What is dental fear?

Fearful dental patients count for more then half of the North American population. Dental fear is known to be one of the most common challenges that dentists or dental hygienists have to face every day in regular basis. Theoretically dental fear is termed as dental phobia. A particular phobia is the experiencing of a continuous  fear from a patient, characterized with avoidance of an object or situation and expressed with anxiety and physiological or physical stress. Dental fear is considered a negative sensation and an emotional distress  that is caused by objects or environment related to past history of unpleasant dental treatment or multiple dental related causes.

What is pain?

In order to explain why and how dental fear increases the pain to an individual during a dental procedure we have to understand the physiological and psychological factors behind dental pain. Pain is a mental and physical discomfort  caused by external stimuli ( E.g burning of the skin, needle poking ) into the brain and transmitted by special nerve endings which transport these stimuli into the brain causing a flight or  flight reaction (Eg. involuntary removal of your hand from a hot object). So basically pain is nothing but a stimuli of our nerve endings that is transmitted through our nerve cells ( neurons) into our brain, which analyzes the stimuli and eventually will  initiate a reaction that will aim  balancing the external or  internal physiological activity of the body.

Physiology of the fear into the body

When body experiences pain, brain responds by stimulating hypothalamus ( part of the brain). Hypothalamus stimulates adrenal cortex gland and adrenal cortex gland produces two hormons: 1- Cortisol ( makes nervous system more sensitive to stimuli) 2- epinephrine ( adrenaline). Both these hormones that are released in blood due to emotional stress (anxiety or fear) when  combined together for a period relatively long will increase the sensitivity of the nervous system  making it more transmissible to external impulses like pain from a needle or tooth extraction. In other words the more fear, anxiety or stress you experience the more painful a dental procedure will be due to increase of the sensitivity to pain stimuli.

To better understand the difference lets assume that pain is divided in units. An individual presents in a dental office for a dental filling procedure that involves local anesthesia. He is fearless and not anxious at all and experiences one unit of pain while the dentist administers a local anesthetic injection to freeze the area that will be treated. If the same patient would have been anxious, fearful and stressed about this appointment he would have experienced at least 2 units of pain for the same exact dental procedure. A dental patient who is nervous and fears the fact that he will be treated by a dentist will basically experience more pain and experiencing more pain will definitely make him even more fearful about dental procedures. There are numerous solutions and treatments to this fear. Starting with the colors of the waiting room in the dental office, the medicine smell etc etc.

Conclusion

Various studies show that dental patients that are fearful and anxious for their dental appointment experience high blood pressure, increase of perspiration ( sweating). increase of cholesterol production, immune system dysfunction ( low ability to fight disease) etc. A dental hygienist or dentist who notices these symptoms in a dental patient should immediately stop the treatment because if the pain anxiety or stress arises blood elevation can reach a level where  cardiac attack may be inevitable. It is very important that a dental clinician takes professional steeps by reviewing the medical and dental history of the patient. Explaining to the patient the relationship between fear and pain not only will minimize  any dental emergencies that might arise in the dental office but  it will make  the dental appointment more comfortable for the patient.

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These are the most common toothbrushing techniques recommended by dental hygienists and dentists that will help you maintain a good oral hygiene

Bass (Sulcular)

Method - Bristles are directed apically at 45◦ to long axis of tooth, gentle force applied into sulcus

Use gentle but firm vibratory strokes without removing bristle ends from sulcus

Indications – Sulcular cleansing, Perio health, Perio disease, Perio maintenance

Stillman’s

Method – Bristles are directed apically and angles same as bass

Bristles are placed partly over cervical part of tooth and partly on adj. gingiva

Short back and forth strokes are used and brush head is moved occlusally with light pressure

Indications – Progressive Perio recession, Gingival stimulation

Charter’s

Method – Bristles are directed toward crown of the tooth. Bristles are placed @ the gingival margin and 45◦ to long axis of tooth; short back and forth strokes

Indications – Ortho, temp cleaning of surgical wounds, fixed prosthetic appliances, gingival stimulation, cleaning of entire facial and lingual surfaces

Modified Bass, Stillman’s and Charter’s

Method - Add a rollto any of  the three maor methods (Charter’s, Stillman’s or Bass);  roll tufts occlusally after cervical area is cleaned by prescribed method

Indication – Rolling motion avoids damaging the base of the gingival sulcus.

Horizontal Scrub

Method – Bristles are activated in gentle, horizontal scrubbing motion

Fone’s (circular)

Method – Bristles are activated in circular motion

Indications – Its mostly indicated for children but it can also be applied to adults. It is a simpler technique but it has shown to be less effective then the three first methods.

Leonard Vertical strokes are used with teeth in an edge to edge position. (Not Recommended)

Roll Stroke

Method – Bristles are pointed apical and rolled occlusally

Indications – Used in conjunction with Bass, Stillman’s and Charter’s

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Flossfish  review

This video will help you understand how to floss your braces. I think it is an excellent idea and i believe that it should motivate all of RDH’s in coming up with new ideas as contribution of our profession towards clients oral hygiene.

• Flossfish is not perfectly adapted at a C shape on the labial side due to the presence of the brackets.
• It is to thick to allow normal flossing motions.
• Patient will have to learn and adapt to a new flossing technique
• However it will be beneficial suggesting it to dental patients

NOTE

Since this product is new in the market it will be great if dental professionals that have had the chance to use it as an oral hygiene aiding tool, would leave a feedback or a review in our site.  It will help other professionals and clients as well understand the advantages and disadvantages of this product.

Floss fish instructions

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Teeth whitening

One of the most popular dentist prescribed methods of bleaching is home-applied bleaching. In the beginning The American Dental Association (ADA) had concerns for safety and efficacy if patients would have managed correctly the instructions given from the dentist, and they published the conclusion after many researches that only ADA accepted products were going to be allowed for use as home-applied bleaching products. This in strict monitoring of the dentist prescriber.

So if there are so many concerns about home-applied bleaching should we still prescribe it? Absolutely YES! Not only it simplifies the restorative procedures, but it is a low cost, and efficacy incomparable with any other restorative methods to patients that “suffer” from unsatisfactory appearance.

Today researches and practical experience have shown that teeth bleaching offers unique treatment to tetracycline stain embedded in the dentin as well as other intrinsic stains.

In conclusion i would like to say that teeth whitening is relatively the best way to avoid crowns, bridges, and veneers that not only come with high costs but are subject to high risk periodontal disease. There is nothing better then bleaching for people that are embarrassed to smile because of discolored color of their teeth. It can improve the patients quality of life and give them brighter smile.

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-Hepatitis B

Vaccination is recommended for anyone older then one year and 4 months old. Contraindicated to people with anaphylactic reaction because it can cause allergic reaction. First two doses are taken four weeks apart and the third dose five months after the second shot. No major complications after the administrations have been noted.when blood titer is low a booster is recommended. This could be identified by periodic blood examination.

-Poliomyelitis

Vaccine is taken orally and is called OPV vaccine because it’s an attenuated virus. Two doses each 8 weeks apart and a third one after 8-9 months period are required for administration. All ages are recommended for immunization. Contraindication to Polio vaccine includes people that are allergic to neomycin. A booster may be required if the dental practitioner has been in contact with oral secretions of a person who is diagnosed with poliomyelitis.

-Influenza

Influenza vaccine has to be taken annually or seasonally because the virulence of the virus periodically changes and the vaccine has to be formulated again after the virus identification. Contraindicated to people that are allergic to eggs (rarely hypersensitive).

-Tetanus and Diphtheria

Tetanus requires boosters every ten years. Both require two doses (4-7 weeks apart) then a third one after 7-12 months. Vaccine can cause hypersensitivity if boosters are taken more often then required. Contraindicated in pregnant patients and

-Rubella

It is a virus and it is associated with birth defects in pregnant women. Vaccine is administered at any age. Just one dose is necessary. Contraindicated to pregnant women because vaccine can infect the fetus since the immune system is not strong enough to control a life attenuated virus. No pregnancy recommended after vaccination for at least three months. Once in life vaccine, no boosters necessary.

-Rubella

Live virus vaccine used in one dose. Contraindicated to pregnant women and immune compromised patients. Some patients that take this vaccine can experience rash and attenuated symptoms of measles . No boosters

-Mumps

People that were born before 1956 are considered to be immune to mumps. Given in early childhood combined with measles and rubella live virus in just one dose. Contraindicated in people with hypersensitivity to neomycin and pregnant women. Adverse reactions are rare and include sort throat fever headache.

-Tuberculosis TB

There are two different types of TB tests:

1-Tb tine test – usually used in infants and children for screening purposes and its not accurate.

2- Tb Mantoux test- Consists of an injection of purified protein under the skin. A positive TB patient is likely to develop a red raised wheal  of more then 10 mm. A positive test indicates the presence of the Tb bacterium but a skin test can not tell if the bacterium is actually active. Statistics researchers have found that approximately 10-15 % of the patients with positive skin test develop active TB during their life.

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1)      Disease prevention

2)      Disease treatment

3)      Health promotion

In order to successfully complete our task as dental practitioners we need to understand what client counseling, principles of learning, client motivation and human needs are

-Patient  Counseling

• For most dental patients major attention is focused on control of caries and periodontal infections with emphasis on microbial plaque control, tobacco cessation, nutrition
• Periodontal infections and dental carries can be prevented or controlled
• Teeth can be preserved throughout the patient’s lifetime
• Consider a client who increases oral health knowledge, attitude, & values. Then instills this in respective family, then the community
• Knowledge and beliefs are not enough…
• Knowledge must be put into action, learning occurs when beneficial changes are incorporated into everyday living

-Principles of learning

• More effective when client is ready to learn
• Individual differences must be considered
• Motivation is essential
• What a client learns in a given situation depends on what is recognized & understood
• Recognition between similarities & differences of past & present situation
• Clients learn what is actually used
• Increased when client feels satisfied
• Evaluating results of instruction is essential to determine if learning is taking place

-Motivation

• Individuals are motivated to practice behavior that leads to achievement of goals that are valued (must consider oral health as a valuable asset)
• Motivation stems from a physiologic or social need (peer group approval, fear of rejection)

-Human Needs Model

(The human needs model is used as a framework for dental hygiene care)

• In the human needs model of dental hygiene the client is seen as a biologic, psychological, spiritual, social, cultural and intellectual human being who is

motivated by the fulfillment of his/her human needs.

• The environment affects the client and the DH and both are capable of influencing the environment.
• The higher the level of human need fulfillment, the higher the state of wellness for the individual.

• Dental Hygiene actions are defined as those interventions aimed at assisting clients in meeting their human needs related to optimal oral wellness and quality of life through out the life cycle.

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1. Assessing: Gathering information regarding clients health
2. Diagnosing: Identifying clients oral problems and deviations from normal
3. Planning: Settlement of goals for the patient
4. Implementing: The process that involves meeting of the clients needs designed by Dental Hygienist during planning.
5. Evaluation: Involves measuring of the clients achievements specified during plan care

Dental Hygienists should be able of decision making as well as responsible in identifying and resolving clients problems within the scope of Dental Hygiene profession.

Three are Dental Hygienists responsibilities

Preventive: To prevent oral disease by any methods that they are professionally trained.

(Applying professional fluoride or dental hygiene education sessions)

1. Therapeutic: Arresting oral disease that can compromise clients health in the future by controlled acts. ( dental scaling, root planning, gingival curettage etc)
2. Educational: Involves methods of explaining and educating clients about oral health management, aiding tools and their techniques, learning reinforcements, (E.g. tooth brushing and flossing techniques)

A Dental Hygienist in United States and Canada works in association with a dentist or as an independent oral health clinician.

Carrier opportunities as a Dental Hygienist

1. Clinical practices (independent or in association with a dentist).
2. Manager of oral care programs in hospitals.
3. Research projects.
4. Public health programs.
5. School/daycare health programs.
6. Faculty in dental and dental hygiene schools.
7. Developer in government or private health care agencies.
8. Private dental companies.
9. Army.
10. Educational institutions.

Dental hygienists play an enormous role in helping clients maintain a healthy oral environment. .  They are without a doubt the key success in healthy white teeth and happy bright smiles.

Dental hygiene as a profession continues to change depending on the society demands.

Researches show that 1 in 3 people seek dental hygiene care at least twice a year in North America. This is one of the reasons why the prevalence of dental caries in this population continues to decrease.

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The proper way to brush your teeth should start with setting a sequence that would be easy to remember.  For example  you can divide your mouth in 4 quadrants 1, 2, 3 and 4. If you are left handed the quadrant 1 will be the maxillary left quadrant ( or upper left quadrant), quadrant number 2 would be upper right quadrant, quadrant number 3 right lower quadrant and quadrant number 4 would be the left lower quadrant. The brushing should start from the last posterior tooth of the first quadrant brushing just one surface of the tooth. For ex. the buccal surface ( the surface that is in contact with the checks), then brushing is continued until the last molar of quadrant 2. The next steep will envolve the lingual side of the maxillary teeth. To do so once the after the client finishes brushing the last tooth of the second quadrant immediately follows brushing the lingual side of the last molar in the 2 quadrant continuing until the last molar of the 1 quadrant. Once booth surfaces ( lingual and buccal) are brushed the only surface left is the occlusal surface or the surface of the tooth that contains groves (presend only on posterior teeth “premolars and molars”). The same sequence is applied for the lower mandibular teeth.

Using a sequence helps the you  brush thoroughly avoiding any missing areas during brushing. Sequencing methods are numerous depending on what logical sequence works better for the you.

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What is nutrition?

The study of nutrition includes all of the processes involved in the selection,
intake, and utilization of nutrients.

What are nutrients?

Nutrients are the components in food that supply the elements necessary to meet the body’s requirements for energy, growth, maintenance, and well-being.

You probably have heard the expression “You are what you eat.” It is true, because food is used to build and repair the body. Food choices must therefore be based on sound information and knowledge.

Malnutrition

Malnutrition during crucial periods may result in physical or mental disabilities. Well-nourished persons are usuallybetter able to heal and ward off infections than poorly nourished individuals

The Role of the Dental Professional

In dentistry as a part of the Dental profession, a Dentist or a Dental Hygienist provides  nutrition counseling and helps patients with food choices in a variety of circumstances, including:

• Counseling patients about the prevention of tooth decay
• Counseling patients regarding their diet following oral surgery or other dental procedures
• Performing dietary analysis with patients
• Counseling patients who have orthodontic appliances on their teeth with regard to food choices

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Plaque is considered a bacterial biofilm that is organized in colonies creating an independent surviving system that makes it impossible for the immune system to fight and destroy. Plaque consists of different types of microbial flora that interact with each other to create what is called biofilm. Plaque maturation is associated with poor oral hygiene, compromised immune system, and lack of capability to perform oral self care among other things.

Quantity of plaque is the number one factor to determine the aggressiveness of periodontal disease development. There are two different types of microorganisms that populate plaque biofilm: gram negative and gram positive. Gram negative bacteria are significantly found in large numbers at periodontal disease sites. They live in anaerobic ( not needing oxygen ) environment and are proven to be an important factor in periodontitis development. The quantity of gram negative bacteria depends largely on what stage of plaque formation and the location where plaque is accumulated.

Many of you would ask how micro bacterial mouth rinse products can effect reduction of plaque biofilm and how they exactly work? Mouth rinses contain chemical products like phenolic compounds that interfere with bacteria by destroying their membrane layer preventing their metabolic system to develop. Phenolic compounds include oils from plants (eucalyptol menthol) that contain antiseptic properties. These oils are found in almost every mouth rinse product.

Many surveys not only in USA but Europe as well indicate that there are a considerable large number of people that do not use the appropriate oral self care aids to mechanically control plaque leading them to gingivitis or periodontitis, therefore the need for micro bacterial mouth rinses is absolutely necessary to prevent the advancement of periodontal disease. We have to understand that it is not enough to mechanically remove plaque from the tooth surfaces through daily brushing or flossing, but the oral mucosa (especially tongue) as well. Mouth rinses have numerous advantages in maintaining good control of the plaque biofilm. For example some areas that might be missed during regular brushing are not visible, so using a mouthwash rinse will help decrease the possibility of any acid attack that could be caused but the remains of food debris.

Conclusion
Despite these benefits we as dental professionals should keep in mind that clinically speaking there is no existing proves to show that any antimicrobial mouthrinse product is efficient in destroying subgingival bacteria (especially gram negative). This is due to incapability of the rinse to penetrate subgingivally. In conclusion I would like to stress the point made by the Canadian Dental Hygiene Association that we as Dental Hygienists must focus our attention on the information provided with every mouth rinse product and keep ourselves up to date with the information provided by many researches worldwide in order to provide good quality care for the patients.

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