Talk Techy to Me: Incorporating Technologies into Your Dental Hygiene

One of my favorite aspects of being a dental hygienist is learning about new technology that helps to make my day easier, helps me take care of my patients, and gives patients the desire to return to the practice. I think of technology as a team member that helps me achieve my goals for the patient and the care I deliver. Technology supports my procedure by helping me assess, diagnose, treat, educate, and implement my care plan. I want to share information about the technology that has personally changed how I care for my patients and has improved patient satisfaction and health outcomes.

As a dental hygiene educator, one of the courses I taught for 9 years was radiology. How many of you remember taking X-rays on a Dexter manakin? I don't remember loving radiology class as much as I love teaching radiology now. I remember how difficult it was, not just as a student but also as a clinician, to find all the possible pathology and bone levels that the next person could or couldn’t see. This led me to Pearl's Second Opinion® chairside, artificial intelligence (AI) technology, which has changed how I practice. Second Opinion works as simple as taking the patient’s X-ray, pulling it up on screen, and allowing the software to indicate potential areas of pathology. Second Opinion is intelligent enough to recognize natural dentition and restorations, so there is no more guessing if you caught anything incorrectly. This technology doesn't take the place of a practitioner's diagnosis, but it spots abnormalities to say, “Hey Kelly! Look over here at this!”

There are a few AI software with U.S. Food and Drug Administration (FDA) approval to detect caries, but Second Opinion is the only AI approved to also catch other common issues like subgingival calculus or overhanging restorations before we see a patient, especially for hygiene. Additionally, Second Opinion is also cleared to use with patients 12+ years of age and for bitewing & periapical X-rays. Beyond diagnosis and treatment planning, I have also found that using this software to educate patients is a way to build trust and establish the health status of hard and soft tissues. It also tells the patient that you are cutting edge by investing in the best technology for them.

Speaking of X-rays, how many of you have a Cone Beam Computed Tomography (CBCT) scanner in your practice? The CBCT scanner is also called a "cone beam scanner" by many practitioners. Typically, the doctor uses CBCT scanning to evaluate bone levels, anatomical landmarks, and potential pathology. CBCT scanners are not currently part of a typical hygiene workflow; however, I think this will change within the next 2 years. Although the CBCT does not take the place of bitewings, the device can image pathology and bone levels in a way that no other device can.

On a CBCT, the contour and height of the bone can help you tell the story to the patient about how periodontal disease and malocclusion are affecting their oral and overall health. Visualization of periapical abscesses is effortless because of the contrast in the imagery, which also helps to improve the accuracy of diagnosis to correctly recommend treatment before the patient experiences pain or more expensive procedures.

Have you ever heard the story of a person going into the emergency room with appendicitis, and the imaging they take shows a tumor that the patient would have otherwise not found?

Another benefit of taking a CBCT scan is that in the image, there is hard and soft tissue imaged from the skull and spinal column (depending on the field of exposure in the CBCT) that can show dental professionals valuable information. As with any type of radiograph, sometimes the pathology is more prominent, but what about what you aren't trained to see, such as cancer and vascular canals that may be blocked in the image? How would you even know what to look for? The good news is you don't have to be the expert.

DentalRay is a subscription-based service that sends your CBCT to a medical radiologist, interprets the radiograph, and sends you back a pathology report of all imaged structures within 48 hours. You are already taking the image on the patient, so why not take advantage of the opportunity to clear your patients of any other abnormalities. Again, this service is positioning you as the provider connecting their oral and overall health and potentially saving their life. Additionally, DentalRay assumes the liability of the interpretation, and the interpretation is also eligible for medical reimbursement. Now it becomes, "Wow, you saved my life."

One of the most significant differences I have experienced in patient communication has been utilizing my iTero Element 5D Plus 3D scanner. Regardless of the brand of 3D scanner you have in your practice, you need to use a digital scanner to educate. The scan connects the patients to their mouths in a unique way, and your patients will think you are a rockstar. When I create a digital health scan with my iTero, I can show the patient gingival inflammation, interproximal caries, cracking, wearing, occlusal wear, and many other issues. I can track these changes over time. I can press "play" on the screen and show the patient the changes in their tooth structure from 6 months ago, a year ago, or whenever I want to choose the point in time based on the images gathered in the system. Not only can they see where they are currently, but they can also see where they have been and the consequences if their teeth are not treated.

The iTero has single-handedly helped me compress time in my hygiene appointments while allowing me to leverage the information I have scanned to develop trust and answer questions they may have about their care.

Next up is clear aligners. We know about products such as Invisalign, Spark, OraFit, and OrthoFX, but we didn't learn anything in hygiene school about how clear aligners work, their materials, or how to tell patients to take care of them. I am a nerd about orthodontics. When I was 23, my dentist enrolled the team and me in 100 hours of continuing education across the United States to learn about functional orthodontics. I learned that malocclusion is a big deal. If the teeth aren't aligned, it puts them at risk for trauma, premature enamel, and tooth loss. Malocclusion is 1 of the 4 ways that we can lose our teeth: periodontal disease, caries, malocclusion, and trauma. Malocclusion is treatable and clear aligners make it so easy with advanced technology.

Here is a fun fact. Did you know that orthodontic brackets have different prescriptions built into the brackets based on the type of bracket chosen? You may not have known that, but what is important to know is that 75% of the population has some form of malocclusion. The hygienist needs to be a part of the discussion, because of tooth loss and how malocclusion affects the progression of periodontal disease. Malocclusion is linked to the function of the teeth, airways, sleep apnea, oral systemic disease, and overall health. Again, it’s a big deal.

Clear aligners are now offered in many general practices, and now that you know how important it is to assess and discuss malocclusion, you can take the next step to discuss clear aligners. Clear aligners are made of a polymer and have differing technology. It's not just about the tooth being moved over in increments. It's also about how predictable the polymers are because of the technology built into them.

The number one issue with clear aligners is patient compliance, so it is essential to reinforce and motivate patients to wear them as frequently as possible. One of the reasons why I find patients do not wear them is because they feel like the device has a bad taste or smell. Patients should not be brushing their clear aligners with a toothbrush because it causes scratching on the surface of many clear aligners on the market. Why does scratching matter? For the same reason why pitting of the aligner matters. Pitting is caused by denture cleaners and other home remedies and pitting and scratching cause biofilm adhesion to the aligner. I always get the question: "there is biofilm in my trays?" Yes. And the trays also contain other bacteria, yeast, and fungus. Dawn dishwashing soap with a toothbrush should be avoided. Some products, such as Steraligner, kill 99% of bacteria, yeast, and mold. Steraligner, which I also consider a technology, is designed to disinfect, and whiten the trays in 3 minutes while your patients brush their teeth. Much like your smartphone, once you use Steraligner, you cannot imagine life without it. Recommend it to your patients, try it yourself, and you will be hooked.

The next technology is a Piezo scaler. Yes, we love how the Cavitron busts off the calculus, and I understand the wide-eyed look and excitement when it happens. Many hygienists wonder if the Piezo is working because of its gentle nature. The Piezo removes the calculus more gently, almost disintegrating the calculus into a sand pile. What I love most about a Piezo is the patient comfort and the choice I get to have with tips. I love the Acteon’s Newtron for a lot of reasons, like the minimal water spray, the LED light built into the handpiece, an interchangeable reservoir (between water and medicament of your choice), and I have many tips choices. Piezo scalers can also be used around titanium implants because the lower vibration setting provides additional versatility. Acteon also has pure titanium Piezo tips (Implant Protect Titanium tips) that can be used around the implant to remove cement, biofilm, and calculus. As I write this, these are the only pure titanium tips on the market.

I must also include my favorite toothbrush—the Philips Sonicare Diamond Clean. I have been using Sonicare since 1994--I even have a picture of my first edition--and it provides the best predictable results for patients. Patients can change the amplitude, the brush heads include a microchip that tells them when to change their brush head, and of course, after every use, you feel like you came from the hygiene chair. Regardless of what you recommend to your patients for electronic toothbrushes, electric is better than a manual toothbrush, and the studies tell us this (regardless of manufacturer) over time that this is the case. Sonicare happens to reduce pocket depths 26x more than a manual toothbrush. Seventy percent of a patient's oral health success occurs at home. We need to help them establish a routine that works into what they are already doing at home and for them to know that the time they spend on any behavior modification is valuable. Your patients probably don’t use a flip phone anymore, so bring your patients into the era where technology makes their life easier and makes what they are already doing considerably more effective.

I would like to mention a new fluoride varnish I discovered, FluroCal. Not all fluoride varnish is created equal, and you may not have thought about your varnish for a while. In a fluoride varnish, we want what will work and what is pleasing to the patients, right? Do you know BISCO? BISCO is an adhesives company, and guess what varnish is? You guessed it! BISCO is known for its dental products and is a favorite among many dentists, including Gordon Christenson. FluroCal has many attributes: xylitol, 24-hour substantivity and release, immediate sensitivity relief, high fluoride uptake, and tri-calcium phosphate. All of the things required to check the boxes that you like in a varnish. Here is what I love. It's not sticky—it's not separated when you open it---it's not like a can of paint; you mix it with the end---its smooth and white. Patients love the subtle taste, and there are more flavors to be revealed soon. I call that technology.

Be encouraged that everything I have mentioned has helped my workflow and efficiency. I know it can seem overwhelming when we think of new products and technology and how and when to use them. Think about your why and how any of these technologies can serve your why and your patients. I encourage you to remain open to new opportunities that will benefit you and your patient by trying something different.