Words and phrases are fascinating. As single words, and when strung together, they can have a myriad of meanings. Phrases such as Mother Nature rules and You can't fool Mother Nature just make sense. These well known phrases applied to dental hygiene practice can change our approach to patient care.
Even though scientists are forever trying to invent or reinvent ways to get around basic scientific principles, it is nearly impossible to alter things at a cellular level without creating havoc. Science rules the biological world and we must create pathways that respect Mother Nature's rules.
Biofilm is the perfect example. For years, dental hygienists scraped plaque off teeth and we've begged patients to brush the slimy stuff off their teeth on a daily basis. Over the years, all types of contraptions have been invented that can aid patients in their quest to remove every bit of plaque.
Regardless of our skills with hand instruments or how proficient patients were with home care, many teeth and their supporting structures were still severely damaged or lost. We were aiming our efforts and weapons at a disease, but science had not moved forward enough to help us understand Mother Nature's basic rules that could result in a positive outcome.
The inherent problem with the approach we had for so many years was the fact that we did not understand plaque biofilm as a unique, highly complex evolving biological entity.
We dutifully scaled all hard and soft deposits off and instructed our patients to remove the offensive plaque as well. We did not understand that we were dealing with a sticky mass of highly organized microbes. We did not understand that biofilm bacteria are diverse, communicate with each other, and are virtually insulated from serious obliteration when attacked with a sharp-bladed hand instrument.
While many of us instinctively understood that some patients were more resistant to the disease process science has just begun to give us real answers to the connections of a patient's immune system to the disease process. We know that genetics plays a role but a patient's life style and habits can also have an extraordinary impact on disease development. Years ago, we did not understand the power of our patient's immune systems. Some of us had an innate sense that there were dramatic differences between patients but we could not put a finger on the actual process that we were observing.
Science to the rescue! Study after study demonstrates that certain diseases and conditions, such as diabetes and cardiac disease, overwhelm the body to such a great extent that the host is left nearly defenseless in combating periodontal pathogens. Or is it the other way around, where unmanaged periodontal pathogens create an unmanaged infection cascade that contributes to the other diseases? Sjogren's syndrome and many other auto immune disorders impact not only the periodontium but leave patients at increased risk for rampant caries. Smoking, stress, compromised nutrition, prescribed medications, and over-the-counter supplements and medications affect our patients' overall ability to fight oral and systemic diseases. We now understand that a little disease or a few less-than-ideal lifestyle habits can go a long way when coupled with a weak immune system.
So where does Mother Nature fit into this discussion? The basic concept of homeostasis, or having everything in balance, is one of her most powerful rules. In our never-ending battle against oral disease, are we really thinking about the whole process and what we are up against? Or are we so sick of trying to convince patients that they have a potentially life-threatening infection that we just shut our mouths and pick up a scaler to remove ever-recurring biofilm and deposits?
Imagine what would happen if we began by explaining that Mother Nature makes the rules and one of the most powerful rules is balance or homeostasis. Would our patient hear a different message and tune in for the details? If they grasp the homeostasis concept then the stage is set to explain how many factors can be manipulated that will set the stage for success.
The list could include ultrasonic debridement, more frequent hygiene visits, power driven brushes, tobacco cessation, stress management, elimination of active infection, orthodontic treatment, laser disinfection, locally delivered antimicrobials, host modulation therapy, oral irrigation, remineralization protocols, or eliminating occlusal trauma. The list could go on and on. All of these therapies and strategies have the potential to help our patients to achieve homeostasis with the result being health not continued disease.
Look at what we have learned about plaque biofilm in recent years. We now know that biofilm is Mother Nature's joke on us. While we may not be able to see or feel the pathogens, they are proliferating all over the planet. Biofilms are responsible for all kinds of disease, mechanical breakdowns, and industrial challenges. Even if disrupted, biofilms quickly begin to reform.
So what is our best defense against this age-old enemy? Simply stated, some type of device that dramatically disrupts the biofilm mass. Science tells us that ultrasonic scalers have the ability to break up these slimy mucopolysaccharide masses as well as shatter the bacterial cell walls much like a tornado passing across the plains of Kansas. The acoustic turbulence, fluid microstreaming, and covering all tooth surfaces with the intensely vibrating ultrasonic tip are the keys to successful destruction of biofilm. Today's sonic brushes if used effectively are fully capable of continuing this destruction on a daily basis. Biofilm destruction like this on a regular basis is so powerful in fact that it alone can help many of our patients achieve the goal of homeostasis.
Scraping bits of plaque off with hand instruments will most likely leave behind an unbelievably dynamic bit of bacteria that will proliferate into a disease-producing biofilm. Mother Nature rules. We now know more of her secrets ... secrets that will allow us to practice in the comfort zone if we are open to the lessons that she is teaching us through science, observation, and careful patient assessment.
Anne Nugent Guignon, RDH, MPH, is an international speaker, has published numerous articles, and authored several textbook chapters. Her popular programs include ergonomics, patient comfort, burnout, and advanced diagnostics and therapeutics. Recipient of the 2004 Mentor of the Year Award, Anne is an ADHA member and has practiced clinical dental hygiene in Houston, Texas, since 1971. You can reach her at [email protected] or (713) 974-4540 and her Web iste is www.ergosonics.com.