Dr.Stanley’s Practice:-)

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http://practiceworkstv.cnpg.com/Video/832/Stanley’s-Practice-Episode-1-%22Walking-Blindly%22.aspx
http://practiceworkstv.cnpg.com/Video/833/Stanley’s-Practice-Episode-2-%22The-Momentous-Arrival%22.aspx
http://practiceworkstv.cnpg.com/Video/834/Stanley’s-Practice-Episode-3-%22A-New-Day%22.aspx

things you should know about dentures

Things you should know about

dentures

Clare Van Sant

by Clare Van Sant, RDH, BS

A thorough cleaning of their dentures may rate low on the priority list of some denture patients. For these patients, a quick brushing and occasional five-minute soak might be the extent of their denture care. Since in many cases poor oral hygiene is a contributing factor to their tooth loss in the first place, convincing these patients to adopt a more stringent daily cleaning routine may be an uphill battle.

Another major challenge with this population is motivating them to visit the dental office for routine recall appointments. One report indicates that only 19 percent of denture wearers remember their dentist’s instruction to come back for regular checkups.1 How can dental hygienists, who recognize the importance of daily disinfecting dentures and routine professional evaluations, help denture patients understand the importance of both regular office visits and everyday at-home care?

The answer may be as simple as sharing a few important facts. We know some patients are hard to motivate and may be resistant to change; however, sound clinical evidence can be a powerful influence for some people. Here are some lesser-known facts about dentures that any dental professional can use to help motivate patients to manage their dentures.

• Partial and full acrylic dentures have surface pores – To the eye, the acrylic surface of a denture appears solid and unbroken, but under a microscope, pockmarks are revealed.2 What does this mean to denture patients? A quick brushing every day may not be enough to thoroughly clean the denture. Even a very thorough brushing may not be sufficient to reach bacteria harbored in microscopic crevices. A denture brush and foaming toothpaste simply may not penetrate the many hiding places that microbes find in a denture surface.

Some might wonder if this is really a cause for concern. After all, everyone’s mouth is filled with germs, thus we get morning breath. But research has isolated Staphylococcus aureus, Streptococcus mutans, Klebsiella pneumoniae, Escherichia coli, and hundreds of other garden-variety germs in acrylic dentures.3,4 Keep in mind that while our mouths have the benefit of the body’s immune system, acrylic denture material has no such germ-fighting properties, so bacteria can easily reproduce within the denture.

From the dental hygienist’s point of view, one of the most important reasons patients should control denture bacteria is to help prevent unnecessary exposure to microbes that could cause oral and systemic disease. But denture bacteria can also have an effect on one of the biggest everyday problems patients are motivated by – bad breath. Eighty-seven percent of denture wearers report that malodor is a major concern.5 Because the body’s scent receptors become accustomed to a smell they are exposed to frequently, patients rightly fear that they may not be able to detect odor coming from their dentures.6 Dental hygienists can help patients manage their malodor and exposure to microbes by educating them on the effectiveness of overnight soaking in reducing odor-causing bacteria.

• Overnight soaking can kill 99.9 percent of denture germs -Pharmacy shelves are lined with denture cleaning options, from all-natural soaking solutions to high-end ultrasonic devices. It’s easy for denture wearers to think one cleaning option is as effective as the next, and therefore choose the fastest or least expensive one. But fast may not be best. By encouraging the use of an overnight soak such as Polident® (GlaxoSmithKline Consumer Healthcare), dental hygienists can empower patients to kill up to 99.9 percent of the bacteria that colonizes on their prostheses. This level of disinfection may not be reached with many quick-fix cleaning methods. Other good products on the market include Dentist On Call Denture Wipes (Majestic Drugs Company) or ProClean™.

Many patients who adopt overnight denture soaking find that the quick-soak method still has its place in their daytime routine. While a three- to five-minute soak may not achieve the 99.9 percent kill rate of an overnight soak, it can nevertheless be effective in reducing bacterial counts and helping patients freshen up quickly before a social event.

• For patients who suffer from dry mouth, contaminated dentures pose potential health risks -Dental professionals should be mindful of the prevalence of dry mouth in the aging population. The likelihood of xerostomia increases with the number of medications a person takes. Since people over 65 use an average of three prescriptions and two over-the-counter medications per day, they stand a good chance of suffering from dry mouth.7,8,9

In normal conditions, saliva provides a variety of protective functions and may be considered the mouth’s first line of defense against harmful bacteria. Denture wearers with reduced salivary flow should be particularly concerned about the cleanliness of their dentures. Dental professionals should make a point of inquiring about dry mouth with all patients, with special attention to dry mouth sufferers wearing dentures, and with emphasis on the importance of thorough daily cleaning to combat bacteria. To relieve ongoing symptoms of xerostomia, dental hygienists can recommend oral moisturizers that provide symptomatic relief and aid denture retention, which boosts patient confidence.

• Older patients – with or without dentures – have higher bacterial counts in their mouths – Researchers have discovered higher counts of lactobacilli and yeasts in the saliva of older people, particularly older denture wearers.10 This is due to several factors, including reduced salivary flow and diminished immune system protection. Unfortunately as people age, their mouths require more vigilant care, which can be an issue for patients experiencing declines in dexterity and self-sufficiency. Dental hygienists can review denture cleaning regimens and products with these patients to ensure that they make nightly soaking part of their routine. If manual dexterity is a problem, supplemental denture cleaning methods (e.g., denture wipes or stationary denture brushes) can be explored.

The average full-mouth denture in the United States is 17.6 years old - Does the dental office consistently recommend routine professional oral evaluations to denture patients? Does the denture patient understand that follow-up is essential, and should not be only when their dentures have loosened or become uncomfortable, or when an oral infection is causing complications? It has been reported that 57 percent of denture wearers seldom or never receive a routine checkup.11

Depending on denture retention and stability, dentures should be replaced every five to seven years – a recommendation that greatly conflicts with the average denture age stated above. Obviously, most patients do not consider replacement that often and hope to get many years of wear out of their dentures. While this is sometimes possible, patients need to be reminded that routine professional evaluations and keeping dentures clean may help prolong the life of both full and partial dentures.

By sharing these five little-known facts with their patients, dental hygienists can inspire even less-compliant denture wearers to consider the many benefits of well-maintained dentures. Since thorough daily cleaning and routine professional follow-up can prolong the life and comfort of dentures, encouragement by dental professionals is worth the effort. The denture wearer experiences greater confidence, satisfaction, and pleasure, and produces more smiles and a healthier, happier life with dentures.

References

1 Burton MA. Current trends in removable prosthodontics. J Am Dent Assoc 2000; 131:52S-56S.
2 Shay K. Denture hygiene: a review and update. J Contemp Dent Pract Feb. 2000; 2(1):28-41.
3 Marsh PD, Percival RS, Challacombe SJ. The influence of denture-wearing and age on the oral microflora. J Dent Res July 1992; 71(7):1374-1381.
4 Shay K. Denture hygiene: a review and update. J Contemp Dent Pract Feb. 2000; 2(1):28-41.
5 Data on file, GlaxoSmithKline Consumer Healthcare.
6 Shay K. Denture Hygiene: A review and Update. J Contemp Dent Pract Feb. 2000; 2(1):28-41.
7 Atkinson JC, Baum BJ. Salivary enhancement: current status and future therapies. J Dent Ed 2001; 65:1096-1101.
8 Helling KD, Lemke JH, Semla TP, et al. Medication use characteristics in the elderly: the Iowa 65+ rural health study. J Am Geriatric Soc 1987; 35:4-12.
9 Espino DV, et al. Correlates of prescription and over-the-counter medication usage among older Mexican Americans: the Hispanic EPESE study. J Am Geriatr Soc 1998; 46:1228-1234.
10 Marsh PD, Percival RS, Challacombe SJ. The influence of denture-wearing and age on the oral microflora. J Dent Res July 1992; 71(7):1374-1381.
11 Burton MA. Current trends in removable prosthodontics. J Am Dent Assoc 2000; 131:52S-56S.

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Poorly Cared-for Dentures Can Lead to Larger Issues

As noted in the adjacent story, 57 percent of denture wearers seldom or never receive a routine checkup. When you estimate that there are 49 million patients with dentures,1 that 57 percent is equivalent to nearly 28 million people who are improperly caring for their mouths and dentures.

All dental professionals have a responsibility to encourage these denture wearers to visit their dentists’ offices for checkups. But routine checkups are not always feasible for denture patients. However, dental professionals can help by providing patients with information to deal with some of the more common issues that can accompany poorly cared-for dentures.

Mouth sores

When dentures are not fixed into place appropriately or do not fit properly due to a patient’s weight loss or a change in the oral environment, they can rub inside the mouth and cause mouth sores or canker sores. These sores can make it uncomfortable to eat, talk, or just wear the dentures. Taking care of these sores is something denture wearers can typically manage themselves by using hydrogen peroxide or a specifically formulated over-the-counter mouth sore product, such as Gly-Oxide Liquid Antiseptic Oral Cleanser (GlaxoSmithKline Consumer Healthcare), that cleans and soothes the wound and promotes natural healing. Another option is an adhesive patch, such as Canker Cover (Quantum, Inc.), that adheres to the sore and helps avoid additional irritation.

Angular cheilitis

This condition can be identified by the deep cracks or splits that can form at the corners of the mouth. For people with dentures, the cause is often an overclosure of the mouth due to not wearing their dentures regularly. Treatment for these people can often be as simple as wearing the dentures regularly. Obviously, if the dentures do not fit and that is the reason for not wearing them, getting them properly fitted will make a world of difference. In the short term, the pain and irritation from angular cheilitis can be eased by using lip lubrication.

Leukoplakia

Another problem caused by ill-fitting dentures, leukoplakia is recognized by thick, hard, white patches in the mouth that cannot be removed. This is commonly caused by chronic irritation of the mouth, as would be the case when poorly fitting dentures rub against soft oral tissue, or from smoking or using smokeless tobacco. To treat this issue, tobacco users are encouraged to stop smoking as the leukoplakia may clear up on its own. Patients who do not smoke and are irritated by the hard patches may need to see a dentist to have them removed. It is also wise to recommend having these spots tested for early indication of oral cancer.

By being able to provide answers to these common denture issues, dental professionals will hopefully encourage those who neglect their dentures to obtain dental care on a regular basis. This advice may also significantly improve a patient’s quality of life and create a more successful overall denture experience.

1 Data on file, GlaxoSmithKlineClare Van Sant, RDH, BS, received her BS in Dental Hygiene from the Medical College of Georgia in 1975 and has been providing onsite dental hygiene care in nursing home settings since 2002. Her professional experience includes working as a public health hygienist, clinical periodontal therapist and community oral health educator. She lives in Spartanburg, S.C. You may reach her at ResiDental@charter.net.

http://www.rdhmag.com/display_article/298176/56/ARTCL/none/

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A Clean Finish

By Laura Hill

At the end of the day, dentists need to feel confident that their office is clean and their instruments are infection-free for their patients. Today’s sterilization technology has become more efficient than ever, enabling them to run their practices safely and smoothly. Distributor reps can help their customers discover the right mix of products and technology that best suits their practice.

Just make it short.

“Dentists want shorter process times,” says Kim Maalouf, product manager, Midmark Corp. (Versailles, Ohio). They are looking to purchase fewer instruments and process them more efficiently, she notes. This calls for gentler processing techniques, which can help extend the life of their instruments. They also are interested in sterilizers that offer greater automation and less handling time.

Any technology that makes the sterilization process faster and more efficient will enable dentists to see more patients and generate more revenue, adds David Pfeifer, marketing manager, Kerr TotalCare (Orange, Calif.). Today, sterilizers include more automated cycles, greatly limiting opportunities for human error, he says. “Record keeping is much easier, due to compatibility of sterilizer digital records and office computer systems. Larger chambers are [now available] for cassettes, and racks help ensure proper [instrument] loading.”

As equipment improves, so do liquid sterilants, which are used for soaking and pre-cleaning instruments. Now offered in tablet form, sterilants can be shipped less expensively and stored more easily. Liquid sterilants are now available with a hydrogen peroxide base for customers who don’t want to deal with disposal issues often associated with glutaraldehyde-based products.

The right sterilizer
A sterilizer can be a sizeable purchase for a dentist. As such, he wants to buy a reliable system upfront that will last for years, says Maalouf. While some smaller units are available for a list price of $2,200 to $2,400, average sized units generally list between $5,000 and $6,000. A class B pre- and post-vacuum unit can list for as much as $7,800. The life of a sterilizer varies from one practice to the next, depending on how well maintained it is and how many cycles the practice runs each day, she explains. “On average, a sterilizer lasts nine or 10 years, with moderate use.”

There are some leading questions distributor reps can ask their customers to determine their sterilization needs:

• What type of instruments do you plan to sterilize? Some specialties, such as orthodontia, use a lot of hinged instruments. Orthodontists traditionally have opted for dry heat sterilization, with the assumption that steam sterilization may rust the hinges on their tools. Today, however, more orthodontists trust that steam sterilizers will sufficiently process their instruments, Maalouf points out.
• How big is your practice? Larger practices with, say, two dentists and three hygienists, may require more – or larger – sterilizers.
• How many instruments will you need to sterilize each day? How many sterilization cycles do you plan to run daily?
• How large are your instruments? The instruments must fit in the chamber of the sterilizer.
• What type of electrical wiring exists in your office? This may dictate the model best suited to a particular practice, notes Pfeifer.
• How large an area exists in the practice to accommodate a sterilization center? This, too, may limit the type of sterilizer a dentist can purchase.

Today, many dentists and their staff depend on intuitive sterilizers, with easy-to-use, programmable controls that allow the operator to return to his duties without having to check on the process. The unit should be designed for easy draining and filling, and it should properly dry instruments and/or packaging, according to sources at Midmark.

Reps can play an important role in their customers’ decision process by educating dentists on their sterilization options. Several different solutions are available today:

• Steam, or autoclaving
• Chemical vapor
• Dry heat
• Liquid chemical immersion.

Steam autoclaves are the “workhorses” of dental sterilization, according to Pfeifer. They combine time, temperature and pressure to sterilize instruments without emitting toxic vapors, he points out. Instruments must be dry before they are loaded, and overloading the chamber can prevent optimal sterilization. Steam cycles usually run for three to 30 minutes at 250 to 270 degrees Fahrenheit.

There are three types of steam sterilizers:

• Gravity displacement
• Steam flush pressure pulse
• Class B (pre- and post-vacuum).

Gravity displacement units work as heat builds up and steam pushes air out via gravity. This process causes a valve to open and close in the chamber, allowing air pockets to form. However, it reportedly is more difficult for steam to penetrate air pockets, or “cold spots.”

In a steam flush pressure pulse system, while the system heats up, the valve to the chamber remains closed. Following the heating process, the valve opens and permits air to pulse out. The sterilizer is pre-programmed and automatically determines when and for how long air will pulse out.

Class B sterilizers incorporate the newest technology in sterilization. Vacuum conditions are created in the chamber to pull steam in, resulting in a more rapid, efficient and effective dispersal of steam, with fewer cold spots. Pre-vacuum refers to a pump on the chamber, which sucks out air before steam and pressure build up. During the post-vacuum stage, a pump sucks out the steam at the end of the cycle, before the drying process begins. The vacuum drying cycle provides added assurance that instruments will be fully dried at the end of the process.

Cassettes vs. pouches
One of the biggest considerations in selecting a sterilizer is whether the dentist plans to use a cassette to hold instruments during the process, or whether he or she will opt for a pouch or simply load instruments loosely into the sterilizer, according to Maalouf. “Cassettes require larger sterilizers,” she says. The size of the sterilizer dictates how many cassettes it can contain.

There is a growing trend toward using cassettes, primarily due to safety concerns: There is less opportunity for the handler to get stuck by an infected instrument when using cassettes. Cassettes, which typically are pre-wrapped in paper wrap, can be transferred from the sterilizer directly to the shelf for storage. In comparison, when instruments are loaded unwrapped into the sterilizer, they must be used immediately at the end of the sterilization process to comply with current infection control guidelines, says Maalouf.

Dentists do have an option of sealing instruments in pouches prior to loading them into the sterilizer. Paper-peel pouches are plastic-coated on one side and paper on the other. The seal sticker is peeled off and the pouch secured tightly. On one hand, pouches require a smaller sterilizer. But, because steam takes longer to penetrate the pouch, the processing time is longer than when using cassettes. As with cassettes, however, pouches can be transferred directly from the sterilizer to the shelf, where sterilized instruments can remain until needed.

Alternatives
Chemical vapor sterilizers require dry instruments to avoid corrosion, says Pfeifer. Dry heat sterilizers, on the other hand, are associated with less risk of instrument corrosion and can be loaded with wet instruments. These systems disinfect instruments at extremely high temperatures (320 to 400 degrees F) for prolonged periods of time (one to two hours).

Chemical immersion, or liquid sterilants, are used either for pre-cleaning instruments prior to sterilization, or for sterilizing heat-sensitive instruments that cannot be processed in a steam autoclave. Traditionally, liquid sterilants have been glutaraldehyde-based. Some dentists may be concerned about exposure to glutaraldehyde vapors, and disposing of the chemicals can be tricky, due to Environmental Protection Agency (EPA) laws. But, glutaraldehyde is a less expensive alternative to steam sterilization, and one that some dentists still prefer.

As with most systems, glutaraldehyde liquid sterilants have their pros and cons. “Chemical sterilization [cannot] be spore-tested and validated as can heat sterilization,” says Pfeifer. “However, for instruments that are heat-sensitive, the reliability of the solution can be improved if test strips are used to confirm the concentration of glutaraldehyde, and accurate records are kept of activation dates and solution discard dates. Unlike manual sterilizers, the use of glutaraldehydes is dependent on operator compliance, with recommendations such as proper soaking time, temperature, dilution of liquid or any other action that may jeopardize the sterilization process. While the process is technique-sensitive, if [it is] done correctly, cold sterilization can be very effective and practical.” [FI]

Go with the flow
Experts agree that a sterilization center should be separated from the operatories, but easily accessible for dentists and staff. The center requires a sink for hand washing, storage cabinets and drawers, sufficient lighting and electrical service. To reduce the risk of injury to the handler or the spread of germs, and to ensure efficiency, the process should follow a specific workflow, beginning with pre-washing or decontamination. Some dentists believe they must pre-soak their instruments before putting them into the ultrasonic system or automated washer. They don’t want the soils to harden prior to sterilization, nor do they want germs and bacteria to grow while infected instruments remain in the open air, as they can contaminate patients and staff. However, instruments presoaked in a chemical solution must be rinsed before loading them into the sterilizer, creating yet another opportunity for the handler to be stuck and infected. For this reason, dentists often opt to load contaminated instruments directly into the ultrasonic cleaner or automated washer. Following pre-cleaning, instruments should be packaged, processed in a sterilizer and, finally, stored for future use.

Midmark Corp. suggests the following workflow for dentists to follow when sterilizing their instruments:

Transport instruments and handpieces to the steri-center. Contaminated instruments and handpieces should be transported in a closed, rigid, leak-proof container to minimize any risk of exposure to staff, patients or the environment. The handler should always wear personal protective equipment when transporting contaminated materials.

Sort instruments and handpieces, and properly dispose of waste. Disposable instruments should be separated and not re-used. Reusable instruments should be separated based on the type of sterilization that will follow. Some instruments require cold soaking prior to sterilization, and handpieces have a separate cleaning procedure before sterilization. All excess waste should be disposed of in a biohazard waste receptacle according to EPA mandates.

Soak and pre-clean instruments. Pre-cleaning should be conducted using a hands-free mechanical process, such as an ultrasonic cleaner or an automated washer. Hand scrubbing is unsafe for the handler, who may get stuck by an instrument.

Rinse and dry instruments. After being ultrasonically cleaned, instruments should be rinsed in clean water or, in some cases, distilled water, and dried thoroughly.

Pouch or wrap instruments. Instruments should be packaged in pouches or wrapped cassettes, unless they will be used immediately afterward. Packaging should be sealed to maintain sterility, and it should be compatible with the type of sterilization used.

Sterilize and dry instruments. It is important to have access to more than one method of sterilization or multiple sterilizers in case equipment breaks, supplies run out or electricity is interrupted.

Store sterilized instruments in a clean, dry, protected area with minimal airflow. Instruments should remain packaged until required for use. If packaging is punctured or has gotten wet, the instruments should be re-sterilized prior to use. Instruments should be rotated on a “first in, first out” basis.

The right thing to do
OSHA and the Centers for Disease Control and Prevention have guidelines for sterilizing instruments, notes Pfeifer,

But it is up to each dental office to implement a system. Manufacturers usually offer test kits for the providers to determine the viability of chemical solutions, adds Lorencovitz. But, each dental office should have a protocol for ensuring that instruments are sterilized regularly and that sterilizing equipment and solutions work proficiently.

It’s not a question of what is the law, but what is best for the dental practice, its patients and its staff. Today, providers can’t afford not to take infection control seriously.

http://firstimpressionsmag.com/

Methacrylates may be at risk for dental assistants

 

Cement in fillings can lead to dental aids’ asthma  Author: Reuters/DZ Dental assistants who work with substances called methacrylates may be at risk of developing asthma or chronic respiratory symptoms, a new study says. Researchers found that among 799 Finnish dental assistants, those with greater methacrylate exposure had higher risks of developing asthma or respiratory problems like chronic nasal symptoms, hoarseness and breathing difficulty. The risk of respiratory symptoms appeared to grow the longer women had been on the job, and those who’d suffered allergies as children seemed particularly susceptible.  Methacrylates are used in dental filling materials and bonding agents, like those used to cement porcelain veneers, crowns and orthodontic brackets. Dental assistants are exposed to airborne methacrylate particles when mixing these materials or during placement or removal of dental restorations. “The risks to respiratory health are related to inhaling these substances,” lead author Dr. Maritta S. Jaakkola, of the University of Birmingham in the UK, told Reuters Health. Probably the most important protective measure is for dentists to install exhaust systems in areas where assistants work with methacrylates. Besides exhaust systems to clear the air, gloves also offer dental assistants protection from methacrylates, Jaakkola noted. The substances can cause skin reactions, she explained, and it’s also possible that sensitization to methacrylates through skin contact makes some people more susceptible to suffering respiratory effects as well.