by Lory Laughter, RDH, BS
When I present a concept or technique to dental hygienists, more often than not someone asks for evidence. We are an evidence-based group of professionals. Every educational program that offers a degree in dental hygiene might as well have a disclaimer that states, “Gullible need not apply.”
While evidence may be the universal requirement, there are varying opinions on what exactly constitutes acceptable proof. Journals, opinions of key leaders and even common sense are often accepted as viable research by many in the dental profession. But somewhere in the search we need to look for trials, systematic reviews, case studies, and our own clinical experience.
In October 2006 I attended the Idaho Conference on Health Care in Pocatello, Idaho. The focus was “Quality Health Care: Sifting Through the Evidence.” Being among scientists and evidence-based decision makers brought on an excitement that is hard to explain to anyone who doesn’t share a passion for research. My anticipation was never dampened by the possibility that some of my strongly held opinions might be challenged.
Mark Lingen, DDS, PhD, is an associate professor in the Department of Pathology at the University of Chicago Pritzker School of Medicine. His presentation, “Oral Cancer: New Technologies for Early Detection and Prevention” was more than enlightening, it was somewhat discouraging. Dr. Lingen provided evidence that oral cancer is often associated with the papillomavirus, the same virus found in several types of cervical cancer. Medical research has recently led to a vaccine to prevent HPV in young women, and the dental community should be on pins and needles waiting to see if this vaccine also leads to a decrease in oral cancer.
Dr. Lingen shared some exciting news about early detection of oral cancer which will hopefully lead to a higher survival rate. His lab is working on identifying biomarkers capable of predicting which dysplastic oral mucosa lesions will progress to dysplasia. When it is confirmed that such biomarkers exist, premalignant tumors can be detected at a much earlier stage. Earlier detection will increase our ability to treat and prevent oral cancer, and finally increase a survival rate that has not changed in the last 50 years.
All the good news about finding a major cause of oral cancer is dampened by one terrible fact. The dental community is well aware that early diagnosis is essential to surviving oral cancer. We are educated and trained to look for and make notations of suspicious lesions. Each and every one of us learned to perform a head and neck exam and oral cancer screening, yet most of us are not doing this simple step. Research shows that we simply don’t take the two minutes necessary to provide this valuable service. This is very discouraging!
The most surprising evidence presented by Dr. Lingen came by way of research in Sweden. In 2005, K. Rosenquist published research in the Sweden Dental Journal Supplement that noted the correlation between smoking tobacco and alcohol consumption and oral cancer rates. It was not surprising to discover a strong connection between smoking tobacco and oral cancer, and it was only mildly surprising that increased alcohol consumption is correlated to oral cancer. Disturbing to me and to many in the audience that day is that this study showed no correlation between wet snuff usage and an increase in oral cancer rates.
This study can be accessed on
PubMed, and the full text can be purchased. Dr. Lingen did not suggest we tell our patients it’s fine to use chewing tobacco, but he did have one interesting recommendation. Since smoking is a known risk factor for oral cancer, smoking cessation should be our primary focus with patients to reduce risk. If a patient needs to take the intermediate step of using snuff to quit tobacco, we should consider that route. Don’t shoot the messenger. Read the study for yourself.
An excellent speaker, Dr. David Wong, DMD, DMSc, grabbed my attention in the first moments of his presentation by stating that his goal is to foster a community where dental hygienists, dentists, researchers, and educators are inspired to move beyond dental health to total health. I have heard fellow dental hygienists talk about similar goals, which led me to jump on the soapbox shouting, “The mouth is connected to the body.” But Dr. Wong is the first dentist and scientist I’ve encountered who has the same goal. Blurring the distinction between dental health and total health will benefit the entire world population.
Dr. Wong’s presentation focused on using saliva as a diagnostic tool, not only for dental disease but for many of the diseases and conditions now diagnosed with blood tests. Proteins and ions are able to transport from blood serum into salivary glands. The glands release the protein and ions into the oral cavity in the saliva, which makes saliva testing a noninvasive way to diagnosis disease and monitor treatment progress. Dr. Wong and his team at UCLA say the science of salivary diagnostics is new and developing rapidly.
The UCLA team demonstrated the oral cancer diagnostic potential of saliva testing by profiling and analyzing saliva from patients with oral cancer. Four identified genes were able to predict whether a saliva sample was from a cancer patient or a healthy subject 91 percent of the time. The team then validated the results and showed that these biomarkers were significantly higher in the saliva of oral cancer patients than in healthy control subjects. What diseases can be diagnosed with saliva is yet to be determined, but Dr. Wong and his team have shown that saliva contains more information than previously thought. Just imagine the number of disease and cancer screenings that could be done in underdeveloped populations using saliva for detection rather than blood.
Scientific research was not the only evidence discovered during my trip to Pocatello. Dental hygienists are very good at paying it forward. We mentor others to show appreciation to those who mentored us and we give to causes within our organizations to ensure the survival of our profession. Yet, by looking around me at the buildings that house the dental hygiene department at ISU it was very evident we are not as good at paying it back. The small and aging structures are not an adequate representation of the quality and cutting-edge education provided inside.
The classroom, lab, and lunch room are all located in the Arthur D. Tranmer Dental Science Building, where the original class in 1961 attended. As I looked around campus, it became apparent this building is one of the oldest still in use at ISU. There is no argument it is functional structure, but it needs a facelift, to say the least. The clinic next door to the Dental Science Building is quickly being overshadowed by larger more modern structures. These buildings are being paid for by colleges and departments with more alumni support than the department of dental hygiene. It is a sad reflection on the status of dental hygiene as a whole, not just on a campus in Idaho. After this visit to the campus, I will never ignore another letter or phone call from my alma mater asking for support. Paying back is paramount in keeping educational standards high, and high standards are necessary to produce graduates ready to tackle the challenges of being a dental hygienist.
Fact finding will always be an integral part of our profession. Research and technology are challenging our opinions and changing the way we deliver care. We need to keep paying it forward by mentoring others and helping them expand their career opportunities. Equally important, we need to remember to pay it back so educational institutions can continue turning out exceptional graduates. Both are essential steps in our quest to make dental hygiene more about total health care and less about scaling teeth.
Lory Laughter, RDH, BS, practices in Napa and Sonoma, Calif., in both general and periodontal offices. She is a partner of Dental IQ, a team committed to arranging quality continuing education opportunities for Northern California. Through her involvement with Dental Hygienists Against Heart Disease and other organizations, Lory hopes to bring a total health concept to the dental practice. You may contact her at [email protected].