Preventive Care

How do you floss under a retainer?

March 14, 2016 By Trish Walraven 17 Comments

It used to be such a dread, seeing patients with fixed lingual retainers. I mean, they’re great because they keep your teeth from shifting after you’ve had braces, but GAWRSH, do they have to be so difficult to floss around?

Not any more.

Thanks to the talented hygienists over at Hygiene Edge we now can share this super-easy secret with patients as well!

Here’s how you do it:

It’s embarrassing to say this, but it took me over 20 years as a dental hygienist to find out about this trick, so now I’m thrilled to see lingual retainers on patients because it gives me a chance to share this newfound secret. That’s why I’m sharing it here, too. And as for you poor folks whose retainers are glued to each and every front tooth? I’m sorry, this trick doesn’t work. You’ll just have to stick it to ’em instead:

Remember, it’s all about friction. Whatever gets in there is good by me.

A blogger since 1997, Trish Walraven, RDH, BSDH is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. Her mission with DentalBuzz is to offer a fresh podium of discourse for those involved in dentistry and to expose fun in our professional lives.

Candy that really fights cavities

February 18, 2016 By Trish Walraven 13 Comments

Why do you get cavities? It’s not because your teeth are soft. Cavities happen in mouths where the environment is all jacked up. Too much acid, too many germs, an abundance of refined foods, too little saliva. Basically the little ecosystem in your mouth is out of whack.

How do you get it back in balance? You already know some things you can do: eat better, brush and floss better, drink water. Sometimes, though that’s not enough. What do you do between meals? Between brushing?

You change the mouth itself by changing what can grow in there.

One way is with licorice:

No, that doesn’t count, sorry. It has to be real, tar-black, sugarless licorice. Real licorice contains licorice extract (unfortunately, that’s the stuff that makes it taste way worse than Red Vines). The way that licorice fights cavities is by changing the mouth environment so that the germs that cause cavities are inhibited.

These are licorice roots:

Licorice roots have been around ever since the original hunters and gatherers realized they were sweet-ish, quenched thirst, and tasted much better than most of the other twigs and sticks they used to dig around in their gums and teeth. Maybe they realized their teeth hurt less when they chewed on them, too. Licorice roots contain a compound called glycyrrhizin, which has been proven to reduce tooth decay. They’re cheap, natural, and abundant; you can even buy them here at this link on Amazon.com. But a word of caution: glycyrrhizin can be dangerous in excess amounts. Since licorice root is considered a natural herb, there’s no way for the FDA to regulate the dosage, and too much of it can cause heart arrhythmias, increase blood pressure, and reduce potassium levels.

If your response to black licorice and licorice roots are No, and Hell No, respectively, then how in the heck do you think you’re going to get kids to put licorice extract in their mouths?

Enter capitalism at its finest, folks.

When this company contacted me about a year ago, I was excited to ~~eat free candy~~ write a product review about something that may really help my patients prevent cavities. Remember what I was saying about licorice? Cavibloc™ is the proprietary formulation of licorice extract used in Loloz™ that you can read on their ingredient list here:

How this works

I’ve seen enough studies and listened to tons of lectures from smart people who know what they’re talking about to be convinced that the science is very strong behind using licorice extract in this way to prevent dental cavities. Here’s the biggest problem about it, though: it doesn’t work if you don’t use it, duh. Follow the steps below to get started on this great cavity prevention regimen:

1. Overcome your objections. Just so you know, I’ve eaten practically a whole box of the berry flavored pops, given them to my kids and friends of my kids, and they taste good. Really good. No problem on the flavor at all. Also, it will cost about $90/year for three boxes. Those are the big obstacles. Everything after this is easy.

2. Buy your boxes at Amazon.com. Lookie, it even comes with Amazon Prime! Here are your flavor choices (and by the way, these are NOT affiliate links – I’m not making any money off of this, just in case you doubt my sincerity):

Loloz Berry Lollipops

Loloz Orange Lollipops

Loloz Lemon Lollipops

For people who aren’t into the whole “stick hanging out of your mouth” thing, there are candy lozenges, too:

Loloz Berry Candy

Loloz Orange Candy

Loloz Lemon Candy

3. Open up your box when it arrives.

You’ll get 20 suckers per box… but maybe they’ll throw in a few for a bonus, with a note to let you know they didn’t count wrong. Maybe eat one of the extra ones as soon as you get them, to make sure you’re going to like them. Then…

4. Put them in the car. What? Following the recommended regimen is the most important part. It takes about 10 days of consecutive exposure time for licorice extract to disrupt the germs that cause cavities. And not just once per day. Two times per day for ten days. You’ll want to have one sucker in the morning, one in the evening. But how do you remember to have two per day? You and your kids (if you take them to school and/or work) are in your car at least twice per day. Maybe you don’t actually leave the lollipops in the car because they may get icky gooey on hot days. But you know what I mean. Discipline yourself to make sure you’re using them two times per day.

5. Repeat in 4 months. You’ll do this about three times per year for excellent cavity control, plus you get to feel good about eating candy. Whee! Over time, the bad bacteria will start creeping back in, but starting up another 10-day treatment in 3 to 4 months will help balance out the mouth environment once again. People who get cavities easily need licorice root extract. It’s just that simple. If you’ve ever been given a prescription for high fluoride toothpaste, Loloz are for you.

So you may be asking yourself, why no one else is talking about this, why there might not be a lot of Amazon reviews on Loloz, it must not be any good, right? No, that’s not it. The company made a big push a year ago to get the word out, but marketing these days is a tricky thing for new companies. I am confident that the product is spot-on, and I’m here to reinforce again to you that balancing your mouth environment is one of the most important things you can do to prevent cavities. There are other ways to reduce tooth decay, but right now Loloz are your best bet for obtaining a proven, long-term, dose-controlled antimicrobial effect against decay-causing bacteria. And if you’re a dentist or hygienist who is thinking about recommending this to your patients, remember:

COMPLIANCE IS EVERYTHING!

…She says, with a delicious, sugar-free Loloz lollipop in her mouth.

Trish Walraven RDH, BSDH is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. She has a very, very bad sweet tooth and doesn’t take money from companies like Loloz because she’s afraid they would give her a lifetime supply of sugarless candy which would be no fun because, hey, if it’s good for you, the days of living dangerously from sugar highs just go phhhht. gone.

Resources and References:

International Journal of Pharma and Bio Sciences, January 2015. “Assessing the effectiveness of liquorice root extract lollopop in reducing the S. mutans count in saliva in children aged 6-12 yrs – a pilot study.” http://www.ijpbs.net/cms/php/upload/4020_pdf.pdf

European Academy of Pediatric Dentistry, December 2010. “Clinical reduction of S. mutans in pre-school children using a novel liquorice root extract lollipop: a pilot study.” http://www.ncbi.nlm.nih.gov/pubmed/21108917

Medscape, January 2012. “Licorice Root May Cut Cavities, Gum Disease.” http://www.medscape.com/viewarticle/756532

John C. Comisi, DDS, MAGD, April 2013. “Employing a whole-patient approach to the lifelong struggle of caries management.” http://www.dentalaegis.com/id/2013/04/oral-disease-the-battle-for-balance

British Dental Journal, December 2009. “Liquorice Alert.” http://www.nature.com/bdj/journal/v207/n11/full/sj.bdj.2009.1090.html

A hygienist’s answer to “what do you do?”

March 11, 2015 By DentalBuzz Staff 8 Comments

If you read Dentaltown Magazine, you may have received the edited, paper version of this article today in your snail mail box. But because I don’t have to make room for saliva ejector advertisements in the sidebar (seriously, this article helps sell SALIVA EJECTORS!) you can enjoy the original here in its more raw form.

A hygienist’s answer to “What do you do?”

by Trish Walraven RDH, BS

You’re at a gathering of acquaintances, a general hob-nobbery of casual conversing, one of those social obligations that you love/hate because you’re really more of an outgoing introvert, someone who plays well with others but enjoys their quiet, navel-gazing world too. Sooner or later you know that the question will be asked.

“So, what do you do?”

No hesitation here. You know what your profession is. You have a title, a position, a calling.

Then that inner part of your thinking begins to twitch.

You weren’t asked about your job title, actually. You were asked a direct question: What do you do?

The typical reaction of hearing that you’re a dentist or hygienist involves a full disregard of the art and compassion that you put into your profession. People want to tell you about their bad experiences as a child, or how much they hate you (but don’t take it personally!). They just nod, warily, quietly, at your response and quickly think of a way to change the subject.

Instead of giving away the conversation and letting it slide into other people’s thought bubbles, then, you can steer the dialogue back to the original question, and the feel-good answer you’ve prepared instead.

“I take care of people’s teeth.”

You’re a regular Mother Theresa now, aren’t you? The way you dedicate your life’s work to helping others, it’s so freaking noble. This response elicits a smile of comfort and familiarity from your obligatory small-talk partner. The conversation can move forward now that your profession has been deemed socially acceptable.

An hour later, driving home, you’re blissfully alone with your thoughts, rewinding your earlier social interactivity, musing over the highlights, and you really, deeply, ask yourself in hindsight, “what do I do?”

I can’t speak for dentists, but if you’re a dental hygienist, you do some pretty strange things, actually.

First of all, perfection to you is wave-shaped. It’s the curve of a thin scallop of attached pinkness that anoints each interproximal space with a coral-tipped point of the healthiest gingiva imaginable. Anything less than this in your patients’ mouths is limbo. Chaos is the reason your job exists, but you always hunger for order and balance. To achieve this imagined perfection in a mouth that is not optimal, then, means that you often resort to some diversions along the way. It’s about the journey, not the destination, right?

How do you handle the patient whose lower anterior linguals are piled with a couple of grams of Grade A calcium phosphate? Sure, you could just chunk the calculus off. But sometimes, when you’re feeling a little dastardly, you carve out the top and the bottom of the tartar evenly, so that you’ve left a neat chalky white mustache, complete with curlicues. With artistic satisfaction, you turn your attention back to your duty and politely erase the Banksy-esque dental graffiti from your patient’s teeth.

This is not something you tell people that you do.

You also tell no one that your deepest fear is running into anything artificial while you’re cleaning someone’s teeth. Your ultrasonic scaler turns into a fierce lead pencil in those situations, which means not only that you are wearing down your precious metal antennae into useless nubs, but also that you’re leaving dark lines where there was once only whiteness. Every last bit of old orthodontic cement has now been revealed like a charcoal rubbing, thanks to you. And you would never admit to leaving a grey streak on a brand new porcelain crown. How could you slip like that? You hope like heck that the prophy paste will get that scary line off before anyone notices.

When it comes to things that you enjoy, then, there’s a bit of hesitation about sharing those stories as well. Like hovering around the periapical abcess that’s begging to be relieved? Or when you’re spraying baking soda slurry under a bridge and the patient becomes aware that its odor speaks more than the thousand words that you could ever say about superfloss? To you the stink is like scoring a point. Or why your trophy at the end of a particularly difficult appointment is a 2×2 gauze loaded with something that looks like buckshot, but is really your patient’s carefully extracted calculus? Fun times.

Probably the most difficult part of your career, though, has to do with patient management. Unless you’re regularly disengaging people from their mouths via nitrous oxide, there are forceful tongues, and lip pulls, and saliva ropes, and people who forget that it’s safe to swallow their own spit. Suck. Suck. Suck. Ten times a minute. At least this way they’re remembering to breathe. When they forget to breathe they feel like they are drowning. It’s not the water; they’re just suffocating because you’re blocking any chance of mouth breathing. Never mind that noses are much more optimal for breathing but whatever. Not everyone has learned how to snorkel either. And how do you convince patients that unless they just ate a handful of almonds, brushing immediately before their dental appointment won’t make your task any easier?

Then there are the patients themselves. Not just their mouths, but the whole person. Patients whose embarrassment about their teeth are the reason they haven’t been to a dentist in a while. People who not only open their mouths but open up to you, tell you their secrets, their fears, their wishes and hopes. People who trust you to take care of them, to love them, to nurture them towards health. They see something special in your eyes, and they open wide.

So go ahead and make it known out there in the big world that you’re hygienist. Or a dentist. You scale teeth. You drill teeth. No biggie. That’s what you do.

What really matters, though, are the reasons why.

Trish Walraven RDH, BSDH is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. She is a bit of an an introvert when she’s writing dental articles, but you get her together with her best friend from high school and Irish festival beer and she begins to make faces like this. She also makes faces like this under her mask if her patients aren’t paying attention to her flossing instructions.

Toothpaste can do more harm than good

December 30, 2014 By Trish Walraven 67 Comments

The next time a patient innocently asks me, “What’s the best toothpaste to use?” I’m going to unleash a whole Chunky Soup can of “You Want The Truth? You CAN’T HANDLE THE TRUTH!!!” Gosh, that’s such an overused movie quote. Sorry about that, but still.

If you’re a dental professional, isn’t this the most annoying question you get, day after day? Do you even care which toothpaste your patients use?

No. You don’t. Asking a dentist what toothpaste to use is like asking your physician which bar of soap or body scrub you should use to clean your skin. Your dentist and dental hygienist have never seen a tube of toothpaste that singlehandedly improves the health of all patients in their practice, and the reason is simple:

Toothpaste is a cosmetic.

We brush our teeth so that out mouths no longer taste like… mouth. Mouth tastes gross, right? It tastes like putrefied skin. It tastes like tongue cheese. It tastes like Cream of Barf.

On the other hand, toothpaste has been exquisitely designed to bring you a brisk rush of York Peppermint Patty, or Triple Cinnamon Heaven, or whatever flavor that drives those tubes off of the shelves in the confusing dental aisle of your local supermarket or drugstore.

Toothpaste definitely tastes better than Cream of Barf. And that’s why you use it. Not because it’s good for you. You use toothpaste because it tastes good, and because it makes you accept your mouth as part of your face again.

From a marketing perspective, all of the other things that are in your toothpaste are in there to give it additional perceived value. So let’s deconstruct these ingredients, shall we?

1. Fluoride.

This was probably the first additive to toothpaste that brought it under the jurisdiction of the Food & Drug Administration and made toothpaste part drug, part cosmetic. Over time, a fluoride toothpaste can improve the strength of teeth, but the fluoride itself does nothing to make teeth cleaner. Some people are scared of fluoride so they don’t use it. Their choice. Professionally speaking, I know that the benefits of a fluoride additive far outweigh the risks.

2. Foam.

Sodium Lauryl Sulfate is soap. Soap has a creamy, thick texture that American tongues especially like and equate to the feeling of cleanliness. There’s not enough surfactant, though, in toothpaste foam to break up the goo that grows on your teeth. If these bubbles scrubbed, you’d better believe that they would also scrub your delicate gum tissues into a bloody pulp.

3. Abrasive particles.

Most toothpastes use hydrated silica as the grit that polishes teeth. You’re probably most familiar with it as the clear beady stuff in the “Do Not Eat” packets. Depending on the size and shape of the particles, silica is the whitening ingredient in most whitening toothpastes. But whitening toothpaste cannot get your teeth any whiter than a professional dental cleaning, because it only cleans the surface. Two weeks to a whiter smile? How about 30 minutes with your hygienist? It’s much more efficient and less harsh.

4. Desensitizers.

Teeth that are sensitive to hot, cold, sweets, or a combination can benefit from the addition of potassium nitrate or stannous fluoride to a toothpaste. This is more of a palliative treatment, when the pain is the problem. Good old Time will usually make teeth feel better, too, unless the pain is coming from a cavity. Yeah, I’m talking to you, the person who is trying to heal the hole in their tooth with Sensodyne.

5. Tartar control.

It burns! It burns! If your toothpaste has a particular biting flavor, it might contain tetrasodium pyrophosphate, an ingredient that is supposed to keep calcium phosphate salts (tartar, or calculus) from fossilizing on the back of your lower front teeth. A little tartar on your teeth doesn’t harm you unless it gets really thick and you can no longer keep it clean. One problem with tartar control toothpastes is that in order for the active ingredient to work, it has to be dissolved in a stronger detergent than usual, which can affect people that are sensitive to a high pH.

6. Triclosan.

This antimicrobial is supposed to reduce infections between the gum and tooth. However, if you just keep the germs off of your teeth in the first place it’s pretty much a waste of an extra ingredient. Its safety has been questioned but, like fluoride, the bulk of the scientific research easily demonstrates that the addition of triclosan in toothpaste does much more good than harm.

Why toothpaste can be bad for you.

Let’s just say it’s not the toothpaste’s fault. It’s yours. The toothpaste is just the co-dependent enabler. You’re the one with the problem.

Remember, toothpaste is a cosmetic, first and foremost. It doesn’t clean your teeth by itself. Just in case you think I’m making this up I’ve included clinical studies in the references at the end of this article that show how ineffective toothpaste really is.

• You’re using too much.

Don’t be so suggestible! Toothpaste ads show you how to use up the tube more quickly. Just use 1/3 as much, the size of a pea. It will still taste good, I promise! And too much foam can make you lose track of where your teeth actually are located.

• You’re not taking enough time.

At least two minutes. Any less and you’re missing spots. Just ’cause it tastes better doesn’t mean you did a good job.

• You’re not paying attention.

I’ve seen people brush the same four spots for two minutes and miss the other 60% of their mouth. The toothbrush needs to touch every crevice of every tooth, not just where it lands when you go into autopilot and start thinking about what you’re going to wear that day. It’s the toothbrush friction that cleans your teeth, not the cleaning product. Plaque is a growth, like the pink or grey mildew that grows around the edges of your shower. You’ve gotta rub it off to get it off. No tooth cleaning liquid, paste, creme, gel, or powder is going to make as much of a difference as your attention to detail will.

The solution.

Use what you like. It’s that simple. If it tastes good and feels clean to you, you’ll use it more often, brush longer, feel better, be healthier.

You can use baking soda, or coconut oil, or your favorite toothpaste, or even just plain water. The key is to have a good technique and to brush often. A music video makes this demonstration a little more fun than your usual lecture at the dental office, although, in my opinion you really still need to feel what it is like to MASH THE BRISTLES OF A SOFT TOOTHBRUSH INTO YOUR GUMS:

A little more serious video from my pal Dr. Mark Burhenne where he demonstrates how to be careful with your toothbrush bristles:

Final word.

♬ It’s all about that Bass, ’bout that Bass, no bubbles. ♬ Heh, dentistry in-joke there.

Seriously, though, the bottom line is that your paste will mask brushing technique issues, so don’t put so much faith in the power of toothpaste.

Also you may have heard that some toothpastes contain decorative plastic that can get swallowed. Yeah, that was a DentalBuzz report I wrote that went viral earlier this year. And while I can’t claim total victory on that front, at least the company in question has promised that the plastic will no longer be added to their toothpaste lines very soon due to the overwhelming amount of letters, emails, and phone calls that they received as a result of people reading that article and making a difference.

But now I’m tired of talking about toothpaste.

Next topic?

I’m bringing pyorrhea back.

Trish Walraven RDH, BSDH is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. She brushes her teeth every morning and night with a major-label toothpaste because she likes the way it makes her mouth taste but at lunch you never know. Sometimes it will be with a dry toothbrush, or dipped in her leftover coffee, one time she even brushed with a starlight peppermint out of desperation.

Resources:

PubMed.Gov: Role of dentifrice in plaque removal: a clinical trial.

PubMed.Gov: Clinical studies to determine the effectiveness of a whitening toothpaste at reducing stain

PubMed.Gov: Factors contributing to adverse soft tissue reactions due to the use of tartar control toothpastes.

Vicky Flint RDH: The Truth about Toothpaste

DearDoctor.com: Toothpaste-What’s in it?

Trisha O’Hehir RDH: Dry Brushing -The Toothpaste Secret

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No more freedom flossers

October 27, 2012 By Trish Walraven Leave a Comment

The Wall Street Journal must have been having a slow day yesterday when they published this article about all the ways that dental floss has been used as a weapon or as a means of escape by inmates over the years. Seems that last month a group of New York prisoners decided to sue because they were getting cavities from not flossing.

What an excuse for American ingenuity to strike – let’s make a floss out of those annoying rubber bands that are sewn into new clothes to keep them on the hanger in the store! By the way, here’s how to break those off of your T-shirts:

Notice how he’s wearing a white dress shirt backwards to make him look like a mental patient…err… dentist. And wrapping the floss professionally around HIS INDEX FINGERS. Every dental professional knows that the middle finger is the way to go. Flip the bird, double flip, point ’em high. That’s the way to break it. Otherwise you’re also suggesting that users should cut their circulation off when they floss. Next thing you know the inmates will be suing because they’ve got gangrene in their nailbeds.

So anyways, here’s the Floss Loops website. The guy who owns the patent also sells inmate-safe soft toothbrushes so if you’re curious about those go take a look. At this posting all the brochures are 404-not-found, but at least you can get an idea of the toothbrush and floss you might have to use when you do finally go all “insane dentist” on the last patient that just really has it coming.