Vanity with Style? Should You Get Tooth Jewellery?

Can you spot the diamond on my canine?

Human beings have been interested in their appearance for thousands of years. Decorating their bodies with tattoos, piercing ears and other parts of body but also decorating their teeth. Already 2500 years ago were the Native Americans making their teeth stand out with gems. This is a phenomenon that has lasted ever since.

Tooth Jewels – Any Harm?

Well in the mid-nineties I had my first tooth jewel. I was a dental student when the tiny golden figures for the teeth came in fashion. Heart, star, droplet were the figures to choose from. I chose a heart and it was attached to my upper right incisor with a bonding adhesive they use to bond the filling.

For a very long time I was happy with it but then I saw other people who had similar jewellery on their teeth. I thought it looked like people had something stuck on their teeth that needed to be scraped off with a finger nail. It didn’t look like you had golden figure on your tooth and the shape was only visibly in very close distance. I did not want people to think I had food stuck on my teeth – after all I was working as a dental professional already.

But then! I saw somebody having a diamond on his tooth and I was sold there and then. It wasn’t a diamond inserted on a golden figure or a diamond glued on the surface of the tooth. It was a diamond that was planted inside the tooth – to the level of the surface of the enamel.

So I went to a jewellery shop and asked for a small diamond. I asked my colleague to attach it to my canine tooth. He used a diamond bur which had the tip shaped like a cone – similar to the shape of the bottom of the diamond. The dentist drilled a small hole on the enamel with the tip of the bur. The hole was just slightly larger than the diamond’s size. Then he prepared the hole the same way as he would do when making a filling – back then it was first the blue etching gel, then the primer and then the bonding adhesive (nowadays the primer is normally self-etching). Then he took a small piece of a blu-tack and took hold of it with the forceps. He attached the top of the diamond to the blu-tack. Like this

I know what you are thinking.

Blu-tack!? What the… it’s not something we use in dentistry…

Let me tell you that this dentist was very inventive and clever. He had found a way to keep hold of the difficult shape of the diamond. The last thing you would need is to see the patient’s precious piece of rock flying past your eyes and on to the floor where you, the nurse and probably the patient would be spending the rest of the appointment bottoms up.

Anyway, the dentist placed a small amount of composite filling to the bottom of the cavity he had just made and inserted the diamond to it’s place. Then he light cured it (for non-professionals this means the special light will harden the filling material).

So Is There? Harm I Mean?

It was in 1997 when the diamond was attached to my tooth and yes, it is still there! Some people notice it, some don’t. Often I forget it is there until someone mentions it. I have never regretted I let the dentist drill my intact tooth to insert a diamond.

So to the question on the title – is there any harm in having jewels attached to your teeth.

The ones that are attached to the surface of the tooth

  • are not harmful in any other way than if you’ve chosen a jewel that looks like you have lettuce from your lunch stuck on your teeth. The reason why people are staring at your teeth is not because of your sparkling smile. They are simply going through a silent debate whether or not to tell that you have something stuck on your teeth. Normally they decide not to (this is something I would like people to have more courage at. You should always tell if someone has food stuck on their teeth – we all know how it feels like when you come home after work and look in the mirror and see the parsley between the front teeth…)
  • can be removed without any sign on the tooth you ever had one

The ones that have required tooth material to be filed or drilled away

  • will require a filling or similar to replace the jewellery if you decide to remove it. And it means the tooth is never the same as when it was intact
  • are best to be attached to the teeth that already have filling/s. Do not follow my example!

But there are also removable tooth jewellery as well. Read further to find out.

You Sure You Want to Look Like a Rapper?

If you plan to have large tooth jewel that requires extensive preparations on teeth, remember that

  • you might look like a rapper/jail bird – do you have a habitus to go hand in hand with your new looks of the teeth?
  • some employers dislike visible jewellery and it can be the one single reason not to choose you for the job
  • some of the extensive jewellery like grills look like you have an orthodontic appliance attached to your teeth, which I’m sure is not the intention

About grills. They can pose a risk to your occlusion and cause decay, abrasion (type of tooth wear, see my post about them) and gum problems. It is advisable to wear removable grill only when absolutely necessary. Do not try to glue it to your teeth if it is meant to be removable.

Here’s further reading on the subject (honestly, what was Madonna thinking?).

  • extensive preparations mean that you will need extensive restorations if you decide to remove the jewellery from your teeth

Conclusion

The most important thing is to consult your dentist before you do any extensive alterations on your teeth. It should always be a dental professional who attaches the jewellery on your teeth.

 

 

Advertisements

Vaping: An Attractive Option or a Destructive Alternative for Oral Health?

Guest post by Jack Simon

Here it is my dear readers – the very first guest post on Dental Revelations Blog. Jack Simon is a skilled writer and I am happy that he has offered to write on my blog. Today’s subject is an important one.

Many people are turning to e-cigarettes as the conventional cigarettes are increasingly considered as anti-social. Plus there is this false belief that vaping is safer health wise than conventional cigarettes. Vaping is not safe and there are many health aspects you should consider if you opt for vaping. Jack Simon has comprehensively pointed out those health aspects in this guest post.

Please read it though before the whole vaping business blows up in your face. Literally.


e-cigarette-1301670_1920

Are e-cigarettes harmful to your health? Image source: http://www.pixabay.com

The flare of e-cigarettes (ECs) in the recent years has put the health professionals’ in a situation to race against time and discover whether its introduction has been for better or for worse.

ECs, also known as ENDS (Electronic Nicotine Delivery Systems) are the battery operated devices with a metal heating element, which vaporizes a solution comprising a range of chemicals.

These days, more and more individuals are taking it up in preference to or in addition to traditional cigarettes. This hot trend in the market has raised some serious questions for government and public health professionals, as the growth of the products has seriously outpaced the regulations.

People consider e-cigarettes to be a healthier option. A common line that they use to give themselves a false gratification is

“I just vape & don’t smoke and it is not injurious to health”

This fake sense of security in e-cigarettes that they pose no harmful impact, as they use water vapor is actually not true. In reality, the notion that these products are no threat is in fact not 100% verified. If you also have the same approach, then it would be a good time to take a closer look at them and consider the effect they may have on our oral health.

Background

Its introduction in the US led to its extensive use by both smokers and non-smokers. Statistics indicate that about 20.1% of adult smokers tried ECs in 2011 and the rate of its use by school children has doubled during 2011-2012 in the US.

Sales of ECs in 2012 were estimated to be $1.7 billion in the US. If not regulated properly, the economics of ECs are expected to have remarkable growth possibility for the tobacco industry and beat the sales of tobacco smoking cigarettes in the coming decade.

Researchers are conducting a range of experiments to look at them closely. One of such findings showed that e-cigarettes consumers are acquiring much higher levels of chemical toxins – this is in clear-cut contrast to the harm decreasing patter in the ads on offer by ECs companies.

These devices have initially escaped scrutiny for safety standards and rules, but the FDA has latterly begun efforts to form regulations that would control the marketing of these products. In view of their warm acceptance and usage, the National Institutes of Health (NIH) held a workshop in 2013 to find-out the future research concerns relating to the effects of ENDS on health, potential use in cessation of smoking, addictiveness and public well-being. Furthermore, rate of queries from patients to medical practitioners relating to the safety and effectiveness of ECs as smoking cessation devices are increasing with increased acceptance.

In recent study by the U.S. Department of Health and Human Services, it has been clarified that during the process of nicotine vaporization, a variety of chemicals and metal particles are produced by these devices. The chemicals identified in the aerosols of ECs are: propylene glycol, formaldehyde, glycerine, acetaldehyde, toluene, acrolein, nickel, cadmium, nitrosamines, silicon, aluminum, and lead.

While the levels of these identified compounds and metals in ENDS are quite lower than tobacco smoke, some of them have been found to be carcinogenic and genotoxic by many studies. In addition, smoking characteristics and potential for exploitation by consumers of ECs, periodontal and upper aerodigestive tract epithelial cells, nicotine yield and degree of exposure of oral, physical characteristics of vaporized nicotine and other chemical products are tremendously different if compared to conventional cigarettes.

Let’s Unveil Its Effects on Oral Health

Apart from the recognizable health implications, vaping pose severe damage to your oral health (teeth, gums and tongue). Problems like tooth decay, teeth loss, gingivitis, periodontal disease and oral cancer are the most common ill-effects caused by conventional cigarettes and e-cigarettes. The nicotine absorbency is very high in ECs.

The Journal of the Indian Society of Periodontology published a report to disclose that nicotine significantly contributes to the development of gum problems (gingivitis and periodontitis), which can be the leading cause for bad breath and inflammation throughout the body.

The Journal of Cellular Physiology published the result of recent study, showing that a high rate of mouth cell die with the increased exposure to e-cigarette vapor.

Studies have also revealed that the menthol additive in ECs liquids have a destructive effect on the epithelial cells and the fibroblasts within the periodontal ligament. Its longer term use may also increase the risk of oral cancer; however this is still under investigation.

The Role of Nicotine in Destroying Your Oral Health

  • In Gum Recession
    Nicotine is a vasoconstrictor; therefore it has the tendency to contract the muscular wall of the blood vessels and cutting-down the amount of blood that flows through the veins. With restricted blood flow, the gums do not get sufficient oxygen and nutrients that is necessary for them to stay healthy. Moreover, it chokes mouth tissues, thus cause death of the gum tissues.

  • In Causing Bad Breath
    Nicotine constrains the body’s ability to produce saliva. Lack of saliva can leave your mouth prone to bacteria buildup, tooth decay and dry mouth. This also affects the mouth’s normal inhibitory function of cleaning and reduces the body’s innate capacity to heal and generate new cells.

  • In Intensifying Grinding
    Nicotine acts as a stimulant that fires-up the muscles, making you grind your teeth more intensely or might prompt you to start grinding even if you aren’t a grinder.

  • In Hiding Tell-Tale Signs of Gum Problem
    Nicotine can mask the initial signs of gum disease and makes it hard for a dentist to diagnose it.

Various researches have clarified that vaping impose many potential ill-effects to our oral health. This should be enough to the most rabid vapers to see the whole picture clearly that it is not safe.

The manufacturers of ECs claim that their product is a healthier therapeutic alternative to conventional smoking, but in the absence of any verified scientific study to back this contention, it would be ideal to avoid it.

Nicotine inhalation puts the person’s dental health at greater risks. Regardless of whether these devices pose less harmful effects than conventional smoking, health specialists concur that they are by no means safe.

Your likelihood of getting gum problem is higher as long as you are using nicotine, so visit your dentist in a frequency of three months to prevent tooth loss, bone loss, gum recession and many oral issues.


Author Biography

Jack Simon is a content strategist at Irresistible Smiles. He has flair of writing engaging articles about oral health care. His keen interest in presenting the dental care issues in a simple and straightforward manner is appealing to the readers.

Shared from WordPress

I simply must share a fellow blogger’s, Back To The Tap, post on Fluoride. It’s always a pleasure to read posts from a talented blogger. Hope you enjoy it too (the subject is also important).

Fluoride in water: Nature’s toothpaste or communist conspiracy? – http://wp.me/p7QijM-2T

Told You So

 

wp-image-855338401jpg.jpg

You think the floss is effective? In most cases it is not.

I couldn’t hide my satisfaction when I read the news in the US about effectiveness of the floss. Finally something I have been preaching about is out and in the open for everyone to read.

You see I have met many dental professionals who have doubted my way of giving oral hygiene instructions especially regarding the floss. I have met so many of them that I have stopped explaining the reasons behind my recommendations.

My hope has been that some day they would get enough experience to notice that the floss isn’t doing a proper job. Or that they would start using the disclosing solution (I use Rondell Disclosing Pellets) which would definitely prove it.

We’ll see what happens. My fear is that many will stubbornly stick to their old ways. Change will always bring along resistance.

If you haven’t read my blog before, please take a look at this page about my recommendations.

And click this link if you haven’t read the news about the effectiveness of floss yet.


You might also like:

Told You So, Part II

Told You So, Part III

Eeny Meeny Miny Moe – Which Type of Tooth Wear?

Dental Revelations Blog-3877

There are four types of tooth wear that we diagnose from patients’ mouths. Erosion, abrasion (I’m sorry for a missing link – I did not agree with any of the images of abrasion), abfraction and attrition. The easiest ones from these to diagnose are the erosion and attrition. You can’t go wrong with them. But it is completely different case with abfraction and abrasion. I run into this very often with my patients.

When a dentist or a hygienist sees tooth wear on the neck of the tooth they diagnose it by default as abrasion caused by too vigorous brushing. They recommend softer toothbrush and this silly brushing technique called Bass (it is so silly that I think I am going to dedicate one post entirely to this technique).

This normally leads into a situation where patient begins to be too careful with the brushing because she doesn’t want to cause further damage to the teeth. That’s when the plaque starts to build up to the gum line, gum gets inflamed because of the plaque and the patient begins to notice bleeding when brushing. Now she’s even more careful with the brushing as in her mind bleeding means she’s doing something wrong – brushing too hard like the dentist said she is.

But what if the dentist/hygienist misdiagnosed the tooth wear? What if the correct diagnosis was the abfraction?

Tooth wear – What to Check?

When you see a tooth wear that you are tempted to diagnose as abrasion, stop for a moment before you proceed giving advice on brushing. Instead do the following:

1. Check if there is mobility on the teeth affected by tooth wear

2. Check if there are interferences on side movements and protrusion

3. Check if there are shiny facets on occluding surfaces

If you get positive answer to even one question the chances for the tooth wear to be abfraction are great. And in this case telling patient that the tooth wear is caused by her brushing can be damaging in many ways:

  1. It is hard to convince a patient that they are not actually brushing too hard and that they have not damaged their teeth by it. I have my ways of convincing the patient but life would be soooo much easier if I didn’t have to.
  2. The dentin will decay very easily (as I’m sure you know) and plaque accumulating and staying there undisturbed for longer period of time because of too careful brushing will very quickly cause decay. And we all know how these fillings in the cervical area are pain in the butt. Somehow they always seem to have overhangs or they come off when scaling. Sound familiar?
  3. The teeth where the surface of the root (dentin) has been exposed by receding gums will get sensitive if the plaque builds up.
  4. If the tooth is mobile and has already bone loss the plaque building up to the gum line and inflaming the gum can be disastrous. Please memorize that

MOBILITY + PLAQUE = RAPID BONE LOSS

The Cause for Abfraction Needs to Be Dealt With

When a tooth interferes with full closure, it will trigger deflective interferences6-8 and cause any of the 7 signs and symptoms of occlusal disease such as hypersensitivity, abfractions, mobility, excessive wear or fractures, and muscle or temporomandibular (TM) pain.

There is no consensus amongst the dental professionals over the right approach to occlusion. Is this the reason why signs of interferences on occlusion are ignored or unchecked and the tooth wear is so easily made as patient’s fault?

The quote above is from an article The Three Golden Rules of Occlusion in dentistrytoday.com and you can read a full article here.

But by Whom?

To be honest – and like I have expressed in my previous post – I would not let just anyone touch my occlusion. I would love if the dentists would refer patients to the specialist in prosthodontics and stomatognathic physiology because they have the best knowledge and skills to treat the occlusion. And that’s something every patient is entitled to.

Guilt Is a Heavy Load to Carry

I have often noticed that patient feel unnecessarily guilty over damaging their teeth. They feel guilty and desperate over the fact that the damage done by brushing is irreversible. And that they are not sure if their brushing technique is still damaging their teeth hence too careful brushing to make sure they are not.

I believe that guilt does not lead us forward in life, it does not bring anything positive into our lives. Therefore I always try to relieve my patient’s guilt whenever it is possible.

In the case of tooth wear and some dental professionals way of putting the blame on patients’ brushing technique I always have the same conversation with a patient. It goes like this.

Me: Have you been told that you brush too hard?
Patient: Yes I have.
Me: I thought you might have. You see when a patient is told this, she starts to be too careful and then the plaque starts to build up and there is actually plaque in the gum line of your teeth. (I take a mirror and show the plaque to the patient)
Patient: Eww..
Me: I personally try not to tell patients that they are brushing too hard because this leads to too careful brushing which will cause more problems like decaying and gingivitis. Instead I interview the patients about how they brush their teeth and correct it if necessary. You see the tooth wear can be caused by other things than just vigorous brushing… 

Prior to this conversation – in the beginning of the treatment – I have interviewed the patient and asked about her oral hygiene habits. Which brush she uses? How often? How often does she replace the brush head/brush? How does the brush head look like before replacing it? Spread or still like new apart from colour fading? This is why I can continue the above conversation like this.

Me: In your case I doubt it that the tooth wear is caused by your brushing but I will just in case show you the right technique. I will first just check couple of things…

And then I check the mobility, the interferences and the occluding surfaces. I feel great satisfaction when the teeth affected by tooth wear have mobility on the side movements. I am on the right path!

The patient is visibly relieved when they can stop worrying about their brushing. Well who wouldn’t be! There is enough to worry about in life even without worry over brushing.


You might also like

Don’t Let Just Anyone Touch Your Occlusion

 

Ever Seen a Patient with an Implant? Read This!

Dental Revelations Blog-4621

Today I saw a patient who had had an implant done to replace upper right first molar. The implant treatment was finished a year ago in another practice.

Since then the patient had seen hygienist twice in my practice. The implant crown itself looked immaculate but the gum was very red and puffy and it bled heavily after probing.

I knew what to ask next and I even knew the patient’s reply to this.

“Were you told how to clean the implant at home?”

“No I wasn’t” replied the patient with is-it-supposed-to-be-cleaned-expression on his face.

This happens too often. Almost every time I see a patient who has recently had an implant done.

Note for all the dental professionals who make the implant treatment’s final stages and do not give oral hygiene instructions (OHI) for the patient:

You should always tell and show how the patient can clean these costly pieces of metal and porcelain. It is your responsibility as a dental professional and the paying patient’s right!

Can you give me any other excuse for not giving OHI than the fact that you are too busy making money and forgetting the basics? I believe you cannot.

And you hygienists who see patients with implants:

  1. Always check how the patient is cleaning them. More so if the gum around the implant is either bleeding or there is plaque around it
  2. Advice if necessary and show in their mouth how it is done
  3. Check if the patient understood your instructions by asking them to show they can do it. Teach them if they struggle
  4. Check on a follow-up visit that the gum has healed. If not, refer to a dentist

Why Is It So Important?

With the implants it is vital that there is no bleeding in the surrounding gum. They will get an implant’s equivalent to gingivitis – peri-implant mucositis which can lead to the peri-implantitis (same as periodontitis with teeth) very rapidly. The worst case scenario is that the implant will lose it’s integration to the bone which could have been easily prevented.

The patient I saw today left home with instructions on how to look after his implant. And I will see him for a follow-up visit to make sure the gum has healed (can you see the shining halo around my head?).

Honestly, it’s not that hard to do your job properly so shape up please!


Here‘s further reading on the subject.

Superiority of the Philips Sonicare Toothbrush

Dental Revelations Blog-4586

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

 

New Natural Remedy (Fluoride-Free) for Decay

Dental Revelations

Just kidding. Just wanted to have your attention.

Today I am going to write about fluoride. And the reason for doing this is that I keep on running into articles and websites promoting fluoride-free toothpastes (and water). Not only they recommend non-fluoride toothpastes but also they tell that the fluoride is toxic or poison when entering body.

It is rather entertaining to read these articles but sooner or later the amusement turns into annoyance. Especially after comments like this

I love the look on dental hygienist’s faces when I refuse the fluoride treatments or toothpaste for me and my kids

When the adults practice their anti-fluoride beliefs on their kids it is simply heart breaking. I have seen kids whose milk teeth were so badly decayed that most of them had to be removed. I have seen kids in pain because of the decay. Why would you want to put your kid through such experiences? They wouldn’t thank you if they knew what caused their bad teeth as an adult. But they will never find out the truth because they have been told that it runs in the family to have weak teeth… yeah right. There is no such thing as weak teeth that are hereditary. It’s all about oral hygiene habits and lifestyle habits. What could be called hereditary is the bacteria in mouth that you might get from your parents as a baby. If the parents neglect their teeth (poor oral hygiene and lifestyle habits) there is great amount of cavity causing bacteria in the mouth and if that bacteria is transferred to the baby there are big chances the child will struggle with decaying. And this means this child needs fluoride. And if the parents do not offer it… pain, screaming in fear at the dentist, sedation/general anaesthesia, fillings, extractions, malposition of the permanent teeth because of the loss of the milk teeth… So unnecessary!

To be honest, I can understand the worry over the fluoridated water to some extent. After all it goes into your body.

But the fluoride toothpaste! You are not meant to swallow it, are you? With young kids you can’t prevent them swallowing the toothpaste but that’s why you use only very tiny amount of it.

But you adults, come on! The local effect of the fluoride is important in prevention of decay. You brush for 2 minutes (hopefully) and that’s the time the fluoride stays in your mouth. Then you spit it out and rinse with water (I don’t but that’s why I glow in the dark…ha-ha). No fluoride has entered your body.

But still some people mix all sorts of things with “healing properties” to be used as a toothpaste. Herbs, clay, coconut oil etc. I just read an article about coconut oil that was recommended by Dr. Somebody to be used instead of fluoride toothpaste. And as if the article wasn’t full of baloney but the comments at the end of the article were even more so.

…I laugh when dentists tell their patients not to brush for an hour….. why leave the acidity on your teeth to do damage for an hour – five times a day – seven days a week etc…. it adds up!

This person refers to a previous comment where somebody said he vigorously rinses his mouth with water after eating anything (which is fine). I’m sure all the professionals know what will happen to the teeth if one brushes every day after every meal – five times a day – seven days a week etc.

Erosion or to be precise it is abrasion that will happen to the teeth and that is irreversible damage which will lead to hypersensitivity of the teeth and make the teeth more prone to decaying.

Facts Simplified

There are minerals in the enamel of the tooth (hydroxyapatite). Minerals like calcium are lost everyday from the enamel because of the acids the bacteria produce from the carbohydrates in the diet.

The saliva tries to minimise the loss of minerals by neutralising the acids (remineralisation) but saliva can’t do magic if the host’s lifestyle is giving it too much to handle. Snacking (eating more frequently than 5-6 times a day), drinking acidic or sugary drinks in daily basis between the meals, eating sweets the wrong way (yes, there is a right way of eating them), adding sugar to the tea/coffee (even milk contains sugar) and consuming them between the meals. All these habits produce too much acid for the saliva to handle and it is not able to return all the lost minerals back to the enamel.

Loosing too much minerals from the enamel means decaying.

So to prevent that you need to find a way to compensate the lost minerals. The most important one is the calcium. And when combined with fluoride it repairs the enamel with very strong fluorapatite that is hard for the acids to break. It is much stronger material than hydroxyapatite that the enamel is originally made of. Some professionals even say that area of the enamel that has been replaced by fluorapatite won’t ever get decay.

But even if you do use fluoride in some form you will get decay if you have poor oral hygiene and your eating habits are harmful to the teeth. The fluoride will only slow down the decaying process.

There are exceptions of course. There are individuals who neglect their teeth and never get a decay. They might not use fluoride toothpaste or they might not brush at all. I will emphasise that they are exceptions. Average Joe will get decay I’m afraid. I have already written about this on my previous post. I wrote that it is very rare for people to have good enough oral hygiene habits. It is about one in thousand patients who do not need my interference in looking after their teeth. So most of us need minerals (calcium and fluoride) to protect the teeth from our laziness and unhealthy lifestyle.

Fluoride we cannot get through our diet unless you eat fish with the bones but even then there is no localised effect on teeth. So we need it from somewhere else. And the fluoridated water is simply not enough as it passes through the mouth and does not provide long enough localised effect (so don’t use that as an excuse). That’s why we use the toothpaste.

Right Way of Eating Sweets (Thought You Might Want to Know)

You can eat sweets without getting decay. Us dental professionals are a living proof of that. You see we looooove to eat sweets but rarely get decay. I will tell you how we do it.

  1. If you buy pack of sweets eat them in one go and have xylitol chewing gum, slice of cheese or fluoride tablet once you are finished. If you eat one sweet every 10 minutes for the next two hours you will have an acid attack in you mouth for approx. 2 hours and 30 minutes. Or even worse example. If you take one sweet every 30 minutes for the full working day it means you have had an acid attack the whole time you were working. Acid attack means losing minerals. And I have already told you earlier what happens if you loose too much minerals which you certainly will do if you have 7-8 hour-long constant acid attack.
  2. Eat sweets as dessert. You get acid attack already because of eating and you can avoid getting an extra acid attack by eating the sweet in one go after a meal. Have xylitol chewing gum, slice of cheese or fluoride tablet once you are finished
  3. Whenever possible and if you stomach can take it, buy sweets that are sweetened by xylitol. Now people often blame the xylitol for the laxative effect of sugar-free sweets. But it is often not the xylitol that causes the upset stomach. It is the maltitol syrup. So seek products that are sweetened 100% by xylitol.

 

Please note: This post is directed to healthy adults. People whose saliva flow is impaired through illness or medication need more intensive fluoride treatment on their teeth.

Cold Sore Is Herpes – Cancel Your Dental Appointment Because Your Dentist Won’t!

Dental Revelations Blog-3942

A patient came in for a long appointment to have a bridge done. This appointment was to include filing down the teeth to abutments which meant that the high speed drill was to be used. A lot.

High speed drills have water cooling system and this means there are aerosols in the air when the drill is used. And the aerosols carry pathogens from the patients mouth as far as two metres (about 6,6 feet) from it’s origin.

The nurse noticed that the patient had a large cold sore on a lip. Dentist appeared as if he had not noticed it and asked the patient to sit down in the patient chair. Chair was tilted back and when the dentist put his fingers inside the patient’s mouth the nurse discreetly pointed out the cold sore. The dentist carried on with the treatment and ignored the cold sore.

The nurse was worried. Very worried. And she had all the right to be. She knew the cold sore virus – herpes simplex – can easily spread to her eyes and hands, dentist’s eyes and hands, patient’s eyes and mouth via the aerosols produced by the high speed drill.

Herpes simplex virus in the eye can result in blindness. Herpes infection on hands (herpetic whitlow) of a dentist/hygienist/nurse might force a career change as one cannot do any treatment on patients when the herpetic whitlow is active.

But the nurse didn’t have any other option but to continue with the treatment as the dentist is considered to be the one who is more educated in the matters of health and carries the responsibility of the treatment. This means the dentist makes the decisions behalf of the nurse and the patient whether to continue with the treatment or not.

Now it might be a good idea to read one of my previous post about integrity of dentists so you understand the motives behind the dentist’s decision in this story.

So on they went with the high speed drill. For an hour and a half.

Less than a week later the nurse developed a bad head ache and the next day she had sores in the mouth. Two days later she had temperature of 40 degrees and the mouth, gums and lips were full of painful sores. The GP diagnosed a primary herpes and prescribed anti-viral medicine. She was off work for a week.

When the patient with the cold sore was seen the next time in the surgery he had small blisters near the operated site.

Cold Sore Aka Herpes Simplex 

Before the anti-viral medication was developed the primary herpes used to be an infection that was often lethal. The doctors treating the patients with primary herpes could only cross their fingers and hope the patient will make through it. Many didn’t.

It can still be lethal but we have medication to treat it.

Most of the people get the primary herpes as a child and it often is asymptomatic. If contracted as an adult the primary herpes can have more difficult symptoms.

The primary herpes can be followed by secondary herpes (recurrent infection) – most commonly as a cold sore on a lip. The most frightening one of the recurrent infection of herpes simplex virus is encephalitis.

Guidelines for Treating Patient’s with Cold Sore

I used my friend Google and she quickly found me several sites that were unanimous about what us dental professionals should do if we see a patient with a cold sore.

Do not do any treatment that can be postponed!

To convince you I copy-pasted guidelines from couple of sites.

Elective dental treatment should be deferred for patients with active lesions as aerosolization of the virus may occur during dental procedures, placing both the patient and oral health care provider at risk for possible infection or re-infection.

Elective treatment should be postponed until the lesion has healed completely. Though the patient may be comfortable after you have applied a topical medication, there is still the risk of spreading the disease to the health-care provider.

Because herpes is transmittable to patients from dental health-care professionals who have active lesions, there is a risk of spreading this disease. The guidelines from the CDC are clear. Each of us has to keep patient safety and staff safety a priority.

Conclusion

The guidelines are clear. The medical facts are clear. Why do dentists still treat patients with cold sores and risk the health of the nurse and the patient, let alone their own health? They if anyone should know how serious risk it is to treat a patient with a cold sore.

So why?

I’m afraid you might know what’s coming (especially if you read my post Morals in Dentistry). Yes, the only reason for this kind of selfish and negligent behaviour from a dentist is GREED. And perhaps small amount of twisted enjoyment of having power – being almighty in this little world that has two people the dentist can make decisions for.

When the patient walks in the surgery with a cold sore it is simply just not acceptable to reschedule the appointment even though everyone’s health is at risk. No, no. Profit overrules the reason. Shame you who just recognised yourself.

I know there are also hygienists who see the patients with a cold sore. But this is because they don’t either know better or because they are not practice owners. Refusing to see a patient with a cold sore is not considered to be in the best interest of the practice. Plus what can you do if the patient with a cold sore just saw a dentist for a filling and is scheduled to see you for a scaling. How can you say no when the dentist said yes?

It requires lot of self confidence and experience to be able to stand up for you right to decide for your own health. Something the nurses do not have a chance to do. It proves once again how the dentist-nurse relationship is nowhere near about equality as co-workers. Not even in the matters of personal health.

I reschedule the appointment if the patient has a cold sore. And the next appointment won’t be sooner than a fortnight. I also use the opportunity to inform patient about the herpes simplex and ask patient to cancel the appointment next time when he gets a cold sore before the dental appointment.

And seriously (for all the dental professionals):

Applying Zovirax and placing a plaster on top of the cold sore before doing the treatment is just simply bonkers.


 

You might also like

Repost with Forewords: Cold Sore Is Herpes – Cancel Your Dental Appointment Because Your Dentist Won’t!
Google for a Day – Comprehensive Answers about Cold Sore and Dentist

And here’s some further reading about the guidelines of seeing a patient with a cold sore.

Why People Hate Teeth Cleaning at the Dentist

Dental Revelations Blog-3916

We do the teeth cleaning with these “hooks”. We like to call them curettes.

The most common things patients say to me when they enter my practice for teeth cleaning are

I hate this

It hurt a lot last time

Are you going to use the hooks??

But once we are done with the treatment they are visibly relieved, thank me for being gentle and share their story about the previous dentist/hygienist who did the scaling. The stories are horrendous and it often makes me feel ashamed of my colleagues. Why are they failing in very simple task – managing the pain?

For those who now think that I must not do the scaling very well if it doesn’t hurt:

Me being gentle does not equal me being less thorough with the scaling. I go to those 12 mm deep pockets with my hand scalers and sometimes even without any local anaesthesia. I remove all the subgingival calculus that is possible without surgery – if not on the first visit then on the following visits. And yet the patient thank me for being gentle.

How is this possible? Let me tell you how. If you are a patient, there is information for you at the end of this post.

Butchers

When I was at dental school I worked as a nurse in private practices (I have written about this period in my life in my previous post). I was a nurse for a young dentist who was performing a scaling for the patient. It was the most unpleasant piece of treatment I have ever witnessed. It was a bloodshed. A complete massacre of the gums.

The patient did not have severe gum disease – just gingivitis. The dentist did not use local anaesthesia and took her sickle and started the scaling (or her interpretation of it). Pieces of interdental papilla were flying around and the mouth was filling up with the blood… I am slightly exaggerating of course, but just slightly.

The patient was wriggling but did the dentist offer local anesthesia? No she didn’t. She carried on with the massacre. All I could do was to place my hand gently on patient’s shoulder as way of comfort in this horrible experience that should never had happened.

In the end of the treatment she had removed all the interdental papillae from patients mouth. Instead of the interdental papillae there were now dark red blood clots. Hands up everyone who knows this should not be done! I hope there are some of you.

Now this was my experience that I witnessed. The rest my patients have told me. The stories do not vary a lot from what you just read.

The Pain Threshold

All the patients are different when it comes to the pain threshold. Some people cannot take any pain and require topical anaesthesia even for probing. Some go through the whole scaling without any complaints and do not want to have a local anaesthesia even when suggested.

But the most important thing with every patient is to tell them about the options for pain relief.

When I see a patient for the first time they are often very sceptical and think they need all the possible pain relief there is. In these cases I suggest that we first try without and if the pain relief is needed it can be applied any time.

The reason I do this is that I have noticed that the fear of the pain is sometimes greater than the actual pain. Once the patients realise this they relax.

Doing It in One Go

This is not how you should do it.

When the gums are inflamed they hurt. As a patient you do not want anyone you just met digging your tender gums with a sharp instrument.

So on the first visit it is important to teach the patient better oral hygiene routines and techniques and get rid of the supragingival calculus (visible calculus) and some of the subgingival (invisible) as well (as much as the patient can take the discomfort).

I rarely use hand instruments on the first visit. I concentrate on very thorough scaling with the sonic scaler (EMS is my favourite). I might still use Mini and Micro Sickle for the lower front area as there is often calculus and stains left after the sonic scaler. Plus the patients loooove to get shiny white smile on the first visit.

Remember to tell the patient that there is (invisible) calculus still to be removed as they might not return for the following visits when the bleeding of the gums stops. It is important to mention that if the calculus is not removed it can result in periodontal abscess and bone loss. Eventually the gums will start bleeding again.

After this I let the gums heal at least for a week. It is much easier for the patient and for me to perform the subgingival scaling when the gums have healed and shrunk. Sometimes they have shrunk that much that not much of the calculus is hidden below the gum line – but this requires the patient to do his share with the oral hygiene at home.

Technique of Scaling

This is where most of the “butchers” fail. They either use wrong tools or right tools but wrong technique.

When I began working in my first surgery abroad and saw the scalers I was supposed to use I declined kindly and persuaded the owner to order me the instruments I preferred. It was a difficult task as the hygienists had used those “instruments for giants” without complaints. I explained that the curettes were far too big for anyone’s teeth. They were clumsy and big and the metal was very “stiff”. Luckily the owner was a wise dentist and I was allowed to order new ones.

The scalers I have by default for all the patients are:

Micro-Sickle by LM

Mini-Sickle by LM

Mini-Syntette by LM

With these I can do simple scale and polish but if there are pockets deeper than 3mm I have curettes at hand in a sterile pouch and I choose them by the location and the shape of the pocket. I have sets of curettes in pouches as listed below:

Mini-Gracey 11/12 by LM

Mini-Gracey 13/14 by LM

Gracey 11/12 by LM

Gracey 13/14 by LM

and

Mini-Gracey 17/18 by LM

and

Gracey 17/18 by LM

and

Furkator KS by LM

Please note that I do not get any financial benefit of writing about certain brand of instruments.

Chlorhexidine After Scaling

I always rinse the deep pockets with syringe filled with 0,12% chlorhexidine liquid or gel. It reduces the risk of complications.

Sharpening

Blunt instrument results in slipping of the instrument either to the patients gum or your finger. Neither is good. Blunt instrument also does not remove the calculus – it only polishes it.

It is very important to sharpen the curettes after each use (sickles and syntette do not require sharpening that often). It doesn’t matter if you do it by hand or by sharpening machine. Both of them require skill but the only difference between these two is that the hand sharpening extends the life expectancy of the curette.

I sharpen my instruments in a cycle of hand sharpening two to three times in a row and then machine sharpening once. I sharpen once a week all the instruments that have built up in a week. For you being able to do this you need at least a week’s worth of instruments in the surgery.

Tip: When you sharpen your instruments always check with a test stick first if the instrument is in fact sharp enough. Sometimes if you have used the instrument only for couple of strokes it remains sharp.

Informing the Patient About the Post-Scaling Complications

There will be tender gums after any scaling and polishing. But the patients can take it much better when they are informed about the different kinds of complications that might occur and how they can manage them.

The most common complications and ways of relieving them are:

  • tender gums – cold drinks/food, paracetamol/ibuprofen, never aspirin as it might make the gums continue bleeding
  • taste of blood in the mouth – normally it is resolved by the next day
  • sensitivity to cold – sensitive toothpaste, leaving the toothpaste in mouth after brushing, avoiding acidic food/beverages

It is also good idea to mention the less common complications and the ways of relieving them:

  • extreme pain in the gum caused by secondary infection that lasts for many days – salt water rinse, chlorhexidine rinse (alcohol free) or to see your dentist if the symptoms persist
  • pain around the partly erupted wisdom teeth – chlorhexidine rinse or to see your dentist if the symptoms get worse despite the rinsing
  • periodontal abscess – to see the dentist

If the patient is left untold about these complications and if they do happen it is very likely that the patient blames you. And he will tell this to ten of his mates (marketing rule) even though there was nothing wrong with your scaling skills.

But when explained that you have now disturbed the bacteria balance in the deep pockets by scaling and even though it was necessary and important thing to do the bacteria in the pockets sometimes – in rare cases – do not like it and the situation might get worse, you will have much more satisfied patient even if complications occur. A patient that still trusts you.

Conclusion

Having the teeth cleaned at the dentist should not be painful. Some discomfort is acceptable but it should always match to the patient’s individual pain threshold. And after the scaling the patient’s gums should not look as if Jack the Ripper had done the treatment.

The right technique of the scaling is difficult to master. But once you do, it will be more rewarding for you as you see better healing results with the gums and a happier patient. Here’s one video about hand scaling technique (it’s not ideal video but hopefully you get the idea) but I’m sure hands on courses are available at the dental schools as well.

For the hygienist – please do not accept just any hand scalers. Check out different brands of curettes at the dental show case and order couple of them to try out. If you are unsure with your technique start with the mini-curettes.

For the patient – If you’ve had bad experience at the dentist with the cleaning of the teeth seek another one. Change until you get proper cleaning, relevant info and oral hygiene instructions. Be prepared to have at least two visits.

When you maintain good oral hygiene habits and see your hygienist for regular teeth cleanings (interval decided individually, see my previous post) you will never ever need to go through the same experience again. It takes just one visit to clean your teeth and it is much less painful.

If you do not do your part at home and leave longer period of time than recommended between the cleanings it often takes two visits to do it. And once again it is unpleasant for you.

I worry over the fact that the patient is unable to tell if the scaling was done thoroughly. I have written about this before. It is not until the patient by chance sees somebody who recognises the gum disease and masters the comprehensive treatment for it, when they realise the poor quality of the treatment they were getting in the previous practice.

That, my dear readers simply is not acceptable in the modern dentistry. So revise, revise and revise. Trust the patient’s reaction. If they complain often that it was a horrible experience then something is wrong with your scaling technique, your tools or your chair side manner. Swallow your pride and do something about it.