Dentaltown April 2013 - (Page 106)

hygiene and prevention profile in oral health by Trisha E. O’Hehir, RDH, MS Hygienetown Editorial Director Past 1960-1985 Scientific Basis for Periodontal Treatment Calculus was considered the cause of periodontal disease in the 1960s. It was viewed as a mechanical irritant to the tissue and removal was considered the primary treatment for periodontal disease. This was followed by the “non-specific plaque hypothesis” that suggested plaque was the primary etiological factor and all plaque was bad plaque. It was the amount of plaque that caused disease. No research was able to prove this, as some patients had so much plaque they deserved disease, but didn’t have any pockets. And others had very little plaque on their teeth, but the connective tissue and bone seemed to be melting away. Plaque was considered “white sticky stuff ” on the teeth made up of bacteria and it was stained red to show patients where they missed with brushing and flossing. It wasn’t until dental offices in the 1970s began using Phase Contrast Microscopy that clinicians actually saw the bacteria as living, growing, multiplying creatures. This enhanced the clinician’s view of plaque, captivated some patients and frightfully scared others. It changed the focus from just calculus removal to the importance of daily plaque removal. It was in the 1960s when Dr. Bass, having lost a tooth to periodontal disease, studied and published his findings on the importance of daily plaque control using his Right Kind toothbrush and dental floss. Next came the “specific plaque hypothesis” that suggested just one bacteria was responsible for periodontal disease. In the 1970s it was widely believed that the identification of a specific bacteria responsible for periodontal disease would be discovered and a vaccine would be developed to eliminate both periodontal disease and the dental hygiene profession. Who would need hygienists if periodontal disease no longer existed? During the 1980s, periodontal researchers were on a quest to identify pathogens within plaque. Each month the periodontal research journals heralded the discovery of yet another pathogen thought to be the “one” responsible for periodontal disease. Identification of bacteria within plaque was done with Scanning Electron Microscopy. Plaque samples are placed on a slide, dried, sputtered with gold and evaluated to identify bacteria. As the 106 APRIL 2013 » months grew to years, it became known as the “bug of the month club” as more and more pathogens were identified. Periodontists identified six to eight potential pathogens among 500 identified species in plaque and research never confirmed one specific bug responsible for gingivitis or for converting gingivitis to periodontitis. With a top-10 list of bacteria identified as the virulent pathogens, the research turned to the episodic nature of the disease. Periodontitis was characterized as having periods of quiescence and periods of disease progression. Dental Hygiene Education Dental hygiene education in the 1960s focused on supragingival deposit removal. Periodontal disease was identified by holding the radiographs up to the light to determine bone loss. Severe, generalized bone loss on the radiographs was a conclusive diagnosis of periodontal disease and these patients were referred to the periodontal department where periodontal probing was done. Probing was not done in the hygiene department. Hygiene students did see periodontal patients for calculus removal, since calculus was the enemy and had to be removed. Power scalers were used only on the toughest cases, followed by extensive hand instrumentation to achieve glassy smooth root surfaces. Power scalers were used for a single pass around the mouth to remove only gross deposits. The bulk of the instrumentation was done with curettes. The importance of calculus removal carried over to the state board examinations requiring, still today, removal of a specific number of calculus deposits. In the 1960s calculus was considered a mechanical irritant that caused periodontal disease.

Table of Contents for the Digital Edition of Dentaltown April 2013 Highlights
Howard Speaks: What Winners Do and Losers Don’t
Professional Courtesy: Three Cheers for IT
Continuing Education Update
Dentaltown Research: Lasers
“Funny Feeling” on Lower Right Jaw
Missing Laterals, Bonded Maryland Bridges, Ribbond or Something Else?
Corporate Profile: Henry Schein
New Products
Office Visit: A Giant in Dentistry
Do-it-Yourself Finance, Part V: Insurance
Two Techniques to Make a Bite Record for a Full-arch Case
Team Strength: What Drives Your Team to Do More?
Living by the Golden Dozen
Diagnosing Aesthetic Disharmonies
Cosmetic Case Presentation
Using Tetric EvoCeram Bulk Fill to Easily and Predictably Place Direct Posterior Restorations
Continuing Education: Utilizing Laser Procedures for Restorative Access
Product Profile: Imaging Sciences International’s i-CAT FLX
In This Issue: Preparing for the Future
Perio Reports
Ad Index
Profile in Oral Health: The RDH’s Approach to Periodontal Therapy: Past, Present and Future
Perio Maintenance
Dentally Incorrect
Dentaltown Special Supplement
Product Profile: Zimmer Dental
Full Lower – Converted to Immediate Load
Immediate Placement #19 and 20 with BSB
American Academy of Implant Dentistry 62nd Annual Meeting Preview
Raising Your Denture Patient to a Higher Standard
Back to the Future – Extractions and Small Diameter Implants for Overdentures
Continuing Education: Top Implantology Breakthroughs for the GP: Part 2

Dentaltown April 2013