Simple Dental Implant Tips for the RDH
With dental implants becoming more common in our world, you’ll definitely come across one (or hundreds) in your office each week. Even though they are becoming more common placed within our patient base, that doesn’t mean they are the easiest thing to assess and treat in our clinical chair. And now, with full mouth reconstruction with implants and having full arches full of implants, we as dental hygienists need to feel confident treating and educating this patient population. Here are a few helpful tips to follow as you enter into the implant world.
The neck is a perfect circle, while natural teeth are not. Lucky for us, we can critically think through adaption and angulation when it comes to a different shape. When you come to these implants, make sure you’re adapting differently, and usually more than you would a normal tooth because of the shape.
Different instruments are needed. Implants are made of titanium, which is a softer metal than our stainless steel instruments. Using stainless steel can potentially scratch the implant, which allows more surface area on a once smooth surface and attracts bacteria and biofilm. And we all know, more biofilm is not good news. Let’s keep these implants as smooth as possible, and use implant specific instruments and air powder polishing units to keep them bacteria free.
Stay away from plastic instruments. Research shows that the plastic from these instruments or shielded implant ultrasonic tips is flaking off and staying around the implant, causing irritation in the tissue. It has also shown that some threads from floss has been getting caught around implants, which causes irritation as well. Better keep those very fibrous flosses, the ones that I personally really like for natural teeth, away from implants.
When it doubt, refer it out. Implants can be finicky. Every year, they are changing their designs, materials, how they’re placed, etc. If you’re concerned about a patient’s implant, if the gingiva is inflamed around it, if there’s an open contact between the implant crown and the natural teeth, you’ll want to jump on those before it gets too late. Refer the implant back to whoever placed it to have it assessed, fixed, the crown replaced, whatever is needed to keep it back in health. The last thing we want is us as professions watch an implant get infected or mobile.
Don’t forget to stage and grade each implant. With the “new” AAP classifications, there’s a section that includes periimplantitis , and how to classify each implant to make sure they’re staying in a healthy stage. Make sure you keep your eye out for a new and improved AAP cheat sheet to download and keep in your operatory to help stage and grade not only implant patients, but any patient.
Home care recommendations. One of the most important parts of implant maintenance? Great home care! Of course. Instead of traditional floss, recommend interproximal brushes to help work under the crown and to get around the abutment as much as possible. We like the Tepe Interproximal brushes as they can be custom fit to your patient’s gingiva and implants, and can easily be purchased online.
Do you see implants in your office? Does your dentist place them? What is your protocol when it comes to maintaining dental implants?
Extrinsic Stain Removal Tips and Tricks
Last week, I had a patient come into my operatory and before sitting down in the patient chair, turned around and looked me in the eyes. She said “I’ve noticed a bit of black stain on my teeth that I’ve never had off before. I’m excited to have it all off and them looking white again.” I instantly froze. Where did this black stain come from? How bad was it? How tenacious was it? Would I be able to get it off in the short time frame I had during the appointment with the instruments I had? Would the patient be happy with the results with her high expectations? It instantly brought back memories of when I was a brand new dental hygienist and I had an extremely difficult, heavy stain patient and I was definitely in over my head. I did as much as I could in the hour appointment, then sent the patient on his way. 6 months later, he came back and was in my chair. He must not have remembered me, because after this second appointment was completed, he immediately stood up to check out his teeth in the mirror hanging in the corner of the operatory. After a few seconds of an up close look, he turned around and said “this was much better than last time.” I was sweating that entire appointment.
My patient last week laid down in the chair, put in her AirPods, and was ready to have the stain removed. It was definitely a tricky case with 6 months of home brewed raspberry kombucha stain, but I felt more comfortable than I did so many years ago. Here are a few helpful tips I’ve learned throughout the year with stain removal.
Triple Bend Ultrasonic Insert. Stain is above the gingival margin, on the lingual, and usually on enamel. Since it’s on this harder surface, don’t be shy to use a triple bend tip with a high power. If the stain is on the dentin, keep your power a bit lower as the high power can make the tooth pretty sensitive after treatment.
Air Powder Polishing. Of course, this is the gold standard when it comes to removing stains. We love using the air powder polisher as it’s a gentle and quick way for removal, but with the newer guidelines of reducing aerosol production in operatories, we haven’t been using it as much. Hopefully, we can go back to using it more regularly soon! Another big part of using the APP is management of the powder. Check out this video to help keep powder out of your patient’s face, eyes, and nose, and make the procedure a bit more comfortable for both you and your patient.
Vera Advanced Bright Prophy Paste. Have you found that sometimes prophy paste works great on one patient, and then doesn’t budge the stain with the next? It’s so hard to gauge if prophy paste will actually be an effective treatment option. The best one we’ve used is the Vera Advanced Bright. The active ingredient is baking soda, which when combined with water, other minerals, and the small amount of abrasiveness tends to work a bit better on stain. I keep a box in my op, and pull them out on patients with stain instead of using them on everyone. Regularly I’ll polish first with this paste to see how much or how little stain will be removed, and then move onto a different treatment based on how much stain is left over.
Recommend 3 month recalls instead of every 6. I tell my patients that come in for appointments with heavy stain and they know where it’s coming from, like from diet, to come in more regularly. They don’t have to have an exam and radiographs at that appointment, but use it as an in between cosmetic prophy to keep the stain at bay. Do you do Zoom whitening at your office? You could totally add that one and complete both treatments at that 1 appointment to remove the stain and whiten up the teeth in general.
Even though this heavy stained patient threw me a bit off last week, I definitely know it isn’t the last patient I’ll have with this same situation.
What do you use for stain removal with your patients?
Aerosol Suppression with Aerosol Assist
Aerosols, aerosols, aerosols. It has been the buzz word for the last two years in dentistry as everyone has been looking for solutions to suppression of those microbe containing aerosols. One company created a product called The Aersosol Assist as a solution to the problem. It has many features including:
Aersosol Reduction with a 35mm wide opening to the HVE
Autoclavable and easy to clean
Backflow prevention
One size fits all.
Watch our latest short video below to see it in action and visit https://www.aerosolassist.com/for more information on ordering.
Hygiene Edge's Favorite Things 2021
Anyone else having a year? It’s been a bit crazy both in the operatory and out with life, patients, etc. Being a dental hygienist doesn’t only happen from 8-5 in your office. Dental hygiene is definitely a full life career. We think about, take, and organize CE credits, we help keep our profession growing, we plan and focus on nutrition to keep our bodies going, we stretch and exercise to keep our body working to serve patients, we’re helping and teaching our families, we volunteer in our communities, and so much more. Dental Hygienists are one of the most amazing groups of people, and we’re so lucky to work with, hang out with, and associate with you each day! Let’s celebrate by chatting about some of our favorite products this year that made our lives easier.
CE Zoom YTP Membership- Looking for an easy way to find CE classes and then track your credits after? Look no further than CE Zoom! This is a handy way to have access to world renown speakers and get all your credits for renewal in your state. Plus, we speak with them every quarter, so hopefully you’ll be able to attend one of the upcoming classes we present!
ADHA Membership- Honestly, one of the best things we’ve done for our careers is being a member of the American Dental Hygienists’ Association. We’ve met so many amazing dental hygienists through the association, grown in different leadership positions, been involved in legislative processes and helped change our profession right here in our home state and in the USA. We totally know no organization is perfect (heck- we’re people and many are volunteering their time to keep it running!), but being together in an organized and collective group makes such a difference, especially in a legislative and government setting.
Stoggles- If you haven’t seen these safety glasses, you need to get yourself a pair. We ordered some when they were on Kickstarter and saw it as an answer to our safety goggle prayers that don’t scratch easily, don’t fog, and weren’t purchased at a Home Depot. They come in several colors and shapes to fit your face, and we love having them for when we don’t need loupes, like during radiographs, giving injections, etc. They’re comfortable, look great, and are light on your face.
G2G Protein Bars- We have these all over the place- at our house, school, office. They’re local to us in Utah, and taste great. They’re perfect for a quick lunch (because we all know we miss them on busy days), they aren’t dry, and are kept in the fridge so they’re definitely more fresh than a shelf stable bar. Plus the different flavors can’t be beat.
Zirc Mirrors- We’re going to be honest, we didn’t think much about our mirrors until we started using Zirc Mirrors. Once you get them in your hands and compare them to your current mirror, you’ll totally see the difference in how bright the teeth look, how light the mirrors are, and how much more clear they are. Just like any mirror, they can get scratched, so you’ll want to keep them in a cassette to prevent wear during sterilization.
Oral B iO- We’ve been using this brush for over a year and have really loved all the technology changes in this brush. It is so much quieter than other Oral B electric brushes, the pressure sensor on the handle is life changing, and the timer screen right on the handle is very handy to keep an eye on the length of how long you or your patient is brushing. Definitely reach out to your Oral B Rep to give you a bit more information about this brush, and it’s time to make the switch if you’re still using the Genius.
These have been a few of our favorite things this year! What would be on your list that has made your hygiene life a bit easier?
Make sure you attend our Instagram Live Event on Monday, December 6th! We’ll be talking about these favorite things, and giving them all away to our friends!
5 Helpful Tips to Make the Ultrasonic Use Comfortable for You and the Patient
This last 18 months has been a whirlwind, right? From closing offices to preventative treatments, to patients delaying treatments for over a year, to people’s home care routines completely changing due to their life routines changing. With all these changes, have you noticed your patients are presenting with much more inflammation, calculus, and stain? You may or may not be using the ultrasonic now, but I’m sure you have plenty of patients that could benefit from using it. If you have decided to use it on occasion for these overdue patients, here are a few helpful tips to make it a bit more comfortable for both the patient and for you.
1. Instrument Selection
There are several different design characteristics of an ultrasonic insert that can affect the use of the instrument. First off, the diameter, when you’re working on cementum and there aren't large deposits, the thinnest tip will be the best and most comfortable for your patient. A thick tip on biofilm removal will cause tooth sensitivity due to how much power the instrument is putting out and putting into the tooth surface. It will also help preserve the tooth surface but not using a higher power that minimal calculus doesn’t need. Once you’ve removed the moderate to heavy calculus with the thicker ultrasonic insert, switch tips to something thinner to get the fine calculus, biofilm and diseased epithelium removed.
Second, the cross section. Use a circle cross section instead of a diamond if there isn’t heavy calculus. When there’s a diamond shape, all the power goes into the corners of the shape, and transfers the power to the tooth and calculus. Use the diamond cross section tips on heavy deposits and not straight on the tooth.
2. Check out the tip for wear.
If your tip is 50% worn down, they need to be replaced. At that point, they’re no longer effective to remove anything. You’ll find soon that you’ll have to instrument the teeth longer or find yourself putting more pressure with the ultrasonic, which can in turn make the teeth sensitive.
3. Manage their expectations.
Before the procedure even begins, let the patient know what they’ll expect, especially if it is the first time they’ve experienced the ultrasonic. Let them know about the water, suction, pressure they could feel, etc. Let them know that if there is any pain, have them give feedback right away.
4. Don’t shy away from topical anesthesia.
There are lots of great options on the market today, and they’re easy and quick to apply. It’s a great option for localized inflammation and sensitivity in the gingiva. If the teeth or roots are sensitive, you’ll want to explore other options for local anesthesia. Get feedback from your patient to see how to proceed.
5. Visit Curved Tips.
Left and right ultrasonic tips are great for deeper pockets. They curve and hug the tooth anatomy, which can be more comfortable for the patient. We’ll have some videos coming up about these tips, how to use them, where to use them, and how they can be more comfortable for your patient and more ergonomic for you.
Next time you have a patient that you need to use the ultrasonic on, make sure you manage the appointment and their pain by reviewing these simple steps. You got this!
Dental Fads That Need to Go
We all know that fads come and go in our lives. Doc Martins? Scrunchies? Certain clothing items? We’ve all them and loved them, the dropped them so fast. Dentistry is no difference. We are constantly having new “findings” and “research” presented from social media, and patients will be asking about them in your operatory. We’ll break down a few current dental trends that your patients may have tried or will be asking you about.
DIY Braces
There are several ways that patients can perform an at home orthodontic treatment. One way is wrapping an elastic, string, or piece of floss around their two anterior teeth, 8 and 9, if they have a diastema. There are so many YouTube videos on this method. And it can work for a bit! The teeth will move, but will probably move back because there’s a space there for a reason. There’s also a high chance of bacteria being caught around the at home aid, causing inflection in the gingiva and bone. Another way is to make your own Invisalign trays with plastic from the craft store. You warm up the plastic beads, make a U shaped that’s a similar size to your teeth, and bite into the plastic when it’s not super hot. Then, before it fully sets, you’ll remove the tray and adjust the teeth that you want to move. And this works too! Not recommended however, because the plastic isn’t medical grade and probably it’s smart to be putting into your mouth during the day or night and constantly sucking on it.
Tooth Filing
You may have seen this on Tik Tok, but you can use a nile file to shape your teeth. Have 8 and 9 that are slightly different lengths? You can use a nail file from the drug store to make them shorter. Nail files and the files we use in the dental office are very similar (we usually use a smaller/less course grit however), and you can totally removal enamel with them. But, definitely not recommended since removal of the hard outer shell of the tooth makes it susceptible to sensitivity, decay, pain and more. Make sure you’re keeping an eye on the insial edges of your patients that are on social media (aka everyone). You never know who will be removing tooth structure for a quick cosmetic fix.
Tooth Gems
These have come and go over time, especially as celebraties like to try out new jewelry for the red carpet. These metal, diamond, or jeweled gems can be purchased anywhere (we actually bought ourselves a few different ones to try from Ali Express), and come with etch and bond to adhere it to the tooth. This definitely can be damaging to the tooth, since a patient with no real dental knowledge can be placing these. We’ve even seen some hair and nail salons adversing this service of them adhering a small decal to an anterior tooth.
What dental trends have you been seeing and what ones have your patients been asking out?
If Dental Hygiene Was Easy...
I have been thinking a lot about dental hygiene, our careers, our patience, our bodies and our families all at once this last little bit. These last 18 months have been so hard on everyone, especially people in healthcare or in a customer facing career. We are working every day on patients that are the entire a range of emotions every single hour- from excited to fearful. Anything else, this year also started to divide not only us is clinicians from patients, but now we’re on a divided front when it comes to ourselves. We have found that each clinician thinks differently, reacts differently, and has difference of opinions when it comes to important decisions that the last year and last few months have come to the surface.
I totally understand the importance of having our own thoughts and opinions and working out what’s best for ourselves and our families. What I am not understanding is the tearing each other down because of these differences of thoughts. We have worked so hard for our degrees, we have worked so hard to help our patients with their health. We have worked so hard to keep our profession growing in the healthcare space and to be seen as a whole healthcare providers. And really, the only way to do that is to keep combined, keep working together and keep supporting each other.
Let’s be kind and open, and help each other feel supported and cared for in our profession. We’re in this together.
Ideas to Get Dental Hygiene Patients in School
September means back to school, which means back to patients for many dental hygiene students. Finding patients and managing your schedule is one of the trickiest parts of hygiene school, since patient care is so important for your degree, but has so many wild cards involved.
Recently, a dental hygiene student asked us online how to find patients, and we put a call out to our community for some advice. And you delivered. Here are some of the ideas:
“Call homeless shelters. Recruit in low income communities as a group.”
“I used a lot of family. In my program, we had patients on State insurance sent over.”
“Make a posting at the unemployment office!”
“Ads at churches, homeless shelters, coffee shops, anything with a bulletin board.”
“Have trusted friends/family/acquaintances ready to come in as back up patients.”
“Ask people their schedules, and if they’d be open to coming in last minute. Some people have schedules where they always have, say, Tuesday morning off, and would be free to come in then.”
“Find retired people! We reached out to a couple retirement homes etc”
“See if your program will offer free/reduced fees to veterans in November. Post fliers about it.”
“I would make small talk everywhere I went- grocery stores, banks, restaurant.”
“I asked family and friends. And ask them to ask their friends too.”
“Local Facebook Groups! Life saver”
“Ask patients that you do have if they have any family or friends who would like to come in too."
“Make business cards and hand them out to places who don’t offer dental insurance.”
“Next Door app, Facebook posts, and their community help pages”
“Post on a local Facebook yard sale page or something similar”
“Facebook Marketplace! Many don’t know how cheap it is for those without insurance”
“FB groups, small business groups. Owners and staff are often uninsured and have flexible schedules.”
“Ads on Facebook and Craigslist”
“Family and friends, then after 6 months they came in again”
“Join an intramural sport, club or group of some time and make some friends!”
“Beg at the library. I’ve heard girls having Tinder/Bumble strictly for patients too!”
“I would make posts on Facebook. That worked really well.”
“Made business cards and handed them out to people I met just about anywhere.”
“Call previous patients from past years. Spend a lot of time in the front office doing recall.”
“Make sure to call and confirm a few days before, then you know it’s on them and not on you.”
“I had a classmate use a dating add. It worked well for her!”
“Hehe! Going clubbing and getting patients there! Before Covid of course.”
“Facebook Yard Sale Pages SAVED ME!”
“Go to the library/entertainment part at school and ask!”
“The Next Door App!”
“I walked around campus and asked other students! But it wasn’t easy”
“Family and friends you can trust! And pay them to show up”
“I did a Kijiji ad. It actually worked- no weirdos”
“Explain that your grade and degree relies on them showing up and being there.”
“Walk around the school and look for people hanging out.”
“I also got close with upperclassmen and took on their patients when they graduated.”
“Made a Google number and posted online. Craigslist, etc…”
“KSL, Facebook pages. It gets deleted but it gets out there they notice.”
“Look at surrounding towns. Other than people I know, that is where I found most of my patients”
“I paid them”
“Walked about my neighborhood with cards. Made posts online. It was way out of my comfort zone.”
“Being persistent and constantly reminding everyone that they made a commitment.”
“I literally negged my heavy SRP patient to come in every time I had a cancellation. He was the real MVP”
“Posted it on Offer Up to get local people and keep track of all my patients in details”
How did you end up finding your patients in dental hygiene school? Let us know to help others!
FAQs from Dental Hygienists
Recently, we asked on our Hygiene Edge Instagram page about any questions that dental hygienists or dental hygiene students have right now for us. And we had some of the best questions! Since they only last a day, we wanted to talk about them here, just in case other RDHs have a similar question pop up in their practice.
Q: About to start my last year of dental hygiene school! Any advice? Studying? Boards?
A: Start looking for a clinical boards patient right now! Is it ethical to make them wait until the spring to have treatment? Probably not. But now is the perfect time to get looking for one if you’re doing live patient this year. Don’t shy away from a boards prep course. They definitely help narrow down what you need to study and prepare for.
Q: New Grad! What are some helpful tips to manage a full schedule?
A: Look through the day at the beginning of the day to see what radiographs each patients need. Don’t spend time taking them if they aren’t due! If you’re feeling super overwhelmed and they have a full healthy perio chart within the last 6 months, spot probe today and record a full chart at the next appointment. Let the dentist know you’re ready for an exam right after taking radiographs. Then, you’re not waiting for 10-30 minutes after finishing for them to come, putting you more behind then we like to be.
Q: Tips for test anxiety? I failed boards and am retaking it soon!
A: While you’re taking the test, take a break, take a breathe, and then go back and focus on the question. It’s ok to spend a second a regroup before moving onto the next question. Make sure you surround yourself with people who love and support you no matter what. And just remeber- you can totally do this!
Q: What inspired you three to form your company? We really wanted great content for our students! There wasn’t anything available to teach and connect our students with easy to understand ways to instrument or to do injections. And it just grew from there! We definitely know there was/still is a need for great, helpful tips and tricks in dentistry to make our lives easier.