Visits to the Dentist

[A930Rocket]

Originally Posted by RNajarian

$1,500 each unit. They are recommended for use anytime a rotary instrument is in use or when an ultrasonic unit is in use.

Looks like you got a better deal. . .

I had my teeth cleaned a few months ago. No vacuum in sight that I saw. 🤬

[JackDidley]

I am still doing my 6 month cleaning. The tech does wear a mask and a shield. I am not going to change my life over this. I do not hate wearing a mask when required so its not a big thing for me.

[RNajarian]

From the CDC/ADA

“The Centers for Disease Control and Prevention suggests dentists consider using a portable air filter that meets the high-efficiency particulate air standard while performing aerosol-generating procedures and immediately afterwards. In its Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response, updated May 19, the CDC states using a filter will reduce the particle count in the room, including droplets, as well as the air turnover time provided by the building HVAC system alone. . . while some practices may have portable filters dentists can place in different parts of the operatory, others may have filters that are part of their ventilation system. Comparing the two is hard to do because both come with their own specifications, Dr. Kumar said. While portable filters allow dentists to control their placement, their capacity may not be as large as the ones that are built into the ventilation system. “

[Nickshu]

Periodontist here. As far as I have read there is still not a single case of doctor/staff to patient COVID transmission tied to any dental office in the United States.

There is WHO data from other countries where dentistry is a trade (not a profession) and infection control is little to none, no surprise there.

There is plenty of data that poor oral health reduces your immunity in general, so avoiding dental care may increase your risk vs reduce it.

We have been using the Air Vac extraoral suctions in our offices since May. We also installed HVAC systems to purify air, as well as air purifiers in the offices to provide adequate turnover rates. Maybe it helps, maybe it doesn't matter, but it makes our patients feel better. No real data out there yet.

That being said there are good studies from back during SARS that plain old regular dental HVE suctions remove well over 90% of aerosols, so there is a good argument that these additional devices are not necessary.

Bottom line is the dental office is among the lowest risk places you can visit as far as COVID. Studies done by MIT and Stanford in recent months put dental offices (in the USA) among the lowest risk places with regard to COVID.

[Nickshu]

Originally Posted by stevej37

I had that done 8 years ago. Once on each side of my lower gum area.
Grafted bone tissue in to fill pockets. Fun, fun, fun. (maybe not bone tissue...but human tissue)
The dentist did a great job...not much pain at all.

We use laser surgery for that now in about 85% of cases. It's a much better patient experience. Lookup LANAP surgery.

[LWJ]

That vacuum gizmo reminds me of fume extraction for welding. Similar role. Different gizmo.

Cool to hear the low transmission stats.

Thanks!

[Nickshu]

Originally Posted by LWJ

That vacuum gizmo reminds me of fume extraction for welding. Similar role. Different gizmo.

Cool to hear the low transmission stats.

Thanks!

LOL well call it "The Scream Extractor" if you have ever seen the Pixar movie Monsters, Inc:




And yes they are basically exactly the same as industrial fume extractors, just with ultra HEPA filters on the end.

[cabmandone]

I don't care who ya are... that's funny!! ^^^^

[DonDavis]

I really would like to know just how often a DDS performs routine prophylaxis on patients?

Once a month? Once a quarter?

Since 1988, ( after my malocclusion correction surgery ), I’ve had my teeth cleaned every 6 months and I’ve never had a dentist do it. Always a hygienist. And when I go in later this month, I’ll ask my DDS the same question. Mark and I have been friends since 2003.

I understand they know the process inside out and backwards, that isn’t in doubt.

[stevej37]

Every 3 months here...always by the hygienist.
When she is done the dentist comes in and 'picks' over my teeth to check them out.

[stevej37]

I forgot to mention in an earlier post....I also went through the 'Dental Planing' procedure before the tissue grafts were done.
That series of visits was worse than the grafting surgery.

[Nickshu]

Originally Posted by DonDavis

I really would like to know just how often a DDS performs routine prophylaxis on patients?

Once a month? Once a quarter?

Since 1988, ( after my malocclusion correction surgery ), I’ve had my teeth cleaned every 6 months and I’ve never had a dentist do it. Always a hygienist. And when I go in later this month, I’ll ask my DDS the same question. Mark and I have been friends since 2003.

I understand they know the process inside out and backwards, that isn’t in doubt.

Originally Posted by stevej37

Every 3 months here...always by the hygienist.
When she is done the dentist comes in and 'picks' over my teeth to check them out.

While it seems simple from a layman's view, instrumenting teeth with scalers and curettes without flap access is quite technically demanding, especially to do it well, comfortably, and effectively (Effectively being the important point). While a dentist certainly can do it, you are correct that it is highly doubtful that 99% of dentists are proficient enough to do this well, especially on periodontally involved teeth. Hygienists are the experts here. Periodontists like me can probably do it better than a general dentist, but my hygienists are still much better at it than I am.

Sort of like how your mechanic can rebuild your engine, but ask him to do a 100 point detail on your car's paintwork...yeah he can do it...but it may not be the greatest work. Best to leave it to someone who does it every day and knows how to use the tools with precision.

[Tobra]

Originally Posted by RNajarian

$1,500 each unit. They are recommended for use anytime a rotary instrument is in use or when an ultrasonic unit is in use.

Looks like you got a better deal. . .

Mine are not rated for aerosols, just nail/skin dust.


I know gross.

Every six months for a cleaning. Hygienist does their thing then dentist looks it over.

[LEAKYSEALS951]

Originally Posted by Nickshu

While it seems simple from a layman's view, instrumenting teeth with scalers and curettes without flap access is quite technically demanding, especially to do it well, comfortably, and effectively (Effectively being the important point). While a dentist certainly can do it, you are correct that it is highly doubtful that 99% of dentists are proficient enough to do this well, especially on periodontally involved teeth. Hygienists are the experts here. Periodontists like me can probably do it better than a general dentist, but my hygienists are still much better at it than I am.

Sort of like how your mechanic can rebuild your engine, but ask him to do a 100 point detail on your car's paintwork...yeah he can do it...but it may not be the greatest work. Best to leave it to someone who does it every day and knows how to use the tools with precision.

Not directed at Nick, or Don, but more of openly talking-

I want to take a couple of minutes and elaborate on my statements from the other night. This thread was originally about safety during covid, but due to comments from "yours truly" , has taken a bit of a detour. Please let me "briefly" clarify

My specific issue with the original statement was that Hygienist were trained better than dentists in the realm of cleanings. At our school, many of the hygiene and dental classes were combined in periodontics- and two, there are some local community college hygiene programs that, well, are perhaps not as capable/ have the resources as larger school's hygiene program, where I attended/ worked as adjunct faculty.

The second issue, was, the perception dentists who did not employ hygienist were 'cheapskates.' A properly run hygiene program should be somewhat of a profit maker for the practice owner. There are a number of reasons, other than money some dentist choose not to employ a hygienist. One- fwiw, right now, there is a tremendous shortage of hygienist, some of that due to covid. Things are so desperate, a local practice is offering a 10K sign on bonus to attract a new hygienist. A neighboring dentist, last night, joked "Maybe I should sell my practice and go work there."

From Don Davis's comments, I can almost bet his ex wife had less than ideal experiences with one or more previous employers who did not value hygiene to her degree (degree meaning "her level of commitment", not degree (rdh,dds,dmd,etc.)). I'd also bet Don has gotten an earful about it over the years, but I bet her experience isn't an educational (meaning she knows more than the dds) gap, it's more likely a complacency (he learned it, but lost it along the way) gap. On the flip side, I have come in behind numerous hygienists and found tartar that I have had to touch up. Same with probing discrepancies. No one likes to find a 6-7 mm pocket behind last month's 3-2-3-2-3 probings. In that sense, a team approach has it's advantages.

I agree that in the sake of day to day proficiency, a hygienist might be more proficient, but I would also add, that I have seen a wide berth of proficiency between dentists and hygienists in terms of training and effectiveness. I have seen some very motivated hygienists who have even gone on to get dental degrees. Some enjoy cleaning during flap surgery, some hate the sight of blood. Some give local anesthesia, some prefer to have local anesthesia given, some prefer to attempt deep cleanings with no anesthesia. I've seen the results (particularly with the latter), that while well intended, haven't worked so well, and even in my own cleanings would be lying to claim I've never missed a chunk of subgingival tartar at some point. In terms of hygienists, I have also seen some, from various community college programs, where, some, are better than others. I have seen some hygienist who are despised by their patients for being rough, but get good results, some patients who love their hygienist for being gentle, who aren't thoroughly cleaning, and the most prized hygienist of all- someone who causes minimal/no pain buts gets maximum results. The point is, the degree doesn't really qualify/disqualify someone as much as their motivation/talent/skill.

Both practices I work at use hygienists, and I would also add a team approach can benefit the patient (I believe "the more eyes, the better"), but the idea that they are better than 99% of dentists would indicate that dentist should not clean teeth at all. Especially aligned with the wide talent levels I have seen, 99% is a pretty damning odd. Although, I'm sure nickshu is giving a well deserved shoutout to his staff, my concern is that could undermine the trust of people who actually have dentists who clean their teeth. I know many general dentists who enjoy it, who limit their own practice to simple fillings and cleanings, referring out all oral surgery, endo, and even fixed. I know one pedodontist, who does cleanings, but would not attempt a simple class one filling on a permanent tooth. A lot of the proficiency comes from experience. Non surgical treatment of larger pockets brings up a higher level of skill needed, but at that point, in my experience, patients who need such, are generally referred to periodontal care for management/treatment.

Where I work, I haven't done a lot of flap surgery for over 15 years. We have the laser too, but, I'm at a point I generally refer out periodontal issues.

By the 99% parameter, all care should be specialist provided. All implants/ extractions by oral surgeons. All endo by endodontist. All fixed crowns/removable by prosthodontist. All ortho by orthodontist. All cleanings by not only a periodontist, but their periodontist's hygienist.

If someone reading this is concerned that their general dentist who does clean their teeth is not doing a good job, I would recommend the following:

Don't focus on the practice, or what their friend's practice is doing (dentist vs hygienist), or what Dr. Phil says. Instead, focus on the idea of "How is my dental health in general?- specifically periodontal health."

At the next cleaning, mention this thread as a starting point for discussion. 1. "Hey, I was reading something about hygienist vs. dentists cleaning teeth. Which is better? Is there a difference? Interesting read, lots of different opinions. " Ask them what they (the dentist) thinks about this. 2. Ask them specifically about the patient's own periodontal situation. "Got me thinking. How are my gums? Am I in good shape? Do I have gum disease? What can I do better? " and 3. Finally asking "If I/ or somebody did have gum disease, at what point do you recommend making a referral? Are there any areas where you think I might eventually need to see a specialist for? If so, would seeing a specialist now help? What are some of the things that a specialist would excel at?

Finally, following up with a "phew... good thing I don't have any of those things/ or/ okay- let's do (x) to address (y) issue."

At the end of that conversation, the patient should have a much better view on the philosophy of the treating dentist, as well as how things really are in their mouth. It might open up some really good dialogue.

Edit- and no offense meant towards Don/Nick, etc.

[Brian 162]

I've been twice for cleanings. They screened me and checked my temp. upon arrival.
My teeth were cleaned the old fashioned way, using instruments. No water jet cleaning.
No flossing or polishing as well.
I also went to my periodontist no issues.

[jyl]

I resumed going for my regular visits as soon as my dentist re-opened. A) I need it. B) I don’t want my dentist to go out of biz. 3) They’re at more risk from me than I am from them.

[RNajarian]

Originally Posted by jyl

I resumed going for my regular visits as soon as my dentist re-opened. A) I need it. B) I don’t want my dentist to go out of biz. 3) They’re at more risk from me than I am from them.

That is definitely true.

https://www.visualcapitalist.com/the-front-line-visualizing-the-occupations-with-the-highest-covid-19-risk/

From the Article. . .

[DonDavis]

Originally Posted by Nickshu

Sort of like how your mechanic can rebuild your engine, but ask him to do a 100 point detail on your car's paintwork...yeah he can do it...but it may not be the greatest work. Best to leave it to someone who does it every day and knows how to use the tools with precision.

In my ham-fisted way, this is what I was implying.

Originally Posted by LEAKYSEALS951

Not directed at Nick, or Don, but more of openly talking-

My specific issue with the original statement was that Hygienist were trained better than dentists in the realm of cleanings. .

mea culpa, what I wrote does have that appearance, that was lazy on my part.
I certainly understand whose had more education.

Originally Posted by LEAKYSEALS951

The second issue, was, the perception dentists who did not employ hygienist were 'cheapskates.' A properly run hygiene program should be somewhat of a profit maker for the practice owner.

From Don Davis's comments, I can almost bet his ex wife had less than ideal experiences with one or more previous employers who did not value hygiene to her degree (degree meaning "her level of commitment", not degree...

Yup, in her early years she had to Temp and a few places to get a full work week. She saw some very poorly run Practices from the top down.

Sounds like your office would a be fantastic place for overall oral health and patient care.

Originally Posted by LEAKYSEALS951

Edit- and no offense meant towards Don/Nick, etc .

To Dr LEAKY, my “drive by” comments were poorly delivered.
Your outstanding post describes the kind of Practice everyone should experience.

Thank you for taking the time to elevate the knowledge of this thread.

[red-beard]

Originally Posted by wdfifteen

Every six months for a tune-up or whatever they call it. I delayed my latest as long as I could, but I needed a crown and some fillings and he had house payments, so we made it work.

Points and plugs?

[GH85Carrera]

My dentist is a one man show, with an assistant to help with calls, and handing his tools during a procedure and cleaning up, and running the autoclave.

My dentist is the guy that does everything in my mouth. I have gone to him for 48 years. He has the exact same decor and cartoons on the walls from the 1970s. He did have to replace the X-ray arm but the rest of of the place is a time warp back to the 1970s.

Tuesdays his office is closed because he is an instructor at the Oklahoma School of Dentistry at OU medical center.

I have a separate oral surgeon for root canals and such.