Over the years, I have met so many dental hygienists who have accepted new career challenges that it’s impossible to count them all. History books and encyclopedias are filled with names of women who have charted a new course or who have carved out new roles as a way to begin a new adventure or chapter in their careers. Natalie Grossman, RDH, MA, is one of those hygienists whose career took her into the fascinating world of periodontal research.
I want to share her story.
Natalie graduated during the Beatlemania era (1963) from Temple University with an associate’s degree in dental hygiene. Besides her love of dental hygiene, Natalie developed a lifelong passion for the English language and received additional degrees in French and comparative literature.
When we began a long telephone conversation last summer, Natalie reminded me that dental hygiene uniforms back in the 1960s were as stiff as a board. In clinic, she used to drape her carefully starched skirt over the back edge of the dental stool to avoid any visible creases.
In charting a different course from clinical practice, Natalie chose academics and research. She was hired as a research assistant at the University of Michigan’s School of Dentistry. She eventually worked her way up the ranks to research associate, working closely with Dr. Walter J. Loesche, the distinguished periodontal researcher.
Initially, Natalie’s work in the 1970s involved dental caries research and studies on tooth brushing. She enjoyed learning various lab techniques, which included growing S. mutans on sucrose-containing blood agar plates. (We knew then that dental caries was an infectious disease caused by the growth of S. Mutans. Did you know that in ancient times up until the 1700s, physicians and dentists believed that dental caries was caused by a worm?) Even as far back as the early 1980s, Natalie was writing in the preventive dentistry literature about the anticariogenic properties of xylitol as a big step toward the prevention of dental decay.1
Work in periodontal research
Of particular interest to clinicians who dedicate a portion of their practice to periodontal therapy, Natalie’s many years as a research associate alongside Dr. Loesche are significant and enlightening. Theories about the etiology of periodontal diseases changed and were continually altered. When we pay careful attention to research that was published before our time, it helps unravel some of nature’s mysteries such as periodontal infections.
In the mid-1900s, the concept that bacterial plaque itself was associated with periodontal disease was the predominant theory. Researchers were unable to isolate a specific bacterial species from diseased individuals. This thinking on the part of researchers at the time led to the development of the concept called the nonspecific plaque hypothesis.
A couple of decades later, Dr. Loesche, with Natalie at his side, was convinced that if dental caries was a specific infection, certain chronic periodontal infections resulted from a predominantly Gram-negative bacterial population with a large number of spirochetes. He proposed a combination of debridement to reduce the levels of certain anaerobes and antimicrobial agents to further improve treatment results. According to Natalie, many periodontal researchers at the time did not buy into this new theory, nor did they accept the concept of cleaning (debridement) and disinfection (adding antimicrobials to wipe out the remaining culprits).
So what made Natalie believe in a “specific” plaque hypothesis? She told me that she once saw a dramatic example of a localized juvenile periodontitis in a 17-year-old girl who presented with no visible caries, calculus, or stain but with a thin layer of foaming plaque that almost looked alive.
After seeing a few cases like this, she was convinced that there were different types of periodontal disease.
In the 1970s, Natalie and Dr. Loesche were using systemic antibiotics along with chlorhexidine and a chlorhexidine gel as disinfectants. They found these antimicrobials to be particularly useful in certain periodontal conditions such as localized juvenile (aggressive) periodontitis and acute necrotizing
ulcerative gingivitis (ANUG). Natalie found the chlorhexidine gel so useful that she used it at home as a first-aid antiseptic agent for wounds because it had substantivity. As with applying a varnish to the teeth, she applied the gel along the gingival margin, and it “stuck” to the teeth.
Natalie seemed to enjoy collecting Gram-negative bacteria (anaerobes) from a variety of settings. She collected samples from pediatricians’ offices, mental hospitals, and nursing homes, and she placed them in an anaerobic chamber. She spent an entire year in a cardiac unit collecting samples because she and Dr. Loesche were studying the link between periodontal disease and coronary heart disease.
She emphasized that 80 or more years ago physicians were able to extract bleeding and badly infected teeth in seriously ill patients as a way to save their lives. Once dentistry evolved as a profession, dentists no longer wanted physicians to perform extractions. Many patients could not afford to see the dentist, so infected teeth remained in place and the patient’s health continued to decline.
In the 1970s and 1980s, the focus in periodontal disease research centered on the “hunt” for specific anaerobes. Natalie took her anaerobic chamber with her to collect samples like an excited child with an empty Easter basket. She collected what I now call “colored gum bugs.”
Dr. Loesche and Natalie still believe in the use of systemic antibiotics and locally-delivered antimicrobials.
Socransky and Haffajee created “colored” bacterial complexes so we can better understand the subgingival ecosystem or housing arrangement for gum bugs. We now know that bacterial species that belong in the red and orange complexes are found more often in diseased sites than in healthy sites. Even in healthy sites of patients with a history of periodontitis, there are more spirochetes and a greater frequency of detection of P. gingivalis compared to healthy sites in individuals who were healthy periodontally.2
So where are periodontal disciples like us headed in the 21st century? Were Dr. Walter Loesche and Natalie Grossman correct when they adopted the specific plaque hypothesis? Will we continue to clean and disinfect periodontal pockets for years to come? Will we continue to alter the subgingival environment in a way that will benefit the host? As we continue to work our message as disciples of periodontal wellness, let’s keep our eyes on the prize (improved overall health) and follow the research as the periodontal disease(s) mystery continues to unfold. RDH
1. Grossman NS: A rationale for using sugar substitutes in the prevention of dental caries. Oral Health, November 1984: 74(11); 25-29.
2. Socransky SS and Haffajee AD: Periodontal microbial ecology. Periodontology 2000, 2005: 38; 135-182.
Lynne H. Slim, RDH, BSDH, MSDH, is a practicing hygienist/periodontal therapist who has more than 20 years experience in both clinical and educational settings. She is also President of Perio C Dent Inc. (Perio-Centered Dentistry), a practice management consulting firm that specializes in creating outstanding dental hygiene teams. Lynne is a member of the Speaking and Consulting Network (SCN) that was founded by Linda Miles, and has won two first place journalism awards from ADHA. Lynne is also owner/moderator of a periodontal therapist yahoo group: http://yahoogroups.com/group/periotherapist. She can be contacted at [email protected].