Your Teeth and COVID

Like many industries and professions, dentistry has changed as a result of COVID. There are new recommendations and guidelines, and dental professionals are striving to ensure the safety of patients and staff as offices open back up.

So what has changed? As a patient there are many new procedures you may encounter when you go for dental treatment or for a dental cleaning. Here are some new things you may find:

Your dentist or dental office staff calls you prior to the appointment to ask you questions. These include questions about COVID-like symptoms, any new medical conditions or medications, and recent travel. You may be asked to do a "teledental" call that includes video to evaluate the problem you are having or if an appointment is needed at this time.

You are asked to wait outside or in your car prior to your appointment, or find that you are the only person in the waiting room. In the waiting room, there will no longer be any reading materials, so bring your own! 

The dental office will request you wear a mask or face covering over your nose and mouth to your appointment. How will you have your teeth worked on then? More about that in a bit.

Your temperature will be taken. A temperature of 100.4 or higher is considered a fever and you will be asked to reschedule your appointment. If you aren't feeling well, save yourself the trouble and stay home. 

You will be asked screening questions, again. A lot can actually happen in 24 to 48 hours when it comes to COVID. Depending on the area and infection rate, some dental and medical offices may require patients to have COVID testing (such as a nasal swab to test for active viral infection) prior to the appointment.

You may be asked to move about the office in a certain way. Dental offices with more than one accessible entrance and exit may ask that you enter in one door and leave through another. Offices with open bay areas may ask that you take a certain route as you walk. Often, this will be explained to you prior to your appointment.

Hygiene on Planet COVID

Once you have gotten to this point, the dentist, dental assistant, and dental hygienist, may look like people equipped to do hazmat decontamination. Starting at the top, hair coverings, goggles, face shields, masks, respirators, gloves, full lab coats, disposable gowns, and shoe coverings are being worn over traditional scrubs.

The exam or treatment room will have some new equipment, too, such as air filter units and/or new suction equipment designed to remove aerosols formed during treatment.

You will be asked to pre-rinse with a solution of hydrogen peroxide or similar type of rinse. This is when you finally remove your mask! 

You may find that your teeth are cleaned using tools different than those you are familiar with. Many dental hygienists are forgoing the use of electronic instruments, such as a cavitron, because they create aerosols that can contain the virus and take a long time to settle. Instead they are using hand scaling instruments. No worries there, your dental hygienist is a trained professional, however, it may take longer to have your teeth cleaned. 

In dentistry, infection control is done in a way that treats all patients as infectious. Because a person with COVID can be asymptomatic and still spread the virus, keeping aerosols as low as possible is considered to be safer. Likewise, your dentist may treat your small cavity with methods that don't require drilling, such as silver diamine fluoride, or interim restorative materials, that require less drilling. This may depend on what is going on in your community with regard to COVID rates of infection as well as your dental condition.

Your hygienist may not be her usual talkative self. Everyone has different personalities, but dental hygienists are known to be talkers, (if I do say so myself and may be so bold to generalize.) With all the extra equipment and new ways of working, your hygienist may not be up to conversation. 

These times are difficult, to say the least, and there is still much unknown about SARS-CoV-2, the virus that causes COVID-19. It is important that everyone follow the recommended precautions to keep each other safe. If you are nervous about going to your dental appointment and do not have an urgent or emergency dental problem, it may be better to postpone it. If you can delay your dental cleaning or treatment, make sure you are doing your daily home care of brushing with a fluoride toothpaste and flossing, and following any instructions from your dentist.  If you must or want to go for a dental appointment, make sure to ask any questions you may have about any new procedures you are asked to follow. If you are in pain or have a dental problem do not delay to call your dentist.

This blog and post are not intended to treat, diagnose, cure, or advise about any dental or medical condition. Please see your dentist or doctor for any treatment you need. Take care and be safe!

Tooth Whitening - It takes all types

Charcoal, anyone?
(photo: Y. Mikalopas)

Often a bright white smile can be obtained simply by brushing and flossing regularly, but even people with good hygiene habits can still be unhappy with the color of their teeth. Factors such as age, heredity, medications, coffee, tea or wine drinking, and habits like smoking can cause teeth to be dull or yellow looking. External stains can usually be removed during regular dental cleanings while internal stains cannot. It is important to look at the reasons why the teeth are stained or discolored, any dental conditions that may be present, cost factors, and the level of whiteness one wants to achieve. There are also several “natural” or “home” remedies that range from the practical, to the strange, to the doubtful. At the end of this post I discuss one I recently tried for myself.

Professional whitening in the dental office is perhaps the best way to get that bright “Hollywood” smile. But there are several things to consider. Staining caused by inherited conditions or some medications, will not respond even to professional treatment. In that case bonding or veneers may be needed to whiten the teeth. Existing bonding and caps or crowns will also not usually respond to whitening treatment. People with recessed gums or sensitivity may have increased tooth sensitivity after whitening treatment. 
Treatments may also take repeated visits and can be expensive.

If time and money is an issue (when isn’t it?) your dentist may suggest whitening trays. These trays, along with professional grade whitening gels can be used at home as needed and instructed. Often these products will come with a desensitizing gel to be used along with the whitening agent to decrease or eliminate sensitivity. 

Professional grade whitening strips can also be ordered through most dental offices. These strips contain a higher amount of the whitening agent than usually found in over the counter products.

For patients who are already sensitive due to gum recession or other reasons, whitening may not be appropriate at all. Let’s face it – it is better to have teeth that are not sparkling white than teeth that hurt. For others, a good place to start is with the over the counter strips while using a desensitizing toothpaste (like Sensodyne.) Strips are available that can be worn from 10 to 30 minutes for a period of days, usually about two weeks.

Another way to brighten the smile is with the use of everyday products you may already have around the house. Swishing a couple of times a week with diluted hydrogen peroxide (half water, half hydrogen peroxide) can help whiten the smile. The active ingredient in whitening agents is a form of hydrogen peroxide and at about $1.00 a bottle, this is a very cheap alternative. (The whitening effect was first noticed in patients with periodontal conditions who were asked to rinse with hydrogen peroxide as part of their therapy.) Always check with your dentist or dental hygienist first, however, to review any dental or medical conditions you may have.

Baking soda (sodium bicarbonate) is a mild abrasive which may help to remove external surface stains and can also be used a couple of times a week. Just dip your toothbrush in a little of the powder, with or without toothpaste, and gently brush the teeth. This is not recommended for people with medical conditions like high blood pressure as baking soda contains sodium.

There are a host of other whitening remedies I have read about and been asked about. Some are harmless – like applying a thin layer of Vaseline on the teeth to make them look shiny (an old technique from the modeling world.) Others are more questionable, like pastes made with fruits such as strawberries or lemons. Because fruits also contain sugar, it is not recommended that they be applied to the teeth for whitening, especially if there are any other existing dental conditions like recessed gums, bridgework, or active cavities. Sugar causes the germs that live in the mouth to grow and make acid on the teeth, which can cause cavities.

Oil pulling with coconut or other oils has also been touted as a whitening remedy and while not necessarily harmful, has its downsides. “Proper” oil pulling needs to be done for a minimum of five minutes at a time and claims that it is a substitute for brushing or flossing have not been supported by hard research. (See my post on oil pulling here: http://mydentalhygienist.blogspot.com/2014/08/oil-pulling-fab-or-fad.html )

Charcoal tablets, anyone? 

(photo: Y. Mikalopas)

Charcoal tablets which are sold in stores as an antacid are also rumored to be useful in reducing stains on teeth. I  purchased a box  for about $4 and after reading up on a couple of different methods, I opened several tablets and, using a toothbrush, applied it to my teeth. A "volunteer" I enlisted used another method and simply chewed on the tablets. While using charcoal is not harmful, it was a complete mess. The charcoal, once on the teeth, was difficult to get off the teeth as well as the gums. The stain removal benefits may be in the amount of brushing it takes to remove it!

Do you have questions about whitening techniques? What techniques have you used or heard about? I welcome your comments and questions.

Please see your medical or dental professional regarding any conditions you may have. This blog is not intended to treat or diagnose any condition.