Christmas Came Early

dental-revelations-blog
Philips Sonicare forever!

I got bribed today. Big time. Remember the representative who got to the wrong side of me? If not, visit here to read the story before you continue further.

I said she was not going to visit our practice if it was up to me. Well, turns out it wasn’t up to me. The others wanted her to come. We had run out of toothpaste samples because the toothpaste manufacturers have started to be rather stingy recently. Perhaps the economic depression has hit them as well? I have noticed this phenomenon also at the dental show cases. Couple of years ago you could get lots of freebies but this year you needed to fill in a questionnaire or a competition to receive one travel sized tube of toothpaste. I didn’t bother.

Anyway, I was not looking forward to this rep coming to our practice as the previous meeting did not go that well. And when she came in, I realised she thought so as well.

First she complemented me about my looks. She did not compliment anybody else. And for your information I do not look like Snow White and the rest of the staff like the seven Dwarfs. So my interpretation of this was that she was trying to break the ice.

Then she began the presentation. Having learned my lesson last time I only listened and did not ask anything. I replied if she asked me a question.

I must say the new electric toothbrush she was demoing to us was quite impressive. It was up-to-date with the smart phone application and the position detection. The only questionable feature was the smart phone holder. It has a suction cup that is supposed to hold my 700+$smart phone at the hight of my face. I dared to ask about it and the rep said it will hold any smart phone as long as the surface is smooth and clean (should be preferably wiped with alcohol prior attaching the holder to the tiles or a mirror – but still I would not attach my smart phone to the holder).

Then she moved on to the toothpastes. Oh dear god how many different kinds of toothpastes they had. Too many in my opinion. The professionals won’t remember which one was for which problem and the patients will be even more confused – like one of my patient said to me

“I went to look for the sensitive one but couldn’t find it anymore. Instead there was so many new ones that I did not buy anything.”

Turns out that they have discontinued the sensitive one. Why didn’t they stick to the one that was supposed to deal with all the problems in mouth?

Then she gave us samples of one of the new toothpastes. She wanted us to try it out and report to her what we thought about it. Naturally she praised the toothpaste while I was browsing through the ingredients. Zinc lactate! Zinc in toothpastes can cause dry mouth. I felt the urge to mention it but remembered our last meeting when I did so. So I stayed silent.

But then came the grande finale. She took out the new, top of the line electric toothbrush and handed it to me with words

“I’m afraid I have only one of these to give out and I thought that it should be you.”

I felt the others staring at me in disbelief but all I could do was to look at the shiny and sleek black packaging she was handing to me. And without hesitation I accepted the gift.

Now, I am not sure what all of this meant. Was she trying to make up the last encounter? Or was she trying to convert me? Could she remember out of hundreds of customers that I am THE ONE not using their toothbrush? That would be scary.

If she tried to convert me, she could not have picked a worse target. I may accept gifts, try them out as expected but I cannot be bribed. I doubt there will ever be better electric toothbrush than my beloved Philips Sonicare.

Advertisements

The FSC Is Putting an End to the Nonsense

The Federal State Commission (FSC) in the US has announced a new enforcement policy that will stop (hopefully) the false claims made by homeopathic drugs. This will naturally include the homeopathic toothpastes and it definitely is good news for us dental professionals. Isn’t it?

You can find more on the subject here.

The FSC: Federal State Commission Enforcement Policy Statement on Marketing Claims for Over-the-Counter Homeopathic Drugs

Today I Saw My One in a Thousand Patient

dental-revelations

A-mazing. Simply amazing. That is what I thought when I took a look at one of my patient’s mouth today. It wasn’t something I expected to happen after interviewing the patient.

You see amongst many other things I always ask the patient if he uses fluoride toothpaste. This patient didn’t. And the reason for not using fluoride was a fear of the side effects and the fact that he has never had decay. He was 36 years old. I was sceptical of course. I was certain what I was going to find. If you have read my post Anti-Patients you know what it is. If you haven’t and you are about to click the link, do scroll down to the paragraph Anti-Fuoride when you get there.

So today I was certain that I was going to find decay. At least the early stages of it. And I was prepared to go through the routine of informing the patient about the consequences of not using the fluoride toothpaste.

But. A big but. The teeth were in immaculate condition. No plaque, only tiny amount of tartar and definitely no decay. No matter how hard I tried to find even the smallest evidence of it – of the patient being fool not to use fluoride.  But he was no fool. Far from it. He had good eating and oral hygiene habits and he attended the dentist regularly. That made him very wise.

Both me and the patient had the same question in our minds. Why isn’t there a toothpaste which contains only calcium for the patients like this one. They don’t need fluoride. Would calcium be enough? But then again, do they need toothpaste at all?

 

 

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.

Hands up Who Knew That Zinc in Toothpaste Can Cause Dry Mouth?

Dental Revelations Blog-4039

I have noticed it is very easy for a health care professional to get annoyed about different things by just browsing through dental forums and discussion sections of dental news.

This time it was the toothpaste.

Especially the toothpastes of certain big brand that promise all sorts of things but have side effects the representatives sweep under the carpet by saying casually

It’s perfectly safe to use

It’s normal

Yeah, peeling off the mucosa in your mouth is normal. I wouldn’t be so sure. Especially with the patients who have a sensitive mouth.

The salesmen of the manufacturers of oral hygiene products would sell their granny to promote their products. They can tell a fib or even lie to your face without loosing a good night’s sleep. All they want to achieve is that you will start to recommend their products. This is enhanced by giving the practices boxes and boxes of free samples which I have written about in my previous post Can you trust the recommendations given to you by a dental professional?

Are We Fooled by the Representatives and Adverts?

I remember an occasion when a representative of this big company came to my practice to introduce new products. These new all-in-one toothpastes. There were many different toothpastes in the same product family. One for everyone even though the first all-in-one toothpaste introduced not so long before these new ones was supposed to be the one to deal with e-v-e-r-y problem one could have. Slightly confusing I think.

Anyway, the rep went through these new toothpastes and recommended the sensitive version also for the sufferers of dry mouth. Then on the next sentence she mentioned that this sensitive toothpaste contains zinc…

Rather boring session got my interest immediately. Dry mouth and zinc? You got to be kidding me?

We dental professionals know our business. Every detail of it. Well at least I hope most of us do. Despite this I have noticed that many dental professionals are fooled by these selling speeches representatives give and do not notice that the things coming out of their mouths are simply bogus.

So I looked around to see if anyone else was looking puzzled? If anyone was about to say something? No, not a chance. They were just leaning back on their chairs with empty eyes staring at the products. But I couldn’t keep quiet. I never really have learned to keep my thoughts to myself especially if somebody is talking nonsense.

So I raised my hand to get a say (and I swear I could see my colleague roll her eyes meaning here we go again). The rep looked surprised.

Me: Did you say this toothpaste is for people with dry mouth?
Rep: Yes I did.
Me: And it has zinc in it?
Rep: Yes it has.
Me: But the zinc associated with dry mouth, isn’t it? It can make the dry mouth worse.
Rep: Err, I must say I do not have an answer for you now. But let me get back to you on that. What’s your e-mail address? I’ll find out and send you an e-mail as soon as possible.

A typical diversion from the subject. About month later I received an e-mail which said:

Hello,

I remember you asked something about the sensitive toothpaste. Care to clarify what was you specific question? All the toothpastes are well researched and tested. They are widely recommended by the dentists. Bla-bla-bla…

Yours truly,

Representative-that-will-not-come-to-my-practice-again-if-it’s-up-to-me.

Knowing Your Business in Depth

Now I must tell you that I did not know that zinc in toothpaste can be a culprit to dry mouth until another rep of another big oral hygiene product manufacturer (wouldn’t it be easier if I just told you which company?!) told me so couple of years ago.

I had recently tested their toothpaste for halitosis and got extremely dry mouth (honestly, I thought I will die of thirst between brushing my teeth and reaching the office in the morning). When I asked the rep about it she said that it could be due to the zinc in the toothpaste and asked me to file an adverse event report. She even gave me the document to fill in.

I was impressed. Not about the Sahara-Desert-in-mouth toothpaste but about the honest rep who could tell me something I didn’t know.

Since then it’s not been just once or twice that I have found out that my patient who is suffering from a dry mouth is using a toothpaste containing zinc.

The dentistry is constantly evolving. It is hard to keep up to it but we must. It is the only way we can give the correct advice to the patients.

Conclusion

It just occurred to me that I might be taking the visits of the representatives of oral hygiene products the wrong way. Perhaps it is accustomed way to let the reps babble away without questioning what they are saying. Am I considered to be rude to interrupt them when they are just trying to do their job? Should I just sit in silence when they are clearly not on the right path?

Perhaps, but I’m afraid it won’t happen in the near future. Or never. You see, isn’t it so that the annoying sides of one’s personality is only enhanced when one gets older?

Anyway. Be cautious of the advertising speeches of the reps. Read scientific studies about the ingredients and then make up your own mind if you will recommend certain products. Try them yourself and pay attention to how your mouth responds.

My advice for the patients is to use a toothpaste that feels good in their mouth. If the toothpaste burns, stings, makes your mouth numb or if you experience any other uncomfortable feeling STOP USING IT.

Profit, Profit And More Profit

Dental Revelations Blog-3559
Do you sometimes feel like screaming after something you read? I do.

I just read a very good article about a new ingredient in toothpaste that will save the teeth of many people. I must say I am normally sceptical about these kinds of releases in the field of dental hygiene products as it is not rocket science when it comes to keeping your teeth healthy. Really!

If you are a healthy individual and you

  1. brush your teeth twice a day with a fluoride toothpaste
  2. clean between the teeth most nights (no-one is perfect – apart from me as I do it meticulously every night)
  3. maintain healthy eating habits (eating 5-6 times per day including the snacks)
  4. don’t drink anything else than water/plain coffee/tea between the meals/snacks

Then you do not get decay. But having said that remember that your teeth won’t suffer from the odd relapse of the routine and good habits. Celebrations, night out, traveling normally mess up the routines and that’s fine. No worries. Your teeth won’t decay because of them as long as you get back to the routines again.

And because it is as simple as this I have found that the news of groundbreaking techniques/bristles in toothbrushes or breakthrough ingredients in toothpastes/mouthwashes are simply ways of marketing for the dental hygiene product manufacturers.

Today it was this toothpaste. With an ingredient that will slowly release calcium, phosphate and fluoride ions. All those that are lost from the enamel of the tooth when we eat or drink something with carbohydrates.

By the way, I never speak about sugar as it is misleading – people tend to think that e.g. bread does not cause decay as it doesn’t have sugar in it (well some do, but you get my point I hope). But it has carbohydrates and if the bread is eaten as a snack many times a day, the bacteria will metabolize the carbohydrates to acid many times a day. And the acids will remove minerals from the enamel of the tooth.

When I began reading the news I said to myself

Just give it a chance… for once just read it through!

And I did. And I found my excitement getting bigger. And bigger. Finally something that might improve the oral hygiene of the ones that are not responsible for decaying of their teeth like children or people suffering from extreme dryness of the mouth.

While I was reading I heard a voice in my head criticizing me for being always so sceptical about the dental hygiene products. I started to think that maybe I have missed something important over the years when I have not given a chance for this sort of news.

But then. I began to read the last sentence:

A fluoride free version of xxxxxx is also being developed for individuals who do not want or need fluoride toothpaste.

Beeeeeeeeeeeeeb.

Somebody-pulled-the-plug-feeling. Then anger.

Once again a new innovation is motivated by profit. Or perhaps there was a genuine desire to find something that would be “The Product” for the sufferers of the decay. But when it became groundbreaking innovation it immediately made it a product with high profit potential. And if you have read my previous post about integrity in dentistry you understand that it is the greed that is orchestrating this release of the toothpaste. No matter how good the initial intentions were.

A Fluoride Free Version? Are You Serious?

I read through many articles about this new ingredient and all of them had one thing in common.

The slow release of fluoride has been identified to be particularly beneficial in prevention of tooth decay.

This sentence in the same article with my previous quote. Do I need to say more? I don’t think so but I will.

I will break down the first quote.

…for individuals who do not want…

Of course there are people who do not want to use fluoride toothpaste. I have written about them in my another previous post Anti-Patients.  But these are the ones who need our guidance in this matter. What they don’t need is another sign from the dental professionals that it is ok to use a fluoride free toothpaste. When it is not.

…for individuals who do not… … need to use fluoride toothpaste.

Excuse me? Do they mean the people who have dentures or mouth full of implants and no teeth at all? They must have as I haven’t met any individual with natural teeth who do not need fluoride toothpaste. But then again if they have meant these people with dentures and implants why would they use this toothpaste anyway?

Conclusion

I am just simply and utterly annoyed and ashamed of the motives of some of the dental professionals. With just one sentence that is spreading in the internet fast and far they made lives of good and honest dentists, hygienists and nurses more difficult when they try to convince patients to use fluoride toothpaste.

The toothpaste manufacturers must be now competing bitterly to get their new toothpaste with this groundbreaking ingredient in the market first. The one that wins this competition is the one that probably paid the most to the company that developed this ingredient.

You would think that they would make enough money just by making fluoride toothpaste as majority of people do use it. But that is so very typical for dentistry – to squeeze out every dollar/pound/euro (or whatever) you can from an opportunity.

Money, profit, creed. A triangle of shame.

When will there be a dental hygiene product line that looks out the consumer’s best interest and is based on the advices of dental professionals? Effective enough electric toothbrush, soap-free fluoride toothpaste (soap is there just for because people think the foam makes it more effective), effective floss and interdental brushes (well there is already one of both, click here to find out which). In the past and currently there are dental hygiene products that are made for what patient’s are looking for

  • a cheap electric toothbrush (battery operated)
  • toothpaste that will deal with all the problems in mouth in one go and it makes mouth full of foam too
  • good tasting and easy to use floss/tape in a fancy looking package

This confuses the consumers as all these products are advertised as if they were very effective. They are not effective in cleaning the teeth and they are just big companies’ way of maximising the profit when they reach all the needs of all different types of people.

I am tempted to write little bit about new models of the manual toothbrushes that the manufacturers bring out every year with massive advertisement campaigns. I am amused every time I see toothbrush ad on tv. It’s just a manual toothbrush for god’s sake. How much can you do developing for it? It has a handle and bristles. That’s all.


Here’s a link to one of the articles about this new ingredient (for those who do not know what on earth I am on about).

 

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

post2 005

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 we recommend them.

Not.

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

1. 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).

2. 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 – what?) 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 toothpastes 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?

3. 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, cds etc) to them when the treatment is done and the nurses, hygienists and the rest hardworking supportive staff get nothing. 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 happily 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.

4. 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).

5. 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 you 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 the 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.

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.