Imagine us actually preventing gingivitis.

June 1, 1998
Let`s take a look at the future. Don`t panic! I`m not talking about eliminating your job. There will always be a need for dental hygiene as we know it today. Besides, if you look through the charts in your office, probably only half the patients are seeing you on a regular basis anyway. Add to that the 50 percent of the population that doesn`t visit the dental office, and you can see we`re dealing with only a small segment of the population as it is.

Imagine us owning oral health spas

Trisha E. O`Hehir, RDH, BS

Let`s take a look at the future. Don`t panic! I`m not talking about eliminating your job. There will always be a need for dental hygiene as we know it today. Besides, if you look through the charts in your office, probably only half the patients are seeing you on a regular basis anyway. Add to that the 50 percent of the population that doesn`t visit the dental office, and you can see we`re dealing with only a small segment of the population as it is.

If you are the type who doesn`t like change, don`t start worrying yet. Just set that thought aside for a few minutes. Read about this new idea that searches for opportunity - not extinction. It may sound crazy. It may sound fanciful. Just remember, with the technological advances we see around us, this concept is entirely possible.

Our days are made up of numerous recall visits comprised of repeated oral hygiene instructions that are often perceived as nagging. The removal of calculus and plaque is described by patients as picking, poking, and generally unpleasant.

We`re stuck in the recall mode because that was what we were taught in school. It`s what we have been doing our entire dental hygiene life. However, is it the best approach? Let`s take a look at the latest advances in science and technology. Let`s identify alternatives for providing our patients the best possible care. Let`s see where the future may take us.

We know that:

- Periodontal disease is a bacterial infection.

- Loosely attached plaque within the pocket is more toxic than attached plaque.

- Plaque left undisturbed for 24 hours or more will calcify due to minerals in the saliva.

- Gingivitis precedes periodontal disease most of the time, but not always.

- Gingivitis is reversible, unlike periodontal disease.

- Effective plaque removal will prevent gingivitis, thus preventing most types of periodontitis.

If plaque is allowed to accumulate and gingivitis results, reinstituting effective plaque control at two weeks will reverse the gingivitis. Dental hygiene visits every two weeks have been effective in preventing almost all caries and gingivitis. However, the concept of two-week recalls has not been embraced by the profession. We know that effective, daily plaque removal will prevent gingivitis, but human nature has made reaching that goal nearly impossible.

Where are we scientifically? In essence, we know what causes periodontal disease, and we have the knowledge and technology to prevent it. We just aren`t doing it. Instead, we see patients every three months, every six months, or maybe once a year. Calculus accumulation can be prevented, but we settle for scraping it off every few months instead. Why? Because it has always been done that way.

Based on our scientific findings, what would be a more effective model? We need effective plaque removal every 24 hours to prevent calculus accumulation and to prevent gingivitis. If we miss that interval, we need to remove all supragingival and subgingival plaque at two weeks to reverse the gingivitis. We are talking about complete plaque removal at intervals between 24 hours and two weeks. Logistically, this does not fit with our current dental hygiene model, so let`s design a new model.

A visit to the spa

Imagine dental hygienists owning oral hygiene centers, like health clubs, all over your city. Imagine people visiting these centers every day, every other day, or even once a week. Instead of weight machines and stationary bicycles, imagine high-tech, commercial oral hygiene units capable of removing all supragingival plaque and irrigating all subgingival areas throughout the mouth in just 10 seconds. These units could be the size of the public telephones you see in airports, the circular ones with four phone stations. The full-mouth oral hygiene unit could be similar to that, providing four docking stations in a single, free-standing unit.

These units could even combine sonic toothbrush technology and subgingival irrigation. Sonic toothbrush technology goes beyond mechanical plaque removal, creating fluid dynamics to remove stain and bacterial plaque, as well as reach beyond the bristles. Sonic technology also has been shown to be very gentle on teeth and soft tissues. Irrigation devices direct irrigation fluids interproximally and subgingivally to flush out the toxic, loosely attached plaque. Combining these two technologies could provide ideal plaque removal.

Imagine a custom-made, full-mouth appliance, like a mouthguard, with bristles and irrigation tips reaching all surfaces: interproximal, facial, lingual, upper, and lower. Each docking station in the high-tech unit would have three connections, one for the antimicrobial irrigation, one for suction, and one for power. The irrigation hose would take the antimicrobial of choice into the mouth and through the irrigation tips aimed subgingivally. The suction hose would remove the antimicrobial and saliva, making the experience comfortable and not at all messy. The power cord would activate the sonic bristles and the irrigation system. There would be power-level selection buttons and choices for the desired antimicrobial. There would also be a timer.

The individual, full-mouth brushes would be stored in small lockers that also serve as gas sterilization units. A member of this oral hygiene center would remove the customized full-mouth brush from a locker, place it in the mouth, and plug into a docking station. Antimicrobial selection would be made, and the time selected. It would only take 10 seconds to do the entire mouth! If customers had more time, they could go for an extra five or 10 seconds. The brushing and irrigation would be guaranteed effective because of the custom fit of the full-mouth brushes and the strategically placed irrigation tips.

This concept wouldn`t replace daily brushing at home, but it could replace recall visits as we now know them. Just think of it. You could provide periodontal debridement therapy, get your patients periodontally healthy, and then offer them the opportunity to stay that way. Eliminating scaling and polishing from recall appointments would allow dental hygienists the opportunity to help more people attain periodontal health.

With this new concept, only a fraction of our time would be spent providing traditional debridement therapy. Most of our time would be devoted to oral-health assessment, evaluation, and education. Hygienists would also manage these oral hygiene centers, which could be installed in dental offices, health spas, work-out gyms, shopping malls, office buildings, or in free-standing units near fast-food enterprises.

I know you are already thinking that dental insurance won`t pay for this. I hope you are right! This concept would take the clinical-medical aspects out of dental hygiene.

No `laying on of the hands`

Dental hygiene would become a fun and desirable way to spend discretionary income. People pay to join health clubs; why not pay to join an oral health center? It might cost $25 per month or $300 per year for unlimited use of the oral health center, plus the initial cost of the full-mouth custom framework with slots for bristle attachment and irrigation tips. The investment in the commercial unit will cost several thousand dollars, but office computers, intraoral cameras, lasers, and now air-abrasion systems all fit into that category. Besides keeping people periodontally healthy, this investment would be earning money without requiring the traditional "laying on of hands" each time the patient used it. The traditional recall model restricts the number of patients we can see. With this new technology, many more patients could be treated.

We need to think of the 50 percent of the population that dentists and dental hygienists do not see, plus all those patients in your office who slip through the cracks. We know how ineffective the present model is in attracting the public. To reach more of the population, we need an innovative model, something quite different from what we now have. Our efforts should target not only our current patients, but also those people who do not now seek dental hygiene care.

This idea might seem crazy to most of you, but let it tickle your imagination. Based on your experience, what futuristic ideas do you have for dental hygiene? What ideas do you have for a better mousetrap? I`m sure you have some if you`d just let your imagination go.

Trisha E. O`Hehir, RDH, BS, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics.The Web site for Perio Reports is Her e-mail address is trisha