Tag: Medical Emergencies

Toothbrushing is the most effective way to remove food debris and plaque from the teeth, which helps prevent cavities, gingivitis, periodontitis, candidiasis and bad breath.
There are manual and electric toothbrushes. Within each type, there are a few options available. So, what kind of toothbrush is best?

Let’s look at manual toothbrushes first.

There are two major types of manual toothbrushes.

The first type is made of natural wood sticks from miswak, neem or babool trees. All three are traditional chewing sticks prepared from the roots or twigs. Studies have demonstrated that they all have an antibacterial effect against Streptococcus mutants, a cavity and gum disease-causing oral bacteria.

The sticks needed to be prepared by chewing the end to create the bristles. However, the strands tend to be hard. The filaments can be difficult to effectively brush the areas between molars and the backs of the front teeth because the filaments are in a straight line with the stick and cannot be bent to reach those areas. Despite its potential antibacterial and anti-inflammatory effects, the sticks can cause damage to the gums, which leads to gum recessions. It is also challenging to get the tips of the bristles to effectively scrape the plaque and food debris away from the tooth surfaces.

Photo courtesy from the article “A review of the therapeutic effects of using miswak (Salvadora Persica) on oral health.” SaudiMed J.
Authors: Mohammad M. Haque, BDS, MPH and Saeed A. Alsareii, SB (Surg), JBGS

The other type is made with a plastic, wood or bamboo handle with nylon bristles at about 90 degrees to the long axis of the handles. That configuration allows better contact with the molars and other difficult-to-reach areas. Dentists only recommend using toothbrushes with soft bristles to prevent “brushing” the gums away. There are a few different shapes, sizes, arrangements of the toothbrushes for diverse needs and purposes.

There are two major types of electric toothbrushes too!

The first type is the oscillating rotary heads, which are circular heads that spin and move back and forth. The exemplifying one is by Oral-B. The newer one has a blue tooth connection to your smartphone that can monitor your brushing in terms of time spent, pressure on the teeth, power level, etc.
The second type is the sonic brush heads which vibrate back and forth extremely fast. Philip Sonicare is the best-known brand using this technology. It also has a blue tooth connection to an app on your phone to monitor the brushing like the Oral-B.

Courtesy of Oral-B and Philips Sonicare

Overall, electric toothbrushes are more effective and efficient in removing plaque and debris simply because they have much faster strokes/vibration per minute than manual toothbrushing. The brush heads of the electric toothbrush are usually smaller than the manual toothbrush heads, especially the Oral-B one; therefore, the bristles can effectively contact the hard-to-reach areas like the molars, the spaces between teeth and the back of the front teeth.

Using electric toothbrushes needs less hand movement and requires less hand dexterity. Hence elderlies with poor hand coordination, patients with muscular dystrophy, multiple sclerosis and parkinsonism can benefit from the do-it-for-you movements of electric toothbrushes.

Patients with braces may also find it easier to clean their teeth with electric toothbrushes.

Despite the superiority of electric toothbrushes in food debris and plaque removal, they do have some factors that some patients may find to be unacceptable. For example, the sound and vibration may be too uncomfortable for certain patients. The initial cost to purchase an electric toothbrush is higher than the manual one. So as the cost of the replacement heads for the electric one is more expensive.

Last week, I blogged about dentists’ stress in their clinical lives.

Stress can never be eliminated from a dental practice. However, it must be minimized as much as possible to avoid the many stress-related physical and emotional problems that it causes.

The key to successfully managing stress is recognizing and understanding its causes. Once the causes have been identified and understood, preventive steps can be taken.

Stress can lead to dysthymia, anxiety, loss of appetite, physical health deterioration and depression. Dentists with excessive stress constantly can end up with alcoholism and drug abuse, unstable family life, divorce, burnout, mental breakdown and suicide.

Statistically, divorce dentists are three times more likely to commit suicide than divorced people in the general population.

The cause of these mental health issues can stem from various things. Many dentists work long hours and can get burnt out quickly. There is a lot of pressure on the job to do things perfectly. Plus, you might not always have the most pleasant patients to deal with.

Some of the preventive measures that could minimize the stress of dental practice are as follows:

• Confinement

I like to have large windows in all my operatories in my practice. I like the operatories to be large and not fully enclosed with drywall and doors. There are a lot of dental offices in a shopping plaza which provides a limited view of the outside world with windows.

However, the average dentist spends most of their life confined to a small, sometimes windowless operatory. Besides adding windows, most of the time is impossible; there are other ways to improve the working environment; dentists can hang photos or pictures on the walls, install glass wall partitions instead of solid wall partitions, and enhance the lighting by adding more warm light (2700K – 4000K) to the bright daylight lighting.

The dentist should sit upright on the dentist’s chair with easy movement around the patient’s head. The dental equipment and instruments should be easily reached without excessively straining the dentist’s head, neck, back and shoulder. It is all about ergonomic with good design and layout of the treatment cabinets, patient’s chair and dentist’s chair.

• Isolation

When dentists practice alone, there is less opportunity to share and solve problems with their colleagues. Dentists need to have a broader network of fellow practitioners to share issues and frustrations. Through peer support, problems can be solved easier.

I recommend joining the local dental society, which regularly provides social networking and seminars. I, for one, am a member of the Burlington Dental Academy, which allows me to have more venues to communicate with my colleagues.

We should communicate more with colleagues, health care practitioners, friends, and staff about issues and concerns.

Having more than one dental practitioner in practice, with associates or partners, often can alleviate the mental stress with isolation and lack of understanding.

• Long hours

I have been there and done that; I worked seven days a week with extended hours each day. Long hours put a lot of stress on my mental and physical health.

Working more sensible hours and taking time each day for a leisurely lunch break;

Have a longer buffer time between each patient and ensure enough time for the lunch break.

• Lack of exercise

Adopting a program of physical exercises, such as regular walking or working out at a local health club;

Take a leisure walk during lunchtime.

• Stress of perfection

The relentless pursuit of perfection and permanence in an inhospitable oral environment is a significant cause of stress and frustration for dentists. The emphasis on perfection is instilled in dental school. However, it must be tempered with the realization that a perfect restoration will ultimately be rendered imperfect by time and patient neglect, despite the dentist’s efforts.

Most important, being kinder to yourself and less critical and demanding of your efforts.

We cannot meet all patients’ unrealistic expectations. We need to tell the patients who demand such expectations that we cannot provide such treatment and recommend the other options. Be prepared to refer the patients to specialists or colleagues for a second opinion.

• Economic pressure

The cost of dental education can easily be over $250,000 to complete if the dental education is in Canada. For those who got their education done in the United States or overseas, the cost can easily be over $500,000 in us dollars.

In addition, the cost of setting up a new dental office can easily be over $500,000. The cost of buying an established practice is even higher – it can easily be two million dollars or more.

Once in practice, the dentist soon learns that office overhead rises to meet income. The overhead often surpasses the revenue in the first few years.

The financial burden is whopping! The dentist who works all the time and never takes time off might make a few dollars more, but there is a high price to pay — BURNOUT! And when dentists burn out, they become emotionally and mentally exhausted, develop a negative, indifferent or cynical attitude towards their patients and their staff, and negatively evaluate themselves.

We need to manage our overhead well, do the expansion with caution, and know the return on investment. We need to be careful about our expenses on professional social media management, the cost of marketing, the cost of equipment updates and acquiring newer technologies.

We need to have a spreadsheet showing the expected incomes versus the cost of the purchases and expenses, including your time and health.

We may want to start as an associate first to pay back the student loan and then consider the ownership of a practice.

Much of the stress that dentists experience is self-inflicted and a product of acting out their strivings and ambitions. In other words, dentists themselves often are the source of most of the stress they experience.

• Staffing pressure

Keeping a supportive and stable staff has been extremely difficult through the history of practice ownership. The situation is worse nowadays with the COVID.

Hiring and keeping the right staff is an art that no single course can teach you.

An excellent dental management consultant can provide you with some advice and management, but they can be very costly.

There are a few basic principles that the staff will more likely want to work with you and stay working with you. Take home money is essential, but it is not all. All staff want a non-stressful environment where they feel comfortable performing their required duties and responsibilities with respectful recognition and acknowledgment from their employers.

If you do not provide enough training, direction, and communication of your expectations, the staff will feel stressed out when performing their duties. It is a vicious cycle that will perpetuate and multiply. They want respect and recognition.

We need to lower our expectations and recognize that each person has a different level and scope of capabilities. We need to make professional development a Top Priority and encourage a conduit for all-way communication in the office.

• Time pressure

Attempting to stay on schedule in a busy dental practice is a chronic source of stress. As we all know, once we are behind schedule, there is no way to catch up. It is important to book enough time for each procedure, provide buffer time between patients, and ensure enough sterilized instruments and supplies for the day.

Make sure there is a time for emergency patients, and do not be afraid to turn away some patients or rebook the patients back for further appointments. You cannot see everyone and make every patient likes you.

• Compromise treatment frustration

Most important, being kinder to yourself and less critical and demanding of your efforts.

Invite the patient back for the remedial work with no charge. Do not count the cost but gauge the degree of satisfaction

We need to know our limits and refer out for additional care if the case is too challenging. Engagement with continuing dental education can also help us to improve our skills and knowledge.

• Patient anxiety

The psychological stress of working with apprehensive and fearful patients can be devastating to the dental practitioner. There is now considerable evidence that dentists experience patterns of physiological stress responses (increased heart rate, high blood pressure, sweating, etc.) that parallel the patient’s responses when performing dental procedures that evoke patient fear and anxiety. We need to learn how to handle patient anxiety and hostility better.

If you have an extremely fearful and anxious patient, suggesting things like rescheduling or offering general health and wellness tips can help.

Sedation like anxiolytics and nitrous oxide can be very helpful for certain patients. Referral to a dental specialist who can provide the needed sedation or general anesthesia can save the grace.

• Processing a good dentist’s personality:

We should show compassion to ourselves and know our limitations. Besides managing the daily operation of the office, managing stress in the office is equally essential.

Things like mindfulness, leisure walk and meditation can help you throughout the day.

We need to be mindful of ourselves, our stress, lives, and families. Harmonious family life will reduce stress at work. Being content leads to security, and security leads to happiness.

Managing your stress every day is crucial to getting through some of the things listed above. Be mindful, relax and seek help if the stressors start to cause problems to you.