Get out!

Feb. 1, 2004
Over the years, as we all know, technology marches on. Colored telephones have replaced black ones. Their shape and functional flexibility have progressed to levels never dreamed of by their inventor.

By Shirley Gutkowski

Over the years, as we all know, technology marches on. Colored telephones have replaced black ones. Their shape and functional flexibility have progressed to levels never dreamed of by their inventor. We'll never know if Mr. Bell would have put the brakes on the cellular phone. Keeping an open mind takes practice. Acknowledging mistakes along the way is one way to develop good thinking habits.

In 1974, at Hamburger High, McDonald's trainees were let in on a secret. Drive-through service was the wave of the future. People wouldn't have to get out of their cars to get their food. Just drive up, order from one window, then drive up to another window to pick up lunch or dinner. Some of the trainees were dumbfounded at the ridiculousness of such an idea. It's already fast food; why would anyone need it even faster? Yet, the idea certainly has survived the test of time.

In 1989, we were told that xylitol would help eliminate decay. Most dental professionals scoffed at the idea. Any time the amount of saliva increased, the acids would be diluted and teeth would be safe — we thought we knew. The idea was tossed aside by the dental industry. Dentists and hygienists, not understanding the unique nature of this sugar alcohol, explained it as junk science to their patients who asked about it.

Product managers saw the contempt in the industry and dropped the ball. The science and substantiation came from Europe over the next decade. Simply chewing gum that contains xylitol dramatically reduces decay rates. It works by disrupting the bacterial metabolism and, as a result, alters the oral ecology. It is more than just increasing salivary flow.

In 1994, a new product was introduced to sanitize hands between patients. It didn't contain water or harsh chemicals and it didn't dry the skin. The active ingredient was alcohol. If you can remember, it was in the early 1990s that most offices finally realized the importance of surface disinfection. They learned that alcohol wasn't effective as a room disinfectant, especially if the person used a single, 2x2 alcohol-soaked gauze square to wipe the surfaces of the entire treatment room. Alcohol was out; iodophors and bleach were in.

Then this sales guy came to the office selling gelled alcohol for disinfecting hands between patients. I'm sure he was politely and impolitely asked to get out. Later that decade, the product went to the consumer as Purell. Today, the CDC has hand-washing guidelines that rest almost exclusively on this type of product. Hospital workers, as well as oral health care providers, are now asked to use this type of product all day between patients, and between de-gloving and gloving.

In 1999, Sonicare reps were in offices telling clinicians that their toothbrushes could stimulate salivary flow. The non-believers scoffed at this concept. First the gimmick of the vibrating brushes removing plaque beyond the bristles; now the brush increases salivary flow — how dumb do they think we are? The reality is that the Sonicare does remove plaque beyond the bristles, because plaque is a biofilm that can be disrupted by the mechanics of fluid dynamics, which is propelled by the motion of the bristles. As an added benefit, simply turning the brush toward the palate and tongue for one minute and activating the bristles facilitates a measurable increase in salivary flow for 45 minutes. It brings a world of relief to those with salivary dysfunction, from Sjögren's syndrome to diabetes to medication-induced xerostomia.

There is a plethora of examples. Keeping current is difficult in a time when information travels at the speed of a keystroke. It is even more difficult when research gets too much play in the early stages. Another problem is that research isn't standardized. This is obvious when we try to compare projects to make an informed decision as a clinician. Determining the amount of damage that polishing paste does to enamel is impossible because all of the research used different parameters; no two study designs were similar.

Comparing projects as a researcher or statistician who is trying to do a metanalysis of a number of research articles is complicated by the maverick nature of research. The most notable and recent in the news is the Cochran Review on power brushes.

Of over 1,000 research articles, the parameters of this metanalysis were set so that only slightly over 60 were used in the analysis. Metanalyses are becoming a recognized way of compiling data, so clinicians can take digested information to their practices and deliver care that has a broad base of evidence. Future research will be designed with this in mind, so that projects can be compared and information will be able to be applied.

Each of the examples used in the opening of this article happened to me. Each of the scenes ended with my tossing out either the information or the sales rep. Being wrong helps me learn. Forming opinions comes too easily for first-born children; changing opinions in the bright light of elucidation takes practice and hard work. With experience, pitching ideas becomes harder and changing opinions has become easier.

Being tempted to yell, "Get out!" at the next new idea is part of the human fabric.

Resisting the temptation could trigger a new process within the folds of gray matter — one where a new brain cell opens and norepinephrine, serotonin, and a new idea take up residence. The old idea can stay. We need old ideas to make new ones work. We need old seeds to grow new plants.

Open minds, better research parameters, metanalysis, and prospective metanalysis can improve our treatment outcomes. They can also keep us from traveling down the wrong corridor or looking foolish when the curtains open and the truth revealed.

2. Papas A, Stack KM, Spodak D. Sonic Toothbrushing Increases Saliva Flow Rate in Sjogrens Syndrome Patients. J Dent Res 1998 77:981

Shirley Gutkowski, RDH, BSDH, has been a practicing dental hygienist since 1986. She is a popular speaker and award-winning author. Gutkowski and Amy Nieves, RDH, are the co-authors of "The Purple Guide: Developing Your Dental Hygiene Career," a handbook for graduates from dental hygiene school. Gutkowski can be contacted at [email protected].