New technologies in dental hygiene

Sept. 1, 2001
The latest technology in diagnostic and therapeutic tools can radically change the way you practice — to everyone's benefit.

The latest technology in diagnostic and therapeutic tools can radically change the way you practice — to everyone's benefit.

Dentistry has enjoyed technological advances for many years. It started with the high-speed handpiece in the 1950s. Fiber optics were added, then magnification in the form of loupes, and now microscopes are available for both dentist and assistant to view the tooth during treatment. Technology allows dentists to produce ceramic restorations in the operatory at the time of treatment. Lasers are used for a wide range of procedures. Computer technology now makes orthodontics for adults possible without bands, using clear plastic appliances fabricated biweekly. Intraoral cameras provide instant visuals for both clinicians and patients. Computer software to artistically enhance photos now allows patients to see what they will look like after the recommended treatment is completed. Dentistry has clearly enjoyed a boom of technological advances in the past 50 years.

That's not the case for dental hygiene. Oh sure, we've had a few things, but nothing to revolutionize dental hygiene practice. The intraoral camera is used by hygienists to educate patients, but before-and-after photos are not as dramatic when most of our work is done subgingivally. Some hygienists use lasers for soft tissue curettage, but not many. Some would argue that micro ultrasonics have made a big impact on dental hygiene. Maybe, but the Cavitron has been around for 50 years! The tips are smaller now, but the standard tips have always been significantly smaller than any curette or scaler.

I'm thinking about all the new technology sweeping the world. Astronauts go to the moon and back and nothing much has changed in our field for 50 years. We're still "scaling and polishing," as it was termed in the 1950s and 1960s, and teaching oral hygiene. It's not surprising that so many hygienists leave the field each year, combined with a reduced number of new graduates to fill all of the available positions. It's time for technology to find its way into the hygiene operatory. And that's exactly what's happening.

It's a great time to be a hygienist! Things are beginning to change, and the changes will be both exciting and dramatic. As hygiene technology catches up with the rest of the world, we may even see more hygienists staying in the profession. Exciting technological changes will provide hygienists with long-overdue tools to ensure successful patient care.

Let's look at just two catagories of the newest technological advances: diagnostics, and therapy.

Diagnostic technology
Automated probes have been around for several years, but have never really become part of routine dental hygiene practice. Until now, they've been bulky, time consuming, no more reliable than manual probing, and painful for the patients. If these drawbacks weren't enough to dissuade you from buying an automated probe, the price was! Researchers continue to use them, but they have yet to find a place in private practice.

The Diamond Probe, by Diamond General Development Corp., combines manual probing with new technology. It's plastic with black bands for visual scoring, and it also measures volatile sulfur compounds in the sulcus. As a patient, I find it more comfortable than traditional metal probes. As a clinician, the Diamond Probe provides more information than simply measuring sulcus depths — it can detect the presence of volatile sulfur compounds alerting me to areas of disease activity. Sure, we can look at bleeding and probing depths to tell us where the disease is, but the Diamond Probe will also tell us which sites are showing signs of activity before gingival attachment is lost and perhaps even before any bleeding is evident. In addition to measuring volatile sulfur compounds in the sulcus, it can also detect sulfides on the tongue.

We've all had our share of frustration when we attempt to impress upon patients the importance of treating and preventing periodontal disease. People seem much more interested in doing things to achieve fresh breath than to prevent gum disease. Volatile sulfur compounds are the source of bad breath and are known to increase permeability of the junctional epithelium, which starts the periodontal disease process. Linking bad breath to periodontal disease through these measurements will definitely get the patient's attention.

We need more hygienists using this probe in practice as well as conducting research with it. We need to document our treatment success with this new technology.

Therapeutic technology
We have several new antimicrobials to squirt, stick, or pack into pockets that don't respond to traditional instrumentation. But, have you ever wondered just why those areas aren't healing the way you expected? Have you ever wanted to take a look inside that pocket? We can refer these patients for surgery, but sometimes it's just one area, tooth, or surface. We can make lots of guesses as to why the area isn't healing: a root fracture, an accessory root canal, an enamel pearl, bacteria in the tissue, or, on only very rare occasions, a piece of missed calculus!

Endoscopes are used in many areas of medicine. It's wonderful to thread a small camera into the stomach, intestines, or blood vessels to evaluate the tissues. Wouldn't it be great to have a tiny camera on our probe or power scaler when we're working in a pocket? I'm sure you've wished for that on many occasions. Now you can have it!

DentalView has been working for several years to streamline an endoscope for periodontal use. The latest version features many improvements: the handpiece is smaller, the screen larger and thinner, and the entire unit is a fraction of the size of the original. We now have the option to view, with the patient, just what is going on inside a pocket. The fiber optics and the camera provide an on-screen display of up to 40 times larger than actual size. The DV2 Perioscopy™ System can be adapted to a probe, curette (of course, I think the best choice will be the O'Hehir Curette), or ultrasonic tip. Besides light and vision, the Perioscopy System will flush the area with water to allow clear imaging.

One of the greatest frustrations we encounter is a schedule full of "prophys" and finding seven out of eight patients with periodontal disease. For each of those seven, do you put your instruments down and discuss the need for periodontal treatment, or do you go ahead with a "prophy" attempting to go a bit deeper in those areas? Do you tell them they really need some periodontal therapy or not? The next time you see a patient scheduled for a "prophy" who has one or more areas of periodontal infection, just imagine being able to take a couple of minutes at the end of the appointment to offer an endoscopic look at those infected areas. When the patient sees and understands the situation, recommend appropriate perioscopic treatment and get it scheduled. No need to try to slip in a little scaling and root planing when they aren't looking! It never works. They just think you're rough!

The Perioscopy System costs $300 per month. It's like buying a car. Adding a single $300 perioscopic treatment to your production each month to treat one of these non-responding or recurrent areas of infection will pay for it.

If I had my own dental hygiene school, every student would pay a technology fee to provide for these new innovations. Just imagine learning to instrument subgingivally by seeing the root surface, the pocket wall, and the curette in action. Not just seeing it, but seeing it enlarged 20 to 40 times the actual size! What about teaching prevention through early intervention? Sulcular areas producing volatile sulfur compounds need attention now, not after attachment is lost. To teach without the new technology is like teaching dentists with only slow-speed handpieces! It doesn't make sense. Students should appreciate the past, but learn for the future.

This is just the beginning of the dental hygiene technology revolution. It's time for us to catch up with the rest of the world. The changes may be so exciting and dramatic in the next decade that we won't even recognize the old "prophy" anymore. It really is an exciting time to be a hygienist!

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