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"

Please read this blog in chronological order starting at the bottom and working up....the blog directly below this is the least important blog to me..an after thought!

"The Hygienist Did the Cleaning Too Fast?"

  When you have been cleaning teeth for 44 years..all the bugs have been worked out! When a patient says to the Dentist or receptionist that the cleaning was too fast they are not complaining as much as they want validation that even though it took less time it was as good a cleaning as previous cleaning that took longer.  When  dentists take that statement as criticism and conveys that criticism  to the hygienist  things go downhill. First the dentist has verified to the patient he employs sub-par hygienists. The hygienist starts 'going through the motions'.  Hygienists are above average in intelligence and work ethic or they would never have been accepted to dental hygiene school.  I refuse spending my workday going through the motions, root planing teeth that don't need it and feeling like I'm not doing an adequate job just because I'm experienced and can do the job faster than a beginner.                              OR
    In my case I realize sometimes I am sloppy....I go though the motions and miss a place. I will deserve the criticism..which I realize is constructive...fine line.

My Favorite Things

Toothpicks..Stimudents, slim Stimudents(new product for small interproximals)  and Soft Picks by Butler
Manual toothbrushes...Jordan V soft(used to be Viadent TB), Lactona S-19 extra soft(great gumline brush), Colgate Slim Soft....great gumline brush!!!
End Tuft Brush...great for hard to get places esp. posterior lingual interproximals
Titan Sonic Cleaner(Blissonic)...so much better than a Cavitron.
Compressed air...I do all my gross scaling with the Titan..can't live without it!
Digital x-rays...very helpful with oral hygiene instruction
Floss...for decay prevention
Instrument...Gracey 17-18 curette great design

The Monkey on Your Back/Why you Want Out of Hygiene

 You were accepted to dental hygiene school because you had good grades, good work ethic and excelled in most things you tried...right!  I believe my experience is typical of most hygiene students. Spring quarter of my senior year I finished my prophy and got the clinic instructor to check my patient and I would be done. She checked my patient and told me I had missed some calculus on the mesial of 14.  I could not feel the calculus I missed so just scaled the whole mesial surface and had her check again.  The calculus was still there!  Again, I tried to find the calculus with my explorer...couldn't find it...scaled the mesial surface again....got my instructor again....yes it was gone!  I graduated that spring knowing I should do a perfect prophy every time...I had never done a perfect prophy....I didn't know how to find all the calculus...I now had one hour to do a prophy not the three hours I had in school....the dentist doing the exam was the instructor.  I believe many young hygienists  leave the profession within a couple years for this reason.  I had been practicing 10 years when I got a part-time job as a clinic instructor at a dental hygiene school. I was finding missed calculus when I did the exams....WHEN HAD I LEARNED TO FIND CALCULUS!  The last ten years when I was checking if I missed anything, I had learned to find calculus.  That's the year the monkey came off my back and I have since found profound pleasure in my work.  Every prophy you do is better then the one before.. every day you get better and better!  I'm 66 years old now and will work in my beloved and fascinating profession til I 'stick the fork in the wall'.

My First Epiphany

  Refer back to my blog 7/26 about oral hygiene education.  A middle aged woman came to me gum infection so bad that her gums were purple.  She was worried and the dentist in New York City had told her she had a Vit C deficiency.  I told I thought it was gum infection  and if she would brush her teeth in the rolling stroke and use floss her gums would get better.  There was improvement but not enough.  I was very discouraged and remember thinking that oral hygiene instruction was probably a waste of my time and I would just clean teeth.  BUT I had been taught that oral hygiene instruction was 50% of my job.  I talked to my sister who was in dental hygiene school at the time and she mentioned the new way to brush called the Bass Technique..... soft brush....45 degree angle to gumline. I also started asking new patients with healthy gums what they did for their oral hygiene....I still do this today.  I kept hearing toothpicks almost 100% of the time.  The New York lady came back for her 3 mo recall . and I had her start using Stimudents  and a Lactona S-19 along the gumline.......her gums became perfect.  I love oral hygiene instruction today.  We live in an anti-tooth
picking culture...floss is the socially acceptable  way to deal with interproximal  oral hygiene.  Shortly after I learned about toothpicks from my patients. I had an opportunity to talk to Don Rolfs DDS periodontist and researcher.  I asked him what he thought of Stimudents...he said "I don't know if I want to blow up the company or buy it...I get my patients to start using the Stimudents and within 6 months they can reduce 4,5,or 6 mm pockets back to 3 mm....anything deeper I have to do surgery"
  I have been a strong advocate of toothpicking since.  I could take a 1000 new patients and walk around the interproximal gingival sulcus and guess right 100% of the time.
-if generalized bleeding....they use nothing between their teeth
-if sporadic bleeding...some interproximals  bleed some don't...they are flossers                                       -if there is no bleeding...they are toothpickers

I like toothpicks that are flexible and conform to the shape of the interproximal space...Stimudents(J&J), Soft Picks(Butler). I wish J&J would made a toothpick out of Balsa wood so it would always be soft and flexible...Stimudents are made out of pine and there are hard and soft toothpicks in each package.  I tell my patients to throw the hard one away or use them for kindling.

Teamwork vs the Prima Donna

  I never ask an assistant to do something for me that I can do myself!  Being a dental assistant for 12 years before I became a dental hygienist taught me....the hardest working people in a dental office is the multi-tasked dental assistant. If I have a cancellation or extra time I try to help the assistant out..because there will be a time I have to ask them for help and I want a lot of karma in my bank!  Dental hygienists who are considered and disliked as PRIMA DONNAS fail to understand this concept.