Tag: dental

It’s ok to swallow, it’s only water… Or is it?

Dental Revelations4 Comments

Sandbox-4950

You feel the water lever rising in your mouth while you are having a treatment done at the dentist. Your natural instinct raises an alarm in you mind.

I’m going to drown…

I’m choking…

Your eyes open wide and you raise your both hands to make a gesture that you want to get up to empty your mouth. The nurse quickly takes the suction to remove the water but there’s always some left, isn’t there? Your hands are still reaching the spittoon next to the dental chair but the nurse lays a hand on your shoulder and says gently

It’s ok to swallow, it’s only water.

Well is it?

Dental Unit (= the Chair) Waterlines Causing Infections?

The water in dental unit waterlines should match the same standards as safe drinking water. In short this means that the bacterial count (colony forming units, CFU) in the water should not exceed certain safe level (if interested to find out more in depth, please visit here). The standards vary in different countries. The countries I have worked the CFU/ml regulations vary from 100-500. Now here comes the nauseating fact:

In practice the CFU/ml levels can be as high as hundreds of thousands of all sorts of nasty bacteria, including the ones of human origin. Needless to say that it is enough to cause problems.

The problem with the dental units is that many of them are old and do not have the latest technology for waterline cleaning. Renewing the dental units is slow as they are expensive and practices want to use the existing ones as long as possible.

Dental units without waterline cleaning system have a slow flow in the waterlines, the water is warm and the water stands still during off-surgery hours (nights and weekends). Sounds like a very bad combination, eh? The old dental units do not have preventive valves in the waterlines to stop suck back of the patient’s saliva into the lines.

So as a result the waterlines in the dental units are lined with biofilm (a mass or layer of live micro-organisms attached to a surface) that should be removed regularly.

Who Is at Risk?

The healthy patients should not worry much. But to be honest, I do not like to swallow the water myself. It’s gross.

The patients whose immune system is impaired are most at risk. The elderly, the young children, medically compromised people and everyone with immunodeficiency. In worst case scenario the visit at the dentist can be lethal.

Of course us professionals are at risk as well. There are lots of aerosols in the air during the use of the dental unit. A bacterium to raise the biggest concern is the Legionella that causes Legionnaires’ disease. So do take care of the unit waterlines.

Advise for Professional to Improve the Water Quality

Use water source that meets the standards for drinking water.

Run the water from the unit waterlines (handpieces, ultrasonic scalers, air/water syringes):

10 minutes after the weekend
3 minutes in the morning
30 seconds after every patient

Use an efficient waterline treatment product recommended by the unit manufacturer. Use it regularly. Running the water as I advised will get rid of the free flowing bacteria but not the biofilm, it needs an effective disinfectant. The most effective product for getting rid of the biofilm are the ones containing:

hydrogen peroxide
hypochlorite
superoxidized water

Invest in new dental unit (do not go to the cheapest option – you only go from bad to worse) with the latest technology. It’s only humane thing to do.

Conclusion and Cause for Worry

In my experience the dental unit waterlines are not looked after as they should to maintain the good quality of the water.

I have seen that instead of cleaning the waterlines the dental professionals have stopped using the water e.g. when using the slow handpiece (the drill that feels like a street drill). Now I must mention that this happened only in the other country I worked at. I never found out why they actually do this (please enlighten me on comment box below!) but perhaps it was because of the water quality problem? When I used a slow handpiece there, I was naturally worried about overheating of the tooth and tried to get water flowing but it was made impossible.

I have seen a dentist performing implant surgery using a water from air/water syringe (it wasn’t the only thing that was wrong with that treatment – imagine dentist’s tie hanging loose and contaminating everything it touches. Sterile surgical coat was nowhere to be seen). Implant surgery if anything needs an absolute clean environment and wearing your personal clothes and using unit’s water supply simply is not up to the standards.

I know for a fact that many dental nurse neglect running the water as described above. It is appalling thing to do. Honestly.

What does this tell about us professionals? We should be the ones that are looking after the patient’s best interest and health. Doing all the fancy and immaculate maneuvers inside the mouth is not enough to fulfil our purpose.

Are we too busy making money and forgetting the basics?

Advise for the Patients

Seek out a modern dental practice with modern equipment. If you are unsure what modern dental unit looks like, here‘s one example (unfortunately I don’t get paid for advertising this site).

It is ok to ask the nurse or the dentist if the waterlines are regularly disinfected and if the nurse runs the water after each patient.

If you liked this post, you might also like:

Are Your Dentist’s Tools Clean

Drowning at the Dentist – Is It Possible?

 

Soap Opera of the Dental Practice

Dental RevelationsLeave a comment
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Sometimes colleagues act like kids in a sandbox. On a frosty day.

The next time you lay back on dentist chair to have either check-up or treatment done, instead of concentrating on squeezing the handles in a fear of the pain and unknown, pay a close attention to the chemistry between the dentist and the nurse. If you are lucky, it can be very entertaining to watch and listen, and you forget the whole business of being nervous.

Ideal Dentist-Nurse Relationship

An ideal relationship between a dentist and a nurse is such where mutual respect prevails. They are two human beings, professionals working together for the patient’s health and earning their living. Both of them understand that one could not work without the other (at least without seriously compromising the safety of the patient) and especially that they could not work without the patient. They may be good friends that go beyond the working day.

Dentist-Nurse Relationship from Hell

It can be a sign of a non-working relationship if it is the nurse that calls your name at the waiting room of the dental practice. Not always, but often it is so.

Why? Because normally it is the nurse who has more to do after the previous patient than the dentist. The nurse spends long time wiping surfaces (should do), equipment, patient chair with a disinfectant, sterilizing instruments and preparing the room for the next patient.

Meanwhile the dentist chats with the previous patient, records the visit (takes couple of minutes, sometimes even less if the dentist is not bothered to write anything else than check-up and adding a sign that tells us professionals that nothing special was found) and checks the next patient’s treatment plan, which she should have done already in the morning. All this often takes less than what the nurse needs to do.

A revelation:

Some dentists feel that they are too highly educated to walk the aisle of the surgery to call the patient in. It is the nurse’s duty even if it meant that the dentist has nothing to do while the nurse is finishing with disinfection business (well, dentist can always have a cuppa while waiting).

Here is an example of this. I have witnessed a very highly educated specialist taking a seat in the front of the computer every time the nurse walks out to call the patient in. And when the nurse returns with the patient, the specialist is looking intensely at the computer screen looking all important and wise for few seconds and then almost like apologetically getting up (for not noticing that the patient arrived) and rushing to shake hands. This happened with e-v-e-r-y patient. Honestly.

But.

There are nurses that prefer to call the patient in from their own will. In this case any of the following won’t happen in the surgery. So keep reading!

Once you have taken a seat in the dental chair, the nurse gives you the safety glasses and a bib to cover you shirt and tilts the seat down. Here comes the next battle of the non-working relationship between the dentist and the nurse.

The ergonomics are very important in dental profession. It means early retirement or occupation change if you work in wrong positions for many years. In a good healthy working environment the dentist and the nurse have tried and tested the positions of the patient chair that is good for both of them (there will be exceptions e.g. when very large patient or heavily pregnant patient comes in).

So the nurse places the seat down and sits beside you. The dentist washes her hands (hopefully) and puts on the face mask and gloves. She moves her chair beside you and starts adjusting the patient chair’s hight and tilting-angle. If you see the nurse moving hastily further away from you or standing up, you know they do not work well together. The dentist has just adjusted the seat so that the nurse is not able to find an ergonomic position.

If they have worked together like this for years, there is lots of anger and resentment from the nurse’s side. You might be collateral damage in this war, I’m afraid. If you feel like your mouth is filling up with water, you need to swallow it a lot (by the way, you can swallow it, it’s just a tap water, is a lie and I will write about it later on this blog) or it pours out from the side of your mouth on to the dentist’s lap, it might be a silent demonstration against the dentist’s tyranny over the position of the patient chair and the patient’s head.

Twisted, but that’s how it goes.

Other Signs of Non-Working Dentist-Nurse Relationship

  • they don’t chat while treating you
  • they don’t make jokes to try to ease you fear
  • you hear lots of clatter from the instruments (they are thrown in the tray)
  • they reply cynically to one another (normally nurse to the dentist and in non-funny way e.g. as soon as I have time)
  • they argue about treatment, equipment and materials. How they should be used or should they be used at all – the dentist wins these arguments as they are the higher educated ones and cannot be wrong. Especially not in the presence of the patient
  • the nurse sits like a statue after the dentist has requested for an instrument. Just before the dentist is about to renew his request the nurse rolls her eyes and slowly reaches for the instrument

Definite Sign of Non-Working Dentist-Nurse Relationship

The nurse walks out of the surgery.

Conclusion

Just imagine what it is like to work as a pair and the chemistry does not work. It is simply and utterly torture for all including the patient. And it is very common in dentistry.

If you, a dental professional recognised yourself from the above, please start working towards a better relationship. It starts from the respect.

You might also like:

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

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

Can You Trust the Recommendations given to You by a Dental Professional?

Dental Revelations2 Comments

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Too Many Options

Floss, tape or ribbon? Soft, medium or hard brush? Manual or electric? Fluoride or herbal toothpaste? Whitening, double-action, triple-action or all-in-one? Mouthwash or not?

These questions are endless in the mind of a common consumer. So no wonder they rely on the advice of a dental professional. Why wouldn’t they? Us professionals have the latest information and studies. We have tested the products ourselves. We have seen them in use amongst patients with good results before recommending them.

Not.

As some of us might have, most of us haven’t. Let me tell you how a product gets recommended.

Annual Dental Show Case

Every year dental professionals gather at dental show cases where manufacturers of dental equipments and oral health care products have set up impressive stands to lure dentists, hygienists and nurses to discuss about the new products.

A revelation:

Most of these professionals are not interested in what types of root canal files they have invented or the qualities of the new toothpaste.

What they are interested in (while acting as if they are listening the representative) is:

Are there any freebies?

Yes, I have seen highly paid dentists with their Louis Vuittons to run after freebies like they had no money to buy them. They sit in free 45 minute lecture sponsored by one of the leading oral hygiene product manufacturer to receive the latest model of an electric toothbrush which they already have. This new one they will either sell or give as a Christmas gift to a relative. They go from stand to stand to pick toothpaste, floss, chewing gum, sweets and reluctantly accept advertisement leaflets which will go straight into the bin when they reach home.

The most generous representatives are the ones whose product end up recommended the most.

Why?

Because they send boxes and boxes of free samples to the practices. Let’s say a dental practice receives 6 boxes of toothpaste samples, those handy travel sized ones, you know? Each box has 100 samples. So 600 tubes of toothpaste to give away. Will all of these be given to the patients? Nope.

300 of them will confiscated by the staff of the dental practice for personal use
200 of them the staff will give to the relatives and friends

And finally the rest will go to a small bowl on the side of the desk in the surgery and these samples are given one by one to a patient who has deserved it. Some might even hide them in a drawer to avoid being forced to give them to a patient that annoyed them (because it’s not good manners to say no if the patient asks for samples).

Salesmen of the Manufacturers

The leading oral hygiene manufacturers have salesmen who visit regularly the dental practices to promote their products. They are warmly welcomed to the practices but often only if they visit whilst the practice is having a lunch break. The reason for this is:

  • The practice does not want to lose any profitable surgery hours.
  • All dental professionals know they will bring something to go with a coffee. A cake, sweets, a swiss roll. They had better or the salesman will be faced with a grumpy audience.

When the dental professionals are happily sipping away their coffee or tea with the cake, the salesman goes through the new products. There might be a question or two but what everyone is thinking while the salesman talks is:

Are there any freebies?

We often meet quite aggressive salesmen who will defend their product to the death. Honestly, what happened to customer is always right? If you are actually listening to the salesman when he is telling you about all the impartial studies of how their pulsating electric toothbrush is better than a manual toothbrush and especially better than their competitor’s sonic toothbrush (their study actually says sonic toothbrush is as crap as the manual toothbrush – whaaaat?) you are urged to raise your hand to get a say.

You want to tell the salesman, that you are actually using the sonic toothbrush and that you have recommended it to the patients with poor oral hygiene and the results are great. If you are wise, you don’t say anything and carry on recommending the product you know is the best. But if you cannot keep quiet, you will soon learn to do so next time. The salesman starts to talk to you as if you are retarded or malpracticing when recommending something their study has shown to be ineffective.

Impartial study my arse (beg pardon my French).

Anyway, the salesman gives everyone toothpaste and promises to send samples later on. Boxes of samples. And they will. And you already know what happens then.

I must say that it amazes me how some of the dental professionals are stubbornly stuck on recommending the same electric toothbrush they are using themselves and have never tried another one. Or they might have tried it once (let’s say this leading sonic toothbrush) with incorrect technique and judge it by that. They refuse to see the good results that are clear with the patients who are using this sonic toothbrush. Where is professionalism in this?

Personalities and Professions Clash inside the Practice

The dentist is the ultimate Master of the Universe (by Universe I mean a dental practice) and if the Master has ordered certain toothbrushes, certain toothpaste, floss and interdental brushes to be sold in the practice, then the rest need to comply. Of course there will be some rebellion inside the closed surgery doors. But it needs to be done so that one does not get exposed as there will be consequences. So one must occasionally recommend the products the Master has chosen.

For some reason unknown to the writer the patients seem to consider the dentists as God. What the dentist says overwrites everything another dental professional has said, including oral hygiene recommendations. The hygienist cannot be right if the dentist said something else.

This leads me into temptation to step out of the subject for a little while as I remembered something that has puzzled me for ages and I think I might get an answer through this blog. Here it goes… Patients consider the dentists as God and bring gifts (wine, chocolate, flowers etc) to them when the treatment is done and the nurses, hygienists and the rest hardworking supportive staff get nothing. Gifts TO THE DENTIST who makes gazillion amount of money compared to the supporting staff! Why o why? Dear patients, please use comment box to enlighten me in this matter!

Back to the subject.

Later on in this blog I will be writing more about the personalities and how it affects dental practice and the treatment given to the patient. But having mentioned it on the heading already I will write shortly here as well.

When a dental professional has a big ego it sometimes runs over the best interest of the patient. Lets say a dental hygienist recommended you a yellow interdental brush and she spent time and effort to get you to learn the technique by showing how to use it and by checking that you understood how and why to use it. You leave the practice happy because you learned a new skill to improve your oral hygiene.

Then you see a dentist the next week and he thinks the interdental brush is rubbish (as you lost a filling made by him when using the interdental brush) and advices you to use floss on your heavily filled teeth with wide gaps. He just casually says this without showing the technique. You try the floss as you have many times previously and it gets stuck, breaks and is difficult to use between the back teeth. You give up and stick to the toothbrush only.

Who wins? Nobody. Especially not the patient. And to be honest, you would be wasting your money anyway as the floss is not the right tool for you.

A revelation:

The dentist is not in the area of the best knowledge when it comes to recommending the oral hygiene products. They are far better drilling and filling the teeth. And doing all sorts of other nasty (from patient’s perspective) things that requires higher and longer academic education than hygienist’s.

Old Habits Die Hard

“I have always recommended floss and it’s been fine”

Oh, dear. Lets start from the basics of oral hygiene.

Patients are all different, our teeth and bones are different shapes. They have teeth that have no fillings, some fillings or mouth full of fillings and other restorations (crowns, bridges, implants). Some restorations are well made, some not. Patients have different motoric skills.

So you cannot recommend something out of custom.

To find out the best product to recommend to the individual patient, we should always use disclosing liquid (the one that dyes the plaque red/blue). If not used, it is impossible to tell what works and what doesn’t. You would be surprised to find out how ineffective the common floss or tape is. I do recommend floss every once in a while but only 3 certain types of certain brands (you will find out from here which they are, plus correct technique for the sonic toothbrush).

How It Should Be Done

This chapter is especially useful for the dental professionals but the patients benefit of reading this as well. You know you are in good hands when a dentist or hygienist is as thorough as I describe.

This is a short version of upcoming post about what recommendations should be based on.  It is last on the list because there are not many dental professionals who are this thorough.

The most important thing is to interview the patients about their current oral hygiene habits and reasons behind them. E.g. if the patient is not cleaning between the teeth, ask why? without sounding or being judgemental. Laziness, ignorance, stress, depression, difficult life situation, too hard… there are as many reasons as there are patients.

The next you need to find out where the problem areas are in patient’s mouth and decide the right tool for the patient to use. Test it, show it to the patient and let the patient try. Remember to say, it won’t be an easy ride at first even if looks easy when I do it.

Tell the patient where she can find them and where they are the cheapest to buy (do your research).

Give leash and don’t be overenthusiastic. By this I mean you should encourage patient even if there has been only small improvement, but also same time encourage to do better next time. Change the tool if it’s not working. Small steps!

In my experience it takes 12-18 months on average until you get it right if the patient is responsive. So don’t give up after the first visit.

Also worth remembering

  • the products sold in the practices are not necessarily the best ones like electric toothbrushes of certain makes and models. They are normally just the owner’s way of making more money on the counter. Use the products recommended by an experienced hygienist.
  • some of the products might even be a health risk like mouthwash which contains alcohol (now this is an issue that divides dental professionals. Some agree with me, some don’t. I will be writing about this later on in this blog).
  • some of the products might not be suitable for you like toothpaste containing soap if your mouth is sensitive (sodium lauryl sulfate).
  • some dental professionals are not revising and open to a new information and studies about dental products. They stick to the old knowledge despite the fact that the new information is indisputable. This happens especially if the new information is delivered by the lower rank colleague in the practice.
  • fillings, when well-made, do not come out with any oral hygiene product. The fault is always in the filling and in it’s maker if the filling is relatively new.

Conclusion

It was a long post, hopefully you made through it. To sum up all 2000+ words, only two words come to my mind that defines us dental professionals these days. Greed and pride. Two out of seven of deadly sins.

But there is hope.

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