The straight and narrow – unique patient requests

straight and narrow COVID-19Emma Laing explains how the current lockdowns are creating some unique patient requests and treatment options.

The winter ‘normality’

I am writing this on the day that I was meant to be at Lapland UK with my kids.

In August my four-year old son reminded me it wasn’t long until Christmas, and persuaded me there and then into booking tickets for Lapland UK. It sounded so magical. Especially putting your tickets in the freezer before giving them to children to give the impression they came from the Arctic.

Nevertheless, we have luckily been able to move our tickets later. And, like in dentistry, everyone has become so adaptive to our new normality. When things like this and other inconveniences do not seem as much of an issue as they might have done 12 months ago.

The recent months certainly have been a time to put things in perspective.

It was surprising how much my children understand about the current situation. They completely understood why we weren’t going when I explained it was because of ‘the virus’. And hopefully the rescheduled date will go ahead.

After hearing of the second lockdown, it was such a relief to understand that dental clinics were staying open; I stood watching the news come in with bated breath. I am not sure I would have been quite so understanding were we to have to close.

It is testament to the organisation of PPE and the hard work in every practice that we are able to continue. Where I work, the team ethos has been incredibly strong, despite months of uncertainty.

An unusual enquiry

Throughout the first lockdown, my patients were contacting me on a daily basis about their treatment. One client who lives in France was insistent on having her debond in France. Mainly because the pandemic period was so long and she couldn’t get to me after reopening.

I assisted finding a Damon brace provider near to her. She had debond, fixed retainers and Essilox retainers as per my prescription.

Following this she continued to contact me saying that she had ‘cotton’ coming out of her fixed retainers. I replied that if the cotton wool rolls were caught, to use some Tepes and a good oral hygiene routine to get them out. I didn’t expect to hear further.

She insisted there was further cotton on several occasions.

Unravelling the cotton

On returning to London last week she booked in with me.

The ‘cotton’ was the unravelling of fibres within fibre-reinforced composite fixed retainers. My clinical preference is never this style of retainer. I do not feel they permit enough physiological tooth movement. And this case demonstrated the issues with cleaning them.

lockdown patient
Figure 1: Degradation of fibre-reinforced retainer

On the upper central incisors they were covering (in an incisal-gingival dimension) 5-6mms of the contact points. There was huge plaque underneath together with the fibres coming out after each Tepe insertion that was inconsistent with the oral hygiene of the patient.

The plaque and fibres looked exactly like cotton and my patient joked asking if I now saw what she meant!

The condition of the lower one was already degrading after being in situ just three to four months (Figure 1).

Figure 2: The huge upper retainer. I had removed a lot of the composite on it prior to the photograph so it was even larger than this

I changed both retainers to my wire and adhesive resin style to both our relief (Figure 2).

I appreciate this example was using very large and thick versions of this style of retainer. And I am sure many colleagues would never place something so grossly over-extended.

After subsequently researching suppliers, the best fibre reinforced retainer I could find was Dentapreg’s very thin (0.1-0.3mms) version.

This covers just 2mms of the interdental contact height. So I imagine it would permit far better oral hygiene.

Figure 3: Replacement with my preferred bond-a-braid retainer customised chairside

Catch up with last month’s Straight and narrow

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