As your cavitron buzzes away you suddenly notice that your patient is snoring in perfect rhythm with your ultrasonic scaler. You check your notes and realize that this happened at their last hygiene appointment and even the one before this. Is this normal or are your scaling skills so amazing they have a soothing effect? Probably not!!! Should this concern you? Being the caring hygienist you are and one fully skilled in the assessment of the periodontium, you start to wonder why this is happening to this patient and not others. Most of the time, patients are pale-knuckled in the chair until their treatment is complete to the point where you sometimes have to pry their fingers off the arm rest. You look at your patient’s file to see if there is anything that you can correlate to her sleeping episodes. She’s a petite young lady in her mid thirties. Since you’ve built great rapport with her, you know that she isn’t married and doesn’t have any children so you start to wonder. Yours and the dentist’s clinical findings indicate she’s a heavy bruxer or clencher and you’d been doing your due diligence in trying to get her to commit to wearing a night guard but she strongly believes she doesn’t need one because she sleeps with her mouth open! Sound familiar?
What else can it be? She’s got you stumped. Most would leave it at that and just book her next hygiene appointment but you know sometime doesn’t feel right so what do you do?
Etiology and Assessment are among the most important tools any clinician has in their arsenal especially when it comes to the field of dental hygiene. We have such an amazing ability to make a difference with our skill set because of the information we can share with patients. Educating them about their periodontal condition, decay prevention, and about the connection between oral health and their systemic health are what we discuss on a daily basis so it’s no wonder when something seems off with our patients, we notice.
Obstructive Sleep Apnea has been a concern for quite some time but until now, our knowledge has been limited. We never thought to extend our assessment to the tongue, tonsils and how wide a patient can open. Sure, we were taught to measure these things in hygiene school but weren’t really taught how to apply them in practice or what their significance is. As part of our complete oral examination, we assess the tongue using the Mallampati Score. Traditionally, this score is used to assess intubation for general anesthesia but the classification a patient is diagnosed with can determine tongue obstruction and its contribution to obstructive sleep apnea.1
The assessment of the tonsils is also significant as this may too contribute to airway obstruction. The Friedman grading scale is what we use clinically in our practice to grade the tonsils from 0 to 4 – 0 being no tonsils are seen or a tonsillectomy has been done to 4 where the tonsils are actually touching or “kissing.” To ensure that we don’t base our findings solely on what we see clinically, we also have a patient fill out a questionnaire which also helps us determine if they may have sleep apnea or are at risk. Click here to see a sample of the sleep apnea questionnaire we utilize.
So what do you do if you suspect your patient has sleep apnea? As clinicians, it is important that we collaborate with other medical professionals and in this case, it is very necessary. You would then recommend that your patient see his or her medical doctor and request a sleep test to be done. It is only through the sleep test that confirmation of a Sleep Apnea Diagnosis can be made. Inform your patient that if their medical doctor doesn’t feel that it is necessary, they can discuss the findings with you. Unfortunately, this has occurred but we are more than willing to share our finding with their medical doctor.
When a final diagnosis has been made then the proper treatment for sleep apnea can be administered. Until treatment is rendered, it is best that certain dental treatments be postponed as they may add to the patient’s risk. For more information on Sleep Apnea, click here!
At Credit River Dental Centre in Mississauga, we are always striving to better educate ourselves so we can provide our clients with the best care possible. Whether it is attending a course, dental seminars or conventions, reading up on dental journals or simply testing out new products, it ensures current up-to-date knowledge. This broadens our range for implementing the best option for each client’s oral health with optimal solutions.
This month, we had the pleasure of speaking with an Oral Science representative. Oral Science is a powerhouse manufacturer of dental innovations. The speakers/educators all come with dental background so they are aware of the most common dental concerns and strive to tackle those problems with new and lasting advancements.
There can be many dental concerns for each client, but the most common problems are cavities, xerostomia (dry mouth), gingivitis (gum disease) and tooth sensitivity. There are many products on the market related to these problems, but we wanted to make sure we were investigating all possible options to help us help you.
One item we learned about is a product called Gengigel. This product is a gel that helps reduce gingival inflammation and bleeding. It can be used after many treatments such as a hygiene appointment, tooth extractions, mouth sores, ulcers and many more. You simply need to apply and massage the gel on the specific areas and not eat drink or rinse for 30 minutes.
Another product we learned about and tested for ourselves is the Plaque HD toothpaste. This is an all natural toothpaste with a fresh minty taste that is proven to prevent cavities by showing you exactly which areas you should be focusing on. There is a plant based component that stains present plaque on your teeth a greenish-blue colour. With a clear visual of the problem areas you can easily tackle and brush away all the plaque ensuring that everything is gone.
Lastly, we were presented with another toothpaste called X-PUR Remin. Unlike Plaque HD toothpaste, X-PUR Remin can tackle more problems than just cavity prevention. It also helps with xerostomia (dry mouth), periodontitis (bone loss disease) and even whitens! X-PUR Remin is free of sodium lauryl sulfate (a foaming agent) and is all natural, GMO, gluten and sugar free.
At our Mississauga dental office, the notion “you never stop learning” is a true thing. We love gaining more knowledge whether it is about our hobbies, work and anything in-between. We would love to share our knowledge with you! We have samples of these products in our office so do not hesitate to call and ask us about all these amazing products.
As your Mississauga dentist, you oral health is our top priority and in order to ensure we provide you with the best options for maintaining your smile, keeping current is definitely important.
Many people just close their eyes and bear and grin it all especially if they've waited a year or two before seeing you for their appointment. This isn't what any dental hygienist wants to be known for and definitely not how we want to be perceived as when patients see us.
So how can we change this? Well, you could be the best guitar player in the world but without a guitar that has the proper strings and is not properly tuned and maintained, it may seem as if you aren't. The same goes for a hygienist. Having the tools that are necessary for treating a variety of people is important especially when it comes to customized care.
In our office, we understand the necessity for a variety of instruments and have tried and tested many of them to see what would provide our patients with the most comfort while helping our hygienists continue to be efficient at what they do.
Based on what we have tried, both the Piezoelectric and Ultrasonic have their benefits. We have tried both yet are still in favor of the Ultrasonic, namely the Cavitron because of its versatility. Unfortunately, because of the lateral tip movement of the Piezo, a major downfall is that the clinician must re-position herself often to adapt the tip whereas with the Cavitron, having elliptical tip movement allows for more adaptability and less operator strain.
Tip On Tips
For universal use, we like the the Triple Bend Focused Spray Slimline 1000. It allows you to fit in those tight interproximal spaces and allows you to adapt with minimal discomfort to the patient. Because of its slender tip, you can access subgingivally quite easily again with minimal discomfort.
One tip that we have come across which is great for those tough lingual surfaces is the Beavertail Insert. How many hygienists can say that they have worked a full day without having that patient with moderate mandibular lingual anterior calculus? The beavertail is great for this and other heavy lingual calculus or smooth surface calculus.
We're lucky enough to have quite a number of inserts in our armamentarium and have been able to get great use out of our lefts and rights as well. They're intended to be used interproximally but are fantastic for using underneath lingual retainers which sometimes pose difficulty to access without operator strain. We keep these in our perio-kits but will pull them out for those difficult to clean fixed lingual retainers.
Having a closed bottle system vs. a city line allows for use of an anti-microbial agent during debridement when necessary and because it is a closed system, there is more control over the water quality in the bottle. One advantage that you can purchase with some ultrasonic systems is the ability to convert to prophy-jet mode which is very effective at removal of stain. So if you're looking into a new unit for your office, these are definitely items to consider.
Maintenance of your Power Driven Instrument
Like with everything, maintenance is key to ensure that your power driven instruments are working properly. Almost all of the city line and even bottled system units that have the option of a city line, contain a filter on the water hose itself that needs to be changed for every so many uses so make sure you have this on your maintenance schedule. When your unit is not outputting any water, this may be the cause as it could be clogged.
Where we have found there to be significant differences are in the varying brands of hand scalers that are available today. After testing a number of scalers and currettes from different companies, we still stand behind Hu-Friedy because of the variety of scalers and currettes that they offer and the fact that you can easily change their coded rings. We typically order the Ever Edges as we like that they don't require as much sharpening as the regular BUT the only downside is that because it is made with a stronger metal which allows it to maintain its sharpness, they are a little tougher to sharpen. For a course on Maintaining Your Edge, click here. So why are the coded rings important? Well, it makes things easier when keeping track of kits and also keeping track of instruments that require sharpening, etc. The rings are made specifically for the design of the instrument so you don't have issues with them falling off or issues with a tacky residue left over like tape leaves. We have tried other brands and have had issues with resin handles cracking and instrument tips discoloring. Some issues were a decrease in tactile sensitivity and not being as ergonomic.
The two instruments that we like and have included in our armamentarium are the Nevi 2 SCNEVI29E2 which is made by Hu-Friedy and other instrument companies or the Montana Jack by P.D.T.. We like that both are very thin at the tip which allows for access in those tight interproximal spaces where light difficult-to-access calculus may be lurking. They can easily access what their wider counterparts cannot. They are both similar so you'd only need one or the other in your kit.
After taking a course and receiving a Sharp Diamond Coated instrument from LM Dental and trying it out for about 7 months now, we can honestly say that they have held up to their claim of maintaining their sharpness without being sharpened - as if we purchased them yesterday. We've had no issues with sterilizing them either which was a concern because of their silicone handle (you can select from 3 different handle types). Ergonomically, they are comfortable to use and allow for good tactile sensitivity. We were very excited to learn about their newest instrument the Syntette which is a combination of a mini 11/12 currette and 13/14 currette all-in-one allowing removal of deposits from both mesial and distal surfaces. We ordered this again in the Sharp Diamond Coat to enjoy the benefits of sharpen free. After 4 months of using it, we love it!!! It is definitely an instrument that can make you more efficient while providing continued comfort to your patients. We do not use LM Dental's instruments exclusively because their Sharp Diamond Coated instruments are still limited to being available in minis but we are hoping that this will change soon.
For implant instruments, we are not fond of plastic instruments or those where you have to screw on the tips. When you're trying to beat the clock, who has time to screw these in? We do like the titanium instruments and have only a universal sickle (H6-H7) and posterior universal (204S) by A. Titan Instruments in our kits. I haven't really encountered sub on an implant that required more than these two instruments to remove. We are also a big fan of the blue implant ultrasonic tips which require a special implant insert (yellow handle). We debride the bulk of calculus with this and remove the rest that is near the thread with the hand scalers.
We hope that we've been able to offer some insight on what we think are great instruments to use in the dental hygiene industry and also what to consider. As an office, we're always looking for ways to improve what we do everyday and understand the importance of having the tools to provide customized care.
After being a hygienist for 14 years and CDA 7 years before that, I've learned that the most important key to doing what you love and doing it well is having the tools to do it with and of course having a workplace you love!
Thank you for taking the time to read this post!
Disclaimer: We have no affiliation with any of these instrument companies or their distributors. We just wanted to offer a review on what we believe are exceptional instruments to have as hygienists.