Register for the ISDH meeting!!

Ergonomics: Be a Part of Your Health

San Francisco Dental Hygiene Society along with Occupational Health Branch of the California Department of Public Health & UC Berkeley Ergonomic are working together to help prevent and alleviate musculoskeletal injuries for dental hygieneist.   Why are we doing this? CDPH has identified dental hygienists as reporting higher cases of workers compensation and want to help our profession stay healthy.    CDPH wants to work with local RDHs as advisors to develop a useful message, CE courses and short videos.    CDPH has an occupational health doctor, data folks, and a health educator, working on this project.   UC Berkeley has an occupational health doctor, an ergonomist, and an engineer.   San Francisco has amazing RDH that want the best for ourselves, each other and our profession.   I have a few more spots for RDH to get on this advisory board. It's our stories, our knowledge of the profession and our physical health concerns that will move our profession forward to ensure long, healthy careers.   Join us on Tueday April 30, 2013 from 6:30-8:30pm at a Union Square location to be a part of this collaborative opportunity.   Contract Michael Long, RDH at sfbayareardh@gmail.com for complete location detail.

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Toothbrush Selection Simplified

Brushing one's teeth is not a human instinct. It is a skill developed to defend against cariogenic agents which, if left undisturbed, will attack oral structures. Toothbrushes are invaluable in protecting against these threats, but, with a dizzying array of brushes on the market, it is not always clear which will provide the most benefit for a particular patient. And even when a patient selects a product that's an ideal match, the toothbrush may not perform effectively if it's not used properly.

For these reasons, it is vital to educate patients so they can make informed buying decisions and exercise proper brushing technique. In this Sunstar E-Brief, dental hygiene educator Caren M. Barnes, RDH, MS, of the University of Nebraska Medical Center's (UNMC) Department of Dental Hygiene, shares insights into the latest developments in toothbrush design. She also explains how to clear up any confusion patients may have about which features are right for them, and offers tips for dental hygienists to help patients get the most from brushing.

The first step is for clinicians to factor in data collected from the comprehensive dental hygiene patient assessment. This, Barnes says, will provide insight into a patient's self-care regimen. More importantly, it identifies products the patient currently uses, as well as how they are being used. At this point, the dental hygienist can identify the type of toothbrush that will provide the greatest benefit. Barnes suggests this approach is a marked improvement over the long-held practice of keeping one type and brand of toothbrush in the dental office to distribute to all patients, regardless of their oral hygiene status—a routine she says should be abandoned.

"Given the huge selection of oral hygiene products, dental hygienists can assist patients in the purchase process by writing the names and specific descriptive information about recommended products," she advises. "In essence, provide the patient with an oral hygiene prescription for those products, along with instructions for use." This will help avoid confusion when the patient faces the variety of oral hygiene products available in stores.

BRISTLES MAKE A DIFFERENCE

For decades, toothbrushes were manufactured only with a predictably straight, utilitarian design. Current models, however, are sophisticated dental tools built to meet highly personalized demands. The market offers an array of toothbrushes with various handle shapes, heads, tufts and bristles. One of the most recent trends in toothbrush design has been the introduction of tapered bristles, which are engineered to improve the effectiveness of cleaning and, by extension, enhance plaque removal. This feature was at the heart of a UNMC-based study that Barnes led comparing—under identical conditions—the efficacy of a toothbrush with soft, tapered bristles to one with soft, straight bristles.¹ The study results, published in the American Journal of Dentistry, demonstrated that tapered bristles provide superior cleaning ability.

According to Barnes, the study's most significant finding was that the soft, tapered bristles were better able to access the most difficult areas for patients to clean, including areas between the teeth, the gingival margin and subgingival areas. Toothbrush performance in these areas is vital, because an inability to clean interproximal spaces leads to interproximal caries, interproximal infection and inflammation of the gingiva.

Considering how toothbrushes vary in performance, patients should understand exactly the type of bristles built into the model they purchase. It is particularly important to point out that a toothbrush with soft bristles of varying heights doesn't necessarily mean that its bristles are tapered. Barnes suggests that patients look for packaging that clearly indicates the product features tapered bristles.

ADJUNCTS COMPLETE THE CARE

Although today's toothbrushes are engineered to be more effective than ever for disrupting biofilm and removing plaque, even the best toothbrush should not be considered the only tool needed for optimized oral care. Many patients still require oral hygiene adjuncts to complement toothbrushing and flossing, such as interproximal brushes and mouthrinses. Patients who have wide interproximal spaces for which dental floss would not be effective, for example, must use interproximal brushes wide enough to fill the interproximal space to remove dental plaque and biofilm. Mouthrinses may also be an advisable addition to brushing for patients with periodontal disease.

These aids are also important in the care of patients who lack the physical function to effectively use a toothbrush, and therefore cannot rely on brushing to remove plaque properly. The use of oral hygiene adjuncts may also be warranted for patients affected by specific physical or medical conditions, as noted in the comprehensive dental hygiene patient assessment.

PERSONALIZED PROGRAM

In tailoring a personalized care program, the most important thing a dental hygienist can do is base oral hygiene instructions and recommendations on individual patient needs. "It is also prudent to record the findings and recommendations in the patient's chart," notes Barnes. Clinicians should accept that some patients will refuse a recommendation for any care product other than what they already use. This, she says, should also be documented in the chart.

"These patients like the products they use—they're comfortable with them, and are not open to change," she explains. "In these cases, the best thing a dental hygienist can do is work with the products the patient will use, and provide appropriate instructions to remove the largest amount of dental plaque and biofilm possible." That's not to say that clinicians can't continue to delicately suggest that patients at least try the products that will likely benefit them most.

While advances in technology have improved the performance of today's toothbrushes, their effectiveness ultimately hinges on daily use and proper brushing technique. By helping patients choose the best brush for each individual, and educating them about effective self-care regimens—including brushing technique and adjunctive care products—dental hygienists can significantly contribute to their patients' oral health.

1. Barnes CM, Covey DA, Shi X, Yankell SL. Laboratory evaluations of a bi-level, extremely tapered bristled toothbrush and a conventional uniform bristled toothbrush. Am J Dent. 2009;22:84–88.

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INFECTIVE ENDOCARDITIS

Diagnosis of endocarditis is usually based on clinical, microbiologic, and echocardiographic findings. Treatment involves antimicrobial therapy targeted to the identified organism. Surgical indications include heart failure, uncontrolled infection, and prevention of embolic events.

Link to NEJM Article

Key Clinical Points

INFECTIVE ENDOCARDITIS

	• Staphylococci and streptococci account for 80% of cases of infective endocarditis, with staphylococci currently the most common pathogens.
	• Cerebral complications are the most frequent and most severe extracardiac complications. Vegetations that are large, mobile, or in the mitral position and infective endocarditis due to Staphylococcus aureus are associated with an increased risk of symptomatic embolism.
	• Identifying the causative microorganism is central to diagnosis and appropriate treatment; two or three blood cultures should routinely be drawn before antibiotic therapy is initiated.
	• When infective endocarditis is suspected, echocardiography should be performed as soon as possible.
	• Indications for surgery include heart failure, uncontrolled infection, and prevention of embolic events.
	• Treatment should involve a multidisciplinary team with expertise in cardiology, cardiac surgery, and infectious disease.
	• Indications for antibiotic prophylaxis have been restricted to invasive dental procedures in patients with a prosthetic valve, a history of infective endocarditis, or unrepaired cyanotic congenital heart disease. Bruno Hoen, M.D., Ph.D., and Xavier Duval, M.D., Ph.D. N Engl J Med 2013; 368:1425-1433April 11, 2013DOI: 10.1056/NEJMcp1206782

An island in dental need

Link to Article

10th Apr 2013

Zanzibar conjures up so many exotic images but there is another side to ‘spice island’, one that brings a special kind of visitor. Iqbal Fasal report

Ru MacDonagh, a consultant urologist from Taunton, Dr Jon Rees, my GMP and a doctor at Nailsea, Bristol, amongst several other medical professionals, have been instrumental with local teams in Zanzibar, in setting up HIP~Z Health Improvement Project, Zanzibar,a British charity, which is now in a joint venture agreement with the Ministry of Health,
Interestingly, the singer Peter Andre is also now involved with HIP~Z, helping to raise awareness of the serious lack of medical facilities and extremely low life expectancy on the island.
Over the past few years, HIP~Z has grown to encompass organisation and management of two hospitals, which offer essential very low cost treatments for up to 250,000 of the islanders who would otherwise be unable to afford surgical, maternity or other even basic, primary health care.
There is still a lot to do; a lot of medical items to be procured with many challenges ahead, but, encouragingly, lives are being saved and made better, one at a time.
Dental clinics
Retired Brighton-based dentist, Dr Feroz Jafferji, originally from Zanzibar, returned to the island three years ago and linked up with old classmates to set up OZ, Outreach Zanzibar (http://outreachzanzibar.org).
OZ has now combined forces with HIP~Z to organise at least two new fully functioning dental clinics, based in two separate hospital locations in Zanzibar, to offer so many people a chance to have simple restorative dentistry, who would otherwise have no access to any dentistry, except perhaps the most basic form of pain relief from locally trained therapists.
This is a really ambitious plan, one which I have committed to assist and enable – as a UK-based dentist with East African origins and many fond childhood memories.
Appeal
I hope fellow dentists can donate any redundant dental items – large equipment, hand instruments, consumables (in date or even slightly out of date are acceptable). From my previous experience when I appealed on behalf of Dental Help Africa many years ago, we were overwhelmed with almost 600 parcels arriving from all over the UK.
We do have ‘a man and a van’ available, so are able, within limits, to collect certain essential large equipment, by mutual agreement, if you feel your items have some use.

To donate, visit http://www.hipz.org.uk/donateHIPZ. Send any items to:
HIP~ Z Appeal for Zanzibar, c/o Dentalsaver (UK), Unit 9
, Carey Develoments, Tweed Road, Clevedon, 
BS21 6RR. Ring 01275 853323
or email bev@dentalsaver.co.uk.

Dental patients to be given direct access to hygienists and therapists

A decision by the General Dental Council (GDC) to give patients direct access to dental hygienists and therapists will mean more and more people benefit from these professionals’ expertise, according to a major dental payment plan provider.
From next month, patients will be able to see other members of a dental practice’s team, such as a hygienist, without first needing an appointment with, or prescription from, a dentist.
The GDC said it has taken the decision with patient safety as “an upmost priority”, noting that dental care professionals must only treat patients directly if they are appropriately trained, competent and indemnified.
Colin Perry, corporate channel manager at Denplan, said the change means that dental care professionals can see and care for patients within their individual skill sets, without the need for patients to see a dentist for an initial examination.
He said this is unlikely to have a significant impact on costs, but will allow patients to have scaling and polishing, oral hygiene advice or straightforward fillings done without the need for an additional preliminary examination by a dentist, thereby enhancing the link between dentistry and overall health.
Perry said: “Currently dental care professionals such as hygienists and therapists are relatively few in number, compared to dentists.
“However over the coming years, more and more patients will benefit from their particular skills and will see ‘a trip to the dentist’ becoming more of a ‘visit to the oral care team’. Maybe the old image of ‘drill and fill’ will begin to fade.”

Link to article

Maine Lawmakers Consider Bill to Allow 'Dental Therapists'

Link

04/10/2013 04:10 PM ET

Supporters say the bill will increase access to dental care, but opponents, including many dentists, say they're concerned that patients will be put at risk.

Supporters and opponents of a bill that would permit mid-level dental hygiene therapists to provide limited oral care under the supervision of a dentist are expected to square off tommorow at the State House. At issue is a bill, sponsored by House Speaker Mark Eves, that's intended to expand access to dental care in Maine, where 1 in 2 children currently lack access to dental services. Dr. Mary Williard has supervised a similar program in Alaska and she says Maine is ready for the new category of licensing for dental hygiene therapists. "The people in Maine hope to increase access to dental care for all people, especially people with MaineCare who are having trouble receiving the dental care in their communities," Willard says. Many dentists oppose the bill, and question whether the 500 hours of training required for the licensure is sufficient for performing invasive surgical procedures. The bill, LD 1230, will be heard in the Labor, Commerce, Research and Economic Development Committee Thrusday at 1 p.m. This story was reported by A.J. Higgins.