The 'as if' attitude

June 1, 2002
My husband and I celebrated our 25th wedding anniversary last September. Apparently, that is an astounding feat. People have asked me how we did it. The short answer is that we act as if.

My husband and I celebrated our 25th wedding anniversary last September. Apparently, that is an astounding feat. People have asked me how we did it. The short answer is that we act as if.

Raising five boys close in age makes for many, many arguments - some of them hair-raising, some of them so volatile that recovery was all but unthinkable. During those times, we acted as if we loved each other. It was a safe assumption. We weighed the consequences of acting as if we hated each other or acted as if we cared for each other. We knew that the feelings we had trusted to get us into this fix (meaning parenthood) would surface again. We had a commitment and a huge obligation to each other and the children. As Zig Ziglar would say, we loved each other in advance.

As if wasn't just between my husband and me. Any parent of a teenager knows the feeling of acting as if you love your offspring. Some days acting is all that you can do!

Why is this applicable to dental hygiene? Because using research, at arguably early stages, can be safe to implement if we use the "as if" adage. The hitch is to be aware of the consequences in case the researchers are mistaken.

My first example involves strep mutans, the primary culprit in the decay process. Some studies have proven that strep mutans is passed from mother to child. So a study was done to examine the possible benefit of giving xylitol gum (a sugar alcohol used as a sugar substitute) to mothers three months postpartum. The goal was to see how chewing gum with this ingredient would affect the amount of strep mutans transferred from mother to child. Are you sitting down? Only 9 percent of the children in the test group at age two had detectable levels of strep mutans!

In contrast, chlorhexidine varnish on the study mothers' teeth biannually transmitted the pathogen to 28 percent of the children by age two; 48 percent of the control children had detectable amounts.

Yes, this is only one study. But what is the harm in acting as if it has been proven to work? I think that providing this information to parents in our offices and through public health outlets could severely cramp the decay rate in the 25 percent of children exhibiting 80 percent of decay.

What impact will this little nugget have on the access-to-care issues screaming in our faces? The active ingredient is not toxic, it is not harmful, and it is readily available. Why not act as if there are 20 years of science to support it? Why should we wait? Acting as if it works could save countless little teeth - not to mention decrease the amount of pain a child would have to endure in his or her life. The consequences are negligible if the study was dead wrong and not repeatable.

Another example of science too-good-to-wait-for is a sulfide detector. Current evidence shows that sulfides are a byproduct of bacteria metabolizing broken-down tissue. What is a perio pocket if it isn't the result of tissue breakdown? A little machine that can detect the presence of sulfides in the pocket - a real-time indicator of tissue breakdown - is available. The Diamond Probe/Perio 2000 System is FDA approved and won a medical design award for the year 2000. To use it, a clinician hydrates a sterile tip, places it into the pocket, and the probe then gives both visual and auditory cues if sulfides are detected.

Some clinicians resist using the sulfide detector because there are no long-term studies to support the thesis that sulfides in a pocket predict attachment loss. Yet, by acting as if sulfide presence is a predictor, we will detect breakdown in sulci that have not yet progressed to bone loss. We will be able to treat the infections more accurately than using BOP (the American Academy of Periodontology's official position is that BOP is not a predictor of attachment loss). The Diamond Probe 2000 is not invasive, it is remediable, and does not encourage overtreatment. Acting on the information this machine provides allows us to treat infected periodontal pockets, not just those that bleed on probing.

What is happening right now, with respect to periodontal treatment, is that we are using clinical judgment - it bleeds, therefore we debride. However, what if a pocket is deep, but doesn't bleed? What if it is shallow and doesn't bleed? Do we skip it?

Are all the clinicians in your practice calibrated to assure statistically significant similarities between your probing techniques? Can we be sure it's a pocket that has bacterial activity without a DNA test?

The list of questions is lengthy. If science proves the idea wrong, we have not lost anything, or harmed anyone. Today, by acting as if the probe gives us superior information to a standard probe, hygienists could be aggressively treating infected gingiva long before losing bone support.

While we are discussing periodontal disease and its treatment, why not act as if treating it reduces risk for heart attack, stroke, chronic obstructive pulmonary disease, low birth weight pre-term birth, and unmanageable diabetes? Periodontal disease also has been implicated as a co-sponsor of rheumatoid arthritis and asthma. How many implications do we need?

We can certainly act as if treating periodontal disease is beneficial for the whole body, not just to save a tooth or teeth. The consequence of all the current research proving to be false is saved teeth. That is not such a bad outcome.

Other examples are fluoride varnish for caries prevention and an array of herbal remedies for increasing health. Examples of modalities that started out questionable, then proved to be worthwhile are the water jet, power brushes, prophy jet and three-month recare appointments.

Let's use our education and some positive deductive reasoning to expand our treatments, increase our experience, and help our patients along to optimal health. Some modalities require meticulous research over years before we can take the plunge into incorporating them. Some are safe even if the outcomes aren't as great as initially thought.

Sometimes it's safe to do as if; to do it in advance.

Shirley Gutkowski, RDH, BSDH, has been a full time practicing dental hygienist in Madison, Wis., since 1986. Ms. Gutkowski is published in print and on Internet sites, and speaks to groups through Cross Links Presentations. She can be contacted at [email protected].