Out of the mouth of babes...

Two weeks ago I was an "expert guest" in my son's third grade classroom. I talked about oral health.. anything a third grader needs to know like: what plaque is, a really gross picture of plaque, how cavities start, how each tooth in our mouth is a little different because it does a different job (incisors tear and molars grind), I talked about mouthguards for sports, juices, sodas, sports drinks... anything any other good dental professional would talk about. I also got a little myofunctional therapy worked in- where your tongue sits in good resting posture, not to suck your thumb and to sleep on your back. I just received some really great thank you cards and would like to share them with you. p.s. I spelled things just as they did, it is part of the charm and innocence of children.

Thank you for coming Miss Sewell.
I learned that you should see your dentist one time every six months. I also learned that you should brush your theeth for two minuts. Thank you for taking time and making shour that we understand. Thank you for your time.
B

Thank you for speaking to us Josey. You taught us remarkably. That cavitys can be wicked enough to get you dentures or fillings. You're a splendid teacher. Thanks again.
Your Friend,
M

Dear Josalyn Sewell,
Thank you for helping. I learned alot about teeth. You tought me a lot. You are the best at explaining things. Thank you for all that you tought me.
Sensely,
S

Dear Ms. Sewell,
Thank you for coming on Tuesday I really learned a lot about teeath and Ethan's brian. (I also talked about the difference between a typical child's brain and an autistic child's brain. My son has autism) It was really amazing to know what a root canal is cased by. I hope that I can learn a lot more when you come again. Thank you again for your time,
O

Josalyn Sewell,
Thank you for your time. I learned that if you didn't brush your teeth it could kill you. I also learned that if your teeth were roten long anuf you can get gingivitis. I thank you for talking to us on Tuesday. Thank you for teaching us these things.
X

Dear Ms. Josalyn Sewell,
Thank you for teaching us about teeth and how Ethan's brain is difrent than ours. I learned that our teeth are very important. We need our teeth to eat. I learned alot about caring for my teeth. To brush my teeth I brush in big circles for two min evry twice a day. I also floss. You taught us well about the teeth and the brain. I like the way you teach. You make it easy to understand. Thank you again for your time and for coming to Mosaic Academy.
B

Dear Josalyn Sewell,
Thank you very much I learned so much I learned that if you get to much cavities you die. I also learned that your adult teeth are harder to loose than your smaller teeth. You get payed a lot of money LUCKY. I bet you do good on you job. I think I would want to be a dentist I really learned a lot.
Your friend
C

I had a good hearty belly laugh with the last one. In my defense I didn't tell them cavities would kill them. I told them that if you get an abscessed tooth and do not take care of it than the infection can go to your brain and told them the story of Deamonte Driver. Ok, I'm guilty I did use a little scare tactic here. But can you blame me?? I also did not say anything about how much I get paid. The day before they had visited the local community college dental hygiene program where salary was mentioned there (I might add it was a "little" exaggerated)

What I loved most was the letters that said I explained things well and was easy to understand. Think I can use that as a recommendation for my next speaking gig? I will be putting these in my portfolio!

Oral care for people with autism

DISCLAIMER: What I share in this post is my PERSONAL opinion and my personal experience with products etc. I DO NOT work for a company that sells any of the items listed. This is not meant to provide lots of scientific information or research and is simply what has worked for me and what I understand to be true and correct.


This post is for all of my comrades who struggle to know how to help their children with autism have healthy teeth. I am a dental hygienist and a mother to a nine-year-old boy with autism. I know first-hand how difficult it is to take care of teeth when there are struggles with sensory issues, diet issues, behavior issues, and might I also admit fatigue issues from raising a special needs child. I found this post on facebook today:  

Michelle Harvey Says
my son was diagnosed with severe autism when he was 18 months, around the same time he stopped eating, I tried everything to get him to eat, he eventually started to eat but had a very limited diet, chips, crisps and cookies!! After 6 long yrs of constant encouragement I finally have him eating various other foods, but have just been told by his dentist that he needs to have all of his top teeth and most of his bottom ones taken out!! (he will not let me brush his teeth at all, he has severe sensory issues) I am so worried about what to do, should I let the dentist do what needs to be done or not I'm worried he will stop eating afterwards, and if he stops will he ever start again!!! The dentist says he must be in pain but it's hard to know as my son is non verbal!! Was wondering if anyone else has had similar problems!!

Following this post there were 71 comments, most of them with similar frustrations, worries, and problems with daily oral care. For this reason I am writing this post directly to Michelle Harvey and all other Mom's who are faced with such a devastating problem.

This is going to be a long post, so bare with me. But if you stick it out I PROMISE it will provide you some useful tools that can help you and your child with autism.

ORAL HEALTH 101

Glossary:
Gingiva- the scientific term for gums

Gingivitis- inflammation or swelling of the gums.

Periodontal disease- gum disease that affects the gums, the bone surrounding the teeth and the connective tissue that holds the teeth in place

Caries- technical term for cavities

Plaque- the sticky stuff on your teeth. It is comprised of bacteria and bacterial byproducts.

Calculus- hard deposits on the teeth. Also known as "tartar"

ITS ALL ABOUT THE BUGS.

Maintaining oral health is all about the control of bacteria. There are over 600 different kinds of bacteria that live in the oral cavity. It is important to understand that different bacteria cause different problems. Some bacteria contribute to dental decay (cavities) while other types of bacteria contribute to periodontal disease or gum disease including gingivitis. The products and ideas I am giving you today are different ways to control, manipulate, remove, or change the bacteria in the mouth.

In order to understand what our goal is and to understand what the disease stages are we are first going to look at a healthy mouth.

This is an example of healthy gums. You will notice they are pink, there are sharp edges pointing in between the teeth and if you look closely you will notice the stippling, like an orange peel. This means the gums are really healthy.

After brushing within hours the bacteria in the mouth will begin to grow and form communities called biofilm. Biofilm is a living, breathing community of bacteria. Believe it or not bacteria can communicate with each other and find ways to thrive. It is our job to constantly remove that biofilm. As the bacteria divide and the biofilm grows our bodies will try to fight off the invaders and we see the first stage of disease. Gingivitis- shown here.

You know how it looks when you get a splinter or any other type of skin injury? The area turns red and gets swollen. The same thing happens with your gums. Notice the color difference in this picture. See how it is more red in between the teeth and the gums look "puffy" and not uniform. This is how gingivitis looks. Most kids have gingivitis to some extent, kids with autism almost always have more gingivitis than their typical peers because they have an especially difficult time with brushing. As you know for yourself, brushing includes a lot of sensory information: taste, texture, smells etc. Gingivitis can cause the gums to be more sensitive and it can be painful when brushing. Bloody toothbrushes ARE NOT NORMAL. This means gingivitis is present.

If gingivitis is not resolved it can lead to periodontal disease or gum disease. This is what it looks like:

Notice how the teeth look "long"? The supporting bone and connective tissue has been destroyed. My entire education examined exactly how this happens, and why. I could go on for hours explaining the process but for our purpose I only need to say it was a combination of the bacteria present in the mouth and the host-response- meaning how the body responded to the bacteria. Once the bone has been lost it CANNOT be restored. The disease can be maintained, but it is a life-long condition that needs to be maintained with the care of a good dental team. Left untreated it can lead to toothloss. Unfortunately many people have periodontal disease and never feel pain or discomfort. It is a silent disease.

Cavities are the result of acidic attacks on the teeth. Your mouth maintains a normal, healthy pH. Sugary foods and carbohydrates are a favorite of bacteria. They digest the food producing acid which eventually breaks down tooth structure and causes cavities. Once a cavity has broken through the enamel it has to be surgically fixed (getting a filling). If it has not broken through the enamel there is a chance to fix it with a remineralization paste (see below).

HOW IMPORTANT ARE BABY TEETH.... REALLY?

Baby teeth fall out, so why should you drain your emotional tank fighting with your child to protect them, why should you spend money restoring them, and if they do come out why should you use a space maintainer?

Although it can be emotionally draining, and physically trying you should do your best to protect the health of baby teeth for several reasons.
1. It takes a very, very long time to teach children with autism habits and routines. The time you invest now will help your child understand the reality and importance of daily oral care.

2. The bacteria that infect baby teeth can infect adult teeth and may lead to cavities in adult teeth before the tooth is completely erupted.

3. Baby teeth hold the place for permanent teeth. If a baby tooth is lost prematurely it can keep a permanent tooth from erupting in the right place which may lead to crowded teeth, misaligned teeth and eventually a need for braces. Yeah, right like my child will EVER wear braces. Talk about a nightmare- an autistic child in braces. High functioning kids will be ok, but not for those who have more severly affected kids like mine. I love straight teeth but straight teeth is not the goal here. I am talking about teeth and jaws that function and are stable and are easy to clean and sometimes braces are needed to provide this.

4. If you know your child has a cavity and you are considering just let it go, read carefully to this. The make-up of a baby tooth is different than a permanent tooth. The enamel is thinner and therefore things can go really bad with a baby tooth really quickly. If it needs to be fixed, fix it. Don't wait- it can lead to pain and extractions or root canal treatment faster than a permanent tooth. There is an exception to this rule. If the Dentist can see on an x-ray and based on the child's age that the tooth will be falling out soon than decay can be left alone. Just do your best to keep it clean. Find a good dental home and trust their judgement.

5. If left untreated decay can lead to an abcessed tooth. Keep in mind the infection can enter the bloodstream and travel to the brain. A young boy named DeMonte Driver was killed by an abscessed tooth when the infection went to his brain. So tragic.

6. Unfortunately, sometimes teeth have to be extracted. In Michelle's case there may be too many teeth involved that cannot be fixed and it may be a potential for greater health problems if left untreated. And sometimes if the tooth is too far gone there is not anything to restore as with a root canal or a crown. Depending on the number of teeth extracted there may not even be a reason for a space maintainer. I have three cousins who have had all of their upper front teeth extracted, and despite a large space left open for a long time the permanent teeth erupted in the proper place.

TELL ME WHAT TO DO ALREADY!

Unfortunately there is not a magic rinse or toothpaste that replaces the need for brushing and flossing. It simply needs to be done every single day twice a day. It is critical to mechanically remove the plaque and bacteria that form on the teeth and gums. Here is a look at some different brushes.

Spin brushes are inexpensive and make brushing fun. Some kids with autism really, really like the vibration.

If you find that a power brush is the ticket you might consider investing in something like the Phillips Sonicare for kids. It is rechargeable, and you simply replace the head. I personally love the Sonicare and my son does too. I would not go out and purchase the more expensive brush like this without trying the cheaper version first though.

There are children that HATE the bristles on a toothbrush. I have found this Banana Brush to be the best way to introduce a toothbrush and usually leads to a regular brush. It is made of silicone (I think) and feels soft and a little squishy. Almost like the chew toys that kids use for oral stimulation. The bristles are not bristles and are made of the soft material and provide a great gateway to a regular brush.

If you simply cannot use any type of brush try using a washcloth. Anything that can remove the plaque will be better than simply not doing anything.

I DO NOT RECOMMEND TOOTHETTES! They are simply too flimsy and do not do a good job of removing anything. They only reason to use this would be to help your child let you put something in their mouth, but if you think they will want you to always use the same "tool" then do not even bother.


XYLITOL, XYLITOL, XYLITOL

Xylitol is a sugar alcohol that can be found in different fibrous plants and foods, like tree bark and corn. The chemical make-up of xylitol is different than regular sugar. This is really important to understand because, the bacteria love the sweetness of xylitol and will want to eat it up. Once the bacteria take in the xylitol it cannot be broken down due to the different chemical make-up and the bacteria die!! If xylitol is used on a regular basis it will prevent cavities and ear infections!!! Something that every single child with autism I know has struggled with at one time or another. Xylitol is great for diabetics as it does not cause a rise in blood sugar. Another great benefit of xylitol is that it will make the surface of the tooth really slick and the bacteria cannot stick. This will help decrease the amount of plaque AND kill the bacteria.  Xylitol can be found in toothpaste, mints, gum, mouthwash, candy etc. When shopping for xylitol products you want to be sure of two things:
1. That xylitol is one of the first three ingredients
2. That xylitol is the ONLY sweetner. If is also has sorrbitol, manitol or any other -itol's it is not pure enough.

How do I use xylitol?
Strive for 5 exposures every day. This is easier than you think. Here is how we do it in my family
1. Brush with xylitol toothpaste. We use Spry made by Xlear. You can also use the mouthwash if your child is capable
2. After breakfast-  xylitol candy or gum
3. After lunch- xylitol candy or gum
4. After dinner- xylitol candy or gum
5. Brush and/or rinse with xylitol

Here are some of my favorite xylitol products that I use personally.

This is the toothpaste my husband and I use. It is mint flavor but not overpowering. 

I LOVE the kids toothpaste. It comes in a strawberry banana flavor and is very, very mild. My son who has a difficult time with strong tastes has absolutely NO PROBLEM with this paste. Even on the days when we simply cannot brush I will put some on my finger and swipe it on his teeth. If I cannot remove the plaque at least I can try decrease how many are in his mouth available to harm his teeth and gums.

You can buy the gum in larger quantities in the small jars or in the blister pack as seen here. Several flavors to chew from. A note about xylitol gum: the flavor does not last long. But it is not supposed to. Chewing and chewing for non-nutritional reasons is not good for the jaw. They did not design it solely for that purpose it is just that the xylitol gum does not keep the flavor forever and that is ok!

The mouthwash is not overly powerful like many mouthwashes, but it does leave a really nice, fresh feeling after use. If your child cannot swish and spit you can simply dip the toothbrush (or washcloth) in the mouthwash to get it in the mouth. And unlike fluoride, it is safe to swallow. 

This is a great delivery system for infants. You can put some xylitol gel into the pacifier and the child sucks on it getting the xylitol. It is never too early to start! Safe to swallow.

This product is used for people with a dry mouth. Dry mouth can be caused by medications. A mouth low in saliva can lead to more cavities. Even my son likes this spray. I keep it in my purse and give him a few squirts after a really sugary snack if I do not have gum or mints. He loves it! 

Some of the xylitol candies. Really tasty, lots of flavors. Easy to tote container. How about using these in behavioral therapy rather than candy that promotes cavities. 

It is really easy to add xylitol to your daily life. It comes in granules like this and can be used in lots of things. Sprinkle some on top of fruit, cereal or make your own popsicles. It is much sweeter than regular sugar so use sparingly. You can bake with it too. BUT, you cannot bake with xylitol if the food needs to rise- like in breads. Just as the bacteria cannot break down the xylitol, neither can the yeast. Be careful about making juice with xylitol because in large amounts in can be a laxative. Or if you need a laxative effect, go ahead and make that picture of xylitol sweetned kool-aid!

If your child suffers from chronic ear infections, allergies, or asthma it would be highly beneficial to use a xylitol nasal spray. It works the same way in the nose, and ears as it does in the mouth. The bacteria die once they take it in and it makes the surface really slick so they cannot stick like they usually do. Use once a day. 



These are Dr. John's Herbal Lollipops. They are made with licorice root and are an orange flavor. They help prevent cavities! The recommended use is one sucker in the morning, one in the evening for ten days straight. Do this every three months to prevent cavities. It does feel a little strange to hand your child a sucker and not worry about what the damage is done, but don't worry. It PREVENTS cavities. You can purchase them at http://www.drjohns.com/?i=herballollipops. They have a plethera of xylitol flavored candies and suckers. Stock up!

PROBIOTICS

No doubt you know that probiotics are beneficial for your digestive system. Probiotics are also a really great way to improve oral health.

The product that I like best and know the most about is made by Oragenics called EvoraKids. You can find this product in natural health food locations. The bacteria used in this product is actually derived from the oral cavity rather than the gut. This is a really great way to help manipulate and control the bacteria in the mouth when removal is difficult and not enough to maintain health.

REMINERALIZTION

There is a cyclical process that happens with our teeth. It is a battle between demineralization (caused by acids in the foods we eat etc) and remineralization. If it tips too much to the demineralization then we end up with cavities. This is a product that has to be purchased through a dental office. MI Paste is a great product that most dental professionals know about and keep in the office. I recommend it all the time for sensitivity, white spots from braces etc, but it uses casein- a milk protein that a lot of kids with autism are allergic to. The product I recommend and love is made by Voco and called Remin Pro. It does not have the casein protein and instead uses xylitol which you now know is really beneficial.

It is a creamy paste and very easy to use. After brushing you simply put some on your finger or on a q-tip and swap it all over the teeth. It is not a toothpaste, and if used on a toothbrush it will make the bristles gunk up and stick together. You can use it once or twice a day. I use it at night on my son. The taste is not offensive by any means and makes me feel better after having all those snacks throughout the day and during therapy.

FRIENDLY FOODS

Some foods are better for your mouth than others. One of my mentors, Shirley Gutkowski travels all over talking to dental professionals about helping their patients improve their oral health without nagging people all day about brushing and flossing. Here is a short list of foods that research shows are beneficial for oral health

• Blueberries
• Cranberries
• Green tea
• Garlic
• Raisins
• Licorice root
• Cheese

What you drink can have a BIG effect on your oral health. There was a research study that took pieces of extracted teeth and weighed them before and after they were soaked in different kinds of popular drinks. This helped us evaluate what kind of damage different sodas, juices, etc. Here is the take away. Citric acid in any form is terrible for your teeth! The soda you need to stay away from is MOUNTAIN DEW. Do not drink it! Every time I see someone with a Mountain Dew I always want to take it from them! Weird, I know. We like soda in my family and my son loves it. We use it as a motivator for him to do things he does not want to. The smarter choice is Root Beer. In the research study I am referring to, A&W Root Beer was the best choice for soda. And better than a lot of juices too. Probably because it is made with licorice, which now you know is good for teeth!

QUANTITY VS FREQUENCY

Would you believe me if I told you it was better to drink 44oz of soda all at once than it was to sip 20oz of lemonade all day? Every time we eat or drink the pH in our mouth changes- to be more acidic which is bad for our teeth. Our mouth works diligently to fix that pH to protect our teeth. Keep in mind that the frequency of what you eat or drink is more important than the quantitiy (except for your hips- but that is not my speciality). What does this make you worry about? Yep, ABA therapy or any other type of situation where food is offered as a reward. Just keep that in mind and do the best you can to overcome the problem. Offer xylitol candies instead of skittles or whatever you use. Have your child finish their juice or soda (with a meal is best) in one sitting rather than sipping on it all day. Take what you know and make it work in your life. Knowledge is power.

If you have lasted this far, I commend you. It has taken me several hours to get this information from my brain to the page. It says a lot about you and your dedication to your child. In my next post I will offer some helpful tools for visiting the dental office.

Oral health is a critical component to overall health. Children with autism already have so much they need to overcome and they need everything working in proper order. A toothache can be detrimental to a nonverbal child. It can be so difficult to know for sure what is wrong and whether or not your child is in pain. I know that it can be difficult and I hope with all of my heart that this information will be beneficial for you. After reading Michelle's post there was a fire inside me that could not be quenched until I accomplished something to get the word out. There are ways other than simply brushing and flossing to keep your child's mouth healthy.

From one mama to another I hope you know how much my heart aches for those of you struggling to do what is best for your child. My son just had his first cavity. I was pretty proud that he made it to 9 without any cavities. We had to go to the hospital to have him sedated with general anesthesia. Even as a hygienist and with all the knowledge and tools I have it still happens. It was difficult for him the following days after surgery and he tried for weeks to pull his stainless steel crown out. Not to mention the 1,500 dollar bill from the hospital, $300. from the dentist, and $900. from the anesthesia docs even after my insurance kicked in, and I have good insurance. All for one stainless steel crown, 4 sealants and some x-rays. That is too much for families, especially with the costs of behavior therapy, speech therapy, occupational therapy and every other therapy these kids need. It does not have to be another difficult challenge associated with autism as long as you are armed with information. I hope this helps, I pray this helps for you and for your special little child.

Lots of dental love from a Mama that cares.

For the love of dental hygiene

I have patients ask me all the time, "Do you actually like your job? I think it has got to be really gross." Well, yes most of us do actually like what we do. So to all of you who are patients and think our job as a dental hygienist is gross, let me clue you in.

For me when I look in your mouth it is not a matter of just "clean" or "dirty". When I see what you might consider "dirty" or "gross" those are not the words that cross my mind. To me I do not see clean or dirty, I see health and disease. When I see disease I know that my skills and expertise can help take your mouth from a disease state to health- with your help. Don't get me wrong- we absolutely see things that are "gross", like cheetos or oreos in every crevice of a child's mouth. But when that little guy sits in my chair with orange colored teeth, I don't gross out- I think his mother must have it out for me, because who in the world feeds their child oreos or cheetos right before a dental appointment? Someone with a vendetta against a hygienist I'm sure. For those of you who get embarrassed in the dental chair or who avoid going because you are worried we will think you are "gross" take this hygienists assurance we see you as an individual with a brain, and a heart and needs and dreams. When we see plaque and tarter we don't ever think, "eww" we think "I can help".


For those of you who decided to become a nurse instead of a dental hygienist (I've met several) because you think the mouth is oh so "yucky", I am pretty sure saliva and plaque cannot hold a candle to the grossness of puke and feces, just sayin.....

Happy Sunday.

Parable of the Dishwasher

When I started this blog I decided it would contain professional content only. I realize now that my failure as a blogger is that I have limited myself by not wanting to write about what I am truly passionate about and that is people... particularly my people. My husband, my children, my patients (as long as they agree), and the many people I work with. I have decided that I am going to let down a few of my walls and I am going to write about what I learn in my personal life as well as my professional life. I hope this is going to be what I have been needing in order to truly enjoy blogging... and gain more than three followers.

The Parable of the Dishwasher

For months my dishwasher has been on the fritz. I have read a lot about dishwashers and and how to troubleshoot one that is not fulfilling its divine potential to keep my dishes clean and shiny. Despite my efforts it was doing everything but keeping my dishes clean and shiny. Food would still be stuck on the dishes, I had to pre-wash everything so much that I could have returned it to the cabinet but was having a hard time truly coming to terms that the dishwasher was not working and kept insisting that it would do better this time trying a new combination of settings only to have to re-wash again to get the dried food and hard water stains removed. I have never lived without a dishwasher, from the time I was a little girl there was always a dishwasher in our kitchen. How can anybody live without one? The thought of having to soak the dishes in a sink of hot soapy water, washing everything one by one, rinsing it, drying it and then being left with the DISGUSTING brown water that the dishes were washed in and having to reach down amid the gunk and pull the plug was barbaric in my mind. Something only savages would be okay with.

My husband spent several hours performing dishwasher CPR only to finally give me the news that there was no hope, it had flat lined and it was time for me to let go. I even tried to just use the bottom rack a couple of times hoping to hand wash only half of the dirty dishes. I had to come to terms with the death of the appliance I have come to rely on day after day after day. Just buy a new one! Nope, not until we get our tax return.

So I am stuck hand washing my dishes for the next several weeks. I could have never imagined what happened next. Getting my dishes ready to soak my 22 month old daughter came up and said "wash!" and so I pulled up a kitchen chair next to me, turned the faucet on just enough to trickle and handed her a sponge. Her job was to rinse- which meant playing in the water and moving the dishes in the sink around until I rinsed them and put them up to dry. This kept her happy and busy for 20 minutes- which is a monumental task for a toddler. Day #2 she finds me at the sink and comes running across the kitchen yelling, "Mama! Wash! Pease!" I pull up her chair thinking the duration will not hold like it did the first time and was so surprised that she stayed until the dishes were done. It is now five days into our life without a dishwasher and day after day she stands next to me on that kitchen chair to help Mama wash dishes. We make it fun. After I was the dish I hand it to her and say, "blue bowl" or "green plate" or whatever it is and she says, "yeah! Blue bowl. Thanks Mama!". We dance and we sing songs and everyday we leave the dry dishes out on the towel to brag to Daddy at night how many dishes we washed by hand. I would have never guessed a mundane task like washing dishes would provide such sweet moments with my baby girl. It made me wonder how much more we might be missing because we surround ourselves with gadgets and appliances and things to make our life "easier", "more fulfilling" and more gratifying. It never occurred to me that done together mundane tasks can become so special, even sacred. Now this does not mean that I will not buy a new dishwasher, because believe me I have already been shopping. But it did teach me a valuable lesson. That we need to learn to turn off the world, turn off our gadgets, hide our phones, iPads, and computers and take time to simply be together. It does not have to be planned out, it doesn't have to be on a vacation, we need to simply be in the present and be with our children and have them right next to us when we do things like pay the bills, fold the laundry, or do dishes.Ho w else will they learn if not from us?You know, house work is quite enjoyable when you have a little person splashing you with water or using the vacuum as a motorcycle to ride through the forests of her imagination. Life is beautiful, families are central to our happiness, and we need to enjoy every moment we are given. Even if it means sticking our hands in dirty brown water to pull the plug.

Orofacial Myofunctional Training Review

I cannot believe December has come and gone. I wanted to update you a little about my training in Orofacial Myofunctional Therapy. It was the most intensive four day brain workout that I have ever had. The only thing that it can compare to was the board review I went to my senior year of hygiene school. My eyes have been opened and I feel like I have been practicing blind for the last four years. I will do a series of information for you so that if you are interested in OMT (Orofacial Myofunctional Therapy) as a career you can learn more about it. More importantly so that myofunctional disorders can be recognized and proper referral given to help your patients. For now, here is a run down on what the course was like.

It was taught by Joy Moeller and Licia Paskay. There were some incredible people in my class. Several hygienists, about a handful of speech therapists, four general dentists that also did ortho in their practice, an orthodontist from El Salvador, a cranial osteopathic doctor, and Patrick McKewn from Ireland that has written several books on the Buteyko method of breathing. Needless to say, I was lucky to be part of such a dynamic group and gleaned SO MUCH information from them.

This was so different than any other experience I have ever had attending a CE course. Every single person there was forward-thinking, passionate, kind, generous, and welcoming. Nobody was there to simply gain CE to renew a license, brag about themselves, or challenge the speaker. It was this great group of professionals coming together to seek information to help patients and it made the class so enjoyable. Joy and Licia were incredible teachers. They knew the information inside-out and backwards and were still very welcoming to any comments or suggestions by the participants. We started at 8:00am and worked diligently until 5:00pm. We did enjoy an hour lunch everyday getting to know our classmates and found ourselves continuously talking about OMT. The Academy did arrange for us to have a couple of little social gatherings at local museums for appetizers and a private tour of the exhibits. It created a sense of camaraderie and a nice little break from the hours of learning.

The course was very thorough and very informative. It covered so much information. We started with a review of head and neck anatomy with detailed focus on muscles. We discussed the proper function and pathology associated with myofunctional disorders. We learned a plethora of exercises to correct myofunctional disorders, how to work with an interdisciplinary team and how to create a business as a therapist or how to incorporate the information into an existing dental practice. Joy and Licia made absolutely sure that we knew how to teach the exercise and how to do it ourselves. Upon completing the course I felt confident that I knew how to create a program to help patients with myofunctional disorders and comfortably understand the scope of practice,

The really fun part of my course- spending time with some of my new friends. I immediately hit it off with four people in the course and we spent our evenings doubled over in laughter. We even got in trouble the first evening because we were being too loud in the hotel lobby late into the evening. It was actually only 8:30pm but we were at the Tiverton House which is a hotel for UCLA medical center patients. It became the running joke of the weekend. It felt so good to laugh so hard and feel so comfortable with these people even though we just met. I imagine our whirlwind romance of the weekend will continue to be great friendships. There is just nothing like being with a group of girls yucking it up.

It was a great weekend. Now a month later, I still think about it nearly everyday. I have been on vacation much of the month and have not treated any patients yet. I have established a young boy I am going to work with first and have a little cousin with a tongue thrust that I am anxious to tackle.

Day 1: Orofacial Myology

It is 6:45am and I am in the city of Los Angelas. Today is my first day of training with the Academy of Orofacial Myofunctional Training. I am stoked. Woke up early this morning giddy with excitement to get the day rolling. I am staying with another hygienist who is taking the course. She attended my Chicago course on alternative practice and is here to broaden her horizons. I feel so honored to have been a part of that. And now we are sharing the journey together. It is amazing how things just fall into place. I will keep you up-to-date on my newest adventure. For now, happy scaling.

My temping experience

I have experienced temping, really temping for the first time in my career this summer. Not like filling in for a hygienist at your office but working at several different offices filling in while someone is sick, on vacation or whatever. I have learned a lot about different delivery systems and a lot about myself. I have developed some opinions that have previously never crossed my mind.
1. It is difficult to come into a new office, new operatory, new instruments, protocols etc. I know we can be a little fanatical about our stuff and our space- but if someone works for you- be gentle and gracious and kind and for crying out loud don't lose your mind when you cannot find an instrument that may be in the sterilizer! If you are the temp- be absolutely diligent in returning things to the proper place and avoid like the plaque your desire to want to clean out that top drawer and throw away that junk that looks like it is 15 years old. That is sure to set off a territorial hygienist and keep you from coming back. And despite the fact that maybe you find burnished calculus all the way down those 6mm pockets they have been "maintaining" for the last 12 months do not say the things you really are thinking to the pt. Like, "Ugh! If she would sharpen her instruments and include something other than 2 graceys and an H6H7 you might not be in this situation!" Just saying.
2. The assistants are worth their weight in gold. The success I have had as a temp is directly related to the assistants in every office. They have all been overwhelmingly kind and helpful and it is difficult to return to my "home" office because I am so spoiled by assistants in other offices. If you temp for an extended period of time consider leaving a thank you note and goodies and BE SURE to give credit where credit is due.
3. Sharpen your instruments! Period. I am so surprised how dull most people leave their instruments- no wonder it still takes an hour to do an easy prophy and pockets are still bleeding.
4. If you do not own a universal curette, a nevi, or a 204S- get one. I love graceys but find them a time waster for the average, easy, every 6 month prophy.
5. Accelerated hygiene is fun!! The day goes by so fast and the best bonus of all- someone else sets up and cleans up. I do not even seat the pt- I just bounce from one room to the next doing what I do best- working the crowd and removing calculus. The down side- less time for education. Particularly difficult when you need to give a little extra TLC or if someone has compromised health. The office I am currently temping for that does accelerated does a fantastic job of balancing the double booked schedule and pt needs. If you need more time you simply schedule it- I am loving it.
The beauty of temping is avoiding all the  drama, gossip, stress over production, ordering, inventory, vacation time etc, etc. I simply work when I want and don't when I don't want to. I come in, follow the schedule, clean up after myself and leave knowing I helped out, took good care of patients and have a new experience under my belt. The down side- missing out on the extended relationship with patients, feeling like a member of a team, and the uncertain schedule.

IDEAS FOR THOSE SEEKING WORK:
In large cities temping agencies are available but if your town is without a temp agency- consider starting one with you as the number 1 employee. Get a business license, learn about tax laws and market yourself. Even if temping agencies are available sometimes employers do not like to use them because they are expensive- as a temp you should be making more due to being available on short notice, helping the office out of a bind, and having to come in and learn the ropes very quickly. Temps have to be great communicators, outgoing, flexible, and willing to go out on a limb. If you do not want to compete with a large agency, or work with them pick a few offices (maybe you know the DDS or the RDH) and offer your services. Once you do it a couple of times and you are successful the word will spread. We know how hard it is to take a day off when we are scheduled out 6 months or more- hygienists will LOVE having you available in their back pocket for times when they need off. I have actually been hired by the offices I work in- even if it is just a temporary hire. So they just include me in their payroll- it is great for me but I will have several W2 forms come tax season. If I pick up any more offices I may just have to get that business license. :)

IF YOU TEMP CONSIDER...
While I have made the best of available resources in any particular office I have often thought that if temping was something I did all the time I would invest in a few things for myself.
1. Consider bringing your own instruments. I never realized how much I loved my universal explorer and my Nevi until I did not have one. I have found myself caught in a really tough spot when I am doing SRP and really, really needed a different instrument that was not available. It made me feel like I was doing a disservice to the patient because I know how much better things could have gone with the right instruments. It would even be worth having an ultrasonic tip or two- many offices are using tips that are ineffective because the ultrasonic has lost that couple of mm in the toe.
2. BRING YOUR LOUPES. If you do not wear them- bring your own goggles. Bring your own patient goggles too- unfortunately I have been in offices that do not have pt goggles available. Isn't that an OSHA violation??
3. If you need a special glove bring it. I have terrible excema on my hands that eats my skin alive- especially when I wear latex gloves. No it is not a latex allergy- it is because my hands sweat more in the latex and it is the wet to dry that causes the excema. I assumed everyone used nitrile... WRONG. Bring your own gloves if you need something special.
4. Pack a lunch, or a snack at least. I have always had a lunch break and was shocked to find out lots of hygienists just work like crazy through the day with no break to get off an hour early. The first day I went home shaking and weak because I did not prepare to go without lunch. Most offices have a fridge and snacks but what kind of guest rummages through the food and takes what they want? Not the kind of guest I want to be.
5. Some people use a special operator stool and if you have one, bring it.
You may feel like the woman who brings 5 suitcases for a weekend trip- but when it comes to patient care and your comfort who cares! By bringing your own things it also leaves out the possibility of putting something in the wrong place and setting off some overly controlling, emotional hygienist who is on vacation.

In closing- do not underestimate the power of your reputation. It will be the greatest tool you have working as a temp. If possible try to gather letters of recommendation from those you have temped for and include it in your portfolio or a package you take to offices to market your services. Be on your best behavior, deliver the best care you can and make it so that offices are begging you to stay permanently. It feels good to be wanted. If you are looking for permanent work what better way to "try out" an office to see if it is somewhere you want to be permanently. While I love the offices I am currently temping for I am not ready to commit to a steady relationship.

Good luck.