Here’s an approach for easing the pain of treating this guy late in the day
By Katie Melko, RDH, MSDH
It’s the end of day, and a patient presents with tenacious, heavy stain. Your hands are already killing you! I know the feeling and use to dread when I would get in a patient’s mouth and see wine, cigarette, or staining from dark foods such as curry.
So many great products and techniques are available to help reduce the hand tension and make these appointments seamless. Not everyone likes the same products or has access to the same ones, so I’m going to go over some of my favorites in hopes to make your day a little easier. When tailoring appointments based on a condition or issue a patient has, take steps that will impact your time management skills and help put you in the proper mindset to tackle the appointment with ease and confidence.
With heavy stain, the approach involves an ultrasonic scaler, hand scalers, selective pumice, stain remover paste, a recommendation of three to four months before the next recare appointment, and a recommend for baking soda toothpaste at home to help neutralize pH.
Here are my top five must-haves:
- Cavitron or Prophy-Jet
- Hand scalers
- Vera disposable prophy angles
- Pumice
- SmartSelect selective polishing paste or coarse polish
The Appointment
Once you get your patient settled, review the medical history and discuss any problem areas; it’s time to take control of this appointment. I like to start by using the Cavitron. This allows me to remove plaque, biofilm, and tartar while providing the gingiva with a lavage treatment as well. The Cavitron will effectively remove stain from most areas of the mouth.
However, most tips are not thin enough to get the stubborn interproximal stain. If you do have access to a Prophy-Jet, this is another great way to remove the bulk of the stain buildup on the patient’s teeth. The Prophy-Jet is messy, especially when cleaning anterior teeth, but it is successful in removing interproximal stain and staining that is very difficult to remove in deep grooves or cracks.
I then like to go around with my hand instruments to remove the rest of plaque, biofilm, and tartar. The anterior scaler is very useful to remove interproximal stain and stain in deep grooves and cracks as well.
While I’m scaling, I like to intermittently polish with pumice in areas that are more involved and difficult to reach, maximizing the use of my instruments. I also like to use the Vera prophy angle by Young Dental or any angle that has external ridges to help enhance the use of the pumice. The external and internal ridges are there to help with interproximal and surface stains that are embedded in cracks, pits, and fracture lines. Once I’ve done this, I rinse my patient out and see if there is any residual stain left.
Most patients make the effort to turn staining around, and some patients, no matter what they do, still get staining.
I will then go back and selective polish the teeth that are still impacted by the staining with Young’s SmartSelect selective polish or Preventech’s Next coarse polish. I feel these two brands work the best for me, and the patients also like the way their teeth look and feel afterwards. I always finish with flossing or a proxy brush and then show my patient the results with a mirror. It is important to me that they are happy with the outcome, because most of the time the staining creates the patient to be self-conscious of their smile.
Some stains are not able to be removed because they are intrinsic or the stains of composite material. I will show them those areas with the mirror and have the doctor discuss options to make the appearance even better for the patient. This could be as simple as bonding, new composite, or a more involved option such as a crown or veneer. Working together with the doctor will create continuity and confidence with the patient and dentist involved.
Recare
When I have patients who are very difficult to take care of, I like to assess their needs and their recare appointments. Do they come regularly every six months, or do they come once a year or even more erratic with their dental appointments.
This is my first conversation with them, establishing a recare schedule tailored to the patients’ needs, making sure they are comfortable and understand the reasoning behind why I’m recommending it. I like to recommended three to four month recare for patients with heavy stain. My reasoning for this is because it is more manageable to maintain a cleaner mouth this way for both the patient and me, and it helps to be able to see their progress, which will ultimately help improve their overall health. I explain insurance coverage, cost, and then we move on to home care.
Home Care
Brushing twice a day, flossing once, using a mouth wash, and a tongue scraper are my usual recommendations for patients. The tongue scraper is more for stain patients because I feel like they usually have bacteria present showing white or brown on their tongue during the appointment.
The flossing recommendation is also tailored to the patients’ individual needs as well. They may need a proxy brush or oral irrigator. I also recommend using baking soda-based toothpaste to help neutralize pH, or making their own paste for patients who are interested. The home remedy is usually baking soda, coconut oil, and essential oil (mint, cinnamon, or orange) mixed to make a toothpaste consistency and then swishing with hydrogen peroxide once or twice a week to help minimize stain buildup.
The last thing I recommend is an electric toothbrush. I don’t recommend this to everyone, though, because some patients are not able to not move the toothbrush with the correct motion. I have many patients who struggle with leaving the toothbrush in the right area for the allotted time.
I also recommend drinking coffee or wine through a straw to help minimize, or drinking water afterwards, to help remove the staining agents from the mouth. Patient compliance is all dependent on how much the stain bothers their teeth.
Most patients make the effort to turn staining around, and some patients, no matter what they do, still get staining. I do the best I can to assist them with their needs, and that’s all you can do. Most of my patients do come every three to four months, and we offer smoking cessation to patients who need it as well. This tobacco cessation tool is great for patients who are ready to take this step with their overall health. Patients usually appreciate the time, knowledge and perseverance to help them understand the need to make a change. It is very rewarding when you see a huge difference and they love the positive reinforcement and recognition of their hard work! It definitely makes my day as well, to see that I’ve impacted someone’s life and see the results too!
Go out there and tailor your appointments, and let me know if it’s helped make a difference in your day!
Katie Melko, RDH, MSDH, is a public health hygienist at Community Health Center Inc. She graduated from Fones School of Dental Hygiene at the University of Bridgeport in 2016 with an MSDH. She has practiced dental hygiene since 2009. Several products mentioned in this article are produced by Young Dental, where she has previously worked as a clinical representative.
