According to the Research By: Trisha E. O’Hehir, RDH, BS
Editorial Director, Hygienetown Magazine

The smell of coffee woke me and the rain and wind rattling the window made me shiver. I pulled the comforter up around my chin to savor one more moment of warmth before stepping onto the cold floor. Stig and Heidi were up and the coffee was ready–I must be crazy leaving this warm, cozy cocoon at 6 a.m. on a Saturday to debate periodontal research in my own kitchen. Half of me insisted I should join them for breakfast as the polite thing to do, and the other half really did enjoy a good debate.

That was 1980 in Port Townsend, Washington, where I worked in a general office Monday through Thursday and Stig, a periodontist and his wife Heidi, an orthodontist, drove out from Seattle to provide specialty care on Friday and Saturday. We’d been friends for years, dating back to Minnesota when we were all on the faculty at the U of M, so I enjoyed having them spent spend Friday nights with me. Saturday morning breakfasts often turned into heated debates over various perio topics. Back then, the standard of care was pocket elimination therapy. The research on conservative therapy was just coming out and thus fueled our debates. The Arizona Expanded Functions Program I’d attended was based on the science supporting root planing, surgical curettage and suturing as an alternative approach to surgery. Curettage was definitely a topic of debate, as well as cell level changes resulting from both periodontal infection and therapy–either surgical or non-surgical. Grasping an understanding of the immune response and then arguing about it back then was enough to make me want to crawl back under the covers. Whether or not “non-surgical” therapy was in fact non-surgical was also a hot topic.

Those debates drove me to the research with a vengeance. I wasn’t going to let this periodontist, even though he was a friend of mine, get the better of me. I was ready each week with new evidence to support my stand on the issues. Little did I know that was his primary intent. He wanted me to be confident in what I believed and understand the scientific evidence to support those views. Those debates and searches through the research provided a solid foundation for my future endeavors with Perio Reports. Although sometimes heated, I looked forward to these debates and didn’t mind getting up early on those cold winter mornings. Now, I know you might think I’m crazy to spend so much time reading research, but since I do it, you don’t have to. In each issue of Hygienetown you can read Perio Reports and have the benefits of what might otherwise take you several days to find, read and decipher. To say nothing of the money it will save you in journal subscriptions each year. My two favorites out of the stack of journals I subscribe to now cost over $900.

With 16 years of research summaries now floating around on the hard drive of my brain, I’ve selected the top ten studies I feel have impacted the way I understand the disease process, the way I provide dental hygiene care, and the way I discuss this information with patients. It could be that these are the only ones I remember or have ready access to in my memory, but in any case, these are my “Top Ten”. You may agree with all or some, or you may have an entirely different list. That’s perfectly OK. Stig challenged me to look at my beliefs and philosophy of patient care from a scientific point of view, rather than simply following tradition. I hope to encourage you to do the same. A heated debate would even be welcome. Go to www.hygienetown.com and weigh in with your opinions and your own Top Ten List. There are many variations that make perfect sense and I’m anxious to learn from you. The entire list and the research summaries for each article are now posted on www.hygienetown.com. I’m looking forward to hearing from you.

If you would like Trisha O'Hehir to speak at your next meeting call (480)598-0001 or email trisha@farranmedia.com

 

The Top Ten

Diagnosis and Etiology

Biofilm Structure Identified — Vol 12, #1
Bacterial plaque - now called biofilm, is a sophisticated ecosystem
Costerton, J., Cheng, K., Geesey, G., Ladd, T., Nickel, J., Dasgupta, M., Marrie, T.: Bacterial Biofilms in Nature and disease. Annual Review of Microbiology 41: 435-464, 1987.

Experimental Gingivitis
Gingivitis is reversible
Löe, H., Theilade, E., Jensen, S.: Experimental Gingivitis in Man. J of Periodontology: 177-187, 1965.

Pregnancy Gingivitis and Subgingival Changes
Uptake of pregnancy hormones by bacteria is 4-fold during middle trimester – the oral-systemic connection begins
Kornman, K., Loesche, W.: The Subgingival Microbial Flora During Pregnancy. J of Periodontal Research 15: 111-122, 1980.

Plaque Control

Water Pik® Reduces Infection
Oral irrigation, in addition to regular oral hygiene, provides added clinical benefits
Cutler, C., Stanford, T., Abraham, C., Cederberg, R., Boardman, T., Ross, C.: Clinical Benefits of Oral irrigation for Periodontitis are Related to Reduction of Pro-Inflammatory Cytokine Levels and Plaque. J of Clinical Periodontology 27: 134-143, 2000.

Mechanical Plaque Control
Needs-related oral hygiene should focus on interproximal surfaces of posterior teeth
Axelsson, P.: Mechanical Plaque Control. Proceedings of the 1st European Workshop on Periodontology. Quintessence Books, 1994.

Video Used to Record Brushing Patterns
Video tapes reveal 30 to 45 second erratic brushing patterns with little or no time spent on lingual surfaces
MacGregor, I., Rugg-Gunn, A.: A Survey of Toothbrushing Sequence in Children and Young Adults. J of Periodontal Research 14: 225-230, 1979.

Treatment

How successful is your therapy?
Non-surgical therapy successful in both shallow and deep pockets - a comparison of hand and power scalers
Badersten, A., Nilveus, R., Egelberg, J: Effect of Nonsurgical Periodontal Therapy. I. Moderately Advanced Periodontitis. J of Clinical Periodontology 8: 57-72, 1981.

Badersten, A., Nilveus, R., Egelberg, J: Effect of Nonsurgical Periodontal Therapy. II. Severely Advanced Periodontitis. J of Clinical Periodontology 11: 63-76, 1984.

The Ramfjord Study
First long-term published study comparing conservative and surgical therapy
Ramfjord, S., Nissle, R., Skick, R., Cooper, H.: Subgingival Curettage Versus Surgical Elimination of Periodontal Pockets. J of Periodontology 39: 167-175, 1968.

Maintenance

Supportive Maintenance Therapy: A Review
3 to 4 month recall recommended for periodontal patients
Ramfjord, S: Maintenance Care and Supportive Periodontal Therapy. Quintessence International 24: 465-471, 1993.

Dental Hygiene Every Two Weeks
Gingivitis and caries nearly eliminated with 10 minute DH visits every 2 weeks
Axelsson, P., Lindhe, J.: The Effect of a Preventive Program on Dental Plaque, Gingivitis, and Caries in School Children. Results After One and Two Years. J of C Periodontology 1: 126-138, 1974.