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Consider this: Your patient is about to go through one of the most challenging phases of their life. In addition to possible oral side effects that make eating and drinking difficult, patients might also experience nausea, hair loss, exhaustion, and a loss of appetite. You have the power to assist them with their oral side effects as their dental expert. We can significantly lessen the intensity of our patients' oral side effects, or even better, help them avoid them altogether, by simply being involved in their treatment. Isn't that amazing?
It's crucial to understand that we can assist people with ANY form of cancer receiving therapy, not just oral cancer. While the majority of dentists are aware that we can help with malignancies that affect the neck and up, many are not aware of the assistance we can offer to people getting cancer treatment in other parts of the body. From treatment, patients are likely to develop oral side effects such as extreme dry mouth, fungal infections, burning mouth, and mouth sores once their treatment has started, regardless of the type of cancer they have. Keep in mind that you have an impact on each of these patients. Because we are likely to see the patient just prior to starting treatment, you can take this opportunity to strategize with them to help manage these symptoms. 1. Discuss the potential side effects and make a plan. When they come to their appointment, prior to treatment, make sure they are aware of your support. Your patient will be suffering the adverse effects outside of your op. Provide them with the information that they need to feel in control of what may come. These side effects are incredibly uncomfortable and you have the ability to help prevent them and ease them if they are severe. 2. Give them a solid home care regimen to follow before treatment begins. You'll want them to begin their cancer treatment with the healthiest mouth possible. Give them a strategy on how to both prevent and treat adverse effects. At the end of their appointment be sure to reiterate the plan. Make sure they are fully aware of what may come and let them know to follow the instructions to help with anything that may come up. 3. Follow up and support. Encourage them to reach out to you if any side effects pop up, and be sure that they are scheduled for an appointment post-cancer treatment. The most important thing to know is that we can help these patients! OraCare is so passionate about providing comfort during this time, we started a FREE program to help patients ease their oral side effects. If you are a current OraCare Provider, you can access this program for FREE and have OraCare sent directly to your patient. Here is the link to fill out the form: https://www.oracareproducts.com/oracare-cares-patient-form.html
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Do you know what is considered a healthy perio percentage in a practice? The magic number is 30%. Some practices don’t track these metrics, but it is so important to make sure you aren’t providing supervised neglect.
If you aren’t familiar with the term “supervised neglect,” it is essentially when there is an active disease in a patient’s mouth and they leave without knowing that it is there. It can sometimes go undiscussed for YEARS in a practice. This includes Periodontitis’ precursor, Gingivitis. We know that gingivitis always precedes periodontitis and at that point it is reversible. We must intervene early in order to help patients prevent tooth and bone loss. Many cases of periodontal disease go undiagnosed in a general practice setting. According to the ADA 47.2% of American adults 30 years and older have some form of gum disease. The incidence of this increases with age up to 70.1% at the age of 65. When you take this into consideration, it is easy to see how a practice can reach a perio percent of 30% (or sometimes higher). Now this doesn’t mean that you find new cases each time, this number also includes patients that are receiving perio maintenance. Even if your office doesn’t complete scaling and root planing, because you refer out, you can assist the Periodontist in keeping the patient on track by completing 2 of their 4 cleanings per year. This also provides them with their regular exam for any other potential restorative needs. Periodontal disease, unlike other diseases, is on the rise. It is up to us as dental professionals to prevent and treat this disease in order to see this number start to go in the other direction. Without early intervention and knowing these metrics inside the walls of our own Ops, we can’t slow this process down. Building and maintaining a perio program is essential to preventative patient care. There are certain problems in dentistry that walk through the office door that make us kind of wince. These are the issues we see in patients that can be difficult to find a resolution for. One condition that has done this to me in the past… Angular Cheilitis. Some refer to it as Perleche or angular stomatitis. Occasionally, cold sores and angular cheilitis can be confused. However, cold sores are a different illness which we know is brought on by the herpes virus. Cold sores can spread, angular cheilitis can’t. Nonetheless, both are hard to treat. But when it is truly angular cheilitis its hard to find a solution that actually provides results.
On top of already being difficult to get rid of, this condition is easily exacerbated by fungal infections. Having something you can apply directly to that area is super helpful. A lot of the time you’re prescribed a topical steroid cream and they don’t work. I like to use OraCare for these patients because it can actually clear that up in just a few days. You pump the liquid out into a cup, take a cotton ball, place it in there, soak it, and then apply the damp ball to the area for about a minute and that’ll clear up in just a few days. Also provides patients with a lot of comfort for this specific condition. As a dental hygienist who is largely out of the OP, a major role I focus on now is making a hygienist’s job easier. My goal is to give dental professionals the information to have the tools to provide the highest standard of care and there are a lot of things that we can equip ourselves with in order to do a better job in a more streamlined manner. I’ve been lucky enough in my career to be able to be exposed to a lot of different technology, a lot of education, as well as some of the top leaders in the dental field. If I use these experiences to gather evidence for all of us on what we should be doing, there is one tool that needs to be in every op. I’d say the biggest game changer out there right now is the Airflow Prophylaxis Master. If this is not something you’re using in your office, I’d 100% recommend looking into it. This equipment provides a higher standard of care and provides a better prophy to your patients while also being much more comfortable. PLUS you get to eliminate your standard prophy angle and paste.
Now, like any new technology, there are some cons and there are some pros. Probably the biggest con that most people struggle with is the price. It’s new technology, it’s an investment but it’s worth EVERY PENNY. If you’re willing to make the investment there are ways to make up for the cost. One thing you will gain by using this machine is time. Once you become proficient at using it you can easily work in other treatments like sealants or maybe fluoride treatments. (Maybe you just even get time to go to the bathroom.) The other con is that it’s a little messy. It uses water and glycine powder to remove biofilm up to 4mm below the gum line (even further if you use the specialized perio tip), so there is aerosol associated with it. It’s a little messy for your patients with a lot of makeup or if they have beards. They’re definitely going to see it around their mouths after their appointment is over. So, it’s pretty important to learn to manage the water flow and aerosols by finding the right suction that works for you. But once you learn, it is very simple to use. The pro that trumps any con is the fact that the Airflow improves our standard of care. Our patients get better cleanings in a shorter period of time. This does an impeccable job at removing biofilm in places that we could never even dream of reaching with our classic scalers and prophy angles. By using this in the office we are truly offering disease prevention because of the rate at which it removes plaque. On top of those benefits, it’s ergonomic and it’s painless. When I talk about this to other dental professionals, who aren’t familiar, they believe it is just like a prophy jet. It is nothing like a proxy jet. You're encouraged to hit the areas of soft tissue unlike a prophy jet, and there is no stinging. This is intended to be used at and below the gum line. It is even gentle enough to clean the roof of the mouth and the surface of the tongue! If this is something that intrigues you, I would recommend reaching out to the manufacturer EMS. Though I love this tech, I don’t work for them and can’t help you get it in your office. But if you go to the site: https://www.ems-dental.com/en/products/airflow-prophylaxis-master, you can find CE and resources on Guided Biofilm Therapy. The coursework that they have is incredibly interesting. I’d 100% recommend those. On top of that, you can actually do a trial at your office with the equipment. Obviously, it’s an investment so you want to be able to try it out and they give you that opportunity. It will change the way you practice and how you approach hygiene, make your cleanings easier, and allow you more time to be able to work in treatment the same day. Take a peek, I promise this is a game-changer! Bad breath is caused by bacteria, we all know that, but it is also caused by bacteria waste, which are volatile sulfur compounds. That waste product also known as a volatile sulfur compound (VSC) is actually what causes the odor in bad breath and in order to manage bad breath, you have to eliminate both: the bacteria and the VSC’s. Just doing one and not the other, doesn’t solve the issue.
OraCare is fantastic for bad breath. One thing the chlorine dioxide does incredibly well is remove VSCs as well as bacteria. Whereas other OTC products that are marketed in regards to bad breath, they are just simply a heavy mint flavoring that will reduce some bacteria and mask some of that odor but it’s not really removing the source of the problem. Fungal infections are typically treated with a prescription mouth rinse. Patient’s can only use it for a week and then throw it away. One unpopular part of utilizing that prescription product is actually that the patient has to swallow it. What OraCare provides is that same removal of fungi as this other rinse without having to ingest it. Plus, if it is someone who frequently gets fungal infections (immunocompromised patients), this is a rinse they can continue to use everyday, long term. So, this is great for patients who have dentures because a lot of times we see fungal overgrowth there. If they’re undergoing chemo and radiation, you see a lot of fungal infections there. All of these scenarios are great scenarios for a patient to be recommended to use OraCare.
Demographically we know most ortho patients are teenagers. Somewhere in that age range where they don’t traditionally have the best track record for taking care of their mouths. A lot of ortho patients face excessive build up around those wires and that’s why dental professionals love OraCare for ortho.
Ortho patients are some of the most challenging patients that you have. They’re typically teenage agers and they struggle with hygiene. Brushing and flossing, now you add brackets and wiring on top of that and it’s even more impossible for them to clean as well as me, a dental hygienist so giving them a rinse to use every single day helps improve their hygiene which ultimately improves their outcome of their treatment. Having less plaque build up on their teeth while they have the appliance in there is so important because if not, you get all of that scarring and that decalcification and the breakdown. Using OraCare as rinse and the ability to break through that plaque is huge. So even giving it to patients who don’t have the best hygiene on a day to day basis, its potential is maximized because there is so much more work to do with them. So a rinse is so critical for an ortho patient to be using day to day.  My father was diagnosed with brain cancer when I was 19 years old. We, as a family, all anticipated him feeling drained and queasy. However, the severity of his oral side effects caught us off guard. I wasn't a dental hygienist, nor was I even a dental hygiene student at the time. Had I known then what I know now, I would have asked our family dentist for guidance, but we relied on the medical staff that was taking care of him. The treatment was circular, the oral problems would not be fixed, and it was assumed that "this just happens." In this circumstance, I felt helpless. Even if it isn't a close family member, I believe that many of us are familiar with this emotion. We are compelled to assist when a patient informs us that they will soon begin receiving cancer treatment. Oral cancer is a topic that receives a lot of attention in dentistry for obvious reasons. However, regardless of where the cancer is located, the oral side effects of radiation and general chemotherapy have significant oral consequences. As dental professionals, we can offer assistance in this circumstance, which can occasionally feel hopeless. The negative effects of cancer treatment on the oral cavity might be prevented or lessened with our knowledge and resources. We at OraCare are establishing the We Can Help awareness campaign for dental professionals (www.WeCanHelpCC.org) in memory of my father and all cancer patients. Our intention is for dentists to understand that they can HELP patients who are undergoing therapy.
A stands for awareness, S for support, S for self-education, I for information, S for side effect prevention, and T for side effect treatment. ASSIST is a method that patients should adhere to while obtaining treatment. Let's take a closer look at each of these actions. Awareness (A)- Being aware that you can help is the first step in providing care for cancer patients. It's important to realize that, in addition to oral cancer, we can help with ANY kind of cancer. Many dental practitioners are unaware of the support we may provide to patients receiving cancer therapy in other sections of the body, despite the fact that the majority of them are familiar with malignancies that affect the neck and higher. Patients may experience oral side effects from their medication, including excessive dry mouth, fungal infections, burning tongue, and mouth sores. Support (S)- It's important to support someone who is going through a difficult time. As one of the most difficult experiences a person can go through, supporting someone with cancer may help a person feel cherished, cared for, and powerful. They may feel more secure, encouraged, and motivated as a result, which could improve their mental and emotional well-being and help them overcome their challenges during this tough time. Self Education (S)- As dental professionals, we have the best expertise regarding the oral cavity and any problems. To ensure that your patients are informed about what to expect and how to handle it if it does, it's critical to educate yourself and get an understanding of the normal side effects of cancer treatment. Information (I)- It is our responsibility as dental practitioners to advise our patients about possible future situations and how to safeguard their mouths. Patients can make informed, proactive decisions about their care by being aware of any potential side effects. This will help them prepare for what to expect during and after treatment. Side Effect Prevention (S)- Create a strategy for your patients. It's possible that you won't even be starting therapy when you see them in the chair. Giving them information on what might happen at this time is a terrific idea. Otherwise, they'll probably go to the medical staff, who are less able to come up with creative treatments for the side effects, if and when they have mouth problems. As a dental professional, you are exposed to a wide range of goods and services that might be able to lessen these conditions. It may be possible to avoid adverse effects or future problems by letting them know the strategy in advance. Treatment of Side Effects (T)- Unfortunately, we are aware of the potential for severe side effects, and prevention is the best course of action while treating cancer. Giving patients the resources they require before the commencement of treatment enables patients to respond as soon as any early symptoms or indicators appear. By doing this, misery and pointless hardships may be avoided. My father unfortunately lost his battle to cancer. As a hygienist, I can't help but sit here and consider whether we could have enhanced his quality of life by contacting our dentist. I want every dentist to understand that they can help. Unfortunately, oncologists and other medical professionals are unaware of these problems or how to handle oral adverse effects that may develop while receiving treatment. We must intervene at this point and offer support. Although your patient's oral health may not be top of mind at the time of treatment, we can inform and prepare them for what may come so they will know what to do. We can actually alter how people react to treatment, so we don't have to stand by helplessly. To say I’m proud to work for OraCare is an understatement. Patients can receive a complimentary set of the rinse as part of our OraCare Cares program, which supports them as they undergo treatment. Many of the usual adverse effects of cancer therapy, such as dry mouth, mouth ulcers, fungus infections, etc., are lessened by using OraCare rinse. Over 3,000 patients have received assistance! Due to this profound effect, we believe it is our responsibility to educate dental professionals on how they might benefit patients undergoing cancer treatment. Visit the website at www.WeCanHelpCC.org to educate your group. We can significantly improve these patients' lives by working together. We can help. In most fairy tales, there’s a villain that gives the heroine what they desperately want – at a price. Ursula will give you legs, but at the cost of your voice. If you’re giving your patients chlorhexidine to fulfill a wish to kill bacteria, you've just been tricked by an evil villain. You’ve probably always detested the dark shadow (stain and calculus) that chlorhexidine casts upon your patients’ teeth. But these side effects are foreboding to more complicated rules and contraindications to the poor unfortunate souls who use it. What is chlorhexidine’s evil plan? Sure, she kills bacteria, but at what price?
Limited to two weeks of use Ever notice in our favorite Disney movies that the villain’s spell is short? Like, unrealistically short. Until midnight… the 3rd day at sunset… you get the idea. With chlorhexidine’s narrow 14 day window, she offers little time to work her “magic”. Even for mild gingivitis (which is the only indicated use by the way, more on that in a moment) tissue usually takes upwards of 30 days to start healing. Do we still need to worry about bacteria after two weeks? Of course. So what do we give them instead of chlorhexidine? Only indicated for gingivitis Chlorhexidine tells us she can ONLY help patients with gingivitis. Has your practice ever used chlorhexidine off label? If so, you’re not alone. After all, it’s what we learned in school to kill bacteria. Since bacteria is a common enemy of periodontal disease, implants, and extractions, it seems it would be suitable anywhere bacteria is at play. Chlorhexidine is actually contraindicated for all of those uses. It gets worse. Let us journey further into the dark forest of risks and limitations. Inhibits Fibroblasts Using chlorhexidine after SRP? Stop. According to a 1991 study conducted by Charles D. Alleyn, DDS(1): “Exposure of root surfaces to Chlorhexidine significantly inhibits subsequent fibroblast attachment which may interfere with regeneration of the periodontium.” Chlorhexidine all but halts the healing process. What’s most alarming is this study is over 20 years old, and practices still send SRP patients home with chlorhexidine, unaware of her consequences. Inactivated in Presence of Blood/Saliva Yep, you heard that right. Like a true villain, chlorhexidine sets forth the ultimate double standard: she’ll kill bacteria in your patient's mouth- but not with blood or saliva present. As found in a 1990 study (2,3,4), this explains why chlorhexidine is of limited value in decontaminating the oral cavity. How do we avoid saliva in the mouth? We can’t. This contributes to why chlorhexidine is contraindicated for implants, extractions and periodontal disease. Cytotoxic effects Since 2006, we’ve been warned of the cytotoxic effects of chlorhexidine on cells and cautioned against her use. Does your practice rely on chlorhexidine as a pre-rinse? You just counteracted the positives of any antibacterial precautions with a high dose of cytotoxic effects. Furthermore, at 1,200 ppm this makes chlorhexidine obsolete as a post-op rinse choice. Severe allergic reactions Hypersensitivity is always a risk with chlorhexidine. Immediate allergic reactions are the most serious, but patients can also experience delayed reactions days or weeks later. (5) To send a patient home with a rinse that has been documented to sometimes cause severe anaphylactic shock can be nerve wracking to say the least. The most unsettling documented cases both occurred with patients in the UK. In the first, a woman was killed in the dental chair after a fatal allergic reaction from pre-rinsing with chlorhexidine. In the second, an autopsy of a 63 year old male showed the cause of death to be an allergic reaction to chlorhexidine. So, what is chlorhexidine’s evil plan? To deceive you into thinking she’s a friend to your practice and patients. Fortunately, there is an alternative whose mission is to make sure you never use chlorhexidine again. OraCare is the only other professional rinse choice. It kills the same bacteria as chlorhexidine at just 44 ppm, and without side effects: no staining, calculus buildup, or altered taste. What really makes this knight in shining armor are the additional benefits it provides: OraCare kills viruses & fungi, eliminates volatile sulfur compounds, and breaks up biofilm. OraCare is also safe for long term use, giving your patients a true ‘happily ever after’.  Our aim as dental specialists is to stop the start of illness. The correct products can help maintain a patient's dental health in between appointments and have a favorable impact on the results of the services we offer. One significant benefit we can offer patients is advice on product selection. There are three options: suggest professional products, over-the-counter products, or say nothing and let the patient decide for themselves which product to use.
Professional Product Choices Products from professionals are those that are unavailable in stores. This is difficult since the patients can't just walk in and get them; they need to be brought in or prescribed. Any condition can be treated more successfully using professional products. Comparable to the distinction between clear aligners manufactured in-office and under the supervision of a dental professional and a home kit that a patient purchases. The at-home equipment might only be effective in a select few situations, but a professional could handle any situation, particularly the most challenging ones. Use professional materials if you want professional results. Chlorhexidine and activated chlorine dioxide (OraCare) are the only two solutions that are truly regarded as professional products when it comes to rinses. Both of these medicines must be administered directly to the patient or recommended by a dental practitioner and neither can be purchased over the counter. Because it is what we were taught in school, hygienists frequently use chlorhexidine by default. Because chlorhexidine is an excellent bactericide, we have been using it. Since this potent biocide (1200 ppm) has so many negative effects, many people are ceasing to use it. Numerous studies show that chlorhexidine harms fibroblasts and impedes the healing process in addition to staining and increased calculus buildup. Blood, saliva, and use within 30 minutes of cleaning your teeth also inactivates it. The fact that it is only advised for a total of two weeks of use makes it impossible to utilize it for routine at-home care. Normally, gingiva heals from a sick condition to a healthy state in a minimum of 34 days. This is a key factor in why chlorhexidine doesn't work well for us. OraCare, the only other professional rinse option, was developed by dental professionals in an effort to displace chlorhexidine due to the issues it causes. There are drawbacks to this rinse as well; it is only available at dental offices and is frequently more expensive than OTC alternatives. OraCare performs better than over-the-counter remedies and kills the same bacteria as chlorhexidine, which is good news. Without any of the negative effects of chlorhexidine, it also eradicates viruses, fungus, neutralizes volatile sulfur compounds, and disintegrates biofilm. OraCare is unique in that it accomplishes all of this while emitting only 44ppm, allowing patients to use it on a daily basis—which is the very definition of homecare. This product has been a go-to choice for dental professionals who have made the switch when seeking for a tool to enhance homecare. Over The Counter Products OTC products are simple to locate and less expensive than professional products. Although there is no professional direction and they typically aren't as effective. For instance, prescription fluoride gel reduces sensitivity better than over-the-counter toothpaste. It is stronger and more efficient, and it is employed for a particular patient need. The OTC product is more accessible to a wider range of people, but it is less effective. Additionally, the majority of OTC products only target a single aspect of complicated dental issues. Consider halitosis, which has bacteria and VSCs as significant factors. Since most OTC treatments simply combat bacteria, both require long-term solutions. Although we prefer that patients use professional medicines, we understand that over-the-counter (OTC) treatments have their purpose. Recommend Nothing You can always opt to make no recommendations and let the patient determine the course of action. This removes any obstacles you might have, but it also increases the likelihood that you won't receive the outcomes you want. It is our responsibility to help our patients achieve the greatest dental health possible. Even if patients decide not to heed our recommendations, it is still crucial to educate them. We are aware that patients' behavior outside of appointments has a significant impact on disease prevention. Because of this, it's crucial that we plan our patients' at-home care. Professional products have the capacity to offer patients the higher caliber of treatment they require. It is our duty to choose the route that results in better clinical outcomes. |
Kristin Goodfellow RDHKristin is Chief Clinical Officer of OraCare, a practicing Registered Dental Hygienist Archives
August 2023
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