Becky Larson, RDH BS

Why can’t I get a regular cleaning?

One of the most common questions I am asked as a dental hygienist is, “why can’t I get a regular cleaning?”  This is always a tough one for me because I want what is best for my patients, but I also want them to be happy.  Many patients do not understand that there is a difference between the hygiene services that are available.  So I’d like to clarify.  There are 3 basic types of hygiene services or “cleanings” that your dentist/dental hygienist might recommend.  

Prophylaxis: 

A prophylaxis or “prophy” is a preventive cleaning where plaque, calculus, and stain are removed or cleaned off the teeth in order to prevent disease.  This type of cleaning is done when disease is not already present, but rather the mouth is in a current state of health.  There is minimal discomfort and little to no bleeding present.  

Scaling in the presence of inflammation (or gingivitis cleaning):

Scaling in the presence of inflammation (SPI or gingivitis cleaning) is different than a prophy in that there is disease present.  In this case, the mouth is in a state of gingivitis or inflammation of the gum tissue.  Gum inflammation includes swollen, red, tender, and bleeding gums.  This cleaning still includes the removal of plaque, calculus, and stain from the teeth.  Since the gums are already in a state of disease, this is not a preventive cleaning.  The gums generally bleed during the cleaning process and anesthetic may be administered for the patient’s comfort.  Since gingivitis can be reversed, there is often a good prognosis with healing of the gums after a gingivitis cleaning.  

Scaling and Root Planing (or a deep cleaning):

Gingivitis is the stage of disease that precedes periodontal disease.  Periodontal disease is an infection of the gum tissue that begins to destroy the supporting structures of the teeth including the gums themselves, periodontal ligaments, and jaw bone.  Once the supporting structures of the teeth are destroyed, they do not grow back.  Periodontal disease is not reversible, nor is there a cure, but it can be kept in an inactive state to prevent further destruction.  Patients with periodontal disease usually have generalized bleeding of the gums, bone loss, gum recession, and deep “pockets” or gum measurements that mean the gum is not attached on the tooth where it should be.  Scaling and root planning (or deep cleaning) involves removing the plaque, calculus, bacteria, and stain in these deep pockets where a toothbrush or floss can’t reach.  Anesthetic is usually always administered due to the need to clean below the normal gum tissue level (which can be very uncomfortable).  The gum tissue can heal as long as everything is removed from the pocket and no other further irritation is present. Thorough homecare is essential to keeping periodontal disease under control, as are more frequent hygiene appointments.  

Your dentist and/or dental hygienist can tell you which cleaning is necessary for you.  Just as we would never try to treat a disease that isn’t present, we can’t perform a prophylaxis cleaning when disease is present.  Doing so would be a great disservice to our patients.  Please talk with your dentist or dental hygienist if you have questions about the health of your teeth or gums.  

 Want to learn more? Visit us at

Dentist in Tempe, AZ | Shalimar Family Dentistry

Dentist in Mesa, AZ | North Stapley Dental Care

Dentist in Tempe, AZ | Alameda Dental Care

Dentist in Gilbert, AZ | Smiles at San Tan Ranch

Sources:

https://medical-dictionary.thefreedictionary.com/dental+prophylaxis

https://www.colgate.com/en-us/oral-health/conditions/gum-disease/what-does-gingivitis-treatment-entail-0513

https://www.mouthhealthy.org/en/az-topics/s/scaling-and-root-planing

https://www.colgateprofessional.com/education/patient-education/topics/plaque-and-gingivitis/what-is-periodontal-disease

Importance of Early Detection

It seems like nowadays there is a holiday for every thing and every reason.  But one we can’t ignore is April being Oral Cancer Awareness Month.  It’s so important, it doesn’t get just a day to be recognized, it gets it’s own month!

As dental professionals in our offices, when you come in for your routine dental visit, we always offer and want you to be aware that we do a basic oral cancer screening for you.  There is one other screening we offer, called Identify, that helps us detect tissues on the cellular level through a light source, to identify areas that may need further attention. The dental hygienist or dentist will look at all the areas in your mouth, including your tongue on the sides and in the back, and the roof of your mouth. They will also check for any swelling along the neck.  Each and every patient should be screened regardless of age or habits.

Another way to identify a possible oral cancer lesion is to be aware of what is in your own mouth.  As mentioned in a previous post by Amanda Orvis, RDH, she gave suggestions on how to do a self-cancer screen.  Look at your tongue, the tissues of your cheeks and around the teeth.  If you notice something like a red or white patch, take note of the appearance.  If the lesion doesn’t go away after 2-3 weeks, go see your dentist for his opinion.  He may check the area again after 2-3 weeks or he may refer you to a specialist to have the area evaluated.

“There is much that can be done for those who are diagnosed with head and neck cancer. Since early detection and treatment is critical, it’s important to see your dentist regularly and to promptly see a medical professional if there are any warnings signs,” — The Oral Cancer Foundation

Oral cancer symptoms:

Persistent mouth sore: A sore in the mouth that does not heal is the most common symptom of oral cancer

Pain: Persistent mouth pain is another common oral cancer sign

A lump or thickening in the cheek

A white or red patch on the gums, tongue, tonsil, or lining of the mouth

A sore throat or feeling that something is caught in the throat that does not go away

Difficulty swallowing or chewing

Difficulty moving the jaw or tongue

Numbness of the tongue or elsewhere in the mouth

Jaw swelling that makes dentures hurt or fit poorly

Loosening of the teeth

Pain in the teeth or jaw

Voice changes

A lump in the neck

Weight loss

Persistent bad breath

Again, if you notice any of these things, come into the office and get things checked out.  The earlier oral cancer is identified, the better the outcome.

According to the American Cancer Society, “A relative survival rate compares people with the same type and stage of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of cancer is 90%, it means that people who have that cancer are, on average, about 90% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed.”

Want to learn more? Visit us at

Dentist in Tempe, AZ | Shalimar Family Dentistry

Dentist in Mesa, AZ | North Stapley Dental Care

Dentist in Tempe, AZ | Alameda Dental Care

Dentist in Gilbert, AZ | Smiles at San Tan Ranch

Sources:

www.cancercenter.com

www.cancer.org

Monthly Oral Cancer Self-exams

The prevalence of oral cancer is on the rise; in fact one person dies per hour from oral cancer. In the early stages oral cancer can often times go unnoticed. It can be painless and not obvious to the naked eye. The most common areas for oral cancer are the floor of the mouth and the sides of the tongue. That being said, oral cancer can be found in various locations as well as a variety of shapes, colors, textures, and sizes. It is important that you perform monthly oral self-exams. If you notice any suspicious areas that do not go away within ten to fourteen days make an appointment with your dentist to have them checked. Remember early detection saves lives. 

How to perform a monthly self-exam 

Steps: 

• Take a moment to look at the skin on your face and neck in the mirror. Look for any changes in the color of your skin, any changes in moles or beauty marks, any swelling, any lumps or sores. 
• Use both hands to gently feel along the outside of your cheeks, your lower jaw bone, your jaw joint, in front of and behind both ears. Check for any areas that do not feel uniform on both sides, and check for any lumps or areas that are swollen or tender. 
• Remove any removable dentures or appliances from your mouth. 
• Check the roof of your mouth for changes in color or texture. Use your index finger to lightly sweep the roof of your mouth to feel for any lumps or swelling. 
• Pull up your upper lip and then pull down your lower lip looking for any changes in color or texture.
• Open wide and look at the back of your mouth and your throat for any changes in color, size and/or texture.
• Stick out your tongue and check all the surfaces (top, underneath, and both sides of your tongue), as well as the floor of your mouth looking for any changes in color, size and/or texture in the oral tissue. 
• Look at your gums throughout your mouth for any change in color and/or texture. Run a finger around all the surfaces of your gums feeling for any swollen or tender areas.

What to look for specifically: 

• White patches or spots
• Red patches or spots 
• Sores that fail to heal 
• Lumps, bumps or masses 
• Any areas that are differ from one side to another 

Want to learn more? Visit us at

Dentist in Tempe, AZ | Shalimar Family Dentistry

Dentist in Mesa, AZ | North Stapley Dental Care

Dentist in Tempe, AZ | Alameda Dental Care

Dentist in Gilbert, AZ | Smiles at San Tan Ranch

Sources:

Public description of a proper exam

Click to access 7231_Oral_Cancer_Fact_Sheet_1.pdf

Sharma Mulqueen RDH

April is Oral Cancer Awareness Month!

Did you know that according to the Oral Cancer Foundation close to 49,750
Americans will be diagnosed with oral cancer this year? It will cause over 9,750 deaths, killing roughly 1 person per hour, 24 hours per day and the numbers are rising.

There are two distinct pathways by which most people come to oral and
oropharyngeal cancer. One is through the use of tobacco and alcohol (if you
drink and use tobacco products are 15x more likely to develop cancer), a long-term historic problem and cause, and the other is through exposure to the HPV.

A small percentage of people (under about 10%) do get oral cancers from no
currently identified cause. It is currently believed that these are likely related to some genetic predisposition.

The demographics of those who develop this cancer have been consistent for some time. While historically the majority of people are over the age of 40 at the time of discovery, it is now occurring more frequently in those under this age.

There are also links to young men and women who use conventional
“smokeless” chewing or spit tobacco. Promoted by some as a safer alternative to smoking, it has in actuality not proven to be significantly safer to those who use it when referring to oral cancers. Same goes for Vaping. Several young men and women are stating Vaping is safer. Studies show that it can have more nicotine and dangerous chemicals.

During the month of April all offices offer a free Oral Cancer Screening. Please schedule your appointment and we can go over any questions you may have!

We look forward to seeing you!

Want to learn more? Visit us at

Dentist in Tempe, AZ | Shalimar Family Dentistry

Dentist in Mesa, AZ | North Stapley Dental Care

Dentist in Tempe, AZ | Alameda Dental Care

Dentist in Gilbert, AZ | Smiles at San Tan Ranch

Sources:

Maria Ambra, RDH

Dry mouth

My mouth is always dry. What I can do?

Very often patients asked this question. They are concernedabout a condition called Xerostomia, in which the salivary glands in the mouth don’t make enough saliva. Saliva is a very important element for the health of our mouth; it is considered a buffer that neutralizes acids produced by bacteria and limitsbacterial growth. Saliva also increases the taste and its enzymes help the digestion. Its absence can increase plaque, tooth decay and gum disease.

SYMPTOMS

Some of the symptoms associated with Xerostomia are:

CAUSES:

Salivary glands not working properly may be the result of:

Medications:  Antihistamine, decongestants, anxiety and hypertensive medications (blood pressure), muscle relaxants, urinary continence drugs, Parkinson’s disease meds, as well antidepressant.

Age: Older age can change the ability to process medications, or to have inadequate nutrition

Cancer Therapy: Radiations and Chemotherapy to the body especially head and neck can damage the salivary glands resulting in less saliva production

Nerve damage: an injury or surgery causing nerve damage to the head and neck area can result in dry mouth.

Tobacco: Chewing, smoking tobacco or vaping can increase the risk of dry mouth.

Other health conditions: Diabetes, stroke, autoimmune disease such as Sjogren’s syndrome, HIV/AIDS, also serious systemic disease, such as systemic lupus erythematosus, rheumatoidarthritis scleroderma, sarcoidosis, amyloidosis,

TREATMENTS

Medications: If the dry mouth is caused by a particular medication, the doctor will either alter

the dosage or prescribe another drug which is less likely to cause dry mouth. 

Stimulating saliva production: Medication may be prescribed to stimulate the production of saliva, such as pilocarpine (Salagen) or cevimeline (Evoxac).

OVER THE COUNTER SALIVA STIMULANTS: Saliva substitutes that contain xylitol, such as gums or mints, Spreyrain oral mist spray (Xlear), Biotine oral balance gel or rinse , Orbit sugar free gums, Trident gums with xylitol

FLUORIDE TREATMENT: To prevent cavities, fluoride traysmay be suggested, which will be fill with fluoride and wear overteeth at night. Also weekly use of rinses to control cavities may be recommended.

GOOD ORAL HYGIENE: Dentists or dental hygienist will reinforce the importance of regular brushing and flossing and may offer additional instructions regarding your daily oral hygiene. The ability to consistently accomplish these daily oral hygiene measures, as instructed, is one of the most important steps in successfully managing the complications of oral dryness. 

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

https://www.ada.org/member-center/oral-health-topics/xerostomia

https://www.webmd.com/oral-health/guide/dental-health-dry-mouth

Asha Cox, RDH

Dental Sealants

Have you ever had a dentist recommend a sealant for you or your child and
wondered: “what is that” and “why do I need it”? Here are some answers to a few of
your questions.

What is a sealant?
 A sealant is a protective coating that is placed in hard to clean areas of the
teeth where cavity-causing bacteria resides.

Why do we need sealants?
 Sealants aid in preventing cavities that may form in the pits and grooves of
teeth where the toothbrush cannot reach, making it difficult to clean, such as
the chewing surfaces of molars and premolars. If not properly cleaned, that
bacteria sits in the grooves of those teeth and causes decay to form. The
sealant provides a barrier, keeping bacteria from residing in those areas.

 They can also minimize progression of lesions that are just beginning to form
but have not yet progressed into full cavities.

At what age do we need sealants?
 Sealants are recommended when our permanent molars (and sometimes
premolars) first come in, generally around the ages of 6 and 12.
How long do they last?

 Sealants last several years, but they do wear down over time. Your dentist
can check them at each visit and may touch them up over time if needed.
What is the process for getting them done?

 The tooth is first dried and an etch material is placed on it, then after a few
seconds it is rinsed off. This step helps the sealant material to form a
stronger bond with the tooth.

 Next the tooth is dried again and the sealant material is applied. Your dentist
will use a blue curing light to make the sealant set and harden.

Sealants are quick and painless to apply, and are a great aid in preventing cavities.
Ask your dentist if sealants are a good option for you and your children!

Want to learn more? Visit us at

Dentist in Tempe, AZ | Shalimar Family Dentistry

Dentist in Mesa, AZ | North Stapley Dental Care

Dentist in Tempe, AZ | Alameda Dental Care

http://www.dentistingilbert.com

Sources:
https://www.mouthhealthy.org/en/az-topics/s/sealants
https://www.ada.org/en/member-center/oral-health-topics/dental-sealants

Maria Iavarone, RDH

Activated Charcoal Toothpaste or Powders

Activated charcoal toothpaste and powders have been gaining popularity the past few years. Ads have been flooding social media. You may have seen the YouTube videos and the Pinterest before and after photos. It has become a true dental fad. Charcoal is not only a trend right now, but historically ancient Romans used charcoal, amongst other products to clean teeth. As a dental hygienist, I get questions about charcoal toothpaste often. Does the toothpaste actually whiten the teeth? Does it help prevent gingivitis? Is charcoal toothpaste effective and safe to use? 

Unfortunately, the answer is unclear on the effectiveness and safety of using activated charcoal toothpastes or powders. The Journal of the American Dental Association did a literature review of 118 articles and smaller studies done on charcoal and charcoal-based toothpastes. The conclusion was that there was insufficient clinical and laboratory data to substantiate the safety and efficacy of charcoal and charcoal-based toothpastes. Larger-scale and well-designed studies are needed to establish conclusive evidence (Brooks, Bashirelahi, & Reynolds, 2017). 

The Pharmaceutical Journal states, there have been no scientific studies published that support the effectiveness of charcoal toothpastes in tooth whitening, oral hygiene and any claimed preventative effects (Greenwall & Wilson, 2017).  

From information I have gathered from journal articles written on the subject, activated charcoal toothpastes are seemingly effective in removing surface stains from coffee, tea, red wine,etc. This is most likely due to the abrasive nature of activated charcoal. There has not been enough evidence to show that activated charcoal toothpaste has an effect on whitening yellow teeth. Activated charcoal is characteristically absorbent,however in the form of a toothpaste, it may be the abrasiveness that is contributing to the removal of the stain.

The abrasive nature of activated charcoal can be seen as a potential concern as well. Activated carbon is more grainy than traditional pastes and can potentially cause damage to the teeth (Potts, 2018). There was not much information supporting gum health, however some reviews claimed that a side effect was gum irritation. There are a lot of positive claims and a lot of negative claims, yet no claim is supported by enough clinical evidence to be deemed as true.

In conclusion, we have to take this information lightly because there is not enough substantial evidence to support these claims. Because activated charcoal toothpastes and powders have grown in popularity, there are a lot of companies making this type product right now and some may be putting harmful ingredients into the mix. RDH magazine claims that some foreign brands of toothpaste may contain toxic ingredients. We must exercise caution when buying a product like this. Several charcoal toothpastes or powders on the market right now do not contain Fluoride, which is the key ingredient for cavity prevention. If you’re using a charcoal toothpaste without Fluoride, your dental professional may recommend supplementing with a Fluoride mouth rinse. 

My recommendation would be to read the ingredients carefully when purchasing toothpaste, especially if it is not from a reputable company.  Be cautious if using activated charcoal toothpaste or powder and do not use it long-term until more research has been published to support the safety and efficacy of the product.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

Brooks, J. K., Bashirelahi, N., & Reynolds, M. A. (2017). Charcoal and Charcoal-Based Dentifrices. The Journal of the American Dental Association, 148(9), 661-670.

Greenwall, L., & Wilson, N. H. (2017, July 13). Charcoal toothpastes: what we know so far. Retrieved February 16, 2019, from The Pharmaceutical Journal: https://www.pharmaceutical-journal.com/opinion/correspondence/charcoal-toothpastes-what-we-know-so-far/20203167.article?firstPass=false

Potts, K. (2018, July 1). Marketing Ingenuity or Beneficial Dentifrice? Retrieved Februrary 16, 2019, from RDH Magazine: https://www.rdhmag.com/articles/print/volume-38/issue-7/content/marketing-ingenuity-or-beneficial-dentifrice.html

Lacee Hogle, RDH

Do I need to take antibiotics before my dental visit?

Physicians and dentists may recommend that a patient takesantibiotics prior to certain dental procedures. This is called “antibiotic prophylaxis”. But why do physicians and dentists at times recommend antibiotic prophylaxis?

All of us have bacteria in our mouths, and many dental procedures allow bacteria to enter the bloodstream. This is known as bacteremia. For most of us, this does not pose a problem. A healthy immune system typically prevents the bacteria from causing any harm. There is a concern, however, that for some people, bacteremia could potentially cause an infection elsewhere in the body. 

Who is at risk? 

Antibiotic prophylaxis is recommended for people who have specific heart conditions. In 2008, the American Heart Association released new guidelines identifying people who need to take antibiotics prior to dental care. Antibiotic prophylaxis should be considered for people with:

Artificial heart Valves

A history of endocarditis

A heart transplant with abnormal heart valve function

Certain congenital heart defects including:

Unrepaired cyanotic congenital heart disease, including people with palliative shunts and conduit

Defects repaired with prosthetic material or a device for the first six months after the repair procedure

Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device

The guidelines prior to 2008 suggested use of antibiotics for many additional conditions. Conditions for which antibiotic prophylaxis is no longer recommended include:

Mitral valve prolapse or heart murmur

Rheumatic heart disease 

Bicuspid valve disease

Calcified aortic stenosis

Any heart condition present from birth that is not listed above

Antibiotic prophylaxis guidelines were also developed for those who have orthopedic implants, such as artificial joints. In the past, antibiotics were recommended for two years post artificial joint placement. And in rare occasions, more than two years. In 2012, the American Dental Association and the American Association of Orthopedic Surgeons updated these recommendations.

The new guidelines do not recommend routinely prescribing antibiotics for people with artificial joints. Due to these changes, dentists and physicians rely more on case-by-case assessments and consultation with patients to determine when antibiotics are appropriate with orthopedic implants. For example, antibiotic prophylaxis might be used for the patients that also have a compromised immune system which might increase the risk of orthopedic implant infection.

If you have a heart condition or an orthopedic implant, talk with your dentist or physician about whether antibiotic prophylaxis is necessary. 

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

https://www.heart.org/en/health-topics/infective-endocarditis

http://www.ada.org/~/media/ADA/Member%20Center/Files/PT ED Page Antibiotics 2.ashx

Amy Smith, RDH

“My teeth are sensitive.”

One of the most common concerns voiced in the dental office; here are a couple solutions. First we need to differentiate between gum and tooth sensitivity. If you have symptoms of sore, bleeding, or red gums, this would indicate gum sensitivity. If you drink cold or hot foods/drinks and begin to feel a “ZING” feeling to the tooth and nerves, this would indicate tooth sensitivity. First and foremost, the easiest method of gum sensitivity prevention it to brush, floss, and remain consistent with your dental re-care visits. In addition, there are different toothpastes and fluoride treatment that can help with tooth sensitivity.  

#1- Home Care: By staying on top of a great home care routine of brushing twice per day for two minutes and integrating a method of flossing, there with be less plaque retention around the gums. This plaque can be causing irritation, inflammation, and in some cases bleeding. By improving your home care regimen, gum pain can reduce and furthermore protect your teeth from decay.

#2- Desensitizing Toothpaste: Sensodyne toothpaste, MI Paste, and PreviDent are created specifically for remineralization of the tooth but also help with sensitivity. Sensodyne is available over the counter while MI Paste and PreviDent are stronger strength and can be dispensed at the dental office. Remember when using these toothpastes to brush, spit, but do NOT rinse. It is important to allow the ingredients to sit on the teeth rather than rinse away with water.

#3- Fluoride Treatment: There are a few different methods of fluoride treatment available for patients. One in specific that has an easy and swift application would be a fluoride varnish. These vitamins are tooth-colored and painted onto the teeth after a cleaning. It is designed to assist with tooth sensitivity and promote remineralization of the tooth. Fluoride varnish is great for all ages and it comes in various flavors.

One size does not fit all to meet our patient’s needs for treatment of sensitivity. Ask your hygienist if you have any other questions regarding sensitivity to chose a possible treatment that is best for you.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/sensitive-teeth/faq-20057854