Oral Hygiene May 2020

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May 2020

GETTING TO KNOW YOUR

Austistic

CLIENTS

Join the best Be part of Canada's leading network of dental practices learn more at careers.dentalcorp.ca

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MAY 2020

Inside this issue ORAL HYGIENE

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A Selfcare Survival Guide for Busy Dental Professionals Uche Odiatu, DMD Mahsa Bakhshandeh, RDH

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Socially Distanced Dentistry Jo-Anne Jones, President, RDH Connection Inc.

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Getting to Know your Austistic Client Jennifer Grzebien, RDH

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Hindsight is 20/20: Missing the Oral and Oropharyngeal Cancer Diagnosis Jo-Anne Jones, President, RDH Connection Inc.

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Keep Calm & ADPIE: Unleashing Hygienists’ Potential Tracy Poirier, RDH, IMC™

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DEPARTMENTS 5

SO HOW HAVE YOU BEEN? Catherine Wilson

6 NEWS A Message to All Dental Hygienists in Ontario – COVID-19 Pandemic

Enacting Change: Dentistry, Dental Hygiene Students Push Green Plans

24 DENTAL MARKETPLACE

MAY 2020

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EDITORIAL

So how have you been?

Catherine Wilson Guest Editorial

MAY 2020

Catherine Wilson was a British serial killer who was hanged for one murder, but was generally thought at the time to have committed six others (according to Wikipedia, anyway). She worked as a nurse and poisoned her victims after encouraging them to leave her money in their wills. She was described privately by the sentencing judge as “the greatest criminal that ever lived.”

Not quite the way I wanted to open my first editorial in more than two years but hey, things aren’t exactly business as usual, are they?

I’ve been writing editorials for years, but this one is different. You see, when Melissa Summerfield, VP of publishing asked if I could briefly help during a transition leading to the arrival of the new dental group managing editor, I jumped at the chance. I spent 19 of the best years of my life with this group.

But just two days after being reintroduced to my old teammates, I was sent home. Well, me and 35 million other people. Come on, I hadn’t even memorized the route to the ladies room. My lanyard was still in its wrapper.

But here we are, in the midst of an unprecedented crisis. The global pandemic, COVID-19, has stricken more than four million people worldwide and claimed approximately 285,000 deaths.

In his guest editorial in the May issue of Oral Health, Dr. Manor Haas writes that this is exactly the time to pick up a little extra knowledge through blogs, webinars, Zoom meetings, etc.

“Turn to colleagues for support or to

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offer support and make the most of this downtime to improve yourselves.”

While this unimaginable time in our history is the source of indescribable anxiety, Dr. Sally Safa writes in her May Oral Health Viewpoint, about the importance of cutting each other, and ourselves, some slack.

Many feel they are alone, she says, in the level of stress they feel, and don’t know where to turn. Her hope is that if we shift our thinking and give each other a break, doing our best will be just perfect.

And what have I been up to these past two years, you ask?

A year ago I had back surgery and I now have enough metal in me to make a nice place setting...I carry one of those cards you show the friendly people at the airport x-ray department. Of course I have no reason to be at the airport x-ray department but hey, it’s nice to have.

Six months ago I moved from my family home after living there many, many decades. I was sad, but now I have a bathroom right inside the front door. It has a big widow. I can wave to my neighbours from a seated position... as I physically distance, of course.

I know you’ll join me in welcoming Amy Bielby as managing editor of the dental group. She brings a wealth of experience to the team and I hope she’ll have as amazing a run with you as I did.

I do miss you and hope with all my heart you will be back full tilt, full time, busier than in memory. For now, I raise a large, disinfecting smoothie to you...cheers!

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NEWS

A Message to All Dental Hygienists in Ontario – COVID-19 Pandemic The RCDSO has advised dentists that they strongly recommend that all non-essential and elective dental services should be suspended immediately. The CDHO has been in discussion with the RCDSO and is in full support of this action. The CDHO also strongly recommends that dental hygienists who are practice owners suspend their services immediately. Public safety is our number one concern.

The CDHO also acknowledges that dental hygiene services in a time of Pandemic are not considered emergency or essential services. In

addition, many health care providers in community settings have not been able to secure a reasonable supply of personal protective equipment (PPE) including masks, gloves, gowns and hand sanitizers. These supplies are required to fully comply with the CDHO Infection Prevention and Control Guidelines. Equally important is the preservation of such supplies so that they can be available to those health care practitioners who are providing essential lifesaving services. This is a socially responsible step to take.

For more information, visit: https://www.cdho.org/cdho-news/cdho-newsitem/2020/03/16/message-to-dental-hygienists-of-ontario---covid-19

Enacting Change: Dentistry, Dental Hygiene Students Push Green Plans

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A group of green-minded students are working to reduce the carbon footprint of the Dr. Gerald Niznick College of Dentistry in the Rady Faculty of Health Sciences.

The Student Environmental Group was created this year to look at ways to decrease the amount of waste in the college. They’re focused on what is being thrown away in the clinic, pre-clinic and in the college as a whole. A lot of paper, plastics and gloves are thrown out in the clinic, which sees about 130 patients each day. However, they face many challenges when it comes to making the clinic more environmentally friendly.

“We have to follow provincial and national guidelines on things like infection prevention and control,” said Madison Flamand, a fourth-year dentistry student. “It is challenging because we have to find a way to reduce carbon emissions and our carbon footprint while still following guidelines for the safety of our patients.”

For the full article, visit: https://news.umanitoba.ca/dentistry-dental-hygienestudents-push-green-plans/ For the latest coverage on COVID-19 as it pertains to the dental industry and profession, please visit www.oralhealthgroup.com/covid-19/

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MAY 2020

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PROGRAM

ORAL HYGIENE

Uche Odiatu, DMD Uche Odiatu DMD is a Toronto area dentist and a professional member of the American College of Sports Medicine and lectures throughout North America on total patient health.

Follow him on Instagram @Fitspeakers

Mahsa Bakhshandeh, RDH Mahsa Bakhshandeh RDH graduated from Durham College and has been in private practice for ten years.

She enjoys travelling and exploring the world, its many cultures & their variety of wonderful cuisines. Mahsa is a licenced Zumba Instructor and a certified meditation workshop facilitator. Follow her on Instagram @tooth_boss

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A SELFCARE SURVIVAL GUIDE FOR BUSY DENTAL PROFESSIONALS any of us only think of getting fit and healthy to look good for college reunions or to rebound after the failure of a relationship (the proverbial “revenge body”). It’s beyond just looking good; it’s about creating a body that can help you weather a financial storm, an emotional storm or even survive a pandemic. When pushed to the limit and life asks everything from us, we need a reserve. Just like having money in the bank helps you weather a financial storm, having impeccable health will help you in get through a global storm of mammoth dimensions.

There are four sections to our Selfcare Survival Guide: 1. Get physical 2. Eat right 3. Slay stress 4. Sleep well

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After this column you will have a foundation to be your physical and emotional best.

GET PHYSICAL

Exercise has the inherent ability to build strength and endurance into the human body. Most people already know this. A strong body can lift things up, it can get things done – you can live independently. Can the benefits go beyond the physical? This is where it gets mindblowing. Psychiatrist and Harvard Medical School professor John Ratey writes, “I have to cement the idea that exercise has a profound effect on cognitive abilities and mental health.”1 Dental professionals think just reading more and practising continuing education is all it takes to build our minds. Who would have thought that getting physically fit could have such far

MAY 2020

Just like having money in the bank helps you weather a financial storm, having impeccable health will help you in get through a global storm of mammoth dimensions.

reaching effects. Brain Derived Neutrophic Factor (BDNF), one of the 100 chemicals working muscles release, encourages new learning or neuroplasticity. We need excellent synaptic connections to think outside of the box and be creative when our lives are disrupted by crisis.

Of course, there’s counselling and cognitive behavioral therapy (CBT). Sports scientists have shown a session of resistance training – yes, the type of training that gives you Jennifer Aniston shoulders – also has the ability to improve your emotional state. Maybe you are upset. Perhaps the online application for COVID-19 financial support was supposed to be deposited today and it didn’t arrive. You had a disagreement with a family member and now you cannot fall asleep.

Progressive muscle relaxation and nasal breathing can help you quiet

MAY 2020

your overactive sympathetic nervous system get you to sleep within a few minutes. 2 Regular exercise habits have powerful antidepressant ability. In the American College of Sports Medicine Journal February 2012, they found an inverse relationship between physical activity and depressive symptoms. Whenever we have prolonged sympathetic nervous system activation it is fatiguing and leads to a feeling of helplessness. If poor sleep quality goes on long enough it supports depression. It is one of the most destructive and disabling mental disorders and is mentioned as one of the highest causes of disability in the western world. Sieverdes researchers and associates showed that even moderate exercise intensity is effective for supporting emotional health. You do not have to run a marathon to get fit and enjoy the mental health benefits.

Can your cardiovascular system weather a crisis? Heart disease is still the biggest killer with a person suffering a heart attack every 35 seconds in North America. An Iowa state study of 55,137 middle-aged runners in 2014 showed that running at any speed as low as 7 minutes a day could reduce the likelihood for a heart attack by 47 percent.

Pedersen BK et al at the Centre of Inflammation and Metabolism in Denmark showed muscle – yes, muscle – is the largest organ in the body and when it flexes and contracts at regular intervals, they release 100 MYOKINES into the circulation, telling every organ, every tissue that we are alive and well. IL4/IL10 and manganese superoxide dismutase are powerful anti-inflammatory and

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harmonizing agents that promote balance and bring the body back to homeostasis. 3 How much exercise do we need?

It could be a 60-minute Zoom video conference call with your dental team led by a local yoga instructor.

If on your own, YouTube has numerous total body exercise videos where no equipment is needed.

The American Council on Exercise (ACE) recommends two to three days a week of total body strength training for muscle toning. Flexibility training should be done at least two days a week for 10 minutes, holding a static stretch for 20–30 seconds. Aerobic activities? There’s a new science of HIIT or interval training, but the gold standard was 30 minutes, five days a week.4

EAT RIGHT

Food is woven into the fabric of life. We eat to celebrate – we have food at weddings, staff meetings, romantic dinners. We feel better when we are sick if mom makes us our favourite meal. This human trait will never go away – food is social. One of the first things patients ask after an appointment is, “When can I eat?” Food is one of the most popular ways to comfort ourselves.

Eating while upset or anxious has been proven scientifically not to be a good stress management strategy.

You see, when we are in a fight or flight mode, all the systems of the body are geared towards keeping you alive. Anger, frustration and resentment ignite the sympathetic nervous system. The body wants you to live through the crisis. The

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Learning good sleep hygiene practices is imperative. Not just for ordinary, everyday living, but especially during a global crisis or personal emotional storm. primitive reptilian brain is activated; all the blood goes to your 600 muscles for running or fighting. Increased ability for the blood to clot and prevent bleeding to death. Bad news: immune function is put on hold as is digestion.

The last thing your body wants is a huge sandwich or for you to dig into a deep dish pizza. All the energy goes to the brain for thinking of the next tactical move. This is one of the reasons for indigestion and reflux with volatility and disagreements at the dinner table. This is one of the reasons the Mediterranean diet is so highly regarded. It’s not just the red wine and cheese, but the habit of eating in a relaxed manner, without TV, for nutrient absorption.

We like to eat ice cream to calm our nerves. Janet Tomiyama PhD in a UCLA study of 59 women saw those who ate fatty sugary comfort foods when stressed had a down regulated response to stress. Lukas Van Oudenhove, a psychiatrist from Belgium, noted the same short-term response when fat and sugar is present in the gut during stress exposure. From a physiological point of view, the body is able to modulate the amount of cortisol in the body.

What’s wrong with stress eating?

What is wrong with buying your favorite treats or goodies in bulk and then keeping them beside you when you are into your third hour of

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Netflix? The modulated cortisol is good as this master hormone is tempered and your body is brought back to homeostasis. But over the long term (weeks, months and years) our pancreas is not able to keep up with the gustatory deluge, elevated A1C levels happen, our arteries thicken and we gain weight. We have short-term benefits of feeling better, but long-term health disaster.

What’s the best thing to do?

Choose an activity other than eating when you have a stressful event happen. For example: shutting off the incessant drama of 24-hour news and going for a short walk.

Calling a supportive friend. Doing an online exercise class. The simple act of boiling water and adding fresh mint (aids digestion) or cinnamon sticks (helps manage blood sugar) and sipping it can be comforting and bring a mindfulness to consumption activities.

SLAY STRESS

Any time we are gripped with angst by challenges beyond our control, our autonomic nervous system is activated. The majority of our 40,000 thoughts a day go toward trying to make sense of the loose ends and the unknowns. Julia Enders MD, author of the book Gut, reports as long as we have a pressing problem to solve, the brain directs all its energy toward finding

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a solution. 5 What gets left out? Digestion gets put on hold. Mastication, breakdown and absorption of nutrients through the body’s 26 feet of gastrointestinal tract takes a load of energy. Energy is better spent running from the perceived lion of a problem of paying your mortgage.

An article in the Journal of Occupational Environmental Medicine verified the intense cardiometabolic and psychological disturbances placed on first responders dealing with fight or flight events at work.6 It measured the physical breakdown that happens when the body mind is in constant activation – the chronic elevation of inflammatory chemicals, the suppression of the immune system and over time distress and feelings of helplessness. It showed that fit first responders had lower cortisol released and a lower heart rate response. This meant their systems weren’t thrown off as much as their unfit colleagues. Besides these physical benefits they perceived events as less threatening and were better able to harness a response.

This is one of the reasons first responders are given access to fitness facilities and healthcare for themselves. In conclusion: fit people perform better during crisis.

Mindfulness is another way to train the body. It is a learned skill and takes practice to do it

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automatically when our world is rocked by unknowns. Sitting still to relax and meditate is an effective stress management strategy. Herbert Bensen, cardiologist and founder of the Mind Body Medical Institute at Massachusetts General Hospital in Boston, had demonstrated circulating amounts of stress hormones decreases with relaxation exercises.

Walter Zimmerman, a very successful investor and host of a monthly webcast credits his accurate financial guidance in the volatile energy markets to his twice daily meditation practice. It strengthens parts of the brain needed for executive function and decision making, improves attention span and memory, restores psychomotor vigilance and increases emotional intelligence.

SLEEP WELL

Quality sleep is not just a pillar of the selfcare guide, it is the foundation. Mary O’Brien MD, in the Healing Power of Sleep, says it’s the unsung hero of most people’s gethealthy plan.7 We simply assume we are getting what we need. We never fully realize how we sabotage our body’s ability to heal, grow and recover from simply being awake.

Neuroscientist Matthew Walked PhD, author of Why We Sleep, says wakefulness is low-level brain damage as this incredibly dynamic organ longs for slumber to process emotion, solidify memory and purge itself of toxins. Rapid eye movement (REM) sleep is not just about dreaming of your special someone, but has been shown by sleep scientists and gastroenterologists like Emeran Mayer MD to help soften the rough edges of your day as the brain does a systematic review.

When our schedules are thrown out of whack and we are in the middle of any kind of crisis, this oxygen hog of an organ makes even more exhaust. Facing challenges all day, putting out family fires, taking hours of virtual online CE or chatting with

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family members all promote the need for pruning and neural cleansing at nighttime. The brain hates unfinished business. It needs a nightly reboot and recovery. One of the ways it does this is with the glymphatic system. This highly specialized system flushes cerebral spinal fluid between all the neurons, cleansing and purging free radicals and toxins from the hardworking brain. This process goes on by day, but while we sleep it is turned up 10 to 20 times. And people who don’t sleep well do not tap into the rejuvenating or cleansing effects of this physiological sewer system.

With heightened anxiety and the Hypothalamic-Pituitary-Adrenal (HPA) system firing without a break, the body mind is almost too tired for sleep by evening time.

High levels of cortisol are incompatible with the pineal gland releasing melatonin. Blasting through a commonly held sleep myth, that melatonin doesn’t help you get to sleep it helps you stay asleep. And without its nightly peak, sleep does not hold its usual immune system strengthening power. This is why shift work is called the “graveyard” shift because it slowly, but surely, damages the worker.

Learning good sleep hygiene practices is imperative. Not just for ordinary, everyday living, but especially during a global crisis or personal emotional storm. Here are a few sleep hygiene strategies: • A cool, dark bedroom facilitates deep sleep.

• Little or no food before bed helps to focus the body’s energy on healing and recovery, not digestion.

• Have little or no screen time in the last few hours before bed so the blue light of your laptop doesn’t interfere with the pineal gland pumping out melatonin.

• Do relaxing activities before bed vs doing your taxes or paying bills.

• Complete intense exercises or

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activities earlier in the night so the heightened hormonal cascade of CrossFit or other intense exercise practices are done away from slumber.

• Have little or no fluids before bed so you are not up all night in the bathroom. This interrupts deep sleep cycles and, over time, wears the body down as much as, or more than, daytime stress damage.

Keeping a regular sleep schedule is even more important with age.

Many people think just as older people are known to sleep less it does not mean they don’t need as much as younger people. The research shows the older people need just as much as their younger counterparts – and with their poor sleep efficiency it leads to poor wound healing, weakening immune function, ill repair of joints, cognitive decline and accelerated aging.

Look beyond the quick fix of alcohol or over-the-counter sleep aids, or just barreling through tough times. There are some easy go-to tools to process emotion and replenish our physical bodies. By utilizing these selfcare strategies, you will not only survive, but thrive, during the storms of life.

References 1 Ratey J. Spark:The Revolutionary New Science of Exercise and the Brain © 2008 Little Brown & Company 2 Walker M. Why We Sleep © 2017 Scribner 3 Pedersen BK et al. Muscles, exercise and obesity: skeletal muscles as a secretory organ. Nat Rev Endocrinology 2012; 8(8) 457-465 4 American Council on Exercise ACE www.acefitness.org 5 Enders J. GUT © 2014 Greystone Books 6 Journal of Occupational Environmental Medicine 2010 7 O’Brien M The Healing Power of Sleep © 2009 Biomed

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ORAL HYGIENE

SOCIALLY DISTANCED DENTISTRY

Jo-Anne Jones, President, RDH Connection Inc. As a successful entrepreneur and international, award winning speaker, Jo-Anne has been selected as one of DPR’s Top 25 Women in Dentistry and is a returning 2017 Dentistry Today CE Leader for the 7th consecutive year.

Jo-Anne is president of an educational and clinical training company and a sought after writer for leading dental journals and publications across the U.S., Canada, and the UK. Her frank and open style of lecturing complemented by the provision of clinical resources has earned many loyal followers. She may be contacted at jjones@jo-annejones.com

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entistry is a very socially interactive profession. COVID-19 has changed our abilities to interact completely. Never in our wildest dreams would any of us ever predicted to be in this circumstance today. It would be impossible to predict exactly how this will impact dentistry, but one thing we know for sure is that it will change us.

In our world of dentistry, we have several “touch points” throughout the day to interact and care for one another. This is our profession; this is what we thrive on. This is who we are and are proud to be. Today, and certainly not forever, this is all gone.

We need to, as integral members of the regulated healthcare professions, rise up and maintain contact through social distance for the sake of our patients, our teams, our businesses and our own mental health.

This is critical and it is doable.

There are several ways in which we may engage in meaningful interaction with one another. Regular contact with our team members is vital to giving our lives purpose and a sense of normalcy. The time on our hands provides us with a wonderful opportunity to be educated as a team, to evaluate our systems and ensure we are following current guidelines. This opportunity is a gift and something we rarely have time for in our busy clinical schedules.

Our websites and social media channels can be ways in which we remain in contact with our patients.

Posting information that will help them sustain their oral health at home in the absence of regular care is so important. For instance, April is Oral Cancer Awareness Month.

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Teach your patients how to check their mouth at home for the early signs of oral cancer through the “Check Your Mouth” website: checkyourmouth.org. Light heartedness is also a gift we may give at this time.

It is not frivolous or foolish to maintain a sense of humour at a time when we feel fearful; it is a necessity.

Keeping in contact with our team members through online meeting platforms such as ZOOM provides us with connection. We must guard our emotional and mental health at this time. We may be unaware as to how self-isolation may be affecting a team member and in particular one who lives alone or is isolating with a partner in a difficult relationship. We must give one another hope and a strong sense of a future.

We also need to consider our patients such as the one who may be experiencing a dental issue. These concerns can be daunting and may just be the tipping point. As a dental professional we often know the exact etiology the moment we glance inside the oral cavity or hear the symptoms described. So how do we maintain social distance and yet alleviate the anxiety our dental patients may be experiencing?

The answer is one word: Teledentistry. Telemedicine and Teledentistry will be the future. COVID-19 has just advanced these two platforms ahead of their anticipated debut. The future is NOW. Case in point, my husband was contacted by his dermatologist and informed that the practice would be closed during the COVID-19 pandemic.

Permission has been provided to share this story as it had such a proMAY 2020

found impact. A request was then received to send in any photos of areas that were of concern via email. He has a history of basal cell carcinoma and was on a six-month recall for ongoing assessments. The photos were captured with TELScope, an intraoral telehealth examination device and accompanying app.

Refer to Figure 1 to view one of the photos submitted. A call was set up the next day, the dermatologist had reviewed the images and confirmed that there were no areas he had any concern over. A follow up appointment was scheduled a few months later when predictably the COVID-19 pandemic would have resolved. The result: my husband’s concerns were diminished and put to rest and he felt connectivity with the practice. There also is the strong result of sustaining a passive revenue stream amidst this crisis.

Dentistry is in the same situation.

Do we sit by and allow dental practices to slowly dissolve or do we look for innovative ways with the use of advances in technology to sustain ourselves? Do we subject our dental patients to overcrowded emergency treatment rooms? Do we continue to overburden frontline medical healthcare professionals with oral health issues that dentistry is better equipped to handle? The question is real, and the answer is your choice.

Teledentistry is the practice of dentistry and dental care at a distance. Dentists who practice within the platform of Teledentistry must adhere to the same Standards of Practice and the professional, legal and ethical obligations that apply to oral health care. The storage of patient information must continue to possess privacy and security settings in accordance with the Personal Health Information Protection Act, 2004. Strong encryption must be used where personal health information is stored and/or transmitted.

Our patients don’t understand the

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Figure 1

Figure 2

different between essential and non-essential dentistry. An area of pain or the finding of an abnormal oral lesion can be very stressful to our patients. Figures 2 and 3 were obtained using Throat Scope, an allin-one illuminated tongue depressor as a retraction tool and the TELScope app. The photos provide an example of areas of concern that our dental patients may have in the absence of regular dental care. We understand the nature of this type of complaint and through a visual assessment can make recommendations that will alleviate the anxiety.

It is time to move this along through regulations and mitigate the damage that will ensue post Pandemic. A time to be proactive not reactive. A time to pivot before it is too late. A COVID world is a different world for all of us and a postCOVID world will be altogether different again. Dental patients will have heightened fears surrounding infection control and will need to be

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Figure 3

reassured. Many may prefer to go the route of Teledentistry first before scheduling an appointment that is not a dental emergency.

There are several things I hope we have learned when we all emerge from this. The first is that our basic needs are just that: basic. Our real superheroes in life are not our professional athletes and celebrities; they are our frontline workers that sacrificed in order for us to be as safe as possible and alive today. Beauty is not purchased or added on, it comes from within. Lastly, there is one thing to place at the forefront of all our actions: kindness. Stay well. Stay safe and stay home.

Disclaimer: A registrant is advised to consult with their respective regulatory body as to the legal and ethical considerations for using Teledentistry. Members are to contact their respective dental associations for questions/clarification regarding procedure codes under their Suggested Fee Guide.

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ORAL HYGIENE

GETTING TO KNOW YOUR AUTISTIC CLIENT

Jennifer Grzebien, RDH Jennifer Grzebien is an independent RDH who specializes in severe dental phobias and special needs. With over 8 years of experience and over half of that working independently, she provides a very unique personalized experience for her clients, working closely with them in order to overcome their fears, anxieties and barriers to care in order to achieve their oral health goals.

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t was in March of 2019 that my daughter was diagnosed with autism at a support level 3, just before her 3rd birthday. This means that she requires substantial support in order to get through her day. Since then, I have spent endless hours reading articles, books and anything that would allow me to better help and understand my nonverbal autistic child. As a mother and hygienist, I have learned quite quickly the obstacles facing those who care for those with autism. Autistic individuals can have issues in all aspects of their life from oral hygiene, bathing, dressing, eating, sleeping, self-regulation, communication, behavioural and sensory.

Autism is a spectrum disorder, which means it can present itself in many ways. It is not a cookie-cutter disorder and those affected can learn and move along the spectrum.

Over time, they may learn to overcome certain obstacles. Every child is unique and, coupled with autism,

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this uniqueness is magnified as the child will have a whole new set of obstacles to face.

One of the greatest challenges for autistic individuals is that of communication and the inability to interact with others. Many suffer with the inability to express their thoughts, desires, joys, sadness, pain, frustrations, or feelings of being cold, hot, hurt, hungry, tired, upset or sick. The ability to express ourselves and to connect with the world around us is something that most people take for granted.

These individuals have intelligence like you or I; they are simply trapped in their heads and unable to communicate their thoughts to others. Understanding these challenges and finding ways to connect with autistic individuals requires patience and effort.

Those with autism often take in what is going on around them all at once. Over time, they learn to filter this input and focus on the infor-

MAY 2020

mation of value to them. When those with autism feel overwhelmed with input, they may cover their ears. This is to lessen and sometimes to alter the way the input sounds. They may also make humming sounds; this is simply them creating output to block the input.

When treating an individual with autism, having an in-depth talk with the client or client’s caregiver prior to the appointment is crucial to having a successful appointment.

Autistic individuals often have sensory issues. Knowing those issues is important in order to not overwhelm the client during the appointment. Here are some questions you could ask: 1. Is the client sensitive to noise? If they are, you may want to try to keep the use of the ultrasonic, suction and hand piece to a minimum, or eliminate them all together. They may not be able to tolerate the noise at all and you will quickly see a reaction from the client if they find these sounds overwhelming. Also keep the music in the room low or turn it off altogether, if possible.

2. Does the client get overwhelmed with too many people in the room? If they do, let the other staff know not to enter your room while you are seeing this client.

3. Do they have any dislikes? They may not be able to tolerate the air/water syringe, the prophy paste or any number of things during a hygiene appointment.

4. Is there something that the client is fond of, such as a TV show? Things like this can be helpful motivators for the client to focus. For example, my daughter loves “Paw Patrol” so I could put “Paw Patrol” on the TV during her appointment.

When seeing an individual with autism, ensure that you have booked enough time for the appointment.

MAY 2020

Getting to know and learning to connect with your autistic client can be very rewarding. Working with them and watching them overcome their obstacles is a demonstration of the hidden intelligence, strength and perseverance that these individuals possess.

Also, make sure the appointment time coincides with the time of day the client finds easiest to manage.

The client may not be able to tolerate items in their mouth for very long so you may have to make several quick trips into and out of their mouth, taking longer than a typical client. Otherwise they may become overwhelmed and can break down and start to cry, or express frustration by slapping your hand away.

This is important to know in order to maintain safety when you have instruments in their mouth. Always pay attention to the client’s mood and, as soon as you see them becoming frustrated, stop whatever it is that you are doing. Do not overwhelm the client to the point of a breakdown. They may also not be able to keep their mouth open for long periods or be able to stay still, which may lengthen the appointment. Consider bringing them back for multiple appointments if you are unable to get through treatment in just one.

If the client can tolerate a fluoride varnish, it can be very helpful.

Also, if the client is able to tolerate a bite block this can be helpful to help prevent injury to the clinician’s fingers if the client tends to bite down or close their mouth frequently. One of the best ways of achieving positive appointments is simply getting to know the client over time. Autistic individuals love familiarity and routine. So even if your first appointment doesn’t go so well, don’t give up.

Homecare is another aspect where support is needed. For example, find out if the client is swallowing toothpaste. If so, recommend one that is safer for consumption.

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Also, if they chew on the toothbrush, then a plastic one is safest as a bamboo brush might break and splinter in the mouth. Brushing may also take longer than usual at home due to them being unable to focus or tolerate items in the mouth.

So once again, you may have to make several quick trips in with the toothbrush, which will take more time. Finding a toothpaste that they can tolerate is very helpful. You can do this by finding one that has a flavour and texture that the client likes. If they swallow, a mouth wash is not recommended. If they bite whatever is in their mouth, this makes it difficult to implement flossing or interdental aids as you don’t want to place your fingers in their mouth and risk injury.

Caring for those with autism is a lifelong commitment where you build on small achievements over time. Remember: just because they might not look like they are listening or paying attention to you, doesn’t mean that they aren’t. Many autistic individuals find it overwhelming to look at someone’s face. It is as if their brains take a thousand photos at once and it can be too much to process. They are often listening, even when it doesn’t seem that way.

Getting to know and learning to connect with your autistic client can be very rewarding. Working with them and watching them overcome their obstacles is a demonstration of the hidden intelligence, strength and perseverance that these individuals possess. You have the privilege to be just one of many support staff that hopefully can support them in their daily life. The best part is when you get a hug, a smile or a high five!

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ORAL HYGIENE

HINDSIGHT IS 20/20:

Missing the Oral and Oropharyngeal Cancer Diagnosis

Jo-Anne Jones, President, RDH Connection Inc. As a successful entrepreneur and international, award winning speaker, Jo-Anne has been selected as one of DPR’s Top 25 Women in Dentistry and is a returning 2017 Dentistry Today CE Leader for the 7th consecutive year.

Jo-Anne is president of an educational and clinical training company and a sought after writer for leading dental journals and publications across the U.S., Canada, and the UK. Her frank and open style of lecturing complemented by the provision of clinical resources has earned many loyal followers. She may be contacted at jjones@jo-annejones.com

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mid our present-day pandemic, the disease of oral and oropharyngeal cancer once again has a much larger adversary. April has come and gone with very little focus on it being Oral Cancer Awareness Month. All attention understandably has been on the COVID-19 pandemic.

However, globally, the picture of oral and oropharyngeal cancer is very troubling. With the data that is available through reporting centres, we understand the burden to be approximately 640,000 cases worldwide. This number repeats itself every year with close to 50 percent of those diagnosed today not surviving beyond five years.

The heartbreaking aspect is that most cases are discovered in the later stages, reducing the five-year survival rate dramatically. This is worthy of our attention and our commitment to do all we can to combat the disease and discover it in its earliest stages.

As a global community we are feeling vulnerable to the COVID19 pandemic. When compared to oral and oropharyngeal cancer, we have taken some solace in recognizing that we can mitigate our risk by abstaining from using tobacco

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products and alcohol. However, don’t be misled. The rising number of oral and predominantly oropharyngeal cases are caused by a very common virus; a virus so common that the CDC (Centers for Disease Control) states that almost every adult will have an infection in their lifetime. Here are the facts.

• Human papillomavirus or HPVrelated oropharyngeal cancer rose 225% in the same time period as a 50% decline was witnessed in HPV-negative oropharyngeal cancer.1,2 Refer to Figure 1.

• HPV-related oropharyngeal cancer surpassed HPV-related cervical cancer in 2015 as the leading anatomical site for HPV-related cancers in the body. 3 Refer to Figure 2.

• Studies estimate 70–90% of all new oropharyngeal cancers are HPV-related.4 • Patients are more likely to be younger, white males in their 40s and 50s, never smokers or have reduced alcohol exposure.4 • Males are at greater risk with an incidence of 4 to 1 over females. 5 • Symptoms vary greatly from the typical oral cancer symptoms with which we are familiar.

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Figure 1: Incidence Rates for Oropharyngeal Cancer

Figure 2: Projected Annual Number of Cases of Oropharyngeal and Cervical Cancer in the United States 20,000

Annual Number of Cases

1 Oropharynx (overall) HPV-positive Oropharynx HPV-negative Oropharynx

15,000

10,000

5,000

Due to HPV’s affinity for lymphoid tissues, we are observing this cancer to occur in the posterior areas of the oropharyngeal region. This presents a challenge to assessment and to discovery of the presence of this cancer. No, we don’t possess a laryngoscope and ability to perform procedures to fully examine this area, however we do have eyes, ears and hands. We have eyes to evaluate asymmetry of both the face and neck. We have ears to observe a change in our client’s voice such as hoarseness. Above all we have hands to feel. The essential extraoral and intraoral visual examination needs to always be accompanied by tactile palpation.

Without this component to our examination, we will miss the detection of many oral abnormalities. Relying on the visual assessment only will hinder our capabilities and place our dental clients at risk for later discovery of oral and oropharyngeal cancer. It is imperative that we recognize the subtle and often life-saving symptoms that accompany this type of cancer.

The following is a list of some of these symptoms that may accompany HPV-related oropharyngeal cancer in the oropharynx.

• A non-healing lesion • Bleeding in the mouth or throat • Pain when swallowing or difficulty swallowing • Unilateral ear pain • Feeling of something caught in the throat or continual clearing of throat • Hoarseness • Persistent cough • Continual lymphadenopathy; asymmetry in neck to swollen, persistent nodes • Difficulty articulating certain words; slurred speech • Unexplained weight loss • Fatigue • Continual throat infections not resolved by antibiotics • Tonsillar asymmetry • Tongue that tracks to one side when stuck out The palpation of the posterior triangle of lymph nodes including the cervical and supraclavicular group bound anteriorly by the posterior border of the sternocleidomastoid muscle and posteriorly by the anterior border of the trapezius muscle is essential. As depicted, a neck mass is more often associated with an HPV-positive tumor vs an HPVnegative.6

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20 30

20 20

20 03 -2 00 4

19 99 -2 00 0

19 95 -1 99 6

0 19 91 -1 99 2

19 88 -1 99 0

0

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Oropharynx (women) Oropharynx (men) Oropharynx (overall) Cervix

20 10

Rates oer 100,000

10

Calendar Year

HPV positive Neck Mass (51%)

Sore Throat (28%)

Dysphagia (10%)

HPV Negative Sore Throat (53%)

Dysphagia (41%)

Neck Mass (18%)

The etiologic pathway for lymphadenopathy may be multi-factorial and related to the onset and duration. An acute, infectious presence may be represented by a node that is tender to palpation, moveable, soft and the patient may already be aware of an underlying infection.

Typically this type of occurrence will resolve on its own or with the

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Relying on the visual assessment only will hinder our capabilities and place our dental clients at risk for later discovery of oral and oropharyngeal cancer. It is imperative that we recognize the subtle and often life-saving symptoms that accompany this type of cancer. use of antibiotic therapy. A lymph node that is firm or hard, fixed to the underlying structures, asymptomatic accompanied often by a lack of awareness is more characteristic of a malignancy. If the health history and assessment do not reveal an etiologic pathway or the lymphadenopathy persists beyond 14 days, further investigation is necessary. Computed tomography, ultrasound and the need for a fine-needle aspiration biopsy may

be performed providing additional diagnostic information and a management pathway. The sensitivity and specificity of fine-needle aspiration biopsy in detecting a malignancy range is from 77% to 97% and 93% to 100%, respectively.7 Intraorally, it is imperative to continue to employ a visual and tactile approach to assessment. High risk anatomical areas include the floor of the mouth, the tongue and the palatal tissues. It is wise to follow a systematic approach when assessing the soft tissues of the oral cavity as we do with all our assessments.

At minimum, a comprehensive visual and tactile extraoral and intraoral examination should be performed on every adult client annually. A symptom or finding persisting more than 14 days

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ORAL HEALTH GROUP

@ORALHEALTHGROUP @ORALHEALTHGRP

2020-05-08 4:44 PM

MAY 2020

should always be investigated further. Magnification and a headlight will provide the clinician with the best opportunity to discern visual changes in the soft tissues.

Without the use of magnification, soft tissue abnormalities will be undeniably overlooked. The use of adjunctive screening devices such as VELscope provide us with further capabilities to see beyond what white light examination may have revealed. Typically, abnormal cellular differentiation and proliferation starts at the basement membrane. With the use of direct fluorescence visualization, adjunctive screening devices can penetrate through to the basement membrane providing greater capabilities for earlier discovery of abnormalities.

Oral cancer doesn’t observe the month of April specifically. Oral cancer is diagnosed 365 days throughout the entire year. A campaign was launched in collaboration with the Oral Cancer Foundation and Throat Scope, an all-in-one illuminated tongue depressor, with an objective to have the public check their mouth in between dental visits for anything new or different that persists beyond 14 days.

This campaign alone is the biggest single opportunity we have to impact earlier discovery of oral cancer. Teach your clients how to

MAY 2020

check their mouth at home for the early signs of oral cancer through the “Check Your Mouth” website: checkyourmouth.org The real objective is to save lives and secondly to improve lives. Late stage discovery subjects a patient to the rigors of radiation therapy often in combination with chemotherapy. Unless personally experienced, we have no idea what it must be like to live with permanent disfigurement, a total depletion of saliva, or fear of choking on thick, ropey saliva, or living with the continual fear of recurrence – and the list goes on and on. Ask an oral cancer survivor and be prepared to be shaken. Together we are a powerful team in minimizing late stage discovery of oral cancer.

Disclaimer: Jo-Anne Jones received no compensation for writing this article. She is a member of the Oral Cancer Foundation RDH Advisory Board and an advisor to Holland Healthcare Inc., developer of Throat Scope, Key Opinion Leader to Apteryx Imaging and Orascoptic. Jo-Anne will be presenting “Hindsight is 20/20: Missing the Oral/Oropharyngeal Cancer Diagnosis” supported by a collection of oral cancer survivor’s inspiring stories at the upcoming 2020 ODHA Re-Energize Conference in September. For further information or to contact Jo-Anne visit her website at jo-annejones.com

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References 1 Chaturvedi A, Engels A, Pfeiffer RM et al. Human Papillomavirus and Rising Oropharyngeal Cancer Incidence in the United States. Jour of Clin Oncol published on October 3, 2011.

2 Dan P, Zandberg MD, Bhargava R et al. The Role of Human Papillomavirus in Nongenital Cancers. CA Cancer J Clin 2013;63:57-81.

3 Trends in Human PapillomavirusAssociated Cancers – United States, 1999 – 2015. Morbidity and Mortality Weekly Report (MMWR) August 24, 2018. 67:33;918-924.

4 Young D, Xiao CC, Murphy B et al.

Increase in head and neck cancer in younger patients due to human papillomavirus (HPV) Oral Oncol Vol 51. Iss 8. August 2015 p. 727 – 730.

5 https://oralcancerfoundation.orgunder standing/hpv/hpv-oral-cancer-facts/ 6 McIlwain WR, Sood AJ, Nguyen SA et al. Initial Symptoms in Patients with HPV-Positive and HPV-Negative Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg. 2014;140(5):441-447.

7 Haynes J, Arnold KR, Aguirre-Oskins C, Chandra S. Evaluation of neck masses in adults. Am Fam Physician 2015 May 15;91(10):698-706.

May 2017

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ORAL HYGIENE

KEEP CALM & ADPIE

Tracy Poirier, RDH, IMC™ Tracy began her journey as a Dental Assistant and then she spent almost 30 years as a Dental Hygienist in both General and Periodontal Practice. In 2016 she obtained a certification as an Integral Master Coach™ which allows her a unique perspective and approach in the world of Dentistry. Her passion is to coach, motivate and inspire dentists and dental hygienists to show up as their best selves personally and in professional practice. She is also a proud member of the Healthy and Respectful Workplace Advisory Committee with The Canadian Dental Hygiene Association. On a personal note, she started writing in 2018 and has been featured in several dental publications since. Tracy can be reached at tracynjpoirier@gmail.com

id you know that acronyms are actually very modern inventions? They were found to be in existence around World War 1, but were still not used very much until World War 2. The word “acronym” did not even come into play until 1943 because they simply were not used in daily life like they are now. Once the U.S. Space Program and the Cold War started using them, a dictionary of acronyms ended up being published in 1960 with over 12,000 entries.

Why am I offering you a little history lesson? Since acronyms are used every day, I was honestly curious about their origin and there is one in particular that dental hygienists need to live by, at least in their clinical practice.

The acronym I am referring to is ADPIE, which refers to the Dental Hygiene Process of Care: Assessment | Diagnosis | Planning Implementation | Evaluation

In 2016, The College of Dental Hygienists of Ontario (CDHO) published an article about The Dental Hygiene Process of Care. The following is a quote from that article: “Best practice indicates that the Dental Hygiene Process of Care (ADPIE) is the framework within which all dental hygiene therapy should be conducted.”

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I decided to do a little more research and comb through the dozens of governing bodies and associations across Canada for any differences in standard of care and responsibilities of dental professionals and here’s what I learned: no matter what province we live in, our regulatory bodies and associations are all sharing the same message. Dental hygienists have a legal and ethical responsibility to ensure that ADPIE is the key to standard of care for each client.

The question we need to ask ourselves is this: How well are we doing with keeping calm and ADPIE? We are probably doing okay in the keeping calm part, but my research uncovered some statistics that says ADPIE might be something we need to improve on.

The reality is that the implementation of “standard of care” is still an ongoing issue here in Ontario.

The CDHO publishes the top discrepancies after reviewing the Quality Assurance Portfolios annually.

Top of the list in 2010 was the failure to perform complete and comprehensive periodontal exams. On that same list was the failure to perform ongoing periodontal re-evaluations.

In checking with the CDHO now 10 years later, this still rings true.

This means that the assessment portion, which includes the comprehensive periodontal exam, is only being partially completed or not at all. Since we know that a

MAY 2020

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Dental hygienists have a legal and ethical responsibility to ensure that ADPIE is the key to standard of care for each client. diagnosis is evidence-based, how are we obtaining that diagnosis without comprehensive charting?

The good news is that Canada is among the world leaders when it comes to the overall oral health of its citizens since oral health is recognized as a basic human right.

However, as many as one out of two Canadians (that’s 16 Million Canadians young and old) have gingivitis and don’t even know it. It’s something that could lead to tooth loss if left to progress and yet is completely curable. In fact, an estimated 20 percent of Canadians are still unaware that they have active periodontal disease.

Did you know that oral diseases account for productivity losses of over one billion per year in Canada alone? That is a staggering statistic!

Now, more than ever, with the world having come undone and now slowly starting to rebuild through the COVID-19 pandemic, it’s going to be essential for dental professionals to apply this system purposefully and to its fullest extent when the time comes to getting back to being able to serve.

If there was ever a time to get serious about initiating a solid periodontal program this is it. Otherwise we will continue to unconsciously be a part of what I refer to as the “perfect storm,” where wellintentioned, good dental hygienists, who had the dream to make a difference, over the course of time, may have lost their motivation for a variety of reasons. And the systems that were in place start to fall apart when that motivation is lost.

I get it! As a 30-year veteran of dental hygiene, I have certainly lost my motivation along the way at times. It’s tough to show up every day, unpack the challenging pieces of our life at the door of the

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practice and be at our best. Not to mention that “being at our best” when life is going well is very different from “being our best” when life is not going well. We have to honour and accept our capabilities in that moment.

However, we do not have any leniency when it comes to our ethical responsibility within this system despite tight time frames, treatment mix and, of course, things that are out of our control. What choices do we actually have?

One choice is to fully understand where we are currently within our clinical practice–where we are solid and where are we wobbly and in need of support. We can choose to look at it with fresh eyes and new perspectives and make moves that might allow you to incorporate this more fully when you all get back into your practices.

There are four questions you can ask yourself to understand your current position within ADPIE. First keep calm and take a breath.

Then ask: 1. Are my current beliefs, thoughts or old patterns, leading me towards being intentional with ADPIE? 2. Are my current actions leading me to being intentional with ADPIE? 3. Are my current relationships with my leader(s), colleagues, team members and with myself guiding me towards being intentional with ADPIE? 4. Are my current instruments, systems, operatory environment(s) leading me to being intentional with ADPIE? After reading through those questions, do you have a sense of (if

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anything) that needs to be addressed to serve your clients?

Breathe again. Because now we’ll review the basics of the process. I am only highlighting the main areas in this article. Please refer to the links added at the end for further reference and additional information.

ADPIE: THE DENTAL HYGIENE PROCESS OF CARE A - for Assement D - for Diagnosis P - for Planning I - for Implementation E - for Evaluation

ASSESSMENT

The collection and analysis of systematic and oral health data in order to identify client needs.

1. Health History 2. Clinical Assessment 3. Risk Assessment

DIAGNOSIS

The dental hygiene diagnosis requires evidence-based critical analysis and interpretation of assessments in order to reach conclusions about the patient’s dental hygiene treatment needs.

PLANNING

Planning is the establishment of realistic goals and the selection of dental hygiene interventions that can move the client closer to optimal oral health. The interventions should support overall patient goals and oral health outcomes.

The dental hygiene care plan should be: • Safe • Evidence-based • Clinically sound • High quality • Equitable

MAY 2020

YEARS OF EXCELLENCE, PERFORMANCE & VALUE There are 5 steps within the dental hygiene treatment plan for each client: 1. A complete clinical assessment 2. A dental hygiene diagnosis 3. Client-centred goals/objectives 4. Planned sequence of activities 5. Client participation

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IMPLEMENTATION

Implementation is the act of carrying out the dental hygiene plan of care.

Care should be delivered in a manner that: • Minimizes risk • Optimizes oral health • Recognizes issues related to patient comfort including pain, fear, and/or anxiety.

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EVALUATION

Evaluation is the measurement of the extent to which the client has achieved the goals specified in the dental hygiene care plan. We once again use evidence-based decisions to continue, discontinue, or modify the care plan based on the ongoing reassessments and subsequent diagnoses.

Breathe. Do you feel solid within the framework of ADPIE? If so, I applaud you and hope that you continue to serve from that foundation.

Do you feel wobbly in some places? If so, I applaud you for being honest with yourself about where you might need support to once again serve from that foundation.

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• https://english.stackexchange.com/questions/33532/ when-did-the-use-of-acronyms-begin • http://www.cdho.org/docs/default-source/pdfs/reference/ guidelines/bestpractice.pdf • https://www.adha.org/resources-docs/2016-RevisedStandards-for-Clinical-Dental-Hygiene-Practice.pdf • http://cdho.org/docs/default-source/pdfs/milestones/ milestones_jun10.pdf • https://www.cda-adc.ca/stateoforalhealth/_files/ TheStateofOralHealthinCanada.pdf

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Contact: Karen Shaw | 416-510-6770 | 437-991-7187 | karen@newcom.ca fax: 416-510-5140 | toll free CDA & USA: 1-888-639-2669

ASSO C I AT ES H I P S NORTHERN ONTARIO (HAILEYBURY/NEW LISKEARD AREA) Experienced Dentist required for a busy clinic located in Northern Ontario (Haileybury/New Liskeard area). Bright modern facility in a pristine beautiful community. Over 2,000 active patients will earn the successful candidate remuneration of between $300,000 to $450,000 per year. Up to 50% of collections for the right accomplished Doctor, relocation a must.

Please send your resume to firstline_dental@hotmail.ca

GTA & SURROUNDING AREAS, ON Associate opportunities available across the GTA and surrounding areas including Scarborough, Mississauga, Brantford, Hamilton, Barrie, Dundas, Brampton, Etobicoke, Oakville, Waterloo, and Owen Sound.

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BRADFORD, ON

Seeking associate dentist to add to our expanding office located in Bradford.

Tuesday 8am to 5pm (maybe extended).

Fridays 8am to 4pm. Saturdays 9am to 4pm.

Must be easy going and well versed clinically.

Send resume to mightymolars@live.ca

REXDALE ON (Kipling and Steeles)

BELLEVILLE , ON Busy non-corporate family practice with sole owner and over 7200 active recall patients seeks a full time associate. Work schedule can accommodate up to 4 days per week. Owner works 4 days per week.

No weekends required. Remuneration 42.5% of billings. Strong communication skills an absolute must. Clinical experience an asset. Newly renovated clinic with great staff and work environment.

Immediate start available if suitable.

Email: toothdoc911@gmail.com

KAMLOOPS, BC Dental Associate Needed in Beautiful British Columbia. We are looking for a motivated dentist to join our busy family dental practice in Kamloops, BC. We are a paperless, digital office with a busy recall system in place. Kamloops is home to world renowned skiing, golf, fishing, and mountain biking.

Our practice is team orientated.

The position is full time and is available for July 2 2020.

New Graduates welcome.

Please call 250-398-0532 or email vitoratos@shaw.ca

Family practice looking for a p/t associate for Saturdays. More days to be offered to the right candidate. Friendly and good communication skills a must. Familiar with all aspects of dentistry.

Please send resume to amdentalinfo@gmail.com

SARNIA, ON Established family practice with loyal patients, located in the downtown core.

Looking for an associate dentist 2-3 days per week to start, with the potential to grow. No evenings or weekends. The ideal candidate is enthusiastic and caring with good communication skills and would enjoy working in a team setting.

Please email resume to eltantydentistry@hotmail.com

EQ U I P M E N T SARNIA, ON E4D, scanner, milling unit and furnace for sale. Very lightly used over its 4 year life.

Not being used by associates is reason for sale. Great opportunity to acquire at fraction of new cost. Best offer.

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oralhygiene

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CONTACT YOUR ADVISOR KAREN SHAW Tel: 416-510-6770 • Cell: 437-991-7187 Email: karen@newcom.ca

www.oralhealthgroup.com

MAY 2020

What reaction do you want?

COVID-19 MESSAGE VOCO Canada wishes you, and all dental professionals, health and safety during this unprecedented global pandemic.

While working from home, VOCO maintains our commitment to support you by providing the materials, continuing education opportunities and answers to clinical questions needed so that emergency healthcare services can remain available.

THE THIN TRANSPARENT 5% SODIUM FLUORIDE VARNISH IN A NON-MESSY SINGLEDOSE DELIVERY SYSTEM

Learn more and order your

FREE SAMPLE

• No yellow discoloration of teeth • Five great tasting flavors without the unpleasant aftertaste of some other brands

www.vocoamerica.com

• Adheres well to moist surface • Sets quickly in seconds after contact with saliva • Enhanced flow characteristics with a thin spreadable consistency allow Profluorid Varnish to reach areas traditional varnishes may miss • High immediate fluoride release to relieve hypersensitivity • Contains Xylitol • Available in both adult and child doses

• Does not contain tree nuts, peanuts, corn, shellfish, eggs, milk protein, soy, gluten, triclosan, petroleum, red dye/artificial coloring, saccharin or aspartame.

• CDT Insurance code D1206 for HIPAA dental claims • CPT Insurance code 99188 for medical claims

Call 1-888-658-2584 VOCO Canada · toll-free 1-888-658-2584 · Fax 905-824-2788 · infousa@voco.com · www.voco.com

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Quelle réaction voulez-vous?

MESSAGE COVID-19 VOCO Canada vous souhaite, et à tous les professionnels dentaires, la santé et la sécurité au cours de cette pandémie mondiale sans précédent.

Tout en travaillant à domicile, chez VOCO, nous maintenons notre engagement à vous soutenir en fournissant le matériel nécessaire, nous continuons à vous donner l’opportunité d‘éducation continue, et répondons aux questions cliniques nécessaires pour que l‘urgence des services de santé puisse rester disponible.

LE VERNIS BLANC TRANSPARENT ET MINCE AU FLUORURE DE SODIUM 5% DANS UN SYSTÈME DE LIVRAISON PROPRE ET SANS GÂCHIS. • Sans décoloration jaunâtre des dents • Cinq différentes saveurs sans arrière goût comme certaines autres marques

Apprenezen plus et commandez votre échantillon

GRATUIT

www.vocoamerica.com

• Adhère très bien à la surface humide • Se fixe en quelques secondes après contact avec la salive • Excellente mouillabilité permettant au vernis Profluorid d’accéder à des régions que d’autres vernis traditionnels ne peuvent atteindre • Libération élevée de fluorure immédiat pour soulager l‘hypersensibilité • Contient du Xylitol • Disponible en doses pour adultes et enfants

• Ne contient pas de noix, arachides, maïs, crustacés, oeufs, protéines du lait, soja, gluten, triclosan, pétrole, colorant rouge / colorant artificiel, saccharine ou aspartame.

• Code CDHA 00611 • Code ADC 12101 • Code 12400 milieux hospitaliers

Contactez 1-888-658-2584 VOCO Canada · Sans Frais 1-888-658-2584 · Fax 905-824-2788 · infousa@voco.com · www.voco.com

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