Like doctors and nurses in hospital, the dental professionals are more at risk of contracting viruses. Dental offices can also be a place where the viruses, such as corona can spread if the cross infection control is not up to the standards.
I have gathered the most important things here for dental professionals to check to make sure you are protecting yourself, the staff and the patients. I have not gone into things like instrument disinfection because that should be organised regardless the coronavirus. If in doubt, read this.
Use Soap
Something we should remember when using hand sanitiser is that it does not kill all the viruses like norovirus (the one causing the winter womiting disease). Therefore it is advisable (also advised by the World Health Organization, WHO) for all of us to wash hands 20 seconds with soap even though it is pain in the backside to wait for the hands to dry so that you can pull on the examination gloves. Remember to use disposable hand towels to dry your hands and close the tap either with your elbow or with the hand towel to prevent re-contamination of your hands from the tap.
Cover Up
In the normal situation where we treat healthy patients, a lower fluid resistance and filtration efficiency are acceptable (personally I use either ASTM Level 2 or Level 3 masks). But when we are at greater risk of treating a patient who might carry airborne diseases like coronavirus, TB and influenza, we should use masks that have the maximum filtration. These face masks you recognise from the markings FFP2.
It is even better if the face mask has a visor attached to the mask. But even if it has the visor, use also safety glasses/your normal glasses under the visor. If the face mask doesn’t have a visor, use safety glasses or separate visor – also on top of your normal glasses.
Now, I would use also disposable hats like they do when performing oral surgery because people (me too) have these mannerisms of touching our head, scratching our head etc. for example on a lunch break. And do we always notice we do that? If we don’t, then how do we know to wash our hands straight after before we take another bite from the sandwich.
Check Your Surface Disinfection Liquid
Today is the day to look deeper into the small print of your practice’s disinfection liquid. I did some research some time ago because I wanted to find out if the liquid we were using was killing everything it was meant to. I found out that not all of them kill for example norovirus. And if they don’t kill norovirus, I doubt that they kill coronavirus.
I cannot tell you which one to use, but the bottle should have all the information needed. If not, contact the supplier or the manufacturer. One thing I noticed when I did my research that the disinfection wipes and liquids for sensitive surfaces are the ones that do not kill viruses.
Wipe Wider
It is good idea to wipe the door and chair handles (the unit’s of course but also the regular chairs) with disinfection wipes. Also it is good idea to go through the other handles of the practice many times a day – even the ones outdoor.
Provide Hand Sanitiser for Patients
Place a bottle of hand sanitiser in the waiting room. I saw my physiotherapist yesterday and first thing I did was to wash my hands. Common people do not realise to do this so could you perhaps ask your patients to wash their hands (for 20 seconds) when they arrive to the surgery?
When patients attend dental office, what is the most common reason they are worried about? It is not the ones that us dental professionals are worried about in people’s oral health. There are two most common worries people have and they are
the appearance of the teeth
bad breath
So today I’m going to write about the reasons for the bad breath because I have noticed that when I tell my patients the most common reasons for the bad breath, some of the reasons come as surprise for them. So read on to find out what it might be that is causing bad breath.
Who Told You That You Have Bad Breath?
Now, this is actually very important question. Normally no other than the very closest people to you have guts to tell you that your breath stinks. It is normally your spouse or your mother. And kids. Keep in mind, that kids are very frank and blatant in their statements. You will probably hear “Eeew, you’re smelly” just when you lean over to your kid at nursery to kiss her goodbye before you head off to an important meeting at work. Now, this if anything makes you slightly insecure and you rush to the off-licence to get mints to freshen your breath. Yet still at the meeting you try to inhale same time as you speak to the person next to you. Sound familiar?
Morning Breath
We all have bad breath in the morning. This is because the saliva flow at night decreases and there hasn’t been enough saliva to kill or rinse the bacteria away. The bad breath gets better when you brush your teeth and drink fluids. So if somebody tells you in the morning that you have bad breath, it is completely normal and most likely the person telling you this has a bad breath as well.
Coffee
I remember how bad my primary school teacher breath smelled when the teacher came to check my schoolwork after a break. You know that the teachers consume lots of coffee during the workday. My teacher drank lots of it on every break and I did not like the smell of his breath in the class. So nowadays I am very aware of my bad after-coffee-breath if I have had coffee and not had any breath freshener afterwards. Sometimes I forget it but when I see frowning at my kids face as I go close to them, I must apologise for my bad breath. So, remember, have sugar-free breath freshener after you have had coffee.
Dehydration
Coffee is also diuretic drink and if you consume lots of it during the day, you will get dehydrated if you don’t drink more water than normally. Dehydration will cause the saliva flow to decrease causing a dry mouth and the bacteria can grow more rapidly causing the bad breath. There are other diuretic drinks as well like tea, alcohol and coke.
Drinks are not the only reason for dehydration. Also working in a office that has strong air ventilation, will dehydrate you. So remember to drink plenty of water during the day (tap water preferably) and even more so if you also are a heavy coffee drinker.
Also certain medication can cause dehydration. These include e.g. diuretics.
Dry Mouth
Dehydration is the most common reason for dry mouth. And as I mentioned already in the previous chapter, the dry mouth can cause bad breath. Medication, stress and certain illnesses can cause dry mouth too. You can read more about it here.
Wrong Medication for the Bad Breath
It is tempting and easy way to try to get rid of the bad breath by using mouth washes. But using the mouth wash for bad breath can actually make the bad breath go from bad to worse. The mouth wash often contains alcohol and alcohol will dry your mouth even further. There are also other chemicals in the mouth washes that your mouth might not like and dry mouth could be a result of using even the non-alcohol mouth washes.
Poor Oral Hygiene Habits
The bacteria is the most common reason for bad breath. The bacteria is in your mouth and so it should be because it looks after the soft tissues. But if it can stay on the surface of the teeth for too long there will be really nasty bacteria attaching to the mass of dental plaque. These nasty bacteria are not only causing bad breath but also diseases like periodontitis.
So if you are not cleaning in between the teeth or only doing it occasionally, this can be the only reason for you bad breath. Cleaning between the teeth will also get rid of any food stuck there. I have sometimes found food debris from patients mouth that has been there for a long time and everyone can guess what happens to the food in long period of time – it rottens. And the rotting food smells.
A tip: You can test if there is smelly bacteria in between your teeth by flossing and then smelling the floss.
If it has been a long time since you had a teeth cleaning at the dentist, it might be a good time to book in an appointment. If you neglect cleaning between the teeth, the plaque build-up will very quickly harden to tartar. That is something you cannot remove yourself. Once it builds up below the gum, you will not get rid of the bad breath until you have had professional cleaning done. Once you have had it, listen to your dental hygienist and follow the instructions to prevent the build up of tartar in the future.
Heartburn
If you get a heartburn often, it can be a sign of gastroesophageal reflux disease (GERD) or more commonly known as acid reflux. In this medical condition, the content of the stomach flows backwards toward the mouth. This backflow can cause problems like dental erosion and bad breath.
The smell of a breath with acid reflux can be very pungent and can be relieved only by right medication for acid reflux. Another way to treat acid reflux is by diet but this will have slower effect on the bad breath. It is advisable that if you get heart burn on weekly basis, you should consult you doctor over a medication as sometimes over-the-counter medication are not effective enough. They might want send you to a gastroscopy to confirm the reason for the acid reflux.
Smoking
This one probably everyone knows – smoking causes bad breath. No matter how you try to hide it with chewing gum, it will smell through. So quit smoking! Not only because of the bad breath but more so because of your health.
Tonsil Stones
Now this is probably the most unknown reason for the bad breath. Some people’s tonsils have such structure that harbours bacteria. The bacteria builds up in the crevices of the tonsils. It builds up until it a tiny white(ish) ball-shaped mass pops out. This is the tonsil stone. If you reach it with you finger before you swallow it, and smell the tiny ball, you understand the reason for your bad breath.
Sometimes the tonsils collect bacteria and the build up is stuck in the structure of the tonsils. This might cause sore throat and if you take a look at your tonsils (back of your mouth), you might see white spots there. By pressing the tissue around the white area, the tonsil stone might pop out and the area begins to heal. So to get rid of the bad breath that is caused by tonsil stones, you should try to get the tonsil stones out.
It might be useful to gargle with chlorhexidine mouthwash or salt water if you get sore throat from the tonsil stones. This will prevent the bacteria growth and help the inflammation in the tissue to heal.
Sometimes surgery might be needed to stop the tonsil stones forming.
Of course we shouldn’t forget that some food can cause bad breath. The most common one is the garlic. This you can only hide away by using breath fresheners when socialising. Although some people say chewing parsley right after eating garlic helps to get rid of the garlic breath.
Word of Comfort
It is good for everyone to know that often when you think that you have a bad breath, it most often is actually just a bad taste in your mouth. It doesn’t necessary smell even if you have a bad taste. But to be sure, you can ask close friend/spouse to tell you if you have a bad breath.
Dry mouth can make your mouth feel like Sahara desert
Dry mouth is something everyone experiences at some point of life. Normally it passes by it self but sometimes it persists and might become a condition that affects the standard of living and oral health. At that point we realise how important the saliva actually is.
Here are the most common reasons for dry mouth.
Dehydration
I start from the most common reason for the dry mouth, the dehydration. There are many reasons for the dehydration and some of them are not so well known amongst common people. Here are the most typical reasons:
The dehydration caused by these reasons is easily cured by drinking enough water. For example if you drink a cup of coffee, drink same amount of water as well.
Dehydration can be caused by other reasons as well like
medication
illnesses (e.g. fever, diabetes)
vomiting, diarrhoea
Mouthwashes
Mouthwashes that contain alcohol can dry the mouth. If you experience dry mouth, it may cause bad breath because saliva is not around to kill bacteria.
It is bacteria that is causing the bad breath and without saliva it will build up quicker. If dry mouth is accompanied with an inadequate oral hygiene regime it will result in thick layer of bacteria (plaque). And the longer the plaque stays in one place, the more sinister bacteria there will be. Even amoebas! Eew!
People who experience bad breath will often turn to mouthwashes but it can actually go from bad to worse. The best thing to do when you get bad breath is to visit your hygienist, follow a good oral hygiene regime and keep yourself hydrated.
Even the alcohol-free mouthwashes can dry the mouth. There are so many chemicals in the mouthwashes that it is not possible to predict how your mouth reacts to one. If you are interested to read more about mouthwashes and if you should use them, read this.
Stress
Stress can cause the saliva flow to decrease leaving your mouth feeling sticky. Also all the stress related illnesses like depression and anxiety can cause dry mouth.
Medications
There are many side effects with medicines, one being the dry mouth. The most common medicines to cause dry mouth are
antihistamines
beta-blockers
antidepressants
anti-psychotics
muscle relaxants
diuretics
Sometimes it is worth consulting your doctor if there would be an alternate medicine for the same condition – maybe this alternate medicine is not causing that many side effects. Also pills from different trade marks can have different composition even though they have the same active ingredient. So trying different trade mark might help with the side-effects.
Remember not to stop taking medicine before you consult your doctor.
Illnesses and Syndromes
There are illnesses that may cause dry mouth. The Sjögren’s Syndrome is one of them. Also Alzheimer’s disease and stroke may cause dry mouth.
Cancer that requires radiation therapy close to salivary glands can damage the salivary glands and this will cause dry mouth. Also chemotherapy will cause dry mouth as it will make the saliva thicker.
Type 1 and type 2 diabetes can cause dry mouth with some individuals. It is not well known why this happens but it has been suspected that the high blood sugar levels are the culprit.
Smoking and Recreational Drug Use
Smoking and chewing tobacco can cause dry mouth symptoms, so does the use of marijuana.
Methamphetamine aka Crystal meth also causes dry mouth and damaged “meth teeth”. But the dry mouth side effect is the least of the worries with this drug. Stay away from it unless you are in a hurry to the grave. It is also good to remember that marijuana can be a gateway to stronger drugs. So it is best to avoid it as well.
Mouth Breathing
Breathing through mouth because of blocked nose or because of anatomy of the facial structures (lips, jaw) causes dry mouth. Also some of the mouth breathing is habitual and some of it happens at night when you sleep. This reminds me that I’ve always wondered if the mouth breathing is a nice way to say you snore at night?
Toothpaste Ingredients
Toothpastes have many ingredients and they vary from toothpaste to toothpaste. But 2 ingredients to avoid when you experience dry mouth are sodium lauryl sulfate (SLS) and zinc. SLS is found in many foam forming products like shampoos and it is better known by the name soap.
Also it is best to choose a toothpaste that does not cause your mouth burn or make it dry. The combo of chemicals reacts differently with each individual (like with mouthwashes) so you can find a suitable toothpaste for you by testing different toothpastes. Remember to always choose a toothpaste that contains fluoride (1450ppm).
How to Relieve the Dry Mouth
drink plenty of water
chew sugar-free chewing gum (preferably sweetened with xylitol or erythritol)
suck 100% xylitol pastilles (100% means that xylitol is the only sweetener used in the pastilles) – xylitol has an ability increase saliva flow. You can suck these as often you stomach can take.
suck on ice cubes
use dry mouth gels, sprays or lozenges that you can get from the pharmacist. Ask the pharmacist to check that they are tooth-friendly.
make sure your nose is not blocked, use decongestant before hitting the hay if it is
use small amount of olive oil before going to bed – spread it all around your mouth with your tongue. This will hopefully prevent you waking up because of the dry mouth at night.
set a room vaporiser to add moisture to the bedroom air if it is very dry – drying laundry indoors will do the same trick
seek help for the snoring from your doctor
think about changing your lifestyle habits especially if you can tick many boxes in the list of the reasons for dry mouth. Some things you cannot change, but those you can, might make a difference to your overall well being. If you are depressed and have medication for the depression – seek help for the root cause of the depression. Maybe a therapy?
It is tempting and easy way to try to get rid of the bad breath by using mouth washes. But using the mouth wash for bad breath can actually make the bad breath go from bad to worse. 
Dental Revelations 