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.
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:
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.
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).
You feel the water lever rising in your mouth while you are having a treatment done at the dentist. Your natural instinct raises an alarm in you mind.
I’m going to drown…
I’m choking…
Your eyes open wide and you raise your both hands to make a gesture that you want to get up to empty your mouth. The nurse quickly takes the suction to remove the water but there’s always some left, isn’t there? Your hands are still reaching the spittoon next to the dental chair but the nurse lays a hand on your shoulder and says gently
It’s ok to swallow, it’s only water.
Well is it?
Dental Unit (= the Chair) Waterlines Causing Infections?
The water in dental unit waterlines should match the same standards as safe drinking water. In short this means that the bacterial count (colony forming units, CFU) in the water should not exceed certain safe level (if interested to find out more in depth, please visit here). The standards vary in different countries. The countries I have worked the CFU/ml regulations vary from 100-500. Now here comes the nauseating fact:
In practice the CFU/ml levels can be as high as hundreds of thousands of all sorts of nasty bacteria, including the ones of human origin. Needless to say that it is enough to cause problems.
The problem with the dental units is that many of them are old and do not have the latest technology for waterline cleaning. Renewing the dental units is slow as they are expensive and practices want to use the existing ones as long as possible.
Dental units without waterline cleaning system have a slow flow in the waterlines, the water is warm and the water stands still during off-surgery hours (nights and weekends). Sounds like a very bad combination, eh? The old dental units do not have preventive valves in the waterlines to stop suck back of the patient’s saliva into the lines.
So as a result the waterlines in the dental units are lined with biofilm (a mass or layer of live micro-organisms attached to a surface) that should be removed regularly.
Who Is at Risk?
The healthy patients should not worry much. But to be honest, I do not like to swallow the water myself. It’s gross.
The patients whose immune system is impaired are most at risk. The elderly, the young children, medically compromised people and everyone with immunodeficiency. In worst case scenario the visit at the dentist can be lethal.
Of course us professionals are at risk as well. There are lots of aerosols in the air during the use of the dental unit. A bacterium to raise the biggest concern is the Legionella that causes Legionnaires’ disease. So do take care of the unit waterlines.
Advise for Professional to Improve the Water Quality
Use water source that meets the standards for drinking water.
Run the water from the unit waterlines (handpieces, ultrasonic scalers, air/water syringes):
10 minutes after the weekend
3 minutes in the morning
30 seconds after every patient
Use an efficient waterline treatment product recommended by the unit manufacturer. Use it regularly. Running the water as I advised will get rid of the free flowing bacteria but not the biofilm, it needs an effective disinfectant. The most effective product for getting rid of the biofilm are the ones containing:
hydrogen peroxide
hypochlorite
superoxidized water
Invest in new dental unit (do not go to the cheapest option – you only go from bad to worse) with the latest technology. It’s only humane thing to do.
Conclusion and Cause for Worry
In my experience the dental unit waterlines are not looked after as they should to maintain the good quality of the water.
I have seen that instead of cleaning the waterlines the dental professionals have stopped using the water e.g. when using the slow handpiece (the drill that feels like a street drill). Now I must mention that this happened only in the other country I worked at. I never found out why they actually do this (please enlighten me on comment box below!) but perhaps it was because of the water quality problem? When I used a slow handpiece there, I was naturally worried about overheating of the tooth and tried to get water flowing but it was made impossible.
I have seen a dentist performing implant surgery using a water from air/water syringe (it wasn’t the only thing that was wrong with that treatment – imagine dentist’s tie hanging loose and contaminating everything it touches. Sterile surgical coat was nowhere to be seen). Implant surgery if anything needs an absolute clean environment and wearing your personal clothes and using unit’s water supply simply is not up to the standards.
I know for a fact that many dental nurse neglect running the water as described above. It is appalling thing to do. Honestly.
What does this tell about us professionals? We should be the ones that are looking after the patient’s best interest and health. Doing all the fancy and immaculate maneuvers inside the mouth is not enough to fulfil our purpose.
Are we too busy making money and forgetting the basics?
Advise for the Patients
Seek out a modern dental practice with modern equipment. If you are unsure what modern dental unit looks like, here‘s one example (unfortunately I don’t get paid for advertising this site).
It is ok to ask the nurse or the dentist if the waterlines are regularly disinfected and if the nurse runs the water after each patient.
Dental Revelations 