Summer 2008
Patients | Web Exclusive
The EBD difference in perio
How the facts transform your treatment.
by Rene Stephenson, RDH, BSDH
At its core, evidence-based dentistry (EBD) and dental hygiene is about two things: What we know and what we think we know. At its best, EBD supports or replaces what we thought we knew with facts that allow us to provide optimal care.
For many dental hygienists, periodontal treatment is a huge piece of the care we provide in our practice. How does what we know about treating periodontal disease stack up against new facts and findings?
STARTING FROM SCRATCH
Periodontal disease is a pathogenic bacterial infection caused by the host response. When it increase, gram-negative anaerobic bacteria and other pathogens alter the nature of the biofilm. Supragingival plaque has been found to act as a reservoir for the bacterium, which can migrate into the subgingival space when the host defense is defeated—creating subgingival biofilm. Although there are as many as 300 species of bacteria that have been identified in the periodontal pocket, it has been agreed that 30 to 40 species are associated with periodontitis; P. gingivitis, T. forsythnesis and T. denticola are the most common gram-negative bacteria found in the disease sites.
Periodontal therapy is a treatment used to eliminate pathogenic bacterial activity and help arrest the progression of disease in the oral cavity. It enables host recovery by eliminating periodontal pathogens, plaque, and calculus as well as bacterial debris. Disruption and reduction of subgingival plaque have been suggested to be the clinical keys in periodontal therapy. Calculus removal is essential as it provides sites for the bacteria to adhere and threatens the periodontal stability and health of the treated sites.
Treatment for periodontal disease, however, has changed because of evidence-based information.
PERIO: MAN VS. MACHINE
Evidence-based periodontal therapy consists of clinical recommendations developed through evaluations made using the collective body of evidence, providing practical applications of scientific information that can assist during clinical decision-making.
Some of the most current changes in periodontal practices due to EBD include the use of ultrasonic scaling as an effective and efficient means of removing subgingival biofilm, calculus deposits, periodontal pathogens, and debris.
The objective in periodontal therapy consists of making the root surfaces biocompatible and smooth upon completion of scaling. This greatly reduces the risk of recolonization and subgingival biofilm adhesion and retention on biocompatible surfaces. Great clinical skills are imperative to achieve satisfactory results during hand instrumentation. Although both hand instrumentation and ultrasonic instrumentation are effective in the removal of subgingival biofilm, instrumentation appears appear to cause more root surface damage than ultrasonic scalers used at a medium power setting. The use of hand instruments can be wearing and ergonomically unsatisfactory, and require highly repetitive, intricate, and complex hand movements, while the ultrasonic scalers are as effective but require less effort.
Another way evidence based information effects the way we practice dental hygiene is by defining the risk factors associated with periodontal disease. By knowing the risk factors, such as smoking and periodontal disease, we are more likely to encourage our patients to quit smoking with the help of a tobacco cessation program. We understand the effects of smoking on the oral cavity, and the potential increase in periodontal disease.
A COMMON GOAL
Our goal as healthcare professionals should be to practice EBD by familiarizing ourselves with vital information and identifying the needs of individual patients. We must be able to critically assess the evidence found in studies of periodontal disease, caries risk, fluoride application and more—all in order to determine those studies’ usefulness and validity and to be able to apply those findings to the patient in the dental chair.
Rene Stephenson, RDH, BSDH, has been a clinical dental hygienist for 22 years. Rene has served as Texas Dental Hygienists? Association vice-president and various council chairs. In 2006, she began a degree completion program at East Tennessee State University, which she completed in May 2008.
Your sources
Successful EBD is based on good information. Where can the eager dental hygienist go to find new and relevant studies?
Believe it or not, a study was actually done “to characterize evidence-based informational resources utilization patterns of a sample of general dentists with respect to clinical decisions regarding posterior composite restorations.”
This study took a random sample of dentists to find out how exactly they were accessing their information. Surprisingly, it showed that out of 699 dentists, 69.2% responded that “study clubs/CEC and discussions with colleagues were commonly used resources for making clinical decisions” (Haj-Ali et al., 2005). On-line resources were used by 24.9%, almost 60% of practicing dentists relied on peer-reviewed journals, and 41.8% turned to manufacturers’ information as resources.
As a word of caution: When using peer-reviewed journals we cannot assume that the reviewers are skilled in the precepts of EBD. Continuing education (CE) courses and study clubs are only as good as the research presented in them, and CE presenters should clearly reveal their conflict of interest in a particular subject (Haj-Ali et al., 2005).
Some reputable sources you should consider include, but are not limited to:
* Cochrane Collaboration
* PubMed
* The CINAHL database
* American Academy of Periodontology
* American Dental Association
Resources
Collins, F., & Veis, R. (2006, Nov.). Periodontal treatment: The delivery and role of locally applied therapeutics. Dental CE Digest, 3(4), 14-20.
Haj-Ali, Petrie, C., Reem, N., Strain, T., & Walker, M. (2005). Utilization of evidence-based information resources for clinical decisions related to posterior composite restorations. Journal of Dental Education, 6 (11), 1251-1256.
Hanes, R., Richardson, D., Rosenberg, W., & Sackett, D. (1998). Evidence-based medicine: how to practice and teach EDM (pp.15-16). Churchill Livingstone: Edinburgh.
Maeda, K., Nakagaki, H., Ogura, Y., Okamoto, Y., Suzuki, S., Tokudome, S., et al. (2006, March). Effects of smoking and drinking habits on the incidence of periodontal disease and tooth loss: Among Japanese males: A 4-year longitudinal study. Journal of Periodontal Research, 560-566.
Reynolds, E. (2006, Nov.). Effectiveness and efficiency in ultrasonic scaling. Dental CE Digest, 3-15.
