Dear RDH:
I enjoyed reading your article, “The Sabotage of Assisted Hygiene,” by Dianne Glasscoe Watterson in the July 2009 issue of RDH. I have utilized an assistant for about seven years. I wouldn't want to be without one now! I was delighted to read that we were doing all the right procedures not to sabotage this practice! One thing I definitely made sure of was that this assistant was a truly dedicated part of my team.
I recently attended my 20th hygiene class reunion. I was surprised to find that out of a class of 13 only a few of us had an assistant. I heard comments such as, “I start the job; I want to finish it.” So be it; but don't knock it until you've tried it is what I say!
Alicia Fitzgerald, RDH
Staunton, VA
Dear RDH:
I just finished reading the Ann Drewenski article in the July issue of RDH. I am very disappointed that you would publish an article that misrepresents such an important topic in a journal that is widely read by dental hygienists.
First of all, what Ms. Drewinski recommends for presurgical treatment by the hygienist prior to implant placement is all over the board, from liberal use of chlorhexidine for all patients to possible laser therapy! I would instead say that there is valid research indicating that success of implants is better in patients who are non–smokers and are periodontally healthy. A proper diagnosis should have been made and periodontal therapy used as needed for the specific patient. Post–implant placement patients, Ms. Drewenski says, should be on a three–month maintenance schedule for the first year (even a healthy 20–year–old with a single implant?), and should be on chlorhexidine. She then says that it is key to have a customized treatment plan. She says that it is important to assess increased sulcus depth, and then says that “probe readings should only be used when needed due to signs of inflammation, bleeding, or loose implant.”
I would venture to say that if the implant is loose there should have been a baseline probing done much earlier. None of what she relates is backed up by any references. I could overlook what she said right up to the point where she said that one should not probe implants. This begs a rebuttal to clarify the issue for the hygienists who read the article.
I teach periodontal instrumentation to the dental students and periodontal residents at the University of Washington. I make sure that what I teach is backed by experts in the field and by relevant clinical research. Many references confirm the need to probe implants as a baseline and at maintenance visits.
One good source is the American Academy of Periodontology Position Paper Periodontal Maintenance (J Periodontol 2003;74:1395–1401). On page 1,396, a synopsis of what should be done in examination of dental implants and peri–implant tissues specifically includes probing. Another reference is the Carranza's Clinical Periodontology textbook. In edition 10 (chapter 35, page 553), it says: “Periimplantitis can create pockets around implants, so probing around the implants becomes part of the examination and diagnosis.”
Another excellent source is the International Journal of Oral and Maxillofacial Implants (volume 19, Supplement 2004). The whole journal is a collection of consensus findings of the Academy of Osseointegration. One specific article in the journal (Lang et al., pages 150–154) reinforces that probing is key to evaluation of implants. I would encourage all dentists and hygienists to learn how to properly probe implants and to use probing implants as a valuable diagnostic tool.
I feel it is important for your journal to present valid information that has a scientific basis.
Diane M. Daubert, RDH, MS
Seattle, Washington
