The Doctor’s View:
There are a variety of viewpoints on this issue which affects dentists and hygienists frequently. I need more details before I can provide my opinion. What are you being asked to do by your dentist during the prophy? Are you enrolling each patient and conducting co-discovery, or are you merely cleaning their teeth? It would be unfair to compare hygiene prophy times. It’s like comparing apples and oranges. Everything depends on the hygienist's responsibilities. As a hygienist, I agree with the dentist that your time should be limited if all you are doing during a prophy is cleaning teeth. You will need additional time if you are performing co-discovery, which entails examining the patient's radiographs, probing to evaluate gingival health, looking for any suspicious lesions, and checking for decay while also evaluating the patient's oral health. Because hygienists are typically unable to provide a final diagnosis for these illnesses, we refer to this as co-discovery. Then, you would require more time if you were to deliver these results and enroll the individuals in treatment. Naturally, the dentist will check everything the hygienist finds, but the more involved the hygienist is with the patient's health and education, the more time is required. As a dentist, I believe that my hygienist deserves more time for a prophy session the more value they add to the patient. The Hygienist’s View: This problem affects so many hygienists! The amount of time allocated for procedures differs from office to office, but how much time is really necessary? We realize that asking for 90 minute prophy times for every patient is unrealistic. What am I currently unable to perform in the time that is available to me should be your first thought. By first asking yourself this question, you can gain some understanding of what you are actually seeking in the time that you have available. You may not necessarily require more time for the prophy, but rather more time to offer a higher caliber of care. Increasing the standard of care is the best approach to boost output. Many doctors disagree with adding more time to a prophy because, in their opinion, adding an extra 10 minutes to your scaling time would be ineffective. Instead of going to your doctor and requesting "more prophy time," request extra time for sealants, fluoride treatments, talking about additional treatment choices (including the treatment they may provide), or enrolling patients in periodontal therapy. These office productivity-boosting care strategies also give you the brief window of time you might need. The Compromise: Expectations are the key to everything. If all you are doing with an adult recall patient is scaling, we believe between 30-40 minutes is the right amount of time. A better amount of time would be 50–60 minutes if you were offering value, such as co–discovery, patient education, or therapy enrollment. Typically, you would allow an extra 20 to 30 minutes for establishing a rapport with a new patient, recording their progress, and finishing their films. Every doctor and hygienist has a unique work schedule, and the times listed above are only suggestions. The doctor-hygiene partnership should, in the end, be a collaborative effort with honest communication about your roles and responsibilities. Expectations must be discussed with your doctor before discussing prophy time.
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Do the crowded tables, flashing lights, and winning money excite you? If so, Las Vegas might be the place for you. However, choosing red or black on the roulette wheel is not as simple in dentistry. Chlorhexidine is one of several high-stakes hazards that you might not be aware of, despite the fact that the payoff isn't worth it. Chlorhexidine was once regarded as the gold standard, but as time went on and because of its capacity to destroy bacteria, we ignored the drawbacks including staining, calculus buildup, and loss of taste. However, things only grow worse, and the odds are not on your side.
RISK Inactivation in Blood and Saliva The mouth is not often a dry location, unlike the desert around Las Vegas. Blood, saliva, and even toothpaste have been found to significantly impair chlorhexidine's antibacterial properties. According to studies, you should wait up to an hour before eating or drinking to prevent inactivation, and wait 30 minutes after using chlorhexidine as a mouthwash. RISK Inhibition of Fibroblasts: One point to emphasize while using chlorhexidine is how it affects the fibroblasts that produce the periodontal ligament. Chlorhexidine has been reported to harm fibroblasts and other collagen-producing cells, according to studies. In order for periodontal therapy to be effective, it is crucial that these cells are created appropriately. Improper development might result in reattachment problems, delayed healing, and an unfavorable outcome for the patient. RISK Allergic Reactions: Death is the most severe side effect of a chlorhexidine rinse that has been documented. The Food and Drug Administration has received reports of over 52 anaphylactic cases. In two of these cases, a fatality following dental extractions has been reported. Chlorhexidine is not meant to be used after surgery or on any open wounds due to its 1,200 ppm concentration. It's crucial to keep in mind that chlorhexidine wasn't intended to be used as a rinse for implants, extractions, or periodontal therapy. It was intended to be used only to treat gingivitis' swelling, bleeding, and inflammation and to be stopped after two weeks. Chlorhexidine use outside of the recommended dosage can have serious consequences. JACKPOT Alternative Only one other professional rinse makes use of activated chlorine dioxide. Fortunately, there are no hazards associated with using this rinse, and both you and your patients will greatly benefit from using it. Professional rinses are only available from licensed professionals and cannot be purchased over the counter. The same germs can be killed by activated chlorine dioxide just like they can be by chlorhexidine, but it also does it more quickly and with fewer parts per million. Since chlorine dioxide is a gas, it can swiftly leave the tissues with no lasting consequences. It is known to be superior to other products at not only getting rid of bacteria but also viruses, fungus, and volatile sulfur compounds. Our patients' many challenges range from simple ones, such as everyday care, to complex ones like chemotherapy or radiation. Help may be just a swish away if they need it. Professional mouth rinses are one of the most underutilized types of products in the dental field, and they are specifically designed to help our patients through some of these challenges. These mouthwashes aren't like the ones your grandparents used, yet they are still effective for bad breath. The rinses of today are supported by science and research. Some contain ingredients that break up biofilm and eliminate bacteria, viruses, fungi, and volatile sulfur compounds, which play a detrimental role in periodontal disease and wound healing.
Let's explore eight ways rinses can tackle some of the difficulties that are given to you and your patients. Challenge Number 1- Everyday Care We all advise our patients to brush and floss their teeth, but as we all know, they don't do a very good job of it. In 2014, a Delta Dental survey found that only four out of ten Americans floss at least once a day, while two out of ten never floss. Additionally, the patients who floss are urged to do it properly. You already know that flossing involves creating a C-shape around each tooth and sliding the floss up and down to remove bacteria. The question is how many of your patients do that correctly? Patients who don't floss or who do it incorrectly may benefit from professional rinses. Please understand that I am not saying that flossing is not vital; nonetheless, I see so many patients who floss poorly or not at all (even after they have had in-chair instruction). Furthermore, neither flossing nor brushing is antibacterial; they are just mechanical. Here, the appropriate rinse might aid in preventing plaque buildup. Rinses can also get to places that brushing and flossing can't, such as the tongue, the floor of the mouth, and any other crevice in the mouth where germs hide and thrive. Challenge Number 2- Plaque Reduction Bacteria form a matrix and create biofilm as a result. This also makes it possible for other germs to attach to the tooth, such as viruses, fungus, and different kinds of bacteria. Many solutions can kill a single strain of bacteria; however, few rinses actually break up biofilm and destroy the remaining bacteria. Dental plaque is a biofilm that can cause significant damage to the oral environment when not adequately removed. Plaque can be significantly reduced by rinses that dislodge biofilm, especially in compromised patients, children, and patients wearing braces. Challenge Number 3- Periodontal Therapy There are many variables that can lead to periodontal disease. We prefer to hone in on bacteria, but we must recognize that studies suggest viruses, fungus, and volatile sulfur compounds are all involved when dealing with any sort of gingivitis or periodontitis. Patients can achieve their ideal outcomes by acknowledging these extra factors during treatment and figuring out simple ways to get rid of them. Plaque and calculus must also be eliminated so that the gingiva can properly recover. Professional rinsing should eradicate volatile sulfur compounds, bacteria, viruses, and fungi without leaving behind stains or calculus. Challenge Number 4- Bad Breath I think we all know that rinses can help with bad breath. However, most over-the-counter rinses simply mask the issue or focus only on killing bacteria. You must kill bacteria and their excretions, which are volatile sulfur compounds (VSCs), if you want to get rid of bad breath. If you've ever come across a patient with halitosis, you are already familiar with the smell that VSCs can provide. The mouth is filled with bacteria and VSCs, particularly on the tongue and beneath the gingiva. By destroying germs and VSCs, the correct rinse can eliminate bad breath for eight to twelve hours. Challenge Number 5- Tissue Management After Surgery The mouth is one of the hardest places to heal after procedures like extractions and implant placements. The mouth cavity is a good environment for bacteria, viruses, fungus, and VSCs. It's also a location where it's challenging to keep wounds clean and dry. This is why professional rinses can speed up healing by assisting in the battle against bacteria and their byproducts. Additionally, it takes the gingiva 32 to 34 days to recover, making it crucial to have a rinse that can be used consistently over an extended period of time. Challenge Number 6- Fungal Infections The mouth is damp and dark. Fungi flourish in the mouth cavity because of this. Although candidiasis, a common fungus, can affect any patient, it is more common in infants, people with immune system disorders, and the elderly, particularly those who wear dentures. Another fungus infection that affects the corners of the mouth is angular cheilitis. These diseases can be cured in a few days with the help of contemporary rinses that kill fungi. Challenge Number 7- Pre Rinsing I believe it is common knowledge that patients should be pre rinsed before every surgery. We should do this for three reasons: (1) to affect the working environment, (2) to avoid patient-to-patient cross-contamination, and (3) to prevent patient-clinician cross-contamination. Before we start working, we should strive to eliminate as many bacteria as possible because the handpieces we use emit aerosols that contain millions of them. Use a rinse that kills both bacteria and viruses as you practice. Many individuals I speak with use a rinse that simply kills bacteria, but viruses are a major threat when we're concerned about cross-contamination. Challenge Number 8- Cancer Care More than 1.5 million new cases of cancer are diagnosed each year, and many patients receive chemotherapy, radiation, or even a combination of the two. The oral mucosa suffers greatly as a result. Many of these patients have dry mouth, burning, and uncomfortable sores. The appropriate rinse, used daily, can significantly lower these problems and keep patients more comfortable. In conclusion, a professional rinse must get rid of bacteria, fungi, viruses, VSCs, and biofilm in order to handle all of these problems. Additionally, because gingiva takes 32–34 days to heal, it must be safe enough to be used every day. There are rinses on the market that address some of these problems, but OraCare is the only one that provides a fix for all eight problems. These microorganisms are eliminated by the active ingredients in OraCare, activated chlorine dioxide and xylitol, which are safe to use daily and do not stain teeth or create calculus. Professional rinses should be an integral part of preserving and improving your patients' oral health, whether you use OraCare or a solution created especially to treat one of the issues mentioned above. You can learn more about OraCare's revolutionary health rinse at www.OraCareProducts.com or by calling 855-255-6722. We are all aware of how important bacteria are for the treatment of wounds, periodontal disease, and foul breath. But are you aware of the secret adversary? The one that bacteria exude to aid in their own success? Like all other living things, bacteria must consume food in order to thrive. They have to use the restroom after eating. Volatile sulfur compounds (VSCs) are emitted and exist uncontrolled in the mouth. VSCs are connected with poor breath because they smell, but they are also poisonous to your tissue, encourage bacterial assaults, and slow the healing of wounds. As a result, they play a significant role in infections, periodontal disease, and the impairment of gingival repair.
Rotten Smells If you are familiar with VSCs, you have probably heard of them in relation to bad breath. The unpleasant scent that we detect on patients' breath is due to VSCs. As dental professionals, we are expected to provide a remedy for this since it is the most common patient complaint. Patients who suffer from bad breath find it disruptive to their everyday lives and spend more than $1 billion annually on halitosis solutions. They frequently experience embarrassment and frustration since they have tried every over-the-counter remedy without success. This is because the majority of these products either target bacteria only or attempt to cover up the odor. Eliminate bacteria and VSCs from your mouth to combat foul breath. Toxic to the Tissue VSCs are hazardous to tissue, even at low concentration levels. VSCs are directly harmful to periodontal tissue, according to studies. Everyone has encountered a patient whose periodontal disease is immediately apparent as they enter the room. In dentistry, we occasionally get things backwards: the smell (VSCs) is what truly causes periodontal disease, not the other way around. Facilitate Bacteria Bacteria excretions and death cause VSCs, which make the cell wall easier for bacteria to move through and essentially allow a bacterial assault on the already compromised tissues. Given that both hard and soft tissues are affected, the presence of VSCs speeds up the transformation of gingivitis, the initial infection, into full-blown periodontitis. The longer VSCs go uncontrolled, the more damage they are able to do, and they actually have a multiplier effect that can worsen periodontal disease. Impede Wound Healing There are numerous hypotheses regarding how VSCs hinder wound healing. Some contend that they stop oxygen from reaching the site, while others assert that they promote collagen degradation. What is certain is that there is a connection between VSCs and inadequate healing. Numerous studies have shown that reducing VSCs helps speed up the healing process. For those of us in dentistry, the particular problem is getting wounds to heal in a setting that isn't really conducive to healing. The mouth is the ideal environment for VSC proliferation and microbial development. It goes without saying that we must address VSCs in order to combat bad breath, periodontal disease, and infections while promoting gingival repair. Therefore, the greatest strategy to aid in bad breath, give appropriate tissue management, and shorten healing time is to regulate the bacteria and VSCs. The placement of VSCs makes removal difficult. They are typically found in places where patients frequently forget to brush and floss and miss them altogether. The regions with the largest levels of bacteria and, consequently, VSCs are the interproximal regions, the back of the tongue, and periodontal pockets. Without introducing something therapeutic, we can't effectively remove VSCs since brushing and flossing only mechanically remove debris. One of the most popular VSC removers has been shown to be activated chlorine dioxide. This is due to the fact that it is a gas that directly interacts with gaseous VSCs in the mouth. Additionally, this chlorine dioxide gas can get to those tricky-to-reach places that are typically neglected. It has to come from a two-bottle system because you must activate that gas with each use. Single bottle systems that advertise themselves as chlorine dioxide are actually just sodium chlorite and do not remove VSCs as quickly as actual activated chlorine dioxide. When selecting a product to combat volatile sulfur compounds, keep that in mind. In conclusion, it is well known that microorganisms thrive in the mouth. We must choose products that destroy germs as well as the hidden enemy known as VSCs. |
Kristin Goodfellow RDHKristin is Chief Clinical Officer of OraCare, a practicing Registered Dental Hygienist Archives
August 2023
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