As dentistry continues to evolve, we discover many reliable sources of information and research. Research is available at our fingertips now, much unlike my college days. Back then, all research information was located in dark and dusty periodical stacks. Internet resources, such as PubMed, and online access to our professional journals are as dust-free as the room where our personal computers are. In addition, copies of our professional publications also arrive at regular intervals in the mailbox.
There is no excuse for any dental hygienist to use a phrase that makes my blood boil: “My dentist said ...” We must stop giving so much credence to a DDS or DMD behind a person’s name. How did the dentist become “mine” in the first place? Even on eBay, where you can buy anything, there are no dentists for sale. Simply ,put, you cannot own a dentist.
During my college years, the science stated that periodontal reattachment could only occur in the presence of a glassy smooth root surface. We were taught to remove all the plaque and calculus as well as the diseased cementum layer. Today, science gives us biofilms, specific pathogens, and the host response as indicators of successful treatment. Reattachment terminology has been replaced by the concept of disrupting the biofilm to create an environment of fewer pathogens. If the host is able to effectively deal with the pathogens, healing will commence.
In fact, the quest for a glassy smooth surface has given us the all too common “hourglass shaped” root. It’s a shape that worked for Marilyn Monroe but is seldom associated with periodontal health.
“Over-scaling” is only one area where the line between science and science fiction is blurred. Take soda as another example. For many years, we have been taught that soda is the dental enemy. Drinking this evil concoction can lead to demineralization, dry mouth, caries, and disapproving glares from your dental professional. Yet, recently I have read an article stating that soda gets a bum rap. According to these “authorities,” soda drinking is not the direct cause of all the dental damage. These authors contend that fruit juice is as big a culprit in dental disease as any soda on the market, and good oral hygiene can overcome any beverage. Who is presenting science? How many of us actually take time to find out the correct information for ourselves? How many of us believe whatever theory that best fits our idea of common sense?
The blurred line has invaded our core beliefs and ideals. Fluoride, once thought to be the cure-all for caries, is now questioned on its ability to harm life. Once-valiant fluoride proponents are now calling for the removal of fluoride from our water systems. Many question the effectiveness of in-office fluoride treatments. Just a few short years ago, some research pointed to stannous fluoride as having superior anti-bacterial properties over other forms of fluoride. Some of those same researchers today no longer promote that theory. When did the science become fiction, or did it? Recently I read that salt fluoridation may be the best way to make fluoride available to the public and help reduce tooth decay.1 All this reading makes me wonder if fluoride is safer when delivered in salt rather than water, or if it is harmful in the water system in the first place.
In June 2004, many of us sat in a lecture and heard a very articulate woman tell everyone that Listerine had been proven as effective as flossing in reducing plaque. In 2005, I received a letter telling me that a judge had determined her statement to be untrue. The ruling leaves us to wonder where the judge found his information, and if his source actually read and dissected the research. Today, I still don’t know whether the judge or the articulate woman is the authority on this matter. It is up to me (and each of you) to extract the science from the fiction.
Opinions are important, and clinical experience is paramount in our decision-making, but when you are telling the dentist you work with why you will no longer be polishing every patient, you better have some solid science to back you up. When discussing your preference for ultrasonic or hand instrumentation, your argument will be more powerful with research in hand. I am not suggesting we never listen to our peers or ignore their advice, but make sure you know where the information originated. Most continuing education presenters would be thrilled to have well-thought-out, science-based questions from an audience member. Be that person and you will be amazed at how much respect you gain as a professional. Of course, remember to use moderation, as I can tell you from personal experience that too much questioning can lead to a title somewhat less appealing than “professional.”
It is not always easy to determine if information is science or science fiction. You need to look no further than all the spam in your email folder to know we are a gullible people. The same poor fellow has had headlights flashed at him “just yesterday” for more than two years now, and half of America is still afraid to use a cell phone at the gas pump.
Since we are treating patients who rely on us for correct science and not fiction, we need to make time for detective work. A good place to start your detective work is in the research itself. Take note of who paid for the research. If research was sponsored by a manufacturer, find out if any other independent sources have been able to duplicate the results. If you find many resources that are negative about a product or theory and suddenly a positive article pops up, find out how the research was conducted.
You can make effective use of limited time by using an online research tool such as PubMed Medline. The Web address is www.ncbi.nlm.nih.gov, but the site can usually be accessed by simply typing PubMed into your search engine. Once at PubMed, you can enter keywords to find research. There is an instruction area that will help you refine your search to limit the number of articles returned, but I have found trial-and-error to be a good teacher.
If you live close to a university, browsing the periodical stacks can make for a fun and interesting afternoon. Resource librarians are available who are often thrilled to help you find your way around. It may be dusty, but you will feel like a true detective. Remember that there are many types of sources available for your detective work. Don’t just look at reviews or tutorials - find a study that used a control group, and always be on the lookout for a systematic review of the literature.
Science fiction is entertaining and a good way to spend an afternoon. You might even bring science fiction to the office in the form of posters or waiting room books, but stick to the facts when discussing scientific truths with your patients or co-workers. Question the dentist you work with on ideas presented, and occasionally question your own ideas and practices. Remember that being wrong now and then is nothing less than a growth opportunity. You can always see more when you are standing on the edge.
1 Promoting Oral Health: The Use of Salt Fluoridation to Prevent Dental Caries. Pan American Health Organization.
Lory Laughter, RDH, BS, practices in Napa and Sonoma, California, in both general and periodontal offices. She is a partner of Dental IQ, a team committed to arranging quality continuing education opportunities for Northern California. Through her involvement with Dental Hygienists against Heart Disease and other organizations, she hopes to bring a total health concept to the dental practice. You may contact Lory at: [email protected].