SENIOR CAPSTONE PROJECT 1

Senior Capstone Project Paper

By

Rahel and Claire

In partial fulfillment

of the requirements for

Seattle Central College

DHY 313: Periodontology I

Mrs. Tanya Kendall, RDH, M.Ed.

December 6, 2023
SENIOR CAPSTONE PROJECT 1

The first article discussed oral biofilm and its impact on oral health and psychological

and social interaction. We learned that there is a complex interaction taking place within the oral

cavity between the host, diet, oral environment, and oral microorganisms. This complex

dynamic interaction results in microbial colonization and oral biofilm formation. It is estimated

that more than 95% of bacteria existing in nature are in biofilms (Meseret, 2021). The formation

of dental biofilm consists of several steps, which start with the formation of the acquired enamel

pellicle, followed by the initial adhesion of planktonic bacteria to the pellicle layer by binding

sites, subsequent maturation of the bacterial biofilm and, finally, the dispersion of biofilm with

detachment of cells. Gram-positive facultative anaerobic cocci and rods, such as Streptococcus

and Actinomyces species, are the first colonizers of teeth (Meseret, 2021). These initial

colonizers provide a foundation for further development of oral biofilm.

The most common oral diseases, like dental caries and periodontal diseases, are caused

by oral biofilm (Meseret, 2021). We also learned that oral diseases are multifactorial, thus

finding the contributing factor must be top priority to address the problem. To prevent the

development of oral biofilm and associated risk factors, different methods have been suggested.

Several strategies have been proposed to stop the formation of oral biofilm and related risk

factors. This covers mechanical techniques including flossing, brushing, and professional scaling

procedures. Additionally, good oral hygiene and limiting sugary foods or frequent cleaning after

consumption, avoiding smoking and alcohol consumption are the main approaches that can

reduce the problem (Meseret, 2021).

The second article discussed modifiable and non-modifiable risk factors for

periodontitis. We learned that smoking and diabetes mellitus are well-established modifiable risk

factors for periodontal disease, whereas the etiologic microorganisms P. gingivalis, T. forsythia
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and A. actinomycetemcomitans are risk indicators (Van Dyke et al., 2005). Among the risk

factors that cannot be modified are genetics and host response. Defects in neutrophil function

may lead to a susceptibility to periodontal disease. The defect could be rather benign in the case

of locally advanced aggressive periodontitis. In cases of severe neutrophil dysfunction, "the

incidence may be so low or the disease so debilitating as to preclude rigorous analysis of

periodontal relationships" (Van Dyke et al., 2005).

Research has indicated that those experiencing psychological stress are more

susceptible to alveolar bone loss and clinical attachment loss. We also learned that several cross-

sectional studies have shown that alveolar bone density is altered in osteoporotic patients (Van

Dyke et al., 2005). However, not many studies have demonstrated a relationship with clinical

attachment levels. Similarly, in longitudinal studies a relationship has been shown between

osteoporosis and alveolar bone loss, but not between osteoporosis and clinical attachment levels

(Van Dyke et al., 2005).

We are planning to incorporate some of the key information we learned from the

journal into our discussion with the junior students. The impact of oral biofilm on oral health and

the distinction between modifiable and non-modifiable risk factors for periodontitis are among

the key points we mentioned above. We also intend to have discussions about the best ways to

educate patients in the clinic regarding such topics in a way that is easy to understand. An

essential component of good patient education and dental hygiene instruction involves

incorporating studies that have been made on oral biofilm and periodontitis risk factors, so the

information is evidence-based.

To enhance our discussion with the juniors, there are a variety of clinical experiences that

relate to our topic. A couple of the main risk factors that we often see in clinic are diabetes and
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smoking. With diabetes, we can observe inflamed gums, excessive bleeding, and a reduction in

healing if the patient does not control their A1C level (Gehrig & Shin, 2023). On the other hand,

with patients who smoke, there may not be as many vascular changes as those with diabetes, but

periodontal disease is still apparent. Smokers commonly present with a greater progression of

bone loss compared to those who do not smoke as well as other conditions such as heavily

coated tongues, halitosis, and tenacious staining that further encourages the accumulation of

biofilm (Gehrig & Shin, 2023).

Therefore, it is important for the clinician to carefully screen their patients for these

conditions to ask follow-up questions to not only verify if the patient is fit to continue treatment

but also keep a detailed record of how their health may impact their periodontal outcomes. Some

examples of follow-up questions are if the patient is under the care of a physician, what

medications they are currently taking for their specific condition, and if there are any updates to

their health information, such as A1C levels. For the specific case of smoking, it is also critical

for the clinician to check in on the patient’s willingness to quit because of how detrimental the

act is towards maintaining periodontal health. Other modifiable factors that contribute to

periodontal disease are malpositioned teeth, overhangs or poorly contoured restorations, and

furcations (Gehrig & Shin, 2023). While there is not a great deal that can be done with

furcations, except to come in for timely maintenance appointments, there is the possibility of

bringing up orthodontic treatment or redoing poor restorations to reduce biofilm accumulation.

In many cases, we also note patients who have gingivitis but do not show signs of

progressing to periodontal disease. Despite their lack of homecare, they can still maintain their

bone levels; this points towards the theory that their immune system is able to deal with the

existing periodontal pathogens to maintain the equilibrium in the oral cavity (Gehrig & Shin,
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2023). On the other hand, the instances where the patient’s immune system cannot adequately

handle the presence of periodontal pathogens may be observed through the tissue reevaluation

that occurs four to six weeks after their non-surgical periodontal therapy. Through the

evaluation, we can observe the appearance of the gingiva, any improvement in pocket depths, as

well as the presence of bleeding. If the condition of the periodontium remains the same as before

the treatment, then it appears that the patient’s immune system may be compromised; in that

case, a referral to the periodontist would be appropriate.

This research has impacted our consideration for becoming dental hygiene instructors by

allowing us to view different perspectives. At this point, it is still early for us to commit to

teaching dental hygiene, but it made us more open to the idea. Throughout our study, we had to

look over the material repeatedly and ask ourselves how we would word the text to have it be

more easily understood by those who are seeing the subject matter for the first time. After the

process of brainstorming and planning, we now have a deeper understanding of the material

compared to before. By having a better grasp of the subjects, it makes us more confident in

sharing our knowledge with our patients.

Additionally, according to Basdh (2022) teaching would be a great way of lessening the

burnout that many clinicians experience. During normal work hours, it can be easy to lose track

of the whole patient experience due to time constraints and production goals. By being a dental

hygiene instructor, one can take the time to slow down a little and gain a new sense of fulfillment

in watching the growth of future clinicians. Another advantage to educating is that it pushes us to

stay on top of the latest dental information by not only granting us more opportunities to attend

CE courses but also interacting with the community of dental instructors.

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Reference
Basdh, A. G. R. (2022). Do You Want to Be a Dental Hygiene Educator? Today’s RDH.

Retrieved from https://www.todaysrdh.com/do-you-want-to-be-a-dental-hygiene-

educator/

Gehrig, J. S., & Shin, D. E. (2023). Foundations of Periodontics for the Dental Hygienist with

Navigate Advantage Access. Jones & Bartlett Learning.

Meseret, A. G. (2021). Oral Biofilm and Its Impact on Oral Health, Psychological and Social

Interaction. International Journal of Oral and Dental Health, 7(1). Retrieved from

https://doi.org/10.23937/2469-5734/1510127

Van Dyke, T. E., & Sheilesh, D. (2005). Risk Factors for Periodontitis. Journal of the

International Academy of Periodontology, 7(1), 3–7. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1351013/pdf/nihms4855.pdf