Hypersensitivity: A Pain in the Tubules

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. Today we'll be talking about hypersensitivity and how it affects our patients. We'll be discussing options to assure patient comfort pre, during, and post-procedure. Our guest is Sarah Eller, a registered dental hygienist who is a clinician and an adjunct clinical faculty member at Coastal Carolina Community College. I would like to mention that Sarah will be presenting a live webinar on VivaLearning.com titled Sensitivity Free, Optimal Solutions for Patient Comfort in Office and at Home. It is scheduled for Tuesday, August 30th at 7 p.m. Eastern. If you're on the West Coast, 4 p.m. Pacific. Simply visit VivaLearning.com to register. The webinar is free and you can earn live interactive CE credit. Sarah, it's a pleasure to have you on Dental Talk. Pleasure to be here, Phil. Thank you so much for having me. Yeah, so this is an interesting topic. We all have patients that have some issues with hypersensitivity. It happens after operative work. It happens after prophy, root planning, and so forth. And you as a dental hygienist certainly have a lot of knowledge and experience with that. So to begin, tell us about the different kinds of hypersensitivity that patients could be experiencing in your practice and our practices. absolutely so as a clinical practicing hygienist typically the times that i'm seeing when it comes to this hypersensitivity and what i mean by the different kinds of hypersensitivity is really just talking about different times it's triggered so there are patients who come into their appointments and they're already sharing that outside of the office they're experiencing hypersensitivity just at home with daily activity is eating drinking things then of course we have those patients that don't really realize that they have hypersensitivity we start our clinical procedures sometimes maybe that's starting to scale the tooth maybe it's only with those scalars maybe it's exacerbated through ultrasonic scalars or power instrumentation and then we have those patients as well that didn't have hypersensitivity and then now that they've had the clinical procedure done some of that has become heightened for them so those are the three areas that I really noticed that hypersensitivity in my specific patient base What would you say is the most prevalent type of hypersensitivity? Honestly, it's pretty mixed. But I would say the people who notice it the most are the people who are hypersensitive on a regular basis. So they're coming in, having that chief concern. Hey, I'm really sensitive. They're usually the ones giving you a disclaimer right away. You know, keep an eye out. for that because I am a sensitive patient. And I would say that overall, they're the most prominent, closely followed by those who maybe had scaling root planning procedures that are now experiencing that for the first time. Yeah. And some of these patients that have this chronic hypersensitivity, they're even sensitive to cold air. If they're in a climate where they go outside and they're in a warm room, I know it's summertime now for most people, but they go outside and then they get this chilly air, that could be very sensitive. That's part of that. first group that you mentioned, right? That's kind of chronically hypersensitive. Exactly. I was born and raised in the New England, Northeast, Maine, New Hampshire. So I used to see all the time, I say around ski season, my skiers particularly, hey, I'm out there and I, even when I'm covering my face, I'm just noticing my teeth are really sensitive. So huge chief complaint for that patient group. So what are some of the things you're doing chair side to make the patient more comfortable? and also to prevent hypersensitivity from compromising their care. So these patients who are coming in with this as a chief concern, we're walking through some options. You know, what are you currently doing at home? Are you using things like a desensitizing toothpaste already? I do tend to find sometimes they have contributing factors at home. For example, maybe they're using a hard bristle toothbrush. They're being very aggressive. Maybe they have some acidity in their diets that's contributing or utilizing very abrasive products. So I do tend to try to pin down what some of those factors could be. And we discussed trying to eliminate some of. those when we get into the appointment a lot of times i do find that those really hypersensitive patients tend to actually be okay with treatment most of the time because they've lived with it for so long they're already just kind of used to it happening they know to expect it so at the end of the appointments i can use certain things a lot of them do really well simply with a fluoride varnish to help desensitize them so we'll talk about the benefits of that as a desensitizer for some who have really pinpointed sensitivity that can tell me hey this upper Rite Canine is the one. I feel it there every single time. I may utilize a more in -depth, maybe a light-cured product. I really like the Amira Protect with Voco because it's super easy to use. My patients find that it lasts a really long time as well. So I'll use a product, maybe like a light cure for those really pinpointed areas. Now, if I have that patient that is sensitive in the chair during treatment, of course, this is where it can get a little more challenging because it depends what they're sensitive to. And a lot of patients can't really determine, am I experiencing gingival sensitivity? Am I experiencing dentinal sensitivity? So we spend a couple minutes just navigating that to make sure we're targeting the correct kind of sensitivity. And from there, of course, I need to be able to do some scaling. It could honestly be that they need some local anesthetic, but a lot of the time I'm able to do some things like pre -polish with an arginine-based product to get some rapid relief and then also go into utilizing things. Actually, one that I have used before is it's called Pro Fluorid L. So it's meant to be like a fluoride varnish, but a little more medicinal and it's very quickly acting. It's not a light cured product. So I'll place that on, let that dry and actually go ahead and complete scaling. And that will typically help me with those patients that I need to get through to the end of their visit. For the patients that have that procedural sensitivity before I'm sending them home, a lot of times, again, I'll kind of reassess. Sometimes a fluoride varnish is a great. for them in that, or they need something a little more intense, like a light cured product. So do you find that most of the sensitivity is related to any particular age group? And I'm asking that question because that correlates with gingival recession. As you get older, your gums recede, you have more cementum exposed. Do you find that that's the most prevalent? group that's experiencing overall general hypersensitivity versus those single teeth that you were talking about before where that product admirer protect would be excellent for exactly i would absolutely say there's a correlation there you know my older generation patients and those patients who have that more perio involvement which again we tend to typically see more progressed in those older patient bases, they're usually the ones that need to benefit from something that's a little more generalized. So what do you recommend for those patients who continue to experience hypersensitivity at home between their visits? So they went to see you, you did your thing, and they go home and they're still dealing with those chronic hypersensitive reactions. Yeah, definitely. So I'm going to recommend that they use a product in their home care routine that can help them with that. So typically I'm going to go for a really strong remineralizing paste to help block those tubules, recalcify that enamel on those root surfaces. I'm a huge fan of the Remin Pro, particularly because the smooth texture is a lot better. It's better as a dentifrice than some of the other options on the market. So my patients have a really high compliance with it because if there's anything I found in that generation as well, is they love the toothpaste that they've been using and there's a big chance that they've been using it for a really long time so it can be hard to make a transition or add an additional product into your routine so allowing them to substitute a product and that they get a really immediate benefit and feeling better from that. It makes a huge difference in how they're able to change into that product. So Remin Pro is a toothpaste or is it a topical cream that you put on the teeth? Remin Pro is a cream, but it can be utilized like a toothpaste. So for example, some of the other products out there have more abrasivity. They're a lot more meant to be used as spa applications. Remin Pro, you can put it on your brush and you can brush with it. Okay, so what do you say to a patient who's really happy with their toothpaste? For instance, I use Crest that I've had for many years, and you tell me to start using Remin Pro, and that will help me with my hypersensitivity issue, but I really love my toothpaste. So am I supposed to use this afterwards? Do I brush first with my toothpaste and then do it again? Because that's going to affect compliance, right? Nobody wants to brush twice. Exactly. Honestly, I'm a huge fan of compromise as a hygienist. If there's anything that I've learned, it's been that you have to meet people halfway a lot of the times. And then once they start to see the benefit, they'll typically help make that transition on their own. So I've had many patients like that that are like, you know, I absolutely love this toothpaste. I've used it forever. I'm not going to completely stop. A lot of times I'll say just once a day, then can you compromise? And one time a day, go ahead and use the toothpaste that you really love. You don't have to use Riemann Pro every time a day if you don't. want to. But maybe in the evening before you go to bed, I want you to go ahead and brush that Remin Pro. Spit, but don't rinse after so it has that time to really absorb into your tooth enamel. Think of it like a topical medication. And so then patients tend to come around and say, OK, like I can do that. I'm not changing a step. I'm just implementing this product at this time of day. I know I have this issue that is affecting maybe my quality of life to a small extent so that they are willing to typically make that change. Can you review for us the different scenarios? Thank you. you like to use in each scenario when i get my patient in the chair you know we kind of talked about those three buckets so that first patient who's coming in that's already telling me that chief concern of hypersensitivity but they can tolerate a hygiene appointment this is something they're living with already a lot of times i'll work on hey let's try a fluoride varnish is our first vet with them and then in their home maybe a reman pro to help supplement them at that time where they're out of the office that i can't be there to help them directly now for those patients who are under going a procedure that are like, you know, I say clinging to the ceiling of the dental office potentially. They're just anticipating the discomfort and pain. I may do an in -mirror protect or a light cured depending on what treatment I'm doing. What I really mean by that is sometimes quadrant therapy. I may do it so I can scale in that area. It is supposed to be undisturbed, but you can always touch it up after. It might give some really quick immediate relief for that patient. I also do really like proflorid L, which is a little bit like a fluoride varnish, but it's a lot more liquidy. It'll create almost like a waxy coating layer. So you can still achieve, or I should say complete the procedure you need to while that patient has that coverage to keep them comfortable during that. For those patients who, you know, they've had their procedure and then as the procedure's concluding, they're saying, okay, I'm feeling that cold water now that this area is exposed. Maybe they have a lot of calculus and SRP patient. I usually do really like to do the profluoid L on that patient. It's just a much more concentrated. They'll be a lot more comfortable on the way out. Or for those really pinpointed spot patients, the Admira Protect. And how do you locate the spot for the Admira Protect? Yep. So this is either self-reported by the patient. They're saying, OK, every time, you know, I feel something on this upper right canine, it just gives me a zing. It's like, all right, we're going to just go ahead and put it there. You can test for it if you're brave. So if you want to put your patient through that little bit of air or sometimes if you are scaling independently and you're finding, oh, that spot, they actually gave you that physical sign that they were sensitive there. If you kind of. go back a little bit, realize that, yes, this is a recurring, it wasn't a one-time thing, you can go ahead and treat that. And the Admirate Protect will stay on for a period of time and literally protect them from that sensitivity. Admirate Protect is great. They're talking two to three years, like for how long that will last for that patient. And what about the Proflorid L? Proflorid is a few months of time. So I find for my patients, it typically works between three to six months, most of them on the higher end of that scale. So now you've handled the situations where the patient was in your chair. You did your thing. They're leaving. They're hopefully comfortable. They have a lot cleaner teeth. So they get back home and then they start to experience some hypersensitivity at home. What's the prescription for that group? Absolutely. And that's where I recommend back to that home product of Reman Pro. Let's implement that in your routine. You can use it either as your toothpaste or dentifrice, or you can take a little on your finger spot tray, you know, place it up by the gingival margin in the area you're experiencing that sensitivity at night before you go to bed, let that soak on there. Even super benefit if your patient happens to have a set of custom whitening trays or trays at home, maybe an Invisalign retainer, have them apply that a little bit in the retainer and wear those. to bed super great for spa application as well as generalized use so do you give your patients some sort of instruction sheet depending on the situation they're in for home care i actually do so i have a created um i like to call it like my home care prescription so it'll have you know different products listed on them it will tell the patient what is the use of the product because i do find a lot of times patients are sent home with a product but then they forget why did i need this product or what is this product going to do for me so i will include the name of the product what the actual goal of the use of the product is for and then where they can locate it so if they can't purchase it on the office which all the remand pro is an office based product purchase, you know, I may direct them wherever that would be, but I just let them know, hey, you're going to maybe need one or two tubes of this before I see you for your next recare visit. So I would grab that on your way out and then here's your instructions and it'll walk them through as well how to apply that. And most of the dental offices sell these products at the front desk or is it part of the dental hygiene program? For the Reman Pro, that would be something that you would have some stock in the office, sell to your patient on the way out. But of course, the things like Amira Protect, Fluoride, the Pro Fluoride L, or Fluoride Varnish in general, those are all going to be something that you would administer as a treatment. Depending on them, some of them do have some reimbursement codes, so you may even be able to at least put them on the ledger and maybe get some insurance reimbursement. I'm actually a huge advocate for doing those at a zero fee. your patients because I honestly think it just creates a better patient experience. And when patients are happier, providers are happier, and it just relieves a lot of stress on us to make sure that we're able to do what we need to do. Those take-home instruction manuals are very useful for the patient because by the time they get home, put it in their bathroom, then they go in there and go like, what is this for? What did she say this was for? How do I apply this? How often do I apply it? So having those instructions, just like you're after surgery, you know, you go home and they tell you how to apply. the bandages or change the bandages, it's really helpful to the patient. So that's great that you do that. Do you have a success story that you could share with us where you've really transformed a patient who is really uncomfortable with their hypersensitivity into a very happy patient? absolutely i actually have two quick different scenarios one of them was actually almost an entire practice shift so i took over a role from a hygienist who had retired and i love to call these patients my tlc patients they all just needed a little bit of extra love very much an older population and they all had generalized hypersensitivity and they were all trained that they needed a micro microprime application a brush-on sensitivity application at every single visit so They needed a John on every single tooth at every single visit. time is money and I just don't have the time to sit there and microprime 30 teeth or 32 teeth for every single patient during my day. So this is actually when I started really diving into what can I do differently for my hypersensitive patients and I really looked into these products and for most of them I actually went into the Admiraprotect route which is the light care product because I was able to say hey I've got this amazing product for you we only have to put it on one time and then you're going to be great for two to three years and of course immediately sold i'm sure a lot of this for this patient base was psychological they were trained into it once we did that they were good to go and then i significantly had a decrease in how much time i had to spend desensitizing patients so huge time saver patients were happy the other was a periodontal therapy an srp case very severe perio where of course quadrant therapies by the end of an appointment you know the hypersensitivity absolutely through the roof where this poor gentleman had left the first time came back it was maybe one or two days later for another quadrant of therapy and just said oh my word I just can't even tell you how sensitive I am. Like I almost didn't even want to come back because I'm so sensitive now. So I said, I'm so glad you told me that. That's where we broke out the pro fluoride L, applied it to that upper quadrant that we had done the day before. So it was protected while we were working on the other quadrants because simply just the air and water in other treatment was just making that area really sensitive. So he was okay to go through the rest of treatment that day. So we just immediately started providing the therapy and then putting on the pro fluoride L. at a time. And that was able to get him through receiving the care that he needed, which otherwise I don't think he would have followed through with. Yeah, it sounds like a great practice builder. I mean, if you could take these patients and manage their treatment comfortably, knowing that they're hypersensitive, nobody wants to have their teeth manipulated with a curette or a scaler when they have that type of sensitivity, because it's just obviously spurring it on to cause more pain. You have that under control. Send them home, help them control their situation at home, and you're going to start to build a practice and have a lot of very happy patients. Great insight, Sarah. We're talking to Sarah Eller. She's a registered dental hygienist. She graduated New Hampshire Technical Institute's dental hygiene program in 2014. She's making big strides in the profession and helping a lot of patients, turning around a lot of practices into really utilizing the latest and the greatest in tools that we have and the medicaments that we have and the products that we have and techniques to manage hypersensitivity. So thank you very much, Sarah, for your time today. And we look forward to having you on future podcasts and webinars. Thank you. Thank you so much. It was a pleasure to be here. I appreciate it.