Tag: dental office

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?

Continue reading “Coronavirus in Dentistry and How to Protect Yourself” →

Climate Change and Dentistry

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Dental Revelations Blog-18

The Climate Report in 2018 wasn’t much fun to read. In fact it was rather depressing and raised many worries over the future of our children and their children. We might even face a situation where many adults living today will face the consequences of polluting our Planet Earth. We’ve all seen the warning signs – natural disasters, unusual weather like long heatwaves in countries where it is normally mild weather, extreme dryness causing crops to die just to name few.

Despite the fact that the report was worrying and depressing, I hope that all of you have read it. Hiding your head in the sand will not make it go away or change the fact that it is going to affect you as well.

We should all participate in saving the Planet Earth. Participating in saving ourselves and our children. That can be done by thinking what changes you can do in your everyday life to help in this cause. There are plenty of choices we make every day that can make a difference to the world’s future.

You can choose a product in the food store that use minimum amount of packing. For example choose muesli which has simple paper bag packaging and which is locally produced (or in your home country). Choose fruits and vegetables that have simple packaging or no packaging at all (there are re-usable fruit bags available).

Choose local fruits and vegetables or the ones that are not shipped from the other side of the world.

Reduce the amount of red meat in your diet or become a vegetarian (I’m not vegetarian but I have almost stopped eating red meat) ‘cos plant-based diet it is far more environmentally friendly than meat-based diet. Think about how large area of fields are needed to herd livestock and to grow food for them when these areas could be used for growing plant based food for humans or for growing trees that help the Planet to get rid of the carbon dioxide – it is a gas that is the largest contributor to the climate change.

Also, once you’ve done your environmentally friendly food shopping, do not use plastic bags to pack your stuff. Instead take a re-usable bags with you when you go food shopping. And why not use them the with all your shopping? Do we really need to tell everyone that we’ve been shopping at Harrods or Louis Vuitton? When the climate change reaches the point that our lives are at risk, these status symbols have very little meaning. So have one re-usable bag always tucked inside your LV hand bag, car, rucksack or pocket.

There are plenty of things we can do differently as long as we think we can make a difference. If everyone would think that it makes no difference if you buy these passion fruits that are shipped from the other side of the world or that it makes no difference if you recycle or not, we are doomed.

Together we can make a difference and you can change the way you do things in every aspects of your life, including your professional life. Personally speaking, I have noticed that I feel more and more guilty over the fact that dentistry is so very environmentally unfriendly.

Single-use materials

We produce massive amounts of waste every day. We have many disposable materials that we throw away after each patient. Many of the disposable materials are made of plastic. There’s no way going around it as disposable, single-use materials are the best option when it comes to cross infection control.

Water

Also, have you ever thought about how much water we use everyday? We wash our hands many times a day. Our rotary instruments require water, our instrument maintenance cycle requires water, our aspiration system loooves water (this is how one maintenance guy for the dental units expressed it) so we suck water into it in the morning, between every patient and in the evening. Well, at least this is how it should be done to prevent the backflow.

Backflow means bacteria and viruses travel towards the patient inside the suction tube. When patients close their mouth and form a seal around the tip of the saliva ejector, a partial vacuum occurs. Blood, viruses, saliva, bacteria, debris might travel as far as into the patient’s mouth. If you don’t believe me, read this. This of course means the patients should not close their mouths around the suction.

I have tried to change my way of using water by closing the tap (with my elbow) while I rub my hands together with soap – you know this should last 15 seconds for the soap to kill e.g. norovirus that is causing Winter Vomiting Disease. In that 15 seconds lots of water is wasted if you keep the tap on. The surgery should have taps that are easily operated without using fingers – the tap should be long enough (medical tap) for you to be able also open it with you elbow. There are also sensor-operated taps that will stop the water flow when hands are moved away from the tap.

Chemicals

We use many different chemicals that are bad for the environment. There’s no way going around this one either. Unless the manufacturers are trying to develop chemicals for disinfection that are more environmentally friendly.

Oral Hygiene Recommendations

On top of everything else we recommend products to our patients that are made of plastic. That’s why the wooden triangle-shaped tooth pick has become a product I recommend more and more (I have written about it in one of my previous posts). Of course it’s not suitable for all the patients, but for those that it is, it will make a difference in the amount of plastic waste.

Conclusion

There are not many things we can change in practising dentistry. But even the smallest changes matter. So please everyone, think about what change you can make and challenge your colleagues and friends to participate in saving the Planet.

Lets make it a norm rather than an exception to re-cycle and to live sustainable life.

Lets do it for our children.

Dental Revelations Blog-17

Compensation Culture Sucks

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A 30-year-old lady had been to see a hygienist for a scale and polish, went home and took a small mirror that she put inside her mouth to have a look behind her front teeth.

“Stains!!”

She went back to the surgery and complained to the receptionist about inadequate scaling. She was booked in to see another hygienist who confirmed there were some stains left behind (palatally) the upper front teeth. Otherwise the scaling was done well enough.

Patient left the practice seemingly happy but the next day she called the practice that she still wasn’t happy. She also complained about the dentist she had seen.

The hygienists and the dentist discussed about the patient and came into conclusion that this patient could not be pleased and the complaints would be never-ending. They all had had the same feeling about the patient when she was in the chair. It was a feeling of unease and of a need to explain excessively everything they were doing or saying to avoid a complaint. They decided together that the patient would not be welcomed anymore and the practice manager was the one to break the news to the patient.

Thankfully the practice owner was supportive over the decision.  He said

“We don’t need that kind of patient in our practice. She will only bring bad blood and it’s just not worth it. We can’t help her.”

The Compensation Culture

The compensation culture in the UK (and perhaps even more so in the US) is making a life of a dental professional very hard. It is ludicrous that the main focus of seeing the patients is in the avoidance of possible complaint.

The rotten apples amongst us dental professionals are perhaps to blame. And the media has done their share as well (has there actually been a program about rogue dentists?). The way the media is sharing news is focused on gruesome headlines and there seem to be less and less investigative journalists in the payroll of the media. Instead there are these copy-paste-wannabe-journalists whose main focus and reason for existence is to get as many clicks as possible on their news. Here’s one example:

“Dental anguish: Indiana man who expected to have four teeth pulled woke up in hospital TOOTHLESS” (Find the news here)

This and similar headlines were quickly released around the world without giving the dentist a chance to respond. He would have wanted to respond, I’m sure but there are laws that prevent us dental professionals responding publicly to the accusations made against us when it is about doctor-patient relationship.

Later on the dentist was allowed to discuss the patient case but far fewer media released his response (you can find the response here). So the dentist suffered financial loss over these headlines only because the media is fishing the clicks. Of course there wouldn’t be these headlines if there weren’t people clicking them…

Learn the Phrases

You know what? It is time to fight back the compensation culture. You can do this by learning to use certain phrases. I will list the phrases I use myself when I see a patient. And without sounding like a super human, I rarely get complaints. It is just the opposite. People are happy after they have seen me.

And before you tell me that there is no time to explain everything to the patient I will say that it takes no extra time. You can use the time when you have your fingers inside the patient’s mouth. Don’t wait until you are finished with the treatment. You chit-chatting might even relax the patient!

Ok here we go and remember these are just examples and you can easily create your own phrases for every situation.

The phrases need to cover:

Post-operative pain/sensitivity/bleeding and instructions

“The gums might feel tender afterwards and it is ok to take a painkiller for them. But do not take aspirin because it might make the gums bleed.”

“Sometimes the teeth get sensitive after scaling which normally will pass very soon. If prolonged it is advised to use a sensitive toothpaste.” 

“Some stains cannot be removed by scale and polish. They are in the deep grooves or inside the enamel or between the filling and a tooth and only replacing the filling will help.”

“The teeth will feel very different afterwards as the tongue has got used to the tartar. You will feel the gaps between the teeth.”

Looks and the feel of the new filling

“You might have sensitivity after new white filling and in the worst case the sensitivity can last for months but it should gradually get less and less. If not, you need to come back to have it checked. And if the pain gets worse you need to come back straight away.”

“The filling is never the same as your natural tooth (so you should think twice next time before you snack between the meals and neglect the teeth… )”

The list of these phrases is endless.

And the most important thing is to remember to write down every advice and information you have given so that it can be easily checked what the patient was told if they complain. In this digital age it is a matter of copy-paste if you have created templates on you computer.

Tell What You Do

It takes no extra effort to babble while you are treating the patient. Of course some people won’t like us talking while we treat them but telling the basic stuff is normally ok. This means very simply informing the patient what you are going to do next.

“I’m going to tilt the seat back…”

“I will rinse now..”

“I will use a drill next. There will be water and you will feel vibration…”

I hear it numerous times per week that the patient felt it was good that I told everything I did. I think it is only respectful thing to do. After all patients come to see us, trust their health in our hands and pay our wages.

There. Now go on and try these advises out! I’m sure you won’t regret it.