The Importance of the Labial Frenum

When you see your pediatric patients, are you checking their labial frenum? I know many hygienists, including myself, always checked the tongue frenum to check for tongue tied. However, lip ties were never a concern for me. Until now.

Recently, studies have been showing the importance of releasing a lip tie. Not only will a class 4 lip tie prevent a baby from having a proper latch and prevent nursing, it can cause problems as the child gets older.

One problem that can occur is higher decay rates on the anterior teeth. With a lower frenum attachment, the lip creates a “pocket” around the anterior teeth which can trap milk and food. This allows the sugar to sit on the teeth, causing decay to begin around the gingival margin. The strong frenum between the teeth also cause problems with brushing and reaching the toothbrush bristles to the gum line, another reason for increased risk of decay. Another issue that can occur is sleep problems. If the labial frenum is too tight, the upper lip cannot reach the lower and the child is constantly breathing through their mouth. This can lead to sleep apnea in the child. It can help the child orthodontically. Regularly when the lie is released, the infants teeth will move together and have less of a diastema, This can prevent further ortho treatment needed as the child gets older.

I am very passionate about checking for labial frena attachments because it has recently happened to me.

This is my daughter Georgia. She is almost 2 years old now. Like most two year olds, she’s curious, busy and into everything in my house. However, she was very behind in her speaking and communication, which of course, as a mother, made me very worry. My dad is a dentist in Alberta, Canada and kept asking if her lip and tongue frena’s were tightly attached. Like a daughter would, I brushed it off and we started working with a speech therapist to hopefully help develop her skills. However, he looked at her first dental visit with him and he highly recommended having them released. I waited a few months to complete the treatment because I was nervous!

I scheduled a frenectomy appointment with a pedodontist that uses a diode laser and treats hundreds of lip and tongue ties a month. After a quick consultation, they preformed the surgery with topical anesthetic only. The most important part of the surgery is the post op instructions and lip stretches. While the area is healing, the frenum can reattach, so I stretched her tongue and lip 5 times/day until it healed (about 1 month) to prevent it from reattaching.

Georgia's Class 4 Labial Frenum

In my experience, the earlier this is diagnosed, the better:

1.    The earlier the child has the frenum release, the quicker it will start to nurse and eat properly.

2.    The treatment is easier to accomplish on a young baby. Since Georgia was almost 2 when it was completed, she was bigger and stronger and didn’t want to sit for our pediatric dentist during the procedure. She also was a bit aware of what was going on and seemed scared. I'm not going to lie. Since she wasn't happy during the procedure and tried to twist away, it was stressful as a mom! 

3.    The younger the patient, the less likely they will remember the appointment. We are hoping that Georgia doesn’t remember the surgery and will be doing “happy visits” at the pedodontist several times before she actually is a patient for a prophylaxis appointment.

Once a patient is a candidate for surgery, it is extremely important to explain the post op instructions to the patient. For at least 1 month after surgery, the parents or caregivers need to perform lip stretches several times a day to prevent reattachment of the frena. If these stretches are not completed, the tissue will reattach and the surgery will be unsuccessful. If you have any questions on lip stretches, contact your local Oral Myologist.

To see different photos between Class 1, 2, 3, and 4 labial frenas, this is a great paper.

Find contact an Oral Myologist, check out the IAOM.

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Sources:

The Influence of the Maxillary Frenum on the Development and Pattern of Dental Caries on Anterior Teeth in Breastfeeding Infants: Prevention, Diagnosis, and Treatment

Lawrence A. Kotlow, DDS

DDS, 340 Fuller Road, Albany, NY 12203

J Hum Lact. 26(3):304-308.

http://www.sleep.theclinics.com/article/S1556-407X(14)00025-3/abstract?cc=y= - article-footnote-

 A Novel Treatment of Pediatric Sleep-Disordered Breathing

Joy L. Moeller, BS, RDH, Licia Coceani Paskay, MS, CCC-SLP, Michael L. Gelb, DDS, MS 

Sleep Medicine Clinics 

June 2014Volume 9, Issue 2, Pages 235–243

The influence of the maxillary frenum on the development and pattern of dental caries on anterior teeth in breastfeeding infants: prevention, diagnosis, and treatment.

Eur J Paediatr Dent. 2015 Dec;16(4):262.

Kotlow LA.

Lingual frenectomy: functional evaluation and new therapeutical approach.

Eur J Paediatr Dent. 2012 Jun;13(2):101-6.

Olivi G1, Signore A, Olivi M, Genovese MD.

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One Of My Best Tips For Efficient Ortho Prophys

Remember to enter our giveaway of a complete GumChucks kit HERE

Ugh. Your 30 min child prophy just showed up, right after school lunch, with a new full set of braces. This is about the time when I USED to shed a little tear as I knew I was going be be put behind in my schedule. Now when I have this scenario, I am excited for the change of routine and can complete it in the time provided. (Feel free however to schedule extra time at the next prophy visit if needed.) Here’s is the time frame ESTIMATION by minute:

• 1m-HH
• 4m-Radiographs (if needed)
• 2m-Brush the patient's teeth/OHE
• 10m-Polish, ultrasonic, hand instrumentation
• 3m-Flossing
• 5m-Exam
• 1m-Fluoride
• 4m-Dismissal/room turnaround

One of my personal biggest time savers to stay on the above schedule on an ortho patient is to disclose, hand them a mirror, and then have the patient watch me brush their teeth. This will give you a good head start on removal of materia alba and biofilm, which these patients usually have lots of, and at the same time you are doing OHE. I love a good BOGO (Brush One Get OHE). You could have the patient brush their teeth over the sink as well but I find that they take longer and still miss those hard to reach areas.

I used to hate flossing braces, as threading the floss through each time was a killer! Some time saving tips on braces are to use an ortho flosser such as the sterilizable handle from the company GumChucks with an ORTHOgami attachment, or you could use the platypus flosser or fish floss. Find one that works best for you by requesting some samples. 

Stay tuned in over the next few weeks to come as we have some videos on how to be more proficient  with the air powder polisher, ultrasonic and hand instruments on patients with ortho. 

It's Ortho Month On Hygiene Edge

It's Ortho Month on Hygiene Edge! Watch for articles and new videos all about how to care for our patients with ortho.

Our first video in ortho month is about an amazing product from GumChucks called ORTHOgami. They make flossing braces easy both for you and for your patients. They also offer metal handles that are sterilizable to use in your practice that makes flossing patients quick and easy. 

To kick off Ortho Month, we are doing a give away! We are giving away a complete GumChucks kit for you to try at home and in your office. It includes multiple handles for kids and adults and inserts for both ortho and non ortho patients. To enter, comment below with your favorite ortho trick or products that you recommend. We will be announcing the winner here on Hygiene Edge on Tuesday!

Does Flossing Really Prevent Cavities?

I sat in a large conference room as the speaker shared that flossing is not very effective in preventing caries. Immediately, there was a tangible feeling of agitation in the air. Who does this lady think she is?  How could someone, let alone a well-known dental hygienist, say such a thing?  The speaker later shared that she has had hygienists even leave her courses over this.

Don’t we drill in our patients head brush, floss, repeat? I certainly have been guilty of being a ‘floss boss’ and telling my patients to “clean-in-between” to prevent decay.   

But, here is the thing, we say a lot of stuff in dentistry out of tradition; or because it kind of makes sense in our minds and we may not even have any research to back up. 

There was a good-sized systematic review (click here) done that showed a very weak correlation between flossing and a decrease in decay. (However, the study did show that flossing decreases gum disease). 

So how has this news changed the way I educate my patients?  If a patient has a lot of decay, and relatively healthy gingiva, I skip the floss lecture and go straight into strengthening the patient’s teeth with different products such as fluoride and eliminating known risk factors such as frequent consumption of energy drinks. 

Hygiene Edge Challenge:  Back your oral hygiene education (OHE) up with research!!

Edgimacated

This past week has been an exciting one for my as an educator. Last Friday, the school where I work graduated some of the best and brightest students, ready to take on the world one dirty tooth at a time. This week, those students finished up their local anesthesia and clinical dental hygiene boards. I was reminded of when I took those boards and still feel some residual anxiety about them and it's been 5 years! I remember being so nervous and stressed out. All of my available brain space was focusing on that exam so it's not surprising that I locked my keys in the car that day, right?! Anyway, I was reflecting on how much study, preparation, work, and money went into the letters at the end of my name, letters many don't know about. That is what I was to discuss today: educating our patients and the general public about what it mean to be a RDH, BSDH! If we remember back in 2012, a national television program called The View proclaimed to the world that is was not necessary to get a college degree to become a Dental Hygienist! Let alone the reputation we have as ditsy women thanks to other television shows. I have had many discussions with my patients about my education. More people than I'd like to admit are surprised when I tell them that I have a bachelor's degree and am licensed by the state to do my job. Imagine their surprise when I tell them I had to take 3 written exam and 2 practical exams in order to be licensed! I have 3 suggestions that I would ask you to consider in order to bring the respect that our profession deserves.

1. Hang your license AND diploma (whether it is an associate or a bachelor's degree) IN your operatory where your patients can see it. This provides you with a conversation piece and an opportunity to educate your patient on the quality of care they are receiving from a qualified individual- YOU!

2. Wear a lab coat or name tag with your name AND credentials on it. You may think it's pretentious. It is NOT. It is PROFESSIONAL.

3. Be a member of your professional organization! Without an organization, we do not have a voice. We need a voice to protect and preserve the professionalism and prestige of our profession.

How do you present yourself in a way that helps others recognize your qualifications? I'd love to know. Let's join forces and not let the stress of boards go unwarranted. Let us be a united voice in letting our patients know that educated professionals are taking care of them. We are much more than the "person that cleans my teeth."

When and How to us a Snap-A-Ray For Bitewings

Snap A Ray For Your Bitewings

Functional Movement Exercises To Keep Your Hands Working Strong

PART 2-How To Increase Production-With The Medical History Interview

UPDATED 4-6-24

In part one of this series, I discussed how in increase production with radiographs. Now I want to address how to do this with the medical history interview.

I often get asked the question, “How can I increase the hygiene department's production?” There are two main reasons why this is being asked. The first is the hygienist is being told that they don’t produce enough or second, because you work on commission you would like to earn what you are worth.  In both of these scenarios, you HAVE to find a balance between producing and improving oral health.

I daily ask myself the question while reviewing my charts, “hHw can I help my patients today?” If you can provide high quality care, the finances will come.

You may see some form of the following questions on your health history. As I go through them, I will discuss the ways you will increase production while improving oral health.

Do you take any medications?

    This increases the patient's risk for caries and causes xerostomia. A full caries prevention protocol needs to be implemented. Consider a fluoride treatment, fluoride toothpastes, xerostomia products and electric toothbrushes.

Do you smoke, use alcohol, have diabetes, or do your gums bleed when you brush?

Prepare for a potential perio case, and lots of oral hygiene education, as these are risk factors for periodontitis. You may be preparing for laser use, HybenX, Arestin, Perio protect, Etc.

Do you participate in high contact sports?

I had a friend get kicked in the face during a soccer game breaking his teeth right off at the gingival margin. I am now an advocate for athletic mouth guards to my patients involved in contact sports. These are as easy to make as a whitening tray. They just take a quick impression and pour up to make one in office. You can even create customized colors and designs. Check with your supply company to get some in your office.

Do you have any concerns with the look of your smile?

Does your office offer 1 hour bleaching like Zoom, Sinsational Smile or whitening trays? Patients love white teeth, so keep alginate and impression trays close by and offer to take the impressions that day to get the process started.

Do you grind your teeth?

This is a sign that a patient may have sleep apnea. Does your office offer sleep apnea devices or referrals to sleep physicians?

Are your teeth sensitive?

Use the dental code D9910 and place Gluma, Crest Pro Relief polishing paste or a fluoride varnish or silver diamine fluoride. Have a brainstorming meeting as an office to set a protocol and cost for desensitizing.

How To Use A Tooth Slooth

Every hygienist must know what this tool is and how to use it. How often do you use it in your office?

I Have Had This Problem...

I have had this problem. Some of you might find this scenario familiar.  My first patient gets an alert, cheerful, hygienist that does cancer screenings, blood pressure, excellent radiographs and OHI that includes handouts.  As the day goes on the schedule gets tricky, I might get behind, I get tired and feel like I’m in a crisis state, barely keeping my head above the water. Blood pressure happens only if a pop up says I need to take it and OHI instruction becomes a quick “pay a little extra attention to brushing your gum line.”   

I guess I thought every hygienist started out like fire and then fizzled out as the day went on.  That was until I worked with a hygienist named Ishalynn. She seemed to give every patient the same high standard of care.  It didn’t matter how late the doctor ran, how crazy the schedule got or if it was her last patient. Every patient was treated like the first. 

At first, I thought it was just her and that she was some anomaly of a hygienist.  From closer observation, I found that Ishalynn makes a deliberate effort to sustain her energy.  After every patient, she takes a minute to catch her breath and drink some water. (She keeps a water bottle in a cupboard in her operatory).  It doesn’t matter how crazy the schedule gets, she knows her one-minute break will get her grounded and thinking clear.  I, on the other hand, have gone all day without any water as I rushed from one patient to the next.

I observed how Ishalynn protects her lunch breaks and lets the office manager know that scheduling emergencies through her lunch is not the best for her and for the office. This is sometimes unusual in dentistry where it is expected to work through lunch (or stand and scarf before the next patient comes).  She seemed less tired having had her break. 

Speaking of tired, does anyone else find it interesting how tired hygiene can make you?  It is not exactly the most physical job out there (I wore a pedometer once and I think I got less than 2000 steps all day).   But dental hygiene takes a lot of focus; which uses a substantial amount of glucose. 

Once, there was a study preformed on Judges.  They found after their midmorning snack the judges would grant parole to a whopping 65 percent of prisoners.  It would drop down to zero before lunch.  After lunch 65 percent of prisoners were granted parole.

It seems when we don’t refuel our body, we don’t have the glucose we need to make clear decisions.  I can’t tell you how many times I’ve seen a dentist and hygienist (myself included) work through lunch with the distorted view their sacrifice was demonstrating dedication to patients and the office. In all actuality, the patients are getting subpar care and the clinician is less effective and productive.

In conclusion:

·      TAKE WATER BREAKS BETWEEN PATIENTS

·      EAT FOR SUSTAINED ENERGY

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I asked Lauren Fowler from the blog Mindful Meals to make the ideal meal plan for hygienist to sustain energy. This is what she suggests:

The key is to having a balance of carbohydrates, proteins, and healthy fats in your meals for sustained energy for your body and brain throughout the day. Having fruits and veggies will also provide antioxidants and fiber.

 Breakfasts:

- Eggs, veggies, avocado, and fruit - Saute some veggies like peppers, onions, or mushrooms with scrambled eggs. Top with avocado. Add a side of fruit. The protein, healthy fats, and fiber in the meal will create sustainable energy and keep you satisfied longer.

- Smoothies with protein and/or healthy fats. Having a smoothie with fruit, as well as protein and healthy fats is a great, easy and convenient breakfast or snack idea. Adding greens will also boost the fiber and antioxidant content. One of my favorites is banana, almond butter, handful of spinach, almond milk, and hemp seeds. Using ingredients like a nut butter, chia, hemp, or flaxseeds, a good quality protein powder, or unsweetened coconut products are great additions.

- Avocado on whole grain toast and a hardboiled egg. Smash avocado on 1-2 slices of toast, using the avocado as a spread.

 Lunches:

- Soup or chili. These are great to cook up a big batch for the week and bring in for lunches. Some of my favorites are sweet potato black bean chili or a butternut squash coconut soup (I like to top this with pumpkin seeds).

 - Salads. Having a big green salad with veggies, a protein like hardboiled eggs, chickpeas, chicken, or tofu, and a fat like a olive oil salad dressing or avocado. You could also top it with some raisins or nuts/seeds.

 - Mexican Bowls. Make a bowl with brown rice or quinoa, black beans, sauteed peppers and onions, avocado, and salsa. You can make a batch of these at the beginning of the week for lunches, and vary the veggies or protein you want to add. 

Snacks:

- Carrots/peppers or whole grain crackers + Hummus - I like Mary's Gone Crackers brand

- Hardboiled egg

- Piece of fruit

- Trail mix with nuts/seeds and dried fruit - Trader Joe's has bunch of them, or you can make your own. 

- Smoothie

- Energy Balls (homemade) - There are a bunch of recipes here, and these are great when you're in a rush for time to pack a few of these for the day and grab one in between patients. My favorite store-bought bars are Kind and Larabars as well.

The key really comes in preparing for the week by making food ahead of time to pack for lunches and snacks, as well as making time for breakfast in the morning. Then, it's about reminding yourself that taking time for lunch or a quick snack helps re-energize you, so you have the energy to give your best to patients throughout the day too.

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