The Changes Over 20 Years

by Lory Laughter, RDH, BS

2014 marks my 20th year of practicing dental hygiene. Anniversaries tend to bring out our nostalgic side as we reflect on the good, not so good, and changes the years have brought. In 1994 I would have never thought that today I would be writing a column for RDH magazine, speaking in public, or even still practicing clinical dental hygiene. Evolution in life, both personal and professional, is necessary for survival, and our careers are no exception -- things are different in dental hygiene today vs. 20 years ago.

Power scaling is not unique to the last two decades, but the frequency with which we use the technology has changed immensely. In school, we had access to a magnetostrictive ultrasonic unit, though it required an advance reservation for use, and all the students shared a few machines. Today most educational settings have a unit for every operatory, and it is not uncommon for students to purchase their own machines. It is no longer a tool for heavy calculus, but a mechanism for enhanced instrumentation that is suitable for most patients.

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The biggest discussion in ultrasonic scaling now centers on magnetostrictive vs. piezoelectric technology. Try bringing up the topic for discussion at a gathering of RDHs and watch colleagues take sides faster than plaque builds on a bracket. A PubMed search returns results that may surprise both sides of the debate.

A 2001 study published in the Journal of Periodontology1 revealed mixed results. While the piezoelectric instrumentation removed more calculus than magnetostrictive, it also led to a slightly rougher tooth surface. Both technologies were superior to hand instrumentation with a curette.

A more recent study2 showed no statistical difference in the amount of deposits remaining after hand, magnetostrictive, or piezoelectric scaling, but there was a significant difference in root surfaces post-treatment, with the hand instrument leaving a rougher surface with deeper gouges and more dentin removal.

While the jury is still out on which method of instrumentation produces the best results, personal preference, opinion, and brand bias appear to guide this conversation. Ergonomics and clinician risk for skeletal injury brings another dynamic to the discussion, though I could find no published studies suggesting that the use of power scaling devices decrease such risks. I am sure if such research does exist, a reader will send it to me in no time.

Another shift over the last 20 years has been in the use of antimicrobials in periodontal treatment. My original education taught subgingival irrigation with stannous fluoride or chlorhexidine to enhance healing, a practice still used today with mixed results. Just after graduation I was introduced to a tetracycline cord for subgingival placement that claimed to reduce bacterial load. The cord had to be packed in a repeating s-shape formation and was removed several days post-treatment. While I noticed a decrease in signs of inflammation and bleeding, placement was not always easy and patient acceptance for a second application was extremely low.

Today the popular choices for sustained released, post-treatment antimicrobial placement are chlorhexidine gluconate gelatin, doxycycline gel, and minocycline powder. As with other product choices, bias for which product is used comes down to personal preference and brand loyalty. The only study I found showing a significant difference in probing depths between products concluded, "The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo."3 Other time-released antimicrobials showed a positive benefit in periodontal pocket reduction, but no significant decrease in bleeding on probing.

Perhaps the biggest change in the last 20 years has been in over-the-counter options for home use. Power toothbrushes are now mainstream, with models available for specific oral needs such as orthodontics, children, and those with sensitive teeth. Floss choices are nearly endless, and interproximal cleaning devices are booming in popularity. It is a rare week that a patient does not come in and show me the greatest new tool to replace flossing, with the most popular lately being SoftPicks by GUM. No hardcore evidence suggests these flexible picks actually remove more plaque or debris than other cleaning methods, yet they excel in one very important factor -- patients will use them and use them regularly.4

Dry mouth has become a frequent complaint from dental patients. Hyposalivary function can lead to increased disease, and it is an uncomfortable condition for those affected. Mouthwashes, pastes, mints, gels, and gums have attempted to adequately address the condition with limited results. Salivary enzymes and glycerine work well for a portion of sufferers but require frequent application. Lozenges to treat the effects of xerostomia show sustained results with fewer doses needed. Most contain xylitol to address decay and demineralization, but one standout adds essential oils to promote a healthier oral cavity while combating dry mouth -- Salese.5

Toothpaste choices address specific conditions such as sensitivity, whitening, plaque, halitosis, and xerostomia. In fact, a quick Internet search easily produces a number of products that claim to treat all these issues and more. For many years the mechanism of action for plaque control in toothpastes was abrasion. You simply scrubbed with enough force and abrasive particles to create a smooth tooth surface.

Antimicrobials found their way into dentifrices, creating an environment of lower bacterial load and thus, less plaque deposits on teeth. Today there are options that work by interfering with biofilm's ability to adhere to oral surfaces. Livionex significantly reduces plaque accumulation in all age groups and without abrasives, antimicrobials, or soaps.6

There are too many changes in dental hygiene to detail in one article. Ergonomic seating, magnification, personal protective equipment, and lighting have all advanced during my career to create a safer work environment. Infection control and radiography continually improve to better serve and protect operators and patients. Settings for providing care are increasing even as private practice opportunities seem to be harder to find. Several states have provisions for alternative practice for RDHs who desire a less contemporary work environment.

Not all change is positive, but overall I will take today's dental hygiene practice over the one 20 years ago. I haven't spent time applying white shoe polish to my scuffed shoes in ages. That alone makes 2014 superior to 1994.

Websites mentioned in this column

1 http://www.ncbi.nlm.nih.gov/pubmed/11422585

2 http://www.ncbi.nlm.nih.gov/pubmed/18060565

3 http://www.ncbi.nlm.nih.gov/pubmed/24071680

4 http://www.gumbrand.com/flossing-deep-teeth-cleaning-tools/products/gum-soft-picks-40-ct/?pg&#tabid_Customer-Reviews

5 http://nuvorainc.com

6 http://www.livionexdental.com

LORY LAUGHTER, RDH, BS, practices clinically in Napa, Calif. She is owner of Dental IQ, a business responsible for the Annual Napa Dental Experience. Lory combines her love for travel with speaking nationally on a variety of topics. She can be contacted at lorylaughter@aol.com.

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