by Joseph A. Blaes, DDS
As I travel the country speaking to dental groups, I find that many dental practices are still operating their hygiene departments as a "loss leader." (Please read a related article in this issue by Dr. Bob Hamric. He will detail the things you need to do to bring your hygiene department into the 21st century.)
The most common error in any kind of restorative dentistry is the failure to diagnose the condition of the gingival tissues. This lack of good gingival tissue health causes most of the problems associated with providing quality dentistry for our patients.
Have you ever been in this scenario? You enter the treatment room and Mrs. Smith is in the chair to have tooth No. 14 prepared for a crown. A large amalgam is present; it has cracked in half, and the broken piece is irritating the tissue. Mrs. Smith has not seen the hygienist for 12 months. The surrounding gingival tissue is puffy and reddened, which indicates — at the very least — that the tissue is inflamed.
So you anesthetize the patient, place a rubber dam, and begin prepping the tooth. Once the broken piece of amalgam is removed, the tooth fills with blood. The tissue is in worse shape than you imagined. You remove the rest of the amalgam and realize that this tooth is going to need a build-up. How do you control the bleeding in order to place the material? Well, maybe you can get by that challenge. You begin prepping the tooth for a crown; as you try to set your margin, the rest of the tissue begins bleeding. Trying to prepare a tooth in the presence of inflamed, bleeding tissue is almost impossible. It is hard to see what you are doing when you are working in a pool of blood. Somehow, you finish the prep. You now begin the almost endless task of packing the tissue to stop the bleeding. You finally get it under control and remove the cord to take impressions. But guess what? The bleeding starts all over again. By this time, you are way behind schedule and have two patients waiting, along with a hygienist whose work needs to be checked. Do you get further behind by trying to control the bleeding again? Do you try to take an impression anyway, because, after all, it is a hydrophilic impression material? Or do you place a temporary and reappoint the patient? What is going to happen in the interval that is going to make taking this new impression any easier?
Are you all stressed out from reading this? I am already feeling tightness in my chest; I have been there too many times. But I decided that I was never going to be there again. To deliver my finest dentistry, I must have the oral tissues in the best health possible. It is so much easier, faster, and better to work around healthy, pink gingival that is nice and tight.
Let's re-examine the above scenario. What if you temporized the tooth and reappointed the patient with the hygienist? The hygienist will gather the information necessary to diagnose her periodontal condition and decide on a treatment plan. As the hygienist works through the treatment plan, she will be educating the patient. These are some of the issues that are important for the patient to understand: tissue health, the role of home care, maintenance visits, the importance of restorative dentistry, and the role healthy tissue plays in keeping her teeth for the rest of her life.
When the hygienist has completed her treatment plan, it is time for the dentist to see the patient again. Why not reschedule Mrs. Smith for a complete exam so you can tell her everything about her mouth? It makes sense to me. In my practice, we would see Mrs. Smith in my schedule for a complete examination, work up a treatment plan, and do a treatment conference to tell her the results. Now, we schedule in an appropriate way and not are concerned about tissue problems interrupting our restorative appointments.
In my practice, a couple of home-care products that we recommend to patients help them maintain healthy gingival tissue. Today, the consumer market has really moved into the "natural products" area. Look at how many people are drinking bottled water. Even on airplanes, I am offered bottled water.
You may use Peridex as I once did. Sure, Peridex works; used religiously, it will aid in the healing process and help effect a speedier and more satisfactory recovery. So, why did I quit using it? Peridex often fails to work because of a lack of patient compliance. It would make sense to counsel the patient on the side effects of chlorhexidine therapy. If patients are aware that they may encounter significant brown staining, then shouldn't compliance improve? Maybe. But in a practice environment that caters to patients, excusing an ugly side effect is not the best we can do.
I have found a wonderful product with all-natural ingredients that is making a huge difference in helping our patients get their tissue back to normal. A few years ago, I met an extremely knowledgeable dentist, Dr. Bernard Schechter. Besides being a practicing dentist, he has a certificate in herbology and extensive training in microbiology. After 20 years of research, he has introduced a truly natural herbal and essential oil remedy to help alleviate periodontal problems nonsurgically. Through his Dental Herb Company, he sells a line of highly effective products that every dental office should be using. The first product is his "Tooth and Gum Tonic" that contains seven different herbal and essential oils. I don't understand everything that Dr. Schechter tells me, but I can tell you this — it works! If you want exhaustive detail on why it works, call Dr. Schechter at (800) 747-4372.
If you are looking for more than a periodontal remedy, read on. Dr. Schechter had the opportunity for Dr. Gordon Christensen to look at his new product in the Clinical Research Associates labs. CRA's first study did not evaluate Tooth and Gum Tonic as an adjunct in periodontal therapy. The first CRA evaluation pitted Dr. Schechter's product against 16 well-known breath remedies. Tooth and Gum Tonic was ranked number one of all the products tested. This included over-the- counter products and many dental products marketed directly to the dental office. It is well-known that the pathogenic bacteria associated with halitosis are also associated with periodontal disease. If you are looking for a way to help your patients have healthy gingival tissues, then you should take a look at Dr. Schechter's Tooth and Gum Tonic.
Another product that can help your patients achieve periodontal health is Hydro-Floss. I have used this product personally and wrote about it in "Pearls for Your Practice" in the April 2001 issue of Dental Economics. It works very well with another product from Dr. Schechter, "Under the Gum" irrigant.
So what does all this have to do with a restorative practice and prepping teeth? I found that the change to better restorative dentistry came after we had changed our hygiene department from a tooth-cleaning factory to a perio-driven hygiene program. The entire practice became dedicated to a healthy foundation as the key to the best restorative dentistry possible. Once the hygiene program was on solid footing and patients were responding well to treatment, we began to explore the new world of aesthetic dentistry.
The entire team — including the hygienists — began attending technique and material lectures and seminars. Back at the office, we began to restore the mouths of all the staff. I feel that it is important for everyone who works with me to have a first-hand experience of my high skill level so they can relate this to the patients. Having experienced excellent dentistry in their own mouths, staff members are easily able to communicate the benefits of this type of dentistry to their patients.
To be effective, hygienists must become completely aware of the restorative philosophy of the practice. The hygienist must become a student of the clinical techniques and materials of the office. Once hygienists understand restorative dentistry, they are better able to contribute to the success of the practice by educating patients about the restorative possibilities offered by the practice. Hygienists can show off their own beautifully restored mouths as a model of the commitment to excellence that exists in the practice. Patients will better understand the need for restorative dentistry and what the benefits are for them. Case acceptance levels will rise dramatically. Stress levels drop, and dentistry becomes more fun for everyone on the team.