Oral health detective?

Feb. 1, 2003
Would you be surprised if I told you dental hygiene was not my first career choice? Dental hygiene was selected by default, all because I had braces as a kid.

By Trisha O'Hehir

Would you be surprised if I told you dental hygiene was not my first career choice? Dental hygiene was selected by default, all because I had braces as a kid. Sure, there was some pain and discomfort involved, but I looked forward to each trip to Dr. Geiser's office. The office was always filled with kids, so many that we ended up lining the halls outside until a chair opened up inside. The dentist always knew my name. I didn't know he read it off a schedule, I thought he always knew me by sight. I'd still like to believe that. Everyone loved Dr. Geiser. Pictures of his patients covered the walls — school pictures, vacation pictures, graduation pictures, wedding pictures, and even pictures of the kids' kids! The environment was fun and always filled with laughter — it didn't seem like any dental office I'd been in before.

The experience was different because I wanted to have braces. I hated my smile and was thrilled my parents figured out how to scrape enough money together for braces. Years later, I found out they could only afford it because the dentist was not an orthodontist, but a general dentist who did ortho on Thursdays and Saturdays and charged only a fraction of what it might have otherwise cost. It made a huge difference in my life at the time and, as it turns out, had a significant influence on my eventual career choice.

I remember asking him one day what I had to do to work in an office like his when I grew up. Remember, this was back in the 1950s when very few women attended dental school. So he did not suggest I become a dentist or an orthodontist. But I give him high marks as he did suggest dental hygiene, even though he didn't employ one himself. And that's how I ended up in dental hygiene.

Do you want to know what my first choice was? As a child, I focused on the two role models closest to me — Mom and Dad. Mom had seven children and ran the house like a CEO of a corporation. She was good at delegating, excellent at organizing, incredibly adept at stretching their small income, and just seemed to be able to do anything. The trouble with her job was it never ended. She never seemed to get a day off and nothing was her own! I remember when she bought herself a beautiful, new, red sweater and, with five daughters, she wasn't even the first to wear it!

I wanted something easier and more exciting. My father was a police detective. Every morning, he would strap on his gun, tuck handcuffs in his back pocket, and drive off in a squad car for a day. In my imagination, his day was filled with solving great mysteries, like the time he figured out the identity of a woman who died in a public sauna. All he had to go by was a key and a small bag of groceries. The bag contained frozen strawberries, so the person wasn't planning to walk too far and the key had some paint on it. A single phone call sent him to a nearby rooming house. Sure enough, the paint on the key matched that on the house, and all he had to do then was try a few doors. In just a few minutes, he found the apartment and the identity of the deceased.

As a kid, police work sounded like the kind of job I'd like to have. I thought my Dad would be so proud of me when I announced to him that I intended to become a policewoman when I grew up. He studied me for a moment, thinking of the two policewomen who worked for him — both "hard drinking, hard smoking and hard living" women — and shook his head. He said to me, "Honey, you can be anything in the world you want to be when you grow up, but you will not be a policewoman. Is that clear?"

I still fancy the idea of being a detective and see myself as an "oral health detective," asking questions and looking for answers. That's why I find research so interesting.

Research is, in fact, detective work. You encounter a problem, ask a question, and seek the answer. Some questions require double-blind, placebo controlled clinical trials performed in university settings. Others can be answered by piecing together existing bits of information. That's my idea of detective work.

Here's an example. Have you ever been asked, "When is it best to brush — before or after eating?" What's your answer? Traditionally, we say, "Brush after every meal." But is that the best answer? I'm not aware of any research that directly compares brushing before and brushing after meals. Here comes the detective work — what bits of research can we put together to answer this?

To do that, we need to ask a few more questions. Why are we brushing? To remove food, or to remove plaque? If food is the reason, then, of course, brushing after eating makes sense. But if brushing is to remove plaque, we need to ask how quickly bacteria convert sugars into acid. According to the research, it happens in mere seconds and can take up to 30 minutes to return to baseline pH levels. So, telling someone to brush after eating may be too late and, thus, not the best answer. Removing plaque before eating sugar seems to make more sense, if the goal is to prevent acid production or at least minimize it.

Here's another problem. Gum disease starts between the teeth for a couple of reasons. First, plaque accumulation between the teeth isn't disturbed by chewing or the tongue. Second, the tissue in the col area isn't keratinized, thus providing less protection than facial and lingual tissue and is therefore more susceptible to bacterial endotoxin. These are bits of scientific information — the pieces of the puzzle.

The question becomes: Why do we traditionally teach toothbrushing first, if the interproximal area is more susceptible? Wouldn't it make more sense to focus plaque control efforts interproximally rather than facially and lingually? Traditionally, we teach brushing first because it's easier for people to learn than flossing. But the message becomes: Brushing is number one and cleaning in-between is less important. That message isn't consistent with the scientific facts in this case. Based on these facts, the message should be "start cleaning in-between."

Not all of our questions are directly answered by well-designed research studies. I see myself as a hygienist doing detective work, putting together findings from different studies in order to answer clinical questions.

For others, hygiene was also their second choice. Sharen, a good friend and colleague here in Tucson, told me she really wanted to be an archeologist and go on digs all over the world. In some ways, she's been able to combine the two — doing plenty of "digging" in periodontal pockets and attending international hygiene meetings. Oral health detective work combines my first career choice with dental hygiene, allowing me to solve clinical mysteries.

Trisha E. O'Hehir, RDH, BS, is a senior consulting editor of RDH. She also is an international speaker and editor of Perio Reports, a newsletter containing news about periodontics for dental professionals. The Web site for Perio Reports is www.perioreports.com. She can be reached by phone at (800) 374-4290 and by e-mail at [email protected].