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"

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'.