Time magazine’s June 6, 1983 cover story called stress “The Epidemic of the Eighties,” and referred to it as our leading health problem. There can be little doubt that the situation has grown progressively worse since then.

Numerous surveys confirm that adult Americans perceive they are under much more stress today, than a decade or two ago.

Stress is one of the most talked about topics these days, with people of all ages discussing it, and more importantly, showing it. Relationship demands, health problems, traffic congestion, work deadlines-from 3 year olds to 83 year olds, there is no escaping it.

In each of our worlds, stress plays a major factor in our lives, and as dental hygienists, we are merely on the cusp of innovation, continually finding ways to help our patients deal with it and the oral manifestations resulting from it.

“Dental offices today need to recognize and address the issue of stress with their patients.”

Stress is difficult for scientists to define, because it is a highly subjective phenomenon that differs for each of us. Things that are stressful for some individuals can be pleasurable for others.1

Stress can be described as the body’s physical, emotional and mental response to a change that calls for some kind of adjustment. When you are stressed, your body responds as though you are in danger. It makes hormones that speed up your heart, make you breathe faster, and give you a burst of energy. This is called the flight or fight response. Continuous stress manifests itself in the form of:

		immune system disturbances resulting in increased susceptibility to infection

		a host of viral linked disorders, from the common cold and herpes to AIDS and certain cancers

		autoimmune diseases like rheumatoid arthritis and multiple sclerosis

In addition, stress can have direct effects on the skin (rashes, hives, atopic dermatitis), the gastrointestinal system (GERD, peptic ulcer, irritable bowel syndrome, ulcerative colitis) and can contribute to insomnia and degenerative neurological disorders like Parkinson’s disease.

In fact, it’s hard to think of any disease in which stress cannot play an aggravating role or any part of the body that is not affected. This list will undoubtedly grow as the extensive ramifications of stress are increasingly being appreciated.

Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources or needs of the worker. The concept of job stress often is confused with challenge, but they are not the same.

Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. When a challenge is met, we feel relaxed and satisfied. However, when the challenge has turned into job demands that cannot be met, relaxation has turned into exhaustion, and a sense of satisfaction has turned into feelings of stress, the stage is set for illness, injury and job failure.

Unlike stress in general, work-related stress affects men and women equally, with common causes including:

		Lack of interpersonal communication between employer and employees

		Lack of interpersonal employee relationships

Dental offices today need to recognize and address the issues of stress with their patients. As dental hygienists, we have the opportunity to positively affect our patients by establishing trust, showing sensitivity, being approachable, communicating and listening to their needs. In some cases, using sedation and anesthesia might be necessary for patients with extreme anxiety. Has your office become trained to deal with patients’ stress?

Too much stress may not only spoil your mood, it may also spoil your smile. The effects of stress can easily be seen in mouths, ranging from problems with TMJ, grinding, clenching, periodontal disease, dry mouth, caries, and cracked teeth, to name just a few (see ”Stress and Oral Health” for details).

It is very important to educate yourself and your patients on the effects of stress in their mouth and provide them with the appropriate home care tools to address those stress-related issues. There is mounting evidence that there is a strong link between stress and gum disease.

Although it is difficult to pinpoint the negative effects of stress on your gums, researchers say the studies suggest that elevated levels of the stress hormone cortisal may be involved in periodontal disease. In addition, stress may make people more lax about their oral health habits, and they may increase the use of nicotine, alcohol or drugs.4

The importance of educating each patient on the effects of stress in their mouth and providing them with the appropriate home care tools to help prevent it, will go a long way toward alleviating their oral health problems, thereby also helping to reduce their stress. By individualizing each patient’s appointment, and stressing the importance of designing a home care treatment plan they can agree to, they are much more likely to be compliant, leading to good overall oral/systemic health. Good health will result in less stress, thereby helping to break the vicious cycle.

According to a study by the National Institute for Occupational Safety and Health, 40 percent of American employees feel their job is very stressful, and 80 percent feel stress while on the job.

In a perfect world, we all need to learn stress management skills and seek healthy ways to relieve stress through exercise, balanced eating, plenty of sleep, good dental habits, meditating, breathing exercises, maintaining a positive attitude, limiting caffeine and alcohol, recognizing spiritual needs and developing alternative activities such as relaxing hobbies. That requires recognition of stress in our daily lives, its’ effects on our bodies, and the desire to take action to help relieve it.

It is our genetics that load the cannon, but our lifestyle is what lights the fuse. There are many ways to make positive changes in our lives that will help us to minimize stress. Remember: It is not what happens to us, it is what we choose to do about it that makes the difference in how our lives turn out. 

Dawn Kasper, RDH, EC, has practiced clinical dental hygiene for 28 years. She is the owner and president of Trusted Success, a Practice Management consulting business providing dental offices with team consulting and coaching, to compliance and success. Dawn is a published author, recognized speaker, and consultant. 

She has been an active member of the American Dental Hygiene Association, The American Dental Education Association, the Illinois Dental Hygiene Association and the North Suburban Dental Hygiene Association.

References available upon request. E-mail mh@advanstar.com.

Articles

Are your patients stressed? Here's how to find out.

The most effective prevention routines have both an in-operatory and at-home component. You and your patient are a team!

As dental hygienists, we have an undeniable opportunity to positively influence each of our patients’ overall oral health. Our treatment prevention protocols in-office and our recommendations for home care not only affect an individual’s oral health, but more importantly, his or her entire well-being.

In the world of dental hygiene, caries is recognized as a transmissible and infectious bacterial disease, and one that can be managed from a preventive medical perspective rather than a surgical or restorative process.¹ Most dental professionals do recognize that caries is a biological disease, but whether it progresses in patients is understood as a function of behavior. Oral hygiene habits, daily practices and patients’ routines play a large factor in whether caries is allowed to progress.

When using traditional methods of caries detection, it becomes very difficult to spot early caries with a radiograph. By the time caries are seen through this method, usually 20-30% of the enamel has eroded.¹ Learning how to locate and treat signs and symptoms of decay is an essential part of practicing a medical model of dentistry.

Essentially skipping the whole concept of treating a bacterial infection¹ and only restoring the damage created by the caries disease will not aid in improving patients’ overall oral health.

Hopefully, most clinicians are familiar with caries management by risk assessment (CAMBRA), which focuses on treating and preventing caries at an early stage, rather than waiting until it causes damage to tooth structure.² Caries risk management involves looking at the individual’s current condition and risk factors for dental caries. This includes examining the individual patient’s bacterial load, reducing the patient’s future susceptibility by using fluorides and other remineralizing agents, and exploring and improving the patient’s initiative for mechanical oral hygiene, specifically brushing and flossing.¹

The difficulty is that this risk assessment protocol-although increasing-is not widely used as part of the traditional discipline of prevention. The key to caries treatment and disease prevention is to focus on modifying and correcting the biofilm disease component and modifying oral factors to favor health.² In other words, the solution to managing caries and patient care is to perform early diagnosis, patient risk assessment, in-office treatments and then enhancement of remineralization processes1 with the aide of specific preventative products.

Having a plethora of products on the market with subtle variations and applications can add a definite layer of difficulty to managing the prevention process with the ideas of CAMBRA. It’s important to choose appropriate products that will simplify and add value to your prevention procedures, so as not to discourage protocol use in a practice.


	Creating a prevention protocol in your practice that the whole team follows ensures a consistent message to your patients.

I have found that when you have a simplified regimen, you don’t need many products to achieve successful reduction of patients’ susceptibility to caries-whether in-office or for at-home use. New solutions have been particularly helpful in my regimen as a hygienist, both for in-office sensitivity treatments, and at-home treatment for remineralization of decayed and potential problem areas.

In office, I always take the patient through a fluoride application, using a 5% sodium fluoride white varnish. If the patient complains of sensitivity or is hesitant for me to touch a specific area in the mouth, I use 3M ESPE’s Vanish™ XT Extended Contact Varnish. This product provides a site-specific, light-cured durable coating that not only creates an immediate layer of protection to relieve dentinal hypersensitivity, but acts as a barrier against demineralization from acids. Vanish XT varnish works well because it reduces dentin permeability by up to 88%, and immediately penetrates and then seals open tubules for at least six months or longer.

The American Dental Association has stated that exposed root surfaces put individuals at a greater risk for decay, but by protecting a patient with a long-term varnish, I’ve found it fully guards these at-risk surfaces. As always, using reliable products has truly given me confidence that I’m offering the patient the best treatment that can be found to halt further demineralization.

I appreciate when a varnish is simple to apply and is versatile for areas with root exposure. As a hygienist, I’ve learned varnish is particularly helpful in guarding newly cleaned surfaces following scaling and root planing. Fluoride varnish also can be used to protect the teeth of children with their 6- to 12-year molars erupting, until we’re able to use a conventional sealant. The Centers for Disease Control and Prevention has proven dental caries is the most common chronic disease of children aged 5 to 17 years.¹ This is why using reliable products for your preventive and caries management regimen is so vital. I’ve even used it on orthodontic patients to protect against further demineralization.

The author uses Vanish XT, but there are many fluoride varnishes to choose from. Above, VOCO America Inc.’s Profluorid Fluoride Varnish. For more fluoride varnishes click here.

Along with in-office treatments, offering take-home treatments to patients is absolutely vital in caries management and the overall prevention protocol we’re enforcing as hygienists.

What is intriguing about this formula is it contains an innovative tri-calcium phosphate ingredient. This product continues to deliver fluoride with daily use, and most significantly, it actually helps strengthen enamel and reverse white spot lesions.

I send patients home with anti-cavity toothpaste for use once or twice a day, as a simple replacement of their conventional toothpaste. I’ve seen more patient compliance with toothpaste versus any other homecare recommendation because it does not add complexity to patients’ home oral healthcare regimen, nor does it add an extra step, such as a rinse. It’s merely a simple switch of product, and it’s important to choose a product patients enjoy using and will last the entire time between dental appointments. This will ensure patients don’t change back to their original product before they visit the dental office again.

Since we began this program in January, our office has seen an immense reduction in decay after three month check-ups with patients using this in-office and at-home regimen.

Recognizing that caries is an infectious disease that is preventable is one of the most important steps toward improving the dental health of our patients. A large challenge that will continue to face dentistry is the fact that dental professionals don’t always take caries risk assessment seriously.¹

Dental professionals may be hesitant about implementing new preventive ideas if they will cause significant changes in the routine.³ Believing in the process is the first step toward success followed by implementing a proven and useful routine, and using high quality products that are easy to use and effective. As a dental professional, I appreciate and assume full responsibility for the opportunity to improve the oral health of children and adults in the United States, one patient at a time. 

Teddie A. Dominy, RDH, BBA, is the President-Elect of the Georgia Dental Hygienists’ Association, as well as a 3M ESPE Dental Practice Specialist in Atlanta, Ga. She consults and works part-time for Dr. Stanley Rye, also of Atlanta, Ga.

References are available upon request. E-mail mh@advanstar.com.

modernhygienist.com-2009-08-01

Are your patients stressed? Here's how to find out.

Prevention requires routine: Here's help