By ANNE NUGENT GUIGNON, RDH, MPH, CSP
Certain subjects fascinate me from the standpoint of clinical dental hygiene practice. So far, 2015 and 2016 are turning out to be banner years in my world for written CEs, webinars, feature articles, live courses, and, of course, this column. Each of these endeavors involves untold hours of research.
My inner geek loves perusing through the National Library of Medicine PubMed files for the latest information on a particular subject. The more research I do, the more interesting the story becomes, and the more fun it is to share information with clinicians.
My PubMed site is full of searches, sorted by date and topic. Since I'm a read-it-on-paper learner, I routinely print out the abstracts from these searches. When I can carve out a quiet space, I start reading the papers and make copious notes in the margins. If the subject is really new, it usually takes multiple reads to get new ideas firmly planted in my brain. Learning by immersion works for me. Over time, the really important concepts begin to take shape.
Rather than pick one single topic this month, I'd like to share key findings from several different studies. These papers caught my attention while preparing for an upcoming webinar, writing a feature article, updating course content, and creating new CE. Think of this month's column as a sneak preview for some important topics that have been published recently or are coming out through the rest of the year.
For decades, dental professionals have used the term plaque to describe what is actually a complex, polymicrobial community. But the discussion is changing to the oral microbiome, a concept now well accepted in biofilm research literature. Hundreds of papers have been published over the last few years that further describe how molecular genetics is changing our thinking about periodontal disease, caries, and oral fungal infections, which are all biofilm-based diseases.
Although many scientists are discussing the oral microbiome, the name Hajishengallis kept popping up over and over. A recent search just using his name revealed 37 papers published since 2012, where he was the primary author or a significant contributor. Not only is he a prolific researcher, but the papers are quite well written.
Dr. George Hajishengallis and colleagues have written numerous papers that describe how certain keystone pathogens, such as P. gingivalis, come into play during the transition from health to disease. While P. gingivalis is found in low abundance in the microbial mix, it is a microbial gang leader, and is present in active periodontal disease conditions. This microbe supports the transition of healthy flora into pathogens. P. gingivalis also disables certain aspects of the body’s immune system, making it hard for the host to fight disease and up regulates the virulence of the infection, making it even harder to get rid of the infection.1
Given enough time, the polymicrobial community becomes dysbiotic—a community of pathogens in a symbiotic relationship. Dysbiotic periodontal microbial communities require the metabolic byproducts of inflammation to support their disease-producing lifestyle.1
Whew, what a mouthful! This is only one of dozens of papers and researchers who are coming to the same conclusion. Bottom line: inflammation has to be controlled. Armed with this knowledge, we now have a much firmer platform to recommend a wide variety of antimicrobial approaches and techniques that support reestablishing or maintaining homeostasis.
When the Glove Fits
The second research paper that caught my eye was by Drabek and Boucek (2010) about the mundane subject of gloves. According to glove manufacturers, dental professionals routinely have some of the longest wear times of any occupation that uses gloves in the work setting.
While gloves are not a hot subject around the water cooler, we all know firsthand (pun intended) that being expected to wear a glove that does not fit well takes a toll on how we feel at the end of the clinical day and impacts what we do away from the job.
As it turns out, clinicians who wear the wrong size of glove, whether it is too large or too small, will spend 7% to 10% more time completing a task than someone who is allowed to wear a glove that truly fits their hand comfortably.2
Since time is money, this study supports the need for wearing a glove that actually fits your personal hand geometry. So the next time you are expected to use whatever is on the shelf, this research may help the key decision maker understand why proper glove fit is so important. If they still won’t budge, it is much safer for you to wear a glove that is too large versus one that is too small.2
The first high-speed air turbine handpiece was introduced by SS White in 1957. The first ultrasonic dental scaler, the Dentsply Cavitron, came on the market a decade later. Based on this historical perspective, it is fair to conclude that the vast majority of today’s dental professionals spend the clinical day exposed to continuous and intermittent loud and often high pitched noises for prolonged periods of time. Think about the combined effects of noise from high-speed handpieces, polishing devices, suction systems, ultrasonic dental scalers, compressors, and model trimmers.
The dental office is a noisy place, and we’re all paying a price for spending hours in this environment. A growing number of dental professionals are recognizing the onset of hearing impairment issues at a much younger age than their family and friends who are not spending time in such noisy environments.
In 2012, Messano and Petti reported the results of their study comparing hearing impairment between Italian general dentists to physicians. The groups were matched by chronological age and for practicing for more than 10 years. Information was gathered about additional risk factors, including hearing impairment symptoms, recreational activities, occupational risk factors, hypertension, ear diseases, and smoking.
The prevalence of hearing impairment among the general dentists (30%) was twice that of the physicians enrolled in this study (14.8%). While all of the risk factors listed above proved to be associated with hearing impairment for the general dentists as compared to the physicians, two work-related tasks were significantly associated: frequent use of ultrasonic scalers and using dental turbine handpieces that were more than a year old.
The authors concluded general dentists in practice for more than 10 years, who routinely used potentially noisy equipment, could be at risk for hearing impairment and recommended regular equipment maintenance and periodic replacement.3 No mention was made by the authors of the benefit of using hearing protection devices in the clinical setting.
Several things should be kept in mind regarding this study. The subjects were all dentists using multiple devices. No dental hygienists or other dental personnel were included in this study. The study also did not control hours of usage for each type of device, the brand of high-speed handpiece, whether the ultrasonic unit was piezoelectric or magnetostrictive, and the ultrasonic unit power level.3
If this brief discussion has whetted your appetite to learn more about these subjects, check out the specifics in the sidebar article, and celebrate the free CE credits that come with some of these offerings. Happy learning! RDH
1. Lamont RJ, Hajishengallis G. Polymicrobial synergy and dysbiosis in inflammatory disease. Trends Mol Med. 2015 Mar;21(3):172-83.
2. Drabek T, Boucek CD, Buffington CW. Wearing the wrong size latex surgical gloves impairs manual dexterity. Occup Environ Hyg. 2010 Mar;7(3):152-5.
3. Messano GA, Petti S. General dental practitioners and hearing impairment. J Dent. 2012 Oct;40(10):821-8.
ANNE NUGENT GUIGNON, RDH, MPH, CSP, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971, and can be contacted at [email protected].