Trisha E. O`Hehir, RDH
By now, you can at least guess about my interest in the research base for dental hygiene practice. I have referred to research countless times in this column. What is the research base for dental hygiene? If you haven`t been in a position to read research journals regularly during the past few years, where do you start? How do you catch up on what you missed in past years?
Dental hygiene doesn`t have a single source that outlines the research supporting specific aspects of practice. A retrospective text of the past seven years of Perio Reports will soon be available, and it categorizes more than 500 research articles according to the clinical aspects of dental hygiene practice. Such a compilation will provide a start for dental hygienists interested in the science behind our practice, but a critical evaluation is still needed.
Specific areas of dental hygiene practice need to be identified as well as dental hygiene experts in those fields. That done, those experts would be the best choices for review committees to evaluate all research available in those areas, coming to a consensus on their findings. Their reviews and recommendations could then be published for the benefit of the entire profession.
Periodontists in both North America and Europe have done just that and their efforts can provide a model for dental hygiene.
Several meetings during the past 40 years have focused on the research base for periodontics, resulting in three World Workshops in Periodontics publications and one European Workshop publication. As an ongoing process, each of those groups have workshops scheduled for the near future. If we look at those meetings in sequence, plus a few which did not result in publications, we will have a quick overview of the path taken by periodontists in establishing a scientific base for their field.
Global gatherings for periodontists
The first meeting of periodontists to address this issue was hosted in Michigan in 1951. The meeting`s theme was, "What do we know about periodontia that is scientifically proven?" Participants of that workshop found the experience "disheartening." Under careful scrutiny it was clear that authorities within the field of periodontics had established the foundation for therapy based primarily upon their personal observations.
The need for sound scientific findings to support practice concepts, however, led to the evaluation of theory and practice. These evaluations employed the scientific method of developing hypotheses based on personal observations and then testing them in order to establish validity.
It was obvious from the first workshop that the knowledge and facts supporting periodontal therapy were actually beliefs based on observations and experience. They lacked the support of validity tests. As a result of that workshop, tremendous research was undertaken to fill the void identified.
Another workshop organized at the University of Michigan in 1966 evaluated the many research studies published in the intervening 15 years. With corporate financial support, the more formal workshop produced a text of reviews and findings. The main task of the 1966 conference was to "evaluate current knowledge related to problems of periodontal health and disease."
The 1966 meeting became known as the First World Workshop in Periodontics. It was later viewed as a monumental event which set the stage for application of the scientific method to periodontics, as well as focusing future research on recognized problems within the field.
In 1977, the Second World Workshop was held at the University of Illinois in Chicago. The focus of this workshop shifted from procedures and techniques to include microbiology and host response. Rather than detailing procedures, the 1977 conference attempted to assess the value of periodontal treatment. Behavioral sciences and public health considerations were included, expanding the scope of the workshop to include economic and social aspects of periodontal disease.
After 1971, there was a burst of research activity as well as reports on the effectiveness of surgical and non-surgical therapy for periodontal disease. In 1979, the first meeting devoted to this topic was hosted in Dublin, Ireland. The meeting`s purpose was to "set standards of acceptable therapeutic approaches based on scientific evidence."
A state-of-the-art workshop on periodontal therapy was sponsored by the National Institute of Dental Research in 1981. It addressed the controversies surrounding treatment decisions. Surgical and non-surgical therapies were compared and the scientific evidence for each form of treatment was critically reviewed.
A panel of periodontists, general dentists, academicians, and clinical scientists reviewed the available research and presented their recommendations for treatment choices. Although this workshop placed periodontal therapy in perspective for 1981, research findings reported through the rest of that decade provided greater understanding of periodontal pathology, challenging the complacency of standard treatment. Of particular interest were the advances in periodontal microbiology and immunology. Despite the increase in research, given modes of therapy still lacked scientific support, leading to a continued controversy.
Recent compilations of research materials
In 1989, Princeton University in New Jersey hosted the Third World Workshop in Periodontics. The goal of this workshop was to analyze clinical periodontics and bring together opinion on clinical therapy, thereby providing a model for researchers, governmental bodies, and post-doctoral programs. Ten discussion sections were identified which encompassed all aspects of clinical therapy: periodontal diagnosis, non-surgical therapy, occlusal treatment, resective procedures, tissue attachment, regenerative procedures, gingival augmentation/mucogingival surgery, implants, supportive treatment, and adjunctive therapy.
For 18 months prior to that workshop, 14 to 18 committee members in each section worked diligently reviewing hundreds of published research articles. Each section produced a Consensus Report which focused on the clinical aspects of the topic, measuring each therapy on its own merits. The four-day workshop provided a forum for all section participants to review the 10 Consensus Reports, provide oral and written feedback, and compose a final report reflecting those discussions.
The resulting publication has provided a wealth of information for clinicians. Not only were the several hundred references listed for each topic session, but analysis of the findings were distilled to manageable sections of the text. The work of those involved in the workshop has made it easy to find information on specific aspects of each clinical therapy section.
The first European workshop of this kind was held in 1993 at a retreat site in Switzerland. The second was held in February of this year. Eighty participants from 18 European countries met for four days at the first workshop. Five treatment related sessions were identified: etiology and diagnostics, surgical and non-surgical therapy, prevention and supportive care, implants, and systemic influences, with each session including presentations on several topics.
This workshop led to formation of the European Academy of Periodontology, which held their first scientific meeting in France in 1994. Reference publications also came out of both of the European workshops.
The dental hygiene profession would definitely benefit from a workshop of this nature. Such an undertaking would require a great deal of work. The results, though, would be worth the effort. The resulting reference publication would be a valuable asset for each and every dental hygienist. Discussion sections for dental hygiene might include: dental hygiene diagnosis, disease control, adjunctive therapy, debridement therapy, and supportive care. Now all we need are some interested academicians, researchers, and clinicians, plus corporate financial support, and this could become a reality for dental hygiene.
Trisha E. O`Hehir, RDH, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics.