Tag: practice

How Clean Are Your Hands?

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Dental Revelations Blog-2

I used to work with a very talented oral and maxillofacial surgeon who did not accept just any nurse to be his assistant. The reason for this was that he wanted absolute aseptic environment for the implant surgeries he was performing. In his words

“One either has an aseptic consciousness or doesn’t. It cannot be taught.”

At that time I thought he was exaggerating but I have learned since that he was actually right.

Simplified, the aseptic conscious is an ability to know when surface, instrument, hand is contaminated by bacteria and how and in which order you start to fix it to make it asepsis. It is an ability to know where you can touch without contaminating the gloves when you are treating a patient. It is the key for effective cross infection control in dental practices.

We learn asepsis at dental schools. But there are things you cannot learn by just reading from the book. Sometimes even practice won’t teach us. In my experience aseptic conscious is as hard to learn as singing. If you do not have the gift you will not become a successful singer (the one’s singing in the shower do not count in this comparison!).

Failing in Basics

A dentist puts her face mask on, washes her hands and puts the gloves on. She gets closer to the patient, adjusts her face mask and uses her little finger to move her hanging fringe to the side of her head…

Err, what went wrong? Pretty much everything after putting the gloves on.

Not understanding what contaminates the clean areas/instruments/hands is a major problem in dentistry. It applies to all the dental professionals – not only the dentists. Even bigger problem is that it is also a subject amongst dental professionals that is hard to bring up if you see a colleague doing something that compromises the cross infection control.

But we must speak about it! How else would they learn asepsis?

Clean Hands

Washing hands needs to be done correctly for it to be effective. But washing hands can be replaced by the use of disinfection gel if the hands are not visibly contaminated. But this needs a correct technique too.

All the professional’s should watch this video about washing hands and using the disinfection gel. I bet many of us fail in the technique.

I must point out that in this video they apply far to little of disinfection gel – if you have an automatic dispenser like the ones the hospitals have, trust the amount the dispenser gives you even if it feels too much.

Also in this video they begin the use of disinfection gel in wrong order. The correct technique goes like this:

  1. Take the gel to the palm of your left hand (or the right, it doesn’t matter from which hand you start)
  2. Dip the finger tips of your right hand in the gel on your balm
  3. Pour the gel to the palm of the right hand
  4. Dip the left hand’s finger tips in the gel
  5. Only then start to spread the gel as advised in the video

Important to remember: Never try to speed up the evaporation of the disinfection gel by waving your hands in the air. This will only contaminate your hands with airborne pathogens.

Revelations

Too many of us professionals fail in either disinfecting the hands or keeping them uncontaminated during the treatments. To prove my point I will tell you my observations.

I have seen

  • dentist removing temporarily his face mask during the treatment to speak to the patient and placing it back again (the same mask and the same gloves) before continuing the treatment
  • dentist using the mirror handle’s tip to press computer keyboard key’s in the middle of the treatment
  • dentist touching the water tap (especially when adjusting dentures/bite block to rinse the apparatus) with the gloves he’s entering patient’s mouth
  • dentists, hygienists and nurses to reach instruments/materials inside the surgery cupboard with gloves that are contaminated by patient’s saliva
  • dentists removing their glove from one hand in the middle of the treatment to do something “aseptically” and then placing the same glove back again
  • dentists removing both of their gloves in the middle of the treatment to do something “aseptically” and then placing the same gloves back again
  • dentists using disinfection gel for the gloves
  • nurses having long and polished nails – I mean reeeally long
  • dentists, hygienists, nurses wearing watches and bracelets

Thank god dental surgeries are pretty much paperless nowadays. The dentists used to check the dental records in the middle of the treatment with the same gloves as they were treating the patient.

Conclusion

A Dentist, hygienist or nurse with pathogen-free hands is every patient’s right to have.

So do pay attention how you get ready for the treatment with each patient. Sometimes we are behind schedule and we cut corners but with this matter you simply cannot.

I will end this post by an information on how all the dental professionals should get ready for the patient (in every day dentistry) and hope you will follow this advise already today.

Before the treatment:

  1. disinfection gel (or hand wash if visibly contaminated hands)
  2. face mask and eye protection
  3. disinfection gel
  4. gloves

After the treatment:

  1. Remove the gloves
  2. disinfection gel
  3. remove the face mask and eye protection
  4. disinfection gel

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Wild West of the Home Whitening

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Dental Revelations Blog-0310

Oh dear, where to begin.

The reason I chose this topic for my next post is that I was reading a dental blog that gave homemade teeth whitening tips to people. I’m sure the intention was good when they listed all known household items than can whiten the teeth. You see people love to get self-help tips on their health – especially on their teeth to avoid seeing the dentist. But dental professionals should know better not to advice certain things as they can very quickly cause permanent damage to the teeth.

(This is a reminder for all of us not to believe everything you read from the net especially regarding your health)

Stains

There are two types of stains on your teeth. Surface stains and deep stains.

Surface stains build up from coffee, tea, red wine, smoking and certain spices, mouthwashes and vitamin supplements (iron in a liquid form).

Deep stains are those that will make the natural colour of your teeth (which you will see after scale and polish when the surface stains have been removed) yellower. The older you get the yellower the teeth will get (or have you seen elderly people with pearly white teeth? If you have they are false).

So what will damage your teeth? I will tell you. Starting from the worst. But at first for clarification

  • I will not give any instructions on how to use these substances
  • it won’t be a comprehensive list of the substances that is advised to use for teeth whitening purposes but a list of most common ones

Whitening Toothpaste

There are normally two types of whitening toothpastes. Toothpastes with increased abrasivity (normally all most common brands’ whitening toothpastes e.g. Crest, Golgate, Arm&Hammer) have high RDA level (higher than RDA 100) and if used regularly, it can lead to toothwear. This toothwear is permanent. I never advice anyone to use these toothpastes on regular basis.

Safer types of whitening toothpastes are the ones that do not have high RDA level but are based on papain enzyme which whitens the teeth. Examples of these toothpastes are brand Youtuel (RDA 40) and Glodent. When I used Youtuel for the first time somewhat 20 years ago, it was impressive how well it removed surface stains.

If you are interested to read a study about papain enzyme as whitening ingredient, click here.

Lemon

Would you love to get white teeth with practically no money spent at all (as you get the lemons anyway for cooking etc) plus super sensitive teeth and eroded enamel to go with the deal? Yes? Use lemon.

An advice to use lemon for teeth whitening isn’t under any circumstance acceptable by a dental professional. Lemon is highly acidic fruit and can erode the teeth when used regularly. Erosion will result in sensitive teeth. Imagine if you already have thinned enamel for any reason and you start to use lemon for whitening purposes. You will soon find out it wasn’t a wise move as your teeth will become so sensitive to the cold that even breathing through your mouth hurts. Also the thin enamel will make you more prone to decay.

In 2005 BBC had to apologise publicly for a lemon tooth whitening tip when one of its programmes recommended lemon as a money saver to families. I happened to watch this programme and couldn’t believe what I was seeing. Thank goodness British Dental Health Foundation soon found out about the programme as well and complained to the BBC.

I’m not convinced that the apology reached everyone who watched the programme.

Strawberry and Baking Soda

Now combination of these two used daily for longer period of time will damage your enamel. Baking soda works as abrasive and strawberry as an acid. A very bad combination.

Safe frequency of use is once a week.

Baking Soda

It is slightly abrasive to teeth and can damage the teeth especially if used with vigorous brushing technique.

Do not use baking soda if you have braces. It can soften the glue.

Salt

Salt crystals can scratch the enamel. Make sure to let the salt dissolve in the water before using it (kinda looses the point of using it, doesn’t it?).

Hydrogen Peroxide

Hydrogen Peroxide is the only known substance that removes deep stains. It doesn’t remove the surface stains so scaling and polishing is normally needed prior the whitening.

There are products over the counter (OTC) that contains hydrogen peroxide but these should be used under a supervision of a dentist as the excessive use of hydrogen peroxide will weaken the enamel permanently.

After Words

If you cause damage to your enamel by these abrasive or acidic home whitening products, it will be permanent. Thin enamel not only make the teeth sensitive to cold and prone to decay but it also makes the teeth look darker or yellower in colour. The dentin under the enamel is more yellow than the enamel and it will start to show through when the enamel gets thinner.

Important facts to remember

  • you can never ever change the natural colour of your tooth by lemon, baking soda, strawberry, whitening toothpastes etc. You may be able to remove the stains from the surface of the tooth but not the actual colour that is different with every individual
  • you should never replace fluoride toothpaste with any of the above means. Thinning of the enamel together with lack of fluoride will speed up sensitivity and decaying
  • all the means of whitening the teeth will result in damage of the enamel at certain level
  • any of the whitening products do not whiten fillings or crowns
  • the surface stains will carry on building up after the whitening if you carry on smoking and drinking coffee/tea/red wine. Also the new whitened natural colour of your teeth (whitened by hydrogen peroxide) will little by little get more yellow for the same lifestyle reasons

An impartial information about the risks of teeth whitening is almost impossible to find. The internet is full of practices advertising themselves and saying it’s all fine and dandy to do the whitening. So be cautious!

If you are interested in reading reliable article click here.

 

Aggressive Patient

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The lift is broken and my dental surgery is on the 6th floor. The last patient is slightly obese 50+ year old lady who has a heart medication. It is the last appointment of the day and most of the practice staff has left the building.

She walks into the reception. She huffs and puffs when I call her in. The first wave of complains hits me. Apparently it is my fault the lift is broken. I manage to calm the situation and she sits down in the patient chair.

I am super-cautious with everything what I say but she – still out of breath – takes another round at me. Now she’s shouting. I try to follow the protocol of how to deal with an aggressive patient. No help. I ask if she’d rather cancel the appointment. She wouldn’t. Instead she demands me to start the treatment and not to speak to her.

But I must speak. This job cannot be done without informing of certain things.

I suggest again that we could reschedule the appointment. It’s the end of the world for the patient and she nearly screams at me. I sit silently, my whole body trembling (which I pray God she wouldn’t notice). The patient demands me to carry on with the treatment and I do so in a fear of… not sure what but I rather carry on than stop the treatment to find out.

I must use calming deep breaths every time the patient does not notice as otherwise it would be difficult to hold an instrument in my hand. But still I must support my mirror hand with the other hand to stop the handle clattering against the patient’s teeth.

Once we are finished with the treatment the patient has calmed down. She even apologies her behaviour. I smile and I’m friendly towards her but inside me I am totally worn out and in a need of comforting.

Aggressive Patients And the Protocol

When a patient is hostile towards you and criticises everything you do there is no way to stop your heart pounding. You may try to hide it and act as we are thought – be calm, remember to listen, listen, listen, address the patient’s feelings with sympathy

I’m sorry you feel this way…

I understand that you are upset…

and let the patient finish until you ask

Do you want to continue with the treatment or should we reschedule?

At the same time your heart is racing like mad and you think the patient can hear from your voice that you are far from being calm. If she doesn’t notice it from you voice she will notice your hands that shake frantically.

Sound familiar? Been there done that!

We Are Not Perfect And Definitely Not Superhumans

No matter how good people skills you have there will be a day when a patient does not like your chair-side manner. The patient might be verbally aggressive towards you or passive-aggressive when you sense that all is not well (arms crossed and hardly answering your questions). Or the patient might act normally during the visit and later on you find out that complaint was made against you.

Whaaat? Me? But I’m always liked by my patients!

I have learned long ago a very important thing that keeps me sane in my professions when it comes to the patients:

You cannot please everyone!

Embrace this sentence and remember it when you hit a difficult time with your patient. If you feel that you have done your best you can calm yourself down by repeating this simple sentence in your mind. And offer it to the newbie who has met her first aggressive patient.

The same was done to me by a kind and wise dentist after one aggressive patient.

Y o u  c a n n o t  p l e a s e  e v e r y o n e!

After Words

I have noticed that there is a pattern of the aggressive behaviour amongst the patients. The fear of dentist is one thing for sure. But the ones that have given the hardest time on my professional life have been female patients between the age 50 to 60. I cannot help but thinking that this unstable behaviour (from 0 mph to 70 mph and back again) could be due to an undiscovered menopause.

Now could it?

But for your safety do not under any circumstance suggest this to the patient. It might be the last thing you do.