Questions to Ask Your Dentist In The Time of Covid19

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Ann Ossinger, RDH, BSDH, EPP

Questions to ask your dentist in the time of Covid19:
By Ann Ossinger, RDH, BSDH, EPP

Unfortunately, we cannot eliminate risk, but we can mitigate the risk as much as possible. Personally, I wish every dental provider, clinic staff, and patient could be tested for Covid19 prior to anyone entering the dental clinic. That is not currently possible, at this time. I hope to see instant “chair-side” tests, to reduce the risks of treating asymptomatic patients soon.


You will have to ask yourself about your own personal risk (age, underlying conditions, etc.) to be weighed against the risk of any untreated dental concerns. At this time, I only recommend emergency (pain & infection) and possibly urgent (non-emergency, yet really needed) treatment at this time. I might change my recommendations within the next few weeks as this is a dynamic situation that is changing on an almost daily basis. Teeth cleaning DOES become more urgent as time go by, but waiting a few weeks right now is best. We will learn a lot about dental clinics, Covid19 and risks in the next few weeks ahead.


Dentists and hygienists are also trying to thread the needle between risks of NOT treating oral conditions and the risk of Covid19. We know that inflammation, bone loss, pain, infection, and other conditions can lead to even more systemic problems. Do No Harm.
There really aren’t WRONG answers to these questions, they are meant to elicit thoughtful answers and hopefully make you feel safer if the process has been well thought through.


Basic Infection Control covers a lot more territory than what this is meant to cover, but most dental clinics are well versed in blood borne pathogens, sterilization and other infection control issues. This is meant to discuss the more recent changes given the new Covid19 reality. Infection Control in this letter covers Administrative, Engineering, and PPE in this context.

CDC (Center for Disease Control) link to recommendations to open dental clinics https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html?fbclid=IwAR2keR4cUJ7hoRr8AY82qRyfIR5t9VUmi_mXoabIfPpnf4Zd_HfhBqdV470

  1. Administrative Controls

Things will look and feel a little different, you will mask, check in by phone, won’t sit in the waiting room, asked to wash hands, someone will take your temperature and ask you if you have Covid19 symptoms. But some of these questions will differentiate the good dentists from the better dentists.

Do they follow up with you or do they trust you will call them if you come down with any Covid19 symptoms within 14 days of treatment? I think an active phone call from the clinic 14 days after your appointment is better than relying on patients to self-report back to the dentist.

If another patient does report having Covid19 within 14 days of being seen in the dental clinic and IF you were seen as a patient the same day but AFTER they were seen, will you be notified? Example, they were seen at 1:00 and you were seen at 2:30 on the same day. All patients seen after a potentially infected Covid19 patient should isolate themselves for 14 days.

How have you changed patient appointments? How much time is allowed for droplets to settle in patient rooms and rooms to be sanitized between patients? Answer should be about 25 minutes. 15 minutes for aerosols to settle, 10 minutes to clean and disinfect.

Does the clinic have sick leave for staff? Are sick leave policies non-punitive, flexible, and consistent with public health guidance? Because you don’t want staff to feel they have to come in if they are not feeling well!

How are aerosol-generating procedures being limited?

Is there a designated person in the clinic whose job is to stay on top of CDC, OSHA, ADA, ADHA, and State Dental and Health Authorities on changing guidelines, recommendations and requirements?

  • Engineering Controls

What upgrades have been done to the HVAC system? More fans? Better and more outside air exchange? New, upgraded, HEPA filters? How often will filters be replaced? Has a HVAC professional been consulted to increase filtration and maximize supplied outdoor air? Has airflow direction been evaluated? (air flow should go from non-contaminated areas such as the front reception area toward contaminated areas such as operatories, not the other way around). Fans should be set to always on, not temperature triggered.

How is the air being filtered and cleaned in the operatory, especially during aerosol generating procedures? Some offices are adding additional portable HEPA air purifying systems. These are being recommended by the CDC, however none are FDA approved or, more importantly, really tested by a 3rd party or OSHA, but dentists are trying to get inventive. I guess I would rather see dentists take initiative in terms of trying to keep on top of the technology.

What is the air exchange rate of the HVAC system? Standard is about once per hour and recommendations have been 3-4X per hour. This is fresh outside air replacing the air inside the clinic. Even just opening a window can make a huge difference in the number of aerosol particles.

Have doors or partitions or other barriers been placed between operatories/patient rooms? Older clinics used to have doors. In the last 20 years “open concept” has been embraced for dental clinics. Now the old style is better! If not doors, barriers such as plastic curtains or glass partitions need to delineate between patient rooms.  We know that using a number of dental instruments (air/water syringe, drills, polishers, scalers, etc.) will aerosolize infectious particulates. Basically, you don’t want to be infected by another patient in the next room. It really is asking how air flow is working within a clinic, from one operatory to another and to the rest of the clinic.

Are you using UVGI light disinfection? Some clinics have added Ultraviolet Light Germicidal Irradiation to sanitize their operatories. CDC recommended (not required) but again, untested, unproven, and this should be in ADDITION to the spray/wipe clean, spray/disinfect cleaning routine as the UV light will not reach any area of shadow from the light. But if your dentist has added it, it means your dentist is doing everything possible to keep things as clean as possible. You can’t have UV light disinfection unless you have staggered your appointments, since no one can be in the room while the UV light is on. It takes a few minutes.

What kind of HVE system do you have? HVE is High Volume Evacuation. You know when your hygienist is juggling 3-4 instruments at once? Scaler, mirror, light, and suction? She might hang a low volume suction off your lip/cheek? Well now recommendations are that there should be HIGH volume suction, not LOW volume suction. And those high-volume suctions need a system to work at their best. Here is a partial list of HVE systems that should be employed (a clinic would have ONE of these system for each patient room/operatory) ReLeaf, DryShield, Isolite/Isovac, Mr. Thirsty, and Izolation. These systems help reduce the number of aerosolized particles in the air by sucking them directly out of the mouth. It doesn’t eliminate them, but it does reduce them by a considerable amount. Dentists can use these too, with dental dams and an assistant to reduce aerosols.  

Does the clinic now have a PPE donning and doffing area? Most dental clinics are small and cramped, but recommendations are to have a specific area for donning and doffing.

  • PPE. Personal Protective Equipment,

Does the clinic have a Comprehensive Respiratory Protection Program? Is it documented? Who is the person responsible for it?

Have all providers (meaning the dentists, hygienists, and assistants) been FIT TESTED for their N95 respirator masks? 

How are they obtaining their respirator masks? Many county health departments are managing N95 mask inventory for the entire county, including hospitals, EMT, police, fire, and other first responders, including dental clinics. I worry about counties that have left inventory completely up to the dentists themselves because there is a slew of counterfeit KN95 masks that the CDC/OSHA has declared unfit and unusable for use. All N95 respirator masks should be NIOSH certified.

Are all N95 or KN95 respirator masks being used NIOSH certified?

Given so few N95 masks are available, how is the inventory conserved and rotated? EXAMPLE: Most offices now have given each provider a respirator mask for each day of the week, so a full-time dentist/hygienist would have a Monday mask, a Tuesday mask, and so forth and re-use those masks the following week. When the mask get visibility dirty or if straps break, you need to replace the mask. As opposed to say an odd/even rotation, which means wearing the same mask every odd day and a different one every even day. I would rather they re-use their masks only once a week. In the past, N95 masks were once considered one-time use/disposable. Another unknown is just HOW many times CAN an N95 mask be continually reused? We don’t know. At some point, the filter will be “full up” of particles, blocking airflow, and reducing the filter’s ability to filter Covid19 particles. But we DON’T KNOW when and we don’t know how to test the masks for their ability to continually to filter. Hope we learn soon.  

Are gowns changed between each and every patient? Clinics should either have tons of disposable gowns, or tons of reusable, washable gowns. Dentists have installed washers/dryers and dressing areas so providers can change before beginning and ending their day.

Ask to have instant chair-side Covid19 tests when they are available!

Patients: should be given protective eyewear when in the treatment chair.

Patients: should wear a face mask when not in the treatment chair.

Stay safe out there!

Ann Ossinger, RDH, BSDH, EPP

What is Silver Diamine Fluoride?

What is Silver Diamine Fluoride (SDF)?

What is old is new again!

About 100 years ago, dentists used to treat cavities with Silver Nitrate. This sometimes worked. It would arrest decay, harden the tooth, and basically the “rot” would stop. But then new drilling techniques, new filling materials, and new dentists saw that as an “old” way of treating decay; and saw a “drill and fill” model of treating cavities as the “best way” to treat cavities. Well to be honest, “drill and fill” is a SURGICAL model of treating cavities, but it doesn’t actually “TREAT” the disease itself.

Fast forward 100 years. There is a new product, reformulated as Silver Diamine Fluoride that works similarly to the older Silver Nitrate (only better, of course).
To apply SDF, we first dry the teeth (using air and cotton rolls), we dab on a single drop of SDF on the lesion for one minute, then we seal the lesion with fluoride varnish. We come back a few weeks later and repeat the process to ensure the treatment has taken hold in the lesion.

It is inexpensive, safe, painless, non-surgical, MEDICAL way to treat cavities and it actually goes to the root cause of cavities, -the bacteria that cause cavities.

(For more information about a medical model of treating cavities, see my blog Medical management of Caries (decay) Posted on ).

The downside? It turns the treated lesion black. This is both a good thing and a bad thing. Black isn’t very pretty, but it only shows up on a decayed tooth, not on sound tooth enamel. This helps a dentist see a lesion better so if “drill and fill” treatment plan is decided on later, the dentist can actually see the lesion being drilled and so the actual filling can be kept to a minimum. From a cosmetic standpoint, people don’t like to see blackened teeth, but they are teeth that are healthier and stronger.

For certain populations, such as very young children and people with cognitive issues, this is a blessing not to have to have to treat caries in a hospital setting.

Here is a link to a fact sheet about SDF.

Here is a link from a PBS report about SDF.

And lastly, another link to a dental publication about using SDF in older populations.

SDF was approved by the FDA in 2014. A new CDT #D1354 (dental treatment code) was created in 2016. Here in Oregon, the Oregon Board of Dentistry has recently allowed Dental Hygienists to treat teeth with SDF.

Let me know if you are interested in this exciting new (old?) treatment!

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!

I’m still here!

Hi,

I know it has been MONTHS since I have updated any of my blogs, but to be honest, I’ve been busy! (I know, haven’t we all)

I am still out here in Benton and Linn counties in Oregon, helping people with special needs, seniors, folks with disabilities, dementia, or any other health conditions that might make it difficult to go out for a dental appointment in a dental clinic, -I’m the one to call!

I’m also in schools applying dental sealants for children, mostly ages 6-8 but I’ve also seen a few kids in their teens too. It mixes it up for me to see folks from all walks of life. For the school sealant program I’ve been mostly working in Linn County/Greater Albany School district.

This fall I’ve been over at the Oregon Veterans Home in Lebanon, giving the caregivers instruction on how to care for their resident veteran’s mouth’s. I also made a stop at the Albany Mennonite Village, talking with both the folks in Lydia’s House as well as the Long Term Care. I love getting calls to train others!

A couple of weeks ago I was at the Corvallis Clinic at the “Just for Seniors” event and fair. I got to see a few people I hadn’t seen in a while. It is always fun to get out in the community and meet folks.

And here is a photo of me with an assistant for the children’s school sealant program in Albany. Gotta love those kids!

Thank you for being interested in my work and in what I do. I have a lot of passion for good oral health, no matter what your age!

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!

Presenting to!

I love presenting my passions!

Last Tuesday, I had the wonderful opportunity to present to the Marion County Dental Hygiene Study Club in Salem, Oregon.

The title of my presentation was “Oral Health and Older Adults in an Alternative Practice Setting”. Even though I woke up that morning with a COLD (first one all year, too!) I was able to speak with the assistance of a microphone!

I discussed a little about my business model, DoorStep DentalHygiene, LLC, a bit about palliative care in a dental hygiene perspective, the power of language, how an older adult differs from a younger adult physiologically, and touched on medications, nutrition and hydration. The core of the presentation though was how to provide dental hygiene care to dependent adults with complex chronic illnesses such as dementia and stroke.  Whew! That was a lot of information! I also handed out an information sheet that covers “Tips and Tricks” of how to approach someone with diminished cognitive abilities, so everyone feels safe and protected.

I also pointed out that we have an ODHA conference coming up! Expanded Practice Dental Hygiene Conference on May 20th and 21st, 2016 in Springfield, Oregon. http://odha.org/index.php is the link to take you to conference details of how to sign up!

I touched on how sugar affects the older adult and here is link to one of my favorite videos on sugar: The title is “Sugar: The Bitter Truth”  https://www.youtube.com/watch?v=dBnniua6-oM

It was a honor to speak to all of you who share my passion, not only for dental hygiene, but especially for those populations who are unable to access care through traditional routes!

Thank you for having me. I love my job! And I love TALKING about my job! 🙂

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!

Children’s Sealants

PIT & FISSURE SEALENTS 2

As an EPDH, I love working with children!

Last year Oregon Health Authority approached me to work with children in schools for their school sealant program, and I said “Yes!”

After passing the required background checks and taking their training for OHA protocol, I was given equipment, supplies and a list of schools to contact and schedule. I was also responsible for finding my own assistant as the protocol is for 4 handed sealant placement (evidence is that 4 handed sealants last longer than 2 handed sealants).

Once I had logistics taken care of it was time to go to the schools!

What are sealants? They are thin plastic coatings applied to the chewing surfaces of the teeth (typically molars) to protect them from decay. They “seal the tooth” from bacteria. Sealants are easy to apply, no anesthetic is needed. You just have to make sure the tooth is “isolated” (kept dry) while applying the sealant.

One thing was immediately apparent: some schools welcome you with open arms and appreciation, other schools view you as another hurtle and a barrier to their class time and curriculum. I am very respectful of teachers and the school administration. They have hard jobs and we are not there to make it any harder. I try to be as independent as possible and work with the school and teachers to make it as seamless and with as little disruption as possible.

The kids are great! I work with kids from about 6 years old to 8 years old (first and second graders), as most of them have just gotten their first permanent molars (sometimes referred to as 6 year molars). These molars are the teeth most likely to be missing in an adult, due to decay. Sealants are great for protecting those teeth from decay! Wish I had gotten them when I was a kid!! I tell the kids these are their “forever teeth” that are meant to last a lifetime and with sealants, they should.

I’ve learned is that you have to be a bit of a “cheerleader” to the kids. I have pictures and I explain what they are and the process to the kids. Then I walk through the process with them while I apply the sealants. 90-95% of the children are easy and don’t have any problems. Of those, about half are a little nervous and I do everything I can to make them comfortable and let them know they are in control. The other 5%-10% of the kids either have extremely sensitive gag reflex that (even with all my tricks) we can’t seem to override their reflex or they are just too terrified to let me touch them.

My main goal isn’t to place the sealants; that is actually my secondary goal. My first main goal is to give them a great dental experience (even if the experience is only explaining to them). To let them know they have control, to let them know that they will not be hurt by any dental provider.

One thing I’ve noticed is this: they may be quiet and subdued while I explain the process and fine while I place the sealants, but when I see them in the hall a few days later (or sometimes the next YEAR later) they will get all excited, rush up to me and give me a hug and say “I remember YOU!! You are my DENTIST!!” –that’s when I know I’ve really been successful!

My wish for every child is not only great dental health, but a great dental experience that will last them a lifetime. If they can have a good experience as children they will seek good dental health through dental providers the rest of their lives. 🙂

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!

 

For Dental Hygienists Only!

Are you a hygienist who wants to work independently & are interested in EPP? (Note: it is no longer called a “LAP”; it is instead an EPP -Expanded Practice Permit.) Do you see my website and go…”oh, I want to do what she is doing!”, “I want to work independently of a dentist!”, “I want to own my own business!” This blog is for you!
After getting umpteen numbers of phone calls, emails, and other contacts from hygienists & hygiene students all around Oregon, I’ve decided I need to blog about how to work independently, as a hygienist in Oregon.
As much as I would love to mentor you guys, I don’t have the time or bandwidth, so please don’t call me and ask me to walk you through this process! But I will give you some tips and starting points to direct you toward working independently.
First off: have you joined ADHA/ODHA (American/Oregon Dental Hygiene Association)? If you haven’t, really, you need to. If it weren’t for people like Lynn Ironside, an ardent ADHA/ODHA member and fabulous Government Relations Council Chair, NONE OF YOU would have the advantages and benefits of our license that we have here in Oregon. So you need to become a member and come to all our conferences! ODHA has a ton of conferences that helps you as a hygienist whether you are a hygienist working in a dentist office or one that works out in the field independently, or all the other myriad ways hygienists work in the world today (public health, research, education, advocate, etc..). Every May ODHA sponsors and puts on a conference JUST FOR YOU, the Expanded Practice Dental Hygiene Conference. Every year is a different set of classes that address topics hygienists normally don’t have any clue about: business planning, marketing, all the ways EPDH’s work, how we work, where we work, networking, clinical concerns (have you considered how you would deal with a medical emergency if you are in the field?), you name it, we have had a class in it. Take advantage of this fabulous opportunity of how ODHA can make your life easier!!
OK, now that you have attended some of the conferences and you have a little better idea of what you want and how you want it, what is next?
Read your State of Oregon Board of Dentistry Practice Act. You will have to do this to get your EPDH (if you don’t have it already, that is) and it will tell you exactly what you can and cannot do with your new permit. You will want to know early on if you plan on working with a collaborative agreement with a dentist or not. (And if you don’t know what a collaborative agreement is, read the Practice Act to find out!) P.S. you can find the practice act online on the Oregon Board of Dentistry website.
My number one advice is this:
Create a business plan. I was lucky that we were made to create a business plan when I was in hygiene school. My school paved the way for us to get our EPDH’s upon graduation and licensure (due to the efforts of both Lisa Rowley and Lynn Ironside, among others) and part of the curriculum was a business class! Most of my classmates just dreamed up their plans as they assumed they would work for a dentist, but I decided to use the opportunity to create my REAL BUSINESS PLAN with 2 other students and my professor critiqued it! Yay! So I graduated from school with a plan that had the input of 3 other people beside myself and that served me very well indeed. What makes up a business plan? Without creating a whole class on the subject, here are the essential components of a business plan:
• Mission statement and/or vision statement. Exactly what area will you target for working independently? Babies? Children? Low income? Underserved populations (which ones)? Seniors? Developmentally disabled children/adults? Mentally ill? Prison inmates? Homeless? What is your niche? Is anyone else in your area filling this?
• Description of your company and service
• Description of how your service is different
• Will you have a collaborative agreement with a dentist? Describe how this relationship will work.
• Market analysis that discusses the market, competitors (anyone else doing what you are doing where you plan to do it?), where you fit, and what type of market share you believe you can secure;
• Description of your management team, including the experience of key team members and previous successes. While you say you are going to do it “all” on your own, consider what it means to do your own accounting, marketing, etc. Really? At a minimum you need to have a lawyer, a CPA and a bank.
• How you plan to market your service;
• Analysis of your company’s strengths, weaknesses, opportunities, and threat, which will show that you’re realistic and have considered opportunities and challenges;
• Develop a cash flow statement so you understand what your needs are now and will be in the future. Don’t underestimate the costs of doing business. It is more than just buying some equipment and going at it! You need insurance, you need to belong to several organizations to network (think ADHA, Chamber of Commerce, etc.), permits, licenses, State of Oregon business registration fees, -you name it. You won’t believe how much it costs just to have a shingle!
• Revenue projections –otherwise known as “how do you plan on getting paid”.
• Summary/conclusion that wraps everything together (this also could be an executive summary at the beginning of the plan).
And before you go….”yeah, yeah, yeah, I’ll do that later!” note that I couldn’t open my business account at the bank without my business plan, I couldn’t talk to my lawyer without my business plan, …well, you get the idea. It all starts with a business plan. If you feel this is all way too daunting, go visit your local community college business department, your chamber of commerce, your small business administration, your local business start-up organization that helps nurture new entrepreneurs in your area and they will help you step through all the steps.
Whew! That seemed hard, didn’t it? Ahhh, that is only the beginning!
You need to register with the Fed’s for your tax ID number (EIN), you will want to get your NPI (National Provider Identifier), and consider being a Medicaid provider (DMAP). You may need to get credentialed with insurance companies and with dental care organizations. EIN & NPI are easy; you just go to the websites and register. All the others take a lot of paperwork and a lot of patience. It can take MONTHS to get your DMAP and some organizations take months to get credentialed. Get used to paperwork, follow-up, hurry-up, more paperwork and WAITING.
Next: OK, here is the fun part; you get to pick your equipment! Price it out, decide what you need now and what you can buy later. Will you have your own sterilizer? Or will you “borrow” your dentist’s sterilizer? Will you have your own room in your house to store all your equipment, have a sterilizing area (clean/dirty), a desk for all the paperwork, cabinets for your files, and laptop for your business? My advice is to start small and work up. It is easy to spend $5K, $10K, and up to $50K on mobile equipment, vans, RV’s, you name it before you have done all your homework on how to make it all pay for itself. But ultimately only YOU can decide what you can live with or without. After you start seeing your patients you will understand exactly what you need. It is easy to buy too much too soon. I’ve heard numerous hygienists start out with $10K (or more) of equipment and after a few months realize they only use a fraction of what they purchased! Arrrg!! That isn’t a smart way to spend your money!
Are you a good speaker? You better be! You will be asked to speak at all kinds of places. It is how you grow your business. You speak at Chamber of Commerce events, you speak at Skilled Nursing Care facilities, you speak at schools, you speak at conferences, you speak to your fellow hygienists, you create classes for caregivers, or CNA’s, or for fellow health professionals, or to the general public such as at health fairs, senior events, diabetes clinics, children at school,….get the idea? I give 1-2 talks a month and I have about a dozen different slide shows for different audiences and for different time slots (2 hours, one hour and 30 minutes). Some discuss oral health and systemic health, some are about basic mouth care, some are for hygienists in how to work in the field, some are for people who have no idea they need to know about what you know! Hate to talk? Freeze at the thought of speaking in front of people? Then join toastmasters to help you get over your fears. You will not be successful unless you can talk about your business. Oh, by the way, be able to describe your business in 30 seconds or what is called “the elevator speech”. You want to be able to tell people what you do quickly and succinctly, the time it takes to take an elevator.
Next: Repeat after me: it takes three years. Repeat after me: it takes three years. What am I talking about? It takes three years to build a hygiene business that starts paying for itself and paying you. And those are hard years of pounding the pavement, knocking on doors and getting doors slammed in your face. Toughen up your skin baby; you are going to need it! Don’t assume you will make a ton of money out of the gate. You won’t. It takes about three years to build your business. Three years before people start referring you to their patients, clients, friends, and loved ones. Three years before all your hard work starts paying off. Don’t expect to get rich. You aren’t doing this to get rich.
Accounting: Do you know Quickbooks? Consider taking a class at your local community college in bookkeeping and in software. Or will you hire someone to do this for you?
When you decide on your lawyer and CPA, make a list of all your questions. You will be paying them to answer your questions by the hour, so make the most of it! Don’t forget your bank, they are another resource too.
Marketing: you will need business cards, brochures, a website, Facebook page, blog, twitter page. Are you on LinkedIn? Social networking is just one of your marketing tools as well as joining every organization that might be able to help you or network you. What about advertising? How much are you willing to spend? It costs a lot of money to advertise and it takes a long time to reap the benefits from advertising. Spend your money wisely. It is all about the plan.
Have you talked to all the dentists & hygienist in your town or area? Do they know what you are trying to do? They should! You want them to refer their patients to you depending on what service you are trying to provide. Have you talked to your local Department of Public Health? They are both another resource and a potential business opportunity to tap into.

Below are questions I have gotten from hygienists & students over that last year that I have collected and answered:
1. How many years after you received your Dental Hygiene License did you apply for the Expanded Practice Permit (EPP)?
Don’t make assumptions about years. I received my LAP permit 6 months after graduation. New graduates from Pacific receive it upon getting their initial license if they want it.
2. Why did you decide to become an Expanded Practice Dental Hygienist (EPDH)? Please provide specifics if you can.
I’ve always had a passion for public health and this is an extension of that. It is also a “tight” market for dental hygiene and I had a mix of experiences as a temp. I didn’t want to have to compromise patient care because of a dentist or a dental group if I didn’t agree with their practices. Being on my own means I can practice dental hygiene as I was taught and using my own critical thinking, not as it is practiced in the “real world” by the dentists supervising the hygienists. Some dentists are great and some are considerably less so.
3. How did you learn about the EPP? Did you practice with Limited Access Permit as well?
I graduated from Pacific University. They emphasize the LAP/Expanded Practice work. LAP was just the earlier form of EPP with a few small exceptions. Anyone with an LAP automatically had their EPP when it changed over.
4. What does it take, or what advice can you offer, about starting to practicing independently apart from what it identified on the EPP application? (2,500+ clinical practice, active BLS/CPR, 40 hours approved CE, and Professional Liability). Please provide specifics if you can.
Pacific University made it easy as by graduating from there, we are automatically eligible for the LAP/EPDH permit, given the number of hours of rotation at various sites.
You have to be a “self-starter” and be strongly self-motivated or you won’t survive. You can’t be afraid of putting yourself “out there” and talking, talking, talking to people one-on-one, in interviews, in groups and giving presentations to large groups. Most people have never heard of such a thing and you have to teach the world what you do.
5. How much does it cost to get a business license? Is it required to practice?
It only costs about $100 to register your business with the state. I wouldn’t practice without it! It allows me to register as an LLC which helps protect my home assets. It also protects my name and my business name. In fact without registering my business name, ANYONE could just “take it” from me. I’ve worked hard to create a “brand”, why would I want someone else to steal it from me? I don’t know if it is a LAW, but I sure can’t see having a business without registering with the state. There are too many advantages.
6. Can you offer any business advice?
HAVE A BUSINESS PLAN! We were required to create one in school. Most people just made it up because they weren’t planning to use it. I DID plan on using mine, so I created it with the intention of actually using it while I was in school. It helps clarify exactly what you want to do, who you want to serve, how to get paid, and how to grow, accounting, marketing, etc. It isn’t written in stone, but it gives you a roadmap of how to proceed. It makes you think about how to do business. While I’ve made a few deviations, it still “holds water” for the most part.
7. Where do you practice and what underserved population(s) do you treat?
Right now, 90% of my client base is seniors that are unable to access dental care due to physical or mental disability and are in long term care of some sort. I have also been working in schools for sealants for 1st graders (Oregon Health Authority) and I work at a dentist office part time as well.
I recently became a provider for E.N.D.S. (exceptional needs dental service) which took about 6 months due to all the paperwork, becoming Medicaid provider, and credentialing with Willamette Dental, Capitol Dental and Managed Dental Care of Oregon.
I am also working with my marketing to help the developmental disabled as well.
8. Could you describe, in as much detail as possible (including treatment protocols, operatory set up, sterilization, patient forms and paperwork, information you give to the patients), how you are utilizing your EPP?
Wow, could you ask for more in one “question”? That is about a dozen questions in one! This could be a book in itself. I will keep it to a couple of paragraphs.
Well, generally speaking, I look at the risks: Caries &/or Periodontal disease. I screen for oral cancer. For the most part I’m unable to do perio-pocket charting because patients won’t allow it (not with severe dementia). You only have a few minutes to do the most good as fast as possible. I rarely do any root planning (SRP). My goal is generally to try to maintain status (perio maintenance or prophy), but if the family or caregivers are motivated I can see great improvements in both perio issues as well as reducing caries risks. I do palliative care which is all about addressing pain, infection and preventative treatments. I customize treatments based on what the patient needs, what the patient can handle and what the caregiver is willing to do. I have many “tips and tricks” for the caregiver to make their job EASIER, not harder. If it is harder, it won’t happen. And I always refer the patient – either to their own dentist, a new dentist, or to whomever it makes sense for them to see. About half the time they are able to get to the dentist, and about half the time they aren’t. Depends on the severity of what I see and how hard I will emphasize the need. I want my patients to see a dentist once a year for an exam and x-rays. That doesn’t always happen. If I think the neglect borders on abuse (broken/bombed out teeth, pain and infection and not going in to see a dentist) then I will do all I can in my power to help the family get their loved one to see a dentist.
Everything I need is in a plastic tote that I pull in my foldable cart. I wipe down whatever table they have plus my equipment and my tote. I have “clean” boxes and I have “dirty” boxes when I’m on the road. I converted my 3rd bathroom into a sterilization room with a clean and dirty side. I purchased an ultrasonic instrument cleaner, a sterilizer and a cordless prophy handpiece.
I took the “best” paperwork I’ve seen used by others and created my own for HIPPA, patient information, health hx, medications, and charts. If there is a prescription, I call it in to the pharmacy. You can go to my website for some of this information.
9. If you wouldn’t mind sharing, how much were your start-up costs and what did they entail? If you feel comfortable, could you please provide specifics? I would greatly appreciate the insight.
It depends on what you already have and what you need!! Every hygienist needs to figure it out and for whom they are taking care of. For me, it was about $3,000 for bare minimum costs, but start-up costs are only the beginning. You have ongoing costs too. It only cost me a couple hundred dollars to convert my bathroom. I already had some equipment, instrument sets and supplies. -Do you need a vehicle? Some people want a van. I didn’t. Some people want the full set up of dental chair, stool, ultrasonic scaler, suction, hand piece, etc. which costs THOUSANDS of dollars-I didn’t (and you need some of this if you are going to do sealants for children). Do you want to take x-rays? That alone will cost you about $8-9,000 dollars. The lowest price sterilizer is $700. But you could spend $5K easy. I know one hygienist who was able to borrow her dentist’s sterilizer. Re: chairs: Most my patients can’t transfer anyway, so I just work on them in their wheelchair, which makes me more portable. Everything I use is pretty much hand instruments. I do have a self-contained cavitron and a small suction machine which I use quite infrequently since most my patients have choking risks. I have a portable, battery hand piece for polishing. You have to spend money on insurance, on business cards, on brochures, on association fees (i.e. chamber of commerce), and on advertising, etc. I am lucky that my husband is an “IT” guy, he helped create my website and web presence. I got that all for free! I have no idea how much that would cost in the real world. I used to work in accounting and I have a background in graphic design, so I used my own experience for that. My weakest link has been marketing, but I’ve actually been doing a pretty good job of it! But do you need to hire an attorney? Do you need to hire a marketing/graphic arts person? Do you need a web designer? Do you need an accountant? Do you want to hire someone for insurance? Do you want to take some business classes? Do you want to network with other business people? Do you want to join associations that will help your business grow? Do you want to be at health fairs with a booth? How do you plan on reaching your target market? What about advertising? Do you want to hire an assistant? That all costs money that isn’t “clinic” related. You better figure it out!
10. If you have a collaborative agreement with (a) dentist(s), what does it entail? What services can you provide within this agreement?
I do not have a collaborative agreement. This means I can’t write a prescription for pre-meds, prescribe anti-inflammatory meds, restore teeth or use local anesthesia. Since I don’t do much SRP, that isn’t a problem and if they need a pre-med, their doctor can write the prescription. I don’t want to restore teeth. I don’t see the great need an agreement for myself. I think it would just make the doctor nervous. Again, this depends on what you are trying to do and who you are trying to help and to what degree. I wouldn’t really feel comfortable doing anesthesia when I’m by myself as over 50% of all medical emergencies have to do with giving anesthesia as well as my patient population is mostly severely compromised. It is a risk I’m not willing to take, to be honest.
11. For the services you provide, what do you charge for each of them? Please provide a specific list if you can and feel comfortable doing so.
I charge $120 per hour for my services. Since 90% of my clients do not have insurance anyway, it works out. If they need me to spend more time because they are more difficult, my time is paid for. If they are “easy”, then I spend less time. I think it works better than “fee for service”, because I will automatically add fluoride varnish if I think that patient needs it. We don’t have to dicker about what services to add or not – it is simple and easy for the families to understand. And it makes my treatment planning easier – I can do what I think is best for the patient.
For Medicaid/ENDS I am working under a contract with them for my services, which is fee for service.
12. Do you choose to bill insurance for the services you provide? If so, what are the obstacles, if any, have you run into when attempted to bill insurance? Any advice that you would like to share in regards to insurance?
I don’t bill insurance. If the families want, I will give them the form for my services so they can get reimbursed. It can take me 8 hours on the phone to get paid for one hour of service and it doesn’t make sense. I’m not an insurance expert. Maybe I will change, but for now that is what it is.
13. Any other advice or specific details that you would like to share? Any information would be greatly appreciated.
Have a business plan! That is the number one advice I would give!

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!

Amazing Xylitol!

Amazing Xylitol Prevents Tooth Decay and Reduces Plaque

Xylitol fights cavities by:

  • Disrupting decay-causing (pathogenic) bacteria. Pathogenic bacteria produce acid & plaque, and by disrupting their metabolism, it increases the pH in your mouth & reduces plaque.
  • Xylitol gum also stimulates saliva. Saliva also neutralizes acids & has minerals your teeth need. Increased pH promotes both healthy “good” bacteria & the re-mineralization of your teeth.

Over 25 years of research & testing confirm that xylitol is the best sweetener for teeth. Xylitol use reduces tooth decay rates for nearly everyone, young and old alike.

Xylitol is a sweet, white substance that looks and tastes like sugar, but has 40% fewer calories than sucrose and is diabetic friendly. It is a 5-carbon sugar, similar to mannitol and sorbitol, but with its own special properties. It is found in the fibers of fruits and vegetables like corn, berries, mushrooms and the wood of trees like birch.

Xylitol is found most often in chewing gum, mints and oral sprays. For xylitol products to be effective, xylitol needs to be the main ingredient. Health food stores can be a good resource for xylitol containing products. Trident gum has only 0.17 grams of xylitol, a fraction of the amount needed. Epic, Spry or Xylichew products have 1 gram per piece.

Dosing: Xylitol gum or mints used 3-5 times daily, for an optimal total intake of 5-6 grams. Gum should be chewed for approximately 5 minutes & mints should be allowed to dissolve.
As xylitol is digested slowly in the large intestine, large amounts can lead to soft stools or have a laxative effect. Some individuals may be more sensitive to this effect, those folks can start with a smaller amount and slowly work up to the 5 grams a day so your body will adjust.

You can even buy a bag of granular xylitol and lightly sweeten your drinking water as a way to encourage greater water consumption and get the xylitol dose you need! One teaspoon has 4 grams of xylitol, so add 1 1/2 teaspoons of xylitol to a liter of water and sip it all day.

Xylitol has been approved for use by people of all ages. With regular use, studies have shown that xylitol can actually help teeth to rebuild early decayed spots. Daily use can help reduce cavities in kids by as much as 80%.

Like chocolate, Xylitol should be kept out of the reach of DOGS. If you suspect your dog has ingested xylitol, contact your veterinarian immediately.

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!

Medical management of Caries (decay)

Are you at high risk for caries (decay)? (The disease is called caries, the symptom is decay & cavities).

If you can say “yes” to any of these, you are at risk for decay. The more “yeses”, the higher the risk. You can modify your risk factors! Keep reading to see how you can modify your risk for decay.

1. Do you have dry mouth (or “cotton mouth”)? Dry mouth is extremely common as we get into our upper 50’s and early 60’s. Saliva not only has anti-bacterial enzymes, but also has buffers to buffer acids and, of course, simply the mechanical action of lavage is important.
2. Are you over 60 years old? Our salivary function declines as we get older.
3. Do you have any chronic disease? Over 400 medications can cause dry mouth.
4. Do you have any orthodontia? Lingual bars? It’s hard to clean around braces!!
5. Have you had any new cavities in the last couple of years? That means the bacteria is “active” in your mouth.
6. Has your dentist told you that you have areas under “watch”, or have some “demineralization”? This is a form of very early decay and if caught early enough, can be reversed. Let’s “watch” the area remineralize & harden, NOT DECAY!
7. Do you have any gum recession? Exposed tooth roots are not covered in enamel, they are covered in cementum which is much more vulnerable to decay. Cementum demineralizes at a higher pH ~6, and enamel takes a lower pH ~5.5 to demineralize.
8. Do you have several (6 or more) restorations? Many fillings, restorations, crowns puts you at risk. Each restoration has a tiny micro-margin between the restoration material and your original tooth structure where plaque and bacteria can hide and multiply. They call this secondary or recurrent caries when you get a cavity here.
9. Do you eat a lot of snacks or several small meals a day? Do you eat a lot of carbohydrates or sugars? Every time we eat, especially carbohydrates, we have an “acid attack” on our teeth. Pregnant women can be more vulnerable due to more frequent meals.
10. Little to no fluoride exposure when growing up while teeth were developing? Fluoride can be important anytime, but especially while we are growing and getting our permanent teeth.
11. Do you smoke? Drink alcohol? Use any recreational drugs? All of these can dry the mouth. And a dry mouth is more susceptible.
12. Do you have deep fissures on your molars? Are your teeth crowded? Do you have “food traps”? It is harder to keep crowded teeth clean and deep fissures clean. They become “plaque traps”.
13. Frequent close contact (kissing) with someone with poor oral health or with decay? Caries is a transmissible disease. Yes, you can catch it from someone. We also think of it as a family disease. I don’t treat the individual, I treat the family!
14. Inadequate oral hygiene? Poor plaque control and plaque accumulation can lead to decay.

When patients give me “yeses” to these questions, I have a long conversation with my patients about what this means and how we can TREAT the caries in a “medical management of a chronic disease” protocol. I hate dentists who just “drill & fill & bill” and act as “surgeons” on the teeth without actually medically treating the underlying disease!! And hygienists are taught all this, but the dentists they work for RARELY give them enough time to teach our patient’s this!! (Makes me so MAD!!!)

It is also important to know that caries is a communicable disease. You significant “other” may also be at risk (their risk profile may be different, but you guys are sharing your bacterial flora). If one member of a family has active disease it is better to treat the FAMILY rather than just the one patient with caries. Yep, it is a family disease.

Every time we eat we reduce the pH in our mouth. The pathogenic bacteria in our mouth, well, they eat what we eat. They love carbohydrates of all kinds (not just sugar), and every time they eat, they produce waste product in the form of acid. This reduces the pH in our mouth and (just like ocean acidification reduces shellfish ability to create shells) it attacks our enamel and reduces our enamel and risks decay. If we have normal salivary function our saliva can buffer this acid after about 20-30 minutes, but if our salivary function is compromised, then it may take 40 (or more) minutes before your mouth is in a neutral pH again. If you are eating frequently, your mouth may be in an acid environment all the time!

High Caries Risk Protocols – This is what I recommend to my patients
1. Dental appointments at LEAST every 6 months for clinical exam and fluoride varnish application. Yes, this is the same fluoride treatment kids get. And it works for adults too. Depending on your risk, your provider may have a different recommendation.

2. Bitewing radiographs (x-rays) every 12 months, and either a panograph OR full mouth radiographs every 4-5 years. Bitewings can extend to 18-24 months when no new caries are detected for 3 years (and no periodontal disease exists).
I personally think you shouldn’t go more than 18 months between radiographs for a variety of reasons.

Dental x-rays are extremely low in radiation, but if you are concerned about radiation ask your dentist this: Are the x-rays digital? (digital uses less radiation), Is the collimator SQUARE ? (uses less radiation), is the PID (positional indication device) at least 12 inches long? (Again, you get less radiation when it is a little farther away) and lastly the lead apron should have a thyroid collar to protect your thyroid (a radiation sensitive organ).

Some offices offer salivary flow test, salivary pH test and/or a bacterial culture & count tests. These tests can be helpful in creating a good treatment plan, but you can treat caries without these tests if you’ve recently been diagnosed with caries! Being diagnosed automatically puts you at high risk.

Nutrition: Eat a healthy diet. Make sure you have 6-9 servings of fruit and vegetables & eat good sources of lean protein. Go easy on acidic foods like citrus fruits. They are good for you but they have both sugar AND acid. If you snack, snack on nuts and cheese as these are anti-cariogenic (and high in fat, so don’t go crazy!). There are new guidelines on sugar limitations and there is a pediatric endocrinologist who believes that EVERY sugar-sweetened drink should be cut out of our diets. Not just soda. Fruit juice and anything else we drink that is sweetened – it is not only bad for our blood sugar but it is also bad for our liver and lastly, our teeth. Drink water! The new sugar guideline is that men should have no more than 150 calories (36 grams or 9 teaspoons) of sugar a day. For women it is 100 calories or 24 grams or 6 teaspoons. Yeah, I have trouble keeping to this guideline too.

Brush your teeth in the morning with good old fashioned baking soda. No, it is not too abrasive, especially if you are brushing gently. I keep a little shot glass of it in my bathroom. Put about a half teaspoon of it in the palm of your hand and dip your toothbrush in it. If you hate the taste, try putting a smear of your regular toothpaste on your brush and then dip into the baking soda – it will make it taste better. Brush 2 minutes. The baking soda has a pH of about 8 (alkaline or “base” if you’ve had any chemistry) and the pathogenic bacteria in your mouth are all acid loving. Over time, this can actually change the flora in your mouth to “healthy bacteria” instead of pathogenic bacteria. You can use this routine forever. Rinse well after brushing, especially if you happen to have high blood pressure (it is sodium, after all). Don’t swallow.

Chlorhexidine gluconate .12% rinse: This is a prescription you should be able to get from your dentist. Really, only one bottle will do it. Use this rinse for one minute daily for one week every month until you are caries free. Use in the morning, after brushing teeth. It alters taste for about 30-45 minutes, so you won’t want to eat or drink after using. You want to use in the morning because it can temporarily stain your teeth -and staining is less if used in the morning. You also don’t want to use too much (no more than one week a month) for two reasons: you want to minimize staining, and because it can cause more calculus buildup (tartar) -so make sure you see your hygienist within 6 months to polish and scale your teeth after using Chlorhexidine rinse for 6 months (but remember, only 1 week out of each month, NOT EVERY DAY ALL MONTH). The idea here is that you would stop using it after 6 months because your bacterial flora should have changed. This is not a treatment you should continue to use forever. For the other three weeks of the month, you can use a fluoride rinse such as ACT.

Xylitol: It comes in many forms, usually gum, mints, candies and sprays. Helps neutralize the acids, messes with the pathogenic bacterial metabolism, reduces plaque and helps prevent bacterial transmission to another person. In other words, it reduces your risk of cavities. Start with a few gum/candies or sprays and slowly work up if you have any GI distress. 6-10 grams total per day of Xylitol, broken up 3 times a day. Best just after meals or snacks. SPRY gum has 1 gram per piece of gum or candy. I like SPRY and EPIC brands because I know they have a therapeutic dose of Xylitol. Other brands may have less. Check the label – if there are OTHER sweeteners then I would be suspect that it only has enough for marketing purposes! You only have to chew 5 minutes to get the full effect. If unable to use gum or candy (choking hazard that they are, esp for the very young or elderly people), SPRY also comes in a spray form called RAIN ~3-4 sprays, 3x a day would put you in the target range of 6-10 grams. I will probably use the xylitol forever. I love how it makes my mouth feel after using for a few weeks. Again, it changes the flora of your mouth.
Xylitol warning – too much too soon can cause gas/laxative effect. Also, it is toxic to dogs, so keep it out of the reach of your furry friends.

Baking soda rinse after any snack or eating any carbohydrate: this is an alternative to the Xylitol above. Use one or the other after any eating/drinking to help bring the low pH in your mouth back up to neutral. About a half a teaspoon of baking soda in an 8 oz glass of warm water. Swish and rinse. You can make some up each morning and use throughout the day. Discard any left over at the end of the day. Do not swallow esp. if you have high blood pressure.

Prescription toothpaste: Your dentist should have already written you a prescription for this and if he or she didn’t, shame on them! 1.1% fluoride. Research has found that the fluoride uptake is better when in the presence of calcium phosphate, so my favorite prescription toothpaste is Clinpro 5000 with TriCalcium Phosphate. Some other anti-caries prescription products have Amorphous Calcium Phosphate or Recaladent (another type of calcium phosphate) which also can enhance fluoride uptake. Talk to your dentist for a prescription. The only warning here is to keep out the reach of small children. If a child were to eat the tube of toothpaste there is enough fluoride to kill them. It is a medication!

Before you brush with the toothpaste: floss (or as I say to my patients: clean interdentally…), use a water pik, and use a tongue scraper, or brush the tongue. THEN, use the toothpaste once a day, in the evening, brush for two minutes (power brushes usually have a timer) and you only need a pea-sized amount. (A tube should last about 6 months.) When you are done brushing: Spit, BUT DO NOT RINSE and do not eat or drink for at least 30 minutes. If you decide NOT to use the oral moisturizer below, then you can use the toothpaste just before bedtime.

If you suffer from dry mouth, especially at night: I recommend Biotene oral moisturizer: Try to brush your teeth 30 minutes before bedtime to give the prescription toothpaste a chance to work. Biotene makes lots of products (toothpaste, rinse, etc.) to combat dry mouth, and you can use them if you wish. My favorite product from their product line is their oral moisturizer. Comes in several forms: spray, lotion, gel. Use right at bedtime to help keep your mouth more moist during the night. Our salivary function decreases dramatically during the night and biotene has special enzymes to replace the salvia that we have lost.

If you consistently wake up with a parched mouth -try to find out what might be causing it: Is it due to a medication? Maybe your doctor can switch you to another medicine. Is it nasal congestion? Maybe a nose strip would help. Is it sleep apnea? Then maybe that should be addressed as there are lots of health consequences from untreated sleep apnea. Older (over 50) over-weight men are at particularly high risk.

If you have very early signs of decay (enamel only) we can actually ARREST and REMINERALIZE the decay with the above medical management of caries protocol without any drilling or filling. Really! We can!!!

Man, I wish I knew this stuff when I was a KID!!!!! If I knew I was going to live this long, I would have taken better care of my teeth!!!

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!

Interdental Cleaning (aka “flossing”)

Hate to floss? You aren’t alone. There are MANY ways to clean between your teeth besides the traditional 12-18 inches of “string”.

Think about it: if you showered daily, but never washed your hair, would you really feel clean? Same with your teeth and gums! Brushing correctly for two minutes only cleans about 40-50% of your mouth (and most people only brush for about 30-40 seconds -significantly less!). Flossing (or interdental cleaning) correctly gets another 20-25%. Scraping/brushing your tongue gets another 15-20%. Using a mouthwash and vigorous swishing for a full minute gets another few percentage points. (Even just chewing xylitol gum will help clean the mouth too).

I found that when I started to REALLY clean my mouth before going to bed, I would wake up WITHOUT the dreaded “morning breath”! How COOL is that?!?

What is important is to find which floss or floss alternative WORKS BEST FOR YOU! Because you won’t do it unless it is easy and painless! Are your hands “too big” and your mouth “too small” to use traditional floss? Do you have arthritis or other dexterity issues? Or, maybe you have very tight contacts, have areas that are food traps, have implants, bridges, lingual bars or braces, or maybe you have old fillings that shred your floss? All of these obstacles can be overcome! Easily! I promise! For every problem there are at least two or three alternatives that can help.

If your hands bled when you washed your hands you might realize you have a problem…right? Same with your gums. If your gums bleed when you brush or floss that is an indication of disease! After brushing and flossing correctly regularly for 3 weeks you should notice significantly less bleeding (or NO bleeding!). If your gums are still bleeding, even a little, it is time to visit a dental professional to determine the cause, as there can be several reasons and they have the instruments and tools to diagnose the specific issue.

The important thing is to clear the area around the base of each tooth of the sticky plaque & food debris that collects in the little collar of tissue where the gum and tooth meet (called the sulcus). If not regularly removed, the bacteria can fester, cause bleeding, develop deep “pockets” in your gums next to your teeth and can eventually cause your teeth to loosen! Yikes!

Here are examples of floss alternative products I like and  regularly recommend.

FlossAlternatives

Pictured: Reach Access Flosser (great for tight contacts & no hands in the mouth!), GUM Soft-Picks (very tiny rubbery toothpick slides between teeth at the base of teeth -great if you have lingual bars or if floss shreds between certain teeth), Sulcabrush (narrow tipped brush that can fit between teeth and BEHIND those very back teeth-again, no hands in the mouth!), GUM rubber tip Stimulator (not usually my first pick, but better than nothing!), and Water Pik oral irrigator -which is great if you still really hate flossing, have areas that continue to bleed or have dreaded food traps (I LOVE my Water Pik irrigator after I eat popcorn!! Gets every little hull out!).

But wait! There’s MORE! There are also traditional toothpicks (if used correctly), Stimudents (which are softer than traditional toothpicks & a little kinder to gums), Go-Betweens/proxabrushes (they are small bristle-brushes that look like bottle brushes that fit between gaps in teeth & under bridges), numerous small pre-threaded flossers (great for on-the-go & for kids to learn how to floss), special flossers for braces -no threading required! (Platypus ortho flosser, is one) and a few sonic/electronic flossers. There are so many floss alternatives it is hard to list them all!

How to floss CORRECTLY: 

Note: there are MANY different types of floss too..from very slick floss that slips between very tight teeth, to fluffy filament floss (almost like yarn) that cleans around implants, bridges and other dental work and many in-between. Try different types to find the one that works best for you.

To receive maximum benefits from flossing, use the following proper technique:

  • Starting with about 18 inches of floss, wind most of the floss around each middle finger, leaving an inch or two of floss to work with.
  • Holding the floss tautly between your thumbs and index fingers, slide it gently up-and-down between your teeth.
  • Gently curve the floss around the base of each tooth, making sure you go beneath the gumline. Never snap or force the floss, as this may cut or bruise delicate gum tissue.
  • Use clean sections of floss as you move from tooth to tooth.
  • To remove the floss, use the same back-and-forth motion to bring the floss up and away from the teeth.

If you have any special needs, problems or issues, you can contact me with your question and I would be happy to help recommend products that would help you achieve better oral health!

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!