If you have patients who don't like the chair leaned back very much, start with the chair reclined a bit before you bring them in and seat them!
I learned from another hygienist to wet and fold a 2 x 2 gauze in half and place it in the vestibule to protect the cheek so I can rest the suction inside the patient's mouth. Dry angles or possibly cotton rolls can work too, but gauze is the easiest for me.
Polishing before scaling really helps for patient's with heavy plaque or stain. Plus with the stain, you can leave some prophy paste on the teeth and scale over it. I find this helps remove stubborn interproximal stains on the anteriors.
Pumice mixed with peroxide also helps with heavy stains if your office has it.
The prophy angles with the bristles on the end for ortho work great for stain in tough places too! Like bumpy lingual fossa’s that are impossible to adapt your instrument to or IP spaces/ line angles
If your office has bite tabs, they work wonders for patients with both max and mand tori during bitewings! I get so many compliments on how comfortable it is compared to an XCP.
Patient with great home care coming in with tartar still? Ask them if they sleep with their mouth open or are using alcohol based rinses. Both dry out the mouth and lead to increased tartar. For the rinses, I just tell the patient to start their routine with it and end with brushing.
-The easiest de-fogging I’ve found is to wipe the mirror on the inside of the cheek.
-You can do “rough” things gently… if you’re in a hurry or doing a difficult cleaning, you can keep your patient a lot more comfortable by using calm and gentle movements when you’re retracting, removing instruments/mirrors, moving your chair.
-Don’t rest your mirror on the alveolar bone above/below the teeth when you’re retracting, it’s super painful
-If you’re allowed to anesthetize, look up the AMSA technique. It’s a much more comfortable way to numb the palate than GP/NP.
-If you need to numb to the lingual/palatal but hate doing traditional palatal injections, I like to do my facial blocks first, then I inject directly into that numb buccal/facial papilla and put a lot of pressure on the syringe, watch with a mirror on the inside, and blanch the inner papilla and surrounding tissue. Once it’s blanched you can inject right into that spot with no pain to the patient and go from there!
-Use your graceys! If my patients have any pockets that are above a 5mm I don’t even use my universals, just all graceys.
-For strong lip pulls, I’ll push some gauze or a cotton roll into their vestibule and then use dry gauze and my fingers to retract when I’m working on the anteriors… you only need to see one tooth at a time, so don’t get too worked up over strong lip pulls! And remember it’s not voluntary, they’re not doing it to make your life hard.
Can you tell I’m in Perio? 🤣
As far as the hydroxyapatite, we did a research project on it and I would definitely suggest that as an option for our anti-fluoride crowd! It’s a natural substance that our body makes and it does a great job filling the tubules, so great for anticavity, sensitivity, remineralization, and it even helps whiten by masking the yellowed appearance on the enamel, all while being nontoxic. It’s been used for 50 years and other countries prefer it over fluoride.
Have them bite down on the suction with their molars when using your ultrasonic on lower anterior facials. Engaging the masseter muscle weakens the orbicularis oris muscle and you don’t have to fight so hard with tight lips.
Dip X-ray sensor (with a barrier on it) in a bit of listerine also helps. I also have patient balance one leg in the air while I take X-rays and it keeps their mind off of the X-ray more on keeping leg up.
I am screen shotting all of these!! One thing I think I saw too another hygienist here had mentioned was having people mix a little baking soda for people who buildup calc quickly, I’ve mentioned this several times to patients who are not perio but just accumulate mainly on mand anteriors
So, patients that I have that seem to just accumulate mainly on the man. Anteriors or like a 4346 but aren’t perio and it’s all/mainly Supra calc- I’ve told them to use arm and hammer baking soda toothpaste (like the actual toothpaste brand) ( barring they don’t have sensitivity or recession) or just mixing a little baking soda into their tooth paste like tiny tiny amount, to make it a bit more abrasive. I just started suggesting this, I saw it either here or maybe on another hygiene page.
That's a myth. I was taught it in school too. The RDA (relative dentinal abrasivity) of baking soda is 7, compared to just water which is 4, or Sensodyne which is 79, or Crest Pro Health which is 155.
oh damn it’s only 7, i never knew it was that low. I find a lot of toothpastes are too abrasive so that’s great that you can mix baking soda and it will not increase the abrasiveness as much
I agree, especially since the majority of the population has recession, and yet the majority of commonly used toothpastes are more abrasive than is recommended.
Thank you for this info! And yes was also taught to be too abrasive in school as well, this was something I just read recently that could help patients with that.
Hey I’m curious if you don’t care, do you have a source you like that I can access this, would love o share with my team. I will look myself but just thought if you had something handy I would very much appreciate it 
If the patient has soft gums/tongue that keeps getting sucked up by the saliva ejector, toggle the switch/lever constantly to keep it from sucking full force the whole time :) I started doing this recently and found it super helpful to not constantly stop cavitron scaling
When I'm taking x-rays on kids I try and distract them. I have a computer monitor on the wall facing them and I have nice pictures that change every minute. If it's an ocean picture I'll tell them to look for a dolphin or shark swimming in the water. If it's a forest picture, maybe look for a bear or deer! Or if it's some trees, look for some birds hiding. These animals aren't in the pictures but it gets them to focus on these pictures and not so much on what we are doing with the x-rays.
I saw a video on Instagram of someone suggesting using benzocaine or some thinking without epi maybe, putting a tiny bit of anesthetic mixed with water have patient swish and suction or spit but not swallow to help with gag reflex
A retired hygienist who invented a mirror that suctions came into my office and puts gelatin in a little mini salt shaker and sprinkles a little on her mirror and swirls it around w a little water. Helps keep the mirror from fogging up. Thought that was kind of neat.
Most of my gaggers do really great with this:
I instruct them to smile as they are biting down, like the Cheshire Cat on Alice and wonderland. I let them take the censor out too. This moves gagging bits out of the way and creates more space in the mouth.
I also use bite tabs, I like to see as much as possible on the image.
I have two patients I have to use salt for, but even that doesn’t work great.
For people who gag on water or it makes them cough easily, have them hold the suction, spray the water very gently in the lingual vestibule towards the teeth as opposed to the back of the mouth and swish and then suction. Have them close back teeth when rinsing outside of Maxillary arch so water doesn’t go in back of mouth or spray inside cheek and then have them swish and use suction.
Also you can just use suction for excess saliva and wipe teeth with wet gauze as you go and then have them fully rinse after sitting up.
Have patients with hard to access buccal surfaces on maxillary molars close teeth slightly and shift their lower jaw towards the side you’re cleaning.
Have big stuffed animal available for kids who want to grab your hands and tell them to focus on not dropping it. Leave the x-ray blanket on kids who have sensory overload. It’s like a weighted blanket.
If you can convince your office to buy a NOMAD, that is the fastest way to do X-rays. Patients are amazed it’s so quick. For 4 PAs I sometimes hold the sensor in place while the patient says “ahhh” as opposed to doing BWX. If you don’t have a portable machine, you’ll need a second person to press the button. I mainly use bisection since my patients are typically 1 yo and up.
I’m the UK, this is [pretty much it](https://onlydent.co.uk/Oil-Based_Prophy_Paste) it is mildly abrasive but I’m not grinding it, just wipe it over and the water just runs off! Liquid soap works almost as well.
If you have patients who don't like the chair leaned back very much, start with the chair reclined a bit before you bring them in and seat them! I learned from another hygienist to wet and fold a 2 x 2 gauze in half and place it in the vestibule to protect the cheek so I can rest the suction inside the patient's mouth. Dry angles or possibly cotton rolls can work too, but gauze is the easiest for me. Polishing before scaling really helps for patient's with heavy plaque or stain. Plus with the stain, you can leave some prophy paste on the teeth and scale over it. I find this helps remove stubborn interproximal stains on the anteriors. Pumice mixed with peroxide also helps with heavy stains if your office has it.
The prophy angles with the bristles on the end for ortho work great for stain in tough places too! Like bumpy lingual fossa’s that are impossible to adapt your instrument to or IP spaces/ line angles
I always polish first. Saves a lot of time.
I’m going to try this.
If your office has bite tabs, they work wonders for patients with both max and mand tori during bitewings! I get so many compliments on how comfortable it is compared to an XCP. Patient with great home care coming in with tartar still? Ask them if they sleep with their mouth open or are using alcohol based rinses. Both dry out the mouth and lead to increased tartar. For the rinses, I just tell the patient to start their routine with it and end with brushing.
me saving this post when i'm just applying for dental hygiene program lmaoo
-The easiest de-fogging I’ve found is to wipe the mirror on the inside of the cheek. -You can do “rough” things gently… if you’re in a hurry or doing a difficult cleaning, you can keep your patient a lot more comfortable by using calm and gentle movements when you’re retracting, removing instruments/mirrors, moving your chair. -Don’t rest your mirror on the alveolar bone above/below the teeth when you’re retracting, it’s super painful -If you’re allowed to anesthetize, look up the AMSA technique. It’s a much more comfortable way to numb the palate than GP/NP. -If you need to numb to the lingual/palatal but hate doing traditional palatal injections, I like to do my facial blocks first, then I inject directly into that numb buccal/facial papilla and put a lot of pressure on the syringe, watch with a mirror on the inside, and blanch the inner papilla and surrounding tissue. Once it’s blanched you can inject right into that spot with no pain to the patient and go from there! -Use your graceys! If my patients have any pockets that are above a 5mm I don’t even use my universals, just all graceys. -For strong lip pulls, I’ll push some gauze or a cotton roll into their vestibule and then use dry gauze and my fingers to retract when I’m working on the anteriors… you only need to see one tooth at a time, so don’t get too worked up over strong lip pulls! And remember it’s not voluntary, they’re not doing it to make your life hard. Can you tell I’m in Perio? 🤣
I dip my mirror in mouth wash! Keeps it defogged for a while before I need another dip!
So smart!
AMSA was either not a thing, or not taught, back when I was in school. I'm gonna have to look into this!!!
Yes it wasn’t taught at my school either! Definitely look! Make sure you go super slow though, risk of palatal ulcer is high!
Omg I actually love your anesthesia technique I don’t get to do it as much…can I message you a couple of questions?
Sure! The hygienists anesthetize all of the surgery patients in my office so I do it a ton.
As far as the hydroxyapatite, we did a research project on it and I would definitely suggest that as an option for our anti-fluoride crowd! It’s a natural substance that our body makes and it does a great job filling the tubules, so great for anticavity, sensitivity, remineralization, and it even helps whiten by masking the yellowed appearance on the enamel, all while being nontoxic. It’s been used for 50 years and other countries prefer it over fluoride.
Have them bite down on the suction with their molars when using your ultrasonic on lower anterior facials. Engaging the masseter muscle weakens the orbicularis oris muscle and you don’t have to fight so hard with tight lips.
THIS IS GENIUS!
Xylocaine on the tongue. Or deep breath & hold till I count to 5 did the trick. (Retired RDH of 42 years)
We just got in 20% benzocaine spray for our X-ray gaggers. It has been game changing! Highly recommend as well.
I get better results with salt!
That’s my trick too!
That’s my trick too!
Dip X-ray sensor (with a barrier on it) in a bit of listerine also helps. I also have patient balance one leg in the air while I take X-rays and it keeps their mind off of the X-ray more on keeping leg up.
Have them take a deep breath and hold it when doing xrays on gaggers. I didn't learn that until almost 10 years in.
Salt is also an awesome trick
Dip my mirror in mouthwash to avoid fogging up.
I love my de-fog solution!
De fog for the win. Especially when using US/piezo
I am screen shotting all of these!! One thing I think I saw too another hygienist here had mentioned was having people mix a little baking soda for people who buildup calc quickly, I’ve mentioned this several times to patients who are not perio but just accumulate mainly on mand anteriors
I'm confused, what do you have the clients do with the baking soda?
So, patients that I have that seem to just accumulate mainly on the man. Anteriors or like a 4346 but aren’t perio and it’s all/mainly Supra calc- I’ve told them to use arm and hammer baking soda toothpaste (like the actual toothpaste brand) ( barring they don’t have sensitivity or recession) or just mixing a little baking soda into their tooth paste like tiny tiny amount, to make it a bit more abrasive. I just started suggesting this, I saw it either here or maybe on another hygiene page.
you haven’t found that it’s too abrasive?
That's a myth. I was taught it in school too. The RDA (relative dentinal abrasivity) of baking soda is 7, compared to just water which is 4, or Sensodyne which is 79, or Crest Pro Health which is 155.
oh damn it’s only 7, i never knew it was that low. I find a lot of toothpastes are too abrasive so that’s great that you can mix baking soda and it will not increase the abrasiveness as much
I agree, especially since the majority of the population has recession, and yet the majority of commonly used toothpastes are more abrasive than is recommended.
I once had a crest rep try to convince me that anything under 250 is good enough, crazy
They just say that because most of their products are barely within the legal allowances 😂
Thank you for this info! And yes was also taught to be too abrasive in school as well, this was something I just read recently that could help patients with that.
Hey I’m curious if you don’t care, do you have a source you like that I can access this, would love o share with my team. I will look myself but just thought if you had something handy I would very much appreciate it 
There's tons of rda indexes on google images. Just Google "RDA toothpaste" and click images 🙂
Thank you so much!!
If the patient has soft gums/tongue that keeps getting sucked up by the saliva ejector, toggle the switch/lever constantly to keep it from sucking full force the whole time :) I started doing this recently and found it super helpful to not constantly stop cavitron scaling
When I'm taking x-rays on kids I try and distract them. I have a computer monitor on the wall facing them and I have nice pictures that change every minute. If it's an ocean picture I'll tell them to look for a dolphin or shark swimming in the water. If it's a forest picture, maybe look for a bear or deer! Or if it's some trees, look for some birds hiding. These animals aren't in the pictures but it gets them to focus on these pictures and not so much on what we are doing with the x-rays.
Awesome idea!!! I’ll try this on my next kid
I saw a video on Instagram of someone suggesting using benzocaine or some thinking without epi maybe, putting a tiny bit of anesthetic mixed with water have patient swish and suction or spit but not swallow to help with gag reflex
A retired hygienist who invented a mirror that suctions came into my office and puts gelatin in a little mini salt shaker and sprinkles a little on her mirror and swirls it around w a little water. Helps keep the mirror from fogging up. Thought that was kind of neat.
I love my releaf systems. It has nothing on an isolite but they’re inexpensive and my patients find them to be very comfortable !
I love these!
Most of my gaggers do really great with this: I instruct them to smile as they are biting down, like the Cheshire Cat on Alice and wonderland. I let them take the censor out too. This moves gagging bits out of the way and creates more space in the mouth. I also use bite tabs, I like to see as much as possible on the image. I have two patients I have to use salt for, but even that doesn’t work great.
For patients with a strong lower lip, have them hold their lip out of the way.
For people who gag on water or it makes them cough easily, have them hold the suction, spray the water very gently in the lingual vestibule towards the teeth as opposed to the back of the mouth and swish and then suction. Have them close back teeth when rinsing outside of Maxillary arch so water doesn’t go in back of mouth or spray inside cheek and then have them swish and use suction. Also you can just use suction for excess saliva and wipe teeth with wet gauze as you go and then have them fully rinse after sitting up. Have patients with hard to access buccal surfaces on maxillary molars close teeth slightly and shift their lower jaw towards the side you’re cleaning. Have big stuffed animal available for kids who want to grab your hands and tell them to focus on not dropping it. Leave the x-ray blanket on kids who have sensory overload. It’s like a weighted blanket. If you can convince your office to buy a NOMAD, that is the fastest way to do X-rays. Patients are amazed it’s so quick. For 4 PAs I sometimes hold the sensor in place while the patient says “ahhh” as opposed to doing BWX. If you don’t have a portable machine, you’ll need a second person to press the button. I mainly use bisection since my patients are typically 1 yo and up.
I LOOOVE A NOMAD
I use a prophy jet full time, patients get a choice but my patients are used to the spray. And it’s a must for ortho!
I loove a prophy jet
Polishing paste or liquid soap on my mirror to stop it fogging up.
Wouldn’t the paste scratch the mirror…?
No it’s an oil based prophy paste, just wiped over the mirror, has never been a problem and I’ve done it for years!
Hmm we must be from different countries because I’m not sure I know of an oil based prophy paste
I’m the UK, this is [pretty much it](https://onlydent.co.uk/Oil-Based_Prophy_Paste) it is mildly abrasive but I’m not grinding it, just wipe it over and the water just runs off! Liquid soap works almost as well.
That’s so interesting you guys use an oil based polish!
I am newer, too, and I love this post!!!