As the coronavirus is pandemic now and in many countries it has become epidemic, like with any epidemic, the most important thing is to slow down the spread of the virus. It’s no longer a question of avoiding it. Coronavirus will come and most likely you will get it but personally that’s not what I’m worried about. What worries us health professionals is that too many people will get sick at the same time and the health care system is not able to cope. That is why we need everyone’s help in slowing down the spread of the virus.
What Can I Do?
Most important thing is to avoid all unnecessary traveling. Even the small scale traveling like going shopping. Stay home. You may go for a walk but keep distance to the other people you encounter.
Do not visit friends or family, especially the elderly or people with low immune system (like cancer sufferers) because for them the coronavirus may be lethal. You can always phone them or connect with online video if available. Cancel your hobbies and don’t go to the birthday parties. Cancel non-urgent appointments to the dentist and doctor. Remember, this is only a temporary measure for common good.
Work remotely if possible.
Wash hands for 20 seconds with soap before you eat, before you prepare a meal, every time you come in from outside, work or home, and after using a toilet. Use proper technique (here’s how) especially when closing the tap. And remember that the door handle is probably the most contaminated thing you can touch in a public toilet, so try to open the door with your elbow or wrist. If the door has a knob, use disposable tissue to open it.
Cough and sneeze on your sleeve or disposable tissue. Cover your nose and mouth properly (here’s how). Remember that even the smallest cough will possibly spread the virus around you and if you happen to walk past an elderly person when not covering your mouth when coughing, you might be responsible for their death.
Wash the vegetables and fruits with soap (remember to rinse) before you eat them. I use washing up liquid or just regular hand soap.
If you get flu like symptoms DO NOT phone the health officials. DO NOT go to the health centre. Treat yourself at home like with any cold. DO NOT go out. Instead ask a friend or family to bring you the stuff you need and ask them to leave them behind your door. But if you develop more severe symptoms like breathing difficulties, that is the time to call your health care officials.
Please help slowing down the virus and share this post to you friends and colleagues to raise awareness.
We all can relate to the panicky feeling when watching a movie or tv programme where the damsel is about to drown in a submerged car. The water level is rising as she tries to find a way out without succeeding. She bangs the windows with her fists, pulls the door handle only to realise there is no way out. She breaths rapidly and you can tell from her face that she thinks she’s going to die. She lifts her mouth to get the last gasps of air as the water level reaches the top. She makes her last attempt to break a window. Then silence as she gives in. Air bubble stream flows out of her nose as she must exhale. The eyes close. She remembers somebody telling her that drowning is a kind way to leave this earth. She floats with her eerie looking hair moving around here head.
Can’t breath. I will drown if I breath.
Then just before the last air bubble comes out of her mouth the hero of the movie breaks the car window and pulls her out. She is taken to the shore and given first aid by the hero. She coughs and opens her eyes. She’s alive! She didn’t drown! The hero saved him and they fall in love and live happily ever after.
Drowning at the Dentist
Most people are pros when it comes to dealing with dental treatments. But every once in a while you notice the patient being in trouble with the water in their mouth when we use our rotary instruments or the sonic scaler. They keep on swallowing rapidly or raise their hand to signal that something is wrong. Some even try to get up while the instrument is still whirring inside the mouth (this is something we strongly discourage as it is a safety hazard).
Once they get a chance to speak they sound like they just ran a marathon and say:
“I need a break to breathe…”
“There’s so much water…”
“I feel like drowning…”
Well, is it possible to drown at the dentist? To my knowledge no-one has drowned at the dentist. And I doubt no-one ever will. But we will keep on getting these patients that struggle with the water. It probably has got something to do with the survival instinct – My mouth is filling up with water! Get up and swallow or do anything to be able to breath or you are going to die!
Of course the patient is not thinking exactly like this but their subconscious is. And their actions are driven by their subconscious when it comes to the matters of life and death.
The big question is:
How can you help the patient to deal with their unreasonable subconscious that is telling them they are going to die when they are most definitely not?
Firstly, tell the patient how they can signal if they are in trouble, need a break or if they have something to say. My advise for my patients is to lift the left hand. Always stop immediately if they signal that they want to have a break. This builds up the trust. Tell them also that you will anyhow take breaks every now and then so that they can have a break. And then remember to give breaks!
Secondly, tell the patient that they should concentrate on breathing through their nose. You would be surprised how many of the patients get this eureka-moment when they realise they can effortlessly breath through the nose even though the mouth is filling up with water.
Thirdly, tell the patients who are still in trouble even though they are breathing through the nose that they should focus their mind to think about the fresh, cool air flowing inside their nose, their lungs and out again when they exhale. This will help to take the focus off from the rising water level inside the mouth. Speak slowly and with relaxed voice when you give this advise – almost like a yoga instructor. It is also helpful to tell the patients to think that they are somewhere pleasant like the Maldives. Under the palm tree and just relaxing.
With these steps patients will get through the most unpleasant moment of the treatment.
Advise for the Patients Who Struggle with the Drowning Feeling
Practice at home! Take a gulp of water and lay back on your sofa without swallowing. Open you mouth and breathe slowly through the nose. Stay there as long as you feel comfortable. Next time take two gulps of water and repeat the above. Slowly your brains learn that there’s no danger having water inside your mouth as you can breath through the nose.
Remember that if you have a blocked nose, use nasal spray before the dental treatment to relieve it. Or reschedule until you are able to breath through the nose effortlessly.
I will once again return to the times when I was a student in dental school and knew only little of the dentistry.
We were learning about cariology and were advised to bring in dental radiographs (x-rays) if we had any. I had had a panoramic radiograph taken recently and the teacher – a specialist in cariology – took a look at it. He said to me:
“You should use a toothpick”
I was very surprised and said to him that there is no way I can fit the toothpick in between the teeth. He showed me from my x-ray that there is enough space between the teeth for the toothpick. But I was not convinced (thought that he was wrong) and carried on using a floss for many years to come.
The reason why this occasion came to my mind was that I was reading through health and dental blogs to get ideas for my next topic and I ran into several blogs that wrongly advice people against using a toothpick. I got this certain annoyed feeling inside of me and I knew I had to write about it.
Toothpick Widens the Gaps Between the Teeth and So It Is Supposed To
I have worked with many periodontists and learned that floss is not – by far – the right tool when we try to tackle the gum disease. It does no massaging for the gums which is needed when we try to make the gums firmer around the teeth (plus it won’t remove all the bacteria). When the gum gets firmer it shrinks and leaves less space for the bacteria to hide and cause the disease.
When I moved abroad I very quickly understood that a toothpick was not considered to be a good tool for cleaning between the teeth. I received wondering commentary from my colleagues when they realised I am recommending it. It was considered to be old-fashioned, ineffective and even harmful to the gum. I had to explain the reasons for recommending it again and again:
“The toothpick – the triangle-shaped wooden one – works well initially when the patient has inflamed and swollen gums. It is cost-effective, easy to use and effective in massaging the loose gum. Once the gums have healed and firmed up we can determine better which sizes of interdental brushes are the best ones to use.”
The patients often fear that whatever they are using to clean between the teeth will widen the gaps. I tell them that it might actually happen but in that case it is only a good sign. I explain to them – with their x-rays – that the bone levels will determine how much the gaps between the teeth will widen.
If the bone around the tooth has receded as a result of the bacteria presence and inflammation and there is swollen and loose gum on top of it, it is an unhealthy situation and will result in more bone loss eventually. The gum needs to be firm on top of the bone so that it can better resist the bacteria.
And the only way to get firm gum is by massaging it. This can be done with the triangle-shaped wooden toothpick by pushing it gently but firmly between the teeth as far as it goes and repeat it couple of times. If there is bleeding at first it is also a good sign – the toothpick is doing its job. The bleeding will stop if the toothpick is used for a week in every between the teeth every night.
People often leave the practice unconvinced of the advice they were given. But the ones that do as they were told despite being sceptical are gobsmacked by the way the bleeding (and hurting) stopped.
I recall having a phone conversation with a patient who had an advanced gum disease and who had recently seen me for the first visit of the course of treatments. I had advised him to use purple interdental brush (1,1mm) but he wasn’t convinced about it and this was the reason for to phone call. He thought the brush was too big as it hurt. I told him that the only thing he can do is to try to prove me wrong. To follow my advice and see if I’m wrong.
He carried on using the interdental brush and about week later I received another phone call from the patient. He wanted to share his amazement and joy about his gums that had stopped bleeding. He was thankful for the correct advise and said that he had suffered from bleeding gums for all his life and only now – at his fifties – he managed to stop the gums bleeding.
The pain makes people think that something they use is not right for them. That’s why it is important to advise patients that when they have a gum disease (any stage from gingivitis to severe periodontitis) it will be painful at first when they begin using the interdental brush or toothpick – there’s no way around it. I always tell patients that for about week they need to suffer from tender and sometimes very painful gums. But if they persevere with the use of interdental brush/toothpick as advised they will notice it won’t hurt after a while.
I have said this before and I am saying it again – do not believe everything you read from the internet. I have run into several sites that offer wrong advise on oral health. Even dental professional offer wrong advise. Here’s one example about advise against the use of toothpick
The sharp surface area might destroy the polish of the tooth, damage the gums or perhaps create the voids in between the teeth to broaden.
A correct technique of any product recommended needs to be established at the dental practice before patient leaves the practice. Toothpick can cause harm to the gum if used incorrectly but so can floss, interdental brush and toothbrushes. I have pointed out two times in this post that the toothpick needs to be the triangle-shaped one if it is used in between the teeth. Never use cocktail sticks!
Also a toothpick should be used only temporarily as it won’t remove all the bacteria from between the teeth for the same reasons as the floss doesn’t. Neither one of them cannot get into the grooves of the teeth (area where the roots start to separate) and the grooves of the fillings.
I will emphasise that a toothpick is perfect in the beginning of the periodontal treatment when the swelling of the gum needs to be reduced.
Finally back to my teacher who advised me to use toothpicks. He was right. Of course he was – he had decades of experience. I was just a cocky rookie in dentistry and thought I knew better.
It wasn’t until I had periodontists as colleagues when I realised that I need to use something else than a floss. My bone level around the teeth was naturally that low that I could fit in a toothpick and later I moved on to the interdental brushes (size 0,7mm). I have used them for over a decade now and haven’t used floss since – and no, I have not developed any decay in the contact point of the tooth.