NAWUGI Shikamo (NS) came to the dental clinic for the first time. Judging from her demeanour she was nervous. Her hands trembled. She happened to be healthy with no history of diabetes, blood pressure or asthma.
She sat down in the dental chair in a wrong way, with legs at the backrest end and her head on the slant of the seat. The fear in her had temporarily disorientated her. The chair side dental assistant corrected the patient’s positioning. Dental Surgeon (DS): “You are very nervous.
You need to take control of yourself. From your history this happens to be your first visit to a dentist. It is therefore understandable that you will also have questions for me. You have to let me know what has led you to come to me. Please breathe in through your nose and exhale through your mouth.
” This brought about a calming effect. The trembling of her hands ceased. DS: Tell me the reason for seeking my appointment. NS: “Doctor, it is embarrassing for me to say that there is bad smell coming out of my mouth.” The DS donned a pair of gloves and focused the beam of light into the mouth of the patient.
With a probe and mirror he carefully examined the mouth of NS. It took about four minutes to complete the dental examination. The DS looked at NS. He related the clinical dental status to her. There was a layer of tartar (also referred to as calculus) deposited around the margins of gums covering almost all the teeth.
The lower anterior teeth consisting of four incisors were crowded. The deposits of tartar were more condensed in this region. Food particles made access to the nooks and corners of the overlapped incisors. This had initially built up as a thin layer known as plaque.
This being a thin film or coating of food debris containing teeming bacteria. With constant lodgment of plaque there is a gradual build up of a solidified layer around the plaque. The soft plaque changes to a hard unyielding thickened formation that begins to press on the gums. Removal of plaque and tartar on a regular basis is the cornerstone of preserving the hygiene and cleanliness of the mouths of patients.
This procedure is known as scaling and polishing of the mouth. The deposits of tartar pressing on the gums were responsible for bleeding. The inflamed gums with bleeding had been the cause of bad breath of NS.
The DS demonstrated the functioning of the ultrasonic scaler to the NS. Simply put, it is a hand piece with a stainless steel blade at its end which vibrates at a controlled speed.
The scaler was moved around the margins of the teeth and gums to remove the deposits. DS: The gums are supposed to be clean and clear of the deposits. That is nature’s way. The margins of the gums attached to the teeth are not supposed to be blocked with tartar. Once the tartar is removed a load is lifted off the gums.
There is clearance achieved. The gums undergo a recovery. They gradually attach to the surfaces of teeth. The attachment becomes firmer with time and gums assume their normal pinkish hue. With the removal of tartar or scales from the teeth the surfaces become rough. Scaling was then followed by polishing.
A slow handpiece with a small round polishing brush was utilised. A paste with a minty taste was applied to the teeth. Polishing was carried out of all teeth in the four quadrants of the mouth. DS: How do the surfaces feel? NS: There is smoothness all around now.
It is a good and fresh feeling. How often does one have to carry out scaling and polishing of the mouth? DS: If our foods are hard and fibrous, these do not adhere to the surfaces of teeth. Items of softish consistency tend to stick to the surfaces. It has been found that patients taking recourse to hard and fibrous foods need one annual visit to the dental clinic while those with softish food eating habits need clearing and polishing two to three times in a year.
Three weeks after her scaling and polishing NS came to the dental clinic for a clinical assessment of her gums. Bleeding from the gums had stopped outright. DS: What do you have to say about the bad breath which was your original issue? NS: It has subsided considerably. I shall endeavour to have scaling and polishing carried out every 9 to 12 months.
DS: That is a good decision. Please stay motivated. A recent graduate with a dental degree but without much clinical dental experience was about to treat a lady patient whose chief complaint being: “Bad mouth”.
She had not been specific with regard to her dental ailment. He had put on his gloves but had decided to forgo the use of his mask. As his eyes viewed the mouth of the patient he saw numerous root pieces.
There was even pus exuding from some of them. With no mask on, his nose detected a horrendous smell issuing from the mouth. He yelled out “God, what halitosis!” The patient was an educated person. Unable to fathom the technical jargon she almost rebuked him, “Why don’t you use a more simpler language that a patient can understand easily?” The fresh graduate realised the folly of his remark. He quickly backtracked and stuttered out, “Madam, halitosis means bad breath.
” The patient got up from her chair, no longer willing to continue with her treatment. She looked at the graduate very sternly ultimately delivering a repartee, “At least it is better than no breath at all.
” The graduate would, with more clinical and socio psychological skills gained, acquire the diplomatic finesse in future to ward off the possibility of such a sudden disconnect with patients. The elite patient may have scored a brownie point with her retort and inflated her ego vis-à-vis the raw graduate.
However, she will have no recourse but to resort to obtaining proper dental treatment. A smelling mouth can be a social embarrassment besides making love revolting if not repulsive. Coming from high society the odour from her mouth will certainly need quelling. She will require elucidation and cooperation rather than eloquence to arrive at a normal clean mouth.
- Dr. K.S.Gupta, B.D.S., is a Dental Surgeon with Private clinical dental practice. He is also the former President of Tanzania Dental Association. Email: kgupta52@hotmail. com