Dr. Fones: Following his vision in 2018’s dental hygiene

The founder of dental hygiene believed in collaboration and, yes, working outside of the dental office

It is vitally important to understand the history of something when developing a solution for an issue. Dental hygienists should always research the history of topics in which they’re engaged because this can teach so much about the process and explain the “whys.”

When planning for dental public health programs, it’s important to remember the founder of dental hygiene, Dr. Alfred Fones’ initial paradigm for the profession. This paradigm focused on a new preventive dental care provider who worked outside of the dental office with the intention of motivating people to obtain comprehensive dental care by a dentist.

A photo of Dr. Fones from Fones School of Dental Hygiene, University of Bridgeport, Bridgeport, Connecticut.

Dr. Fones saw dental hygiene as a distinct profession that would be positioned within dental public health, and he believed that dental hygienists should provide education and preventive treatment outside of the dental office. Dr. Fones envisioned dental hygienists working collaboratively with other health and social service workers to provide preventive dental care to the public.

He stated that health education should be carried out by specially trained and educated teachers, and that dental hygiene was, in fact, created for this type of service.1 He further stated that because dental disease and resultant systemic infections were almost universal maladies, trained workers for maintaining mouth health were essential. The present need of the dental profession to solve the public health problem of mouth hygiene means dental hygienists should be competent to enter public schools, dental offices, infirmaries, public clinics, factories, assisted living facilities, and other institutions to care for the mouths of the millions who need these educational services.1 (Figure 1)

A guide for dental hygienists

Author’s table visually links up systemic conditions

For the last several months, I’ve been writing about the oral-systemic link between periodontal disease and several systemic diseases. This month, I want to provide readers with a reference guide of how these diseases link with periodontal disease and the information that can be useful for hygienists while treating their patients.

With those patients who have periodontal disease, we’ve been seeing how the inflammation of their gingival tissue can affect other systemic disease processes. Use this guide to ask more in-depth medical history questions. We need to concentrate on explaining the inflammatory process to our patients. This explanation can help patients understand how their oral health might affect the other disease processes they’re dealing with. It may be a way to encourage them to take better care of their oral health and take your suggestions more seriously.

With the US population living longer and many people keeping most of their teeth, diverse health issues and periodontal disease will be a topic we’ll be dealing with more in our practices. We need to make sure that our patients understand that their periodontal health truly does affect their overall health.

Becoming collaborative partners with other medical professionals will become increasingly more common as the medical field continues to make the link between the mouth and the rest of the body. Asking more in-depth medical history questions will help us know more about our patients’ overall health so we can better serve them. One of the tools we have at our disposal is salivary diagnostics testing. By doing in-office saliva testing, we can help decrease the inflammatory burden that many of our periodontal patients experience.

Sacramento is a nice place, I hear.

Mark Hartley

I have traveled so often to California that it’s hard to remember the destination of every visit. I don’t believe I’ve seen Sacramento, though. I think I would have remembered the Tower Bridge. I admire the engineering and architectural designs that went into older generations of bridges. The Tower Bridge has vertical lifts to enable boats on the Sacramento River to pass underneath. Two towers rise up to more than 160 feet into the air. I would have remembered Sacramento.

The offices for the California Dental Hygienists’ Association sits in a cluster of professional office buildings—pretty much similar to what you find in any city—about five miles northeast of the state capitol buildings. It’s a little ironic that the street address is Point West Way, since many significant events in dental hygiene over the last 30 years prompted the rest of us to look west, particularly within the last three years.

I’m pretty sure I’ve never driven down Point West Way, even if I’ve passed through Sacramento at some point. We all should pay a visit to the CDHA headquarters. We can also visit the Tower Bridge, Sutter Creek, Tower Bridge, Crocker Art Museum, and, of course, the capitol on the way out of town.

Don’t get me wrong. The state’s dental hygienists withdrew from the American Dental Hygienists’ Association in June 2016, and it still bothers me a bit. The importance of unity within the ADHA community is as important as it ever was. California’s absence is a shame for both financial and political reasons. It just doesn’t sound right to say the ADHA has the support of 49 states. Any outsider in a position of influence for the profession could think, “Only 49? Have you, uh, miscounted? You meant to say 50, right?”

Implant care: Two dental hygienist team up for CE company

Seminars presented by Healy and Obrotka explain the importance of implant maintenance

With implant surgical and restorative markets forecasted to reach $12.32 billion by 2021, dental professionals will encounter patients who are either candidates for implants or have implants currently. Do you know what to expect with a patient with implants and how to decide whether the area is healthy or exhibits peri-implant disease? With the increased incidence of peri-implant diseases, implant maintenance is an important aspect of total implant care and long-term success.

Maintenance protocols vary but Shavonne Healy, RDH, BSDH, and Melissa Obrotka, RDH, BBAOM, have developed a company, RDH Innovations, that provide strategies for safe, effective implant maintenance care and information. Their programs include:

  • “Dental Implants Uncovered: Prevention, Detection and Intervention”
  • “Are You Prepared to Treat the Terminator? Caring for Patients with Advanced Implant Supported Prosthesis”
  • “A Dental Hygienist in Oral Surgery? Introducing the Implant Care Practitioner.”

The “Dental Implants Uncovered” program reviews:

– The etiology and factors associated with peri-implant diseases

– Froum and Rosen’s peri-implantitis classification system

– Implant surface characteristics and prosthetic design

– Decontamination protocols and combination therapies for the management of peri-implant diseases.

A case for the rubber dam: How the dental dam improves treatment and patient quality of care

How a rubber dam during dental procedures improves treatment and quality of care

The rubber dam is used in dentistry mainly for endodontic, fixed prosthodontic (crowns and bridges), and restorative procedures.

A dental or rubber dam, also known as a Kofferdam, is a thin, six-inch, latex or nitrile square sheet that is used in dentistry as a shield to isolate one or more teeth from the remainder of the mouth during a dental procedure. The rubber dam is used in dentistry mainly for endodontic, fixed prosthodontic (crowns and bridges), and restorative procedures. Aside from isolating the treatment or operative site, “the purpose of the rubber dam is to prevent saliva from interfering with the dental work, such as contamination of oral microorganisms during root canal therapy, or to keep filling materials such as composite dry during placement and curing, and to prevent instruments and materials from being aspirated, swallowed, or damaging the mouth.”1 Consider this analogy: A doctor uses surgical drapes to isolate the area of the body being operated on to prevent bacterial contamination from occurring; this is the equivalent of a dentist using a rubber dam for a dental procedure where isolation is necessary.

The dental dam

The dental dam is detained over a single tooth or multiple teeth by the appropriate rubber dam clamps over the anchor tooth. The tooth crowns protrude out from the rubber dam through the individual holes made by a hole punch, isolating the tooth to be treated from the rest of the patient’s mouth. This keeps the tooth dry and reduces the risk of exposure to microorganisms. Listed below are several advantages and disadvantages of using a rubber dam during a dental procedure.2

The dental dam is detained over a single tooth or multiple teeth by the appropriate rubber dam clamps over the anchor tooth.

The advantages of using a rubber dam:

  • enhances visibility of the treatment site since the dam retracts the cheeks and lips

Infection prevention: Control aerosols when using an ultrasonic scaler or air polisher

Devices can help control aerosols during patient treatment

Dear Dianne,

I heard a talk about infection control recently, and the speaker described the need to control aerosols when using the power scaler and air polisher. He said the best way to accomplish that would be to have someone suction while I work. I do not have that luxury. Of course, I always use the saliva ejector to control pooling water, but I know it does little to control aerosols.

In a lecture you give, you talk about several different options for controlling airborne pathogens. Could you revisit that subject? What about my hair? Does a hairnet keep airborne pathogens out?

Brittany

Hi Brittany,

We know that pathogens come from two sources: the patient and dental unit water lines. We also know that aerosols, or tiny microdroplets, are created when we use instruments such as power scalers and air polishers. Aerosols are measured in microns. One millimeter is equal to 1,000 microns. If an aerosolized particle is 0.5 microns, 2,000 particles could fill the space of one millimeter. Particles this small can pass through a standard face mask.

In a literature review conducted by Harrell, et al., which looked at blood in aerosols and splatter found that 100% of samples collected during ultrasonic scaling contained blood.1 According to Stephen K. Harrel, DDS, blood in aerosols and splatter “may represent a surrogate marker for pathogenic organisms and thus create an infection control risk.”1 Herpes simplex viruses, hepatitis viruses, and MRSA can be present in the mouth. It is logical that these organisms will be forced into aerosols resulting from the use of an ultrasonic scaler. This explains why aerosols should be controlled to the greatest extent possible.

Toothbrushing: Infection contol in the school setting

Infection control practices, though, may be missing from the lunchroom

I walked into the school cafeteria. It looked like a plume of dust was rising. It wasn’t until I heard that familiar tune, “Well, you wake up in the morning. It’s a quarter to one and you wanna have a little fun. You brush your teeth…” that I realized what was happening. Over a 100 children who just finished lunch were brushing teeth all at once. Two boys were “dulling” toothbrush swords. Two girls declared they were trading toothbrushes; one wanted the Trolls toothbrush and the other one wanted the Minnie Mouse toothbrush.

The intention of this afternoon brushing program was noble; the action may be doing more harm than good.

I discussed the issue with the school nurse and soon found out that many times not even the school nurse is aware of the contagious nature of dental diseases. I gave the nurse the example of dental caries. I explained this is the simple most common chronic childhood disease. It is a contagious infectious disease. Family members, caregivers, and even playmates can transmit caries producing oral bacteria. This can happen by sharing a spoon, kissing, and even wiping off a pacifier that has fallen on the ground in the mouth.1,2,3 The nurse was shocked. She said she had no idea.

In the school setting, the Centers for Disease Control and Prevention takes a strong stand in this area on the need for both a protocol and a high level of supervision. They state that the likelihood of toothbrush cross-contamination in the school setting in toothbrushing activities is very high. Improper storage and children’s behavior can have a big impact. There is also a small chance exists that toothbrushes could become contaminated with blood during brushing (gingivitis, trauma, etc.).4

Collaborative care: Michigan dental hygiene school sends interns out into the medical community

Ferris State searches for ways to initiate oral health as part of collaborative care

Providers and students from optometry, pharmacy, nursing, social work, and dental hygiene gather together at Ferris State University’s Interprofessional Wellness Clinic to discuss ways they can integrate oral health into an existing program that serves diabetes patients.

Providers and students from optometry, pharmacy, nursing, social work, and dental hygiene gather together at Ferris State University’s Interprofessional Wellness Clinic to discuss ways they can integrate oral health into an existing program that serves diabetes patients.

According to Oral Health in America: A Report from the Surgeon General, “all care providers can and should contribute to enhancing oral health.” Now that the medical community has finally embraced the oral systemic link as a care gap in their treatment, hygienists are being considered as affordable educators and disease screeners in health-care systems nationwide to improve health outcomes.

Confidence starts in school. What better place to prepare students to be part of the collaborative care model. Even so, are our dental hygiene program curriculums including this model in their teaching methods? How can current clinicians collaborate in their communities? There are exciting projects going on now that are making a difference in disease by integrating hygienists into collaborative care teams.

2018 Heart to Hands Award: Hygienists use video to explain how they deliver oral health messages

With videos, three hygienists highlight how dental hygiene continues to shape their destiny

 

Editor’s Note: Some of you may have arrived at this link due to a reference within the April 2018 issue of RDH magazine. If so, you are at the right place. The videos for the three award recipients are below. You may have read the article elsewhere, but please scroll down until you can see and play the videos. If you have stumbled across this article quite innocently, we hope you enjoy the article and videos.

The “safe” environment in dental settings, oral health education in the hospital setting, and anecdotes about villagers in Uganda will receive some quality video time during the second annual Heart to Hands award this June.

In a ceremony during the American Dental Hygienists’ Association’s annual session, dental hygiene leaders will watch and salute the award-winning Heart to Hands videos submitted by Mandi Bauer, RDH, Dara McConnell, RDH, and Rachel Bellon-Roxas, RDH.

Bauer, a dental hygienist in Jonesboro, Ark., offered the most global view in her video, sharing how preventive care in Uganda struggles to overcome tribal traditions. Bellon-Roxas is a Canadian recipient of the award, and she explained in her video “the value of being proactive with dental care is a lot more valuable than being reactive.” The final recipient, McConnell, practices in Maryland, but on a monthly basis she dedicates time to providing care to underprivileged children in six Maryland counties. The trio described their visions in videos that were approximately two minutes long.

Supra- and subgingival polishing transform preventive care

Glycine powder appears to inhibit bacterial recolonization on implants

Our role as dental hygienists includes preventing the progression of disease. Traditionally, we remove periodontal pathogens and biofilm both subgingivally and supragingivally through hand and ultrasonic oscillation. However, removing calculus and biofilm through debridement, repeated instrumentation with hand and ultrasonic technologies can cause gingival recession and loss of tooth structure. Air polishing technology empowers hygienists to effectively remove more bacteria with a reduced risk of gingival trauma.1

Traditionally, polishing is performed with a rubber cup with the intention of removing stain and biofilm. Despite efforts to selectively polish, traditionally removing stain with a cup and prophy cup can lead to abrasion of the tooth.2

Alternatively, air polishing removes tenacious stain and bacteria without adverse effects. Air polishing is a technology that utilizes a jet of compressed air and water to deliver a controlled stream of powder through the handpiece nozzle to remove biofilm.1 Solo air polishing units are typically attached to the handpiece connection on the dental unit. The average water psi on the unit is 10-15, with an air pressure of 60 psi, allowing the unit to dispense a pressure of 58-60 psi.2 The pressure and site-specific powders enable clinicians to remove stain and biofilm in less time with minimal effort. “Air polishing can produce uniformly smooth root surfaces and remove 100% of bacteria and/or bacterial endotoxins from cementum.”1