DDD and the RDH

Screen Shot 2016-01-19 at 1.47.29 PM

What is Degenerative Disc Disease?

Degenerative disc disease is not a disease per se. It is a condition to describe chronic pain caused by a disc in the spine or neck. Typical person with DDD is a healthy active person in his/her 30’s or 40’s.


What Do Discs Do?

The discs of the spine are designed to make the back and neck flexible. These discs are shock absorbers made of 2 layers that help with this flexibility. The annulus fibrosus is the outer fibrous band layer. The nucleus pulposus is the innermost layer and can be described as jelly like.

If the inner disc material comes out of its enclosed area due to damage to the annulus fibrosus it may come in contact with the nerve root extending from the spinal cord and create pain. This pain may radiate to the leg causing what is called sciatica or lumbar radiculopathy or down the arm causing cervical radiculopathy. Once a disc is damaged it cannot repair itself due to its limited blood supply.

The body, sensing less stability in the spine due to disc herniation, tries to create more stability by adding bone to the spine. These bony spurs or osteophytes can potentially impinge on the nerve roots extending from the spinal cord and cause pain.


Symptoms of DDD

The first sign of a problem with the neck or spine is stiffness. One may notice periods of severe pain that comes and goes. The pain may be felt when seated and worsening when bending and twisting. Numbness or tingling in arms and fingers and weakness in extremities caused by damage to nerve roots extending from the spine and should not be ignored as nerve damage can occur. It has been found that some alleviation of some pain symptoms may occur when walking or changing positions.


Causes and Risk Factors of DDD

There is no one reason degenerative disc disease occurs. The drying out of discs decreasing the height of the space between vertebrae is a factor as is injury. The injury that occurs could be an acute trauma, such as a car accident, or chronic trauma, such as high repetitive tasks that occur over years.

This is where the practice of dental hygiene would be considered a risk factor for disc problems. The act of providing dental hygiene services to patients is a highly repetitive act. Many hygienists favor keeping their patients comfortable rather than worrying about the effects of their posture on their health. A slight change in head tilt, just a mere 15 degrees adds 27 pounds to the head!



Since there is radiating pain from the spine the source of the pain may not be brought to physicians first. Shoulder pain may not be shoulder pain at all. The pain may be radiating from the neck. All symptoms must be accounted to physicians including pain, numbness, tingling.

Magnetic resonance imaging (MRI scan) can help to determine damage to discs and a neurologist may perform a nerve conduction study to determine nerve damage of numbness and tingling are symptoms.



Conservative therapies such as physical therapy can be helpful as well as exercise.   Alternating 30 min strengthening with low impact aerobic exercise such as walking, biking or swimming can keep the areas limber and make muscles of the back and shoulders stronger this must include stretching.

Proper body mechanics and keeping hydrated will help decrease the chance of a flare up as well. Twisting and bending from the back could cause more pain. Using arms to help raise the body from a seated position as well as using larger muscle groups such as quadriceps for bending instead of bending from the hips/back are ways to use proper ergonomics.

When the pain is severe doctors may prescribe anti-inflammatories and steroids as well as heat/cold compresses. Epidurals can be used to diminish the inflammation as well, although only work about 50% of the time.

Surgical intervention such as a fusion or a cervical disc replacement may be necessary if all conservative therapies have been tried with limited success. From personal experience, this may be an option that alleviates the pain you have had for years.


What is an RDH to do?

You are the most valuable tool of your career! You need maintenance just as your instruments do. Spending money on loupes and an ergonomically designed chair is only the beginning.

Be self-aware. What you do everyday will impact your life. Do you feel a twinge somewhere? Investigate. You may be positioning yourself, or your patient, incorrectly. Sit, stand and change positions frequently. Take a walk. Drink water.

Degenerative disc disease may not be preventable but managing is possible with the right information and a great medical team.

National Dental Hygiene Month – A Promise to my Patients

DH month

October is the month in which the dental hygienists are celebrated for their nagging efforts to make their patients healthier. After almost 2 decades in dentistry I’ve learned that my patients don’t care about cavities or whether or not they have gum disease. I’ve talked and, yes, actually nagged my patients for years to brush better or floss more or they would have to suffer through listening to the same recorded message again at the next appointment. I am done fighting with patients who don’t want to listen to me anymore. I am giving up because I care.

To celebrate National Dental Hygiene Month I’m changing the relationship I have with my current patients and will have with my future ones, by making some promises that I plan to keep. (1) I promise to tell you what’s important to you, not to me (2) I will only teach you to avoid dental diseases like cavities and gum disease if you want to learn how (Psst, here’s a secret, all dental disease is preventable and learning how to prevent it can save you thousands of dollars!) and (3) I will always tell them if their breath smells worse than a sewer…because I care.

The reason I am making these promises is because I’m tired of butting heads with my patients and them not getting healthier. Our goals have always been different. My goal is to tell them if they could have a life threatening illness and a decreased quality of life due to a bacterial infection of the gums called periodontal disease and get them to treat it. Most patients don’t care if their gums bleed because of this infection, even if they should be running to the nearest dental office if they do. What is their goal? Their goal is to get out of the office without me saying the dreaded “F” word. If they have to hear the word floss one more time they’re going to lunge at me and strangle me with the bib clips watching my face turn blue. I see it in their eyes!

For years I’ve given them information they don’t want to hear. I know bleeding gums means an infection has already invited its way in and is causing inflammation in their arteries making them sicker every day. I know that it contributes to high blood pressure, heart attacks strokes, the inability to maintain good blood sugar levels and that it even could cause premature babies. Unfortunately, they only hear this message at their dental checkups. Medical doctors have too much on their plates to discuss oral health with them and pump them with medications to control these symptoms so they can move onto their next patient. Since we are the only ones talking about how bleeding gums are bad I’m going to stop sounding like a crazy person trying to get them to understand.

I will focus on the affect of the bleeding gums on their everyday lives. Family and friends won’t tell them that their breath smells like a landfill in the middle of a summer full of 100 degree days. So it’s actually my job to tell them that the bacterial infection causing bleeding is making their gums rot causing their breath to smell like a decomposing corpse. (Yes, cadaverine is a smell caused by bacteria). For years I tiptoed around this fact and instead told them a complicated message they didn’t care about. For that, I am sorry.

If you were to visit me for your dental hygiene visit what would our new goal be? Do you want whiter and straighter teeth? Would you want to learn how to stop paying money to have cavities fixed? Do you not want to have to wear dentures like your parents did? Your goal is now mine. I will tell you what I see, feel and smell because you deserve that. I am here to get you healthier but only when you want to. Until then, I’ll be waiting.

Would you pay a fee to cut your cavity risk?


crystal ball

What if, during a dental checkup, a dentist or hygienist could predict whether or not you have a chance of getting a cavity. Would you be interested in finding out what your future may hold? Would you like to have an idea of what costs and time lay ahead for you if you continue down the road to decay?

It is possible. When visiting the dental office we can tell you if you have a chance for decay.

There are many ways to identify if fillings, or crowns, are in your future. Let’s take a look at how we make a prediction at your appointment.

We have the ability to deduce whether or not you will have future decay by looking at your past:

Past History

A mouthful of dental work indicates that at some time in your past that you had decay. Those fillings and crowns tend to breakdown and allow bacteria from your mouth to seep into the areas around the fillings. This bacteria and the acid it produces breaks down the tooth structure from the inside out. Metals fillings cannot be x-rayed through so seeping decay around fillings can only be visualized with our eyes. Grayness indicates his seepage has occurred and the filling or crown is failing.

We can predict what the future holds by looking at your present:

Recent Decay

If your dentist has found decay that has reached the inner part of the tooth and a hole is felt then you have a carious infection aka decay. The bacteria that causes infection does not just go away when the tooth is filled or fixed. The bacteria that remains has the potential to attack other areas of your mouth by producing more acid attacks thus more cavities. * Recent decay in close family members makes a patient at high risk for decay, too.

Saliva Flow

The amount of saliva you have will determine the cleanliness of your teeth. Saliva not only helps us when we chew and swallow but it has the ability to wash away food particles and buffer our saliva (see pH in next section). Many drugs that we take will diminish the flow of this miracle fluid and increase our chances of dental decay. Not enough saliva puts you at risk for more cavities.


X-rays are essential for us to see if you have incipient, or beginning, decay in areas we cannot see with our eyes. These lesions are detectible on an x-ray and show decalcification of the outer layer of the tooth, your enamel. What this means is that we can see that the enamel is not as strong but a hole has not been created yet. If changes are not made to your mouth’s environment the decalcification can turn into decay.


An acidic saliva erodes the teeth just as acid erodes other structures. Plaque bacteria creates acid. Nutrition plays a part in pH, too. A test can be done to determine your pH level.

It surprises many dental professionals that many patients refuse the diagnostic tests that could potentially save them hours of time and hundreds of dollars. The fees for x-rays, pH testing (and the nutritional counseling involved with changing pH) and home care instructions (to reduce bacterial levels) are minimal compared to the money and time needed to fix the problem.

So the question remains – can dental professionals predict a person’s chances of having cavities? The answer is yes, we do have the ability to determine if you are at risk if you allow the tests to help make that determination. Help us help you.  Is a nominal fee worth having the knowledge of what the further holds?



Toothpaste…$20 a tube? I’d rather spend it on candy!

There have been recent claims that a certain toothpaste costing $20 a tube is better at controlling plaque than the pastes that we regularly see on the shelves at our local pharmacies. It’s high price tag make people wonder if spending the money is worth it.

I have seen on social media people questioning why a toothpaste with that price point would not add fluoride to its list of ingredients.

In a study conducted in 2012 by the Center for Disease Control, 20% of children aged 5-11 having one untreated tooth with decay. Studies have shown that even since fluoride’s introduction in water and toothpastes, dental decay is still prevalent. Dental decay continues to be one of the most common diseases in children.


Isn’t it time for another idea?lollipops

Cavities are caused by acid attacks on your teeth. Reduce the acid; reduce decay. Xylitol shows promise at reducing decay. Xylitol is a natural sugar that cannot be digested by the Strep mutans bacteria in plaque. If the bacteria has no food source it cannot “poop” the acid to demineralize your teeth.

Xylitol has the ability to change an acidic pH to an alkaline one so your teeth have a chance to remineralize when they are not under the acid attack. It’s pretty awesome, too, because it comes in toothpaste, gums, candies and mints! Adding

MI paste with xylitol and you can add calcium and phosphate back into the demineralized enamel.

Fluoridated teeth cannot save you from frequent acid attacks. We need to limit our attacks by limiting what and how often we put foods and drinks into our mouths (even water can be acidic!) and allowing our teeth to rest from these attacks.

I’m not sure I would pay $20 for a tube of toothpaste but I do know I would spent $20 on a month’s worth supply of candy that help my teeth!

We all know that kids are not compliant when it comes to brushing twice a day but I know that they would use candy 5 times a day if I told them they could. Maybe this is the direction we need to go. Give kids candy (that doesn’t promote diabetes) and fight dental decay. That’s money well spent.

Average Hygienist?

I have always thought of myself as an average dental hygienist. I come to work and provide patients with care every hour of every day.

I begin by taking a blood pressure and a periodontal exam. The exam includes probe depth readings, measurement of recession, evaluation of furcation involvement and mobility. I look for signs of wear to access if there is the possibility of occlusal disease or a traumatic bite. I look for signs of sleep apnea. My oral cancer exam includes a visual exam and feeling of the tongue, lips, throat and neck. I test pH to assess whether or not the patient is at risk for decay because of acidic saliva and I also check to make sure the patient has adequate salivary flow. I review this data with my patient and then we proceed with any procedures scheduled or treatment plan new treatment with the dentist.

To me this is the average.

The more I learn from my new patients, when they say that they have never had such a thorough examination, the more I worry about what my colleagues are actually doing and why.

The “why” could be due a number of reasons. Time is the most prevalent reason. I have the luxury of a full hour with my patients. Many of my colleagues do not. Not having enough time can create an environment where something needs to be cut in order to stay on time.

I would not be able to pick one item to delete.

Data collection is important. How can we help our patients if they or we don’t know what their problems are? Not checking for abnormal lesions is not an option either. Maybe checking pH is over the top. But is it? Isn’t our profession one that is focused on prevention? This may cut into the bottom line of a practice and some are not as lucky as I to work with a dentist who would rather prevent disease than amputate a tooth. Maybe cutting out blood pressure would save me two minutes and the occasional lost appointment when I need to dismiss a patient to get them to the ER because their BP is in the stroke zone. I don’t know. This sounds kind of important to me.

I also wonder if other office’s exams aren’t as thorough because some dental hygienists work with other dental personnel who do not value the services we provide. Yes, we clean teeth but that is not the only service we provide. We have moral and ethical responsibilities to provide above average care to our patients and to use everything we have learned in school and throughout our careers to better the health of our patients.

There are times when I am not popular with other hygienists or even some of my patients who just want to polish or be polished and who want to scrape or be scraped. It hurts me when I am criticized for doing more than what is expected in their eyes.

I honestly do not think that I am an above average hygienist even when my new patients compliment us on the thoroughness of our exam. I aspire to be more than I am and my reach is high. Our patients deserve that.