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Monday, September 20, 2010

A Child’s First Dental Visit: Developing Healthy Lifestyles Through Oral Health Promotion of the Very Young

Provincial and national professional dental hygiene and dental associations recommend that children receive their first dental visit by or shortly after the eruption of the child’s first tooth or by the child’s first birthday, whichever comes first.

As oral health care workers (OHCWs,) are we consistently making this recommendation to our clients, the parents of these infants and toddlers?  How do we address the surprising concerns about this being “too early?”  And of course, how can OHCWs in a general practice setting effectively welcome these new, little clients into our practices in an effective, nonthreatening, and successful manner?

The foundation of this recommendation lies in the concept of primary disease prevention:  preventing disease before it starts.  By seeing a child so young, we are able to examine the oral cavity for any signs of disease, trauma, abuse, or neglect.  Parental education about oral self care, dietary considerations, strategies to reduce early childhood caries, and accident/injury prevention can also be emphasized. 

Parents of small children can be reassured about an early first visit to an OHCW through education about the importance of early examination of the child’s oral cavity and newly erupting primary dentition.  Insight into what will occur at the first visit will help to reassure the parents, by reducing the fear of the unknown.  A discussion with the parent about the importance of the primary teeth with regards to oral development, diet, speech maturation, aesthetics, and self-esteem can further assist to create value for that early, first dental or dental hygiene visit.

‘Conditioning’ of the young child prior to the first dental visit can greatly assist with it’s success.  Conditioning involves suitable preparation to make the visit easier and the client more manageable.  For example, parents may be instructed to only discuss the dental office in a positive light such as “it’s going to be fun” or “the dental hygienist is our friend.” Unfortunately, children struggle to understand the concept of a double-negative and saying to the child “there’s nothing to be scared of” may have the opposite effect and might encourage the child to be scared.  Parents can also practice with the young children what might happen in the dental office, by having the child lie of the sofa, open their mouth, turn their head to the left and right, perhaps with the parent shining a small flashlight into the child’s mouth.

Upon arrival of the child in the dental office, the use of positive terminology only is to be continued by both the parent and the OHCW.  Smiling will help to diffuse fear and promote relaxation for all individuals, including the parent.  Children tend to follow the parent’s lead, so a relaxed parent is likely to result in a relaxed child; an anxious, frightful parent is likely to result in an anxious, frightful child. 

A medical and dental history review of small children is likely to be brief, but is still an important aspect of assessment.  Insight gathered regarding medication use, illness/infection history, previous head and neck injury, and overall parental attitude towards oral health will help to guide the rest of the process of care.

A few options exist for examining the small child’s oral cavity. First, the child may lie on the parent’s abdomen while the parent lies in the dental chair; the parent may then securely and comfortably wrap their arms around the child.  Another option is for the parent and OHCW to sit knee-to-knee while the child lies on their thighs, with the parent’s arms crossed firmly over the child and the child’s head towards the OHCW for examination.

Of course, not all first dental visits, especially of infants and toddlers, are completed smoothly or according to our hope and intention.  Sometimes the first dental visit might simply be a ride in the dental chair and a discussion with the parents regarding their child’s oral health; this could be considered a success over that of no dental visit at all. By scheduling another appointment in six months, there will likely be a gradual increase in both comfort and compliance. An early dental visit can also provide insight into whether a child might require a referral to a qualified specialist.

Oral health care of infants and toddlers may seem daunting and certainly presents with a unique set of challenges. Our greatest success lies with our patience, compassion, and early intervention as we open our practices and hearts to these small but special clients.


References
Darby, Michelle Leonardi, and Margaret M. Walsh. Dental Hygiene Theory and Practice Third Edition. St. Louis, MO: Saunders Elsevier, 2010.
Newborns and Infants. 2010. Ontario Dental Association. 6 Sept. 2010. <http://www.oda.on.ca/newborns-a-infants.html#baby>
Oral Health for Children – A Parent’s Guide.  2009. Ontario Dental Hygienists’ Association. 6 Sept. 2010. <https://www.odha.on.ca/PDFs/5childrenWeb.pdf>
Oral Health Matters for You and Your Baby. Smile City.ca brought to you by CDHA. 6 Sept. 2010. <http://www.smilecity.ca/parents_resources.asp>
Wilkins, Esther M., Clinical Practice of the Dental Hygienist 10th Edition. Baltimore, MD: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009.
Your Child’s First Visit. 10 Apr. 2005. Canadian Dental Association. 6 Sept. 2010. <http://www.cda-adc.ca/en/oral_health/cfyt/dental_care_children/first_visit.asp>

Friday, September 10, 2010

Instrument Sharpening


Maintaining instrument sharpness helps you maintain your professional and clinical “edge”.  In a busy dental practice environment instrument sharpening is not often on the top of the “to-do” list.  One of the reasons that instrument sharpening may get neglected is because some may view it as time consuming. Also, some clinicians may not feel confident in their sharpening skills

The benefits of maintaining sharp instruments include; easier calculus removal, improved stroke control, reduced number of strokes, increased client comfort, and increased clinician comfort.

 A sharp cutting edge “bites” into the deposit, removing it more efficiently; whereas a dull cutting edge slides over the deposit, which results in burnished calculus.  A burnished deposit is one in which only the outer layers are removed. A burnished deposit feels smooth and it is difficult to distinguish between a smooth calculus-free root surface and a burnished deposit.  Clinicians may not immediately know that a deposit has been burnished until they see their client again for re-evaluation.  The presence of burnished calculus deposits compromises healing.

Tiny, controlled, upward alternating strokes are most desirable for successful calculus removal. These strokes are best achieved with a sharp instrument.

Many individuals benefit from the prudent clinicians ability to maintain his/her instruments.  Clinicians experience less fatigue and greater professional satisfaction from improved clinical results, dentists benefit from increased productivity and clients benefit from less time in the chair and a more comfortable appointment.

For clinicians that want to improve their instrument sharpening confidence there are some very effective systems with a quick learning curve.  These systems are; Hu-Friedy “It’s About Time System”, PDT Gleason Guide and the Hu-Friedy Sidekick. 

A basic comparison of some of these great systems is as follows…

Hu-Friedy “clock” system:  Is a manual stone system, in which the clinician angulates both the stone and the instrument to maintain the cutting edge.  A conventional clock is used as a reference for correct angulation.

PDT Gleason guide: Is a manual stone with an accompanying metal guide.   The guide helps to maintain consistent results.  Instruments are simply placed in the appropriate channel, which will ensure the correct sharpening angle for each instrument.

Hu-Friedy Sidekick:  This is a powered device in which the stone moves “automatically” and the instrument is placed in a guide. The guide helps to ensure correct sharpening angle for each instrument.

Regardless of what system you choose to maintain your instruments, make sure that you select one that does just that…”maintain” the integrity of them.  The last thing that you want is to warp your curettes to sickles.  Always bear in mind the design features of your instruments. A magnifying glass will help you get a closer look.  Sickles come to a point or tip and curettes come to a rounded toe.  Closely monitor the size of the instruments working end, as too small of a working end can be dangerous as it may break easily.  A good idea is to keep a package of never used instruments in your office and compare instruments in your current rotation to brand new ones.

Now you are one “sharp” RDH.

Peace, love and dental hygiene.

References:

Nield-Gehrig, Jill S.  Fundamentals of Periodontal Instrumentation and Advanced Root Instrumentation Sixth Edition.  Baltimore, MD: Lippincott Williams & Wilkins, 2008.

Darby, Michelle Leonardi, and Margaret M. Walsh. Dental Hygiene Theory and Practice Third Edition. St. Louis, MO: Saunders Elsevier, 2010.

Wilkins, Esther M., Clinical Practice of the Dental Hygienist 10th Edition. Baltimore, MD: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009.

HuFriedy.  It’s About Time To Get On The Cutting Edge: A Self-Instructional Video and Manual for a Simpliefied Approach to Sharpening Periodontal Scalers and Curettes.


Thursday, September 9, 2010

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Peace, love and dental hygiene.

Which dental floss should I use?

Dental hygienists might find themselves on the receiving end of this question on a regular basis.  Oral self care recommendations need to be customized for each client, and many factors need to take into consideration when advising clients about suitable interdental aids.  Factors to consider include: dental anatomy, restorations, embrasure spaces, level of oral health knowledge, manual dexterity, financial resources, and motivation.  For clients that are motivated, have good manual dexterity, and type 1 embrasure spaces, I often answer this question with: "the floss you like the best."  If a client has no contraindications for that type of floss or floss technique, the floss the client prefers is the one that he/she will most-likely use.

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