by Carol A. Jahn, RDH, MS
We've all had that uncomfortable moment when the way we practice is challenged. Perhaps while sitting in a CE course or maybe it was conversation with that new hygienist and recent graduate your office just hired. It is easy to be dismissive and think it's "just their opinion," but more often than not, the information or the conversation haunts us a bit, and we think,"What if they are right?"
As a continuing education presenter, it's not uncommon for me to be approached by someone who is concerned about data I have reported that is in conflict with "the way it has always been done." Often, the issue at hand is not the implementation of new technology, but rather modification of those things we do and recommend daily. Here are some of the most common issues that generate angst in the courses that I provide.
- Healthy patients may not need yearly radiographs. The December 2012 guidelines from the American Dental Association and the FDA acknowledge that the optimal interval for taking radiographs is a part of clinical judgment and varies depending upon age, dentition, and oral health status. The guidelines suggest that an adult patient of record with no history of periodontal disease, no clinical caries, and no risk factors for caries need posterior bitewings on a 24- to 36-month schedule. In comparison, people with a history of periodontal disease and/or caries will likely need X-rays more frequently than someone with a healthy mouth.1
- Sealing noncavitated lesions arrest decay. A report from the American Dental Association found that sealants tend to be underutilized on those with the highest risk.2 Even though people may be hesitant, sealants can be placed over a noncavitated lesion to arrest decay. This is contrary to the belief that placing a sealant over decay will "bomb out" the tooth. Instead, sealing an incipient lesion has been shown to provide a 100-fold decrease in mean bacterial counts in carious lesions, thus preventing caries progression.3
- Flossing may not reduce the risk for tooth decay. Common sense seems to indicate that if a patient experiences interproximal caries, then flossing would be essential in helping reduce the risk for this type of decay. Yet the evidence does not bear this out. In a systematic review of dental flossing and interproximal caries, the effect of dental floss in reducing the risk of caries was found to be minimal in people with adequate exposure to fluoride.4 They note that dental floss has largely escaped rigorous scientific evaluation. As evidence, there have been no real-world clinical studies showing flossing prevents decay in adults. The authors caution justifying the recommendation of floss for caries reduction when other caries-preventive interventions, such as fluoride, are supported by higher levels of evidence.
- The Waterpik Water Flosser does remove plaque. In school, most of us learned that simple swishing with water could not remove plaque; mechanical action was required. Pulsating water is a different story. Researchers at the University of Southern California Center for Biofilm found that a three-second application of pulsating water at 70 psi was capable of reducing 99.9% of plaque biofilm from the treated area. The researchers concluded that the hydraulic forces produced by a pulsating Water Flosser with 1,200 pulsations per minute exerting sheer force (70 psi) can efficiently and effectively remove biofilm.5 In a separate study, researchers compared the plaque-removing capability of the Water Flosser to traditional dental floss. In a group of subjects who had abstained from all oral hygiene for 23 to 25 hours, the Water Flosser, paired with a manual toothbrush, was 29% more effective at removing plaque from all areas and 29% more effective at removing plaque from approximal areas than traditional dental floss and a manual toothbrush.6
- Bleeding may not mean periodontal breakdown. Bleeding on probing indicates inflammation and drives concern about periodontal health. Yet the overall significance of bleeding is dependent upon many factors, including frequency and overall number of bleeding sites. Over a three-year period, it was found that the people with the highest frequency of bleeding, along with the greatest number of bleeding sites, had only a 26.4% risk of disease progression. In comparison, the absence of bleeding showed a higher predictive value for the absence of disease progression, at 93.3%.7
The fuel for these changes is evidence-based care. Both the American Dental Hygienists' Association and the American Dental Association are advocates of utilizing the best evidence possible for providing excellence in patient care and best practice. The identification of specific risk factors or behaviors that make a patient more likely to have caries or periodontal disease mean dental hygiene care is no longer "one size fits all." Add to the mix an aging population, along with more people than ever before living with and managing a chronic disease or condition, and the option to customize care becomes a necessity. RDH
1. American Dental Association Council on Scientific Affairs. Dental radiographic examinations: Recommendations for patient selection and limiting radiation exposure. December 2012. http://www.ada.org/sections/professionalResources/pdfs/Dental_Radiographic_Examinations_2012.pdf.
2. Beauchamp J et al. Evidence-based clinical recommendations for the use of pit-and-fissure sealants: A report of the American Dental Association on Scientific Affairs. JADA 2008;139:257. http://jada.ada.org/content/139/3/257.full.pdf+html.
3. Oong EM et al. The effect of dental sealants on bacteria levels in caries lesions. JADA 2008;139:271. http://jada.ada.org/content/139/3/271.full.pdf+html.
4. Hujoel PP et al. Dental flossing and interproximal caries: A systematic review. J Dent Res 2006;85:298. http://jdr.sagepub.com/content/85/4/298.abstract.
5. Gorur A et al. Biofilm removal with a dental water jet. Compend Contin Educ Dent 2009;30(Suppl 1):1–6. http://professional.waterpik.com/pdfs/clinical-research/Gorur_abstract_021010_v5.pdf.
6. Goyal R et al. Evaluation of the plaque removal efficacy of a water flosser compared to string floss in adults after a single use. J Clin Dent 2013;24:37-42.
7. Rahardjo et al. Relationship between bleeding on probing and periodontal disease progression on community-dwelling older adults. J Clin Periodontol 2005;32:1129.
Carol Jahn, RDH, MS, is the senior professional relations manager for Water Pik, Inc.
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