Who do you want to be for your patients

Part 2 - Three ways to lose teeth

Instructors:

Ms. Rachel Smith, RDH

Ms. Rachel Smith, RDH

Rachel Smith has been a peridontal therapist and passionate dental hygienist for over 20 years.  She currently works in Plano, TX with Dr. Marcus Whitmore. Rachel was one of the first hygienists in the state of TX to incorporate diode lasers in her practice.

Rachel discusses how patients can lose their teeth, how to effectively communicate that to patients as well as the

There's basically three ways that you can lose your teeth and I'm going to definitely give that back over to Dr. Mac Lee. He's an excellent, excellent dentist down in Edna, Texas and he has so made verbiage so easy for me and I encourage you, he can so help your team as a team make everything so simple. So there will be a link for him at the end of this presentation and I am going to go ahead and steal lots of stuff from him right now.

So the three ways that can lose teeth, one of those is a bad bite. So if you have a bad bite, you know, are you going to be able to identify that and be able to explain to your patients exactly what's going on with them? You know, I have some great visuals up here of the bad bite in the upper left corner certainly shows how that bad bite has contributed towards decay and you know, that kind of thing. Your key phrase is for someone who has a bad bite would be when you have a missing tooth, are like a table with only three legs, a bookends without books in the middle, and a collapsed bite is aging your face faster than it should. We use that a lot in our practice because we do some new face dentures, which basically adds bite or adds age, adds years back to someone's life once we open their bite. For actions, which are, those notches that are in the sides of your teeth are from excessive force and they're like a fencepost that's been repeatedly hit with your car. So when you explain that to a patient when they're like these notches have always been there, well that's great that they've always been there but let me explain to you why those things have happened. You know, because if you explain it to them, easily that it's like excessive force like a fencepost, you know, most people understand a fencepost that if you back your car up into that fencepost it will repeatedly that it would definitely pull it away from the ground.
Broken teeth are like a crack in the windshield and they ñ or a run in pantyhose. So basically if you have someone who's got a fractured tooth or broken teeth, let them understand that even though it's been broken for that amount of time, that it's going to continue. That once that crack gets down into the nerve center that we're looking at root canal, you know, so you're trying to prevent them from having more dentistry than they need to do. So understanding if they have a big risk from losing their teeth towards their bite then help them understand that. And then I would challenge you even if someone is 50, 60 whatever I challenge them to really think about orthodontically will they be willing to look at doing some invisline or some small braces or even you know, six months smiles anything like that, anything that's going to help them get their bite back to where it's supposed to be.

Where's your possible profit from this? Your possible profit from this is invisline cases there are 5000 or plus for your practice. If you have someone who's got a lot of TMJ pain or a lot of bite problems or a lot of broken down or really collapsed bite certainly introducing them to neuromuscular orthotics that will be a great profit center for you. Neuromuscular orthotics run anywhere from $3000 to $5000 and I would challenge your doctors to really get into this. This is a neurofacitive dentistry that really is opening up a lot of great solution for patients who do not have solutions and the past.

Then of course once you get them into a neuromuscular orthotic, open their bite, get them into a comfortable place then you've set yourself up for full mouth reconstruction which is more dollars for the doctor. This is where the hygienist can definitely get themselves into the whole practice so that you're not just looking on dollar profit for ourselves as far as periodontal therapy but also understand that once the whole practice is profitable, we will be profitable as well. You know, really entry level as far as bite breakdown is an NTI or an net guard. In our practice, we certainly know the benefits of really just opening the front part of the bite with an NTI, that's our practice philosophy but certainly even just some [0:16:19] [Indiscernible] guard that's where your practice is then that is a perfect way to understand the profit for that.

The second way people lose their teeth is certainly from cavities. We like to just make it simple. When a patient comes in there's three ways they lose their teeth, two of them are from infection, infection of cavities, infection of gum disease. The third way is how their teeth fit together. So we already talked about how teeth fit together, I want to talk a little bit about cavities right now and certainly that opens the door for us as hygienists as far as talking to someone about nutritional therapy or nutritional counseling. You know, if you have a little kid, a younger child who's got rampant decay that's a great opportunity to talk to mom who might be close to help her understand the rest of the family and how to get those the rest of the family under control as far as changing or stopping this whole cavity problem.

Key phrases for patients who are losing their teeth to cavities are root canals like a tree with the root system cut off, like a pencil with the lead out of it if someone needs a root canal, large fillings with the need for full coverage like seams in a bridge that expand and contract. Certainly we've all seen photographs of ugly old amalgams that are shrinking out of their original contact places and that's where the seams come in. Or like an eggshell of a teeth with a filling in it and we've certainly all seen teeth like that where there's just a little bit of shell over the enamel that's left over. Then again this works for cracks around weak teeth like a crack the windshield in the windshield. They don't go away. They just keep going.

Defective crowns are like a bald tire with a weak spot in it so all these ways are ways for you to just explain to a patient exactly what's going on with them. Certainly profit centers for cavities, I will really challenge all of you to really look at caries assessment by risk, okay. So and that's camera, that's certainly the American Dental Association has got some great pages on their website to kind of help you understand and help the patients understand their risk. Certainly xylitol products and if you're not familiar with xylitol, I will challenge you again please look into xylitol. It is really such an amazing sweetener. I explain to patients most patients who've gotten themselves into trouble with cavities have gotten themselves there because of their diet or because of their habits. So if they've got a lot of simple sugars in their diets, well then you know, let's go ahead and help them understand that they can still have the sweets that they want in their lives but they just need to plug it in with stride for five. If you've heard about that from xylitol that's really when we have five experiences of xylitol a day really dramatically reduced the risk of cavities in the mouth. The two great things about xylitol, xylitol binds up the bacteria that's acid releasing and also promotes salivary flow. So easy way to help patients and certainly, you know, a lot of these products are more widely found than they used to be years ago.

Easy fluoride therapy, patients who are getting fluoride therapy great. Introduce them to MI paste or amorphous calcium phosphate, more xylitol so don't think that if you get parents in there who are like do not want to do any fluoride because of the poison factor, I understand that and respect that from them as far as where they are as a family but they need to understand too that you know, the risk for cavities is still there due to our food sources. We talked a little bit about nutritional counseling. You know, nutritional counseling is key and taking that time and there are practices who charge for that. You know, if you want to have them go home with the a week's worth of would you please write down your diet and what you're doing and how many times you're eating and that kind of thing help them with their nutritional counseling. Medications that dry the mouth, all these things open up ways for us to really help our patients set themselves up for success. There's nothing more discouraging for a patient to have a full mouth or a lot of restorative dentistry done only to come back into the practice and all of it is failing again. I cannot tell you how many patients have come into my practice who have never been shown how to properly brush their teeth, floss their teeth or have even had any conversation whatsoever about what cause them to get to where they are. Really with cavities that's so easy, that's easy slam dunk for us. It's not that complicated. What is the trigger that's causing the cavities? What can we do to plug in to help them get out of that terrible spin that they are on right now? Definitely I didn't even bring this up. Certainly the carry free program with using the carry free meter that is a great real way for people to see what their real number is and what is their risk factor. Let's try and help to cure them because we know that bacterial infection of cavities is a bacterial infection and we can certainly stop the madness and get them to a better place.
The last way or the third way that people lose their teeth and that is gum disease. I love these pictures that I pulled up and if you are a hygienist, anything like me, you probably want to get in there right now and get all that stuff out of there. You know, even after 20-some years of being a dental hygienist, I still love to go and get all that stuff out of there. Okay.

So gum disease is certainly a multi-faceted, very complex way that people lose their teeth. We're so fortunate now right now in 2013 more so than I was in 1988. As far as our tools that we have, as far as understanding what exactly causes gum disease. One tool that I really appreciate having that might [0:21:52] [Indiscernible] is the floor to probe system, floor to probe system actually is a hands-free periodontal probing. Probably the two very important things for the patient is that it's audible, so they can listen along. What I tell them when I see them your normal healthy gum tissue should measure anywhere from one to three millimeters with no bleeding and no infection. As we go along, you can listen along and the floor to probe will let you know warning 4, warning 5.

One of the best things that the floor to probe system has is the word pus. Pus is a real thing and I don't think it should be sugar coated and patients really have great response to that because they don't want pus. So actually having someone else say those things out loud as we're measuring helps the patient identify that it's their disease, not my disease, not something I'm telling them about but something that's really real as we go along. I've just been amazed in the years that I've been using this system at how much patients really pay attention. They want to really see that their numbers get better and also their infection and their bleeding points go away.

So I'm going to go ahead and show you also the other thing when I've had patients in the practice, I've asked them you know, what are the things about hygienists you've seen over the years that maybe you haven't really enjoyed or things that you'd like to see changed? One common thing that I've heard from more than one patient is that a lot of hygienists tend to really probe deeply and hard like they tend to be heavy handed. One nice thing about the floor to probe system is it is a calibrated system that really you cannot push this probe too hard. So I also will tell you hygienists that have you know, just manual probing just be mindful about how hard you're probing.

So I'm going to show you some proper angulation here. So as we go in, I have a foot pedal below meÖ You can hear the audible in the background and as you can see I'm just gently in between there and always remember you know, when we were in school to stay parallel to the long axis of the tooth is very, very important. Now that second number we can also the a fast pass with floor to probe so that we can also measure any kind of recession that's going on.

Now I just went ahead and just said that believing in the pus down there just so that you can hear because I have a very healthy patient todayÖ
This patient also has an implant retained bridge here in the front. So this is an implant that I'm probing around and these the tips that are on here are this is actually the disposable one is a plastic so you're safe to probe around implants with this. So we did have a bleeding point there. You can see that your angulation with your probe is very important and when you're using the floor to probe system, that really helps you stay in the right position and also this is a very small probe so it's easy to use any place in the mouth.
If you use some key phrases for your folks, like a fencepost with loose dirt around it, I think that that's a good one. Because you know, we've got to get that dirt tied around that fencepost because that fence has got to stay tight in the ground. Another one is like a turtleneck sweater with a collar stretched out. If your mouth is infected, it's impossible for your immune system to perform at its peak. I really want you to hear that one and I really want you to use it because patients really get that. For a lot of times if you ask a patient, oh well you know, do your gums bleed when you brush them? Oh, not any more than usual, well what is usual? I would challenge you to say to them hey well if your hands bleed when you wash your hands, would you be concerned? I guarantee you 100% of them will say yes. So why is it okay for there to be pink in the sink? Why is it okay for them to have bleeding in the mouth? You really need to champion for these patients and really champion for yourself to really go for zero bleeding points, to let your patients know the bleeding in the mouth is not okay. Our gums are not designed to ever bleed. We now know that the role of oral bacteria contributes to heart disease, type 2 diabetes, risk of stroke and preterm labor, low birth weight. There also has been some new reports out there that really are linking oral bacteria to Alzheimer's. We know that we have such a huge problem with that. I mean I don't know if you've noticed this but how many memory care places are popping up all over the place? You know, Alzheimer's is such a huge problem in our society and I personally would like to champion our whole area to try and figure out a way to keep this risk down. Because I don't want to be a victim of that either.
You know, certainly we have been ñ you know, it's been told to us for many years even when we started into dental hygiene school, the possible profit centers for us is periodontal therapy and there again I'm going to say to you, be a champion of zero bleeding points. If someone is bleeding still, you really need to continue to treat that patient. If they have recurrence of gum disease, you need to let them know hey we have bleeding, we have disease going on here and we've got to get on top of that. You know, if you can't, if you're not having traditional healing from traditional therapy, then I would challenge you to also start doing some oral DNA, okay.
Oral DNA is perfect because they come up with a great menu for you to go through so that you can help your patients get healthy. So you know exactly which bacteria that you are facing so that you can better put them on systemic antibiotic while you do some biofilm reduction and then have them come back and do another oral DNA. That also helps them to own their disease.

I think a big problem a lot of us have in our practice is that we become addicted to our patient's approval. We want them to like us. We don't want to tell them anything bad. We don't want to do anything like that. So by letting them know and using the great terminology of like it's my job to let you know what I see and it's your job to decide what you want to do with that. That has been the most liberating phrase for me as a practitioner, as a dental hygienist is just to let those patients know, it is my job, you came to me as your professional to let you know what kind of health you're in. If you have gum disease, I want to be the one to help you get healthy. You know, I'm just letting you know what I see, it's your job to decide what you want to do with that.

Same thing goes with restorative dentistry. If you see teeth that need to be fixed, and you see you multiple teeth, and you're starting to feel bad because they have so many teeth that need to be taken care of I need you to let that go. You need to let the patient know say it's my job to let you know that all these things are going on and it's your job to decide what to do with that. We are here to support you no matter what. That will definitely help you in your practice.
Okay let me get back to what I was talking about. So our possible profit centers, oral DNA, laser bacterial reduction. Now as I tell my patients when I see them, it's my job to decide which risk factor you fall into. Are you going to lose your teeth fastest by your bite, by cavities or by gum disease? By doing that I'm going to tailor a complete treatment plan for you so that you can be most successful in getting healthy.

So my patients that have gum disease I'm going to tell them I would really like to use a laser to reduce all the bacteria in your mouth. This is going to reduce the level of bacteria for up to two weeks after you leave me and also it's going to reduce the amount of bacteria that's going to go back into your blood stream. Then for us as far as our working environment, it's going to reduce the amount of bacteria in the aerosol. Now if I have a patient who is a high risk for cavities, I'm going to recommend to them that they're going to have a fluoride treatment. Both of those things are not covered by insurance but we charge $30 per patient when those things happen.

Another profit center and a great product on the market is perioscience. I will encourage you to please look into that. There's links to all those things at the end of my presentation. Also probiotics, probiotics in the mouth are different than digestive probiotics. The probiotics that we introduce to the mouth actually are made for the mouth specifically. It's a lozenge that dissolves into the mouth. There's two big players there, one is Evora Pro, the other one is Butler Gum. They both have a ñ I have a great product that's just a lozenge that dissolves into the mouth, introduces more good bacteria so those patients who have dry mouth, those patients who have actually risk of cavities, two of the Evora probiotic bacteria actually fight gum disease. One actually fights cavities. So it's good for both ways. The other one is Perioprotect if you have someone you're really having a hard time with. We don't use Perioprotect in the practice but I know a lot of practices that do and are very, very successful with that. Also you know, you can place arestin locally or atrodox if you need to do a whole mouth. So those are all definite ways that you can ñ once you tailor and make it simple and figure out which category your patient falls into then you can tailor a treatment plan for them and also make it more profitable for you and for your practice.