Oral Hygiene for the Physically or Mentally Impaired Part II

  How to proceed
   You have had the patient's teeth cleaned and examined at the dental office. You will now disorganize the bacteria at the gumline once a day.
   The teeth are a four sided object and you want to clean all four sides.  The tooth brush will get two sides..the cheek and tongue side. The end tuft brush will clean the other two sides. You will moisten the brush as needed with the mouthwash.  Finish by having the patient rinse with the remaining mouthwash.
  1. Put on your gloves
  2. Have ready the toothbrush, end tuft brush and a cup of mouthwash.
  3. Place the patient in comfortable position for them and you ie laying on bed with head on pillow or in chair with a head rest.
  4. Picture the mouth having four rows you need to brush 1. Upper cheek and lip side
                                                                                              2. Upper tongue side
                                                                                              3. Lower cheek and lip side
                                                                                              4. Lower tongue side
      Do it methodically....know where you are going and where you have been. I go upper outside, upper inside, lower outside and lower inside. Just so you know where you are going and where you have been.
    5. The end tuft brush is to disturb the bacteria between the teeth.  Like with the tooth brush do this methodically. Stick the end tuft brush between the teeth and wiggle. Do this from the cheek side and the tongue side. For example...starting between the upper right last two teeth I stick the end tuft brush at a 45* angle and wiggle the end tuft brush.  I work my way around to the other side and come back around on the tongue side. I will repeat this procedure on the bottom arch.
   6. Have patient swish with the rest of the mouthwash.
Note: The tooth is a four sided object..when you brush the teeth you have cleaned 50%.... the end tuft brush(or floss, tooth pick etc) is the other 50%

Oral Hygiene for the Physically or Mentally Impaired...How to get ready to brush someone's elses teeth. Part I

   I'm going to start with some facts you need to know:
1. Bacteria(plaque, tartar, biofilm) form on the teeth constantly and becomes more tenacious and harder with age.
2. Most of the bacteria are harmless but in the mix is the bacteria that causes decay and gum disease.
3. The bad bacteria must work in the absence of oxygen..they are anaerobic.
4. It takes the anaerobic bacteria about 24 hours to get organized..they then begin to eat the sugar that comes into the mouth and poop acid.  The acid eats away at the gums and dissolves the tooth structure.
5. The gums fit the tooth like a turtleneck collar....if you disorganize the bacteria at the gumline you can prevent gum disease and decay along the gumline(the most susceptible place for decay in people with poor oral hygiene).
6. Tooth paste does not clean teeth..it's a mouth wash. It makes your mouth taste better and puts some fluoride on teeth. It also makes you salivate when it's in the mouth.
7.  The average person finds the mouth scarey...they describe it as dirty or repulsive. They can be, but not if you clean them every day.
8.  Fresh plaque or bacteria are are very easy to remove...like talcum powder on a washboard..you can't shake it off but you can just touch it and it comes off. Bacteria in the mouth just needs to be touched.
   What you want to accomplish:
1.  Once a day you want to disturb or aerate the organized bacteria all around the base of the teeth.
2.  Apply fluoride to teeth to prevent decay.
   How to start:
1. Start with a clean slate.  Take the patient to the dentist and have the hygienist clean their teeth, have the dentist do an exam.  Have the hygienist or dentist show you potential problem areas.  Don't worry....you are like a blind man at this point but your eyes will slowly start focusing.  It will take practice.
2. Tools to get: Toothbrush, end tuft brush, fluoride mouthwash and latex gloves for yourself.                                       a. A very soft tooth brush, preferably with spaces between the bristles. The best one out there is the Lactona S-19. I have found them on Drugstore.com and even on Ebay.  They are a tooth brush made in Holland.  The bristles are soft and the bristle ends have been rounded to prevent abrasion.  You can't hurt any one with this brush.
                          b. An end tuft brush.  This is a tooth brush with the back bristles missing.
                          c. Mouthwash for dry mouth like Biotene or Act for dry mouth. They don't use alcohol as a base...very mild.  You don't want the patient salivating and wanting to spit.

Professionalism and Honesty in the Dental Office

       As a hygienist it is not my place to diagnosis.  Over the years I have worked for many wonderful dentists.  They all have a different styles...some very conservative to very aggressive. There is that gray area...but if they treat their friends and family the same way I don't question their treatment.   I do not want to sit there knowing the dentist is not being forthright with the insurance company(easy to do) and eventually the patient.  The patients are the innocent ones that expect us to be professionals and honest with them.  When I sit there knowing that dishonesty is in progress.... I feel like the driver in the get away car!  That's the time to find another job!

Polishing-When and why

  It has been brought to my attention by a couple of hygienists that they polish before they start the cleaning!  Any patient with plaque will be polished before the gross scaling starts because it's gross to push plaque around and you need visibility. I finish the cleaning with a polish also for all the reasons we polish at the end of the cleaning.

Gag reflex and Dental X-rays

  People who gag while getting dental x-rays have a phobia about putting things in their mouth.  The gag reflex is a panic attack.  The tongue is like a bouncer at the bar door and will cause the gag reflex.  If you have a skiddish bouncer he will puff his chest out, ask no questions and block any suspect from entering through  the bar door!
  Phobias are unreasonable fears coming from the primitive(or reptilian) part of our brain. That's the fight or flight response...no reasoning just knee jerk reflex.
   I tell the patient they have a phobia or fear of things in their mouth...which comes from the primitive part of their brain ...and I touch the back of their head.  Then I put my hand on their forehead and tell them that's their pre-frontal cortex or human reasoning part of the brain.  The pre-frontal cortex can talk to the primitive part of the brain....tell it to relax and buy some time.  I show them with my finger where I will put the x-ray sensor(no surprises)...tell them I will go around the corner...punch a button ..they will hear a buzz..then they can do what ever they need to do with the sensor.
   I take full mouth x-rays every day and have no problems with my phobic patients.

Oral Hygiene for an Aging Population

 Now that the aging population are going into assisted living with their teeth, not dentures. I'm seeing adult children bring their parent into the office.  What you see is a person who took good care of their mouth all their life and now there is nothing happening...no brushing, flossing or tooth picking. The layman is intimidated with the idea of being in some one's mouth. There is a niche to be filled and a hygienist/dental assistant could make money and fill a need.  Example: I would enter into a contract with the adult child...for a fee I would,once a week,  brush the parent's teeth and gumline, use a end tuft brush between the teeth coming from the buccal and lingual, using mild flouride mouth wash instead of tooth paste which is messy, and finish with the parent rinsing with the mouthwash. I would communicate any complaints the parent had with the adult child about their mouth. I would put the brushes in a sterilizing pack with the parent's name to sterilize and reuse. It takes about two weeks after cleaning the mouth for the biofilm to reestablish its self. What if you had 15 patients at one rest home that you charged $40/mo. to brush their teeth once a week.....that's $600/ month for a half days work........just an IDEA if I ever retire from my day job!

How to Soften Calculus

   If you are working with old tenacious calculus...don't try to take it off in one appointment.  It builds in layers..think of an onion. The outer layer is the softest and the innermost layer is the most tenacious.  I get as much off as I can with a sonic cleaner. Basically I do a gross debridment throughout the mouth. Then I reschedule the patient in two or more weeks.  The outer layer of calculus will soften in those two weeks.  I repeat the process...most of the time three appointments will do it...one time it took me five appointments on a lady in her fifties who had never had a cleaning.  Refer to my blog "Calculus and it's Characteristics" and "First Time I See the Patient"