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Prakash Chandran: October is National Dental Hygiene Month. The month-long campaign is targeted mostly towards children's oral health, but also works to remind adults that they need to take care of their teeth too. We're going to talk about it today with Jennifer Tuttle and Amy Ames, two dental hygienists at Ridgecrest Regional Hospital.

This is the Ridgecrest Regional Hospital podcast. My name is Prakash Chandran. So, Amy and Jennifer, thank you so much for joining us today. I truly appreciate your time. Jennifer, I wanted to direct the first question at you and ask just broadly, what does it mean to have good dental hygiene?

Jennifer Tuttle, RDH: That is a great question. So, good oral hygiene consists of several things. So, it would be seeing your dentist and your hygienist, establishing good oral hygiene routine, which would be brushing, flossing and rinsing, and just keeping that up on a regular pace.

Prakash Chandran: Okay. That makes a lot of sense. So Amy, when we talk about seeing a dental hygienist, how many times a year should you be seeing one?

Amy Ames, RDH: You should see a dental hygienist at least two times a year. That depends on the hygiene of the teeth and gums. Some patients may need to see a hygienist every three to four months.

Prakash Chandran: And Amy, just as a layperson, a dental hygienist is usually the individual that cleans your teeth before the dentist comes to inspect things. Or is a dental hygienist someone else?

Amy Ames, RDH: No. A dental hygienist is someone that does clean your teeth. Usually, the dentist will see the patient first to do a series of x-rays, exam, recommend any treatment that needs to be diagnosed, and then you see the hygienist who cleans the teeth and takes care of the gums, gives advice on maintaining that and the periodontal issues that you have.

Prakash Chandran: Okay, that makes a lot of sense. So, I want to just broadly talk about good dental hygiene. Now, like for me, I try to brush my teeth in the morning and the evening. I floss in the evening and brush in the evening as well, or at least that's what I'm telling you to appear like I actually have good dental hygiene. But I wanted to, I guess, Jennifer, ask you when we talk about that good dental hygiene, what exactly does that mean? Does that mean just brushing twice a day and flossing as well?

Jennifer Tuttle, RDH: In addition to rinsing, actually watching what you eat and drinks, so we want to try and limit the amount of sugar consumption because sugar with bacteria will cause caries or cavities.

Prakash Chandran: Now, Jennifer, when you say rinsing, what does that mean? Are we talking about like Listerine? Are we talking about Scope or something different?

Jennifer Tuttle, RDH: So for rinses, it could be any mouthwash that a patient prefers, unless a doctor or hygienist specifically gives a mouthwash that is tailored to their treatment plan.

Prakash Chandran: And, Amy, you know, I don't know if this is the case, but are all mouthwash is created equal? Like I've always heard that Listerine works better because it stings when you have it in your mouth for a long time, which means it's doing more work. What are your thoughts on that?

Amy Ames, RDH: No. All mouth washes are not created equal. Listerine doesn't do more because it stings. It only stings because it has alcohol in it. You can use any other mouthwash that you like. They make Listerine without alcohol in it. You can have some for fluoride some that have peroxide bases to them, and some can be prescription strength. So, you got a little bit of a variety there.

Prakash Chandran: Okay, that makes sense. Now, Jennifer, there are so many different types of toothbrushes out there on the market. There's kind of the soft bristle, the hard bristle, the flexible and, of course, there are all the electrical toothbrushes. How do you, as a dental hygienist view which ones are better than others? And how would you recommend selecting the right toothbrush for every individual?

Jennifer Tuttle, RDH: That's a great question. So, I feel like the type of toothbrush is really going to be a patient choice. So, once we get to know the patient, kind of figure out their routine and, based on their oral hygiene status, we can then determine whether a manual toothbrush or electric toothbrush is better for them. But it also depends on the brushing technique of that individual as well. We do tell our patients if they're using a electric toothbrush, is to not double brush. So, what that means is to not turn on the electric toothbrush and then try to brush like a manual toothbrush, like just let the electric toothbrush do its job.

Prakash Chandran: Okay. But Amy, broadly speaking, I have heard that an electric toothbrush is better than a normal toothbrush. But I'm assuming that is because with a normal toothbrush, people don't maybe get in there as much as they need to. Is that correct?

Amy Ames, RDH: Yes, there is some truth to that. An electric toothbrush does remove more plaque and it does help with not brushing so hard, so you don't have, you know, more recession on your gums. But some people, just like Jen said, they brush way too fast, they don't let it do what it's supposed to do. They don't have the right technique. I do recommend an electric toothbrush if used right. And it also depends on the style. But you can still get really good results with a manual toothbrush, also if used right.

Prakash Chandran: So, I want to talk about flossing. And Jennifer, one of my favorite comedians who has passed is Mitch Hedberg. And he had said something to the effect of, "I know how hard it is to quit smoking. It is as hard as it is to actually start flossing." And I'm sure you see that there's a lot of the population, myself included sometimes, that does not floss. Can you talk to us broadly around the importance of flossing?

Jennifer Tuttle, RDH: So, flossing is just as important as brushing. So, we like to say brush and floss, not brush or floss. So, flossing is a must. So, with flossing you could use regular string floss. There are different floss picks out there, or even a water pick. But each of these need proper technique. So if you're unsure, it's really great to ask your hygienist or even any of the assistants that work with the dentist because we would always love to show our patients how to correctly use any of these flossing items.

Prakash Chandran: And Amy, Jennifer mentioned a water pick or different types of picks. Could you talk about what those are and why they are sometimes preferred over the flossing method by some.

Amy Ames, RDH: Yeah, sure. A water pick is really good for getting in there with people that just don't have great dexterity. And also if you have braces, it really helps clean around those. It also has to be used with the right technique, of course. But it's a really good item. And then, any floss picks or floss string, any type of dental aid that can get in between the teeth to prevent that tartar calculus buildup is really going to help you out.

Prakash Chandran: So Jennifer, talking a little bit about frequency. What is best practice around how often you should be brushing your teeth?

Jennifer Tuttle, RDH: So, we should be brushing at least twice a day for two minutes. Now, depending on the patient's oral hygiene status, if they have gingivitis or if they have periodontal disease, we may increase the amount of times of brushing, but no more than four times a day because we really want to try and avoid any kind of gum recession or any abrasion to the teeth that might cause future sensitivity.

Prakash Chandran: Now, Amy, my daughter, who is three years old, asked me the other day why she needs to brush her teeth in the morning because she hasn't eaten anything during the middle of the night, she just brushed it night before. Why is it so important to brush in the morning? I didn't really have a great answer for her. I was like, "Actually, that makes a lot of sense." I will be sure to ask that on my podcast today. Amy, can you give us a better answer than the one I gave?

Amy Ames, RDH: Yeah, of course. It is always good to brush your teeth in the morning because, when you sleep, bacteria tend to multiply. Brushing in the morning, it always helps with that morning breath and that mothy taste that we sometimes get. It fights against bacteria, that they're just acidic for the enamel on your teeth.

Prakash Chandran: So, Jennifer, speaking of children, I'm sure that getting children or even young teens to develop good dental hygiene is difficult and it's something that I certainly struggle with as a parent, to get my children to have good dental hygiene. Can you talk a little bit about how you go about doing that, what that means, and any tips for parents around instilling that in their children?

Jennifer Tuttle, RDH: Oh yeah, absolutely. So with younger children, especially the little ones, really starts with the parent or the guardian of the child. So, it should start at birth with a daily routine. So with babies, we like to use like a cloth to just wipe the inside of their mouth. And once they start getting teeth, we can start using baby toothbrushes and just really make it a fun experience for the kids.

And I think it's a great idea to do a tell-show-do system with kids. So, you can try to tell the kids what you're doing and why we're doing it, and to show them to, So, you would show the child how you're doing it on yourself, and then try to do it on the child and then try to do it together. That way, it becomes a routine and they're ready to do it every day.

Prakash Chandran: Yeah, I think this is especially important because, let's face it, especially, during Halloween time, kids tend to take in things with a lot of sugar, and sugar eats away at your teeth and the importance of brushing to maintain that good hygiene really builds a good foundation for healthy teeth for the long run. Is that more or less accurate? Amy?

Amy Ames, RDH: So around Halloween, I always tell my daughter to just eat the candy all at once. Don't space it out over a little bit every day for the next couple months or whatever the case may be. I tell her, just eat what she wants, we get rid of the rest and then you brush and floss really good and resume all of those good habits. Because if people tend to space out eating sugary stuff every single day a little bit, that just adds more acidic and more germs, bacteria to get cavities.

Prakash Chandran: Well, that makes a ton of sense. But I have to be honest, that's probably the first time I've ever heard that advice. I think my daughter will be very happy to hear that. Obviously, you probably have to balance that with a tummy ache, but that does make a good amount of sense in terms of dental hygiene.

Amy Ames, RDH: Yeah.

Prakash Chandran: Another thing I wanted to ask, Jennifer, is the role of genetics. Like I've heard that some people are maybe a little bit more predisposed to cavities and things going wrong in their teeth or within their mouth. Is that true?

Jennifer Tuttle, RDH: That is absolutely true. Yes, genetics plays a huge role. And you're correct, some people are predisposed to gingivitis or periodontal disease. And so, this is why patients should be going to their dentist and hygienist regularly to establish a personalized treatment plan and to be able to continue or even establish a new oral hygiene routine that can help stop any kind of bone loss or tooth mobility or even just losing any teeth.

Prakash Chandran: Another question I wanted to ask, Amy, is I've heard about these tongue scrapers before and I've had friends growing up that scrape their tongues in addition to brushing and flossing. Is that overkill or is that something we should all be doing?

Amy Ames, RDH: Oh, it's something we should all be doing. There is so much bacteria on the surface of the tongue. It tends to hold more than we think. There is something called black hairy tongue. And I've seen it on patients and they don't brush their tongue. They just get a lot of bacteria that just hasn't sloughed off. So, you definitely want to clean your tongue, brush it with your toothbrush. A tongue scraper is wonderful for that. So yes, brush, floss, and clean your tongue.

Jennifer Tuttle, RDH: In addition to Amy's comment, I wanted to add that being able to brush your tongue and getting off that bacteria and plaque or any kind of food, I mean, it really helps you enjoy your next meal because everything is clean and you'll really be able to taste everything and have clean taste buds.

Prakash Chandran: Yeah, we all want that, for sure. So I'm starting to kind of get a picture of what good oral or dental hygiene is, and that is you're brushing at least twice a day. You're flossing either by hand or with a water pick at least once a day. You're rinsing and you're scraping your tongue on a daily basis. Is that more or less fair to say, Amy?

Amy Ames, RDH: Yes, that is absolutely correct. We want to be doing all of those things.

Prakash Chandran: Now, Jennifer, there's going to be some older adults that are listening to this and they're going to be saying to themselves, "You know what" I'm hearing all of this and I definitely have not been consistent. I'm certainly not doing everything at the frequency that everyone is talking about here." What advice would you give them for getting into good dental habits? And can you address the question whether it's too late to start?

Jennifer Tuttle, RDH: Oh, absolutely not. It is never too late to start, You know, it's never too late to start a good habit. It's never too late to start establishing a new technique of some kind or trying out new products. So, I just want the audience to know that today's a new day. So, they can start today and they can continue with it tomorrow and the next day. And then, to come in and see the dentist and figure out where they are with their prognosis of their mouth, whether it's the teeth, the gums, anything else that they might need attention to. So, it's never too late.

Prakash Chandran: Okay. That's really great to hear. So, final question for each of you. And Amy, we'll start with you. Given all of your experience as a dental hygienist, what is one thing that you know to be true that you wish more patients knew before they came in?

Amy Ames, RDH: What I would like people to know before coming into the dentist or the hygienist is that it is never too late and don't be embarrassed. We always want you to come in and see me, see Jennifer. We want you to come in. We want to help whatever situation you might be worried about. It doesn't matter how long, and just don't feel embarrassed. I love when I get to clean up a patient's mouth and then keep seeing them. It really makes me happy that their gums and their teeth are happy afterwards and healthy. So, just don't ever be embarrassed and just come in and see us.

Prakash Chandran: And Jennifer, I'll give you the last word.

Jennifer Tuttle, RDH: I would love all of our patients and our future patients to know, like don't be afraid to try new products. There's so many dental products out there and sometimes we might get overwhelmed as to what products to use. And just try it. And if you have any questions, ask your hygienist. Ask Amy or I, or even the dentist or the assistant because we may have already tried it and we can give better recommendations.

Prakash Chandran: Well, Jennifer and Amy, I think that is the perfect place to end. Thank you both so much for your time today.

Jennifer Tuttle, RDH: Thank you so much.

Amy Ames, RDH: Thank you so much.

Prakash Chandran: That was Jennifer Tuttle and Amy Ames, two dental hygienists at Ridgecrest Regional Hospital. Thanks for checking out this episode of the Ridgecrest Regional Hospital Podcast. To learn more, you can visit rrh.org. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. My name's Prakash. Thanks again for listening, and we'll talk next time.