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Friday, June 17, 2011

The Good Side of Calculus

As dental hygienists one of our biggest enemies is calculus.
We dedicate our lives to removing it, preventing it, and educating our patients on it.

But recently I discovered that it does have one good attribute...

The ability to form calculus may actually be a sign of good health- with the potential to cause problems if not managed correctly.

Recently I posted this question on Hygiene Town and this was the explanation that I got:

Have you ever noticed that people who form more calculus tend to have have less decay?

"In general think of calculus as having an alkaline etiology and decay related to acid.This is why the lower anteriors usually have the greatest amount of calculus. The lingual gland puts out an alkaline fluid. This is natures way of protecting the tiniest, most  fragile teeth in the mouth.

The people who get decay on the lower anteriors usually are those with a very acidic mouth who have depleted their alkaline mineral reserves via excess sugars and the strong acids of soda pop or candy.

To see how fast a person drinking soda amps up their depletion of minerals get some litmus paper and do the following experiment:

Take a neutral pH with nothing to eat or drink (including gum) 30 min prior. Take an oral pH optimal is 7.0 - 7.4 (similar to blood)-people with a pH of 6.0 or lower always have the most symptoms, diseases, take the most medications and have the most pain. Give the person a sip of soda pop and watch the pH change.
You would think that an acid drink would result in a more acidic mouth. NOT AT ALL, because the body has to protect the blood stream and its organs and tissue from strong acids it instantly pumps out huge amounts of alkaline minerals to neutralize this strong poison. The litmus paper turns deep purple.

This is how people eventually get weak and sick from consuming strong acid.

Soda has a pH  50,000 times more acidic then blood."
Dr. Elizabeth Walker

Saturday, June 11, 2011

How do you talk to your patients about grinding

Sometimes I think that hearing how other people are explaining things to their patients can be helpful. One topic that I find myself discussing day after day is grinding.

This is my typical explanation to a patient regarding the damage caused by clenching and grinding
An intraoral picture comes in handy , especially if you can get a picture where the recession is obvious on opposing teeth
I always start by asking if they notice if they clench or grind and if they have headaches or jaw pain
About half the time they are certain that they don't- almost a little defensive like I have just accused them of something horrible and then tell me that there spouse would have told them if they did (why people get so defensive I have no idea?)

I say something about in the past we thought that the recession was caused from aggressive tooth brushing but today we know that unless you are using a brillo pad to brush with it is actually caused by excessive trauma to your teeth and usually this occurs while you are sleeping.

A lot of times I will pull out a hand mirror and have them take a look and see if they can line their upper and lower teeth up "like a puzzle" most patients will agree that it isn't a comfortable position that they purposely put their jaw in during the day.

Then I explain that everyone clenches and or grinds differently so we see different signs- some times headaches, jaw pain, "pot holes" in the tops of the teeth, bone loss on the front of the teeth, gum recession, and sometimes enamel flaking off.

I use the analogy that if you put a stick in the ground (tooth in the bone) and kept tapping on the top of the stick eventually the sand around the stick would start to break away- this is similar to what happens to the bone around your teeth- your teeth come together in a specific way and the teeth that you contact first and hardest take the brunt of your grinding( ex. intraoral picture)- when you lose the bone the gum tissue also migrates away from the tooth because it doesn't have anything the attach to.

For abfractions : the junction of the tooth and the root is the weakest point of the tooth so when you are clenching or grinding you are causing a lot of torque on this area and sometimes it is too much for the enamel to withstand and it flakes off.

This seems horribly long but the whole conversation takes about 3 minutes and usually ends with a bite guard

Now we are discussing the link between clenching and grinding and sleep apnea- that’s another 2 minute spiel

Hope this helps

Thursday, June 2, 2011

A New Spin on Specialist Gift Baskets

Dental offices tend to be a dumping ground for gift baskets around the holidays.
Cookies, candy, popcorn - you name it- they give it. Orthodontists, endodontists, periodontists saying "thank you" for the referrals by adding pounds to your hips.

An orthodontist that we refer to has taken the gift basket tradition to a new level- one that we actually feel good about using. One of his team members dropped off a basket with individual packages for each of our team members- each package contained a nail polish, file and toe separator. There was an envelope with instructions not to open until everyone had picked out their polish. The note inside the envelope instructed every one to look at the bottom of the polish and the one with the star sticker on the bottom was the winner of a pedicure- whoo hoo (I won- yay)

He also hosted a March Madness basketball pool that all of the offices that refer to him were able to participate in- I didn't actually make any picks, but I loved the idea.

I started thinking that I wanted to do something like this for the specialist that we refer to. I know that traditionally they are the ones to give the gift baskets but it could go both ways. Often times people will seek out specialists even if they don't have a general dentist, granted the specialists are going to spread their referrals around but why not try to get you name at the top of the list. Also its a great opportunity to introduce yourself .

In January we dropped off gift baskets from Harry and Davids containing fruit to our periodontist, orthodontist and endodontist- we also included an invitation for complimentary preventative services for their team members (cleaning, exam and xrays) As long as the team member is employed at that particular office we will continue to provide these services free of charge.

In April we delivered a gift basket to the plastic surgeon that we refer to, each bottle in the sand includes a poem inviting the team member to our office for complimentary whitening trays. This would also be a nice gift for our other specialists since these offices typically don't provide whitening services.

Each of these gifts provided the recipients with something they were glad to receive and gave us an opportunity to introduce them to our office, services we provide and form a relationship outside of a referral slip.
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