Karen Davis offers her perspective ondisease prevention in an interview with RDH
RDH: What is the current trend in disease prevention in dental hygiene, including oral hygiene care?
Davis: Disease prevention and intervention are topics gaining much more attention as a significant portion of our population ages and lives longer. It wasn't that many years ago that dental professionals thought all plaque contributed to disease. Therefore, plaque control and oral hygiene instruction was the primary focus of dental hygiene visits.
Today, we know that the host plays a huge role in disease initiation and disease progression, so the more effectively dental professionals can identify and manage risk factors that impact the host response, the greater the likelihood of arresting disease. Biofilm is still our enemy, and oral hygiene guidance to patients must include effective and realistic methods to remove as much plaque biofilm as possible. It must also include a reduction in risk factors and consideration of the host response.
Let me give you an example. Simply disclosing a patient to reveal poor plaque control without consideration that the same patient has a three-sodas-a-day habit, is a smoker, and is pre-diabetic will yield minimal progress in disease prevention without reducing risks. We must include risk assessments, and Philips Oral Healthcare has an outstanding online tool called CARE (Customized Assessment and Risk Evaluator) to assist in identifying risks for periodontal diseases, dental caries, and oral pathology. It also provides evidence-based recommendations for risk reduction.
RDH: How have new technologies impacted this area of the dental practice, and what oral hygiene products do you recommend to your patients?
Davis: Technology explosion is what has happened in dentistry, but I'll focus on a couple of technologies where I have seen superb results with to manage biofilm daily. Noticeably, I will not be focusing on floss. The recent EuroPerio 8 meeting held in London, England, featured experts and research that should give clinicians ample reasons to move away from tedious floss instructions and instead guide patients toward prevention of gingival bleeding with the use of power brushes and interdental cleaning devices.1
There is a high tech brush I want as many of my patients to use as possible. I joke with them that immediately they become more sophisticated with the brush, which actually motivates many men to purchase one. Its patented sonic technology literally creates a dynamic cleaning action that drives fluid interproximally and along the gumline targeting removal of adherent biofilm.
If you have not seen the new Philips Sonicare DiamondClean Amethyst, which also comes in black and white, once you do, you may agree that it can double as classy décor that happens to tackle biofilm! For interdental cleaning, I love the ease of the Philips AirFloss Pro using triple bursts of air and liquid micro-droplets to remove biofilm and debris interproximally. I find high patient compliance with this technology. Additionally, for those who prefer interdental brushes, I have found ease of use and compliance with GUM Soft-Pics or TePe interproximal brushes and Curaprox brushes available in a multitude of sizes.
RDH: You recently spoke on salivary diagnostics and biofilm at RDH Under One Roof last summer in Las Vegas. How can salivary diagnostics aid in the instruction of home care recommendations?
Davis: It is phenomenally common to see patients in the dental office that present with relatively low accumulated hard deposits, yet significant inflammatory response as evidenced by substantial bleeding upon probing or instrumentation. Correlated with that is often a low value on their daily plaque control regimen. They have no symptoms, and plaque control is not a priority.
With the use of salivary diagnostics to identify an excessive load of pathogens that are highly destructive periodontally, and salivary tests to identify increased genetic risk for disease progression, often for the first time ever, patients begin to feel concerned about their bleeding gums. With this increased concern, patients become invested in what they can do differently to prevent disease progression and tooth loss. It is against this backdrop of salivary diagnostic results that I have experienced numerous patients with a previous low value of oral health take ownership, and become avid users of technologies our practices recommends for biofilm management such as the Philips Sonicare toothbrush line and Air Floss Pro.
RDH: What do you foresee as future directions for dental disease prevention?
Davis: Without a doubt, the lines will become more and more blurred between a patient's oral health status and their overall health. I recently attended the Bale Doneen Method for Heart Attack and Stroke prevention in Atlanta and was amazed by the amount of attention devoted to the topic of pathogen-laden biofilms.
No doubt chronic periodontal inflammatory conditions and specific pathogens directly impact risk of cardiovascular disease. The more clinicians can educate themselves on oral and systemic health interactions, the more they will alter their practices to co-manage dental disease with other health care professionals.
Philips Oral Healthcare is hosting their second Oral Health and the Connected Body Symposium on Friday, October 2, 2015, in Cleveland, Ohio. Forward-thinking dental professionals won't want to miss this! RDH
1. Van der Weijden FA, Slot DE. Efficacy of homecare regimines for mechanical plaque removal in managing gingivitis: a meta review. J Clin Periodontol. 2015; 42(suppl..160:S77-S91.doi 10.1111/jcpe.12359.
Karen Davis, RDH, BSDH, is the founder of Cutting Edge Concepts, an international continuing education company. She has over 30 years experience in dental hygiene, and currently merges lecturing with private practice. Karen served as trainer with The JP Institute for over 15 years, and has served on numerous advisory boards in the profession. Dentistry Today recognizes Karen as a "Top Clinician In Continuing Education," and she is the author of the Action Points column in RDH magazine. RDH recently asked her the four questions below.