense

As dental professionals, most of the work we do as a matter of routine may be considered insane. For example, we work in a small dark area all day; we are constantly told that patients would rather be other places; and we are members of one of the most feared professions. Nonetheless, Albert Einstein defined insanity as doing the same thing over and over and expecting different results. Can this definition be applicable to dentistry? Let’s take a look at five ways we are doing the same thing over and over in dentistry while expecting a different result each time:

1. Telling people to floss

By now, it would seem that everyone has heard about the flossing debacle that the Associated Press started, yet so many still haven’t heard the news that not every individual’s teeth would benefit from floss. Dental professionals continue to say: You have to brush two times a day and floss between your teeth. It is a broken record in a majority of dental practices that produces the same result—patients continue not to floss. The time has come to help patients find a way to clean between their teeth and manage their oral health. (1) Stepping away from the monotonous flossing recommendation and suggesting products such as properly sized interdental brushes (figures 1 and 2), oral irrigation or on-the-go solutions (figure 3) that can be easily kept in a pocket or desk drawer would be efficacious of the dental profession. Each patient is different, and the days of asking everyone to floss, knowing that some patients may not be compliant or have the dexterity to perform the task, is insanity. Approaching interdental care in a more pragmatic way by finding a product or combination of products that are easy to use and deliver better results is a great way to break away from the insane practices we ask our patients to do.

Figure 1: Larger grey TePe interdental brush used in an area where previous inflammation has caused attachment loss.

Figure 2: Crown margins and root surface decay are issues for many. Properly sized interdental brushes can clean the surfaces better than flossing alone.

Figure 3: On-the-go options are a great solution for patients to keep handy in their pocket and use throughout the day.

2. Placing implants in patients who cannot manage to clean their natural teeth

Dental implants are the shiny new toys in the dental professional’s toy box, and they are here to stay. Unfortunately, dental professionals are quick to suggest and place dental implants without properly communicating to patients their responsibility in the implant’s long-term success. This creates a situation ripe for failure. (2) Proper at-home maintenance of a dental implant is vital, but we still hear professionals tell patients to clean it like a natural tooth. The anatomy of a natural tooth is different from that of an implant. Implants may require different products, daily regimens, and more frequent trips to the dentist to ensure success. When looking at a patient’s mouth and how they care—or cared for—their natural dentition should direct the conversation and treatment plan process. Making sure the patient is on board with the proper at-home maintenance regimen is crucial. Placing an implant and thinking it will be more successful in a mouth with poor at-home care is insane.

3. Putting little emphasis on the products in the patient’s goody bag

Dental practices have a tendency to use certain products or limit their take-home products to just a few items, especially the ones that are patient giveaways. Typically, the giveaways that go home in patients’ goody bags are ones that the office received free or got a discount on, without much thought on how they reflect on the practice. Dental professionals tend to put more value on items that the patient typically doesn’t see. For instance, they use the best composite material, the best dental implant system, the best cement for crowns, etc., but place little thought on the products that the patient takes home and associates with the practice. Dental professionals ask patients to trust that they did great work in their mouth, and then ask them to manage that dental work with a toothbrush that they may not actually endorse or one that may not be the best for that patient’s needs. (3,4) Ending a dental appointment that may have gone well with expensive materials used, then sending the patient home with just any home-care tool and asking that patient to believe in the service they received that day is absurd.

4. Believing that everyone needs to have fluoride

These days everyone has an opinion on fluoride. Whether you are for or against the daily application of fluoride, dental professionals need to be armed with other suggestions for those patients who are not interested. Telling a mom whose child is in the chair with multiple cavities that fluoride is the only way is wrong. Fluoride is not the only option these days, and trying to push it on those who are not interested and expecting them to simply change their minds is lunacy. In February 2015, Anne Guignon wrote a great article naming five fluoride-free products that could be suggested to patients who are not interested in fluoride. (5) Give your patients options instead of an argument. The same conversation at each appointment will not deliver results, but meeting patients where they are in their ideologies can.

5. Keeping everyone on a three- or six-month recall

It is no mystery that patients want only what their insurance will pay for, and that includes the frequency in seeing their dental provider. However, not every patient is meant to maintain their oral health with the standard three- or six-month recall. (4) Allowing patients to come in for their six-month “bloody prophy” and hope that within the next six months something with change and they will become healthy is madness. It can be exasperating to be mindful of the fact that insurance coverage dictates most patients’ decisions while at the same time trying to educate patients about the importance of more frequent dental visits. Dental professionals must not become complacent in their recommendations for dental visit frequency. Tailoring treatment to what each individual needs is key, even if your patient doesn’t agree to it.

Thinking outside of the box and providing a more patient-centered type of treatment will help stop the insanity of the routines of dentistry. If the recommendations that we give patients time and time again are not producing needed results, why continue to give them? Helping patients find the best way to achieve their oral health—on an individual basis—will help redefine the future of dentistry.

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References

1. Chapple IL, Van der Weijden F, Doerfer C et al. Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol. 2015;42(S16)S71-76. doi: 10.1111/jcpe.12366.
2. Massad JJ, Swati A, Goodacre CJ. Implants and Prosthetic Restorations: Clinical Considerations. Oral Health. http://www.oralhealthgroup.com/features/implants-and-prosthetic-restorations-clinical-considerations/. Published July 1, 2015. Accessed February 2, 2017.
3. Schechter B. Selling home care. Dental Economics. 2000;90(8).
4. Bidra AS, Daubert DM, Garcia LT et al. Clinical practice guidelines for recall and maintenance of patients with tooth‐borne and implant‐borne dental restorations. J Prosthod. 2016;25(S1):S32-S40. doi: 10.1111/jopr.12416.
5. Guignon AN. Fluoride-free products that patients will love. RDH Magazine. 2015;35(2).

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You have a medical disease of the mouth

I like to joke with my patients by saying,

“I don’t know if you know this, but your mouth is actually connected to your body”.

Because dentistry and medicine don’t always cross paths, we can forget that what happens in the body can manifest signs and symptoms in the mouth. Conversely, inflammation in the mouth can exacerbate systemic disease. The dental hygiene profession has based its existence on prevention and education of disease. I feel, at times, we have lost sight of that. 

Patients don’t always take us seriously.  “I know I should be flossing”, “I don’t have time to floss” ,“Please don’t lecture me on flossing”. How do we help them to see the importance of our recommendations? I have adopted the technique of linking my patient education to a prescription plan. It is my belief, and many others, that what I am teaching them is just as important as a medical procedure or prescription. When I started doing this, patients would often become more engaged. My conversation goes a little like this: 

“You have a medical disease of the mouth. The inflammation/infection that is in your mouth can affect the rest of your body, including your heart. Today I am going to prescribe to you (insert sized interdental brush color and/or specialty brush). Using this everyday will be as important as you taking a prescription medication. If you don’t use it, you are increasing your chance of decay/tooth loss/periodontal disease/ peri-implantitis and other concerns throughout your body.”

 After that, I teach them to use the recommended product and discuss with them any limitations they may have, concerns about their level of compliance, or how I can help motivate them to develop this new habit. It won’t happen overnight, but eventually our patients will see our home care recommendation is as important as a prescription they need to take every day. As a profession, we just have to remember how important patient education is to the long-term success of our patients. If you need help sizing the interdental brushes so you can “prescribe” one to your patient, check out my blog on “Sizing Interdental Brushes”.

"I don't know if you know this, but your mouth is actually connected to your body."

Patient-Centered Care

I had a recent discussion with a dentist about building trusting relationships in your practice by ensuring we’re recommending the best for our patients. This means offering the best care, using the best materials, and recommending the best products that are tailored to treat a patient’s unique needs. I then happened to read an article referring to this same concept. Both my discussion and the article similarly concluded that individualized care elevates a patient’s overall success.

            I feel like a broken record lately when discussing patient-centered care but it is such an important aspect of our profession. Staying up-to-date on the best cements, composites, and surgical techniques is truly important.  And so are our tools for patient education. I have said before, a patient may not come to your office because you offer products like TePe, but once they see that you are recommending quality home-care tools that are tailored to them, they can further trust in the level of care you are delivering in other areas of the practice. 

           I recently temped in an office that had very basic items in their hygiene closet and recommended outdated practices even though the façade of the practice seemed very progressive. I felt terrible knowing that there are so many more options for each patient’s success, but I wasn’t in a position in which I could help. The experience further reinforced my fight for tailored patient care. 

          I like to think of it as the “golden-rule”. As a patient, what if you found out you were getting the same one-size-fits-all care as every other individual that walked through the door?  Everyone’s story and needs are so very different from the next person. TePe has created products that can be tailored to individuals for more than 50 years. Take a look at the many educational videos to learn how they can be implemented in your practice. 

British Society of Periodontology Statement on Flossing

2 August 2016

PRESS RELEASE

Following articles published today in various national newspapers, the British Society of Periodontology would like to make the following statement with regard to comments made by the Associated Press in the United States about the ineffectiveness of flossing.

Evidence supports the use of small interdental brushes for cleaning between the teeth, where there is space to do so, in preference to flossing. The recommendation from the 11th European Workshop on the prevention of gum diseases (2015) to patients is : “Daily cleaning between your teeth using special interdental brushes is essential for treating and preventing gum disease. Floss is of little value unless the spaces between your teeth are too tight for the interdental brushes to fit without hurting or causing harm.” Therefore, floss is not a waste of time - it is a viable alternative to interdental brushing where appropriate. Public Health England makes a similar recommendation.

The British Society of Periodontology has just launched a national gum heath awareness campaign (www.bsperio.org.uk/howsyoursmile) in conjunction with Public Health England to raise awareness of the importance of gum health, not just for oral health but to promote good general health. One of the key messages is that daily interdental cleaning is an important health measure to prevent the onset of gum disease. The British Society of Periodontology would be happy to put forward a spokesperson for interview on request.

Philip Ower
President, British Society of Periodontology
www.bsperio.org.uk
philip.ower@btopenworld.com

SOURCE: http://www.bsperio.org.uk/news/pdf/statement--flossing-198.pdf

Success or survival?

Dental implants have become a part of everyday dentistry within the U.S. placing upwards of 1 million implants a year.  The ability to give patients a viable option for missing teeth is incredible.  However, we as clinicians need to make sure that the procedure is going to yield a positive outcome with long-term success.  Unfortunately, many dental implants are merely surviving and not considered fully successful.  Oftentimes we read studies that will say something like, “these implants have a survival rate of 97%”.  That sounds like a positive outcome, doesn’t it?  But realistically, surviving doesn’t mean success.  But what is the difference between the two?  

In order for a dental implant to be considered successful, it has to meet many requirements:  be in clinical function, have good esthetics, minimal bone loss radiographically, stable prosthetics, absence of soft-tissue infection, lack any pain, and the patient must be satisfied.

In order for a dental implant to be considered a surviving implant, it simply has to still be present in the mouth.  I don’t know about you, but if I have a medical device placed in my body, I hope that it does more than just survives! 

So how can we help our patients’ dental implants be successful?  Well, here at TePe, we believe the patient’s home care routine is vital to their success.  Finding products that align with their level of motivation, capabilities, and also factor in their limitations, is key.  TePe has created a variety of products that are easy to use and can be tailored to an individual.  I encourage you to watch the educational videos on maintaining dental implants so you can see each product in action.  All patients are different and their home care routine will need to be tailored to the individual.  Let TePe help your patients have more than just surviving dental implants. 

Let’s aim for success! 

Check out how to clean dental implants with TePe interdental brushes: 

Do we know why patients don’t comply?

            I was just reading an interesting article about compliance.  Lack of compliance is one of the biggest enemies we fight in our profession.  How do we get our patients to actually perform our recommendations?  First, we need to understand why they don’t always comply.

            The study outlined in the article, found that half of all patients fail to follow a clinician’s instructions.  This is mainly due to one or a combination of the following reasons: 

1. Fear—Not only the common fear in being in a dental office, but a fear of discovering health concerns while performing their home-care routine. It sounds counter-intuitive, but it is fairly common for a person to notice something wrong and ignore it out of fear of a serious diagnosis. 
2. Lack of information—Explaining the big picture and the progression of the disease along with options to attack the issues helps increase compliance. 
3. Socioeconomic status—Sometimes recommended treatment takes a backseat to necessities. Understandably, basic needs like food and shelter are the priority within a limited budget.
4. Perception of the clinician—If we are not up-to-date or knowledgeable on the topics we are discussing with patients, our recommendations will not be taken seriously.
5. Involvement in decision-making—We need to fully inform patients so they can make educated decisions about their future treatment.  If they don’t feel involved then they won’t comply.

           Understanding where our patients’ hesitation stems can help us increase their compliance.  Making sure they have all the facts is also important.  I never want a patient to come back and say, ‘she never told me’.  If anything, I may have put a few on information overload.  But I need them to understand what is happening in their mouth and how to make it right.  The next time a patient just won’t comply, think about what could be hindering them.

Lee, C. T., Huang, H. Y., Sun, T. C., & Karimbux, N. (2015). Impact of patient compliance on tooth loss during supportive periodontal therapy a systematic review and meta-analysis. Journal of dental research, 0022034515578910.

But I'm too tired to clean my teeth at night!

As a dental hygienist, I hear this a lot. Disturbing the bacteria that has accumulated throughout the day that is sitting along the gum line and between your teeth is very important. Brushing before bedtime is crucial because that accumulation of aggressive, disease causing bacteria won’t sit on your teeth and around your gums all night. When we sleep, it is the perfect time for the bacteria to assault our teeth and gums. We are not salivating as much and flushing away that bacteria so it sits on the gums and teeth all night.

Even though nighttime cleaning is ideal, it isn’t always possible. We are exhausted from the day and the thought of spending even just a few extra minutes on cleaning our teeth seems daunting. I get it. This is why when I clean my teeth, it isn’t always in the bathroom and it isn’t always at night. Again, nighttime cleaning is ideal, but if you do something through out the day to disrupt and dislodge the disease causing bacteria, it is better than nothing at all. Often times, I will clean between my teeth after lunch and not at night when I am tired. Or maybe you have more time in the morning for such teeth cleaning activities, so performing those actions in the morning is okay too. I suggest putting items like the TePe EasyPick or the Interdental brushes out where you can see them and put them everywhere. I keep the handy TePe EasyPick in my purse, in my desk drawer and in my car! It is a great "on-the-go" option to disrupt the bacteria and remove food between the teeth. The TePe EasyPick is also a great way to stimulate our gum tissue between the teeth, which is also an important aspect of gum health. 

Cleaning between your teeth is an extremely important aspect of fighting dental diseases but remembering to do this is sometimes hard. I joke often that I grew up flossing while watching TV. It was a great time to zone out watching a show but have my hands occupied cleaning my teeth. Now, using an interdental brush outside of the bathroom will not work at first. If inflammation is present, you will see some bleeding when initially using the brushes. Rinsing out your mouth and cleaning the brush will be important. After a week or so of cleaning, you will see less bleeding and won’t have to be tied to your bathroom sink for these cleaning habits. 

Don’t beat yourself up if you can’t do these homecare routines at night. Just think of a moment in the day where you do have time to concentrate on cleaning your teeth and do it then!  And, don't forget to check out TePe's EasyPick. It comes in a pack of 36 and has a handy travel case, allowing you to keep it with you without getting it dirty. You'll always have a great on-the-go option for improving your oral health!

Access Health: Our Teeth and Bones

Being a dental hygienist doesn’t typically get you a behind the scenes look at the world of television. Yet, I was lucky enough to get invited to Access Health as a dental correspondent. This show airs on the Lifetime Network and explores cutting-edge developments and innovations in medicine, nutrition, and fitness.

During my segment with Access Health, I was honored to interview Dr. Jeb Jacobson from Renaissance Dental and the “grannies” who created Ice Chips Candy.  These two interviews provided a wealth of knowledge for me, even if I did my research prior to the interviews. Dr. “J” and I chatted about the increase in oral cancer and how it simply isn’t the old man’s disease that it once was considered.  Now we are seeing it in younger generations and in women. We also discussed the need for continued dental insurance as we age. So many are without dental insurance and as we live longer, Dr. J explains that there is a shelf life on our restorations and previous dental work. This will need to be replaced and because of the many medications people take, the incidence of dry mouth is increasing.  Dry mouth can increase your risk for dental diseases and the need to help counteract this issue is very important. 

The self-proclaimed “grannies”, Charlotte McClary and Beverly Vines-Hanes are an inspiration—just watch their episode on Shark Tank.  These two women have come up with a hard candy that uses a natural sweetener, xylitol, to help fight tooth decay.  Xylitol is a carbohydrate that comes from birch bark and tastes like sugar; however, it is a sugar alcohol that will actually kill the bacteria in your mouth. A sweet treat that will help fight cavities—sounds like a win-win for sure.  The “grannies” work very hard to only incorporate natural products in their Ice Chips Candy and are working to become Kosher certified. They are very specific about what ingredients are included so you will always know what you are putting into your body. I must admit, I was excited to meet these “grannies”.  I had just discovered their lemon flavored candies and was truly enjoying them. Then I found out there were 22 flavors—really good flavors too! 

I encourage you to watch the segments in the video above. The information that Dr. J offers is great for all to hear and who wouldn’t want to learn about a sweet treat that can help our patients fight tooth decay? 

The Tongue Test

Oh the tongue! The nemesis to all dental hygienists. I have spent most of my clinical career battling the most curious, and in my opinion, strongest muscle in the body. Patients are not even aware that their tongue is trying to push me away or trying to feel where my instrument is. The tongue may be difficult to work around but it can be a great asset to help patients improve their brushing skills. 

I know that I am a neurotic hygienist who always feels the need to brush my teeth but I am sure you have also experienced the feeling of having ‘furry’ teeth. The next time you have a dental cleaning, run your tongue over all of your teeth. Especially the back teeth next to your cheek and your bottom front teeth. Feel how smooth they are. Now, after your next tooth brushing, take your tongue and do the same thing, feeling each tooth with your tongue. Do they feel as smooth? If not, get that toothbrush back out and brush those areas that still feel a little furry. If you do this every time you brush, you will brush away more plaque, preventing it from building up and turning into tartar or calculus (the rough stuff that hygienist need to scale away). 

Another tip for a thorough tooth bushing is to start in your trouble areas. Do you always miss the same place? Is the hard to reach area for you down by your tongue or your bottom front teeth? Well, start there! We tend to be more focused when we first start to brush, so if you start there before you drift off into la la land, you will have tackled your hardest to reach areas! I have seen this work. Remember, dental disease is not expected. Finding the most effective way to brush and clean between our teeth can help control the plaque biofilm before the dental disease occurs.

Try out TePe’s Supreme toothbrush and check out our educational videos on how to care for those hard to reach areas! 

Good Luck!

National Children’s Dental Health Month: Waging the War on Sugar

Kids love sweets, there is no doubt about that. Unfortunately, they're full of sugar which - in high quantities - can significantly alter a child's physical and emotional wellbeing.

Sugar is found in almost everything we consume, from the obvious sweet foods like chocolate and cakes to processed foods and microwaveable dinners. February is National Children’s Dental Health Month and this year the dental community is waging its war on sugar. We are learning more and more about the harmful effects that sugar has on our bodies. So it’s no surprise that sugar is also extremely harmful to our teeth, especially kids’ teeth.

Sugar hides in some of the most unexpected places. As parents looking after the dental health of your children, it’s very important to read labels and check for sugar content while grocery shopping. One of the most common hiding places for sugar is in our children's favorite drinks. Even juice and milk can be loaded with harmful sugar. Regulating what drinks your children consume and introducing regular dental exams early in your childrens' lives are critical in helping to prevent your child from developing a very painful toothache and to treat any dental decay in its early stages.

So how can TePe help you keep your kids' teeth as clean as possible and prevent them from being in pain? We have awesome child-sized toothbrushes with fun, animated designs.

Here are a few suggestions I often give parents:

1. Let your kids be independent and brush their teeth on their own
2. Even if they are brushing their own teeth, you should always be checking to make sure they actually brushed.
3. Brushing your kids’ teeth isn’t always the easiest task, so one item I like to suggest to parents of small children is the Compact Tuft brush. This is a great brush with a very small head and densely packed bristles. This brush allows you to get in your child’s mouth without bumping their teeth and you are able to really scrub the chewing surfaces.

For some great answers to frequently asked children’s dentistry questions such as “when do I start to take my child to the dentist” or “are baby teeth really important” visit The American Academy of Pediatric Dentistry’s website.

I hope this information helps point you in the right direction to prevent those painful toothaches for your children and to get you thinking about children’s dentistry this month!