Not Truly Gone

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“Grandpa slipped away,
Quietly today.
He simply went to sleep,
No more to wake or weep.

But Grandpa’s not truly gone,
Because his memory lives on,
In all of us who loved him,
Never to be forgotten”

Please read and share the post that is under this link.

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Oh, by the Way

Where am I?

I have been on a holiday for couple of days in a place that is beautiful beyond words. Traveling with kids means no time to do any writing. Plus I try to practice my another hobby – photography. 

So bear with me. I’ll be back!

Repost with Forewords: Alcohol – The Feared Subject

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Acute pancreatitis is life threatening illness

Today I went to see a man who for my children is very dear despite his dependency to alcohol. They never defined him as an addict and never thought anything but the best of him. This man is their grandfather who fell gravely ill several months ago with acute pancreatitis caused by lifelong abuse of alcohol.

Having spent over five months in hospital of which he spent four in an intensive care (2 months in coma), he was finally at home. But he was a shadow of a man he used to be.

This man used to be proud. He was a kind and pleasant (when sober) man. He was very skilled and was ready to help others when needed. He loved kids and knew what would make them happy.

Today when I went to see him he was lying in bed barely recognisable weighing just 50 kg. He had tubes coming out of his stomach leading into a bag that was filling up with brownish secretion from his organs that were riddled with a spreading necrosis. He was unable to obtain any food or drink inside, taking several medications many times a day, dependent of his wife who was looking after him. His voice was like he was speaking from the grave.

It was the saddest sight I have ever seen. There was no need or desire to say I told you so. No gloating over being right all these years about his future. It was just simple sadness over a kind man, father, husband, grandfather who would have had so much more to give to so many but instead now was bed-bound waiting the imminent death. Slow death that took away all pride and dignity and which every day reminded him why he is where he is now. Alcohol.

But even more sad than seeing him now is the fact that he never got the help he would have needed for his drinking which started at his twenties. No-one intervened when there was still a chance to turn the tables. Instead of this a troubled sensitive soul was taken over by the numbing comfort of an alcohol that took a firmer hold of him as the years went by. He faced many misfortunes in his life and he dealt with them by alcohol. He had happy times and he dealt with them by alcohol. Before he reached his fifties everything he did, everywhere he went the alcohol came along.

He was told by all the close relatives that he cannot continue drinking like this. He was told he has a problem with the alcohol. One day he admitted he does, the other he declined. He never seeked help. And no-one could force him. Instead he came a master in finding excuses to visit his hidden bottle. Taking the garbage out, checking something from the garage, fetching firewood for the fireplace. Everyone who was witnessing this knew that he went for his hidden bottle. This too was heartbreaking to watch.

When he finally fell ill and the house needed to be emptied of all the alcohol there was altogether 30 litres of strong spirit.

This man’s story is not unique. There are plenty of similar fates in the world.

The longer the alcoholic carries on drinking the harder it is to intervene. I mean that the intervention we can do at the dental practice has less impact than it would have in the early days of an addiction. That is why the early intervention is very important and us dental professionals have a very easy and natural way to intervene.

Please read one of my earliest post below and hopefully it will bring you courage to ask about patients’ alcohol consumption.


About 60 year-old man came to see me one morning and complained that every once in a while a layer of skin comes off inside his mouth and no-one has been able to tell why. He was concerned and felt…

Source: Alcohol – The feared subject

Eeny Meeny Miny Moe – Which Type of Tooth Wear?

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There are four types of tooth wear that we diagnose from patients’ mouths. Erosion, abrasion (I’m sorry for a missing link – I did not agree with any of the images of abrasion), abfraction and attrition. The easiest ones from these to diagnose are the erosion and attrition. You can’t go wrong with them. But it is completely different case with abfraction and abrasion. I run into this very often with my patients.

When a dentist or a hygienist sees tooth wear on the neck of the tooth they diagnose it by default as abrasion caused by too vigorous brushing. They recommend softer toothbrush and this silly brushing technique called Bass (it is so silly that I think I am going to dedicate one post entirely to this technique).

This normally leads into a situation where patient begins to be too careful with the brushing because she doesn’t want to cause further damage to the teeth. That’s when the plaque starts to build up to the gum line, gum gets inflamed because of the plaque and the patient begins to notice bleeding when brushing. Now she’s even more careful with the brushing as in her mind bleeding means she’s doing something wrong – brushing too hard like the dentist said she is.

But what if the dentist/hygienist misdiagnosed the tooth wear? What if the correct diagnosis was the abfraction?

Tooth wear – What to Check?

When you see a tooth wear that you are tempted to diagnose as abrasion, stop for a moment before you proceed giving advice on brushing. Instead do the following:

1. Check if there is mobility on the teeth affected by tooth wear

2. Check if there are interferences on side movements and protrusion

3. Check if there are shiny facets on occluding surfaces

If you get positive answer to even one question the chances for the tooth wear to be abfraction are great. And in this case telling patient that the tooth wear is caused by her brushing can be damaging in many ways:

  1. It is hard to convince a patient that they are not actually brushing too hard and that they have not damaged their teeth by it. I have my ways of convincing the patient but life would be soooo much easier if I didn’t have to.
  2. The dentin will decay very easily (as I’m sure you know) and plaque accumulating and staying there undisturbed for longer period of time because of too careful brushing will very quickly cause decay. And we all know how these fillings in the cervical area are pain in the butt. Somehow they always seem to have overhangs or they come off when scaling. Sound familiar?
  3. The teeth where the surface of the root (dentin) has been exposed by receding gums will get sensitive if the plaque builds up.
  4. If the tooth is mobile and has already bone loss the plaque building up to the gum line and inflaming the gum can be disastrous. Please memorize that

MOBILITY + PLAQUE = RAPID BONE LOSS

The Cause for Abfraction Needs to Be Dealt With

When a tooth interferes with full closure, it will trigger deflective interferences6-8 and cause any of the 7 signs and symptoms of occlusal disease such as hypersensitivity, abfractions, mobility, excessive wear or fractures, and muscle or temporomandibular (TM) pain.

There is no consensus amongst the dental professionals over the right approach to occlusion. Is this the reason why signs of interferences on occlusion are ignored or unchecked and the tooth wear is so easily made as patient’s fault?

The quote above is from an article The Three Golden Rules of Occlusion in dentistrytoday.com and you can read a full article here.

But by Whom?

To be honest – and like I have expressed in my previous post – I would not let just anyone touch my occlusion. I would love if the dentists would refer patients to the specialist in prosthodontics and stomatognathic physiology because they have the best knowledge and skills to treat the occlusion. And that’s something every patient is entitled to.

Guilt Is a Heavy Load to Carry

I have often noticed that patient feel unnecessarily guilty over damaging their teeth. They feel guilty and desperate over the fact that the damage done by brushing is irreversible. And that they are not sure if their brushing technique is still damaging their teeth hence too careful brushing to make sure they are not.

I believe that guilt does not lead us forward in life, it does not bring anything positive into our lives. Therefore I always try to relieve my patient’s guilt whenever it is possible.

In the case of tooth wear and some dental professionals way of putting the blame on patients’ brushing technique I always have the same conversation with a patient. It goes like this.

Me: Have you been told that you brush too hard?
Patient: Yes I have.
Me: I thought you might have. You see when a patient is told this, she starts to be too careful and then the plaque starts to build up and there is actually plaque in the gum line of your teeth. (I take a mirror and show the plaque to the patient)
Patient: Eww..
Me: I personally try not to tell patients that they are brushing too hard because this leads to too careful brushing which will cause more problems like decaying and gingivitis. Instead I interview the patients about how they brush their teeth and correct it if necessary. You see the tooth wear can be caused by other things than just vigorous brushing… 

Prior to this conversation – in the beginning of the treatment – I have interviewed the patient and asked about her oral hygiene habits. Which brush she uses? How often? How often does she replace the brush head/brush? How does the brush head look like before replacing it? Spread or still like new apart from colour fading? This is why I can continue the above conversation like this.

Me: In your case I doubt it that the tooth wear is caused by your brushing but I will just in case show you the right technique. I will first just check couple of things…

And then I check the mobility, the interferences and the occluding surfaces. I feel great satisfaction when the teeth affected by tooth wear have mobility on the side movements. I am on the right path!

The patient is visibly relieved when they can stop worrying about their brushing. Well who wouldn’t be! There is enough to worry about in life even without worry over brushing.

 

 

My Take on the Brexit

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Like actual politicians do, I will revert a statement I made in my previous post about politics. I will write about politics once more (and probably will be again). Today I am going to write about the Brexit.

Thank You Londoners

My London is multicultural, tolerant and welcoming. When I laid my feet on its ground for the first time it immediately felt like home. It was something I had never felt anywhere in the world. Not even in my home town.

Nobody asked me what my qualifications were or what I had achieved. Nobody even asked me  what I do for a living. People I met for the first time were genuinely interested about me as a person – not about all the superficial and secondary details that in many places seem to define us as human beings.

I loved to meet people from around world. In my last workplace there were 9 different nationalities including the english colleagues. And it wasn’t a burden to anyone. It was anything but a burden. I can only speak for myself but I would not know as much as I do now about various cultures if I hadn’t met these people. I often tell stories about them when I teach the wonders of the world to my children.

When I was on the secondary upper school in my home country I remember London was described as a melting pot of all the nations. And that it truly was. People from different origins giving space for one another in the biggest metropolis in the Europe. Metropolis where unknown was a source for endless curiosity for people – not fear and prejudice.

That’s why I fell in love with London and thought up until the recent times that the rest of the UK was the same. Oh, how naive was I! In the light of the morning when the results of the Brexit vote were revealed, I felt ashamed of my connection to the UK and utterly disappointed. The few friendships I made with english people suddenly felt like they were established on false grounds. Were they smiling with me but frowning at my back?

Who knows what the future will bring for London when the UK leave Europeans behind? I guess nobody knows for certain. What I do know is that I am waiting it with a heavy heart and great sadness as I believe things will never be the same in the UK and London.

Ever Seen a Patient with an Implant? Read This!

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Today I saw a patient who had had an implant done to replace upper right first molar. The implant treatment was finished a year ago in another practice.

Since then the patient had seen hygienist twice in my practice. The implant crown itself looked immaculate but the gum was very red and puffy and it bled heavily after probing.

I knew what to ask next and I even knew the patient’s reply to this.

“Were you told how to clean the implant at home?”

“No I wasn’t” replied the patient with is-it-supposed-to-be-cleaned-expression on his face.

This happens too often. Almost every time I see a patient who has recently had an implant done.

Note for all the dental professionals who make the implant treatment’s final stages and do not give oral hygiene instructions (OHI) for the patient:

You should always tell and show how the patient can clean these costly pieces of metal and porcelain. It is your responsibility as a dental professional and the paying patient’s right!

Can you give me any other excuse for not giving OHI than the fact that you are too busy making money and forgetting the basics? I believe you cannot.

And you hygienists who see patients with implants:

  1. Always check how the patient is cleaning them. More so if the gum around the implant is either bleeding or there is plaque around it
  2. Advice if necessary and show in their mouth how it is done
  3. Check if the patient understood your instructions by asking them to show they can do it. Teach them if they struggle
  4. Check on a follow-up visit that the gum has healed. If not, refer to a dentist

Why Is It So Important?

With the implants it is vital that there is no bleeding in the surrounding gum. They will get an implant’s equivalent to gingivitis – peri-implant mucositis which can lead to the peri-implantitis (same as periodontitis with teeth) very rapidly. The worst case scenario is that the implant will lose it’s integration to the bone which could have been easily prevented.

The patient I saw today left home with instructions on how to look after his implant. And I will see him for a follow-up visit to make sure the gum has healed (can you see the shining halo around my head?).

Honestly, it’s not that hard to do your job properly so shape up please!


Here‘s further reading on the subject.

Blast from the Past

Do you know how it was like to work at dental practice in the 70’s?

Once upon time there was a young nurse Jane. She was hard working and liked by the dentists. One day Jane moved to another town and applied for two dental nurse’s posts. She was offered a job from both of them but she chose a dental practice of four dentists. She was allocated to work with a 30 year old dentist Anna.
Anna was pleasant in behaviour towards Jane. Using kind words and voice when talking to her. Jane was very happy to have found such a good workplace.

But then – and not very long after Jane had started working there – became a day when everything changed. Jane had done something to upset Anna. It was something that Anna found completely incomprehensible.

“You are not a very good nurse, are you?! Not half as good as your predecessor! She at least cleaned my windows!” Anna said with a raised voice.

Jane wasn’t sure how to react. She was in shock about this sudden change in Anna’s behaviour. What windows did she possibly mean?

“I don’t understand what you mean?” Jane said cautiously.

“You… What… You… Don’t understand?!” Anna gasped.

“MY windows of course. My windows at home!” She added and stormed out of the room.

Jane was standing still for a while holding the instruments she was organising. She didn’t know she was supposed to clean dentist’s private windows as well. And probably on her own time as working hours she spent in the practice. That’s not what she signed for.

From this day onwards Anna treated Jane like garbage. Shouting and swearing at her even in front of the patients. Jane felt humiliated and insecure. Should she leave? She didn’t want to as nurse’s jobs were hard to find. So she stayed and the thing that made it easier to put up with Anna’s bullying was the practice’s other dentists’ support to her. They told Anna off many times but it made no difference whatsoever.

One morning Jane came to work and was walking practice’s long corridor to her surgery. Just when she was reaching to open the door Anna came out. She was sitting on her chair and rolling it forwards with her feet.

“Odd.” thought Jane, “What a peculiar thing to do…”

She watched Anna and her transporter chair rolling to the other end of the corridor where the toilet was. In she went and so did the chair without Anna getting up. Her long white saggy uniform got stuck between the door and it went up and down as Anna tried to pull it in without opening the door. Jane was amused and was wondering if Anna has completely lost it. Probably has.

The bullying – and the chair rolling – carried on for the next 4 months but Jane put up with it and did her job as well as she could. But she did not clean Anna’s windows. Nor her home. That’s where she drew the line. She was a dental nurse, not a servant!

Jane had been working for Anna for almost six months when Anna one day – at the end of the day – said to Jane

“Your employment will be discontinued in a fortnight.”

Jane was caught by surprise and wasn’t able to say anything sensible to Anna. But perhaps the question mark over her head was so obvious that Anna continued with a blunt voice

“I am pregnant and my due date is in a month.”

Now Jane was even more surprised but suddenly it all made sense. The saggy uniform, rolling with the chair, mood swings… It wasn’t because Anna was a loony. She was pregnant which now was obvious!

Jane felt angry and helpless. There was nothing she could do but to find a new job. Should she have known it was a temporary post she would have chosen the other job she was offered.

The working relationship between these two ladies came to an end. Whenever Jane saw Anna in town with her baby and husband she never greeted Jane or made any gesture she knew her.

Today is the day of the retirement for Jane but she remembers Anna and her bullying like it was yesterday. Even 40 years was not enough to forget or forgive and she secretly feels satisfaction over the fact that Anna is in a care home suffering from the Alzheimer’s.

“Karma” She thought when she closed the door of her work place for the last time.