Respiratory diseases: Do breathing issues signal complications caused by periodontal disease?

By Jannette Whisenhunt, RDH, BS, MEd, PhD

Most of us have treated patients with respiratory issues such as asthma and chronic obstructive pulmonary disease (COPD). When we treat patients who have breathing issues, we remember that we have to sit them up a little more in case they have a difficult time lying flat in the chair. Another very common thing we are familiar with is that certain inhalers, particularly those that contain steroids, can cause oral fungal infections, so patients should always rinse their mouths out after inhaler use to decrease this chance. But did you know that there is an oral-systemic link between periodontal disease and some other serious respiratory issues? Periodontal disease bacteria may contribute to a higher risk of COPD in patients with respiratory depression and to a higher risk of pneumonia in patients who are hospitalized.

You know to teach patients to take care of their oral tissues, but do you discuss the potential of periodontal disease to impact their breathing issues? I don’t think many of us think of that when we are going over our patients’ medical histories. We should focus on it more, and we should look at the whole patient and all of his or her medical issues. As dental hygiene professionals, we need to increase our knowledge about the various inflammatory diseases our patients have in order to know how these disease processes may be aggravated with the bacteria from their periodontal disease.

Patients who have advanced respiratory issues are more susceptible to infections from periodontal disease bacteria.1 Several studies have examined whether periodontal disease correlates with a higher risk of COPD, and the results have been mixed.2 Many studies have verified that there is a direct link between periodontal disease bacteria and hospital-acquired pneumonia, an infection of the lungs contracted during a stay in the hospital or a long-term care facility.3

Turmeric in oral health: Benefits are touted on social media, but research results are limited

By Amanda Dutra, BSDH, Leslie Briceño, BSDH, Jackie Dent, BSDH, and Kathryn Bell, RDH, MS

Within the last several years, a growing interest in all-natural medicines and products has surfaced on popular social media sites and marketing agents, such as Pinterest and Livestrong. Social media continuously draw attention to the alternatives to traditional medicine. Turmeric has become a commonly recommended agent on these sites.

Turmeric has been touted to boost cognitive function, fight inflammation, support cardiovascular function, promote youthful skin, support joint and muscle health, boost detoxification, promote healthy mood balance, and support natural weight loss.1 Additionally, these sites also propose the use of turmeric as a tooth whitener, remedy for toothaches, and as an adjunct in tightening gums and healing gum inflammation.2

Turmeric is a widely used plant in Eastern medicine and is indigenous to Southeast Asia and cultivated in India.3 Turmeric belongs to the ginger family and is derived from an herb called the Curcuma longa. The active ingredient, curcuma, originates from the rhizomes of the Curcuma longa. The terms curcuma, curcumin, and turmeric are often used interchangeably. Curcuma or turmeric is typically orange with a rootlike structure. It can be found in various forms such as a dry yellow powder, tablets, or a liquid extract.

Its bitter yet slightly sweet taste is why turmeric is most commonly used as a fresh spice.3 However, research on turmeric also claims a wide spectrum of therapeutic effects such as anti-inflammatory, antioxidant, antibacterial, antiviral, antifungal, and wound healing.4 Many developing countries rely on natural remedies such as turmeric for health care.3

Considering these recommendations are highly visible on social media, it is important to evaluate the current research supporting these oral health outcomes. The purpose of this article is to summarize the available literature regarding the use of turmeric for oral health benefits.

Dry comfort: A variety of factors impair salivary function in an aging population

By Jamie Collins, RDH, CDA

The Silent Generation and baby boomers are getting older, and even those in Generation X are feeling the aches and pains of aging. Age and wisdom are often accompanied by health concerns and ailments treated by two, three, or more medications. These medications can contribute to xerostomia, among other potential side effects.

Clinically we do our due diligence when we seat a patient and update the person’s medical history at every appointment. It never fails to surprise me how many patients do not know what medications they’re taking or for what reasons. I’ve learned through trial and error that my questions must be specific and include verbiage that pointedly asks about medications and surgeries. Often, in patients’ minds, “any changes” does not include changes unless they’re related to the oral cavity.

Educating individuals about the oral-systemic link and whole body connection, and informing them about risk factors, are essential to help them think beyond what they were taught early in life. My grandmother was of the generation that went to the dentist only when there was pain, and her visits usually ended with the extraction of one or more teeth. In my clinical experience, the elderly tend to wait for pain rather than focus on prevention. Changing that mindset is not easy, especially when it’s combined with fear of the dentist.

Long gone are the days when a medium or hard toothbrush was the standard, and I’ve often heard patients complain how they’re unable to find a hard brush anymore. While I’m cringing when I hear patients want a hard brush, I am also rejoicing that retailers are not selling them anymore. Education, education, and more education is needed to speak to patients about the risk factors of abrasion and about ideal homecare techniques. Changing the perception of a generation raised on hard brushing and going to the dentist only when something hurts is no easy task. However, for many patients, the brushing and flossing are just the tip of the iceberg. The biggest risk of declining oral health often comes in the form of xerostomia (see sidebar).

Why palpation is so important: Early detection of oral cancer still depends on correct technique

By Nancy W. Burkhart, BSDH, EdD

I recently attended the Donald Kerr Symposium at the University of Michigan. The theme was, “Personalized Medicine in Oral Cancer.” The seminar had some notable speakers, and I wanted some updates about the human papilloma virus and its role in oral/pharyngeal cancer.

Other topics included valuable information related to the complete treatment of oral cancer patients by head and neck surgeons, ranging from identification of oral/pharyngeal cancer through the actual treatment phase. All of the speakers were excellent and so knowledgeable about HPV and oral cancer.

Two speakers expanded upon the importance of the oral exam in early cancer detection and that the exam is a key factor leading to an early diagnosis – one of the most important components being intraoral and extraoral palpation. One participant asked some specific questions about how one should palpate during an oral exam. I remember thinking that there are probably many dentists and hygienists who really do not know if they are performing this task in the most beneficial way. This is especially crucial regarding pharyngeal cancer since palpation is essential to early detection for this type of cancer.

Carol Bradford, MD, demonstrated on someone close by and suggested some techniques that she felt could be beneficial. Dr. Bradford also stressed the point that these types of cancers are not usually detected early in a medical office but rather in a dental office. She also raised the question of whether we might see dental personnel administering the HPV vaccine since patients are seen more often by dental professionals than medical professionals.

Another speaker, Dr. Mark Lingen, mentioned that a thorough oral exam surpasses any other device that is currently on the market. In the case of HPV, a few signs are known to occur:

  • Swelling and nodules in the salivary gland areas such as submandibular and sublingual glands
  • Pain, discomfort, or tenderness extending into the auricular area
  • Some lesions may be detectable toward the base of the tongue

Because of the extensive tonsillar crypts, there is little to no warning of tissue lesions/ulcerations until the cancer is more advanced in tonsillar cancer. But, palpation is often able to detect the nodes that have been invaded and these nodes often feel firm or hard.

Caring for oral cancer patients: Hygienists can adjust dental treatment protocols

By Kathryn Gilliam, RDH, BA

As dental professionals, we’re in a unique place to serve our patients during challenging times. We see them more often than their physicians do, and we often have deeper personal relationships. Because of this intimacy, we have the opportunity to help those who are fighting oral cancer in a very practical day-to-day way. We can give both professional and personal support that can make a significant difference in their ability to survive this devastating disease.

Before medical treatment

Perhaps you were the one who discovered the signs of oral cancer in your patient. If so, you have the opportunity to prepare the patient before treatment starts. Your part in their treatment is a quality-of-life issue as oral cancer and its treatment affects all aspects of a patient’s life.

If possible, prepare a comprehensive dental assessment before medical intervention begins. If potential issues aren’t addressed before medical treatment begins, they could cause very serious problems later1 (see sidebar titled, “Prior to cancer treatment”).

During and after medical treatment

Be extremely empathetic to cancer patients, because they are suffering. They can’t eat or swallow even saliva – if they have any – without pain. They can’t speak comfortably. Sometimes even breathing is painful if their mouths are ulcerated and dry. Often, at this point, they are not social. It’s very uncomfortable to interact with others when one can’t speak or eat. To help your patient, offer products to increase comfort and protect against further mucosal breakdown, as well as prevent caries and periodontal infection.

Several issues arise for an oral cancer patient that you can help alleviate including pain, mucositis, xerostomia, nutritional challenges, and psychosocial issues. The side effects must be cured or alleviated so the patient can continue cancer treatment (see sidebar titled, “Guidelines for pain control during cancer treatment”).

In harm’s way: Breaches in infection control protocols are baffling, seemingly contrary to our vows

By Lory Laughter, RDH, BS, MS

There aren’t many things in life that baffle me anymore. When you’ve lived over half a century, the uncommon becomes commonplace. I’ve always considered my acceptance of every level of weird as a good thing, even, perhaps, as a bit of maturity showing. I’ll admit I still struggle with the ideas of adults who don’t flush public toilets and people who swim with sharks, but other than that, my head does not shake much. That is, until the recent events regarding dental hygiene programs and private dental offices showed an almost uncaring attitude for patient safety. I do not make this statement lightly and the blame does not lie solely with these entities.

I remember a ceremony around the time of my graduation during which we repeated an oath as new health-care professionals. I don’t remember all the words as it was over 23 years ago, but I distinctly recall a reference to serving the public and making the health needs of the population a top priority. As I am sure most dental professionals, including educators, dentists, and assistants, take a similar oath, it confuses me when information comes to light showing a total disregard for patient safety.

Today I read a rant on social media about a dental office with a nonfunctioning autoclave. The obvious answers to their dilemma appear to be a) cancel patient treatment until the autoclave is repaired and spore tested, or b) use the autoclave of a nearby friendly office and perhaps postpone some patient visits in order to accommodate the break. Instead, the dentist-owner took dirty instruments home and boiled them in a pot on his stovetop for 20 minutes. Many dental hygienists who commented on social media were disgusted and appalled, and rightfully so. Yet, a few were OK with the idea in the short term, although their replies were quickly deleted. Several mentioned an OSHA violation, which it probably is, but more importantly, it should come to the attention of the health department because patient health is at risk.

Being careful with nitrous: Limit exposure risks with the use of nitrous in the dental setting

By Noel Kelsch, RDH, RDHAP, MS

There are simple things we do on a daily basis in the dental setting that keep us all out of harm’s way. Sometimes we just get into a routine and do not see the impact of harmful things being overlooked. Three things are there to keep you and your patient safe: engineering, administrative, and work practice controls. There are steps using these concepts that have been recommended for many years to minimize exposure to nitrous oxide (N2O) during dental procedures.

It has long been known that delivery of nitrous oxide to patients can expose dental workers to this anesthetic gas, which does have an impact on the clinician. This can range from short-term behavior to long-term reproductive health impacts. It has been shown in several studies that acute exposure to nitrous oxide may cause a variety of symptoms for the clinician, such as lightheadedness, eye and upper airway irritation, cough, shortness of breath, and decreases in mental performance and manual dexterity. Chronic exposure to high levels of nitrous oxide among female dental assistants who worked in offices where scavenging equipment was not used was associated with an increased risk of spontaneous abortion and reduced fertility. Occupational exposure to nitrous oxide has also been associated with an increased risk of neurologic, renal, and liver disease.1-3

The National Institute for Occupational Safety and Health (NIOSH) recently conducted a web-based survey of dental professionals including dentists, hygienists, and assistants with 284 respondents, to look at their compliance levels in use of nitrous oxide regarding engineering, administrative, and work practice controls. To participate in the survey, you had to have administered nitrous oxide within seven days of taking the survey. They looked at those serving adult patients and those serving pediatric patients. The findings were both good and not so good.4

nitrous oxide dental

An old enemy lurking in the shadows: The problems associated with latex products are still with us

By Anne Guignon, RDH, MPH, CSP

Latex allergies need to remain on the radar of all dental professionals, especially those practicing from the early 1990s forward.

First, a history lesson; then, the reality of a continued, potentially life-threatening situation.

In the early 1980s, reports swirled about a dangerous new viral infection that scientists named HIV/AIDS. Ten years later, a television report implicating the transmission of the human immunodeficiency virus to a dental patient hit the airways. The public went wild. People were scared to undergo dental treatment. Dental health-care workers were scrambling for answers on how to protect themselves.

Evolution of PPE

The world of health care turned upside down. The Centers for Disease Control and Infection (CDC) started sending out infection control protocols right and left. Dental supply companies worked as fast as they could to fill the mounting orders of gloves, masks, gowns, disinfecting chemicals, and other barrier techniques.

Dental professionals had to learn to work differently. Seasoned clinicians complained about losing tactile sensitivity, poor glove fit, sweaty hands, and itchy skin. Clinicians heard the public outcry and were worried about their safety. New regulations for personal protective equipment (PPE) soon became the standard of care, and workers learned to adapt. Manufacturers looked for products that would protect from bloodborne hazards and provide increased comfort. No one ever imagined that products health-care workers were required to wear would lead to the demise of their clinical careers.

Most gloves at that time were made from natural rubber latex (NRL), a stretchy material that conformed well to the hand. Wearing a latex glove is like covering one’s hand with a thin rubber-band-like film; compression keeps gloves in place. Workers complained that gloves were hot and hard to don. In response, companies added powder.

latex allergies

Does the dental hygiene profession create a barrier by not pushing for bachelor’s and advanced degrees?

By Christine Nathe, RDH, MS

Much is published about access to care in the dental literature. In fact, access to care and barriers that might prevent populations from accessing care are taught in dental hygiene school. Additionally, legislative initiatives aimed at improving access to care routinely highlight the role of dental hygienists in primary dental care, as well as the integration of dental hygienists in medical settings.

Recently, at a University of New Mexico, School of Medicine (UNM SOM) Health Profession’s Retreat, the keynote speaker, Martha Cole McGrew, MD, who is the executive dean at the university’s medical school, discussed current issues in medical care. What struck me was a statement she made about access to care for patients. She stated that, indeed, professions themselves sometimes create barriers to care. One example she gave was creating a myriad of visits a patient must complete to access physical therapy. This certainly does create a barrier to care. How many times has the complexity and number of visits deterred one of us from accessing medical care?

If this statement about creating barriers to care focused on dental hygiene care, what would the answer look like? How does dental hygiene create barriers to care? More importantly, how do we prevent barriers to care created by dental hygiene?

The first barrier that we help create is the education of future dental hygienists. Do we ensure that all dental hygienists graduate ready to assume roles in public health, with the skill sets to develop positions in primary care clinics, schools and community health centers? I do not think that any dental hygienist would be able to state that, as a profession, we do this. Updating the accreditation standards to ensure competence in these skill sets is mandatory if we want to ensure future dental hygienists can initiate practices in these settings.

Although the American Dental Hygienists’ Association (ADHA) has advocated for an entry-level BSDH degree, some in dental hygiene still oppose this progression. How do we help educate our own members that a well-rounded graduate will help advance our science and practice? The increase in continuing education courses, on both local and national platforms, focusing on the advancement of dental hygiene science, scholarly identity of a dental hygienists and the natural progression of health professions should be a focus of dental hygiene.

Dentists do not want this to come to light; THIS is the method for teeth whitening

Dentists do not want this to come to light; THIS is the method for teeth whitening

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Dentists do not want this to come to light; THIS is the method for teeth whitening

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