By Carol Wells, RDH
Think of a visit with your usual dental hygienist, and you probably think: Yeah, I’ll get my teeth cleaned and a little lecture about flossing, and that’s it. Every appointment is just like another – though each patient’s dental needs are not.
Fortunately, there are growing numbers of hygienists who think outside this box. Free from its confines, we can take a “whole body systems” approach to oral and overall health.
We call this Biological Dental Hygiene.
As a biological dental hygienist, I’m concerned with how the mouth affects the body and how the body affects the mouth. Each patient’s treatment plan is unique, customized to their personal oral-systemic health situation and needs.
What Makes a Biological Hygiene Appointment Different
Conventional dentistry has a pretty set plan for how a hygiene appointment should go:
- The patient is seated in the operatory.
- Their medical history is reviewed and charted.
- Necessary x-rays are taken.
- Conditions of both hard and soft tissues in the mouth are charted.
- The patient is screened for oral cancer.
- The hygienist reviews the patient’s home care and suggests improvements.
- The patient’s teeth are cleaned and polished, likely with a fluoridated prophy paste.
- The teeth are flossed.
- Fluoride is applied.
- The patient returns to the front desk to book their next appointment.
Things go a bit differently at a Biological Hygiene appointment. For one, we start by talking with you outside of the operatory. We want to know
- What your past dental experiences have been.
- What your current oral and overall health is like.
- What you would like your oral and overall health to be.
In other words, we want the big picture before we move on to the operatory.
Though each biological dental hygienist may work a little differently, I always start by taking your blood pressure and giving a blood glucose test. (There’s a strong relationship between diabetes and gum disease!) I also screen for head and neck cancer.
If any x-rays are needed, we take them – digitally, to minimize radiation exposure. (Some also provide homeopathics to counter the effects of radiation.) I also take intra-oral photos of your mouth and then look at a sample of your subgingival plaque with a phase contrast microscope, to get a glimpse of the health of your oral microbiome.
You get to see this in real time, too, observing pathogens – “bad bugs” that may be wreaking havoc with your health. When you do, it raises an obvious question: “How do I get rid of them?” You can see the infection for yourself.
We know that infection produces inflammation not just in the mouth but throughout your body. With the phase contrast microscope, you can see its cause – and have a better understanding of how your teeth, gums and the bone that supports their teeth are affected by these disease-related bacteria.
The biggest difference between this and a conventional dental visit, though, is the conversation we have with you. We’re not there to lecture you on flossing. Instead, together we explore a set of factors that play a big role in both oral and systemic health, identifying your challenges and creating a plan for conquering them.
These factors are summed up nicely in an acronym: HONEST AGE.
H – HYGIENE
O – OCCLUSION
N – NUTRITION
E – EXERCISE
S – STRESS
T – TOBACCO
A – AGE
G – GENETICS
E – EXERCISE/ EXPERIENCE
Let’s break down what these mean:
Hygiene: How does the way you brush your teeth impact the health of your teeth, gums, and body? Do you floss? Do your gums bleed when you brush or floss? How many times a day do you brush and floss? How effective are you?
Occlusion: How do your teeth fit together? Which teeth are affecting your bite relationship? How does this affect your mouth? Are there areas that are hard to reach?
Nutrition: Is your diet well balanced? What can you do to improve it?
Exercise: Are you getting enough physical activity? What can you do to get more of it into each day?
Stress: How do you handle stress? How would you rate your stress level on a scale of 1 to 10, where 10 is “maxed out” and 1 is “pretty mellow”? What can you do to lower that number?
Tobacco: Do you smoke or chew? How much is too much? Do you want to quit?
Age: Are you having any difficulties with mobility and dexterity as you age? Are there other, easier ways to do what you need to get done?
Genetics: Are you predisposed to certain illnesses? How do the ones that affect you affect your oral health?
Experience: Do negative dental experiences in your past keep you from seeing your dentist or hygienist regularly? Are you able to take care of yourself in the environment you live in?
Talking about these points in an open, honest, and nonjudgmental way empowers you to take charge of your oral and overall health. The info we uncover and share becomes the basis of a game plan for improving both.
After this strategizing, we’ll have you swish a disclosing solution in your mouth that will highlight any plaque on your teeth. (Dental plaque is invisible to the naked eye.) You’ll be able to see where you’ve been cleaning effectively, as well as areas you’ve been missing with brush and floss. I’ll take an intra-oral picture of this, as well, so we can compare it to results at your next visit. That way, we can track your progress.
And so you can progress, I’ll give you a mirror to look in as we review home care techniques. Most patients don’t realize how hard it can be to remove mature dental plaque. So I ask you to show me your brushing technique so I can advise on what you can do to get better at removing those soft deposits of bacteria. We may review flossing technique, as well.
And I may suggest other tools you can incorporate into your home care routine to get better results – for instance, oral irrigators, interproximal/interdental (“proxy”) brushes, rubber tips, power brushes, sulcus brushes, and more.
Once we’re done with that, I’ll ask you to rinse with a fluoride-free, alcohol-free rinse in preparation for your cleaning. Before scaling – scraping the biofilm from your teeth – I’ll irrigate with ozonated water or use a subgingival laser (i.e., a laser that goes below your gumline) to reduce the bacterial load in the pockets (sulci) that flank each of your teeth. This lessens the bacterial cascade into the body that can happen during a deep cleaning.
I then scale the teeth to remove both hard and soft deposits (calculus and plaque, respectively). If I’m using an ultrasonic scaler, I’ll use ozonated water in it to further eliminate harmful bacteria. Afterwards, I’ll irrigate again with ozonated water and then polish your teeth with a fluoride-free, organic prophy paste, followed by a good flossing.
Your next appointment is then booked based not on some predetermined schedule but your actual needs.
Another biological dental hygienist may do these things in a different order or in a different way, but all of us take into account the whole body picture with respect to your oral health and opt for the least invasive nontoxic ways of providing the care you need.
YOU Take an Active Role
Conventional dentistry trains patients to be relatively passive in their care. The dentist and hygienist are the ones who “do things.” The patient is the one “done to.”
We want to bring about an end to what I call “the Yes Syndrome” – where patients agree with whatever the hygienist or dentist says, just to get on with the cleaning so they can get out of the dental chair and on with the rest of their day’s business.
In the biological model, though, we expect you to be engaged in your own treatment plan, as well as your home care routine. We want you to be involved in your own oral and overall health.
After all, it’s YOUR mouth we’re working on.