Advices in dental health

Interview with Alina Bachmațchi, Dental Hygienist London

1. For how long have you worked as a hygienist and how would you describe this line of work?

I have graduated as a Dental Hygienist and Therapist from Kings College Hospital in 2014 and ever since I have worked as a Dental Hygienist in different private practices across London. Prior to that I was a dental nurse in an Oral surgery unit in a hospital in Surrey. Since 2016 I have been working in a periodontal specialist practice in West End.

As a dental hygienist you are seen as the bad guy in the dental practice, the one that likes to inflict pain, if you know what I mean. However, I think dental hygienists are very important in a dental practice. We provide instructions on how to keep your mouth and teeth healthy and clean, we do cancer screening, provide smoking and diet advice and we focus a lot on prevention of oral diseases as well as doing scaling and polishes.  We also help in treatment and maintenance of periodontitis or gum disease as is known.

2. What are the challenges in this job?

There are a lot of challenges when it comes to my job. But I would say people are the main challenge. The fear of dentists is well known and that extends to fear of hygienists. Therefore, people come to us when their problem is very advanced therefore more extensive treatment needs doing. I hear every day, several times per day : “I hate dentists (meaning hygienist included)”.

 Gum disease for one is a silent one. You only notice your gums bleeding and most of the people ignore that problem. Its only when teeth become loose that they decide to see a specialist. And that holds true for a lot of oral diseases.

A lot of what I do is in close connection to one’s habits so adjusting their behaviors and habits it’s a big challenge as well as helping them understand the importance of those changes and maintaining them long term.

3. From what I know dental hygienists are concerned more about prevention. What are the main things you tell your patients about dental health? What should we do every day to keep our teeth and gums healthy? What products (foods or drinks) should we avoid?

Yes, as previously mentioned we focus a lot on prevention of oral diseases like decay or periodontitis or other diseases. As my daily focus is periodontal disease, I focus on that. Usually when I see someone for the first time and start discussing tooth health, it begins from tooth cleaning habits. How often they clean, how they clean and what tools they use for cleaning their teeth. This brings me to your next question.

I usually advise people to use a fluoridated toothpaste 2x daily (morning and last thing at night) on a manual or electric toothbrush and interdental cleaning either with floss or interdental brushes (depending on the need) once or 2x daily. The recommended time for tooth brushing is approximately 3 minutes which is very important however the technique is a bit more important than the time spent.

You will ask me ok but what do you mean technique. Well, here it is: I advise my patients to do their interdental (in-between the teeth) cleaning first. But this can be done at the end as well. How you do the interdental cleaning? Well, if you have floss then break a piece of floss wrap the floss around both of your middle fingers and hold it in-between your thumb and index finger (both hands of course) then find the area where two teeth meet and rock the floss until the floss goes past the contact point you will feel tension and you will know when you went past the contact point. Once there, hold firmly the floss against one tooth (floss will wrap nicely around the tooth forming a C-shape) then move the floss in a vertical direction (up and down several times) against one tooth then do the same with the other tooth and you have cleaned that area. Do that on every single gap in-between the teeth. If you use interdental brushes then choose the right size (you may need more than one size as gaps are different) insert the interdental brush keep it firmly against one tooth then move it back and forth, then hold it against the other tooth move back and forth again about 5-10 times and move on every gap and you are done .

Put a pea size amount of fluoridated tooth paste on a wet toothbrush

Place the brush on the teeth @ a 45-degree angle to the gumline.

Here is where things change depending on what you use. If you use a manual toothbrush then circular movements on each tooth are recommended spending a good 5-10 seconds on each tooth. If you use an electric toothbrush again, depends on the technology in that toothbrush, but the idea is holding the brush at a slight angle to the gumline and avoid moving the brush from side to side. So, stay on each tooth again for about 5-10 seconds until you cleaned all the teeth in the mouth (remember you need to do cheek side and roof of the mouth/tongue side of the teeth).

Once you have cleaned all the teeth you spit the excess of the toothpaste and do not rinse, this way you allow the fluoride to work on your teeth.

You will ask: ‘ok, but when do you use mouth wash then?’ The short answer is at any other point in time during the day rather than the time you brush your teeth. So, lunch time or mid-way through the day etc and use them as boosters and breath-fresheners. Always select a mouth wash that is alcohol free and with fluoride. If you use any specialized mouthwashes like Peroxyl or Corsodyl same rule applies

Always do this routine in front of a mirror so that you have a more precise tooth brushing and remember never go to bed without brushing your teeth.

Now with my patients is easy as I demonstrate this in their mouths in front of a mirror making sure they know what I mean. The reason I do this is because no matter what treatment we do for them in the practice if not followed by a good routine at home we won’t be able to achieve stabilization of gum disease. But this is also important from a caries or decay point of view. Now bear in mind that I usually spend approximately 45 min – 1 hour discussing this so it is difficult to explain it all here.

But if you ever go to see a hygienist bring all your tools with you so they can show you the correct way to use them.

When it comes to products as long as the toothpaste has 1250-1450 ppm fluoride you are ok.

When it comes to diet as long as you base your food intake by the following principle you should be ok: your teeth are geared to take 4 attacks a day, that is pretty much anything you eat and drink apart from water (unflavored and still). So that is 3 main meals and one snack. Yes, sugar is bad, but from a teeth point of view frequency of food intake/sugar intake that is more important. So, remember 3 main meals and one snack. If you drink coffee, drink it with your meal and avoid sipping from it over a long period of time. This way you can prevent decay, periodontal disease; as well as maintaining and stabilizing them.

4. What are the main rules in dental hygiene that people often break? Why do you think that happens?

They don’t brush their teeth or if they do, they don’t clean in-between their teeth hardly ever. The short answer is lack of education regarding importance of a good oral hygiene regime and no information about the correct technique.

5. Do you feel that there is a need for more education regarding dental health? What ways of educating people do you find helpful?

Yes, dental education is incredibly important. I usually say start them young. Take time to teach your children how to care for their teeth. Go to the dentist regularly even if just for a checkup (that is prevention). Take your young and old children to the dental checkups with you. This way they will get used to the experience and will learn at an early stage how to keep their mouths healthy.  Dental education in school would be another way of achieving that.

Personally when I discuss with my patients their oral hygiene I start with explaining them the consequences of bad oral hygiene (caries, periodontitis). Then I demonstrate how is done correctly and sometimes I use illustrations and charts.

6. Did you have any special experiences with your patients? (maybe funny stories or something unusual)

Most of my patients and I have lots of fun, I am always told that my colleagues hear a lot of laughter from my room.

The following story is not funny but…

I saw a gentleman and I noticed a scab on the corner of one of his eyebrows. It looked a bit funny to me, so I asked him what has happened. He said he was not aware of having anything there, no pain, had no idea when it appeared. Alarm bells started to ring in my ears. So I said to him to go to his GP or even a dermatologist if that scab was still there in 3 weeks. Few months later he came and saw the professor from the practice I work at, and he said he was in shock. He did not know that hygienists look at lesions elsewhere apart from in the mouth. He told him: “your hygienist saved my life; I would have walked around with cancer and it would have just progressed more and more, and I wouldn’t have had a clue”. He listened to my advice and went to his dermatologist in NYC who told him it was a type of skin cancer it was at a very incipient stage and it only needed removal which they did there and then, and he told him he was very lucky it was spotted so early. He was so grateful to us that we saved his life. 

7. Wow, amazing experience! Good sense of observing! What can you tell us about the tooth whitening – what are the advantages and disadvantages?

Tooth whitening or bleaching is a cosmetic procedure that uses a type of acid, sometimes activated by a light, to whiten the teeth. They usually have some concentration of hydrogen peroxide in their components.

As long as the procedure is done by a dental professional it is safe. I have come across a lot of problems from whitening done in beauty salons so be aware. I have seen plenty of bad gum burns from procedures done with non-regulated products.

8. How can we prevent gum disease?

Good tooth cleaning habits is a good way to start. Gum disease is caused by the following: bad oral hygiene (so bacteria), smoking, systemic diseases (e.g. diabetes), genetic predispositions, age, stress, medication (some of them), hormonal changes (pregnancy, puberty, menopause), poor nutrition and obesity to name a few. They will generally affect the inflammatory response and or increase predisposition to onset of periodontitis.

However, there is a well known link between cardiovascular diseases and untreated periodontitis, so if you know you have gum disease make sure you get it stabilized.

9. Why is it important to visit a dental hygienist regularly?

It is important for prevention and treatment and maintenance. I think the answer to my previous questions will give you an insight as to why is important to see a hygienist regularly.

10. What do you do now, professionally speaking (tell me about the master program you are in) and what are your plans for the future?

At present I am in the final year (3rd) of an MSc degree in Dental Hygiene at University College London as well as working part time in a high-end periodontal practice.

We all have dreams and plans. I am hoping in the future to get a position to teach dental hygiene students and /or maybe continue my career academically. I suppose we shall see.