About Me: Hi, I'm Kara and I'm the founder of Dental Hygiene Answers! I started this site to expand the dental hygiene community beyond my Facebook page, Dental Hygiene with Kara RDH. I get many questions on a daily basis through my FB page, so I thought I would create a space where I can share my answers, as well as give other hygienists the opportunity to answer questions from their peers. I am always looking for ways to improve this site, so if you have any suggestions feel free to contact me on my FB page!
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Location: Portland, Oregon
This is a tough one to answer because of the small number of employees in a dental office. For a definitive answer it might be best to contact California’s Employment Development Department directly: http://www.edd.ca.gov/Disability/Contact_DI.htm
From contacting employment agencies in the past, I’ve found that depending on who you talk to you can get different answers so it may also be a good idea to contact an employment/labor attorney to confirm the info you are given. I’m sorry I can’t be of more help, I just don’t want to give you an incorrect answer because I don’t know California employment laws.
Congrats on expecting a little one! How exciting!
Question: Pregnancy Leave Requirements | February 19, 2017
As long as they aren’t swallowing it (just like any other fluoridated toothpaste) or have any contraindications based on health history, I don’t see any reason why a person couldn’t use a prescription fluoride toothpaste indefinitely if its needed (high caries risk due to xerostomia, sensitivity due to root exposure, etc.). It comes down to the individual needs of the patient, being aware that these needs can change and need to be assessed in an ongoing manner. On the 3M Clinpro 5000 website they state, “You can use Clinpro 5000 toothpaste in place of your regular toothpaste for the time needed to prevent tooth decay.” http://solutions.3m.com/wps/portal/3M/en_US/dental-oral-health-care/dental-patients/prof-products/clinpro5000-fluoride-toothpaste/
Question: Clinpro 5000 | February 19, 2017
By definition a prophy (D1110) is, “Removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.” It is preventive in nature, for a patient with healthy gingiva and pocket depths.
Non-surgical periodontal therapy (SRP) (D4341/D4342): “This procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in nature. Root planing is the definitive procedure designed for the removal of cementum and dentin that is rough, and/or permeated by calculus or contaminated with toxins or microorganisms. Some soft tissue removal occurs. This procedure may be used as a definitive treatment in some stages of periodontal disease and/or as a part of pre-surgical procedures in others.” This is for patients who have active periodontitis with clinical attachment loss (bone loss, recession, furcations, etc.), the key work here being “active.”
Don’t hesitate to pull out your Wilkins book or any perio books you may have and even talk with your instructors to clarify and understand better. Use your instructors while you have them! Also, don’t forget about your ability to research; Google searches can bring up great information, just make sure you find reliable sources. Here are two links that you might find helpful:
Question: Prophy vs. SC/RP (scaling and root planing) | February 17, 2017
Depending on the insert(s) used, some research has shown that ultrasonic scaling is as effective as hand instrumentation. Here’s a study for example: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928767/ With that said, the dental hygiene educators I know teach the use of ultrasonics should be followed by hand scaling for the most effective clinical outcomes. Personally, I wouldn’t feel like I treated a patient thoroughly without using both hand instruments and an ultrasonic. I feel I have more tactile sense with hand instruments too.
Question: What do you think about a hygienist that never picks up a hand scaler during SRP and only uses the ultrasonic? | February 16, 2017
If you are already stressed out at the amount of time you are given (or lack thereof) for appointments, it may not be a job you want to accept. Personally, I don’t feel like 1 hour for full mouth SRP is enough time. Offices that are patient-focused tend to give 1 hour per quad so you able to treat the patient thoroughly. Not having an appropriate amount of time for appointments is not only a disservice to the patient but its hard on the clinician, both physically and mentally. Burn out is a big possibility with keeping a schedule like this, as is musculoskeletal injury.
As far as injection landmarks, they would be the same as if you were doing 1 quad.
ASA/IO: height of mucobuccal fold directly over first molar. Feel for infraorbital notch below eye pupil, move down to foramen.
PSA: height of mucobuccal fold above the maxillary 2nd premolar, 45 degrees out and down from occlusal plain. Other landmarks: maxillary tuberosity, zygomatic process of maxilla.
MSA: height of mucobuccal fold above the maxillary 2nd premolar.
IA: insert at mucous membrane on medial side of mandibular ramus, height of where pterygomandibular raphe goes vertical. Insertion: half way to coronoid notch, then half of that back (1/4 out from raphe), barrel of syringe over contralateral premolars.
long buccal: mucous membrane distal and buccal to the most distal molar in arch, syringe parallel to occlusal plane.
UR: ASA/IO (2/3-3/4 carp), MSA (1/2-2/3 carp), PSA (3/4-1 carp)
UL: ASA/IO (2/3-3/4 carp), MSA (1/2-2/3 carp), PSA (3/4-1 carp)
LR: IA, long buccal (1 carp)
LL: IA, long buccal (1 carp)
If a patient isn’t profoundly anesthetized and an injection must be redone or additional infiltrations need to be done, there’s added anesthetic.
Some hygienists like to do all 4 quads at once, however you need to question if you are comfortable giving that much anesthetic and if the patient can even handle having their entire mouth anesthetized. On a side note, its normally not recommended to anesthetize the entire mandible at one time because of self-mutilation risk. Being numb also makes patients feel “swollen” and a patient can panic if they feel like they cannot breath or swallow. Not that we treat according to insurance, but some insurance won’t cover a full mouth in one sitting. To get around this, some offices submit the claim over several days, which is fraud. You definitely don’t want to be a part of that!
Lastly, when hygienists accept being treated like a money-maker robot and accept working under these conditions it perpetuates the cycle of hygienists being treated poorly and isn’t good for the hygiene field as a whole. Not to mention it perpetuates a cycle of poor patient care. Its best to stick with offices where patient care is the main focus, not just the bottom line (money).
Question: One hour full mouth SRP | February 14, 2017
You might want to contact the local ADHA component or even a hygiene school for direction in finding a local course. I believe the American Board of Dental and Hygiene Licensure Prep Courses, Inc. (http://www.americanboardprep.com/) offers courses in Florida. Best of luck!
Question: dental hygiene refresher course | February 13, 2017
I agree with you, this is ridiculous! I’m so sorry this happened to you! While I’ve never had this happen to me, I’ve heard of it happening to others unfortunately. On the bright side, if an office doesn’t support you and is this quick to fire you, its not an office you want to be at anyway. Better to find out sooner than later. The least they could have done was see which hygienist (temp or you) saw the complaining patient though! Again, I’m so sorry this happened to you, look at it as a blessing in disguise!
Question: Fired for One Bad Social Media Review | February 7, 2017
Pathogenic bacteria can recolonize to pretreatment levels in about 9-11 weeks (2-3 months), but this recolonization can vary among patients. Because of this, after non-surgical periodontal treatment/SRP, I like to place patients on a 3 month recall. As time passes, if their periodontal condition remains stable, then I re-assess whether they can be placed on a 4 month recall. However, if signs of disease begin again, I like to tighten it back up to 3 months. This is not a “set in stone” protocol, it’s just what I do based on research of the topic. You make the decision based on your clinical judgement; evaluate the patients’ homecare, severity of disease, risk factors, etc. Each patient is different!
Question: 3 or 4 month recall? | February 6, 2017
The manufacturers of Arestin recommend placement at the time of SRPs, however many hygienists place it as needed if certain sites aren’t responding. Arestin can be billed to medical insurance so that’s an option to help patients afford it. I would hate to see patients decline treatment all together because they can’t afford Arestin, so declining that portion of treatment should be an option for them. I should mention that a study in the Journal of the American Dental Association, looked at the benefits of SRP with and without adjuncts (lasers, antibiotics) and the results showed no clear benefit to locally placed antibiotics such as Arestin over SRP alone. Here’s the link: http://jada.ada.org/article/S0002-8177(15)00334-7/fulltext
Question: Arestin Placement | February 3, 2017
While the research shows some possible promise to the efficacy of oral probiotics, it also shows the jury is still out and more research is needed. I tend to err on the side of what research shows, so I haven’t yet recommended oral probiotics. Here are some studies that you may find helpful in whether you want to recommend them or not:
Question: oral probiotics | January 29, 2017
Wow, unbelievable! First, who is the person who is in charge of patient’s insurance and doing the insurance breakdown? If it’s not you, then YOU should not be “punished” for THEIR (big) mistake. Coverage should be checked before the patient even sits in the chair! So in my opinion, doing any work (especially SRPs!) you should be compensated and no it’s not fair that you aren’t. The Fair Labor Standards Act, which is Federal law, states that any work done on behalf of your employer must be compensated at or above minimum wage. Of course I believe you deserve more than minimum wage, but that’s just what the law says! So this almost makes me wonder if a Federal law is being broken here…
Regarding the no shows: I wonder why there are so many no shows. Do you have an office policy that patients sign stating that after so many no shows they will be released from the practice? Also, are these recall patients not showing up or new patients? If its recall patients, then something is going on there. Whether it be a patient care issue, front desk issues, whatever, finding out why this is happening, so it can be fixed, should be number one. I have heard of some offices making the hygienist clock out if there is a no show, however I think if you remain busy stocking, sharpening, even filing, I believe you should be paid for the same reasons I stated above.
If these things continue to be a problem, honestly, I would look for another office to work for. I know that’s hard, especially since you are only working part time right now and are probably looking for a full time job anyway. On the bright side, if and when the patient base grows in the practice getting paid on production can be extremely lucrative.
I hope I was able to help at least a little, and best of luck going forward!
Question: Should I still be getting paid if there is an insurance screwup and the office doesn't get paid? | March 16, 2014
Oil pulling is popping up all over the internet lately and I too am starting to have patients ask me about it. In fact, one patient of mine who has been oil pulling is now in need of SRPs as he presented with radiographic calculus, generalized 6mm pockets, mild bone loss, furcation involvement, and recession. I could barely get through perio charting as he was so tender due to infection. I don’t like not having a science-based answer when it comes to patient questions (even though clinically I had my answer) so I began my research into oil pulling.
Oil pulling is an ancient Ayurvedic remedy for oral health and detoxification. It involves the use of pure vegetable oils as agents for supposedly pulling harmful bacteria, fungus, and other organisms out of the mouth, teeth, gums, and even throat. As a hygienist, I’d like to focus on the oral health benefit claims as many people are oil pulling instead of brushing and flossing.
First, we need to look at dental plaque. For review: dental plaque is a bacterial biofilm that forms a physical barrier, a polysaccharide matrix, which protects bacteria from the effects of antibiotics, antiseptics (rinses), and your immune system. This is why taking an antibiotic for gum disease is not effective, as the antibiotic cannot break through the biofilm’s protective layer. The claim that oil can break this through this barrier has not been proven. The most effective and proven method to disrupt biofilm is through mechanical/physical means, in other words by brushing and flossing.
Next I’d like to comment on the claims of oil pulling “healing” gum disease. Simply rinsing with mouthwash, oil, or any other liquid only reaches 2 mm into a gingival sulcus. Most people have deeper pockets than this, especially when they have gingivitis or periodontitis. This is why rinsing, alone, is not the delivery of choice. Like mechanical removal of biofilm, this has been proven in scientific studies. So why would oil be able to miraculously get deeper into the pocket? Until I see a valid, reproducible, scientific study, again I must hold true to what has been proven thus far.
When you read these articles online I hope you notice who they are written by. Were they written by a dental hygienist or dentist? When studies are referenced validating the claims of oil pulling are you able to easily find these studies and fact check? I’ve noticed that the study results referenced in many articles were written in a way to make oil pulling look effective, but the actual results of the research were actually left out! For instance, saying oil pulling was effective after 4 weeks regarding plaque reduction, but leaving out the control group using chlorhexidine was effective at 2 weeks. Further, wouldn’t just swishing with water or any liquid for 20 minutes be just as “effective?” The studies do not delve into if it was the actual oil or the act of swishing that made it effective. Also, what about probing depths, bleeding indices, using a control group of just water or salt water, etc. So many questions unanswered!
Finally, brushing for two minutes twice per day along with flossing for a few minutes once per day, simply takes less time. I have a hard time motivating patients to brush for two minutes let alone swish with oil for 20 minutes! So if a patient chooses to oil pull, doing it in conjunction with brushing and flossing and not as a substitute, would be my recommendation as an oral healthcare professional whose job is prevention. A healthy mouth is a healthy body; so until I see scientific research that shows that oil can reach the bottom of a gingival pocket, can break through the barrier of biofilm, among other points of interest, I’m sticking with what is proven!
As hygienists, it is our duty to use science-based evidence so I urge you to do your own research and use your critical thinking in combination with what you know to be fact from your hygiene education to base your opinion on this fad.
Question: What are your thoughts on oil pulling? | March 22, 2014
In most cases, any pain or discomfort will get better without treatment. But if you have severe, ongoing pain, medication can help. These are examples of what your doctor or dentist may prescribe:
Over-the-counter pain relievers
Mouth rinses with anesthetic
Corticosteroids applied directly on the tongue
If you’re wondering about steps you can take to hasten the relief of symptoms, try limiting these substances or avoid them altogether:
Hot, spicy, or acidic foods or dried, salty nuts
Toothpaste with additives, whitening agents, or heavy flavoring (toothpaste for sensitive teeth is a better choice)
Question: Does anyone know how to soothe the burning of Geographic Tongue? | May 2, 2014
With time comes confidence. It sounds like you may be getting stressed out because of the limited time you have for SRPs. It also sounds like you are perceiving it as a need to question your technique, instead of the circumstances you are faced with. This may be presumptious, but is it time to move on from your current office? Top-notch patient care seems important to you and if you don’t feel like you have the proper time to accomplish this, it’s just not worth the stress. As far as taking BWX after SRPs, it’s not a must, unless as Sue Halverson stated, there’s a tenacious, questionable area. Just make sure you have an 11/12 explorer handy! That may not be the most popular answer, but I feel like you might be held back by working with an office that doesn’t share your same patient care standard. I want to applaud you for trying to be the best you can be! You are a professional, you got this!
Question: SRP | September 27, 2014
If an OSHA inspector saw this, your dentist would be fined. OSHA states to change masks between patients or during patient treatment if the mask becomes wet. A gown can be worn all day unless it becomes “visibly soiled.” It may help to print out OSHA guidelines to show the people who are in question.
Question: Using same mask all day | August 2, 2014
In my experience, I’ve not been given a lower pay rate for attending mandatory training or meetings – and I’ve worked for some very frugal doctors. I do agree with you that your time should be valued! My question would be, is every one in the office getting a lower rate of pay? If not, than that inflates the issue. It is my understanding that under the Fair Labor Standards Act, pay can be lowered but I believe you need to be informed and consent. I’m not an attorney, so that may be worth investigating. It’s hard to be a team player, if you are not valued as part of the team. This is a tough issue to address with the doctor, but it may be worth a chat him if only to express your feelings of being undervalued. I wish you the best of luck with this!
Question: Regular pay rate vs. education pay rate | February 5, 2016