What does patient safety mean to you? Is a small investment worth saving a patient’s life? Or maybe the life of a staff member, or maybe even your own life? An interesting point was brought to my attention today during a Brain Food Seminar from a dentist who doesn’t believe in having an automated external defibrillator onsite due to clinic location being in close proximity to a hospital. “We don’t need an AED, the hospital is right across the street”.
This is one of my favourite and most frequent comments I hear in the industry. People tend to forget that cardiac arrest can occur at any age, at any time, to people of all fitness levels, and without warning. We only have minutes to help before death can occur.
Although your clinic may be close to a health care facility or even across the street from emergency responders, the emergency dispatch steps work the same way regardless of your location. Although the clinic may be located by a hospital or by an EMS station, we need to be able to take on the challenge of SCA should emergency responders be busy elsewhere. We also need to take into consideration traffic or road congestion. With such a high-risk emergency like sudden cardiac arrest, we do not want to take the risk of waiting on immediate attention from an outside party. For the health of our dental community and patients, I encourage all clinics to be equipped with an easy to use defibrillator because of course; it’s easier to be over prepared than under prepared.
HANSAmed Limited conducted a cleaning test and our findings are quite surprising. As it turns out, disinfectants are not all the same. All products have different specifications such as contact times, bacterial targets and active ingredients. This information is usually in the fine print which often accidently gets missed. There is no one to blame on this matter as it is a common human error to skim on the fine print. So, what we have done at HANSAmed, is an experiment testing cleaning efficacy. Using OPTIM wipes, CaviWipes, TB Minute Man, Sani-Cloth PLUS and Ultra Swipes we compared its ability to clean contaminated tiles. Using one wipe per tile, one hema-stick per tile, a 2-3-minute contact time and saline to hydrate we are able to detect each products ability to remove organic debris.
The results may or may not surprise you too. The test confirms that clean is not relative.
The idea of a successful dental procedure differs based on the opinion of the dentist and the opinion of the patient. To the dental clinician, a successful procedure could be: restoring a tooth, correct placement of an implant, or finally seeing pocket depth reduction in an uncontrollable 8mm infected periodontal pocket. To the patient, all of these factors matter as well. However, above all, a painless procedure is one major detail that a patient will base the procedures’ success off of. If the patients pain control is not taken into consideration throughout the entire procedure, they may reconsider going through this type of treatment again, or even worse, they may consider receiving dental treatment elsewhere.
Among all phobias, dental phobia is one of the most common. One (according to the patient’s standards) unsuccessful/painful procedure might cause mental trauma and have them never wanting to visit a clinic again. A story from some else’s bad experience may also discourage them from coming to the dental clinic.
The use of local anesthesia is closely tied with unpleasant experiences related to dental treatment and dental anxiety. Most fear has to do with dental injections:
General fear of dental injections
Pain of injection and of bodily injury from injection
Fear related to local anesthetic (such as side effects, inadequate anesthesia, etc.)
It is important to select a local anesthetic drug that will achieve the desired anesthetic effect as quickly and effectively as possible to complete the treatment while having pain controlled.
Ultracaine offers the advantages of not only a fast onset and profound action, but also the added benefit of two different vasoconstrictor concentrations. The 1:200,000 solution offers pulpal anesthesia in the range of 45-60 minutes, while the 1:100, 000 solution will extend further to 60-75 minutes. This is a significant advantage over the use of lidocaine HCl solutions, since they only offer pulpal anesthesia in the range of 60 minutes. By using a profound anesthetic, such as 4% Ultracaine, you will reduce the amount of discomfort your patient feels, without having to reinject due to the lasting effect making it a successful procedure for both the dentist and the patient.
Do we really know what we are getting into at the beginning of each and every dental day? We typically expect for each day to be like the last: successful and without mishap. I once read that 90% of life-threatening situations can be prevented. But how?
Prior to treatment, the patient will complete a medical history form, which is a moral and legal necessity to all health care professions. As important as the completed written medical history form is for the overall health of the patient, it has its limitations.
As a dental professional, I play an important role in emergency prevention. I often casually converse with the patient upon seating by asking how they feel about the day’s treatment or how they’re feeling in general. Responses from the patient could include having a headache, feeling hunger or feeling stressed. This is all part of physical evaluation. Once I develop a good idea of the patient’s physical circumstances and psychological state of mind, I communicate with the dentist. This is especially important if I hear of a potential emergency trigger. As patients tend to be nervous, scared or stressed to see the dentist, they may choose to confide in another dental team member instead. The physical evaluation tactic is used to determine how and if the patient should be treated (forewarned). A dental clinic should not feel obligated to treat a patient if they feel the patient is at risk of an emergency. We ask ourselves before the start of treatment: Should we sedate the patient for comfort? Are they able to tolerate the treatment? Do we need to modify treatment in any way? (forearmed).
As dental professionals, we care about the well-being of our patients. That is why understanding and performing a physical evaluation is so important. These physical evaluations aid in the prevention of a medical emergency.
Scientific research and literature remain the foundation of each avenue of dentistry. Dr. Giulia Cerino, Manager of Medical Communications at Geistlich Pharma, sits down with Dr. Steven Eckert to discuss the keys to success in regard to scientific research. Dr. Steven Eckert definitely has a library of tips and experience being a researcher himself as well as the Editor-in-Chief for the International Journal of Oral and Maxillofacial Implants. Whether you are conducting your own research, or you are looking forward to an interesting read – checking out this interview is without-a-doubt worthwhile.
Cleanliness and infection control have certainly come a long way in the dental office. I mean, there was once a time when you would go to your local barber and squeeze in a dental visit at the same time (seriously – believe it or not, barbering and dentistry co-existed up until the 1800s!). Nowadays, cleanliness is a top priority for dental offices, and for good reason.
In all areas of healthcare, infection control remains immensely important – and that is no exception in dentistry. Whether it is cross-contamination, infectious aerosols or harbouring bacteria, there seems to be an endless list of concerns to tackle in the dental setting.
Without proper precautions in place, bacteria and disease transmission poses a threat to both the dental professional and the patient. I understand that this sounds particularly daunting but, fear not! In today’s day-and-age of dentistry we have the solution for infection prevention to put the mind of both the dental professional and the patient at ease. Thank goodness for that because we wouldn’t want to revert back to the barber and dentist 2-for-1 deal!
The Centers for Disease Control and Prevention (CDC) is your go-to guide for all things infection control. A good place to start would be checking out the “Summary of Infection Prevention Practices in Dental Settings”. Here you can find how dental personnel can protect themselves and patients from infection. Whether it’s proper handing washing, safe injection processes or instrument sterilization, you’ve really struck the gold mine of dental safety precautions.
From this exhaustive list of precautions, I’d like to point out arguably the most stylish recommendation – personal protective equipment. These gloves, masks and gowns don’t resemble designer brands, but they are critical, nonetheless. The CDC advises for the use of gloves in situations involving possible exposure to blood, bodily fluids, mucous membranes, non-intact skin and other potentially infectious material. On top of that, such gloves are not to be worn with more than one patient and must be single use, washing the gloves is not an option. Similarly, gowns and masks are to be worn to protect skin during procedures where exposure to blood and bodily fluids is expected.
During essentially any dental procedure, you can expect exposure to bodily fluids – it is inevitable. As you can see from the CDC guidelines, it’s no surprise that personal protective equipment is a must in a dental setting. Fortunately, a brand by the name of OMNIA has you covered (literally and figurately) for all of your protection and infection control needs. Better yet, OMNIA offers different pre-assembled sets of disposables depending on the dental procedure at hand. These procedure kits allow infection control to be handled by providing dental professionals with all of the sterile and disposable materials they may need for the task at hand.
Approaching infection control with confidence is a breeze with OMNIA procedure kits in your cleanliness arsenal.
What do you consider to be “sedation”? Some clinicians consider “nitrous oxide” to be a form of sedation. Do you agree? Sedation is defined as either the state of being relaxed or sleepy because of a drug or the act of drugging someone with a sedative. In dentistry, there are different types of sedation levels including mild-moderate sedation and deep sedation in which such sedative medications are being taken before dental treatment to tranquilize the patient for their procedure. This happens quite often in a variety of clinics. Due to the commonality of this in practice, its often overlooked. However, any time a sedative (medication) is involved in the practice, the medical emergency armamentarium changes as well.
Province dependant, an Automated External Defibrillator is required in clinics upon the use of benzodiazepines. As of now, it is strongly recommended in all clinics but required where mild-moderate – deep sedation (and of course general anesthesia) is performed. In 2017 L’Ordre des dentistes du Québec updated their regulations to have all dental clinics across the province to be equipped with an AED whether or not sedation is involved. If you are not sure whether or not you need an AED at your clinic, it’s better to have one and be prepared than to not. The Philips HeartStart Onsite is proven to be one of the easiest AED’s on the market for all staff members, trained or not.
If your clinic is delivering sedation, altering someone’s state of mind, an AED must be present in your clinic. According to the heart and stroke foundation, cardiac arrest can occur at any age, any time, to people of all fitness levels without warning. Are you prepared to save a life? Are you complaint based on your clinic’s profile?
You can buy Philips HeartStart Defibrillator at HANSAmed’s iSHOP or you may Contact us for more information about the Philips HartStart AED
Periodontitis is a battle between the host’s mouth and the harmful bacteria causing the damage. Despite there being two players in this situation, the emphasis of current periodontal treatment only focuses on one part of the equation. The main spotlight is held on the pathogenic bacteria, or periopathogens, while giving little attention to sensitivity of the host and lack of mouth microbiota balance.
Presently, the main means of tackling periodontitis involves a combination of scaling and root planing (SRP) in addition to keeping up with good oral hygiene practices. However, these methods come with their limitations. While SRP can significantly decrease the amount of periopathogens in the mouth, the solution poses to be short-lived as the bacteria begins to rapidly re-colonize. Although the suggestion of maintaining impeccable oral hygiene following SPR sounds promising, the re-establishment of that bacteria is inevitable. Even when good oral hygiene practices are followed and used in conjunction with antibiotics or antiseptics, the pathogenic bacteria continue to harbor within the mouth.
It is evident that we are faced with a problem. With the inescapable army of periopathogens continuing to wreak havoc on the oral environment, a different approach to treating periodontal disease could be refreshing. This roadblock has caused professionals within the dental field to think outside-the-box in terms of periodontal therapy. This is where the use of beneficial bacteria comes into the equation.
Rather than battling against the stubborn and relentless periopathogens, new research suggests an alternative technique – balancing the host’s oral environment. This can be achieved through the introduction of beneficial bacteria in the form of probiotics. Promoting a balance in the mouth not only reduces the host’s susceptibility to the damage caused by pathogenic bacteria, it also provides an abundance of additional benefits. Some of these benefits include reductions in plaque, halitosis and caries-related risk factors, to name a few.
This particular topic has had a lack of exploration until recent years. In 2013, a study published in The Journal of Clinical Periodontology decided it was time to investigate. The study focused on exploring the adjunctive use of Lactobacillus reuteri following SRP in adults with chronic periodontitis. The researchers hypothesized that the use of lozenges containing this beneficial bacterium would be more effective in the maintenance of periodontal disease as opposed to SRP treatment alone.
With a sample size of 30 chronic periodontitis patients, the individuals were randomized into 1 of 2 groups: one receiving SRP plus a placebo and the other receiving SRP plus a probiotic. Monitoring of each patient occurred at the beginning of the study and continued to weeks 3, 6, 9 and 12. After wrapping up the clinical trial at week 12, evaluations demonstrated promising results and conclusions. Compared to the placebo group, the cohort receiving the probiotic in conjunction to SRP treatment showed significant pocket depth reduction as well as lower Porphyromonas gingivalis numbers.
The results of this study hold valuable conclusions that can be used in the advancements of non-surgical periodontal therapy. The introduction of beneficial bacteria, Lactobacillus reuteri in particular, is what some may consider the future of oral health maintenance. BioGaia Prodentis lozenges make use of this excellent lactic acid bacterium to better the oral health of patients. With its minty flavour and tablet-like appearance, administration is both easy and convenient. Although this study focused on treating periodontitis, BioGaia Prodentis lozenges have been studied and shown to help treat multiple other oral health related risk factors. Whether it is reduction in plaque, gingivitis, halitosis, you name it, BioGaia is ready to solve your problem.
Teughels, W., Durukan, A., Ozcelik, O., Pauwels, M., Quirynen, M., & Haytac, M. C. (2013). Clinical and microbiological effect of Lactobacillus reuteri probiotics in the treatment of chronic periodontitis: a randomized placebo-controlled study. Journal of Clinical Periodontology, (40)11,1025-1035.
Periodontitis is an inflammatory disease of the supporting tissue of the teeth caused by the presence of subgingival Gram-negative bacteria, the red complex bacteria (RCB). The red complex bacteria include Porphyromonas gingivalis (P. gingivalis), Treponema denticola (T. denticola), and Tannerella forsythia (T. forsythia, formerly Bacteroides forsythus). These are recognized as the most important pathogens in adult periodontal disease. RCB multiply rapidly and re-colonization is a persistent threat.
Periodontitis is usually treated with scaling and root planing (SRP), which removes subgingival plaque mechanically. This procedure, even when meticulously performed, improves periodontal status, but is rarely effective in the complete removal of periodontal pathogens. If left untreated, periodontitis can increase periodontal pocket depth (PD) and bleeding on probing (BOP), and may lead to the spread of active infection to healthy sites. That being said, due to the limitations of scaling and root planing, adjunctive therapy is an essential part of treatment. Minocycline HCl Microspheres Reduce Red-Complex Bacteria in Periodontal Disease Therapy (Goodson, 2007).
Arestin (minocycline HCl) Microspheres, 1 mg is a concentrated locally administered antibiotic that when used with scaling and root planing, is proven to maintain and control the chronic bacterial infection. Arestin is a site specific antibiotic meaning one carpule contains the correct dosage to treat one individual pocket at a time. The microspheres release antibiotic over time, targeting bacteria to reduce pocket depth, so gums can heal better than with scaling and root planing (SRP) alone1. Adding Arestin to SRP disrupts the pathogenic progression of periodontitis by specifically targeting the active infection.
Studies are show the hypothesis that RCBs are responsible for periodontal disease and that local antimicrobial therapy using MM + SRP effectively reduces numbers of RCBs and their proportions to a greater extent than SRP alone. (Goodson, 2007)
“Regardless of practice setting or employment arrangement, dental hygienists are expected to use their knowledge, skill and judgment to determine which treatment, product, drug, referral or combination of, is in the client’s best interest.”
(College of Dental Hygienists of Ontario, 2015)
In many industries, especially health care, there is a strong focus on improving education. Learning how to improve outcomes and enhance treatment and better patient care. Another aspect would be to refresh standing information or to see if there have been any new additions to the industry standards.
As a dental professional I look to find the truth with the best scientific backing possible. My current focus has been uncovering the additions or edits needed to follow infection control.
Where do we start?
What information is correct?
Who can assist me?
These are all very valid and global questions at the moment. My goal is to tackle the confusion, build confidence and answer as many questions as possible one demo at a time. Join me along my journey of answering questions and uncovering truths like sterilization monitoring and how to complete it efficiently and correctly.