This action might not be possible to undo. Are you sure you want to continue?
Measuring your choices
Pharmacology and Periodontal Disease
Implications and future options
New Sonicare FlexCare +
Put the motivation to brush in their hands
Give your patients the motivation they need to improve their gum health, with FlexCare+. The most advanced reason yet to recommend Sonicare. The new FlexCare+ gives your patients a clean, invigorating feel every time they brush, and the motivation they need to achieve exceptional results. • Improves gum health in only 2 weeks1 • Patients brush significantly longer with Flexcare+ in Gum Care mode than with Oral-B Triumph with SmartGuideTM 2 • Helps prevent gum recession and reduces bleeding sites by up to 71% in 4 weeks1,3 • New Gum Care mode for two minutes of overall cleaning followed by one minute of gentle cleaning to focus on trouble spots along the gumline To try FlexCare+ please contact your local representative or call 1-800-676-SONIC (7664) www.sonicare.com/dp
Two brush head sizes for complete and precise cleaning
(1) Holt J, Sturm D. Master A, Jenkins W, Schmitt P, Hefti A. A randomized, parallel-design study to compare the effects of the Sonicare FlexCare and the Oral-B P40 manual toothbrush on plaque and gingivitis. Comp Cont Dent Educ. 2007:28. (2) Milleman J, Putt M, Jenkins W, Jinling W, Strate J. data on file, 2009. (3) Heasman PA, McCracken GI, De Jager M. Changes in localized gingival recession with manual and powered toothbrushes. J Dent Res. 2009:88 (special issue A):3505. Oral-B, Triumph, and SmartGuide are trademarks of The Procter & Gamble Company.
In this issue of the
5 7 9 24 26 27 President’s Message
Reflections from President Daphne Von Essen
Cover Story 9
Come Grow With Us
The value of CDHA membership
Pharmacology and Periodontal Disease
Learn about proven benefactors and future options
An interview with a dental hygiene icon
Exploring the possibilities
Promoting critical thinking
This Journal is printed on 100% recycled paper
CDHA thanks Philips Sonicare and Discus Dental for their generous sponsorship of this issue
RDH. MSDH Debi Gerger. BS Nadine Lavell. CA 91784 Display and classified advertising. RDH. The opinions expressed or implied in this publication are strictly those of the authors and do not necessarily reflect the opinion. revise or reject any manuscript submitted.S. or the use by libraries. RDH. RDH Kristi Hughes. position or official policies of the CDHA nor are claims or statements by authors verified. CA Graphic Design Printer Cover Photo: SEM of dental floss with bacterial plaque biofilm . RDH. All change of name or address should be sent to: California Dental Hygienists’ Association 130 North Brand Boulevard. MSEd Dorreen P.cdha. BS Donna Smith. • Stockton. Contributors are notified within 90 days if a manuscript is accepted for publication. MA Carole Broder. EdD Juanita E.net info available @ cdha. BS Teresa Rodriguez. RDH Jocelyn Weinhagen. CA 95204 Shandawallacerdh@comcast. MPH Michelle Gray. 2010 Dental Hygiene Committee of CA Sacramento. reduce. BS. RDH. RDH Noël Kelsch. Articles are considered for publication on condition they are contributed solely to the Journal. RDH Susan Slosing. RDHAP Rosie Tesselaar Component Trustees Central Coast East Bay Kern County Long Beach Los Angeles Monterey Bay Mt. BS Lygia Jolley. BS Lori Gagliardi. all other uses require the written permission of the Editor or President. BS San Fernando Valley San Francisco San Gabriel Valley San Joaquin Valley Santa Barbara Santa Clara Valley Six Rivers Shasta South Bay Tri County Valley Oaks Ventura County Lynn Taylor. CDA. RDH. BS Emilia Ion. RDH Ellen Standley. Adams. CA November 5. CA November 6. BA Eva Adams. RDH Susan Lopez. RDH. RDH. CA 91203 Phone: 818-500-8217 FAX: 818-247-2348 E-mail: info@cdha. RDH Journal Staff Editor Associate Editor Advisory Board Michelle Hurlbutt.org Copyright ©2010 by the California Dental Hygienists’ Association. RDH. RDH. RDH Tricia Osuna. MS Linda Belaus. RDH. RDH Rhonda McMorran. RDH. MSDH E-mail: mhurlbutt@earthlink. MPH Toni S.S. RDH Charmaine Young. RDH. and non-members within the U. $50 to ADHA members outside the U. RDH Jeri Badour. Suite 301 Glendale. 2010 Fall CE Extravaganza Burlingame. RDH Elvira Cabelli. Davis Moore Bergstrom Co. RDH 611 Bristol Ave. CDHA reserves the right to illustrate. RDH.S. BS. Inquiries regarding display advertising should be directed to: Shanda Wallace. The Journal is published on a regular schedule by the California Dental Hygienists’ Association. BA Lisa Okamoto. RDHAP.net Fax: 909-985-6542 Mail: 1685 Francis Avenue • Upland. RDH. Correspondence should be addressed directly to the Editor: Michelle Hurlbutt. RDH Darlene Cheek. RDH. Subscription rate is as follows: $15 for CDHA members $25 for non-CDHA members and ADHA members within U. The California Dental Hygienists’ Association does not assume liability for contents of advertisements. BS Karen Olson. PhD Kirsten Jarvi. RDH Kirsten Jarvi. FAADH Mary Jo Cardinale. RDH. MA Heidi Emmerling.org Internet: http://www. 2010 Board of Trustees Meeting Burlingame. RDH Beth Strauss. The only permission granted for photocopying or storage of items is for personal use. RDH. RDHAP Lupita Guzman-Antunez. RDH. Diablo Napa-Solano Orange County Peninsula Redwood Sacramento Valley San Diego County Maureen Titus. Silva.2009–2010 Executive Officers President President Elect Contributions of scientific and original articles. The Journal of the California Dental Hygienists’ Association is formatted by and published under the supervision of the Editor. RDH.org VP Membership & Professional Development VP Administration & Public Relations Secretary-Treasurer Immediate Past President Executive Administrator Daphne Von Essen. Calendar of Events September 27.
Make a conscious choice to spend your time with positive people who share your values and priorities. Although it’s not always comfortable to associate with people who are ahead of you in growth. The Success Journey: The Process of Living Your Dreams. two companies who offer outstanding resources to dental professionals. continuing education seminars or webinars. You can begin by reading this journal.OnMyMind Challenge Yourself Make a Plan for Growth Are you so snug inside your comfort zone that you feel like you can’t get out of it? It’s human nature to stick with something we’ve found to be easy and seems to work. Motivational writer John Maxwell introduced the concept of a personal growth plan over a decade ago in his book. encourage you and reinforce your desire to transform your professional life. a plan of self-development should: • Identify the areas of professional growth you wish to develop. RDH. Many of us often wait until life demands us to move forward. Plan to bring something of value to these relationships. talking with experts in your areas of interest. Dedicate at least one hour per day. We convince ourselves we’re making progress. generously sponsored by Philips Sonicare and Discus Dental. one where you are in control of your own destiny and results in a positive new perspective. with more knowledge. to learn new skills and to develop beyond our current self. • Develop relationships with growing people. In order to transform professionally. we need to move outside our comfort zone. Concentrate on one or two aspirations at the heart of where you want to be. or even going back to college to earn an advanced degree. Start small. Examine your closest associations and choose wisely. While this unconscious growth can result in ultimate happiness. five days a week on your professional growth plan. it’s always beneficial. Challenge yourself to choose a path of conscious growth. don’t think in terms of only what you can gain. • List resources available to you. but secretly we know we’re not growing or learning anything new. skills and wisdom. podcasts and tapes. if you have a plan you are more likely to follow through and be successful. How long has it been since you set out to make a major change or transformation in your professional life? While it’s difficult to take a step into the unknown. These can be trade journals. Spend some time reflecting on your strengths and weaknesses as a dental hygienist. MSDH Editor CDHA Journal – Summer 2010 3 . Michelle Hurlbutt. Don’t wait until your professional life forces you to make changes. What key competencies will make the greatest impact on your career life? Be brave enough to ask a trusted colleague about what they feel you should improve. the process can be stressful and unpredictable. According to Maxwell.
to strive or to try. Aim allows us to have focus and direction in our lives. your life and in the future of CDHA. friendship. If you are not a member. for all of your efforts. instruction. DIRECT ACCESS: Many CDHA members continue to give back to their communities through their volunteerism to help our underserved populations. If we do not attain a healthy membership within the association we will be unable to accomplish our aims. Many members give back to their communities. ensuring that our patients are protected and safe. Our council members have been busy setting precedents. CDHA is committed to doing just that. In the clinician’s world. monitoring legislation. RDH 2009-2010 CDHA President CDHA Journal – Summer 2010 5 . it is about personal growth. Like our patients with periodontal disease. serving children. special needs and the elderly. and integrity. AUTHORITY: CDHA continues to grow in its recognition as the authority for our profession in this state because of the efforts of our volunteer members. healthy tissue. We work hard to help our patients understand the goals for their care through education. Continue to rise and shine in your hearts. we thank you.Message from the President AIm – To direct. Just as many of us have personal aims. every day is already a mistake if you don’t know where you are going. If you are a member. Board of Trustees. the homeless. This association is so much more than advocacy. Attaining decreased probing depths. the California Dental Hygienists’ Association has goals for our organization: Goal 1: Serve as the recognized AUTHORITY for the profession of dental hygiene Goal 2: Achieve AUTONOMY of dental hygiene education. I have been honored to serve as president this year and would like to extend my gratitude to the Executive Committee. volunteering in community programs. Dental hygienists were key to the success of two Remote Access Medical (RAM) events that took place this year in our state. Daphne Von Essen. Without aim. Several thousand people sought dental care at these two events. Our profession deserves to have a professional organization that represents the interests of dental hygienists and their patients in this state. committees and staff. councils. and motivation. providing innovative courses and supporting student members through regional conferences. the dental hygienist. To AIM is to direct to or toward a specified goal. licensure and practice Goal 3: Advocate DIRECT ACCESS to the services of the registered dental hygienist We are commited to achieving these aims for our profession. I would like to thank you. attending public health meetings. networking. As dental hygienists. and reinforced behavioral changes in our patient’s is the result of knowing the aim and direction to go. In addition. you’re promising that you’ll do everything in your power to see it through – CDHA members are dedicated to accomplishing three important goals. licensure and practice of dental hygiene. Just as when you commit to a goal. nothing is more motivating than a patient transformed. AUTONOMY: The Dental Hygiene Committee of California became a reality this year and is working to set new regulations to govern our profession related to the education. one of our many aims is to rid the world of periodontal disease. please consider joining with us to become part of the legacy of professionalism that has existed in our state since the early 20th century. this committee is charged with enforcement of our profession. CDHA needs to continually work to improve the health of our organization. It helps us to be clear about what exactly we are doing and where we are going. But most of all.
The Dental Hygiene Committee of California (DHCC) is now a reality and is working to regulate the education. To learn more about the DHCC. AS Lisa Greenshields. If you are a student. CDHA continues to provide the strength. our leaders continue to protect the integrity of our profession. diversity. Grow with Us in Access to Care We applaud our local members who have grown with CDHA. this committee has full authority over enforcement. Take advantage of the quarterly payment plan offered by ADHA. CDHA respects our members for their values. Be sure to renew today to ensure uninterrupted delivery for of all your valuable member benefits. endurance and longevity our profession deserves. This reflection helps us find new understanding and vision from our experiences. In addition. We welcome you to be a part of our future. licensure and practice of our profession.org Like the mighty California oak tree. CDHA was instrumental in the formation of this new regulatory board. ensuring that the consumers we serve are protected and safe. CDHA Journal – Summer 2010 7 .org or ADHA. We invite all dental hygienists to become members of CDHA. We continue to imagine the endless possibilities that our association provides our profession. Imagine if those members didn’t grow with us. go to their website: www. Joining together as part of the only organization that represents the interests of dental hygienists in our state helps us to grow professionally and personally. with the efforts and leadership of CDHA. friendship and belonging to a support system that recognizes its members for their diverse contributions within the profession of dental hygiene. culture. BS Come Grow With Us – The Value of membership Membership within the California Dental Hygienists’ Association (CDHA) brings forth a networking “buzz” throughout California. This is one example in which CDHA has helped to provide its members with opportunities for advancement. continuing education seminars and professional websites. The number of practicing Registered Dental Hygienist in Alternative Practice (RDHAPs) is increasing throughout our state.dhcc. assuring that a RDA would not be allowed to perform the licensed duties of a registered dental hygienist. Grow with Us in Autonomy Dental hygienists across California are celebrating our new found self-regulation. Membership is about networking. we invite you to become a member of the only professional organization that represents the interests of dental hygienists and the consumers we treat. Come Grow with Us You ask how CDHA can help you grow within our profession? With your membership. CDHA continues to protect the integrity of the dental hygiene profession. providing preventive care for direct reimbursement. transition your student membership by visiting CDHA. An application is included with this publication.Liz Marks. RDH. introducing and supporting legislation that promotes access to care. CDHA members attend important public health meetings to serve as the voice of dental hygiene when policy decisions are being made.gov Grow with Us in Advocacy In 2006.ca. the first in the United States. Dental hygienists are allowed to work unsupervised in public health settings in this state because of the efforts of CDHA. SB1541 obtained clarification that a “work experience pathways to licensure” of an Registered Dental Assistant (RDA) would never be applied to dental hygiene. this wouldn’t be a reality. we applaud you! For those who would like to grow with us. our members have access to evidence based research. For those members who have grown with CDHA. It is said while sitting under an oak tree one should take time to reflect. RDH. SB1541 was passed. Through a collaborative networking community of dental hygiene researchers. connecting each of us to a greater common goal. Through professional journals. ideas and time that is spent volunteering in the many activities throughout the state. CDHA members have the newest scientific information available to assure optimal patient care.
– Mon.firstname.lastname@example.org Noël Kelsch. Mexico Cabins start at $329. 2011 . 2010 Aboard The Carnival Paradise Depart: Long Beach. Oct.com Sponsors Dentsply Professional GC America Sunstar America Sonicare Kerr Total Care Pennwell Next annual cruise September 30.kelsch@sbcglobal. 1 – 4.00 For more information contact: Elaine Siebers. BS at: 805-983-8874 elaine53@roadrunner.Cruise and Learn Join us for the 4th Annual Cruise and Learn – a quality continuing education experience from Elaine Siebers and Noël Kelsch 3 Night Mexico Baja Cruise When: Fri.. RDHAP at: hy-ginx. RDH.net To make travel plans & book courses call: Belinda Edwards Frosch Travel 1-800-334-7318 belinda.com or n. CA Port of Call: Ensenada.
”1 By the time the systemic antibiotic reaches the gingival sulcus it no longer has an adequate concentraClassification of Antibiotic Agents That Can Affect Periodontal Microbes tion to achieve the desired antimicrobial effect. Randomized double blind placebo controlled trials demonstrated reduction in probing depths. microbial resistance is a growing concern.3 These guidelines suggest that aggressive types of periodontitis and acute periodontal infections should be treated with systemic antibiotics while chronic infections should be treated with topical therapy. Penicillin VK) Quinolones (Includes Ciprofloxacin) *Bactericidal against some organisms at high blood levels Table modified from: Haveles. The most commonly used include tetracycline. and has become bacterial resistant. either systemic or topical. Macrolides* (Includes Erythromycin. and may cause gastrointestinal discomfort. Antibiotics as a stand-alone treatment are ineffective at diminishing intact subgingival biofilms. host response and patient behavior.5 Although there are some studies supporting the use of topicals. BS Pharmacology and Periodontal Disease: Implications and Future Options Introduction Periodontal disease is a complex inflammatory disease characterized by bacterial infection. antivirals and vaccines may also be beneficial when combined with scaling and root planing. When administered at this low dose. targets gram negative rods.4 Other issues with oral antibiotic administration are patient adherence and adequate absorption from the gastrointestinal tract. Minocycline) Penicillins (Includes Ampicillin. including amoxicillin and amoxicillin/clavulanate acid (Augmentin®). Clarithromycin) Topical Antibiotic Therapy Topical (local) antibiotic/antimicrobial therapy (LAA) was the natural progression from systemic administration. Macrolides* (Includes Erythromycin. There is research both in support of and against the use of supplemental therapy to traditional biofilm removal. there is no consensus as to an ideal dose and duration. doxycycline does not cause the long term side effects seen with other systemic antibiotics. CDHA Journal – Summer 2010 9 . There are many systemic antibiotics on the market. antimicrobials. Augmentin®. Augmentin was developed due to amoxicillin’s bacterial resistance from penicillinase enzyme sensitivity. like anaphylactic shock.1 When considering the use of adjunctive therapy it is always important to do a detailed medical health history with your patient to rule out any known contraindications. most fail to demonstrate a significant difference between scaling and root planing alone. Continued on Page 10 Tetracyclines (Includes Doxycycline. Azithromycin. The debridement of plaque biofilm and adequate home care are essential elements of a patient’s periodontal treatment.5 Antibiotics The physical removal of biofilm has proven to be the most effective method for treating periodontal disease. Azithromycin. improvement in clinical attachment levels and decreased bleeding on probing when used as an adjunct with scaling and root planing. The choice of antibiotic should be made on an individual basis. Maryland Heights. Some studies show superior results with antibiotic use while others show no clinical difference. Antibiotic therapy is generally used as a follow up treatment after conventional mechanical therapy. Applied Pharmacology for the Dental Hygienist. In addition to serious adverse effects. (6th ed. ciprofloxacin.Melissa Fellman. The use of adjunctive antibiotic therapy. metronidazole and the penicillins. There is a general consensus that antibiotics should not be used as a monotherapy in the treatment of periodontal disease. E.). p. This supports BACTERICIDAL BACTERIOSTATIC the fact that the mechanical disruption of biofilm must be Cephalosporins (Includes Keflex®. is controversial. RDH. with Augmentin targeting a more narrow spectrum than amoxicillin. (2011). Ceclor®) Clindamycin* included in the treatment of periodontal disease. MO: Mosby Elsevier. herbs.1 Of the many systemic antibiotics available. Amoxicillin and Augmentin are both bactericidal.2 The American Academy of Periodontology has offered guidelines for systemic and topical antibiotic use in treating periodontal disease. Aggressive periodontitis may use systemic antibiotics as an adjunctive therapy. Antibiotics. B. then cross the crevicular and junctional epithelia to enter the gingival sulcus. 77-78. Amoxicillin. It was thought that LAAs would solve the risk to benefit ratio of systemic antibiotics. targets both gram positive and gram negative organisms. Understanding that the periodontal disease process may be initiated by bacteria but the individual’s host response was critical to the progression of this disease led to the FDA approval of doxycycline at a sub-antimicrobial dose (20mg twice daily). Clarithromycin) Metronidazole A recent review evaluating non-surgical chemotherapeutic strategies for the management of periodontal disease determined that “systemic antibiotics reach the periodontal tissues by transuduction across serum. Tetracycline is bacteriostatic. Ciprofloxacin is bactericidal.
quaternary compounds. and reduces gingivitis approximately 15%. Cell death results from altered osmotic equilibrium. some more serious than others. The antibiotic is administered into the gingival sulcus through a cannula. and viricidal properties.12% chlorhexidine. Although Actisite was found to be effective in many cases. Listerine contains 26. Their active ingredient is 0.11 First generation antimicrobials include phenolic. when compared with scaling and root planing alone. This term refers to the adherent qualities of a mouthwash and its ability to be retained. who do not respond to mechanical therapy. Substantivity is a crucial component when considering the effectiveness of a mouth 10 CDHA Journal Vol. It has anti-inflammatory properties as well as a bubbling action to clean and alleviate discomfort.10 Locally administered antibiotics still require a strict health history review to verify there are no known allergies.1 Other antimicrobials include oxygenating. It was comprised of 34% chlorhexidine gluconate. resulting in a similar efficacy as Listerine. Short term studies have produced controversial findings. Saliva has a natural flushing property making it difficult to maintain an antimicrobial effect. Listerine® and its generics are phenolics which possess the only ADA Seal of Acceptance among the first generation antimicrobials. more than one site can be treated depending on the depth and size of the pockets. about 5mm round and 1mm thick. quaternary ammonium compounds.1 Antimicrobial mouth rinses have been linked to several side effects. Research shows a significant antibacterial effect up to 7 hours after mouthrinses with high a substantivity property. such as smokers.1 Arestin® is comprised of spheres embedded with 2% minocycline HCl that is slowly released and holds the therapeutic dose in the gingival crivicular fluid for 14-21 days. Oxyfresh®. CHX efficacy in the reduction of certain aerobic and anaerobic bacteria has been shown to be as high as 97% after 6 months of use.8-9 The first locally administered antibiotic for periodontal disease was Actisite®. provide limited improvement. oral rinses do not penetrate deep into the gingival sulcus. A commercial name for CPC is Crest® Pro-Health®. resorbable antibiotics such as Atridox® and Arestin® are the topical antibiotics of choice. The American Academy of Periodontology (AAP) supports that local adjuncts. Research has demonstrated permanent damage to enamel through erosive pH levels and abrasive antimicrobial toothpastes.9% alcohol. Atridox® is a 10% doxycyline hyclate gel and is prepared by mixing powder and liquid from two syringes. Bacteria cells are killed by cellular pressure. contain 14% and 18. Currently. Inc. Single site Absorption 21 days 14-21 days rinse. CHX has 29% gingivitis reduction. Oxyfresh is primarily used for the treatment of halitosis. The most notable drawback is the high level of clinician skill needed to deliver this therapy as the material tends to come out of the pocket as the syringe is being pulled out of the sulcus. 25 No.1 Second generation antimicrobials include cetylpyridinium chloride (CPC) and chlorhexidine (CHX). placement and patient follow-up for fiber removal were challenging issues. a 1% chlorine dioxide agent. free radical and an oxidant with algicidal.9% alcohol respectively. and zinc chloride agents. has minimal plaque reduction. The majority of the time. chlorine dioxide. Chlorhexidine can cause supragingival calculus build-up and staining.1 Carcinogenic changes have been linked to the use of oxygenating agents and mouth rinses containing alcohol. The most notable drawback for Arestin is the delivery dose. Absorption lasts up to 21 days. It is a stable.1 A bioabsorbable local delivery device called PerioChip® was then developed. 2 . and has 36% gingivitis reduction. increase bacterial cell wall permeability causing cell lysis. sanguinarine. This results in the need to reapply in the same pocket. Peridex® by 3M Espe and Periogard® by Colgate® Professional are two examples of popular chlorhexidine-based products. It claims to be a scientific bad breath treatment specifically designed to help treat the causes of bad breath and the symptoms. Even though these medications are applied topically. sporicidal. fungicidal. the same precautions apply.1 Cepacol® and Scope®. cysticidal. The syringe holds pre-set doses that may not be sufficient for every site.1 Antiseptics Unlike topical controlled-released antibiotics. alters the bacterial cell wall. The gingivitis reduction percents listed above for both first and second generation antimicrobials are based on efficacy data published by manufacturers. which contains 0. made up of nonabsorbable fibers filled with tetracycline. while therapeutic drug levels in the gingival crevicular fluid start to decline at 7 days. as opposed to oral administration.Investigations do show benefits for high risk patients. Chlorhexidine has many commercial products including the availability of a nonalcoholic version by Sunstar Americas. Oral rinses are also of great value in post surgical healing. Antibiotic 10% Doxycyline 2% Minocycline HCl microspheres Brand Name Atridox® Arestin® Delivery Fluid mixed in a syringe.07% CPC. Breath Rx® is a zinc chloride agent designed to odorize sulfhydryl groups with zinc ions. bactericidal. Multisite Solid dose applies with a syringe. Peroxyl® is an oxygenating agent with the active ingredient of hydrogen peroxide. First generation compounds like Listerine can cause a burning sensation and bitter taste.6-7 Recent studies have demonstrated that the use of LAAs resulted in an overall reduction of the bacterial bioburden with reduced cardiovascular event risks. It is the only LAA that is not an antibiotic. Despite this limitation they do show benefit when used adjunctively for gingival inflammation.
3.12 The use of probiotics in the control of periodontal pathogens is emerging. J Oral Sci. Gorur A. Sallum AW. Kirkwood KL. health care providers looking for alternate adjunctive periodontal therapies for their patients. Systemic antibiotics in periodontal therapy. JADA. and claims a reduction in periopathogens within the periodontal pocket. A reduction in gingivitis and dental plaque has been shown with the administration of L. 2009. Herbal plant extracts have been shown to reduce the level of biofilms influencing the level of bacterial adhesion. NV where she teaches pharmacology. reuteri Prodentis® gum chewed twice daily in patients with moderate to severe gingivitis. with only 1% having been photochemically investigated. This has shown results with the reduction of periodontal disease. is the Program Coordinator and Evaluation Specialist for the Nevada State Oral Health Program. Some herbs such as Coptidis rhizome extract and Hamamelis virginiana. Krayer JW. Nociti FH Jr. they are healthy bacteria that displace unhealthy or pathogenic bacteria.50(3): 259-65.140: 978-86. Porphyromonas gingivalis and Aggregatibacter actinobacillus CDHA Journal – Summer 2010 References continued on Page 25 11 . Grossi SG. The future is promising in the areas of nutraceuticals and vaccines but more research is needed. reuteri Prodentis® that claims a reduction in moderate to severe plaque and bad breath. Lecio G. RDH. Machion L. Goodson JM. Periodontal lesions can exhibit great amounts of EBV and HCMV. oralis KJ3. Cortelli JR. About the Author Melissa Fellman. and S. Am Heart J. Melissa can be reached at mfellman@tmcc. 2009. Doherty F. BS. Since bacterial disease may be secondary to viral infections. which when administered in adequate amounts confer a health benefit on the host. D’Aiuto F.18 Vaccines Vaccine therapy in the fight against periodontal disease is also a new and exciting option. The future of public health can be greatly affected by the scientific breakthroughs becoming made in dentistry. Cortillo SC. Carvalho-Filho J. Roman-Torres CVG.17 The Human Cytomegalovirus (HCMV) has also been linked to periodontal disease. 2007. S. The American Academy of Periodontology (AAP). Probiotics are “live microorganisms. As discussed earlier.”13 Simply put. Heitz-Mayfield LJA. Gunsolley JC. Periodontal infections cause changes in traditional and novel cardiovascular risk factors: results from a randomized controlled clinical trial.000 plant species.151(5): 977-84. Casati MZ. J Periodontol. J. Antivirals A new area of research when evaluating periodontal disease is the use of antivirals. Anti-herpesvirus chemotherapy can decrease salivary viral loads resulting in the improvement if secondary bacterial periodontal infections exist. In addition. Locally delivered doxycylcline as an adjunctive therapy to scaling and root planing in the treatment of smokers: a two-year follow-up. Melissa is in the process of completing a Master’s degree in public health at the University of Nevada. 2009. Some examples of nutraceuticals include herbal and nutritional supplements and the future of this type of therapy is promising.edu References 1. 2004. Sallum EA. Polygonum cuspidatum and Mikania are used to inhibit adhesion. rattus JH145. When used for periodontal disease. 8.54(1 Suppl): S96-S101. This supplement contains a combination of three bacterial strains Streptococcus uberis KJ2. Periodontol. Keller D.Nutraceuticals As antibiotic resistance becomes more of a concern. Minocycline HCl microspheres reduce red-complex bacteria in periodontal disease therapy. Andia DC. 4. 2006. The Epstein-Barr (EBV) virus has been associated with recurrent periodontal disease. Nibali L. Bland PS. 2006. Leite RS. The HCMV can cause infections in immune-compromised individuals like organ transplant patients or patients with acquired immune deficiency syndrome (AIDS). Aquino DR.75: 1553-65.16 have been identified as antigenic targets. is another new probiotic for oral health and is used once daily. Costa FO.78: 1568-79. Parkar M.77(4): 606-13. There are approximately 500. Vaccine development is based on the identification of virulence factors that stimulate the induction of salivary immunoglobulin A antibody response. J Periodontol. are used as bactericidal agents against oral bacteria while others such as cranberry. Inc. A double-blinded randomized clinical trial of subgingival minocycline for chronic periodontitis.15 EvoraPlus™ from Oragenics. Reno where her graduate research includes conducting a dental hygiene needs assessment on HIV outpatients and developing a coalition to increase access to dental hygiene care for HIV positive individuals in northern NV. Comiskey J. 7. Schaudinn C. Costerton JW. 6. 2. Conclusion All drug sensitivities and allergies should be reviewed prior to incorporating pharmacological agents into a patient’s treatment regimen. is a once daily lozenge with L. Otomo-Corgel J. marketed by Sunstar Americas. Tonetti MS. Long time traditional regimens of antibiotics and antimicrobials have served our profession well and assisted hygienists to achieve optimal patient results. 5. 54: 13-33.14 GUM® PerioBalance®. Vaccines offer a solution to the overuse of antibiotics in dentistry. antiviral treatment decreases EBV and improves the periodontal condition. Dent Clin N Am. Sedghizadeh PP. 2010. Non-surgical chemotherapeutic treatment strategies for the management of periodontal diseases. antibiotic resistance is a growing worldwide problem. Suvan J. Lessem J. she is an instructor in the dental hygiene program at Truckee Meadows Community College (TMCC) in Reno. Aus Dent J. Periodontitis: an archetypical biofilm disease.19 More research is needed in this field before it is widely accepted as an alternative to antibiotic or antimicrobial therapy.
the necessary interventions for wellness and the outcomes of any treatment performed.oraldna.com Designed to be fundamental elements of a patient’s wellness plan. to periodontal surgery.2 These results led to a paradigm shift in the treatment of periodontal disease still practiced today and periodontal research continues to focus on non-surgical methods to prevent attachment loss. MyPerioPath® MyPerioID® PST® OralDNA Labs® Inc. MS Advances in Technology and Periodontal Therapy Treatment of periodontal disease has changed tremendously in the last 60 years. www. Hygienists who practiced in the 1960’s and 70’s will remember referring most patients with 5 to 6 millimeter pockets to the periodontist for evaluation and surgery.com Described as a user-friendly Internet based technology. drug delivery systems and implants to restore lost tissue and function. The unit has been shown to register readings in areas where only slight amounts of residual calculus remain or in difficult access areas such as furcations and deep line angles.3 Dental hygienists today have a variety of tests available to identify patient’s risk factors and to treat and manage disease tissues.previser. The audible tone and detection values can also prove beneficial in patient acceptance and compliance with periodontal treatment recommendations. gene therapy. The thin. growth factors. analyzes and quantifies information about an individual’s current oral health status.kavousa.InnovationSavvy Cathy Draper. DIAGNOdent® Perio Probe KaVo Dental Corporation www. While the role of periodontal therapy in the prevention or reduction of systemic disease has not been proven by randomized controlled trials. PreViser can now be used with Dentrix practice management software for seamless integration into your patient assessment data. elicits an audible tone and gives a measurable value in pocket depths up to 9 mm. It was not until the 1980’s when well-designed clinical trials compared scaling and root planing therapy. The basic principles of periodontal surgery as described by Shluger in 1949 called on periodontists to eliminate the periodontal pocket. perio tip insert attaches to the handpiece and detects calculus. The clinician’s goal was to diagnose the disease and provide treatment without any consideration of risk factors or host susceptibility. that the outcomes of the various treatments were systematically reviewed. create a harmonious gingival form and recontour the alveolar bone in order to prevent the progression or recurrence of periodontal pocketing.2 Clinical trials carried out over a period of five years demonstrated that thorough debridement was often as effective as periodontal surgery in preventing the progression of alveolar bone loss in patients with chronic periodontitis. When evaluating any new technique or technology.1 The traditional treatment modalities were based on the repair model of care. RDH. 25 No. the Oral Health Information Suite (OHIS) compiles. these salivary diagnostic tests measure periodontal disease infection and genetic risk factors for periodontal disease. remember to make decisions based on the best evidence supporting the treatment or technology along with clinical experience and the specific needs of the patient. 2 . The Periodontal Assessment Tool (PAT) analyses the input of 23 items taken from a routine periodontal examination and provides clinicians and patients with objective measurements of the outcomes and the effectiveness of therapeutic interventions based on the wellness model of dental care. new research with improved study designs is ongoing.com This periodontal probe utilizes the laser fluorescence properties of subgingival calculus to quantify the amount of residual calculus on the root surfaces following scaling and root planing. The new frontier in periodontal research is in the application of new technologies including lasers. The OHIS features quantitative risk assessment tools and places quantitative values on changes in periodontal status over time. MyPerioPath® offers genomic DNA testing that 12 CDHA Journal Vol. The device utilizes the DIAGNOdent caries detection classic or pen model handpiece. Risk Assessment and Diagnostics PreViser™ Oral Health Information Suite www.
Incorporation of the disposable tips eliminates the need for fiber management and enhances the portability of the device. It is compatible with inserts produced by all major magnetostrictive scaling unit manufacturers. with a quantification of the specific pathogens and their risk factors.periowave. ZEN™ Prophy Cordless Handpiece Discus Dental. Inc.com Designed to maximize scaling efficiency and effectiveness. A user-friendly touch pad and dual power modes within the scaler simplify use and ensure proper power adjustment. InSight™ LED Ultrasonic Scaler Inserts Discus Dental. LLC Distributed by Discus Dental. neutral wrist and shoulder positioning without cord tension or twisting. eliminates cord-catching.InnovationSavvy identifies the type and concentration of 13 specific periodontal pathogens found in a saliva sample.com The NV Microlaser™ delivers full power and the capabilities of the larger. desktop soft tissue diode lasers in a light-weight pen-sized package. allows flexibility of movement. LLC www.com The Periowave™ utilizes photodisinfection to target specific periodontal pathogenic bacteria. LLC www. Laser energy is transferred to the photosensitive molecules bound to the subgingival biofilms by the methylene blue dye. Controlled by a foot pedal. pre-threaded disposable tips and a combination charger/sensor holder. Continued on Page 14 Innovations for Treatment NV Microlaser™ Manufactured by Zap Lasers.discusdental. Formerly known as the Styla MicroLaser. Custom features include preset procedure settings.com This unique suction system is designed by a dental hygienist to assist clinicians with efficient water and saliva evacuation particularly while using an ultrasonic scaler. thus improving workflow and allowing the user to assume a neutral body position. Additional clinical and medical risk factors are included as well as treatment considerations and reassessment recommendations.com The SWERV3™ magnetostrictive power scaler offers finely tuned electronics and delivers a full range of power with a color-coded lighted display. diode laser is then used in the pocket for 60 seconds to initiate the photodynamic chain of events. LLC www. SWERV3™ Magnetostrictive Ultrasonic Scaler Hu-Friedy Manufacturing Company. The ZEN has a non-slip grip for better handling as well as a light-weight and balanced design to reduce clinician fatigue and wrist strain. www. The dye binds to the lipopolysaccharides and lipids found in the cell walls of gram positive and gram negative bacteria. Periowave™ Ondine Biopharma Corporation www. CDHA Journal – Summer 2010 13 . the NV microlaser is completely wireless. The wireless connection between the foot pedal and the handpiece enhances portability. A latex-free autoclavable shell slips over the handpiece to ensure the highest level of infection control between each appointment. Retreatment is recommended at 3 to 6 weeks to prevent the biofilm from re-establishing during the healing process. and improves control of speed and power with a rheostat foot pedal. and causes less stress and user fatigue. Saliva samples are mailed to the laboratory and a detailed analysis is conducted.com The ZEN™ Phophy Cordless Handpiece has total maneuverability.discusdental. The inserts’ smooth swivel mechanism provides comfortable. Blue Boa® Suction System www. enables movement from operatory to operatory without limitations. Both tests can be used as part of the baseline data for any patient at increased risk for periodontal infections as well as for patients who are unresponsive to their current treatment. InSight™ LED ultrasonic scaler inserts provide dual-LED illumination to eliminate the need to move the overhead dental chair light.theblueboa. The unit has a high powered lithium battery for extended use and a discrete compact charger base for counter or wall mount. The handpiece features a comfort zone grip that reduces muscle strain and enhances clinician comfort.discusdental. FDA approval is pending for use in the United States. Methylene blue dye is injected into the periodontal pocket following scaling and root planing. MyPerioID® PST® identifies an individuals genetic susceptibility to periodontal disease by testing for the presence of two interleukin-1 polymorphisms. The Periowave is designed for treating patients with 4 to 9 millimeter pockets with bleeding on probing. a rechargeable lithium ion battery powers the micro diode laser in continuous wave or pulsed modes. Periowave’s non-thermal.hu-friedy.
and Herpes simplex virus. teaching at Foothill College. Assembly and operating instructions can be viewed on the manufacturer’s web site videos. Oral Surg. PC. She currently splits her time between private practice. The FlexCare+ features a UV light sanitizing chamber that kills 99% of selected pathogens including: E. or iPod touch. Inc. California. The lightweight tubing.70: 316-25. Water Pik® Water Flosser Water Pik. 2. Four modalities of periodontal treatment compared over five years.orasphere. www. Her dental hygiene career has taken her many places.2 and 3 minute cycles and 3 speeds or intensities. The airBUG™ features four components: sterilizable bite springs and U-Tubes. Hygienists using this system can have both hands free to effectively instrument all areas of the mouth.sonicare. Inc. Field isolation is made easy without compromising patient comfort. 3.waterpik.com Now marketed as water flossers. Shluger S.54: 163-81. Air-BUG™ Edge Medical Technologies. About the Author Cathy Draper RDH. Osseous resection-a basic principle in periodontal surgery. mutans. Units vary from countertop models to completely portable models with selfcontained water reservoirs. Topics in periodontics include scaling and root planing. et al. China as well as her home state.coli.22(3): 22-3. Germany.com Orasphere patient education programs are available for viewing from the reception area. Croatia. The system is fully portable and does not require any additional tubing. Scannapieco FA. 25 No. S. or from the practice website. and single use tongue shields and bite grips. high volume evacuation and formfitting saliva ejectors provide excellent moisture control for ultrasonic instrumentation as well as sealant placement. References 1. www. Cafesse RG. The online subscription option allows patients requesting treatment information over the phone to be directed to a log in password page to view patient education videos. Oral Hygiene Products Flexcare + Philips Oral Healthcare www. “Does periodontal therapy reduce the risk for systemic disease?” Dent Clin N Am. presenting CE courses and volunteering as a library reference associate at Stanford Hospital. Ramfjord SP. Web. 2 . graduated in 1975 from Foothill College and completed her MS in dental hygiene at the University of Michigan in 1978. Dasanayake AP. 14 CDHA Journal Vol. Water Pik® offers a full line of products that feature state of the art dental water jet technology. operatories. Added product benefits include ease of use and the capability of adding oral medicaments to the irrigating solution.InnovationSavvy One end of the tubing attaches to the high volume evacuator while the other is attached to an ergonomically designed saliva ejector. Blue Boa® tubing is reusable and can be fully sterilized after each use. J Periodont Res. 1949.airbug. The FlexCare+ offers advanced features including 1. The dental education software system is delivered via DVD. The units come with a variety of tips and intraoral devices designed for oral irrigation. periodontal surgery and gingival grafts.com The Sonicare FlexCare+ is specifically designed to help motivate patients to achieve consistency with their home brushing habits. The brush head attachment slides on and off the lightweight handle making it easy to clean. 2010. www.com The air-BUG™ is a patented high speed evacuation and retraction system featuring a unique one size adult design incorporating a tongue and cheek retractor to create a virtual shield from debris and fluids. Patient Education Software Orasphere® Orasphere Ltd. The manufacturer’s web site features a demonstration video of a dental hygienist using the system for ultrasonic debridement. MS. Morrison EC. 1987.
2. Russell developed the Periodontal Index (PI) in 1956 which used only a mirror. this has not always been the case.”11 Furthermore. Wilkins states the probe is “the only accurate. tapered 10mm length . Treatment of the Periodontal Pocket.1 Darby writes. and attachment level.”1 Probing has been referred to as the gold standard of periodontal assessment. used pressure sensitive probe holder to which any type of probe could be attached Van der Velden and de Vries “Pressure Probe” which allowed probing force to be adjusted. recession. “The only accurate method of detecting and measuring periodontal pockets is careful exploration with a periodontal probe. same probe styles CDHA Journal – Summer 2010 1986 1988 1988 1987 1992 Continued on Page 16 15 . as well as Nabers. 1-16 mm marks with emphasis on 2. dental hygienists should deliberately try several probes and choose the one that works best for them. light source and explorer. and angle. mucogingival relationships. 1. 3. no calibration marks WG Cross modified the Box probes (1928) using three types. bleeding points.10 The periodontal probe was not used because Russell believed including actual pocket depths in the index “added little and proved to be a troublesome focus of examiner disagreement.5mm ball tip probe with 3. developed the Florida Probe in response to RFP put out by NIDR Goodson and Kondon developed the Accutek probe Birek et al.5-8 Furthermore. RDH.5mm wide HK Box wrote a textbook. “Given the importance of the periodontal probe in the process of care and long term occupational health. documenting pocket depths. developed the Toronto automated probe. 9.5 and 11. dependable. 6 and 9mm marks World Health Organization recommended the use of a . These standards state that a comprehensive clinical evaluation includes full mouth periodontal charting. 10 marks) regarded as the prototype for many first generation probes used today such as Merritt and University of Michigan. used in research Armitage et al. pressure. RDH. diameter. The American Dental Hygienists’ Association. 9mm length with 1mm marks from 1-9mm with emphasis on 5mm. 8. instruments for right and left sides were available Schmid presented the Plast-O-Probe with metal handle and disposable plastic tip with 9mm length and 3. Commonly used probes vary by markings. 1943 1946 1966 1967 1978 1971 1977 1978 Historical Perspective Probes can be grouped into classifications according to Pihlstrom9: • First Generation: Conventional manual probes • Second Generation: Constant force controlled pressure probes • Third Generation: Constant force plus computer assisted probes While probes are now widely used to assess individual and group populations.”4 Many dental hygiene textbooks include chapters on periodontal probing and the importance of assessment. a set of six stainless steel probes from 3-8mm in length CHM Williams(a periodontist) developed a probe which has continued to be used and modified . modified in 1994 Bose and Ott developed the Peri-Probe The periodontal probe is an essential instrument in every dental hygienist’s armamentarium. thin stainless steel 13mm length (1. probe readings have long been a source of discussion due to the variations in operator technique. 6mm marks. Furthermore. suppuration. which referenced a set of six probes Sachs (German periodontist who was trained in Chicago by R.3 Carranza’s Clinical Periodontology states. BS. 5. and McCulloch et al.5. Jeffcoat et al. as well as clinicians all acknowledge the importance of the periodontal probe.5mm marks. Fish(Europe) round tip. MA Probing into Probes Introduction measuring the Choices Hefti’s History of Probes10 1887 1928 1929 GV Black used flat blade probes bent slightly to the right and left: 8 mm length. probing is imperative in managing the legal risk since failure to accurately diagnose periodontal disease is one of the top ten reasons for dental malpractice. assess. and subjective measurement and recording of the probe marks. and measure sulci and pockets. presented the first controlled force with automated detection Gibbs et al. Additionally Goldman and Fox. 4. Good) “Paradentometer” a thin steel blade with six groove at 2mm increments Struckman (Germany) Duka Taschenmass. have been referenced as possible modifications. method to locate. 5.5.”2 The Standards of Clinical Dental Hygiene Practice were adopted in 2008 by the American Dental Hygienists’ Association. material.Heidi Emmerling. dental and dental hygiene textbooks. studies have shown that there is difference in measurements between varying probe styles. angulation. Most clinicians use the probe they were taught in their dental hygiene education. Gabathuler and Hassell developed first true pressure sensitive probe consisting of a standard ZIS probe and a piezoelectric pressure sensor. 7. 8. PhD Ellen Standley.2 1934 1936. made of sterling silver. color. For use with the community periodontal index of treatment needs (CPITN) as well as for individual screenings of private practice patients.
flat. In referring to National Health and Nutrition Examination Survey (NHANES) III.22mm. 2 Photo courtesy of Hu-Friedy produced by different manufacturers. Table 1: California and Regional Exam Probe Styles California Western Regional Examining Board (WREB) 1-2-3-4-5-6-7-8-9-1011-12 PCP UNC12 (Regular or Color Coded at 5-10) (Williams style probe. • Novatech: The Novatech probe incorporates a right angle plus upward bend which enhances the access to the difficult posterior areas. red millimeter markings at 5 or 6mm and thereafter. When the probe is too bulky or is flat. “With so many Contrast Provided by Color Vue Probe patients opting for dental implants. Dye and Thornton-Evans reported. The EasyView Probe by Paradise Dental Technology is a thermal resin probe with yellow and green bands at 3. 5. Furthermore. and its slight flexibility enhances patient comfort. and even same probe styles produced by the same manufacturer in different batches.5 Specialty First Generation Probes There are several first generation probes designed for specific purposes (Table 3). it is often difficult to insert the instrument into tight tissue. round. All state clinical boards and regional testing agencies include periodontal assessment as a component of the clinical exam. The design of the working ends of manual probes are either tapered.13 This index uses a special probe with a ball tip and color coded markings. regular or color coded) (Williams style probe) (Williams style probe) Southern Regional Testing Agency (SRTA) 1-2-3-5-7-8-9-10 North East Regional Board (NERB) 1-2-3-5-7-8-9-10 Central Regional Dental Testing Service (CRDTS) 1-2-3-4-5-6-7-8-9-10 Council of Interstate Testing Agencies (CITA) 3-6-9-12 PCV-12 (Hu-Friedy PH-6 Color Vue) 3-6-9-12 PCP 12 Marquis (color coded) 16 CDHA Journal Vol. gingival recession and attachment loss in the United States. The Color Vue probe can be used to assess signs of a failing implant.11 There are many styles of probes.12 Probes from the same batch and same production line could differ by more than 0. The probes with curved working ends are paired and are used for examining the topography of furcations. fine. The Orascoptic DK kits can be ordered directly from the Orascoptic online store.” 2 . The Marquis probe is favored by many on the west coast. It is unique due to the incorporation of the use of disposable fiber optic fibers for ease of visibility. 5 and 7mm markings to measure pocket depth. sharp and thin probes pose the danger of trauma and perforation of the junctional epithelium. Thin probes are also subject to bending and damage during sterilization. According a study.5mm in calibration. and 10mm. Probes have either straight or curved working ends.The World Health Organization (WHO) endorsed the Community Periodontal Index of Treatment Needs (CPITN) in the late 1970s. yet tapered probe is easily angulated into tight areas. the dental hygienist does not have to change from a metal to a plastic probe when dental implants are present. Michele Darby writes that the Color Vue probe is her favorite because the yellow provides better contrast than the traditional metal. A few of the commonly used manual probes are shown and described in Table 2. or rectangular with smooth rounded ends and are calibrated in millimeters at various intervals. Other plastic probes include the PerioWise Friendly Probe by Premier Dental which has a green band at 3mm or less.”14 Probes Used in Examinations Dental hygiene clinical examinations include probing documentation. The DK Fiber Lite Attachment holds disposable fiber optic fibers for perio work with 3. 9 and 12mm or 3. The rounded. A number of schools use either the traditional Marquis or the newer plastic Color Vue version. The handle is autoclavable.28 to 0.5 The Orascoptic DK is a newer version of a first generation probe. First Generation Probes First generation probes are composed of either stainless steel or plastic. “The descriptive findings from phase I (1988 to 1991) and later from the combined phases (1988-1994) represented the first reporting of probing depth. Ramfjord introduced the Periodontal Disease Index (PDI) and is credited with being the first index to use a periodontal probe to measure clinical loss of attachment. mean inaccuracies of different probe sets varied from 0. 6. Mean tip diameter ranged from 0. In 1959. different boards and testing agencies specify acceptable probe styles and most limit the probe to only one style (Table 1).70mm.06 to 0. 25 No. 7.
lightweight. Third Generation Probes Florida probe The Florida Probe was developed following the criteria defined by the National Institute of Dental and Craniofacial Research for overcoming limitations of conventional probing.Table 2: Commonly Used Periodontal Probes All photos are courtesy of Hu-Friedy PQO Michigan-O Style PCP 12 Marquis PCV 12 Color Vue UNC-12 (or 15) PQW Williams P26G Glickman P3/4 Cattoni PGF Goldman-Fox Marks 3-6-9-12 Marquis (shown) Williams style UNC 12 style Yes 1-2-3-4-5-6-78-9-10-11-12 Color coded at 5-10 (UNC 15 at 5-10-15) Thin shank allows access into tight fibrotic sulci.The technology of second generation probes was the basis of the third generation probes. some research “identified a positive correlation between probing force and depth of probe penetration.8 The second generation probes did not have electronic data collection. UNC 15 diameter is for attachment loss • Nabers: The Nabers probe has curved workings ends and a blunt tip to facilitate detection and classification of furcations.”10 Weinberg et al. noninvasive.tapered. which included the electronic data collection capability. Although the conventional straight probes can still be used. These criteria include constant and standardized force. According to Hefti et al. The purpose of the ball tip is to provide patient comfort and help detect calculus as well as irregular margins of restorations. most clinicians find the Nabers probe to be superior for furcation areas. will not scratch implants Markings wear away then entire probe or tip needs to be thrown out Thin shank allows access into tight fibrotic sulci Spaces between 3 and 5 and between 5 and 7 minimize confusion Difficult to read Spaces between 3 and 5 and between 5 and 7 minimize confusion Disadvantages5 Markings must be estimated between color bands. and easy to use. narrow nance. clinically meaningful. • World Health Organization (WHO): This probe has a ball tip 0. degree of penetration into the furca. a guidance system to ensure proper angulation. complete sterilization of all portions entering mouth.4 Continued on Page 18 Second Generation Probes Second generation probes were developed in an effort to standardize and quantify the pressure used during probing. fine 12 is for mainte. no biohazard from material or electric shock. thin shank allows access into tight. easy access to any location around all teeth.5mm in diameter. ie. stated that controlled force of 20 to 25 grams probes reduced examiner error and made depth changes of less than 2mm CDHA Journal – Summer 2010 17 . thin tip may penetrate junctional epithelium Markings end at Difficult to read 8mm Difficult to read Difficult to read Flat shank does not allow easy access into tight fibrotic pockets Other features Plastic probe offers the option of using replaceable and flexible yellow tips Very thin UNC Round.. and direct electronic reading and digital output. thin shank allows access into tight fibrotic sulci. UNC 15 is for clients with attachment loss while UNC 12 is for maintenance N/A 3-6-8 (shown) or w/ Williams markings No 1-2-3-5-7-89-10 Also available with color-code at 3-5-7-10 Spaces between 3 and 5 and between 5 and 7 minimize confusion 1-2-3-5-7-89-10 No 3-6-9-12 1-2-3-5-7-89-10 No Color coding (Usually black bands) Advantages5 Yes No Easy to read. fibrotic sulci Easy to read due to contrast. sterilizable.
5mm Disadvantages5 May feel bulky when clinician is accustomed to using a periodontal explorer for furcation detection Curved working end. Carranza reports. a colored chart can be printed and used as part of the patient’s record or for patient education purposes.Table 3: Specialty First Generation Probes All photos are courtesy of Hu-Friedy PCPNT2 Novatech PQ2N Nabers Style PCP11. the clinician presses the foot petal and the system automatically records pocket depth.4 Although not clinically CDHA Journal Vol. more research is needed to validate these claims. less prone to examiner variability.5 UltraSonographic Probe Designed at NASA to detect cracks in airplanes.5-8.”15 Markings Depends on style.5 Photos courtesy of Florida Probe Limitations The periodontal probe presents problems of sensitivity and reproducibility. bleeding.5-11. ronded for investigating furcas Other features Right-angle design Marks at. and computer.4mm and applies 15g of pressure. precise management of inflammation). color coded from 3. plaque. The probe moves through a sleeve. “The ultrasound probe projects a very narrow beam of high-frequency (10-15 MHz) ultrasonic waves into the gingival sulcus and then detects echoes of returning waves. attachment loss. The ultrasound probe is able to painlessly capture a series of observations (depth measurements plus contour) across the entire subgingival area as the probe tip passes along the gingival margin.3mm) in clinical probing results.5-1. furcation. However. thin shank allows access into tight fibrotic sulci Markings at 0.5-5. size of the probe. “The ultrasound probe may offer an important alternative to traditional manual periodontal probing because it is non-invasive. and mucoginigval involvement. the US Probe is an ultrasonographic instrument that integrates diagnostic medical ultrasound techniques with advanced artificial intelligence to automatically detect. there is no subgingival penetration. All of these variables contribute to the large standard deviations (0. Issues such as the cost of research and development and the price of bringing a new product to market all play important roles in the rates of development. According to McCombs and Hinders. The ultrasound probe tip is gently placed on the gingival margin until slight blanching occurs. computer storage of data. computer interface. round tapered fine with ball end The system includes a probe handpiece.5B WHO/PSR Screening sensitivity. paired furcation probes. and precision of calibration. “The precise location of the probe tip depends on the degree of inflammation…technique. The probe measures 0. production. 2 The advantages include constant probing force with precise electronic measurements and computer storage of data. force. They conclude. particularly on distobuccal and distolingual aspects of posterior teeth. foot switch. angulation. mobility.5 Color coding Advantages Yes Ideal for detection of mesial and distal furcations in maxillary molars. Other electronic probes (Interprobe and Peri-Probe) provide some of the benefits of the electronic probe (constant force. smooth insertion into sulcus May feel bulky due to angulation 5 3-6-9-12 3. then swept along the entire gingival area. markings are helpful Yes Ball tip for client comfort. and diagnose periodontal disease. suppuration. A problem is a lack of tactile Florida Probe 18 Photos courtesy of US Probe . easy to read markings. painless. and may yield additional histological information. Next. hyperplasia. more accurate readings. Once the tip of the probe is inserted into the sulcus. digital readout. which are reflected back from tissues….”15 In other words. 25 No. were designed to address these problems. therefore yielding more information. US Probe map. and an underestimation of deep probing depths. primarily the Florida Probe. Marquis markings are shown 3-6-9-12 Yes Adaptability in areas of limited access. recession. and adoption of the new ultrasound probing technology. a fixed force setting regardless of inflammatory status.5. smooth.5-5. potentially more sensitive.”4 Electronic probes.
Darby M. Willmann D. Conclusion Conventional probes come in a variety of designs which offer advantages and disadvantages. 2002. Motta A. Davies E.18(7): 516-20. Available from: http://www. 7. (2006). 2009. is Professor of Dental Hygiene at Sacramento City College and has taught in the department for over 30 years. American Dental Hygienists’ Association. A system of classification and scoring for prevalence surveys of periodontal disease. particularly with the third generation or automated probes. these probes have reported only slightly improved reproducibility compared with conventional probing.com). Educators can facilitate operator confidence by introducing students to a variety of probes. J Clin Periodontol. 2010. Boston: Pearson. MA. Hefti A. 14. a guide to preparing professional development and job search materials. Biao M. St Louis: Saunders. 2006.significant. She can be reached at Standle@scc. J Periodontol. Philadelphia: Lippincott Williams and Wilkins. calibration from tip and tine diameter of periodontal probes. 2007 July. and literature. 2. Friends of Hu-Friedy [Internet]. a writing and editing service. Licensed clinicians have the opportunity to familiarize themselves with probes through sales representatives. Rapp G. 9. BS. Measurement of attachment level in clinical trials: probing methods. References 1. Nield-Gehrig J. Palat M. Schoor R.org/downloads/adha_standards08.losrios. Van der Zee E. RDH. Takei H. 1991. J Periodontol. St Louis: Saunders.63(12 Suppl): 1072-7. 3. conventions. 10th ed. Westphal C.losrios.pdf Newman M. Weinberg M. Russell A. which includes probe measurements and documentation.writingcures. 2008.13(1): 61-5. A brief history of national surveillance efforts for periodontal disease in the United States. Froum S. 550p. Philadelphia: Lippincott Williams & Wilkins. Available from: http://adha. 2006. Manufacturers continue to address the concerns by developing and implementing new technology. Ms. 2007. 3rd ed. Klokkevold P Carranza F. RDH. trade shows.asp Standards for Clinical Dental Hygiene Practice. PhD. Marking width. Dr Emmerling can be reached at EmmerlH@scc. 5. 1992. 2nd ed. 2010. Clinical practice of the dental hygienist. The potential of the ultrasonic probe. J Dent Res. Thornton-Evans G. Comprehensive periodontics for the dental hygienist. Crit Rev Oral Biol Med. [Internet] [Cited 1 June 2010]. Wilkins E. 1997. Dye B. About the Authors Heidi Emmerling.friendsofhu-friedy. It is imperative that the dental hygienist be familiar with different probe styles and be comfortable using a variety of probes due to office and examining board requirements. 6.edu Ellen Standley.78(Suppl): 1373-9.edu 10. Foundations of periodontics for the dental hygienist. the standard of care in dental hygiene treatment is to do a thorough periodontal assessment on all patients. is Assistant Professor of Dental Hygiene at Sacramento City College and a CODA site consultant. 11. Carranza’s . McCombs G. Darby M. Beemsterboer P. and co-author of Purple Guide: Paper Persona.4(4): 16-8. Newman H.com/ resources/InstrumentoftheMonth. Dimens Dent Hyg. Dental hygiene theory and practice. 1956. (2007) Periodontology for the dental hygienist. Hinders M. Brz Dent J. Perry D. Louis: Saunders. Barbosa Jr A. [Cited 24 Mar 2010]. clinical periodontology. In spite of identified limitations. Periodontal probing. 13. 8. Technical assessment of WHO-621 periodontal probe made in Brazil. 12. 4.35: 350-57. Standley is the 2010-2011 President of the California Dental Hygienists’ Association. Mendes A. 3rd ed. My favorite probe. 10th ed. Walsh M. CDHA Journal – Summer 2010 19 . St. She is also owner of Writing Cures (www. She is a member of the California Dental Hygiene Educator’s Association and the American Academy of Dental Hygiene. 3rd ed. Pihlstrom B. Garcia R.8: 336-56.
4-7 Scaling and root planing (SRP) have long been considered the ‘gold standard’ of non-surgical treatment for periodontal diseases by diminishing plaque and calculus deposits.21-22 However. Two distinct drawbacks with antibiotics exist: the inability to neutralize virulence factors and the formation of bacterial resistance. are not eliminated with antibiotic therapy. 25 No. damage to the alveolar bone.10 CDHA Journal Vol. subsequently altering the subgingival microbial load. peri-implant inflammatory lesions resemble periodontal diseases with similar periodontal pathogens. dental implant maintenance requires routine monitoring of the peri-implant soft and hard tissues.14-15 Bacterial resistance is increasing due to the heightened use of broad spectrum antibiotics and the evolution of bacteria and biofilm to acquire new mechanisms needed for resistance. gingivalis to select antibiotics capable of entering eurkaryotic cells.3. and possible tooth loss.13 Studies indicate virulence factors will continue to exert adverse effects on host tissues after the infecting pathogen is eliminated with an antibiotic regimen.3-4 Likewise.20 Dental implants face equal challenges with colonization of pathogenic bacterial species.9-10 However. shows promise as a locally delivered antimicrobial (LDA) adjunct in the treatment of both periodontal and peri-implant diseases.6-7 Consequently.8 Individuals who do not respond as favorably to standard scaling and root planing often require additional treatment modalities such as systemic antibiotics and locally delivered antimicrobials.14-15 Specific periodontal pathogens have also been shown to invade oral epithelial cells perhaps enhancing their ability to further evade eradication following standard treatment protocols including systemic antibiotic therapy.29 Although no resistant isolates remained permanently. bacterial resistance had occurred. natural dentition or dental implant. a percentage of resistant isolates increased in plaque samples in all adjunctive treatment groups. periodontal pocket formation.23-24 Short-term pathogen reductions followed by re-colonization by the same species is consistent among full-mouth disinfection studies. Prevotella intermedia. both locally and systemically delivered. Treponema denticola and Tannerella forsythensis as well as the facultative anaerobe Aggregatibacter actinomycetemcomitans.11 Particular bacterial species existing in intricate biofilms play a key role in the initiation and progression of periodontal diseases.18 Most studies indicate that no single instru20 mentation technique is totally effective in eliminating all bacteria from the subgingival tooth surfaces. combined with mechanical debridement of the biofilm and adjunctive therapies as needed.25 In addition.1. including lipopolysaccharides and proteolytic enzymes.13 A common known limitation to antibiotic therapy is the inability to neutralize or eliminate virulence factors. indicating that healthy periimplant sites may be threatened by periodontal pathogens existing in other areas of the oral cavity.24-26 It has been established that P. The pathogenesis of periodontal diseases is not simple with bacteria and host immune responses working together. gingivalis was able to recolonize subgingival sites in which it had been earlier suppressed shortly after active periodontal treatment. host immune responses and inflammatory reactions. metronidazole or a sub-antimicrobial dose of doxycycline. 28 In subjects with chronic periodontitis who received SRP alone or with systemically administered azithromycin. limitations such as re-colonization of subgingival sites and bacterial resistance exist with current adjunctive therapies. RDH Photodisinfection – Innovative Adjunctive Therapy Treatment protocols for periodontal diseases strive to evolve and provide enhanced outcomes in conjunction with a culminating body of research that demonstrates the complexity of these diseases.19 It has been stated that improved treatment outcomes could be achieved with full mouth disinfection or anti-infective therapy that includes both mechanical and chemotherapeutic approaches to reduce or eliminate the microbial biofilm. it has been demonstrated that pathogenic bacteria were able to colonize ‘pristine’ peri-implant sites in mixed dentitions. intracellular bacterial invasion research demonstrated resistant strains of intracellular P. an emerging technology.1-3 The host immune inflammatory response to this microbial challenge leads to tissue destruction.12 Each of these bacteria has virulence factors that act locally to enhance destruction within the sulcular tissues.3 This list includes gram-negative anaerobes such as Porphymonas gingivalis. reduction in probing depths. may demonstrate recolonization due to extracrevicular sources such as active periodontal disease in separate periodontal defects despite comprehensive periodontal therapy.5-7 Eradication of periodontal pathogens plays a key role in the treatment of periodontal and periimplant diseases. leading researchers to investigate possible re-colonization from sources outside the treated periodontal pocket or from pathogens which have invaded epithelial cells. Further.1 The primary etiology of these diseases consists of periodontal bacteria and their products that exist in multispecies biofilms. 2 . peaking at the end of administration.9 Studies report improved gains in clinical attachment levels.9.27 These findings support the theory that previously treated subgingival areas.14 Virulence factors. and decreased bleeding on probing following scaling and root planing therapy when combined with adjunctive antimicrobial use. Photodisinfection (PD).25 Current antimicrobial treatment modalities are based primarily on antibiotic therapies.16-17 The use of adjunctive antimicrobials has been shown to improve clinical outcomes and suppress bacterial loads as compared to scaling and root planing alone.Photodynamic Therapy Catherine Fairfield. Virulence factors contribute to a pathogens success at initiating and progressing host tissue destruction. the reductions of subgingival pathogenic bacteria associated with adjunctive antimicrobials are not permanent with most studies indicating suppressions for terms of 3 to 18 months.9-10.
5-6 Thus. The process has a possible cytotoxic effect on surrounding tissues and produces heat during illumination.46 In spite of these concerns.32. however bacteria are not likely to develop resistance to photodisinfection. lipid peroxidation and the inactivation of essential enzymes follows. their damaging virulence factors and increasing bacterial resistance to antibiotic regimens. multi-antibiotic resistant strains have been eradicated by photodisinfection.48 A recent study utilized methylene blue and demonstrated the effectiveness of photodisinfection as an adjunct to SRP. when combined with low intensity red light energy have been shown to eliminate the infecting organisms and the related virulence factors without causing damage to the adjacent host tissues.15.32. Periimplant diseases have a similar etiology to periodontal diseases. (Figure 1) The second step consists of illuminating the site with the light-diffusing tip from a non-thermal diode laser of the appropriate and constant wavelength for a set time.39 Photodisinfection for the treatment of periodontal and peri-implant diseases consists of a simple two-step clinical procedure.38-39 This excitation generates localized singlet oxygen and free radicals that directly attack the targeted plasma membrane resulting in cell membrane disruption. however the reactive oxygen species may inadvertently cause damage to host tissues.39 Bacterial cell death via loss of membrane integrity.38. gingivalis Continued on Page 22 CDHA Journal – Summer 2010 21 .43 The low concentrations of non.27.32-35 A rise in resistant strains of bacteria appearing more readily sparked interest in the use of photodisinfection for the treatment of infectious diseases. (Figure 2) occurring in-vivo and resulted in decreased bone loss in rats. viruses. 29-31 Photodisinfection presents a novel antimicrobial therapeutic approach for periodontal and peri-implant diseases. This cytotoxicity destroys bacteria. photodisinfection is capable of neutralizing ing the limitations of current non-surgical treatment virulence factors.40 The first step is thorough irrigation of the affected site with the photosensitizing solution that selectively binds to gram-negative bacteria. Unlike antibiotic periodontal and peri-implant diseases further identifytherapy. research has reported lethal photosensitization of P.Limitations exist with current adjunctive treatment modalities due likely to numerous factors such as evasive periodontal pathogens.11. which if excessive may lead to delayed healing or tissue necrosis. 41-42 Although bacterial biofilms ment modalities is clear. It has also been demonstrated the in-vivo killing of epidemic methicillin-resistant Staphylococcus aureus (EMRSA-16) strain in two mouse wound models utilizing methylene blue as the photosensitizing agent.36 The non-antibiotic technology of photodisinfection targets and eliminates microbes including bacteria. In addition.46 Potential problems with photodisinfection do exist. thus preventing further damage to the sureliminate or reduce the current limitations to treatrounding host tissues. researchers proposed that lethal photosensitization could be an effective means of eliminating peridontopathogenic bacteria from dental plaque.45 Resistance in the target bacteria would be unlikely as the killing is achieved in very short periods of time.37-38 Designated photosensitizing agents on the cell membrane of targeted pathogens are activated by light of a specific wavelength. Biopsies have been examined in a recent study following treatment with methylene blue and red light illumination and did not reveal any tissue necrosis after 24 hours. 49 Figure 1: Step one – Irrigation Photodisinfection has certain advantages over other Research continues to unfold the complex nature of antimicrobial treatment modalities. fungi and protazoa.44 Formation of bacterial resistance is a key concern with antibiotic therapies.40 These in vivo results showed increases in clinical attachment levels. such as methylene blue.48 The greatest level of killing occurred with exposure to laser light in conjunction with methylene blue as a photosensitizing agent. a and peri-implant diseases warrants further investigation and shows study has confirmed that light in the presence of a photosensitizing 28.35-36 As early as 1992. photodisinfection has been identified as a non-invasive adjunctive therapy that could reduce microorganisms and related virulence factors in periimplant diseases.32 Prior treatment of bacteria with a chemical photosensitizing agent was found to sensitize targeted bacteria to killing by light emitted from low-power non-thermal lasers.toxic photosensitizing solutions. reductions in probing depth and decreases in bleeding on probing as compared to SRP alone.43 much promise. disinfection of blood products and drinking water. The science of photodisinfection began over 100 years ago when the combination of harmless dyes and visible light in vitro resulted in the killing of microorganisms. Further. The need for novel adjunctive therapies that enzymes. Research led to the introduction of photodisinfection for the treatment of cancers. agent can kill substantial numbers of oral bacteria. The role of photodisinfection protect the pathogenic organisms from immune system as an adjunctive antimicrobial in the clinical treatment of periodontal clearance and increase resistance to phagocytosis and antibiotics. including both lipopolysaccharides and Figure 2: Step two – Illumination protocols. lethal photosensitization for periodontal and peri-implant diseases is considered safe.47 Heat is produced by red light illumination.
J Clin Periodontol. Komerik N. 22 CDHA Journal Vol. Johnson JD. The effect of a one-stage full-mouth disinfection on different intra-oral niches. Andersen R. Lasers Med Sci. Efficacy of antibiotics against periodontopathogenic bacteria within epithelial cells: an in vitro study. 2001. Hinrichs JE. Wolff LF. 27. Vorozhtsov G.77: 1333–9. 2004. 28. Huang YY. Lasers Med Sci. 17: 63-76. 2004. Bonito AJ. Photochem Photobiol Sci. Clinical and microbiological observations.59: 493-503. Treatment of periodontal disease by photodisinfection compared to scaling and root planing. 1994. J Periodontol. and hands-on advanced instrumentation workshops.5: 78–111. Periodontol. 2007. Socransky SS. 1993. 1996. 7. Haffajee AD. J Clin Dent. J Periodontol. Lang NP. Risk of Porphyromonas gingivalis recolonization during the early period of periodontal maintenance in initially severe periodontitis sites. et al. 32. Alberta and is currently practicing in both periodontal and prosthodontic disciplines. Jori G. J Periodontol.29 Suppl 2:6-16. Periodontology. Loebel N. Drisko CH. Initial subgingival colonization of ‘pristine’ pockets. Pfister W. Wilson M. 17: 63-76. Meyer DH.15: 24–30. Nakanishi H. 18. 30. J Periodontol. Marcantonio EJ. J Clin Periodontol. 19. Packer S. Mombelli A. Walker CB. 23. 2000. scaling and root planing. Quirynen M. O’Neill JF. Miura M. Gioso MA. Rouabhia M.18: 34–8. Ehmke B. et al. Inactivation of Proteolytic Enzymes from Porphyromonas gingivalis using light-activated agents. Eick S. Catherine can be reached at catherinefairfield@gmail. The diagnosis and treatment of peri-implantitis.70(5):784-94. She has 21 years of experience in private periodontal practices in Calgary. Bactericidal effects of different laser wavelengths on periodontopathic germs in photodynamic therapy. Araujo NS. Wilson M. Lambrechts SA. Chen R.3: 406-11. Periodontol. 39. Offenbacher S. Fujise O. Lenton PA. Saglie R. 47. 1999. Chan Y. Photochem Photobiol Sci.25: 56–66. 12.4: 119-26. 5.3: 412-8. 45. 33. Microbial etiological agents of destructive periodontal diseases. 2008 May. In vitro models of tissue penetration and destruction by Porphyromonas gingivalis. Clin Oral Impl Res. 2003. 13. 2001. 6(3-4): 170-88. J Periodontol. Teles RP. MacRobert AJ.72(5): 676-80. Microbiological changes associated with four different periodontal therapies for the treatment of chronic periodontitis. Walker C. 2002. adjunctive therapies for the treatment of periodontal and peri-implant diseases. Pihlstrom B. Photodiagnosis Photodyn Ther.9: 127-43.38: 468–81. The diagnosis and treatment of peri-implantitis.31. Oral bacteria in multi-species biofilms can be killed by red light in the presence of toluidine blue. 49. Comparative study between the effects of photodynamic therapy and conventional therapy on microbial reduction in ligature-induced peri-implantitis in dogs. Singer M. Karpinia K. Wilson M. 1998. Dobson J. 2006. et al. et al. Sensitization of oral bacteria in biofilms to filling by light from a low-power laser. et al. 24. Periodontol. Cristiani I. Erratum in: J Periodontol. Photochem Photobiol Sci. Photochem Photobiol. 11. Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing. 16. Photochem Photobiol. 43. Zolfaghari PS. Cobb CM. Komerik N. Wainright. 2004. 2009. Carranza FA. RDH. Oral Microbiol Immunol. Feres M. Martins MC. 2005.53: 217–22. Arch Oral Biol. 2009. Sharma M. 2006. M. 2008. Wilson M. J Clin Periodontol. Photodynamic therapy for Staphylococcus aureus infected burn wounds in mice. J Periodontol. Photochem Photobiol Sci. Karpinia K Rationale for use of antibiotics in periodontics. The effect of photodynamic action on two virulence factors of gram-negative bacteria. 2004.44(2): 181-9. J Dent Hyg. Mongardini C. Hamblin MR.36: 146-65. Disease progression in periodontally healthy and maintenace subjects. She currently provides educational seminars in non-surgical periodontal therapy. Nair SP. 2005. Kaliya O. Virulence factors of Actinobacillus actinomycetemcomitans. et al. 1998.146: 487-91. 2006. Grenier D. Aalders MC. 2008. Andrian E. 2004. De Boever Ja. Soncin M. Theodoro LH.77(2): 326. Omar GS. Dai T. Poole S. Microbiological findings and host response in patients with peri-implantitis. et al. and the periodontal condition. Microbes. Wainright. 2000. 2002 May. Hayek RR. Implants and infection with special reference to oral bacteria.13: 349-58. 1988. Bactericidal effect of laser light and its potential use in the treatment of plaque-related diseases. Zhang G. Shibli JA. Lethal photosensitization of wound-associated microbes using indocyanine green and near-infrared light. Bollen CM. 2005. Photosensitized oxidation by dioxygen as the base for drinking water disinfection. 2007. Newman MG. 2003. Papaioannou W. Packer S. J Hazard Mater. graduated from the dental hygiene program at the University of Alberta in 1989. 8. et al. Mombelli A. Lotufo RF. Ultrastructural observations on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth.About the Author Catherine Fairfield. Speziale P. Haffajee AD. Adjunctive antimicrobial therapy of periodontitis: long-term effects on disease progression and oral colonization. J Periodontol. Natural distribution of 5 bacteria associated with periodontal disease. 2004. Haffajee AD. Lethal photosensitisation of oral bacteria and its potential application in the photodynamic therapy of oral infections. Demidova TN. Int Dent J.37(11): 883-7. 31. 2000.3: 412-8. Pauwels M. J Periodontol. Hamblin MR. 1982. 36. Wilson M. Komerik N. Haanaes HR. Hasan T. 2. References 1. 14.25: 77-88. Hallstrom H. Chemotherapeutics: antibiotics and other antimicrobials. 2000. Periodontol. inflammation. 2000. 42. Kuznetsova N.76: 749–59. Periodontal diseases: pathogenesis. Loesche WJ.1: 821–78. 2000. Edwards Ca. 25 No. 9. Gupta PK. 26. Nyman SR. et al. 2008. Hamachi. 82(3): 4-9.18(1): 51-5. Lethal photosensitization in microbiological treatment of ligature-induced peri-implantitis: a preliminary study in dogs. Periodontol. J Periodontology.79(12): 2305-12. 4. Patel M. Garcia VG. 2002. Photodynamic therapy for localized infections – state of the art.47(3): 932-40. Wilson M. Fabris C.23(2): 148-57. Hultin M. 22. Toludine blue-mediated photodynamic effects of staphylococcal biofilms. Review. 2005. Photoinactivation of viruses. Antimicrob Agents Chemother. 1998. 44. 2000. Infect Immun. Lai CH. Cobb CM. Nonsurgical periodontal therapy. Wilson M.84: 340–4.72(5): 676-80. dental implant maintenance therapy. Socransky SS. Mintz KP. 2000. Allard K. et al. Change in subgingival microbial profiles in adult periodontitis subjects receiving either systemically-administered amoxicillin or metronidazole. J Clin Periodontol. Periodontol.20: 699–706. Hope CK. 3. 1994. 10.45(1): 17 -23. 2005. et al. 2000. 25. Burns T. 1992 Nov. Impact of local adjuncts to scaling and root planing in periodontal disease therapy: a systematic review. Beikler T.52(1): 299-305. Lang NP. Fives-Taylor PM.28: 597–609. Adriaens PA. The effect of photodynamic action on two virulence factors of gramnegative bacteria. 1990. Hammond D.20: 136–67. 41. Lohr KN. 40. 2002. J Dent Res. Bhatti M. Wilson M. J Oral Sci.31: 86–90. Wilson M. M. 2002. 15. et al.72: 4689–98. 48. et al. Antimicrob Agents Chemother. J Periodontol. Moter A. Catherine continues to provide consulting services and lectures on behalf of various companies in the dental industry and has just completed 7 years as a member of the Competence Committee for the College of Registered Dental Hygienists of Alberta. 2003. Socransky SS. In vivo killing of Porphyromonas gingivalis by toluidine blue-mediated photosensititzation in an animal model. 2008.8:111–120. 2 . 37. BMC Microbiol. 6.73(10): 1188-96. Lux L. Aeppli DM. Lasers Surg. Ann Periodontol. Poole S. Vogels R.com 20.17: 516-24. J Clin Periodontol.76(8): 1227-36. 35. Visai L. Catherine contributed as a part-time clinical educator and guest lecturer in the Graduate Periodontal program at the University of British Columbia for 6 years. Baehni P. 2000. Pathogen inactivation in blood products. 1994. 46.75: 1327-34. 38. Persistence of extracrevicular bacterial reservoirs after treatment of aggressive periodontitis. 21. 2008. Curr Med Chem. Gustafsson A. BMC Microbiol. In vivo killing of Staphylococcus aureus using a lightactivated antimicrobial agent.4: 503–9. Haffajee AD. Lang NP. Bacterial invasion of gingiva in advanced periodontitis in humans. 34.76(8): 1275-81. 17. Supportive maintenance care for patients with implants and advanced restorative therapy. Lethal photosensitisation of oral bacteria and its potential application in the photodynamic therapy of oral infections. 29. Patel M.9: 27. Makarov D. Rudney JD. Wilson M. Photodynamic therapy in the treatment of microbial infections: basic principles and perspective applications. Bragheri F. Lasers Surg Med.
d. An advantage of the Florida probe includes: a. c. 10. UNC-12 probe. d. Photodisinfection technique includes: a. phenolics. 7-14 days. amoxicillin. 3. b. Glendale. quarternary compounds. 9. and illumination of the site with a non-thermal diode laser. four steps. including irrigation of the affected site with a photosensitizing solution. multi-antibiotic resistant strains can be eradicated.LifeLongLearning Home Study Correspondence Course 2 CE Units (Category I) Read the following articles and answer the questions: • Pharmacology and Periodontal Disease • Advances in Technology and Periodontal Therapy • Probing into Probes • Photodisinfection-Innovative Antimicrobial Adjunctive Therapy 2 CE Units – Member $25. placement of a locally delivered antimicrobial. illumination of the site with a non-thermal diode laser and rinsing with a hydrogen peroxide rinse for one minute following the procedure. c. c. 8. c. d. Of the many systemic antibiotics available to treat periodontal disease. CA 91203 CDHA Journal – Summer 2010 23 . increased tactile sensitivity. PreViser. Suite 301. three steps. c. Williams probe. b. a. InSight™ LED ultrasonic scaler insert. ColorVue probe. d. constant probing force. Marquis probe. sanguinarine. d. Brand Blvd. 2. 7. Please allow 4 . 10-21 days. placement of a locally delivered antimicrobial. after 30 days. b. Swerv3™ magnetostrictive ultrasonic scaler. it is non-invasive. illuminating the affected site with a non-thermal diode laser. The periodontal probe favored by many on the west coast is the: a. False All of the following antibiotic agents are bactericidal EXCEPT: a. tetracycline. DIAGNOdent Perio Probe. including irrigation of the affected site with a photosensitizing solution and illumination of the site with a non-thermal diode laser. c. The advantages of photodisinfection include all of the following EXCEPT: a. True b. cephalosporin. Technology that allows for risk assessment for periodontal disease is the: a. capable of neutralizing virulence factors. Potential member $35 Circle the correct answer for questions 1-10 1. d. d. Blue Boa®. two steps. c. New innovations for treatment of periodontal disease include all of the following EXCEPT: a. 4 5 6. d. b. b. The therapuetic drug levels of locally delivered antimicrobials in the gingivial crevicular fluid.6 weeks to receive your certificate. Orasphere. c. First generation antimicrobial antiseptics include all of the following EXCEPT: a. b. b. less bacterial resistance. metronidazole. including irrigation of the the affected site with a photosensitizing solution. chlorhexidine. b. b. increased healing due to heat production. The following information is needed to process your CE certificate. NV Microlaser™. painless probing. 3-5 days. MyPerioPath. d. one step. begin to decline in: a. c. there is no consensus as to the ideal dose and duration of treatment required. Please print clearly: ADHA Membership ID#: ________________________ Expiration:___________ ❑ I am not a member Name: _____________________________________________________ License #: ___________________ Mailing Address: __________________________________________________________________________ Phone: ______________________ Email: __________________________ Fax: ______________________ Signature: ______________________________________________________________________________ Please mail photocopy of completed Post-test and completed information with your check payable to CDHA: 130 N.
to speak at a meeting somewhere in the US. RDH. Just when I thought I would finally have lots of free time. one at USC and one at UOP in San Francisco. lecturer. I could go to graduate school and be a short subway ride away from the Metropolitan Museum of Art! I got my Master’s degree in one year. In 2001. Europe. get back to art history and travel through Europe. She thought I should have a career only to fall back on in case my future husband (whom she was hoping I would meet in college) ever became disabled or died suddenly in an accident. right on schedule. Teaching and writing eventually led to opportunities for me to lecture at professional meetings and provide continuing education courses in Advanced Periodontal Instrumentation. What led you to the work you do now in education. Ragland scolded me and sent me out of the room. I would have to work to put myself through the extra years of college to study Art History. publishing. This was in the fall of 1966. I said that was a shame and someone should make a clinical manual with pictures for students. Dr. and was accepted to the USC dental hygiene program at the age of eighteen. “You can’t move to New York! And if you get a PhD. did the interview. Two of my brothers had gone to dental school. Since my husband was a periodontal faculty member at both UCLA and USC Dental Schools. taught first year dental hygiene instrumentation at USC for two years and wrote the first edition of my book in 1970. I retired from full time teaching at USC. Australia. no one will marry you!” She and my father said that they would put me through USC to get my Bachelor’s degree in Dental Hygiene. at least one or two weekends a month. There is no typical routine because I teach one or two days at USC.” She said. New Zealand or Asia. She said. An interview with Anna Pattison. editor-in-chief and practicing hygienist without being tired all the time. it never stops. The second and third editions of this textbook. “What can I do to get the education and preparation to write the book. I took a fantastic course called.CareerCorner Debi Gerger. we have co-authored the instrumentation chapters in Glickman’s and Carranza’s Clinical Periodontology textbook for the last six editions.” I said. She said there were 24 CDHA Journal Vol. We had met as freshmen at USC and dated all through undergraduate and dental school. Periodontal Instrumentation. teach first year dental hygiene for a few years and then write the book. She was pretty typical of moms from the 1950’s except she didn’t wear pearls with her apron. My mother was appalled. I cut back to part-time teaching and hoped to finish writing the next edition of my book. All the while I am writing and editing for Dimensions of Dental Hygiene and working on various book projects. I get very little sleep. etc? During my first semester in dental hygiene. but I was not a happy camper. “Why don’t you write that book. I do different things almost every day but one thing is constant. complete an internship and residency in anesthesiology or OB-GYN and still be young enough to get married and have children. I got the information on obtaining a Master’s degree and when I found out that one of the best graduate programs in the country was at Columbia University in New York City. After that. I have been doing this since graduate school. So much for retirement. I never wanted to be a dental hygienist. I finished my pre-requisites. I entered USC at the age of 16 because my goal was to go to medical school. “You can’t become a MD. “You should get a Master’s degree. Canada. work in my husband’s private periodontal practice every Thursday and I fly off. It is not possible to be a wife. “A Survey of Western Art. 2 . It was very difficult to see the instrument and remember everything she was showing. I stay up until 4AM or I stay up all night several nights a week in order to get everything done. Lorene Kent convinced me to help her launch Dimensions of Dental Hygiene by becoming the editor-in-chief. speaking. like my older sister before me. Gordon Pattison. I had been up late the night before and I began falling asleep on my feet during the lab session. MPH Why Dental Hygiene? Tell the Journal readers about your pathway to dental hygiene. Ruth Ragland.” I fell completely in love with art history and decided to change my major. author. gave a scaling demonstration on a typodont for a group of ten students. the Chair of the USC Dental Hygiene Department. I was excited about dental hygiene for the first time. mS no videotapes and no such book. She said. 25 No. She said. mother of two.” Within weeks. so my parents thought I should work as a dental hygienist for one of them while I continued on with art history. were coauthored by my periodontist husband. RDH. My new goal was to get a Master’s and a PhD in Art History and become a curator at the Metropolitan Museum of Art in New York City. I had a very traditional Japanese mother who did not speak English and did not want me to become a doctor or a professional woman who would have to work full time. Describe a day in the life of Anna Pattison. I later went to her office to apologize and ask if there was a videotape or book with pictures that I could study to make up for the time I missed in her class. I had finished high school in three years and I wanted to go to medical school. Mrs. No one will marry you!” During my freshman year at USC. I just wanted to finish the program.
Dahl C. 19. Slots J.com/default. Vaccines and photodynamic therapies for oral microbial-related disease. of the Pattison Institute which offers lectures and hands-on instrumentation workshops throughout the U. Kubar A. CDHA Journal – Summer 2010 25 . Looking for a fast. “I can teach a monkey to scale. Olsen I. the keystone of good periodontal therapy still is. Traditional medicinal plant extracts and natural products with activity against oral bacteria: potential application in the prevention and treatment of oral diseases. Diz P. Dr. Paulsson A. Pharmacology references continued from page 11 9. Available from: http://www. Oral Micro Immunol.30(2): 55-60. Treatment of periodontitis and endothelial function. J Oral Dis. Decreased gum bleeding and reduced gingivitis by the probiotic Lactobacillus reuteri.1-15. From 1973 to 1975. 10.periobalance. J Clin Vir. Saygun I. Available from: http://evoraplus. I can only teach a small number of students to be very highly skilled at advanced periodontal scaling and root planing.org/es/esn/food/ wgreport2. 2006. et al.CareerCorner What is the most exciting aspect of your work? Traveling and teaching hands-on advanced periodontal instrumentation courses around the world. Evoraplus. Periodontitis lesions are the main source of salivary cytomegalovirus. Liu P-F. She is currently the Co-Director with her husband. line angles and furcations. 13. Hygienists who oversimplify periodontal treatment do a great disservice to their patients and to the dental hygiene profession as a whole. Palombo EA. subgingival irrigation or lasers. thorough debridement of calculus and biofilm. Ms. 2009. Joint FAO/WHO Working Group Report on Drafting Guidelines for the Evaluation of Probiotics in Food. she received the Pfizer-ADHA Excellence in Dental Hygiene Award and the USC School of Dentistry Alumnus of the Year Award. Dr. Cousido MC. I know that I can teach any student to gross scale with an ultrasonic scaler and place Arestin® in a short period of time. She has been an Associate Professor at USC for over 30 years and has served as Chair of the Department of Dental Hygiene. Gordon Pattison. 2009. 12. In 2006 she received the California Society of Periodontists Award. D’Aiuto F.” After 40 years of teaching dental and dental hygiene students. Huang C-M. The American Academy of Periodontology (AAP). Excellent treatment requires intensive initial therapy and constant vigilance during a lifetime of maintenance. Limeres J. She continues to inspire me to do my best to keep working and contributing to our profession. Anna is currently editor-in-chief of Dimensions of Dental Hygiene.71: 125-40. Dental hygienists. Nibali L. J.pdf 14. 2009. eCAM. Evaluation of chlorhexidine substantivity on salivary flora by epifluorescence microscopy.S. Periodontol. In 2009 she was selected to be inducted into the USC School of Dentistry Hall of Fame. Patients with severe periodontitis and subgingival Epstein-Barr virus treated with antiviral therapy. and abroad. Periodontal disease is not simple and it is not easy to treat effectively. Healthy gums and teeth. Sinkiewicz G. 2009. What do you believe our profession should know about periodontal disease in 2010? Regardless of adjunctive antimicrobial therapies such as local delivery antibiotics. 2009. Australia and New Zealand. Europe. Anna Matsuishi Pattison received her BS degree in Dental Hygiene from the University of Southern California and her MS degree in Dental Hygiene from Columbia University. the rapid improvement and gratitude of these clinicians is extremely rewarding and renews my resolve to keep on traveling and teaching. Food and Health Agricultural Organization of the United Nations and World Health Organization. 2008. Wilkins’ influence on me and almost every other hygienist in the country has been profound. We now lecture together in a continuing education course that allows us to travel together all over the country. Krasse P. 2007. 2007. In 2005.fao.php?option=com_content&view=section&layout=blog&id=10<emid-57 17. When I teach the advanced instrumentation course.10(1): 90-4. Nilsson A. Carlsson B. 18.42: 176-8. Curr Drug Metab. I have heard some dentists say. What an experience to be able to teach with and assist the “Guru” of Dental Hygiene! We worked together so well that we developed a deep professional and personal friendship that has lasted for 37 years. Please share a memorable experience from your professional career. Asia. However. 15. Álvarez M.com/ index. GUM PerioBalance.16(6): 428-33. N Engl J Med. run the risk of losing their positions to lesser educated individuals. Available from: ftp://ftp. Tomás I. who lose their focus and do not develop advanced skills. I shared an office and taught dental students with Dr. Sunde PT. A breakthrough in oral healthcare. 2009.aspx. Esther Wilkins at the Tufts School of Dental Medicine in Boston. Pattison has been a featured speaker throughout then US. easy way out and shifting the focus away from meticulous root debridement is a dangerous path. Tonetti MS.356(9): 911-20.24: 340-2. and has always been. Our profession needs to be recognized for special knowledge and exceptional skills that are not easily acquired. adaptation and scaling of difficult problem areas such as deep distal or palatal pockets. Sahin S. Swed Dent J. Basic instrumentation skills and ultrasonic instrumentation are taught and practiced everywhere but there are very few teachers or practitioners who have ever been able to take an advanced course that focuses on access. 2002. 16. Zhu W-H. Guidelines for the evaluation of probiotics in foods. Grinde B. García-Caballero L . 11. Enersen M.
corporate opportunities. where students and exhibitors displayed their wares. gift cards. RDH. During a short break participants spent time in the marketplace. RDH. Laura Ruffino (Oxnard College. Janette Dellinger. Philips Sonicare and Discus Dental. Panelists in the south included: Debi Gerger. and the students ran with it. Panelists represented various career pathways including education. and CDHA nail files to name just a few of the items. They gave of their precious time and energy to make the 2010 Student Regional Conferences two days to remember! CDHA Journal Vol. Students also had the opportunity to fund raise by selling tickets for their own gift baskets. and CDHA members donated t-shirts.Dental Hygiene: A Multi-Faceted Profession” was the theme for the day. Their main theme being “get involved with your professional organization. RDH. Foothill College and USC were host schools for the event and did a great job getting everyone energized and ready for the day. RDH. Local components. RDH. RDH. MS. The driving force behind this success? The students of course! Their enthusiasm throughout the day was inspiring. RDHAP. The momentum started from there and just kept going as the guest panelists were introduced. RDH (President) and Carole Broder. component members. and our representative from Philips Sonicare. Tiffany Saxton (Chabot College. They emphasized that the potential for career advancement was limited only by the student’s own imagination and desires. RDH. The students’ favorite speaker. spoke about CDHA HOD/SHOR. Anna Pattison. 25 No. Participates included educators. The applause was resounding when Anna shared a story from her own personal hygiene education experience. “Exploring the Possibilities…. Much time and effort went into making these conferences a success. sponsors. grocery store shoppers. Both students did a great job encouraging their fellow classmates to get involved in their future profession’s political process. After presentations. The mornings started off with introductions and greetings from our CDHA President. and lecture and publishing. MA (President-Elect) in the north. RDH. exhibitors. and of course our sponsors. shared her experiences at last year’s ADHA House of Delegates (HOD) and Student House of Representatives (SHOR). and provided the students with possibilities as they decide their futures. Kristy Menage Bernie. their questions thought provoking. 26 CDHA Student Delegate. RDH. RDHAP and/or public health. MBA and Janette Dellinger. MPH.” Students were then invited to give program updates and share their ideas on how to find the perfect patient. Some of the ideas included recruiting family members. Nikki Moultrie. Then it was back to the ballroom for more discussion. and Daphne Von Essen. RDHAP. the students were invited to ask questions. BA (VP of Administration & Public Relations) and Ellen Standley. rounded out the southern panel. Daphne Von Essen. Lygia Jolley. students on campus. They shared a multitude of ideas about where to find and recruit the perfect patient. BS (VP Professional Development and Membership) in the south addressed the students updating them on what’s going on in ADHA and CDHA. The CDHA sponsored Northern and Southern Regional Conferences that were a great success. BSDH Nicole Scoles. South). The imaginative and thoughtful ideas often directed student’s search efforts towards organizations that help underserved populations in need of dental hygiene care. Phyllis Martina. Guest speakers representing professional opportunities beyond clinical practice created food for thought and insightful inquiries. and their presentations entertaining as well as informative. CDHA leadership. MS. BSDH. Each school presented a PowerPoint presentation including class photos and candid shots of hygiene education in progress. Our panel discussions were a great success. instruments. along with nearly 600 students representing every hygiene program in the state. Noël Kelsch. RYT. BSDH. friends. and advertising on Craig’s list. BS. MPH. Closing ceremonies included the all-time favorite raffle. the one that inspired her to write a textbook on instrumentation that is still used throughout hygiene education today. MA Exploring the Possibilities CDHA Student Regional Conferences CDHA Student Relations Council February was dedicated to dental hygiene students. RDH. RDH. North) 2009 District XI Student Delegate.StudentConnection Julie Coan. RDH. but the greatest thanks and praise must go to the students themselves. 2 . Panelists for the north included Barbara Heckman.
“ All reasoning is an attempt to FIGURE something out. the decision must be based on facts and clear rational thought. and if not.1 Everyone thinks.2 Critical thinking requires the use of monitoring and self-correction in order to judge the reasonableness of thinking. sound decisions not only in their clinical practice. a voice that guides them in their reasoning skills. In those courses that emphasize complex clinical care. and even patient adherence to healthy routines. Most importantly. Which of the viewpoints makes the most sense for the patient case? The decision making must include the patient’s point of view and preferences. attachment loss. the quality of thinking is improved. clarity requires the clinician to seek out additional information in order to establish a problem. Critical thinking has many definitions. Complete information will aid in establishing clarity which helps drive the formation of the clinical question that needs to be solved.4 Case-based learning works well with student teams or collaborative groups where students can safely learn through their own discoveries. the clinician must use clinical reasoning skills to ensure that the proposed treatment is germane to the case. Logic: Does this all make sense for the patient? Is the decision that has been made logical for this patient at this point in time? To be logical. The most necessary treatment should be considered and completed first. The clinician must consider the patient’s age and overall systemic health as well as the affordability of treatment. Clarity: The first step is to be clear whether or not there is a problem. Have all the options for treatment been discussed and thoroughly investigated? Is the decision based on the evidence? If so. objective or function. knowledge and competence in order to make appropriate inferences. to settle some QUESTIONS. Because periodontal disease is a complex. MA Critical Thinking: Teaching Students to Think Like Dental Hygienists What can dental hygiene educators do to ensure that students develop the skills and abilities which will enable them to be successful in their daily clinical decision making? Enhancing critical thinking skills will help to ensure that students are better able to make confident. Decisions made with critical thinking are like a chain reaction. In order to accomplish this. determine the state or the condition. All critical thinking has a purpose. This includes gingival description. the critical thinker must consider multiple viewpoints. The clinician must use his/her reasoning skills to determine whether or not the information is valid and true. the clinician must be able to recognize the difference between health and disease and have an understanding of the periodontal indices used to determine a diagnosis. Breadth: Before a final decision on the treatment phase can be made. reject or suspend judgment regarding a specific situation or problem. When applied to clinical practice. critical thinking and clinical reasoning. critical thinking includes the ability of the thinker to take charge of their own thinking. assessment of the patient’s systemic health including medications as well as a thorough assessment of the patient’s oral health. This is accomplished through the assessment phase of treatment. multifactorial. In practice.EducationExchange Fran Soderling. What does the evidence reveal about this case? In clinical practice. this may come in the form of additional diagnostic tests.”1 Critical thinkers are curious and skeptical. but with critical thinking. these standards can be practiced through case-based learning. The clinician must be willing to reconsider the decision if other reasons and evidence warrant. Continued on Page 28 27 . These authors have developed a checklist of standards for critical thinking that are designed to help students in the development of their inner voice. Precision: If required. goal. but in life. allowing the patient the final decision. CDHA Journal – Summer 2010 periodontal measurements. Students should be required to thoroughly investigate and determine the possible treatment options for each assigned case and then present their decision making process to the entire class for discussion. a presentation of the diagnosis and possible prognosis with treatment or without treatment can be made to the patient. such as periodontology. Critical thinking requires the application of assumptions. Relevance: The appropriateness of the treatment phase must have some logical connection with the clinical question or problem. making them more motivated to find solutions to situations or problems. The complexities of the disease need to be included in the thinker’s reasoning. polymicrobial infection. but most experts agree that it includes the ability for a person to use his/her intelligence and reasoning for a careful and deliberate determination of whether to accept. solve some PROBLEM. tooth mobility. radiographs. Determine whether or not a patient is in a state of oral health. it is critical that an information rich decision is used to determine the patient’s treatment phase. Critical thinking requires the thinker to step back and reflect on the quality of that thinking. The information is gathered in an in-depth manner through evaluation of the medical and dental histories. Reviewing comprehensive case studies that include all necessary assessment and diagnostic information promotes self-directed learning. the clinician must seek out more details in order to gain a better understanding of the problem at hand.3 Paul and Elder (2008) in their guide to critical thinking point out. furcation involvement of bone loss. RDH. Accuracy: Verification needs to be established. A critical thinker is skillful and able to get past biases to view situations from different perspectives. each decision made creates a range of new choices to consider.
Educators need to allow students enough time to think. It is important to stress to the students that they do not need to become subject matter experts before they can learn to critically think. Elder L. J Dent Educ. The past 8 years also included a part-time instructorship in the Cerritos College Dental Hygiene Program where she has had the honor to be awarded the Outstanding Faculty Member Award for the year 2006-2007. 2008. 2 . TX. Richards PS. 2. Her Master of Arts degree in Post Secondary and Adult Educa- Exceed Your Expectations! Earn Your BSDH From Home With over 50 years of dental hygiene experience. About the Author Fran Soderling has been an educator. accurate and precise.). The miniature guide to critical thinking concepts and tools (4th ed. References 1. Promoting the teaching of critical thinking skills through faculty development. Chabot College Contact us Today! degreecompletion@llu. 4. Paul R. intellectual development and community service. An interdisciplinary approach to case-based teaching: does it create patient-centered and culturally sensitive providers? J Dent Educ. students are better able to transfer the use of these standards to the dental hygiene process of care.EducationExchange Following the case presentations to the class. relevant and logically developed treatment plan decision that is in the best interests of the patient. BSDH 2009 Graduate Instructor. Ms Soderling has practiced clinical dental hygiene her entire career and has developed and coordinated periodontal maintenance programs and non-surgical therapy treatment programs for periodontal disease in numerous dental offices. Inglehart MR. Schneider-Mitchell G. Paul R. the Department of Dental Hygiene is dedicated to providing the highest quality education. ◆ Online BSDH degree completion program ◆ Designed for licensed dental hygienists with a Certificate or Associate degree ◆ Two tracks available: Dental Hygiene Education Public/Community Oral Health Services ◆ Courses designed for the working professional ◆ Now accepting applications for March 2011 Julie Coan.70(3): 284-91. students should decide how many standards for critical thinking were met in the group’s decision making process. Behar-Horenstein LS.73(6): 665-75. Offering an environment for learning that emphasizes Christian values. Foundation for Critical Thinking Press. tion was completed at Cal State University Long Beach where she taught for 12 years. Loma Linda University encourages personal wholeness and professional growth. 25 No. Critical thinking: why must we transform our teaching? J Dev Educ. Presently. community and professional leader for over 40 years. Graff R. Ultimately the competent clinician will be able to gather the information through the assessment phase to make a clear. She received her BSDH from Baylor Caruth School of Dental Hygiene in Dallas. 2006. Dillon Beach. Elder L. time is needed to apply the standards of critical thinking to the information gathered. CA. 3. Just as time is needed for students to learn all the assessments for determining health or disease and time to complete all the assessments. 1994.edu 28 CDHA Journal Vol. 2009. she is proud to be the Senior Clinical Coordinator within the new Dental Hygiene BS program at West Coast University.18(1): 34-5. RDH. By practicing critical thinking in the class room via complex cases.
Executive Administrator California Dental Hygienists’ Association 130 North Brand Boulevard. Category 1 "Child and Adolescent Health: New Challenges for the 21st Century" Carol Jahn. MS 3 CEUs. 104 San Dimas. CA 91203 CDHA2008 RETURN SERVICE REQUESTED Presorted STD U. Postage Permit No. CA Event Courses: Women's Aging Complexities: The Impact on Oral Health Needs" Pam Hughes. RDH. Suite 301 Glendale. RDH. Category 1 . MS 3 CEUs.S. CA PAID 9 Annual CE Extravaganza th Hyatt Regency San Francisco Airport Burlingame.Rosie Tesselaar. BS.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.