By Lee Ann Brady, DMD 

One of the most common ways that we temporize a patient who is having maxillary anterior implant dentistry is with an Essix retainer. Some patients will wear it 24 hours a day and others for less. Hopefully they are taking it out to rinse, brush, and floss, but the reality is they are wearing a removable device that covers all of the tooth surfaces for a lot of hours every day, and we’re increasing their risk of caries, decalcification, and gingivitis. 

In addition to discussing the normal oral hygiene to be done at home, in our practice, we typically dispense a product like Clinpro 5000 from 3M or MI Paste from GC America. These are high calcium and fluoride products that provide fluoride treatments inside the Essex retainer. 

• If a patient is sleeping in the Essix, the instructions are to brush and floss the teeth and then use a toothbrush to spread a little bit of Clinpro or MI Paste on the inside of the retainer before going to sleep. 
•  If they are not wearing the Essix during sleep, the instructions are the same but to wear the Essix for up to an hour every evening before removing it to go to sleep. 

If the patient’s caries risk is high, I prefer using 10% carbamide peroxide gel instead of Clinpro or MI Paste. This is the active ingredient we us in perio trays to help prevent gingivitis. This is also the means by which patients can whiten their teeth while wearing an Essix retainer. 

To prevent damage to the Essix, instruct patients to rinse it with cold water and, when not wearing it, to store it in the provided container.  

Most dentists have some stories about buying and trying different types of face shields as we have started to practice again. The challenges of fit, being comfortable and working with loupes are common conversations. I have tried six types to date with more on the way.

I started with “What can we get?” Then I moved on to “What will be the most comfortable and best on our loupes?”

I and my two hygienists wear loupes. I wear a 4.0x power, flip-up loupe. The hygienists wear 1.5x power loupes. In addition to the loupes, we wear a light.

We’ve tried face shields that hang from a visor. This is the kind my assistants love and wear all the time. However, this type of shield does not fit over my loupe. It fits over my hygienists’ loupes but by the end of the day, they have a headache from the pressure of the temple pieces on the visor.

We tried the disposable face shields that hang from a headband with foam padding. They did not fit over loupes.

A third type from Bio-Mask® turned out to be my hygienists’ favorite and the one I wear when I am doing a consult and not wearing my loupe. This type of visor frame has replaceable face shields. It is lightweight and comfortable (due to its weight, adjustable head strap, and foam padding), and it is designed to be worn with loupes. The replaceable shields can be washed with hot soapy water. The shields are designed to protect from splatter and spray that might come over the top of the visor, so you have full-face protection. I can wear it over my loupe by enlarging the headband and resting the front of the visor frame on my light.

Just recently I came across a different face shield designed to wear over dental loupes that I really like. It’s the PRO-TEX® extra-wide 13″x 7″ shield (model FSX). It clips directly onto the frame of my loupe. I wear eyeglasses, a face mask, my loupe with a light, and then clip the face shield to my loupe frame. This is the least pressure on my ears and temples that I have discovered. The shield can be washed between patients with warm soapy water.

I know a lot of people are praising loupe face shields from Ultra Light Optics®. I am looking forward to trying these when they come in because they are designed so you can mount your light outside the shield and not have to reach under the mask to flip down your light.

It was August of 1995 when I first walked through the doors of The Pankey Institute.

At that time, I had only one year of experience under my belt as a licensed hygienist, and I believed I had won the “dental lottery” by having spent the past six months working for a Pankey Institute trained dentist. Dr. Steve Ratcliff was passionate about the Institute and his philosophy of care that was inspired by what he was learning there. He proudly shared everything possible with me about how he wanted our practice to develop.

It was a hands-on perio course at the Institute where I eagerly learned about non-traditional use of Gracey currettes, utilization of ultrasonics, and the current science of periodontal disease and its management with Dr. Sam Low. I remember being so nervous and so excited. There were hygienists from all over the country with similar desires, challenges, and dreams, and together we formed a sweet community of our own, learning and growing together with an even better understanding of what was possible as a dental hygienist.

It’s difficult to believe that 25 years have flown by, and it’s so cool that here I am about to lead the 2020 version of that very same program. Appreciating the magnitude and beauty of Quid Pro Quo, I’m honored to now be teaching with Dr. Sam Low to support hygienists toward their full scope of practice.

Our program will focus on two key components of the hygiene chair:

1. What it means to be a Restorative Partner in your practice by deepening the art of co-discovery and patient engagement.

2. Understanding current science around the diagnosis and management of periodontal disease, including hands-on utilization of power instruments, air polishing, and adjunctive therapies.

There are many pieces and parts to my enthusiasm about this program, The Pankey Hygienist.

What brings me the most joy is knowing that I get to share “my version” of Dr. L.D. Pankey’s philosophy with the doctors and hygienists in attendance. The Institute was certainly a game-changer for our practice and our patients 25 years ago. It continues to be a life-changing experience for me each and every time I get to be within this community, whether it is at the Institute, at an offsite event, or visiting other dental practices inspired by their own time with the Institute. I’m not just grateful. I’m “over the moon” grateful for this life.

Hygienists make up a huge component of a dental practice’s atmosphere and productivity. You should be devoting plenty of time to understanding their motivations as well as your own. Even better, you should actively consider how best to support them.

Supporting New Hygienists

One obvious instance of support a dentist can provide occurs with the dental hygienist who is fresh out of school. Hiring someone new to the field confers pros and cons. The biggest upside is that you can mold them to your preferences. But in that upside lies a heavy burden: You must be willing to guide their learning and influence their patient care.

A hygienist who is very new to either your practice or dentistry itself needs plenty of time to become oriented. You can support them by seeing all of their patients for a while and completing an extremely thorough exam. This will ensure both the hygienist and patient get the most out of the experience.

Take steps like:

1. Ensure all deposits that can be removed are removed.
2. Observe the gingiva and determine if prophylaxis has caused as little trauma as possible.
3. Measure pocket depths to calibrate the hygienists readings to yours.
4. Look closely for decay and provide an opportunity for the hygienist to feel the signs of disease that you do.
5. Check for wear or breakdown and teach both patient and hygienist how to see it.
6. Carry out an oral cancer exam and clarify what is cause for concern.
7. Point out what draws your attention on an x-ray.
8. Finally, make any diagnostics you offer into a learning experience for both the patient and the hygienist.

Once you feel comfortable that your hygienist is appropriately skilled, you must open lines of communication surrounding who handles what responsibilities.

How do you bring new hygienists into your practice culture? Please let me know! 

The hygiene exam can be a dreaded topic in the dental practice, especially if you’ve been dodging the issue for a while. Depending on your state, there may be specific rules or regulations about how the hygiene exam should be conducted. After meeting these rules though, it’s up to you to determine what style of hygiene exam best suits your goals.

Hygiene exams can complicate your relationship with hygienists if you don’t have an open dialogue about why you conduct them the way you do. There isn’t one right or wrong way to do things. That’s what makes it such a challenge for clinicians.

Conducting a More Effective Hygiene Exam

Commitment to your purpose should help you decide on how you want a hygiene exam to go. Most importantly, don’t do something you dislike simply because you think it’s the only option. Your obligation is to meet your patients’ needs while fulfilling your ethical or moral responsibility.

Patient expectations are where things get tricky. It doesn’t necessarily matter if your style is to put most of the responsibility in your hygienist’s hands or if you prefer to enact a thorough exam yourself. What does matter is that your patient knows what to expect and that you meet that expectation.

If you want to meet with patients for an in-depth exam, then schedule that time. If your hygienist will handle the majority of the exam, give them the tools and the training they need to feel confident. By the same token, if you want to check in on patients, but don’t want to do more than visit, then don’t even put on your gloves.

In the end, you can choose a combination of hygiene exam processes. Just keep your patients and your team informed.

How do you conduct hygiene exams in your practice and why? We’d love to hear from you!