Veteran hygienist reflects on her career and the seminars presented at RDH Under One Roof
By Sandy Sheffler, RDH
Renee Cina Acosta, RDH, led a seminar titled, “A bite of sugar: Retrain your brain,” at the 2017 RDH Under One Roof conference.
Reflecting back over 44 years as a dental hygienist, I am still amazed at how much I love my career. I have been so lucky to work in dental offices where not only my skills count but also my ability to impact people’s lives, where I am truly appreciated and respected. After attending RDH Under One Roof (UOR) this year, I was so happy and proud to see so many dental hygienists, both young and “seasoned.” The quality of the speakers and their personal stories were so inspiring and heart-warming that I wanted to reach out to the readers of RDH magazine with my story and how I help people.
In the past, I have written three articles speaking about using a phase contrast microscope and how this impacts the quality of care to my patients. I have been treating patients for almost 30 years with the aid of the phase contrast microscope using bacterial micro-assays. Our profession, the media, and all instructors talk about the bacteria in the mouth and how it not only leads to oral diseases, but also the impact these organisms have on our general health.
Using the phase contrast microscope to look at subgingival microflora can reveal potential periodontal pathogens or their absence. If there are no pathogens, there is no active periodontal disease! Antibacterial subgingival irrigation after debridement is critical and teaching patients to follow up with carefully directed water irrigation and other techniques ensures pathogen reduction or elimination. Pockets stop bleeding and there has been mostly no additional bone loss in deep pockets over the decades of my practice.
Periodontal surgery is rarely required except in pre-prosthetic cases. Also, an active micro-assay slide three months after initial or routine therapy indicates the disease is still active, and the therapist must consider poor patient compliance, systemic disease, or re-infection from a significant other or possibly pets. Most of the time at the three-month follow-up, the micro-assay is negative or significantly better judging by the elimination or reduction of particular pathogen types.
If you do not do a micro-assay to check for pathogens (or use DNA testing), there is no objective way to evaluate patient compliance and to see if your therapy is successful. My mentor, Dr. Paul Keyes, the former head of the National Institute of Dental Research for 25 years, researched and taught this periodontal treatment in the 1960s, emphasizing the importance of identifying the bacteria in the mouth and eliminating the pathogens that lead to poor oral health.
As time has gone on, I have learned so much more. Oral pathogens are communicable. They will spread from person to person. We are not telling our patients enough if we don’t tell them that their dental diseases are contagious with both caries and periodontal issues.
We have such a challenge in this day and time. There are so many things that we need to teach our patients and don’t always have enough time to do that. Dental disease is not only caused by oral pathogens. There are nutritional factors, systemic factors, and medications, all of which affect the oral cavity. We need to be knowledgeable about these areas in order to educate our patients thoroughly to help them achieve optimal health.
As far as nutrition goes, in one of our classes during UOR, we learned even more about the dangers of sugars. Not only do we need to know how sugar affects the mouth, we need to understand how it affects a person’s entire body. The prevalence of diabetes, heart disease, obesity, and oral disease is so closely related that we must continue to do what we can to help our patients understand the importance of a healthy, low-sugar diet.
Most consumers are ignorant about the contents of the food products bought in stores. The amounts of “hidden” sugar and the presence of high fructose corn syrup is overwhelming. In a container of well-known bread crumbs, the first three ingredients are white flour bread crumbs, high fructose syrup, corn syrup, and three other sugars. We are so inundated with these hidden sugars that we don’t even taste them.
Soup broths are another product that absolutely do not need added sugars. However, I have to read several different packages to see which ones don’t add sugar. The “organic” varieties seem to always add sugar. They call it “organic cane sugar,” which is still sugar. My homemade meals never have added sugar in my soups.
We are fighting a very tough battle. I have been so fortunate to have worked for dentists who feel as strongly as I do about the importance of a healthy diet. Back in the 1970s, I stopped eating margarine, started using better oils, and started reading labels. I read every label of any food I am getting ready to purchase.
This takes a lot of time. Some manufacturers change an ingredient. So if you bought a product that didn’t include sugar or high fructose corn syrup, they may have added it in by the next time you need it. Nothing is easy! I spend a lot of time during my hygiene visits educating patients on just this. They are very aware of the obvious things that cause tooth decay. Sodas, sugared chewing gum, candy, cookies, etc. but they are so unaware of what their foods contain and the harmful effects these foods have on their body and mouths.
Even the fluoride in the water is failing to eliminate tooth decay due to the poor diets Americans have. When I have a patient with rampant decay, I will ask them to come back for a half-hour visit to review what they are eating and try to get them to modify the sugar and “carbs” in their diet. I did learn a lesson, though, with a patient who had such a poor diet and decided to make extreme changes all at once. The young man came to see me a few years ago. His entire mouth was riddled with caries. I started talking to him about his diet. He said all he ate was pizza, and he drank 10 “super-sized” sodas a day.
Whoa! I was very worried about him and encouraged him to see his physician as well. He decided to stop the sodas “cold turkey”. He went through withdrawal. When he saw his doctor, his triglycerides were over 1,000 and he was only 34 years old. Eventually, he was willing to modify his diet and the numbers came down. He also had his mouth restored. It had a good outcome and I really felt like I saved his life.
The brush-and floss mantra
Back to my UOR experience, I also learned some different aspects of mental illnesses and how these patients are at extreme risk for dental disease. The speaker, a dental hygienist, described how she had lost her son to mental illness. She pointed out how these patients are addicted to “carbs” and sugar. Many times, they are too ashamed to seek dental health for fear of being reprimanded. It is a good reminder not to be judgmental with our patients and come from a place of wanting to help.
I also took a course that focused on cancer patients. I learned about the effects of many chemotherapy drugs as well as the effects of radiation treatment. These patients need special help as well and our role in understanding the complications is very important during and after their treatments.
One of my pet peeves is the overemphasis on dental floss. I started dental hygiene school is 1971. During my education, we were taught that there were many dental aids along with tooth brushing that were effective in removing dental plaque interproximally to control dental disease.
Since the time I started using the microscope, I found that many patients that told me they used dental floss, still had many of the harmful pathogens and their periodontal situation was not resolving. Dr. Keyes taught the Keyes Technique during the 1970s. He proved that baking soda and peroxide would eliminate these pathogens and would reverse periodontal disease. In the 1980s, several companies introduced mechanical home irrigators for flushing around and between the gums, actually eliminating the harmful bacteria causing dental disease. My patients were all instructed to add some type of antiseptic to the water reservoir.
I recommend an array of different products. Baking soda is a very effective antibacterial. I know this because all of my patients have a bacterial microscope assay both before and after treatment. The patients can see on the monitor that the periodontal disease is being controlled with the elimination of those pathogens. My patients even know the names of some of the bacteria and point them out on screen. “Look, there are no spirochetes.” I am still seeing patients today that have followed me from various offices and some have been under my care since the late 1970s. Very few teeth have been lost after all this time. In most cases, they are using oral irrigation daily with an antibacterial additive. I have not taught dental flossing since 1988. I do teach my patients to use interproximal brushes, end-tuft brushes, and rubber tip stimulators among the many other interdental aids that are available.
Again, I stress the importance of a healthy diet, which is more influential in controlling tooth decay and (probably) periodontal disease than some other factors. I want to see our profession stop saying “brush and floss” like it’s some kind of a mantra. I’m not saying that dental floss is not right for some people. However, I’d be rich if I received money every time someone would say, “I must confess; I don’t floss.” We need to remove the guilt and say, “That’s fine. There are all kinds of products available to keep your mouth healthy.” After I have said this, I can actually see relief on the face of a new patient. In the future, I would like to hear presenters and all of us say, “Brush and use the interdental aids your hygienist recommends.” It’s wordier but much more inclusive.
Hygienists go way above and beyond just “scraping” stuff off of people’s teeth. In my office, everyone is trained to say, “Do you need an appointment for your hygiene visit,” not “Do you need a cleaning appointment?”
This allows us to determine what is needed for a person’s individual dental situation. It gives us the freedom to help people both with their mouths and their health as well. Again, we all know that it is so important to have ample time with our patients. As hygienists we also need to educate our dentists to understand the importance of our role as health providers and allow the proper amount of time to benefit the patients. Ultimately, that will also benefit the practice as well. I have an hour for all adult patients and 90 minutes for new patients. In most cases, I am not doing any scaling on that first visit. I call it a fact-finding visit.” I have often heard presenters say that the dental hygienist will be a person’s most important health-care provider and I believe that to be so.
To conclude, our profession has come along way. In 1973, patients would ask me “why do I need to take care of my mouth? I’m going to lose my teeth anyway.” I told them then and I continue to educate them that it is possible to save their teeth for the rest of their lives. I help them understand what needs to be done to restore their mouth and continue to return for hygiene care and encouragement. My schedule is so packed I hardly ever have any openings. Dental hygienists can and have made such an unbelievable positive impact and I am so proud to say that I am a dental hygienist.
I would like to dedicate this article to Dr. Paul Keyes who passed away this year at the age of 99. Dr. Keyes, with his tireless research and international lectures, impacted all of our lives in many positive ways. Although he will be missed, his contribution to the field of oral health will live on.
Sandy Sheffler, RDH, has been a clinical dental hygienist in private practice, in Baltimore, MD since 1973. To reach Sandy email to: [email protected].