Author: Dental Revelations

A dental professional on a mission. Also loves photography and writing. Follow me to learn the secrets of dentistry.

Have you dropped your dentures in the toilet?

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Henna blog

You know the feeling when you have just finished writing an important project like a novel, report or a BLOG POST and the device throws in a blue screen of death. Well my equivalent to blue screen today was to drop my mobile phone into the toilet (continue reading for the advice on dentures). In it went and so did my nearly ready next blog post stored in the phone’s memory.

At the moment – 3 hours from the moment of doom – the phone is still dead and I have arrived to a holiday destination in a remote area where replacement for my device is difficult to get (thank god for spouse’s pc that makes this post update possible). So I am sipping away well deserved wine despite the fact that the bacteria in my mouth will metabolise it to nasty carcinogen and cause me an early death.

Anyway about toilet seats. I live in a country where the toilet is flushed with a drinking water and if you have read my previous post you know that the quality of the drinking water needs to be of certain level. So dropping your dentures or mobile phone into the toilet is not THAT disastrous thing really (if only the mobile phone would survive the wet conditions). Plus I have a memory of my teacher in dental school – the same scary periodontist as on one of my previous post. She was teaching us about different bacteria in mouth and said with great wonder that

“they have found even bacteria that is normally found from people’s rectum”

To us young students it was no reason for wonder (like it was to this near-retirement-age teacher) that bacteria from rectum was found from people’s mouth. People mingle with all sorts of things nowadays.

So there is more reason not to worry if you dentures accidentally fall into the toilet. If they survived the fall without cracking, just pick them up, wash your hands and clean the denture with washing up liquid like Fairy (not toothpaste) and they are as good as new.

Now I must apologise my rampant writing, just poured down my third glass of wine. Also, I hope you understand that my blog post might be quiet for a week or so.

Chin-chin!

 

Do You Recognise the Gum Disease?

Dental Revelations6 Comments
Dental Revelations Blog
Be careful next time you open your mouth in the bus. I might be sitting next to you.

Many people have gum disease without knowing it and it often comes as surprise when they are told about it at the dentist. Even bigger surprise would be if they knew how many dentists do not recognise the gum disease or know what a comprehensive treatment is for it.

I have seen countless amounts of patients in my career whose gum disease has gone undetected. It’s astounding! I’ve had patients who have visited the hygienist and the dentist every six months but still there is massive amounts of subgingival calculus around every teeth. And it is deep and tough to remove.

Just guess the surprise of the patient when instead of having a 15 minute check-up and 30 minute hygienist visit like normally, she will now need three 60 minute visits to remove the calculus thoroughly and a 4th visit in three months time. To be honest, this upsets me often. It’s not that difficult to diagnose the gum disease. It’s not rocket science for crying out loud!

I have spent way too many hours explaining why my colleagues have not noticed the gum disease. And my efforts for not sounding too annoyed at my fellow professionals sometimes fail miserably. Luckily, most of the patients take it relatively easy and do not demand compensation from the previous dentist. Instead they are normally very grateful that somebody caught the condition.

There will be information for professionals next but the patients benefit of reading it too. If you are a patient you can move on to the end of this post if you want to skip the professional part.

So Why Don’t You Recognise the Gum Disease?

There are five probable reasons (add more to the comment box if you wish).

Lack of time. In 15 minute check-up the dentist should go through the medical history of the patient, check the teeth (loose fillings, decay, fractures etc.), the soft tissues (inside the cheeks, tongue, lips, roof and floor of the mouth and the throat) and the gums. Plus there might be need for the x-rays. Fifteen minutes simply is not enough for this considering that the disinfection business before the next patient should be done as well. Even 30 minute appointment might not be enough.

The X-factor. By X I mean money and it is related to the time issue. Dental practices have 15 minute check-ups because instead of having two patients in an hour that pay X amount for the visit they can have four. Four times X is better than two times X. At least for the practice.

Lack of basic skills. We have an instrument which finds any gum disease from any patients mouth when used correctly. Or when used. It is not by default that this instrument, perio probe finds it’s way to the check-up tray. I have seen dentist doing the check-up by using the sharp explorer only. And even if the perio probe is used, it is used incorrectly and the gum disease goes undetected. Even a gum specialist (periodontist) has failed at this and I will tell you more about it later in this post.

Lack of experience. When you are an experienced dental professional (either a dentist with a great interest in the gum disease or a hygienist) you can recognise gum disease from a distance. I will give you an example.

You sit in a bus on your way home and somebody sits next to you. He yawns and 3 seconds later your nose detects an odour you rather not smell on your free time. Periodontitis (aka gum disease)! Thank goodness the bus has a good ventilation and the odour is soon gone and you hope he keeps his mouth closed for the rest of the journey. Then the guy’s phone rings and it’s his mother…

I can often recognise the gum disease by just looking at the patients mouth. The gums have a certain look on the sites of the pockets. Even if there is only one deep pocket in a healthy mouth, you can spot it out by the looks of the gum. It is difficult to explain how they look so I won’t even try. Anyone experienced know what I mean. The point is that the more you examine the gums and find the sites where the deep pockets, subgingival calculus and gingivitis (bleeding of the gums) are, the more you learn to tell what looks normal and what doesn’t.

But do not worry if you are a newbie. Just learn to use the perio probe correctly and you will be fine!

Forgetting how smoking hides the gum disease. Heavy smoking can make the gum disease invisible to the eye and often the dentists and hygienists are misled by the looks of the heavy smoker’s gums especially if the oral hygiene is good at that very moment. Heavy smoker’s gums look healthy and pale. There’s no sign of the red and swollen gums. No sign of the bleeding after probing. And yet the disease is there.

Even if the gum disease is not visible to the eye with the smoker, it is still there for the perio probe to find but with the smokers you really need to master the technique. Often the smokers gum line is very tight and it is difficult to find access to the pocket (once you do, don’t let it out until you have probed the whole side of the tooth).

Use of the Periodontal Probe

When I was at dental school learning the arts of the dentistry, one of our teachers (a periodontist) said one day annoyingly “They didn’t even know how to use a perio probe!” At that moment we were practicing scaling in the school’s clinic but this outburst was not addressed to us students (thank god as the teacher was scary as hell) but to a group of dental hygienists who had come to revise perio skills at the dental school. This one sentence has stayed in my memory for some reason and only until now I understand what she meant and why she was so annoyed.

Not only the hygienists fail in the technique of the perio probe but also the dentists and even the periodontists. I will tell you about one periodontist who saw one of my patient.

I had referred the patient to the specialist with all the relevant documentation (x-rays, perio chart etc). When I saw the patient 6 months later a course of treatment was finished with the periodontist. I examined the patient’s gums and found a 10 mm pocket on one of the molars. The depth was the same as before referring. The patient told me she was going to have a control visit soon with the periodontist so I wrote letter about the persistent pocket.

Three months later I saw the patient again and nothing was done to it. A periodontist had said to the patient that there is no pocket.

No pocket! I’m going to show you the pocket!

I took my DSLR and put a perio probe into the pocket and fired away. The patient got the photo on cd and gave it to the periodontist on the next visit. I’m afraid my story ends there. I never saw this patient again as she got retired and was not able to see me as we were too expensive.

Ten millimetres deep pocket and it went unnoticed by the specialist even when the location was pointed out. What chances do the rest of us less-educated ones have if the one wearing the black belt in our industry is not able to do it?

Note to all dental professionals who examine patients gums: Please check your perio probe technique. There are plenty of information about the use of the perio probe on the internet plus hands on courses at the dental schools. And those who are not using a perio probe, shame on and start now!

What Is the Gum Disease?

I won’t go much into details about the gum disease but I will tell you the warning signs when you should visit your dentist:

  • your gums bleed when brushing/flossing/eating or they bleed spontaneously
  • your gums hurt when brushing/flossing/eating
  • your teeth have become longer over the years or they have tilted/rotated/moved
  • your teeth feel loose
  • you have wider gaps between the teeth than before
  • somebody has told you often that your breath smells. Gum disease doesn’t always produce bad breath especially in the early stages. It is the advanced periodontitis when the smell can be obvious to everyone else except to the bearer. But how many of you tell the other person that their breath stinks? Not many, unless it is your spouse in concern

The gum disease is always caused by the bacteria in your mouth. When the bacteria is removed effectively and regularly the chances for you getting a gum disease are minimal. But even if you are looking after the teeth well (brushing thoroughly twice a day and cleaning between the teeth once a day with a product that was recommended by the hygienist) go to see your dentist if:

  • you are a heavy smoker (here‘s why)
  • you have a diabetes
  • you are pregnant

If the gum disease is left untreated it will result in loss of tooth. It is also associated with certain illnesses so your general health is to be concerned as well.

If you want to find out more please visit American Academy of Periodontology’s site which provides lots of useful information for the patients.

How Is It Treated and Can I Do It Myself?

The gum disease is treated by simply removing the bacteria (both soft bacteria, plaque and hardened bacteria, calculus) and teaching the patient the correct techniques for removing the soft bacteria regularly by themselves.

Anyone can start better oral hygiene routine at home without seeing a dentist. Getting rid of the daily build up of bacteria effectively may cure the gum disease. This means brushing twice a day with electric toothbrush and cleaning between the teeth preferably with something else than a floss (floss is better than nothing of course). You could try Gum Soft Picks at first. Aim to the size that feels slightly tight between the teeth.

But remember, you are not able to remove the hardened plaque (calculus). Also if the calculus has build up below the gum, you will need to see dentist (for an assessment) and hygienist (for scaling) to stop the gum disease progressing.

A revelation:

There is no easy way out of the gum disease. It will most probably hurt like hell and the gum will bleed (in some cases heavily) in the beginning when you brush and clean between the teeth. If you at this point stop e.g. using an interdental brush that was recommended to you or you use it every second night because you think you are harming the gums, the gums will keep on bleeding and hurting. You will never get out of the vicious cycle. So persevere, be brave and have a faith on us professionals.

Sometimes if the gum disease has advanced to severe stage, you might need surgery on your gums (performed by the periodontist).

 

 

Anti-Patients

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Dental Revelations Blog-24982

I have a confession to make. I am not perfect as a dental professional even though my posts may give the expression that I do everything as we are taught at the dental school. I do my best but I have weaknesses as well.

Another confession. I sometimes feel quite overwhelmed by some patients’ way of arguing about the well researched facts on dental health. Banging your head against the wall is not fun in the long run and in our business it tends to make us cynical and worn out mentally.

Of course there are good days and bad days. On bad days I have thought about changing my profession to the one where I could sit between piles of paper and no-one to talk to (anyone care to hire me?). On bad days I have given up trying to convince the patient about cleaning between the teeth when I have faced a non-cooperative patient the fifth time that day.

Fine, carry on practicing your beliefs…

Sooner or later you will learn I was right…

It’s your teeth not mine…

This does not happen often, but I wanted to bring out the great mental load we have on our profession. We need to have sort of a mental radar on ALL the time so that we can find the right approach to each patient. As each patient is different. But there will be a patient that slips beneath our radar. I have come to conclusion that with these patients there is no right approach. I call these patients Anti-Patients.

There are at least 5 types of Anti-Patients that I have listed below. If a new one comes to your mind, please share it in the comment box.

Anti-Fluoride

When I interview patients on their first visit, one of my questions is:

Which toothpaste do you use?

The most common reply is:

Dunno… Anything they sell in the supermarket.

But if the patient is a health-conscious one, they know exactly which toothpaste they use. And it won’t be just anything from the supermarket’s shelf. They also know that often their beliefs in health can be found controversial amongst the health professionals.

So after they have told that they use the aloe vera toothpaste/herbal toothpaste or any other non-fluoride toothpaste, they will carry on explaining the reasons behind it with fists raised into boxer’s pose (not really, but you get the gist?).

The fluoride is toxic..

There is fluoride in the drinking water anyway…

The fluoride is linked to health problems like cancer…

I only listen, let the patient finish and then carry on to the next question on the interview. I leave the toothpaste issue until I have build up a little bit more trust and until I have examined the patient’s mouth.

I know what I am going to find especially when the patient has used non-fluoride toothpaste for a long time. In my experience about 1 in 1000 patients has oral hygiene habits that good that my interference is not needed. One in thousand! And the likelihood that this one patient is the one who uses the non-fluoride toothpaste is close to zero. This means that poor oral hygiene together with non-fluoride toothpaste results in decay. And that is what I am going to find from the anti-fluoride patient’s teeth.

A faint white line on the enamel of the tooth close to the gum line that is the first stage of the decay. They are still reversible lesions of decay but they will often get discolouration that ruin the aesthetics of the smile. Sometimes the decay is already beyond stopping and requires a filling.

As some anti-fluoride patients take the advice on board, many don’t. And the most disheartening are the ones who practice their anti-fluoride beliefs on their children as well.

Want to know more impartial information on fluoride? Click here.

Anti-Amalgam

Amalgam has been used for about 150 years on people’s teeth. Although we have passed the peak of the amalgam phobia long time ago, there are patients who still believe the amalgam is a health risk. They either do not want to have a new filling made of the amalgam or they want to have the existing ones to be removed and replaced with white ones.

Now, there are dentists who have dollar/pound/euro (or whatever your currency) signs in their eyes whenever this kind of a patient walks in. They do not discuss about the reasons behind the patient’s wish or what the operation of changing the amalgam into white fillings mean. Of course they don’t. They do not want the patient to change their mind.

When a patient expresses this kind of a wish to me, they get this info every time:

  • Composite filling is not an option for an amalgam. Instead the ceramic or gold fillings are and those are many times more expensive than amalgam
  • Amalgam can last a lifetime, whereas average lifespan of a composite filling is somewhere way under 10 years and ceramic’s just slightly higher
  • If there is no problems with the amalgam filling, there is no reason to replace it
  • Replacing many amalgam fillings with white fillings will affect the bite
  • There are no health risks with amalgam as a filling
  • If choosing to have all the amalgam replaced with white fillings anyways, find a dentist who does laboratory-made ceramic/gold fillings and uses proper protection when removing the amalgam fillings as it is the most hazardous part of the life of an amalgam filling

I am always happy when I learn on the next visit that the patient has changed his mind about having amalgam replaced. And for some reason the patient is relieved as well.

It makes me sad when beautiful amalgam fillings have been replaced with composite fillings. It just isn’t right.

Note for professionals: Do polish the amalgam fillings regularly as the darkened amalgam fillings work as retention for bacteria. This is important especially with patients who have advanced periodontal disease.

Anti-X-Ray

X-rays are the vital part of making a diagnosis for the dentists and certain conditions will go undetected without them.

Refusing to have an x-ray taken is just pure madness. It is almost the same as if you would take your car to the car mechanic and tell him that

There is something wrong with the car but do not look under the hood.

In the worst case scenario, your life might be at risk. In the matter of the car and refusing the x-rays.

Anyone concerned about radiation with dental x-rays should read this and simply trust the dental professional’s judgement on whether or not you need to have x-rays taken.

Anti-Safety Glasses

Why on earth would you decline using the safety glasses that are meant for the protection of your eyes? Beats me.

We drill at high speed just a short distance of your eyes and anything can fly out of the patients mouth – a piece of an enamel, calculus (tartar), a broken bur and all sorts of nasty bacteria and viruses. We use chemicals that are acidic when making a filling. None of these you want in your eyes, believe me.

“We should not treat a patient who refuses to use the safety glasses”, I was told on one of the health and safety courses. In ideal world yes. But when you work at a private practice it is totally different story. What do you think that would happen if I send a patient home for not using the safety glasses. No income for the practice and who is the blame? Me.

So we let the patient to refuse the use of the safety glasses and tell them to keep their eyes closed. But they never do, do they?

Anti-Everything-You-Say-or-Do

I know the fear of the dental visit can bring out the worst in people. But it is always frightening when a patient comes across as aggressive from the moment you call the patient in. They walk to the surgery, throw their belongings to the side table and almost jump to the dental chair with arms crossed. They

  • dismiss everything you say
  • do not take the safety glasses
  • are suspicious of everything you do and want to see every instrument you have
  • tell you that they do not want to have a lecture
  • ask when you graduated
  • tell you how another dentist/hygienist did things differently compared to you

Thank goodness these kinds of patients are rare. But when I am faced with this kind of a hostile situation, I speak only when it is absolutely necessary and just do my job. I am glad when the patient is gone and hope we never meet again. But there is an exception. You see sometimes a miracle happens somewhere between the polishing and goodbyes.

The patient that just moments ago was a manifestation of the devil is suddenly the opposite and full of questions about oral hygiene. “Now he wants advice!” is my thought when I have couple of minutes time left before the next patient. But I do not have a heart to ask the patient to leave when I realise that all the hostility was due to the fear of the dental visit. The amazing fear!

Want to know one more Anti-patient type? Click here for my post Yet Another Anti-Patient.