Money-Saving Advice on Dental Visits

Dental Revelations Blog-3892
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 maximising 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

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Why People Hate Teeth Cleaning at the Dentist

Do You Recommend Toothpick?

Dental Revelations Blog-24529
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