The Implant Imperative:
Enrolling the Patient as a Partner
in Infection Control
Sheila Wolf, RDH
(This article appeared in a dental magazine
called Implant News and Views)
To the average person, what is going on inside
their mouth is as mysterious as what is going on under the
hood of their car. It is a rare mechanic who offers the consumer
anything more than a recommendation to bring in the car for
an oil change every . well, however long it is. The average
person coming in for an implant consultation has about the
same amount of information on oral care as the driver who
knows only that he should change the oil but not why. As dental
professionals, if we wish to be effective, we have a responsibility
not only to treat but also to educate the patient. It is up
to us to teach patients their role in ensuring success with
their implants; to encourage them in what to do, and to have
them understand the reasons for doing it.
About ten years ago, I had an awakening that
was to change my life as a hygienist. I was introduced to
the phase contrast microscope. Learning that periodontal disease
is a bacterial infection is one thing. Seeing it under a microscope
is an altogether different experience. I saw, up close and
personal, squirmy, squiggly spirochetes, fascinating, undulating
eel like critters, gliding, spinning, and clock-arm rods,
and sluggish amoebic parasites. I saw organisms called Trichomonads,
which look surprisingly like foraging mice, that I learned,
are sexually transmitted. I actually watched white blood cells
cluster around a pathogen and make a stand for health. I discovered
a tool that could show patients the "why" of the need to master
their oral hygiene.
Whether the infection is around natural teeth
or implants, the bacteria are basically the same, according
to Dr. Dan Watt. It is important to get these microorganisms
under control otherwise patients will continue to have breakdown
in the underlying bone, and to host a disease that seriously
impacts their whole body health.
Armed with the "why", I am out to enroll my
patients as partners in a treatment process that requires
them to participate as fully as I do. This is no mechanic
shop. They are not bringing their mouths in for repair. They
are learning to take control. Whether the patient comes in
as an implant candidate or with failing implants makes no
difference. Treatment needs to begin at whatever stage they
are at present.
To establish a basis for relationship and trust,
I create an environment where patients can freely express
themselves. On our first visit, generally a two-hour appointment,
we discuss their medical, social and dental history. I listen
patiently to their concerns, let them express their frustrations
and fears, and watch their body language, which tells me a
lot about how to proceed with treatment.
I explain the distinction between teacher (one
who imparts information) and coach, (one who takes a stand
for them to be as great as they can be). As their partner
and coach, my commitment is for them to get rid of this chronic
infection, the bad taste and smell in their mouths, their
pain and self consciousness, and to enable them to reach a
level of oral health, energy, and full body wellness that
they may not even be aware they are missing.
As in athletic coaching, at each visit we study,
practice, and refine their use of equipment, their techniques,
and their applications of specific chemicals. I generally
suggest a sonic toothbrush (SonicareT), an irrigator (HydroflossT
or WaterpikT), and I recommend certain solutions such as TherasolT
(Oratec), Closys ll (Rowpar products), chlorhexidine, and
a special "Magic Mix" of baking soda, salt, and peroxide used
as a toothpaste. My focus lies as heavily on the "chemical"
as on the "mechanical."
We create a vision and a mission. If we do not
have a vision for health, we do not know what to strive for.
Each patient is treated individually. There is no generic
treatment except that each patient needs to feel loved, nurtured
and pampered. I promise them they will not feel discomfort
and I keep my word!
Their first few visits are generally superficial
(light supra gingival scaling and polishing,) and treatment
progresses, on subsequent visits, to include 4 to 8 quadrants
of root planning, with plenty of topical and local anesthesia,
nitrous oxide sedation if they like, and music of their choice
on a cassette player with great earphones. They are wrapped
in a blanket, pillow under their knees, and are as comfortable
and spoiled as they want to be.
Patients return every 2-4 weeks, depending on
the severity of their infection. Our one to two-hour appointment
is spent sampling and reassessing their plaque smear, reviewing
their oral hygiene, looking at the healthy changes in their
tissues, and addressing concerns and answering questions.
The level of infection, (assessed from their plaque sample
at each visit,) determines clinical treatment as well as their
possible need for antibiotic therapy. I never do any sub-gingival
scaling until they are clear of the risk of septicemia and
trust is established. All visits include anti-microbial irrigations
and patients are taught to master the home equivalent of that
technique on a daily basis.
Patients are encouraged to set their own goals
with me. They tell me what is realistic for them and what
they are willing to do between appointments. I write that
in their chart and hold them accountable for what they said.
When they keep their agreements, they are rewarded with a
colorful star, words of encouragement, and perhaps a new dental
"toy," (a more streamlined irrigation tip.?) which will help
them to the next level of optimum health. Before long, they
feel empowered, and have learned to take charge of their own
mouths and health, a goal that is truly gratifying for both
The end point in treatment is three
negative plaque smears in a row over a 3-month period. Tissues
that are pink and tight, with reduced pocket depths and
no bleeding or exudation present, are now ready and healthy
enough to place implants. No longer is the patient na´ve
and unknowing. He still may not know anything more about
what is under the hood of his car, but he certainly knows
what his mouth is supposed to look like. And he is probably
a lot happier, knowing that he has a healthy foundation
onto which will be "implanted
" the smile he has always dreamed of having.
Sheila Wolf, RDH, affectionately called Mama Gums, has been a registered dental hygienist since 1971. She is currently retired from clinical practice but enjoys writing, speaking, and consulting on various oral health issues. She has authored two award-winning books, Pregnancy and Oral Health: The critical connection between your mouth and your baby, and Your Mouth Could Be KILLING You. Both are available on her website, http://www.mamagums.com/about_book.html, through Amazon, and at finer bookstores everywhere. Sheila also works with people privately as an oral wellness coach, educating and empowering people to keep their natural teeth for a lifetime, avoid gum surgery, and just possibly add years to their lives. You may reach Sheila through her website, www.mamagums.com or in San Diego at 866-MAMA-GUMs.
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