Oral-B Gum & Enamel Repair Original Toothpaste Review

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Oral-G Gum & Enamel Repair Original toothpaste

Today I am going to review a toothpaste for the first time ever. It is a toothpaste that was given to me by a representative of Oral-b. It is called Oral-b Gum & Enamel Repair Original toothpaste and it is Oral-b’s newest toothpaste.

Here’s the manufacturer’s selling speech about the toothpaste on their website:

  • It defends against acid erosion and helps to repair enamel
  • It provides antibacterial action to help rejuvenate gums
  • For sensitive teeth – clinically proven
  • Oral-B Gum & Repair Original toothpaste comes with a mild flavour and a smooth texture

The Design

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The design of the packaging looks simplified and minimalistic which I very much like. This is welcome change from their previous toothpastes’ outlook that had too much information in a small space.

The tube is still easy to open, but there is small change in the lid. It used to be made of metal which at least in my opinion is better recycling-wise than plastic. Small detail but still. Can’t help this image of whales’ intestines full of plastic popping in my mind. But then again the whole tube is plastic.

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The Testing

Staying on the environmental subject. The plastic and the whales. There has been lots of talk over microbeads that are found in many consumer products. Even in toothpastes. These microbeads will eventually find their way into the sea and cause problems to the oceans as persistent pollutant. The representative who gave me this Gum & Enamel Repair Original toothpaste sample promised that there are no microbeads in it. The ingredient to look for is polyethylene when you want to make sure there is none of them. I found no polyethylene in the ingredients list (see at the end of this post). Great.

The texture of the toothpaste looks smooth as they promised but when you take closer look, it is not that smooth after all and the fear of microbeads is getting stronger again.

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The texture of the Gum & Enamel Repair Original toothpaste

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Closer look of the toothpaste reveals tiny beads.

The tiny granules are clearly visible but these could be actually hydrated silica (abrasive), not microbeads.

Ok, time to add toothpaste to my toothbrush. Like with Oral-b Pro-Expert toothpaste, this new one is also quite runny and can be messy if you are not quick enough. Once I had applied toothpaste to my toothbrush I was in a rush to take a photo before it dripped on to the table.

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I use my beloved Philips Sonicare

and with this brush the runny texture is actually better than the ones that are stiffer pastes. But I can see that the sink in the bathroom will have toothpaste marks here and there. Also, note to myself – do not let husband use this toothpaste as he brushes his teeth after he has put his suit on. Silly man.

So lets put the toothpaste in my mouth. It does begin to formulate foam which means there is soap in the toothpaste. Not the best option for somebody with sensitive soft tissues or dry mouth. Soap aka sodium lauryl sulfate can make the mouth dry and also it has been linked to canker sores aka aphthous ulcers (although nothing is scientifically proven and oh boy don’t I hear it from the rep e-v-e-r-y time).

Very soon I begin to feel burning sensation on first third of the tongue (the tip of the tongue), both top and bottom of the tongue. Also the tongue feels slightly numb. This carries on all through the brushing and after spitting the toothpaste out. Now, I do advise my patients not to rinse after brushing but the burning sensation is so strong that I must rinse lightly. Once I did that and bit my teeth together, I could feel biting on some grit. This made me think about the abrasiveness of the toothpaste. It is new toothpaste so the RDA value (Relative Dentine Abrasivity) was impossible to find. I will add the RDA value as soon I find it out.

Ten minutes after brushing the burning can still be felt. Also I feel that the layer of skin inside my lips is peeling off. This has been “a feature” with Oral-b Pro-Expert toothpastes and the reps have said it’s absolutely normal and will diminish when using the toothpaste for longer period of time. My colleague asked the rep if this new Gum & Enamel Repair Original toothpaste does the same. I must say that I cannot remember the rep’s exact answer but I think she said this toothpaste should cause less of the peeling of the mucosa. Well it doesn’t. At least with me. If anything I think the peeling of the mucosa is quicker than with Pro-Expert toothpaste.

Twenty minutes after brushing I can still feel the burning feeling slightly. I guess some people will associate this burning feeling with effectiveness of the toothpaste. The more it burns, the more effective it is. As a dental professional I must say that this is not true. No toothpaste should feel uncomfortable to use.

Would I Recommend?

To be honest, most likely I will not recommend this toothpaste to anyone. Not after I took a closer look at the ingredients. One ingredient has been nominated as Allergen of the Year for 2018 by American Contact Dermatitis Society. This ingredient is called propylene glycol.

The list of ingredients is long and to my mind the longer the list is the more side-effects there will be. My favourite toothpaste that I recommend to my patients a lot has only eight ingredients (aqua, crystalline sorbitol, hydrated silica, crystalline xylitol, PEG, anhydrous natural betaine, cellulose gum, sodium fluoride (1500 ppm F), sorbate). Oral-b Gum & Enamel Repair Original toothpaste has nineteen! Three of these ingredients can have adverse reactions to one’s health – propylene glycol, CI 77891 and sodium lauryl sulfate.

Also the fact that I got this burning feeling in my mouth tells me this toothpaste is not suitable for most of the people. Remember that it should not feel unpleasant to use a toothpaste. Certainly it should not hurt. So change if it does.

The Ingredients

Here are the ingredients of the Oral-B Gum & Enamel Repair Original toothpaste and short explanation of what they are (by clicking the link you will find more information):

  1. Glycerin – an organic compound most commonly from animal fat and vegetable oil
  2. Hydrated Silica – abrasive
  3. Sodium Hexametaphosphate – anti-stains and anti-tartar
  4. PEG-6 – an emulsifier and foaming agent
  5. Propylene Glycol – the American Contact Dermatitis Society’s Allergen of the Year for 2018. An emollient and emulsifier.
  6. Aqua – the main carrier for all ingredients. Helps dissolve other soluble ingredients. Helps the mechanical process of cleaning teeth in mouthwashes
  7. Zinc Lactate – such a difficult ingredient to find any information solely on zinc lactate. Lots of information on zinc but there must be difference in different types of zinc? If anyone finds trustworthy site with information on zinc lactate, please drop me a line.
  8. Sodium Gluconate – to sequester calcium and helps to prevent gingivitis
  9. CI 77891 – titanium dioxide (nanoparticles). A thickening agent and colourant.
  10. Sodium Lauryl Sulfate – soap, the foaming agent. Can work as an irritant.
  11. Silica – a mild abrasive to clean teeth.
  12. Aroma – a chemical compound which adds odours to dental products.
  13. Sodium Saccharin – an artificial sweetener
  14. Carrageenan – an extract from a red seaweed. Binds and gels all the ingredients together
  15. Trisodium Phosphate – stain remover and de-greaser
  16. Stannous Fluoride – the good in the toothpaste
  17. Stannous Chloride – antibacterial
  18. Xanthan Gum – a thickening agent
  19. Sodium Fluoride – the good in the toothpaste

If you are interested in other common ingredients in toothpastes, click here.

Edit 21.6.2018

Want to know what the rep told me about the RDA level of the Oral-B Gum & Enamel Repair Original toothpaste? Click here to find out.

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RDA Value in Toothpastes – Any Relevance?
Hands up Who Knew That Zinc in Toothpaste Can Cause Dry Mouth?
Testing Oral-b Smart Phone Holder, Take 1
Testing Oral-b Smart Phone Holder, Take 2

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Yet Another Anti-Patient

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How on earth did I not remember this type of Anti-Patient? I guess it is all coming slowly (but surely) back to me after returning to work.

Before you read any further, it might be good idea to read my post Anti-Patient so you know what I am on about.

Anti-Local Anesthesia

Now, this type of patient is not so uncommon in the dental chair. Let me tell you about the two of the most typical situations I face.

Patient Case I

I am about to start the scaling and root planing and I can tell from the looks of the gum that it is going to be painful. I offer local anesthesia (LA) but the patient declines by saying:

“I once had such a bad experience with LA that I have not taken any since..”

Or

“Oh, I never take any LA, not even when I have a filling done.”

I explain that it will most likely hurt but the patient does not change his mind. Not even when I explain we could use topical LA (I use Oraqix) which would not require needles.

So I begin the treatment. The sonic scaler goes relatively well but when I begin to scale those deep pockets the patient is jumpy (as if somebody was poking his limbs with a needle), turns his head suddenly (exaggeratingly) and is kinda slowly sliding towards my lap as he’s pushing from the handles of the chair.

After I have nearly injured my own finger and patient’s lips for the third time because of the unpredictable motions and after I have three times asked patient not to move his head, I stop the scaling and tell the patient that I won’t be able to carry on unless he keeps the head absolutely still. Because it’s not safe. I offer the LA again and usually at this point they agree.

Patient Case II

The patient (who also just declined LA) keeps still throughout the treatment (scaling) and says she’s fine when I ask her if she’s ok  (multiple times). So naturally I carry on to finish the treatment.

Once the patient gets up from the chair she does not look happy and says

“It hurt a lot.”

Or

“Oh I hate having this done.”

Or

“It’s never hurt before.”

Soooo annoying! Did I or did I not offer you LA? Of course it hurts if you decline LA when it is recommended. And why would you say you are fine when you are not?

What is the most annoying in all this is that she will go and tell ten of her mates how horrible experience it is to have the teeth cleaned. Simple marketing rule – bad experiences you tell to ten people, good experiences to one. So unfair!

Superiority of the Philips Sonicare Toothbrush

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Philips Sonicare forever!

I used to be brainwashed by one of the biggest electric toothbrush manufacturers and thought that there is no better toothbrush than these round-headed ones. I was so stuck in this illusion that I didn’t even give another toothbrush a chance to be better.

But then I moved to another country where two of the biggest toothbrush brands were almost equally popular compared to my country of origin where this manufacturer with round-headed toothbrush was and is dominating the markets.

In my new country of residence I was offered a free trial of the Philips Sonicare. I was amused by the looks of it (it was the old model) and thought it wouldn’t be a very good toothbrush. I almost declined the free trial because I was so convinced about the superiority of this round-headed toothbrush.

But then I gave it a go. It was ticklish as hell at first but thankfully my colleague dentist had warned me about it. I carried on using it for the full two minutes. Once I was done I got my moment of awakening.  My teeth had never felt better. So smooth, so clean.

Patient Case

I was treating a lady – lets call her Sue – at her early twenties for severe gum disease. She had already had periodontist treatment and understood the severity of the situation considering her young age. Sue was very motivated to look after her teeth and did everything she was advised to do.

Sue had a surface retained glass fibre reinforced periodontal splints (everStick®PERIO) on her lower and upper teeth. She was using Tepe interdental brushes of various sizes twice a day and an electric toothbrush – the round head one. She changed the brush heads every month (even though she was informed it was necessary every 3 months). Her brushing technique was checked many times and it was perfect.

But every time I saw Sue for the 4-monthly scale and polish she had supragingival (visible) calculus on her lower front teeth. Lots of it. And she started to be very distressed about it because she was doing all the right things to prevent it. I tried to ease her worry and told that the supragingival calculus was not a problem gum wise as long as it was removed regularly. And in her case the gum didn’t even get inflamed by the presence of supragingival calculus. But it did not calm her mind. She didn’t like the looks of it as it was clearly visible for anyone when she smiled.

I had no idea what to advice more than I already had. She had all the right tools – interdental brushes and a latest model of an electric toothbrush. She used them often enough and with a correct technique.

Then I thought about Philips Sonicare I was using. I suggested to Sue that she could change her toothbrush. I expressed my frustration over the fact that she had spent quite a lot of money for the current toothbrush but this was all I could think of that might help her. I showed her the correct technique of the Sonicare just in case she followed my advice.

Next time Sue came in she had a wide smile on her face when she entered my surgery. She said the calculus had not built up at all! Sue had gone straight to the shop after the last visit and bought the Philips Sonicare toothbrush. She was very happy and thankful for the advice I had given.

This was even more of an eye opener for me than my own first experience with Philips Sonicare.

Why Is It Better?

The name says it all. It’s because of the sonic vibration. When used correctly the sonic vibration can reach beyond the bristles as the sonic vibration travels through the liquids in mouth.

People who think Sonicare is not a good toothbrush have not used it with a correct technique.

Conclusion

In my country where I live and work now the Philips Sonicare toothbrush is not very widely used or recommended by the dental professionals. I am considered as odd one out when I tell I use one. And even stranger it seems that I recommend it to some of my patients. Almost as if I didn’t know my business.

In the dental show case I didn’t even find a representative of Philips Sonicare from any stands. And I cannot find any contact details for a rep to invite her to my practice or to express my views over their marketing strategy. You see the marketing is very poor compared to their competitor who has given trial models to my practise with disposable brush heads so that the patient can be shown the correct technique etc. They give out free electric toothbrushes to the professionals (I have written about it on my previous post) and visit practices regularly to promote their products.

But thankfully the Philips Sonicare toothbrush is available in the shops. And I am doing a small-scale marketing for them. My hope is that they would take more aggressive approach to the almost non-existing marketing. I could even go to the next show case as their representative just to annoy the rep of their competitor who told me that the Philips Sonicare is as effective as manual toothbrush (you can read about it here).

It would definitely make my work easier when convincing the patients about the superiority of the Philips Sonicare toothbrush. And perhaps my colleagues will start to recommend it too.

Here are couple of models of Philips Sonicare electric toothbrush:

Basic model with 31000 brushstrokes per minute (don’t buy anything lower than 31000)

The flagship model with 31000 brushstrokes per minute

 

Part II: Just Another Day at the Office

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“The most dangerous irony is, people are angry with others because of their own incomptence” – Jar of Quotes

Goodness gracious me! It has been too long since my last post. Hope you are still there and reading my posts!

It is time for the dentist’s point of view as a team member of dental practice.

At 8.45am

Oh no, not the Ms. Flumsy again” thought the dentist in the morning when she entered her surgery. Apparently her regular nurse was off sick or something as the practice manager (PM) had called in the temp. The one that had visited the surgery before.

The dentist was disappointed at the PM who clearly had not listened to her when she said she would not want to see this temp again.

You see, everything was wrong with this one. She had long and colourful nails. She had heavy makeup and strong perfume. She didn’t have any idea of assisting a dentist. She thought that using the suction was the most important thing as a nurse. And every task she did took ages to do. And she did them in wrong order. And knew nothing about cross infection control. And went for a cigarette when she should have called a new patient in.

Even though the dark cloud hanging above the dentist head was obvious she forced a smile and said with overly sweet voice “Good morning. How are you?”

“I’m good. And you? Okay?” replied the nurse with a wide cockney accent sending shivers down the dentist’s spine.

The dentist took a look at the day’s schedule. She could feel panic increasing the further she read the day’s treatment plans. Check-up, root canal treatment, crown work, extraction of wisdom tooth, check-up… And of course the time-table had been planned so that the dentist would have her regular nurse assisting her. It was a tight schedule but manageable when the nurse knew her business.

Nevertheless the dentist made a decision not to cancel any patients.

At 9.05am

The first patient was sitting in the patient chair with the bib and safety glasses on. She was about to have a check-up done.

“Oh, I didn’ remember yew ‘ave dis computer software! Don’ know ‘ow ter use it” the nurse says suddenly. The dentist sighs and gives a piece of a paper to the nurse to record her findings.

Then she begins her check-up routine and after checking the teeth with a mirror and a probe she reaches for the fiberoptic. Only it’s not there. She turns her gaze at the nurse who is at the front of the computer screen cleaning her fingernails and looking disinterested.

“Could I please have the fiberoptic?” she says with overly calm manner.

The nurse begins to go through the drawers but cannot find the device. The dentist waits. The nurse checks the autoclave.

“Gawdon Bennet! There are instrumun’s ‘ere from yesterday but its not ‘ere, innit.”

The dentist remembers that her colleague sometimes borrows the fiberoptic as the practice has only one of them. She asks the nurse to go and check from there. She examines the patient’s soft tissues meanwhile.

“Here i’ is” the nurse says triumphantly when she returns and waves the fiberoptic in the air and attaches it to the unit. The dentist notes that the nurse did not wipe it with disinfectant but she thinks it’s not that big deal especially now when she’s running 5 minutes behind the schedule.

She completes the check-up and sends the patient to the reception. Then she records her notes to the computer as quickly as she can.

“Exam” she writes. No time for all the gibberish.

Then she updates the chart from the piece of paper and checks the next patient’s records. A root canal treatment. She notices that the nurse has placed only the basic instruments on the tray and disappeared somewhere – probably for a ciggie. The dentist starts to collect instruments she needs and calls the patient in. She feels her blood pressure raising.

I really cannot be doing nurses duty, simply just cannot…” 

She is numbing up the patient when the nurse walks in.

“Oh, yew ‘ave already taken da patien’ in! Wasn’t da appointmen’ at 9.45?” 

The dentist does not reply and carries on with the treatment.

At 10.10am

The dentist is done with the filing of the root canals and is about to rinse the canals with the sodium hypochlorite for the last time. The nurse grabs the suction.

Silence.

The nurse places the suction back to its holder and takes it off again.

Silence. Not a sound.

The dentist realises that something is wrong and it cannot be fixed quickly. She asks the nurse to inform the practice manager about the malfunction.

Meanwhile she tries to figure out how she can finish the treatment without the suction. Luckily she wasn’t born yesterday and she takes a sterile gauze and places it close to the root canal treated tooth before she rinses the canal with the sodium hypochlorite. The gauze absorbs the liquid. She puts the calcium hydroxide to the root canals and seals the canals with temporary filling.

She escorts the patient to the reception in an intention to ask the PM what she has done about the suction but then she sees two practice’s regular nurses entering her surgery. She goes after them to see if they can fix the problem.

The nurses try to figure out why the suction is not working even though all the other suctions in other surgeries are fine.

The dentist checks the time. She’s now over 10 minutes late from the schedule. And the next treatment is crown work and that cannot be done without the suction.

The nurses need to return to assist their dentists and the PM needs to call in repairman. This means the dentist needs to cancel the next patient’s appointment. Zero income for the next two hours or so or until the suction is fixed. She walks to the reception to meet the patient and break the news.

The patient is not happy. He has taken two hours off work to come to the appointment. In a fear of losing the patient to another practice the dentist promises a discount from the treatment.

At 12.30pm

The dentist has tried to make a use of the spare time and goes through laboratory bills in her surgery. The repairman has not been in yet and it is soon lunchtime at the practice. Things are not looking good. She won’t be working until the late afternoon.

The surgery door opens and the hygienist pops her head in.

“Great, you don’t have a patient. Would you mind coming in to my surgery to check something? I have your patient in the chair and I think I found a decay on the lower right 6 and also something on soft tissues…”

The dentist walks in the hygienist’s surgery and greets the patient. She puts the gloves and face mask on.

Dentist: When did I do the last check up?
Hygienist: Err, yesterday…
D: And where was it that you suspect a decay?
H: On lower right 6. On the buccal side just below the gum line. There is another one as well but I think it is still in early stages…
D: Where is this?
H: On upper right 2, mesially. I don’t have a fiber optic so I couldn’t check it properly.
D: There is one in my surgery.
H: I know, but the turbine attachment is not working in my unit.
D: Ok then, let’s have a look…

The dentist takes the probe and checks the lower right 6 first while the hygienist stands on the nurses side and watches.

D: It seems to be ok…
H: It’s more subgingivally. You need to push the gum aside slightly.

The dentist feels this unpleasant feeling in her stomach when the probe sinks inside the tooth on the site hygienist mentioned.

D: Yes… yes, you are quite right. This needs to be repaired. Let’s see what we can do about it as it is quite deep… How about the other one. It was the upper left 2?
H: Upper right 2 mesially.
D: You are right it is decay but hard to say without the fiber optic if it’s advanced. I will check it on the next visit.
H: There is also something on the soft tissues I’d like you to have a look. It’s on the cheeks and under the tongue. Could it be lichen planus?

The dentist takes a look.

D: I can see what you mean. Hard to say for sure without biopsy but it does look like lichen.

Then she goes on informing the patient about lichen and asks the patient to book an appointment to decide what can be done to the lower right 6.

The patient looks shaken. Yesterday she got all clear and today she hears there is something seriously wrong with one of her back tooth plus something – possible cancer – on her soft tissues. She is not convinced when the dentist says there’s nothing to be worried about.

The dentist leaves the surgery and feels like going home. Or to the pub. This day is just one of those days she would like to forget. But she must stay to treat the rest of the patients – providing that the suction is fixed before this.

But it is time for a lunch first and she decides to go out for the full hour.

At 2.30pm

The dentist returns to the practice after the lunch break and chats with the receptionist before going to the surgery. The receptionist tells her that the repairman came in and did his magic in 15 minutes. The suction works again. Whoopty doo!

When the dentist reaches the surgery she can see through a glass tile window that the surgery’s lights are off. She opens the door and sees the unit lifted up to the highest position which the nurses do at the end of the day.

“What the hell?” comes out of the dentist’s mouth.

She walks back to the reception to see the PM.

“Why is my surgery closed?”

“Oh is it?” replies the PM and walks to the surgery.

“Oh lord” she says when she sees the surgery, “the temp must have gone home… I thought she went for a lunch!”

“I cannot believe this… this is unacceptable… did I or did I not tell you that I do not want to have this temp assisting me ever again?”

“I’m sorry but I did not have…”

“I don’t care. Your job is to keep the surgery running and I have seen only two patients today which is outrageous. And those two I have had to treat practically alone as the nurse is useless…”

“I understand. I see what I can do… I will try to reach the temp. Maybe she’s somewhere close by. I don’t understand how she thought she could go home.”

The dentist was fuming. She did not want the temp back but she did not have other options if she wanted to see the rest of the patients. But she soon learned that the temp was nowhere to be reached. The PM offers to come in to assist her.

“Well it’s better than nothing” she replies.

After she had seen the first patient for the check-up she was much calmer. She took in the next patient who had just seen a hygienist for a scale and polish.

When the patient opened the mouth she started to get annoyed again. The hygienist had not rinsed the polishing paste properly. It was in every between the teeth, this gritty blue paste.

“Seriously, who uses this much polishing paste!” she thought whilst her cheeks were getting red from the annoyance. You see, this wasn’t the first time. It happened with every patient who came to see her after the hygienist treatment. Soooo annoying!

At 5.30pm

When the day was over the dentist felt like she was the only one in this practice who knew her business. How was it possible that she was surrounded by so many incompetent people? She thought about changing jobs.

But would the patients follow? Some probably. Would it go from bad to worse? Yes possibly. Should she start her own practice? Definitely not, too much stress. Should she quit dentistry? Yes, it would be the wisest thing to do but she wouldn’t afford it as she’s still paying the student loan.

She went home fearing what the next day would bring. One thing she has learned in these couple of years of practising dentistry was not to check the next day’s patients. It was about minimising the stress. But there were so many other things she had no control over that sometimes just felt too overwhelming. Way too overwhelming.


You might also like these posts:

Part I: Is It a Skyskraper? No, It’s Your Ego
Part III: I’m Sorry but I Did Not Get Qualified So That I Can Make Coffee for You

Part I: Is It a Skyskraper? No, It’s Your Ego

Dentalrevelations

On my second post I promised to write about personalities of the staff in dental practices and how they may affect the dental practice and the treatment given to the patient. I’m going to fulfil this promise today. And on my next post. And the next.

I am going to write a series of posts about this topic. Each post will have a viewpoint of one dental professional. Today it will be the hygienist’s.

I’m Not Going to Play with You

As long as there have been dental hygienists there have been dentists who are afraid of losing their living because of them. These dentists either refer only the simple scale and polish to the hygienist or do not refer at all.

They treat the patients with advanced gum disease themselves as it requires more visits. More visits equals more money per patient. And the money is the only motive they have for this silly way of practicing the dentistry.

The problem with these kinds of dentists is that most often the hygienist would have better skills to treat the advanced gum disease than the dentist and this is revealed when the patient sees the hygienist six months later. Often there is subgingival (invisible) calculus still left even though it should have been removed on the first course of treatment. Plus the patient has no clue how to clean her teeth effectively.

Big Ego

It is a fact that the oral and maxillofacial surgeons have a big ego. Or to precise – they have a huge ego. But in my opinion they have all the right to have one. They NEED one to be able to perform all the talent requiring hocus pocus on patients mouth, jaw and face. Plus they don’t use their ego against co-workers or the patients.

But when a dentist has a big ego it rarely is attractive or talent enhancing. I will give you an example from a real life.

A dentist does a check-up for a patient. Then the patient sees a hygienist for a scale and polish. Whilst scaling with curettes the hygienist notices there are potential cavities in three different sites and she checks the patient’s x-rays. The x-rays confirm the suspicion.

The hygienist checks the dentist’s notes for the check-up visit to see if there is a treatment plan to fix these cavities. There isn’t. It appears as if the dentist has missed the cavities when doing the check-up.

The hygienist sends the patient back to see the dentist. When the dentist sees the hygienist’s message about the cavities he acts as if the patient has come in unnecessarily.

“I’m sure there’s nothing there”

he says to the patient. He quickly checks the sites with a mirror, sighs and continues by saying

“One of these suspected cavities is a borderline cavity. We could do a filling for that so that you didn’t come this far for nothing. The other two we can still monitor.”

The hygienist sees a patient for another scale and polish couple of weeks later. She checks the dentist’s notes and realises that only one cavity has been filled. She asks the patient if the dentist has asked her to come back to have the other two to be done. Negative.

The hygienist is baffled. She checks again with her curette the other two suspected cavities. The instrument goes between the filling and a tooth and sinks deep into a soft area – it is a cavity for sure.

The hygienist decides to ask another dentist to come and have a look there and then. The dentist confirms the two remaining cavities and recommends the patient to have them filled.

At this point the patient is very confused. Who is not doing their job properly? Who to believe?

This was just one example. There are plenty more but I won’t write them down as I am not writing a novel. But my point is that when a lower ranking dental professional finds something the almighty dentist didn’t the ego goes before the patient’s best interest.

Not good. Not good dentistry at all and everyone who recognise themselves from this should be ashamed.

But why the dentist did not notice the cavities even from the x-rays? That is completely another story.

Hygienist’s Difficult Role

It is tough to be a hygienist. They often have skills to make the same diagnosis as the dentists but only the dentists have a right to make one. The hygienist must always remember to add a question mark after their findings or the hell will break loose and she is quickly put back to her place by the dentist who kindly reminds her that she has no right to make a diagnosis.

And when she finds something that the dentist missed she will be between rock and a hard place. Especially if the dentist does not agree with her because of the big ego problem. The confused patient often thinks the dentist was right which makes the situation even more difficult.

But the time is on hygienist’s side. She has recorded every finding on the patient’s dental records – with the question marks! She has recorded that she has consulted a dentist. Sooner or later the cavity (or whatever her finding was) will get worse. There will be pain. Or the crown will come off as the cavity has eaten the tooth under it and perhaps so much so that it is beyond repair.

The dentist can only hope the patient do not file a complaint.

Lonely Rider in a Cupboard under the Stairs

Another side of being hygienist is the fact that they are often quite alone in the practice. It is often so that the practice has only one hygienist. This means they don’t have peer support in the practice. Peer support is something that every dental professional would need.

Also the hygienist is given the oldest dental unit in the practice and the smallest room, the one without a window. Or perhaps the room under the stairs. Not sure if the Harry Potter fate has happened for real – perhaps it was just sarcasm from a hygienist that I once knew?

Conclusion

Why do the dentists feel so threatened by hygienists? Why is it hard to be wrong or admit that you have missed something? Why do they need to feel and let others know that dentists are at the top of the command chain?

I’m afraid I do not have the answers. One dentist once said to me that the dentists are non-qualifiers for medical school which means that the dentistry was not their first choice of profession. Are these kinds of dentists letting everyone else suffer for their disappointment?

I will remind you that not all the dentist are like this of course. But in my current workplace two out of four dentists are. That’s 50%. That’s a lot!

I hope practice owners will start to value their hygienist more than before. And get them the brand new dental unit, a saddle chair (or whatever chair the hygienist prefers) and curettes the hygienist wants so that there would be even a small chance to work in an ergonomic position during the treatment. After all they bring in steady flow of cash with very little expenses.

And dear dentists, we are all equal human beings no matter what our profession is.


You might also like these posts:
Part II: Just Another Day at the Office
Part III: I’m Sorry but I Did Not Get Qualified So That I Can Make Coffee for You

Want to Have a Say?

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Are you a patient who is annoyed about certain things that you encounter at the dental office? Have you had bad experiences at the dentist?

Or are you a dental professional who is cross about something a dentist/hygienist/nurse/management/patients do?

I believe problems in dentistry are universal and I want to give you a chance to have your say. Send me an email on dentalrevelations@gmail.com and pour your heart out (trust me, it is liberating). Please write to the subject field My Say.

What I hope you will mention on you e-mail is:

  • your gender
  • age range (20-30, 30-40, 40-50, 50-60, 60-70…)
  • what size of a town did the thing you are writing about happen
  • your profession (applies only the dental professionals)

I will handle all the emails with utmost confidentiality but I might use direct quotes of your text so please write in non-identifiable manner.

Yours sincerely,

Dental Revelations Blog

Waste Not Want Not

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Is there something in dentistry that could be recycled?

I have had this great idea for ages and I just realised this blog would be just perfect channel to get it out in the open.

I am into recycling and saving our planet in my personal life and because of this it is sometimes hard to work in a profession that produces lots of waste every day. Waste that we do not sort in any way (well clinical waste and domestic waste in UK but that’s not really sorting in the matter of recycling). 

It has forced me to think that could dentistry be more sustainable? 

Don’t be alarmed. I’m not going to suggest that we start to wash our gloves and saliva ejectors.

Expensive Business

Materials and equipment are very expensive in dentistry. Sometimes we order equipment that for one reason or another lays in the storage shelf nearly unused.

Sometimes we use only half a pack of costly composite filling material before we order a new one – the one that just came out in the market and is supposed to be better than the previous ones. The old half-a-pack composite filling material stays in the shelf until it is out of date and is thrown away eventually.

That is just one example. Let me tell you another one. Somebody in my current workplace thought it would be a good idea to buy the EMS Air-Flow S1 for soda whitening. Then she changed jobs and the brand new Air-Flow was forgotten. The two hygienists and four dentists in the practice did not think there was any benefit of using the Air-Flow. Money wasted.

One more. The root canal files. Our practice has so many unused packages of root canal files that no-one uses. Perhaps because of the Wave-One that is easier and more user-friendly than traditional files. But I’m sure there is somebody that still uses these traditional files? 

THE Grand Idea

Could these unwanted materials and equipments be sold second-hand to the practises who need them? The price would be lower of course than when buying new ones.

I think they could. It would need a website for sure. Some kind of dental online flea-market. And if it was global it would be even better. But then again it’s not about saving our planet because of the carbon footprint. So let’s do it locally so that we will maintain our humble idea of recycling (but I still want my share of the advertisement income the website will have because of its popularity). 

Money-Saving Advice on Dental Visits

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Are you seeing your dentist for a check-up too often?

Here we go again. I am annoyed about something that is waiting to burst out. I have written about integrity of the dentists in one of my previous posts and today I am going to touch the same subject.

This post is about dentist check-up frequency patients should have.

Many dental practices very commonly advise people on their websites and in the surgeries to see dentist every three to six months and they justify this by prevention of bigger dental problems.

A revelation:

Recommending the same check-up interval to all the patients is not up to the standards of modern dentistry. It is merely (once again) about maximizing the profit of the practice.

Check-up intervals should be decided after carefully evaluating the current status of the oral health, general health and oral hygiene routines. I will list the guidelines that are practiced in one of the leading countries.

Managing Decay

24 to 36 Months Interval in Check-Ups

This concerns the patients who have

  • no treatment requiring decay
  • no early decay that needs to be stopped or reversed
  • not had any decay for many years

It is important to check the patient’s eating habits to make sure that they are not harmful to the teeth and encourage patient to change them if needed.

6 to 12 Months Interval in Check-Ups

This concerns the patients who have

  • one or more early decay or advanced decay

It is important to make a plan together with a patient to stop the decaying. This might include visits to the hygienist.

Exceptions

Certain groups of people might need to see dentist more often than advised above. These are:

  • children and youngsters
  • people with illnesses and medications that reduce saliva flow
  • users of intoxicants
  • immigrants of certain countries
  • people with dental phobia
  • people with big life events (pregnancy, divorce, military service, retirement)
  • people of low education
  • smokers
  • people with illnesses or injuries that cause disability that prevent good oral hygiene
  • people with harmful eating habits and/or poor oral hygiene
  • people who use fluoride toothpaste less than twice a day
  • mouth breathers
  • people who are undergoing orthodontic treatment
  • people with dentures
  • people with erosion on teeth
  • patients who have had teeth extracted/root canal treated due to decay in the past 3 years

Managing Gum Disease

3 to 12 Months Intervals in Maintenance Visits

After a comprehensive therapy for the gum disease the patient needs to see periodontist/hygienist regularly for the maintenance visits. The interval of the maintenance visits is based on many risk factors like

  • severity of the bone loss
  • smoking status
  • overall health (diabetes)
  • genetics
  • age related (medications, illnesses)
  • gender (male)
  • low socioeconomic status
  • poor oral hygiene
  • condition of the teeth (restorations – especially subgingival crown margins, removable dentures)
  • furcations
  • anatomic abnormalities
  • residual pockets

The more advanced gums disease the shorter the maintenance interval. The more risk factors the shorter maintenance interval.

Conclusion

To recommend all the patients the same 3-monthly check ups is simply madness and it stinks of foul play.

Dear patients,

please be advised that you most definitely do not need to see a dentist every three months unless you fall into one of those risk factor categories above. But even in these cases a top-notch oral hygiene habits can make wonders and extend the check-up interval from three months to six.

Also if you do want to see a dentist every three months there is no harm done. Apart from you needing to pay unnecessarily for a treatment you don’t need.

Yours sincerely,

Dental Revelations Blog

Times change. So does the dentistry. Sticking to the old ways – “it has always been done like this” – is simply not what modern dental practice should do.

More on the subject click the links below.

NHS

Daily Mail

NICE – National Institute for Health and Care Excellence

Do You Recommend Toothpick?

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Toothpick or no toothpick, that is the question!

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.

Suspicion

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.

 Conclusion

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.

Have You Read a Poem About Dentistry?

This is a nice read and there will be a poem by Ogden Nash in the end. Worth reading through! Picture and text courtesy of The PB Chronicle.

While I was in Germany, I had the worst toothache. I am not one with perfect teeth, but I had never had a toothache like this. My face was swollen on one side for two days. Luckily, someone who was traveling with me had some medicine that worked and I was fine until I got […]

via The dreaded ‘D’ word — The PB Chronicle