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!
You can pretty much find bling on just about anything these days from jewelled cell phone cases to jewelled nails to live jewelled insects. Adding a little bling to give you that extra sparkle has always been a top accessory and now you can even add a little bling to your teeth!!! Why you ask, well they are very low maintenance, don’t require you to put them on daily, and can last a very long time if taken care of properly.
With various companies that offer tooth jewellery (also spelt as tooth Jewellery or tooth Jewelry) and with various you tube videos saying you can do it yourself, it has become a topic of confusion in deciding where to get tooth jewels or tooth gems and how or who to pick to place it on your teeth for you.
In our research, we have come across some concerns regarding the type of tooth jewels being sold or where they are being obtained. There are only a few select distributors who guarantee that their tooth jewellery doesn’t contain lead and that their metal jewels are truly gold or white gold so it is important to either do your research if you plan on purchasing a jewel yourself or select a professional that can confirm that the jewel being placed on your tooth is safe for dental purposes.
Once you’ve decided which tooth jewel or gem option would be best for you, picking the right professional to place them on is just as important.
Just like cementing an orthodontic bracket, your dental professional is trained to ensure that certain precautions are taken when bonding the tooth jewel to your tooth’s surface.
In order for tooth jewel to bond properly to the tooth’s surface, a chemical bond must occur and in order for this to occur, the tooth surface has to be completely dry then roughened up.
To roughen the tooth surface, an etchant is used which is left on the tooth for about 30 seconds. It is then washed away and a primer and bonding agent is then applied and cured using a curing light. Proper eye protection must be worn as this light can cause damage to the eyes. An adhesive is then used to bond the tooth jewel or gem to your teeth which is then cured again using the curing light. When done properly, no damage to the tooth should occur.
At Credit River Dental, as we do everyday, all instruments are processed through a sterilizer ensuring no cross-contamination takes place and all one time use items are disposed of. It is important to remember that we are dealing with the oral cavity so proper precautions to prevent cross-contamination between not only the professional and the client but also between clients must be taken to ensure there is no transmission of disease.
Tooth Jewellery is definitely a fun and low maintenance way to…
If you’d like to find out more, you can click here or you can contact our team at Credit River Dental Centre at 905-278-4297! We’d be happy to answer any questions you may have about Tooth Jewellery!
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.
Updated Antibiotic Prophylaxis Guidelines Prior to Dental Treatment
In 2007 the American Heart Association’s (AHA) established its latest guidelines for antibiotic prophylaxis prior to dental procedures to prevent infective endocarditis. The guidelines were changed as a growing body of scientific evidence has shown that the risks of taking preventive antibiotics outweigh the benefits for most patients. These risks include adverse reactions to antibiotics ranging from mild to potentially severe and the development of drug-resistant bacteria.
The AHA guidelines emphasize the importance of achieving and maintaining excellent oral health and practising daily oral hygiene. For most patients, taking preventive antibiotics before a dental visit is not indicated. The guidelines state that prophylactic antibiotics, which were routinely administered to certain patients in the past, are no longer needed for patients with:
Only patients at greatest risk of developing infective endocarditis, an infection of the heart’s inner lining or the heart valves should receive short term preventive antibiotics before common, routine dental procedures.
People who should take antibiotics include those with:
1.prosthetic cardiac valve or prosthetic material used for cardiac valve repair
2.a history of infective endocarditis
3.certain specific, serious congenital (present from birth) heart conditions, including:
4.a cardiac transplant that develops a problem in a heart valve
Antibiotic prophylaxis is recommended for patients with the above conditions who undergo any dental procedure that involves manipulation of gingival tissues or the periapical region of a tooth and for those procedures that perforate the oral mucosa. The following procedures and events do not need prophylaxis:
The Canadian Orthopedic Association (COA), the Canadian Dental Association (CDA) and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada provide the following guidance in regards to the management of dental patients with orthopedic devices:
From time to time we do see patients whose Orthopedic Surgeons still insist that the patients take an antibiotic prior to dental treatment in some cases for 2 years after surgery and in some cases for the rest of the patient’s life. In light of these new guidelines, it is therefore recommended that the Orthopedic Surgeon prescribe the course of antibiotics for the patient in these cases. If you have any questions regarding any of the above information, please feel free to call us!
What is Sleep Apnea?
Sleep apnea is a common medical condition in which you have one or more pauses in breathing or reduced breaths while you sleep. These stoppages can last a few seconds or a few minutes. Usually normal breathing starts up again with a snort or a choking sound. Sleep apnea for many years was thought to be a condition that only affected older overweight men. Recent studies have found that although age and obesity do play a factor in who does or does not have sleep apnea, sleep apnea can affect men and women alike, all shapes and body types, and can even affect children.
Complications of Sleep Apnea
A number of complications can result from sleep apnea including:
• Memory loss
• Daytime Fatigue
• Trouble concentrating
• Gastric reflux (heartburn)
• Hypertension (high blood pressure)
• Erectile dysfunction
• Type 2 Diabetes
• Liver problems
• Abnormal cholesterol
• Sleep deprived partners
Why the Dentist?
You may be wondering why a dentist would be concerned about sleep apnea. One of the signs of sleep apnea is tooth grinding or bruxism. That’s not to say that all grinding is due to sleep apnea but when someone has sleep apnea, one of the protective mechanisms for the body to achieve a more open airway is to move the lower jaw back and forth. Secondly, your dentist or hygienist usually spends a fair bit of time looking in your mouth and down your throat or airway so we can give a fair assessment if we see anything suspicious.
Sleep Apnea in Children
Pediatric obstructive sleep apnea is a sleep disorder that occurs when your child’s breathing becomes partially or completely blocked repeatedly during sleep. The condition is due to narrowing or blockage of the upper airway during sleep.
There are some differences between pediatric obstructive sleep apnea and adult sleep apnea. Children often have only partially narrowed airways rather than a complete blockage as often seen in adults.
Obesity is a common factor underlying obstructive sleep apnea in adults. But in children the most common condition leading to obstructive sleep apnea is enlarged tonsils and adenoids. If your child suffers from any or all of the following symptoms, talk to your dentist or family doctor:
• Snoring. Approximately 10% of children who snore have sleep apnea
• Mouth breathing. Children with enlarged adenoids tend to breath with their mouths open.
• Breathing pauses during sleep
• Daytime sleepiness
• Difficulty with concentration
• Poor attention span
• Behavioral issues
• Poor performance at school
• Night time Bedwetting.
Sleep apnea is one of the most UNDERdiagnosed medical conditions which has very serious health concerns. We now know there is no one body type or only one segment of the population that prone to sleep apnea. If you or your child experiences any of these signs and symptoms and would like more information, please do not hesitate to call us at 905-278-4297.
TODAY IS WORLD CAVITY-FREE FUTURE DAY!
All around the world, the Alliance for a Cavity-Free Future (ACFF) has come together and recognized that cavities are a worldwide issue that can be prevented through a collaboration of various professionals which will in turn improve the quality of life for those who can remain cavity free.
As dental professionals, our team at Credit River Dental Centre strives towards this goal as we continue to work with our patients in helping them achieve and maintain optimal oral health.
No matter what your age is, it is important in assessing your risks whether it be diet, age, ability, independence, medical and medication concerns, we will work with you and your other health professionals collaboratively in order to ensure that we maintain not only your oral health but your overall health.
Think you are at Risk? Take this Early Cavity Risk Assessment provided by the ACFF and know your risk!