Oral Hygiene - March 2021

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oralhygiene

MARCH 2021

Inside this issue ORAL HYGIENE

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Introducing the 2018 Classification of Periodontal and Peri-implant Diseases Jodi Cantarelli, AAS, RDH, Dip.AdEd, Manager of Dental Hygiene Programs at dentalcorp

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Pandemic Proof Your Hygiene Department!

Gabriele Maycher, CEO, GEM Dental Experts Inc. BSc, PID, dip DH, RDH

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How to Get a Raise Alina Fintineanu, RDH, CTP, C.A Ed

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DEPARTMENTS 4

IT’S BEEN A YEAR… WHAT HAVE WE LEARNED?

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Equipment on the Go Jennifer Grzebien, RDH

Jo-Anne Jones, President, RDH Connection Inc.

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Sleep Apnea… a NOT so Silent Killer: Kathleen Bokrossy, RDH

5 NEWS

Study Finds Low Rate of COVID-19 Among Dental Hygienists (US)

TikTok and Dentists Battle Over $15 DIY Prosthetic Teeth Hack: ‘Dental Work Shouldn’t be a Luxury’

Survey Reveals COVID-19 a Major Factor in Americans’ Failing Dental Health

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7 Q&A - TECHNICALLY SPEAKING:

Answering your questions about implementing

the 2018 AAP Periodontal Classification

Gabriele Maycher, CEO, GEM Dental Experts Inc., BSc, PID, dip DH, RDH

28 DENTAL MARKETPLACE

MARCH 2021

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EDITORIAL

It’s Been a Year…

What Have We Learned?

Jo-Anne Jones, President, RDH Connection Inc. Jo-Anne Jones is an international speaker, president of a clinical and educational training company and continues to maintain active registration as a dental hygienist. She joins the Dentistry Today CE Leaders in 2021 for the 11th consecutive year. Jo-Anne has received the Elizabeth Craig Award of Distinction for her contribution to the profession of dental hygiene.

To contact Jo-Anne, email at jjones@jo-annejones.com

Well, it’s been a year. Most of us would agree that the current pandemic is not something we had ever imagined we would live through. What have we learned through this past year? How will our lives, our careers, our relationships benefit from this chapter in our history?

Dental hygiene garnered a top spot in the U.S. News and World Report published list of best healthcare support jobs. We’ve navigated through unchartered waters while at the same time identified as being the top profession at risk for transmission of COVID-19. We have realized that we are essential caregivers.

There has been an abundance of compelling research to intertwine poor oral health with increased incidence of COVID-19 complications.

Here’s the connection: periodontal disease is a chronic inflammatory disease with far reaching systemic consequences.

The burden of an ongoing inflammatory disease such as periodontal disease directs our immune system to an ongoing release of pro-inflammatory mediators or cytokines to an excessive level.

Researchers from around the world have joined forces to try to further understand the potential role of ‘cytokine storms’ in dictating the severity of this viral infection. One such cytokine, interleukin-6 which is a recognized mediator of periodontal destruction, has risen to the research forefront.

“What shocked us was the discovery of

the protein’s devastating, life-threatening impact to patients once they’re hospitalized.

One tiny, inflammatory protein [IL-6_] robbed them of their ability to breathe.”1 The role of the dental hygienist in reducing levels of IL-6 accomplished through periodontal therapy is not to be underestimated. We have a critical and essential role in mitigating risk for the clients we treat through reducing the inflammatory burden. To overlook this, we are unintentionally setting our clients up for risk of systemic disease and viral infection severity.

On a personal note, one of the best books to emerge in 2020 (in my humble opinion) is the children’s book, The Great Realization. 2 Tomos Roberts, a 26-yearold filmmaker, released the poem on YouTube in April. Since then, it has captured attention worldwide and been translated into multiple languages. It’s a simple rhyme, based on an intimate view of our world uncovering corporate greed, the self-indulgence of instant gratification, social media and its inherent social alienation and, finally, the pandemic. The poem inspires a brighter future, concluding that “sometimes you’ve got to get sick, before you start feeling better.”

The ending embraces a “new normal” and a better world,supporting the old adage that hindsight is 20/20. Perhaps we are beginning to understand what we need to learn. Take care, stay well and know we are in this together.

References 1 Molayem S, Pontes CC. The Mouth-COVID Connection. IL-6 Levels in Periodontal Disease – _Potential Role in COVID-19 Related Respiratory Complication. Published online ahead of print July 30, 2020. J Calif Dent Assoc.

2 The Great Realization https://www.youtube.com/watch?v=SzOGHUozpmE

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MARCH 2021

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MARCH 2021

Study Finds Low Rate of COVID-19 Among Dental Hygienists (US) Despite having been designated as high risk for COVID-19 by the Occupational Safety and Health Administration, a new study finds 3.1 percent of dental hygienists have had COVID-19 based on data collected in October 2020. This is in alignment with the cumulative infection prevalence rate among dentists and far below that of other health professionals in the U.S., although slightly higher than that of the general population.

The research, published by The Journal of Dental Hygiene, is the first largescale collection and publication of U.S. dental hygienists’ infection rates and infection control practices related to COVID-19. In partnership, the American Dental Hygienists’ Association (ADHA) and the American Dental Association (ADA) have released initial findings from their ongoing, joint research designed to estimate the prevalence of COVID-19 among U.S. dental hygienists, as well as examine infection prevention and control procedures and any associated trends, including employment data.

To read the full article, please visit: https://www.oralhealthgroup.com/news/ study-finds-low-rate-of-covid-19-among-dental-hygienists-1003958042/

TikTok and Dentists Battle Over $15 DIY Prosthetic Teeth Hack: ‘Dental Work Shouldn’t be a Luxury’ A TikTok trend suggesting that prosthetic teeth can be made from InstaMorph beads has gone viral – and dentists are not happy.

User Gypsy Lou posted a series of videos explaining how she figured out a cheaper version of partial dentures. The TikToker ordered a pack of InstaMorph beads – plastic beads that can be heated then molded into various shapes – and showed how she made her own “flipper.”

But dentists absolutely hate it. One even commented on Lou’s first video. “Dental professional here,” they wrote.

“No, No, No.” Check out the full article here: https://ca.sports.yahoo.com/news/tiktokers-makingdiy-teeth-instamorph-210930631.html

Survey Reveals COVID-19 a Major Factor in Americans’ Failing Dental Health

A recent survey commissioned by the American Association of Endodontists reveals that more than half of Americans say the COVID-19 pandemic has caused them to put off general dental check-ups, which can lead to serious oral health problems. The survey also showed that the pandemic is takings its toll on those working or studying remotely when it comes to changes to their daily dental hygiene routine. Significant findings include: • 31% were snacking more on sweets; • 28% didn’t schedule or forgot to schedule a dental visit; • 21% didn’t brush in the morning at all.

To read more, please visit: https://www.oralhealthgroup.com/news/survey-revealscovid-19-a-major-factor-in-americans-failing-dental-health-1003957737/ 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 2017

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ORAL HYGIENE

INTRODUCING THE 2018 CLASSIFICATION OF PERIODONTAL AND PERI-IMPLANT DISEASES Jodi Cantarelli, AAS, RDH, Dip.AdEd, Manager of Dental Hygiene Programs at dentalcorp Jodie is a Manager of Dental Hygiene Programs at dentalcorp.

In her role, she partners with dental teams across Canada to help them provide optimal patient care.

Jodie earned her degree in Dental Hygiene, diploma in Adult Education at St. Francis Xavier University. Her professional experience includes private practice, a clinical evaluator for the College of Dental Hygienists of Ontario, a clinical and didactic instructor, program director, past advisory board member, published author and professional speaker.

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y now you would have seen or heard of the new classification of periodontal and periimplant diseases, which replaced the previous (1999) classification system and addressed most of its limitations.

Research indicates that 80% of North American adults have some form of periodontal disease, while evidence also indicates that there is a link between oral and systemic health.

In 2017, the American Academy of Periodontology (AAP), in collaboration with the European Federation of Periodontology (EFP), developed a redesigned disease classification framework that guides comprehensive treatment planning and allows for a personalized approach to patient care.

A recent edition of CDHO Milestones magazine states that this new classification scheme facilitates an international language for clinical communication. It is the new standard of information that all dental hygienists around the world should be aware of and have adopted in their practice by now. Having an international language such as this will ensure consistency and continuity of client care.

The new system aims to distill the most striking changes and important concepts into several key tables suitable for immediate chair side implementation. Key elements include:

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• Multi-dimensional system with systemic correlation • Classification done by stages and grades of periodontitis • Defined treatment protocols that follow the classifications Several factors are taken into account in order to determine the periodontal status of a patient. In addition to the clinical and radiographic findings, we are now considering the complexity of case management, as well as the rate of disease progression (including the systemic factors that may affect it), before we assign the proper disease stage and grade to our patient.

THINK OUTSIDE THE BOX

Think outside the time-managed care, reactive treatment and insurance coverage, and focus on the factors that affect overall health.

Unlike the 1999 one-dimensional model of strictly classifying the oral condition, the new system takes into account a more broad spectrum assessment, encompassing all aspects of periodontal health to help inform a customized proactive treatment plan.

For more information and to obtain chairside resources, visit www.perio.org.

MARCH 2021

Q&A

TECHNICALLY SPEAKING: Gabriele Maycher, CEO, GEM Dental Experts Inc. BSc, PID, dip DH, RDH A passionate educator with 30+ years of clinical and business experience, Gabriele has revolutionized the way practices optimize client outcomes, growth, and revenue through her consultancy company, GEM Dental Experts Inc. A former practice owner, published author, dental hygiene program director, quality assurance program assessor, entrepreneur of the year, and thought leader for Crest and Oral B, Gabriele shares her innovative views on dental hygiene through her work as a public speaker, consultant, educator, and business coach for forward-thinking dental practices.

Gabriele can be reached at gem@gemdentalexperts.com or visit www.gemdentalexperts.com.

Answering your questions about implementing the 2018 AAP Periodontal Classification Can you regress a patient’s Stage?

A stage can only regress under one condition: when surgical intervention eliminates a complexity factor like Class II and III furcations or vertical defects. So, if a patient is a classified as Stage III due to these complexity factors and has them surgically repaired, they can regress to Stage II. I am still confused about how to Grade a periodontitis patient?

Can you explain direct evidence, indirect evidence, and Grade modifiers?

Grading helps us, as hygienists, track the rate of progression, the responsiveness to nonsurgical periodontal therapy, and the potential impact of disease on the patient’s systemic health throughout the course of treatment. So, understanding how to accurately grade a periodontitis patient is one of the most vital skills for a hygienist to master. That said, let’s try to simplify the process.

STARTING AT GRADE B

Most of our periodontitis patients will fall in the category of Grade B,

MARCH 2021

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so clinicians should start with this assumption and then seek specific evidence to shift the patient to Grade A or C, based on clinical findings. That evidence can be in the form of: Direct evidence – which is based on longitudinal observation available in the form of older diagnostic quality radiographs (i.e., a comparison of FMS to FMS five years later). No loss over five years would put the patient at Grade A, or slow progression. Less than 2mm loss over five years would indicate Grade B, or moderate progression. Anything >2mm over five years indicates rapid progression, or Grade C. Indirect evidence – is based on the assessment of percentage of bone loss at the worst affected tooth in the dentition as a function of age (i.e., % bone loss at site of greatest loss ÷ patient’s age) or case phenotype, which simply refers to disease outcomes (i.e., how much bone destruction exists versus biofilms). Less than 0.25 (% bone loss ÷ patient’s age) or heavy biofilm

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Table 1 - PERIODONTITIS: GRADING Progression Primary criteria Whenever available, direct evidence should be used

Grade Modifiers

Grade A: Slow rate

Grade B: Moderate rate

Grade C: Rapid rate

Direct evidence of progression

Radiographical bone loss or CAL

No loss over 5 years

<2 mm over 5 years

≥2 mm over 5 years

Indirect evidence of progression

% bone loss/age

<0.25

0.25 to 1.0

>1.0

Case phenotype (Disease outcomes)

Heavy biofilm deposits with low levels of destruction

Destruction commensurate with biofilm deposits

Destruction exceeds expectations given biofilm deposits; specific clinical patterns suggestive of periods of rapid progression and/or early onset disease

Smoking

Non-smoker

<10 cigarettes/day

≥10 cigarettes/day

Diabetes

Normoglycemic/ no diabetes

HbA1c <7.0% in patients with diabetes

HbA1c ≥7.0% in patients with diabetes

Risk factors

Tonetti MS, Greenwell H, Kornman K.S. Staging and grading of peridontitis: Framework and proposal of a new classification and case definition. J Periodontal.2018;89(suppl 1):S159-S172. https://doi.org?10.1002/JPER.18-0006

deposits with low levels of destruction indicates Grade A. A 0.251.0 (% bone loss ÷ patient’s age) or destruction commensurate with biofilm deposits should be charted as Grade B. Again, Grade C represents a more rapid disease process, as indicated by >1.0 (% bone loss ÷ patient’s age) or destruction that exceeds expectations given biofilm deposits. With Grade C you may also identify specific clinical patterns suggestive of periods of rapid progression and/or early onset disease. See Table 1 - Periodontitis: Grading.

WEIGHING THE EVIDENCE

If your direct evidence and indirect evidence conflict, direct evidence

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Grading helps us, as hygienists, track the rate of progression, the responsiveness to nonsurgical periodontal therapy, and the potential impact of disease on the patient’s systemic health throughout the course of treatment. should always trump indirect evidence. So, if you compare a patient’s FMS from five years ago to their new FMS and it indicates that they had experienced “no loss over five years” you would shift them from the assumptive B category into the A category based on that direct evidence.

There is, however, a factor that trumps both direct and indirect

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evidence when grading periodontitis: Grade Modifiers/Risk factors, such as smoking and diabetes. So, if a patient is a Grade C due to Smoking >10 cigarettes/day or has a HbA1C >7, they will not regress even if the direct evidence and/or indirect evidence proves otherwise. Grade modifiers help us measure the potential for progression, so the only way these patients can regress is if they

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start smoking less than 10 cigarettes/day or get their HbA1C down to less than 7. Hence, the question about the patient’s smoking habits and HbA1C (if applicable) should be asked at every appointment. Keep in mind a patient needs to be a non-smoker for >5 years before they are considered a non-smoker.

How has the definition of “localized” and “generalized” changed with the new 2018 AAP Periodontal classification?

The newest global 2018 American Academy of Periodontology (AAP) Classification changed the definition of these terms when describing extent of periodontal disease –and it’s an important distinction. They no longer refer to the number of sites but rather the number of teeth involved. Localized means that fewer than 30% of teeth in the mouth are periodontally involved. The term generalized is used when 30% or more teeth in the mouth are periodontally involved.

However, when using the terms localized and generalized in describing deposit and gingival findings, we still use sites, not teeth, to describe the extent.

A bonus: The new AAP classification added molar/ incisor pattern to the extent and distribution category to describe the extent in what was formally known as Aggressive Periodontitis. In addition, when describing extent of a periodontitis patient, the AAP has decided that we no longer describe the periodontal condition or diagnosis as, “Generalized Stage I with Localized Stage II Periodontitis in posterior areas, Grade B. This is categorically incorrect! It is generalized or localized, not both. Period. So, the proper way to describe your periodontal condition or diagnosis in this case is, “Generalized Periodontitis, Stage II, Grade B”, since 30% or more teeth have been affected by periodontitis.

The stage was determined by the site of greatest CAL or RBL interdentally, which in this case was Stage II.

References 1 Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontal.2018;89(Suppl 1):S159-S172. https://doi. org?10.1002/JPER.18-0006 2 Murakami S, Mealey BL, Mariotti A, Chapple ILC. Dental plaque–induced gingival conditions. J Periodontol.

2018;89(Suppl 1): S17–S27. https://doi.org/10.1002/ JPER.17-0095 3 Realization https://www.youtube.com/ watch?v=SzOGHUozpmE

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ORAL HYGIENE

PANDEMIC PROOF YOUR HYGIENE DEPARTMENT!

When you stabilize your internal economy, your practice can weather the most volatile economic storms.

Gabriele Maycher, CEO, GEM Dental Experts Inc. BSc, PID, dip DH, RDH A passionate educator with 30+ years of clinical and business experience, Gabriele has revolutionized the way practices optimize client outcomes, growth, and revenue through her consultancy company, GEM Dental Experts Inc. A former practice owner, dental hygiene program director, quality assurance program assessor, entrepreneur of the year, and thought leader for Crest and Oral B, Gabriele shares her innovative views on dental hygiene through her work as a public speaker, consultant, and business coach for forward-thinking dental practices.

Gabriele can be reached at gem@gemdentalexperts.com or visit www.gemdentalexperts.com.

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he Canadian Dental Hygiene Association (CDHA) conducted a nation-wide survey in the fall of 2020 to evaluate the impact of Covid-19 on its members and found that one-third of the nearly 3,600 respondents had seen a reduction in their working hours, some reporting cuts as high as 50%.

Hygienists cited “patients’ general fear, anxiety of returning, concerns about infection control practises, loss of insurance coverage, affordability, and limited appointment times” for the decline in business. However, this same study also tells us that 31% of hygienists reported their clients had no concerns, and in fact, a number of respondents mentioned that “they’ve never been busier.” What sets these hygienists apart from the rest? How are their practices thriving when others are barely surviving?

YOUR REALITY CHECK

If you’re blaming the lagging economy for a drop in appointment scheduling, a reduction in work hours, and an unstable job situation, then consider this: Every business is impacted by what I call an “external economy” and an “internal economy.” The external economy is influenced by national and global

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markets that we have little control of. And the 2020 Covid environment is a perfect example of that. In the mid to late 70s it was the global HIV/ AIDS epidemic. Although only a few sporadic cases were documented at that time, by the early 80s it had already spread to five continents and 300,000 people. It was an unsettled time for our profession because we were struggling to understand this new emerging disease and characterize the risk of infection. Just as with COVID-19, we weren’t sure about the necessary safety protocols, splatter consequences, infection rates and modes of transmission. When I graduated, I was one of the first hygienists to wear safety glasses, gloves and a mask. Can you image how startled patients were to see me for the first time donning personal protective equipment at a time when unmasked faces and bare hands were the norm?

And then there were those patients who were nervous about coming in for treatment because they knew we treated HIV/AIDS patients, and they were afraid we could transmit it to them by simply being near them.

So, if it isn’t COVID or AIDS, it will always be something. How about the runaway inflation of the 80s, which was responsible for 21%

MARCH 2021

interest rates? And yet a lot of practices were their busiest and thriving, including the practices I worked in and managed. Remember the early 2010s when hygienists were in a surplus, getting offered a fraction of the wage they were worth? Like I said, there will always be external economic factors threatening your security as a healthcare provider, so how do we build an internal economy that can thrive regardless of what’s happening in the world around us?

BUILDING FROM THE INSIDE OUT

You have great influence over the internal economy of your hygiene practice, those factors that you can control, like systems, process, protocols, procedures and most, importantly, treatment philosophy. Hygienists who report they’ve never been busier in 2020 are thriving because they are focused on optimizing their internal economy, which allows them to continue practising dentistry just as if there wasn’t a global pandemic knocking at their door, draining patient retention, limiting working hours and convincing patients that maintaining their oral health isn’t really an essential service.

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These thrivers have a different treatment philosophy than their cohorts who are struggling just to get by. And it comes down to how they deliver basic care, shifting their focus from six-month “cleanings” to providing more comprehensive nonsurgical periodontal therapy for the treatment of gum disease. The American Academy of Periodontogy (AAP) reports that 86% of practices don’t provide the standard of care to treat periodontal disease.

That means there’s a lot of room for improving our competencies and providing patients with better outcomes. The remaining 14% of practices that are effectively treating periodontal disease are the busy ones, delivering comprehensive therapy and vital long-term treatment to meet the standard of care set out by the AAP and their college.

LET’S DEFINE ‘CLEANING’

My blood pressure hits the roof whenever I hear dental professionals and patients refer to their visits as a “basic cleaning” and checkup appointment. It infuriates me because there is nothing “basic” about a patient’s cleaning appointment since 80% of patients have some level of periodontal disease

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according to the American Dental Association, requiring nonsurgical periodontal therapy to get them to optimal health. How often do you as a professional use this term–a term that’s not even recognized in the dental literature?

Despite my best efforts, I know that dental professionals will continue to use this term. So rather than trying to eliminate it, why don’t we give it a definition to help us distinguish the difference between a basic “cleaning” and “nonsurgical periodontal therapy,” especially when speaking with our patients. Here is my definition: a “basic cleaning” is maintenance treatment we do for patients with “healthy gums,” (which is only 20% of patients in your practice) and “health” is defined in the literature as, <3mm sulcus or pocket depths and <10% bleeding on probing. If you have pocket depths >3mm and/ or > 10% bleeding on probing you have “unhealthy gums” or periodontal disease, which requires nonsurgical periodontal therapy to get your gums back to health. This typically means your treatment may involve up to six appointments, plus a postcare appointment for initial therapy and/or more frequent maintenance appointments until such a time we establish health.

Darby and Walsh’s definition of nonsurgical periodontal therapy (NSPT) is “therapy that encompasses the control of oral biofilm through self-care and professional periodontal debridement, supplemented by adjunctive therapy with antimicrobial or host modulation agents as needed for the treatment of periodontal diseases involving natural teeth and implant replacements.” With 80% of your patients having some level of periodontal disease, most will need more than just a basic “cleaning.”

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With 80% of your patients having some level of periodontal disease, most will need more than just a basic “cleaning”.

A BREAKDOWN IN BASIC CARE

Before we discuss how to implement NSPT 80% of the time, let’s discuss the clinical breakdowns holding back most hygienists from developing that highly perio focused practice. As a consultant, there are three clinical breakdowns I typically find during the chart audit process that you need to fix and become laser focused on if you want to create this change, and those areas are the comprehensive oral exam (COE), the number and type of radiographs exposed for a dental hygiene diagnosis, and using best practices in the treatment of periodontal disease.

C o m p r e h e n s i ve o r a l ex a m – Conducting a COE requires fundamental hygiene skills and provides a vital service to our patients. So why do I see so many common mistakes as I conduct chart audits in practices across Canada? Here’s what I see most often.

COE not being done at all. There seems to be an assumption that minimal assessments are required if you only bill for a new patient (NP) exam.

In fact, sometimes only a caries assessment is performed. The practice should worry less about billing protocols and more about meeting the expectations of their college or practice standards. Whether you are performing a specific exam, NP exam, comprehensive exam or recall exam, you are liable to the requirements of your college’s standard of

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care, not the fee guide’s interpretation of the standard of care.

COE being done once per lifetime. According to the AAP, a COE should be done once a year. Whether or not you decide to bill for it has nothing to do with whether it should be done.

COE billed but all the assessments not completed according to requirements. A COE isn’t just caries and or probing assessments. If you’re unsure of the requirements that constitute a COE, consult your college and do not rely on just your fee guide’s interpretation of requirements.

When sufficient time is given at the patient’s initial appointment and these required assessments are done comprehensively, a quick review at followup appointments is all that’s needed for most of them. Some assessments like medical dental history review, intraoral exam, vitals, probing, bleeding on probing, and recommended and accepted treatment will need to be updated at each appointment or annually as per college standards or patient-specific needs, which shouldn’t require any substantial additional time. In most of my practices, we provide more time every third year to establish a new baseline of assessments and ensure accuracy.

At this appointment, patients are once again billed for a COE fee.

All COE assessments are done, but they do not translate into a comprehensive treatment plan.

Instead of treatment planning for nonsurgical periodontal therapy, I

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often see that a basic “cleaning” is the only treatment planned. It’s as if there is a breakdown in the interpretation of the assessments collected and/or a misunderstanding about how they should translate into treatment. Or, perhaps, limiting beliefs about what a patient will and will not pay for gets in the way of the clinician discussing the recommended treatment and associated costs. Most of the time it is a combination of all these factors.

The number and type of radiographs exposed – Exposing the correct radiographs is as fundamental as telling patients to “say aah”. Here are the breakdowns I have encountered.

Radiographs focus on a dental diagnosis only. I know this to be true because typically only horizontal radiographs are taken. With horizontal radiographs, 50% of the time you cannot see the crestal bone levels either on the mandible or maxilla. So how can these radiographs be conducive for a dental hygiene diagnosis? They can’t.

No dental hygiene radiographic interpretation documented. Well what can I say about this? If it ain’t documented, it didn’t happen.

Hyg ienist and or dentist is unaware of the hygienist’s scope of practice. In some provinces it is in the hygienist’s scope of practice to initiate or expose radiographs for a dental hygiene diagnosis. In other provinces only the dentist can prescribe radiographs. Regardless,

MARCH 2021

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Appropriate maintenance intervals need to be determined and scheduled to maintain oral health and stability. it is important to know where the responsibility lies and make sure it happens and an interpretation gets documented. And perhaps vertical bite wings are a better choice for viewing both caries and crestal bone levels to evaluated for a dental hygiene diagnosis?

Dentist not allowing RDH to work within their scope of practice. This happens more often than you know mainly because either the dentist is unaware of the hygienists’ scope or the hygienists themselves are unaware as they move from province to province. Another possibility is that the practice owner is just more focused on restorative than preventative care, thinking patients won’t value more than a basic “cleaning.”

Team is not aligned to a periodontal classification. With each clinician in the practice boasting different years of clinical experience and educational training, there is no doubt the team is not aligned on a common periodontal classification and, therefore, not aligning on what radiographs are required to screen for all periodontal conditions. Everyone should be using and aligned to the new global 2018 AAP Periodontal Classification when it comes to the type and number of radiographs needed.

Not using best practices in treating periodontal disease – If you are providing a basic “cleaning” for most of your patients, then there is a good chance you’re not providing the standard of care to treat periodontal disease. And if you’re not up to date with the new global 2018

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AAP Periodontal Classification, then this is doubly true.

W hen t reat i ng per iodont a l disease, there are six phases to treatment that can’t possibly be done in one basic “cleaning” appointment, according to Foundations of Periodontics for the Dental Hygienist (Nield-Gehrig and Willmann, 5th Edition, 2019). The treatment phases are as follows: Assessment and Preliminary Therapy Phase (assessment, diagnosis, planning). Depending on the level of periodontal disease, this could take an entire appointment.

Not only do all the assessments need to be gathered but hygienists need to interpret and discuss their findings with the patient to establish a logical and accepted treatment plan, including discussion of fees. This phase also includes prescribing, exposing, and interpreting radiographs to determine an accurate dental hygiene diagnosis. Education on periodontal disease and prognosis is an important part of this phase.

All of this takes time.

Phase I Nonsurgical Periodontal Therapy Phase (implementation, evaluation). Initial therapy could take up to six appointments and include an additional post-care appointment to reevaluate.

Phase II Surgical Therapy. This may include periodontal surgery, endodontic surgery, and/or dental implant placement. Although these

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procedures are not within our scope, they need to be discussed collaboratively with the dentist to get the patient to health.

Phase I I I Restorative Therapy. Dental restorations, fixed and removable prostheses and reevaluation of overall response to treatment. Again, not in our scope, but all these conditions affecting the periodontium (predisposing factors) need to be identified and addressed to get the patient to health.

Phase IV Periodontal Maintenance. Appropriate maintenance intervals need to be determined and scheduled to maintain oral health and stability.

According to the CDHA survey, one of the benefits of COVID-19 was increased time with patients. Why do we need COVID as an excuse to take more time with patients when the standard of care set out by our college and literature already states that we need more time than we are taking?

Has there ever been a dentist who has only diagnosed four cavities because he or she was afraid the patient wouldn’t accept or pay for treatment of eight diagnosed cavities? Never, but still, we try to treat patients with periodontal disease in one appointment versus what’s needed.

The truth is, the hygienists who reported that they had never been busier are the ones performing comprehensive oral exams, taking the appropriate type and number of

MARCH 2021

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1 John A. Molinari, Ph.D., Peri Nelson, B.S., Antonia Molinari. Environmental Surface Wetness Test: Comparison of Disinfectant Wipes. Ann Arbor: Dental Advisor, 2015. 2 John A. Molinari, PhD, Peri Nelson, BS, and Devi J.V. Raghavan, BDS. OPTIM 1 Environmental Surface Cleaning Investigation. Ann Arbor: Dental Advisor, 2016. 3 Too good to be true? Read our Safety Data Sheet at www.scican.com/products/cleaners-disinfectants/optim-1/. 4 John A. Molinari, Ph.D., Peri Nelson, B.S. Effect of OPTIM 1 on Tensile Properties of Dental Chair Fabrics. Ann Arbor: Dental Advisor, 2016.

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radiographs to screen for all periodontal conditions that may exist, and treatment planning the appropriate amount of time to get their patients back to health. When patients routinely experience this level of care, they don’t have to be convinced about the value to their oral and overall health.

T he good news is that you currently have everything in place to become a practice that can thrive in the face of any global economic and health crisis. By leveraging your hygiene department and putting a laser focus on patient outcomes, you can not only recover your lost 2020 revenue, but also set yourself up for unprecedented growth moving forward as we continue toward a return to normalcy. But just as important, you’ll be prepared when that next crisis comes knocking.

References 1 Covid-19 Member Impact Survey Results, September 8th & 22nd, 2020. https:// www.cdha.ca/.../COVID-19_Surveys/.../CDHA_COVID-19_member_ impact_survey.aspx?...

2 Prevalence of periodontitis in adults in the United States: 2009 and 2010 P I Eke 1 , B A Dye, L Wei, G O Thornton-Evans, R J Genco, CDC 2012 Oct;91(10):91420. Journal of Dental Research.

3 Chapple ILC, Mealey BL et al. Periodontal. Health and gingival disease and conditions on an intact and a reduced periodontium: Consensus report workgroup 1 of 2017 World Workshop on the Classification of Periodontal and PeriImplant Health. J Clin Periodontol. 2018;45(Suppl 20): S68-S77. https://doi. org/10.111/jcpe.12940 4 Comprehensive Periodontal Therapy: A Statement by the American Academy of Periodontology July 2011, American Academy of Periodontology.

5 Foundations of Periodontics for the Dental Hygienist, Nield-Gehrig and Willmann, 5th Edition, 2019. Chapter 10, pg. 195, Table 10-4, Phases in the Management of Periodontal Disease.

6 Darby and Walsh Dental Hygiene Theory and Practice, 5th Edition, 2015. Denise M. Bowen & Jennifer A. Pieren. 2020. Pg. 519 7 American Academy of Periodontology: Perio.org https://www.perio.org/consumer/perio-evaluation.htm?

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MARCH 2021

ASM21: A BIGGER, BETTER VIRTUAL EXPERIENCE! There’s more to enjoy than ever before at this year’s virtual conference! Dentists and dental teams can access your choice of nearly 50 top-notch lectures, hands-on workshops and an inspiring keynote session.

We’ve introduced an incredible interactive exhibits floor where you can meet with your favourite exhibitors, learn about innovative products and services and explore entertaining feature areas.

We’re also bringing you a virtual networking lounge to catch up with colleagues and friends from the comfort and safety of your own desk.

FEATURED KEYNOTE SPEAKER Amanda Lindhout

New York Times bestselling author of A House in the Sky and expert on resilience, survival and optimal mindset.

A SAMPLING OF SPEAKERS YOU CAN LOOK FORWARD TO INCLUDE: Sangeeta Patodia

Tim Caulfield

Dentists: Are They the New Oral Physicians? Medical Management of the Dental Patient

Stress and Anxiety in a COVID Environment

Tim Donley

Dayna Johnson

Periodontal Treatment: The Science

The Three Most Common Battles Between the Front and the Back and How to Solve Them

Registration and the Virtual ASM21 Show Guide will be available online in March.

For the most up-to-date information, please visit asm.oda.ca.

OntarioDentalAssociation

@ONDentalAssn

ORAL HYGIENE

HOW TO GET A RAISE Alina Fintineanu, RDH, CTP, C.A Ed Alina Fintineanu is a Registered Dental Hygienist with 10 years of experience in dentistry. She currently works in private orthodontic practice in Toronto. Alina has obtained a Certificate in Adult Education and is a Certified Training Practitioner. She is an educator on Invisalign and profoundly passionate about all things Orthodontics. When she is not reminding patients to wear their elastics, you can find her traveling, baking and petting dogs.

Contact her at: alina_fin@yahoo.ca

ould you rather: 1) do your taxes, 2) use a restroom with broken locks, or 3) listen to a young child learn how to play the violin, rather than approach your employer for a raise? In the field of dental hygiene, many of us find it challenging to assert ourselves and discuss money. It makes the world go round and keeps the roof over our heads, but I’ve lost track of how many times I’ve heard a hygienist say they haven’t had a raise in 5…10…15+ years. The cost of living goes up every year, but what happens if our compensation remains unchanged?

I surveyed 180 dental hygienists from both Canada and the United States to find out how they are (or aren’t!) being compensated, and the results may surprise you, too. Before you bite my head off because “It’s a

“The most difficult thing in any negotiation, almost, is making sure that you strip it of the emotion and deal with the facts.”

– Howard Baker

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pandemic! This isn’t the moment,” you’re not wrong. Times are very tough, and your employers have been suffering as well with the staggering cost of PPE, new health and safety regulations, office closures and so much more. I’m writing this for you, for all of us, for the moment when we rise from the ashes of COVID19 and regain some semblance of normalcy. I’ve combined my survey findings with techniques on how to approach a difficult topic with your employer that will provide you the highest chance of a positive return.

According to my findings, 65% of dental hygienists feel they are being compensated below market value – in a range anywhere from $1–10/hour below what they feel they should be earning (Fig. 1). As health practitioners, we aim to provide optimal care, maintain current certifications and continuing education, produce a considerable return for the office, and help our team work as seamlessly as possible. By accepting a wage that is below market, this indicates to our employer what we feel our monetary

MARCH 2021

taken on, flexibility you provide for the office such as travelling to multiple locations or working longer to accommodate clients, and additional treatments you provide/sell such as whitening or laser therapy.

Consider speaking to hygienists in other offices in the area to see what they are making, and check job postings to ensure you are in line with market demand and offers. In addition, 47% of hygienists said they have had a performance assessment in the past 3 years. A performance assessment is a good opportunity to gather information on the value you bring to the office.

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35%

34%

7%

24%

■ $1–3 per hour below market ■ $4–6 per hour below market ■ $7–10 per hour below market ■ Compensation is fair Figure 3: Increase in hourly wage for Hygienists working for 6–15+ years

According to my findings, 71% of hygienists were too scared, nervous or embarrassed to ask for a raise, and hoped a raise would just be offered based on their performance.

We’ve all heard the saying: if you don’t ask, the answer is always “no”.

Have a plan of action for how you’ll approach the issue. Ideally, schedule a time to meet with your employer, and ask for a raise in person and in private. Do you get nervous in

$0–5/hour

$15+/hour

$10–15/hour $5–10/hour

Figure 2: Increase in hourly wage to years worked as a hygienist

KNOW YOUR WORTH

Thirty-one percent of the hygienists I surveyed are earning anywhere from $4–10 per hour below market. Prior to approaching your employer for a raise, do your research. Look into what you should be earning based on your experience, skills, qualifications, location and demand. Factor in additional responsibilities you’ve

Figure 1: Compensation in dental hygiene

HAVE A STRATEGY

Number of Hygienists

worth is. In turn, the wages offered will continue to decrease if employers are seeing hygienists accepting low pay. Even now, I’m seeing job postings for just $1–2 per hour more than what I made 10+ years ago as a new graduate!

Figure 3 illustrates the increase in hourly wage for hygienists who have been working for 6–15+ years. Of these hygienists, 33% reported that their hourly wage had only gone up $0–5/hour since they began practising. We can conclude that they are earning less money each year that they do not keep up with inflation.

Let’s look at an example: the average yearly rate of inflation in Canada from 2010–2020 has been 1.80%.

You start a job in 2010 being paid $35/hour. By 2015, with annual compounding, inflation is 9.3% higher than it was in 2010, so your wage should be at least 9.3% higher too, just to be earning the same value.

To merely keep up with inflation, in 2015 you should be earning $38.26.

At the very least, you should aim to obtain a raise that keeps up with the rising costs of living(1–3% per year).

This does not consider the fact that you have amassed 5 more years of experience and perhaps additional certifications, skills or responsibilities. Furthermore, the dental fee guide goes up year after year; is your compensation doing the same?

Let’s put our money where our mouths are (see what I did there?) and discuss actual techniques for getting what (and how much) you want.

50 45 40 35 30 25 20 15 10 5 0

0–5 years

6–10 years

11–15 years

15+ years

■ $0–5/hour

47

22

6

13

■ $5–10/hour

7

11

8

13

■ $11–15/hour

3

5

5

13

■ $15+/hour

1

2

1

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May 2017

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56% of the hygienists surveyed reported that they remained at the same office even without a raise because they love the patients, office, commute, schedule and team. confrontation or in difficult discussions? If you must, consider putting the request for a raise in writing – this will have the added benefit of having a paper trail of the exact date you asked for the raise so that there is no miscommunication later on. It also allows your employer time to consider your request rather than just denying it in a knee-jerk reaction. If you have been working at the same office for less than a year, you may have a lower chance of receiving the raise; this increases exponentially if you’ve been at the office for 2 or more years.

Research wages in your area, and factor in your experience, seniority, and additional responsibilities you’ve taken on. If despite all this, you are told “no”, you could ask what your employer’s expectations are which will enable you to receive the raise, and ask to revisit the topic in a set number of months.

KNOW YOUR AUDIENCE

Presumably, you’ve worked with your employer long enough to know what motivates him/her. Are they most focused on acquiring new patients?

In that case, showing them referrals you’ve brought in, positive Google reviews or marketing incentives you’ve suggested or adopted might be a good route of approach. Are they most interested in patient retention? Here is where you may want to emphasize the relationships you’ve

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built with your patients, the positive feedback you’ve received and the loyalty you’ve established with patients who request you in particular. Perhaps most common of all is the office’s bottom line. At the end of the day, a dental office is a business and numbers will resonate. Keep track of your production/performance – have documentation to show exactly how much you produce for the office per hour/day/month/year. Follow up on patient acceptance of high value proposed treatment such as Invisalign, additional services you’ve sold or performed such as laser treatment/ whitening/mouthguards, or anything else that brings revenue to the office.

You may also want to consider your timing: COVID-19 may not be the best time to ask for a raise or if you know your employer has been struggling financially and is under pressure. Finally, come well prepared to reason and prove exactly why you deserve a raise.

WALK AWAY

Twenty-two percent of hygienists reported that when they asked for a raise, they were told it was not in the budget or they had maxed out.

Walking away is the least preferred option but is sometimes necessary.

At this point, it’s time to reassess the situation. Money isn’t everything, and there are other factors that may come into play in keeping you at the

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same office. In a positive spin, 56% of the hygienists I surveyed reported that they remained at the same office even without a raise because they love the patients, office, commute, schedule and team. Others remain at the same hourly wage but are offered a monthly bonus, benefits, or other perks that make it worthwhile for them to stay. Sometimes there are more factors to consider than just the bottom line. However, if you’ve looked at all the benefits and drawbacks and decided it’s time to move on, that may be the next natural step.

It’s common knowledge that one of the best ways to get a significant raise is to move to another office.

THINGS TO AVOID

Getting emotional – Remain professional, calm, and collected. If the answer to the raise is “no”, revisit your initial plan of action to know how you will proceed from there. Do not threaten to leave the office. Do not bring up your own personal expenses or financial pressures, the reality is that your salary represents how you benefit your employer, and that is what he/she is most interested in.

Comparing yourself to others – If your argument is that Jenny has been at the office for 6 months less and you found out she’s earning more, this will likely not go over well. It is also possible that discussing salary with other employees is against your employer’s policy. Furthermore, this is not a strong approach. Highlight in detail the value you bring to the office and the reasons why you deserve a raise.

We would all love to work in unicorn offices that grant us raises with a wave of a wand (or curing light), but that is rarely the case. Obtaining a raise makes us feel more valued, respected and satisfied with our jobs, and less likely to look for a change in employment. Being well prepared, having a plan of action and knowing our employer are key strategies for getting what we want.

MARCH 2021

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ORAL HYGIENE

EQUIPMENT ON THE GO Jennifer Grzebien, RDH Jennifer is an Independent Dental Hygienist with 10 years of experience specializing in dental phobias and those with special needs, and is also the co-founder of Mobile DH Solutions.

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t the age of 26, I decided to go back to school and become a RDH. I sought a change from retail management and wanted to do something that provided greater job opportunities and greater job satisfaction. What has taken more than a decade to achieve has been a tough but fulfilling journey and I am so grateful for where I am now in my career.

Practising independently is amazing and brings me such joy. Partnering up with my friend Regina BermudezSchlesinger, RDH to create Mobile DH Solutions has been another rewarding path where I find joy helping other RDH’s achieve their dreams.

Regina was a single mom and wanted to spend more time with her, at the time, young son but not reduce her income. Have more free

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time to explore other opportunities and interests as well. I was already working independently in order to be able to care for my autistic daughter. Having started out as a mobile hygienist, I already had the larger equipment that I was no longer using since I transitioned to working out of my house.

We saw a need for clients who needed access to care but were unable to access it for various reasons at a typical dental office. There were also IRDHs who needed increased job flexibility and were looking to expand outside the typical office setting.

Regina and I got talking and the idea of renting out the equipment for others that are in the same boat sounded like a great premise.

The idea of Mobile DH Solutions

MARCH 2021

Photography: Nikolina Zelic

One RDH decides to rent her equipment to those in need.

The biggest obstacle that independent dental hygienists face starting their own practice is cost.

To purchase the equipment necessary requires a large financial investment.

(MDHS) was born. Being selfinitiated was one thing but actually putting this plan into place was a different challenge. The most important thing to figure out was how to streamline the rental process to make it work efficiently for our renters. Working with the equipment is like learning to ride a bike and we give a crash course when the equipment is dropped off.

The biggest obstacle that independent dental hygienists face starting their own practice is cost.

To purchase the equipment necessary requires a large financial investment. In addition, the RDH may be unsure if they will enjoy independent practice or may just want to do it part time and can’t justify making the investment. Being able to rent the equipment and not have to worry about sterilization it removes most of the hurdles hygienists face when starting their own practice.

Working independently allows you to book your own schedule, giving you a better work/life balance and also allows you to practise as you see fit, which can increase quality of care delivered and job satisfaction.

It also gives better financial benefits since you are paid for the services provided and not by the hour which means you get paid more while working less. With all the tension going on between differentiating RCDSO and CDHO guidelines and new IPAC protocols working

MARCH 2021

A TESTIMONY FROM ONE RDH “I was initially inspired many years ago while working as a receptionist at one of the very first independent dental hygiene centers in Toronto.

Fast forward almost 10yrs and much less motivated, I found myself working alongside a very motivated independent mobile hygienist aka Regina from Mobile DH Solutions! Seeing her drive, and passion for her mobile dental hygiene businesses brought back the urge to do more and be more in my profession. I’ve reignited my love for dental hygiene, only now I’m doing it independently. We’re living in very uncertain times right now and being able to help bring peace of mind to my clients when it comes to their own and their family’s oral health is a win for me! Building my own schedule, with my own clients who trust me to provide safe and professional treatment for themselves and their families is a great feeling.

I enjoy being a dental hygienist very much, but I love being an entrepreneur while practicing dental hygiene even more! With the ability to rent costly equipment, I was able to start my own mobile hygiene business almost overnight, and I’m only getting started!

My advice is to take the leap, trust yourself and take advantage of companies like Mobile DH Solutions, who help kickstart and make starting your independent dental hygiene career seamless!”

Ashley Subnarain RDH

independently has become a very desirable option.

Both Regina and I have independent practices and are both advocates for independent practice. As a self-regulated profession it is very difficult as hygienists to reach their full potential and maximize client care while working under and relying on income from another profession. MDHS is a way of advocating for independent RDHs and contribution to advancing our profession.

It warms our hearts to see other RDHs being able to advance their careers and branch out onto their own, delivering higher levels of client care and achieving increased job satisfaction.

So, if you are a RDH and are feeling frustrated and stuck in your career know that there are other options and that working in a typical office under a DDS isn’t the only road. As an IRDH there are so many

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options and opportunities especially now in this changing world where people’s expectations and ideas of care are also changing. Clients are finding the option of having their oral health appointments in the comfort of their homes very appealing. Don’t be afraid to look at different avenues and step outside the box because you may be surprised at how rewarding it can be!

May 2017

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ORAL HYGIENE

SLEEP APNEA… A NOT SO SILENT KILLER: What dental hygienists need to know to help save lives.

Kathleen Bokrossy, RDH President of rdhu Kathleen is the president of rdhu, a Professional Development company, which provides team events, handson programs and online learning to help Transform the Dental Hygiene Experience for the clinician, the client/ patient and the practice. www.rdhu.ca

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bstructive sleep apnea (OSA) is a disorder characterized by upper airway collapse during sleep. OSA is one of the most prevalent sleep disorders and is potentially fatal, affecting approximately 4-9% of the adult population.1 Like most sleep disorders, OSA is unrecognized, underdiagnosed and undertreated with an estimated 70-90% of cases going undiagnosed.1 Dental Hygienists are the first line of defence in recognizing and screening for potential OSA. We play a critical role in improving the quality and longevity of life of our clients.

Understanding the sleep disorder, how it affects our clients, how to screen for potential OSA, and recognize when to refer is in our area of influence.

My interest in sleep apnea began because of my own personal journey.

Here I am, in the dental profession, president of a professional development company and unbeknownst to me, I suffered from sleep apnea for far too long. Not only sleep apnea, but severe sleep apnea. I was one of the undiagnosed statistics.

It was because of this diagnosis that I decided to dig deeper into this topic and have made it a passion to bring awareness to this disorder.

I had seen many different dental hygienists (as a client) over the years, a cardiologist, my GP and even a couple of different dentists, and not one of these healthcare providers ever asked me about my sleep.

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Seems so simple to ask, but it never came up during any assessment or medical history questionnaire given.

I have been happily married for a long time and my husband, not once, ever mentioned (God bless him) that he noticed something peculiar while I slept. For instance, loud snoring, choking and gasping for air, grinding and bruxism, to name a few.

It wasn’t until I was away and sharing a room with my friend, Jennifer Turner (who I was co-presenting with the next day) that she admitted “Kath, I used to hear you gently sleep and it made me happy to know that you were getting sleep, but now, I feel like I am sharing a room with a truck driver.” (No offense to truck drivers!

But you can understand what she was implying!) I had a physical booked the next week with my GP and during this appointment I mentioned to her that my friend mentioned my snoring.

“You snore?” she asked. “I am going to book you in with the sleep clinic.”

Looking back at how long I was suffering was truly disheartening. I thought perhaps I suffered from anxiety, because I couldn’t sleep at night.

One night in particular stood out for me. I was away in the States for RDH Under One Roof, where I was a part of the mega session and presenting to 2200 people the next morning. I met with my friend and co-presenter Jo-Anne Jones, we had a light dinner and off to bed we went (this time we had separate rooms). After 1.5 hours

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of sleep I was up for the day. I took a selfie and sent it to my husband. I was so upset. How was I going to get up there on the stage that morning and present to a large audience? I felt terrible. I was in a fog and couldn’t think straight. Luckily, I rallied.

Ordered a Coca Cola (which was my secret weapon prior to presentations at the time – that I don’t need now, thanks to my CPAP!), did my hair and makeup, and was ready for the day.

I share this story because of how I looked like image 1, to then looking like image 2. And nobody would ever guess I had a problem.

No matter how a client looks, you never know what that client is going through or what their concerns are.

We can’t prejudge or assume something by their outward appearance alone. Questions need to be asked.

We need to start the conversation.

For many years I suffered from: • Brain fog • Memory issues • Weight gain • High cholesterol • Day-time sleepiness • TMJ problems • Bruxism • Limited opening (due to my TMJ problems) • Nightmares • Snoring • Gasping for air/choking • Acid reflux • Tinnitus • Frequent trips to the washroom at night All of these symptoms are related to sleep apnea.

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Image 1

Image 2

No matter how a client looks, you never know what that client is going through or what their concerns are. We can’t prejudge or assume something by their outward appearance alone. Questions need to be asked. We need to start the conversation.

Figure 1: Mallampati Classification

Source: Wikipedia. User: Jmarchn

I waited 6 months to get into the sleep clinic for my initial assessment. In the meantime, I went for a “new patient exam” with my friend Dr. Samuel Lee. During the assessment he stated ‘Class 3 Tongue’ to his assistant. “Class 3 Tongue?”, I asked.

I had not heard that term since dental hygiene school, to be honest.

He refreshed my knowledge on Mallampati Classification. (Figure 1) A simple physical trait that can be indicative of OSA is the client’s Mallampati Classification. Clients with a Class 3 or Class 4 Mallampati Classification are most likely to have some degree of OSA due to the small space

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in the throat for the passage of air.2 Once the results for my test came in, the sleep clinic had me in for my fitting of the CPAP machine that night. There was no waiting as my results indicated that I had severe sleep apnea.

So, what is sleep apnea?

Sleep apnea is characterized by repetitive apneas during sleep. An apnea is the complete interruption of breath for at least 10 seconds. 2 Characterized by partial or complete narrowing of the pharyngeal airway during sleep.

It is defined as a condition in which there is a decrease of oxygen intake (hypopnea) or temporary

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cessation of breathing (apnea). 2 This chronic, multifactorial, and potentially life-threatening disorder is associated with a reduction in oxygen levels, increased carbon dioxide in the bloodstream, and numerous medical conditions. 3 Results in: • Disruption in sleep cycle • Daytime fatigue • Deprivation of deep and REM sleep • Interferes with important physiological processes Obstructive sleep apnea increases the risk of morbidity and mortality.

With a diagnosis and appropriate treatment, coexisting health conditions can improve.

This is why I became passionate about this topic and want to share with dental hygienists to help empower you to realize that you can really make a difference in someone’s life with one simple screening tool.

We are at the first line of defence.

There are many dental practices who specialize in sleep and have fully implemented assessing and treating or referring to the appropriate specialist to help clients and patients; however, there are still a number of professionals who don’t screen for this disorder.

According to the Institute of Medicine (US) Committee on Sleep Medicine and Research; obstructive sleep apnea is an unmet public health problem. 4 During my initial research I came across a study that was conducted on a group of dental hygienists. The purpose of this study was to determine the knowledge and attitudes of OSA among this group. The conclusion stated that dental hygienists perceive that assessing patients for OSA is important, however they have moderate knowledge of the disease.

Results support incorporating OSA into dental hygiene practice through additions to the dental hygiene

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education curriculum and ongoing professional development courses with the goal of improving the screening and referral of patients presenting with OSA symptoms.1 Sleep apnea can lead to many diseases and conditions; such as, obesity, diabetes, cardiovascular disease, increased cholesterol levels, it can affect the brain function, mood and behavior, just to name a few.

My suggestion, establish an obstructive sleep apnea assessment protocol for your practice: 1. Get the team on board. Educate the entire team on this disorder. Dr. Viviano, from Mississauga, Ontario has an educational facility where dental teams come from all over the world to participate in Sleep CE classes (sleepdisordersdentistry.com). There are also online courses available through this website and www.rdhu.ca 2. Determine which assessment tool you are going to implement. There are many available online: stopbang.ca; Epworth Sleepiness Scale epworthsleepinessscale.com 3. Establish options for treatment. (oral appliance or CPAP) 4. Who will you collaborate with?

Sleep specialist? Refer first to the GP. 5. Implement a follow-up protocol. Now that your client/patient is

aware that they have this disorder, be sure to check that they are wearing their appliance or CPAP every night. Clients need encouragement and reinforcement. We need to make sure that the client understands the severity of their condition so that they work through the initial stages of adapting to their new device at night. Work with them to see what treatment option works best for them.

Obstructive sleep apnea is a huge topic and one that you can do a lot of research on.

My goal in writing this article was to bring awareness that assessing for obstructive sleep apnea, even by adding a few questions to your medical history and update, is essential.

You could follow some of the screening tools or simply implement questions like: Do you snore? Do you wake up choking and gasping for air? Are you tired and feel like you are in a fog?

I recorded a 1-hour CE online course on sleep apnea (Sleep apnea… a NOT so silent killer: What dental hygienists need to know to help save lives); which includes many references and extra resources. If you are interested, please go to rdhu.ca/sleepapnea and you will receive instant access to this online presentation.

You can help someone by not only extending their life but also by giving back their quality of life. I know I have been feeling great since starting my treatment!

References 1 Obstructive Sleep Apnea Knowledge: Attitudes and screening practices of Minnesota dental hygienists; Author: Reibel YG; Pusalavidyasagar S; Flynn PM J Dent Hyg. 2019 Jun;93(3):29-36. https://www.ncbi.nlm.nih.gov/pubmed/31182566 2 Obstructive sleep apnea. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3286155/ 3 Dimensions of Dental Hygiene: Screening for Sleep Apnea. https://dimensionsofdentalhygiene.com/screening-sleep-apnea/ 4 Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Institute of Medicine (US) Committee on Sleep Medicine and Research Harvey R Colten, Bruce M Altevogt. Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders; ncbi.nlm.gov.

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To advertise contact: Karen Shaw • tel: 416-510-6770 • fax: 416-510-5140 • e-mail: karen@newcom.ca Toll free: CDA 1-800-268-7742, ext 6770 • Toll free: USA 1-800-387-0273, ext. 6770

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To advertise contact: Karen Shaw • tel: 416-510-6770 • fax: 416-510-5140 • e-mail: karen@newcom.ca Toll free: CDA 1-800-268-7742, ext 6770 • Toll free: USA 1-800-387-0273, ext. 6770

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