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Coronavirus in Dentistry and How to Protect Yourself

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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?

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8 Reasons Why Your Mouth Is Dry

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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:

  • exercise
  • drinking diuretic drinks (e.g. coffee, tea, coke, alcohol)
  • hot weather
  • air conditioning

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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

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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?

The Reason Dentist Tilts You Upside Down

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Don’t like when the dentist chair goes down? Well, you are not alone. When sitting on a dental chair and your dentist begins to tilt the chair down, you feel comfortable to the certain point. But when the seat keeps on going down after you think that surely it cannot go any further and you feel like you are going to slide off the chair, you clutch the chair handles (if there is any – mine doesn’t). You might state that you feel like you are upside down. You might ask the dentist to lift the chair more upward position, or to adjust the head rest so that you feel more comfortable.

Guess what we think at that point? Well, normally we might feel slightly annoyed because you might be the dentist’s fifteenth patient that day and her back and shoulders are aching from the difficult working positions. Nevertheless the dentist might lift the chair more upright. Some might not even tilt patients low enough in the first place to avoid complaint that we have heard gazillion times before.

Neither of these ways is good practice because these dentists and hygienists who are trying to fulfil patient’s every wish, risk their future as dental professionals. Keeping the patient chair in too upright position means that it is practically impossible to work ergonomically. Working ergonomically as often as possible guarantees that we will be working on our dream job (?) until we retire.

Of course there are patients that we need to leave upright position by default. These patient are e.g. heavily pregnant ladies, obese people, people with heart condition and elderly people. But the normal patients can be tilted to the position that is best for dental professionals posture. By normal I mean patients that are healthy or do not have severe medical conditions.

Request for the Patients

Next time you visit your dentist, make her happy by not saying anything about the position of the chair. They will not let you fall. Also you will get better quality of treatment when the dentist can see better to the difficult areas of you mouth. And you don’t need to swallow so much of water when the nurse is able to see the back of you mouth.

Advice for the Dental Professional

But what to do when a patient complains about the chair position? Well, the key to keeping patient happy is to be one step ahead of the game.

First thing you can do is to take the chair down gradually. Taking it all the way down in one go will most probably make your patient complain.

If I hear a complaint even though I’be been tilting the chair down slowly, I reassure the patient by saying

I know you feel like you are going to slide off the chair but so far no-one has. You will get used to the position soon. This position helps me to keep my posture and to see your upper teeth properly.

Patient is often fine during the treatment. When the session is over and I lift the chair up again, some patients state that they feel dizzy when getting up. Tell them to sit still and that there’s no hurry to leave the patient chair (well, you need to make the notes anyway, so it does not require extra time). It is best to sit still, well supported and wait for the things to settle.

If you face a difficult patient that insists to lift the chair more upright even though there is no medical reason for it, tell them that you will do so if the patients feels it is necessary but that you cannot guarantee the best possible result of e.g. scaling because you won’t be able to reach the upper back teeth in a right angle. And if you do still need to lift the chair too upright, it is best to stand up to be able to have as good posture as possible.

If It Really Is Your Dream Job – Important Tip for You

I’ve noticed that it is often the dentists and hygienists that have just graduated that too easily work in non-ergonomic way. It probably is because they still feel invincible. I know, because I did so too! Now having been on this profession for over 20 years and having had both of my shoulders operated (successfully!) due to work related conditions in both of them, I really need to focus on better posture with each patient. And still I get back ache almost every day. But I’m no longer in despair because I have found a cure for the back ache. So keep on reading because I’m going to share the best tip for keeping you going day after day, week after week, year after year in this profession.

I’ve known for a long time that there are these foam rollers that you can buy to exercise at home. Even my gym has had them for ages. But I never really knew how or why to use it until one day I tried one for my back. I placed it between the floor and my back, placed my hands on my shoulders (left hand to right shoulder and right hand to left shoulder) and by using my legs rolled the foam roller slowly up and down my spine like in the picture here. You can also find a good video of using the roller here.

This really keeps me going and I wonder why no-one has told me about it before!? That is why I’m telling you.

Before you start using the foam roller, there is one thing you need to keep in mind. My physiatrist emphasised that if you are going to use a roller, it needs to be a foam roller. Too hard roller will not be good for your spine.

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