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Lies, damned lies, and statistics: The truth behind the importance of flossing

Last week the Associated Press released an investigative report citing “weak evidence” behind the importance of flossing. This week Scott Froum, DDS, editorial director of Perio-Implant Advisory, gives the history behind this investigative report, examines what the term “weak evidence” means in the larger scheme of things, and offers dental professionals talking points when patients ask about the importance of flossing.

The new street drugs some of your patients may be using that you have never heard of

Perio-Implant Advisory’s Editorial Director Scott Froum, DDS, teams up with Joseph Palamar, PhD, MPH, to highlight how some of the more well-known street drugs are being adulterated by new synthetics that are less expensive to make yet cause even greater damage to the person taking them. They discuss a few of the more potentially deadly street drugs that your patients may be taking with or without their knowledge—a synthetic opiate that produces a heroin-like high but is thought to be 10,000 times more powerful than morphine, a new psychedelic with stimulant properties much more dangerous than LSD, and the very potent $5 insanity. You’ll learn to spot the signs and symptoms of drug abuse on the oral cavity.

Antibiotic resistance and periodontitis

Bacteria dividing every 20 minutes can form more than 5,000 billion, billion bacteria in 24 hours, and this number of divisions fosters the possibility of mutations, some of which can enable the bacteria to produce enzymes that inactivate antibiotics while other mutations protect the bacteria from the antibiotic—for example, modifying the entry point on the bacteria. The New York Times recently reported on infectious bacteria resistant to all antibiotics, and the CDC has long raised awareness that antibiotic resistance is a danger, calling it the “public health’s ticking time bomb.” Duane C. Keller, DMD, FAGD, details how antibiotic resistance acts in the sulcus, making treatment of periodontitis extremely difficult, and talks about what you can do to overcome the challenges.

Oral-systemic links and tests we never thought about

Oral-systemic interconnections—typically understood to mean the impact of periodontal disease and periodontal pathogens on a variety of systemic diseases and conditions—have been studied intensely for generations. The consensus is that they are now accepted in both the dental and medical professions, although the strength of the various relationships is still being investigated. An equally impactful oral-systemic link that has quietly proceeded largely unnoticed by many dental professionals is the use of saliva to detect the presence of an incredible number of diseases and conditions by evaluation of biomarkers of disease. Richard H. Nagelberg, DDS, discusses the advancements in salivary diagnostic testing and explains how the effects of this technology on health care and the dental profession in particular will be profound.

Improving traditional nonsurgical methods for peri-implant disease: A new adjunctive therapy

Peri-implant disease is an increasingly common challenge with multiple nonsurgical and surgical treatment options. The pathogens that cause periodontal disease can be hard to manage between office visits due to the recolonization of bacteria after surgical or hygiene procedures. One adjunct to treatment that can help with nonsurgical periodontal and dental implant procedures as well as improve home care is tray delivery of hydrogen peroxide gel. Jeffrey N. Goldstein, DMD, presents a case example of how prescription trays were used to reduce diseased tissue around dental implants and teeth to avoid more invasive surgery.

Predictable halitosis treatment: Using microbial testing and antibiotic rinse therapy

Treatment of patients with breath concerns is a difficult process, because no formal training currently exists in dental or dental hygiene schools. The perception of halitosis is that it is related to poor oral hygiene or due to a medical concern. However, oral bacteria—mainly periodontal pathogens—are the most common cause of halitosis. Jim Hyland, DDS, presents a case study showing a novel way of treating halitosis predictably through objective measurements and microbial testing to identify the location of the infection followed by antibiotic rinse therapy.  

A patient's perspective on the importance of tooth-sparing periodontal treatment

Martin Heilweil, PhD, faced severe bone loss and periodontal treatment consisting of extraction, bone grafts, sinus lifts, implants, and crowns. He didn’t like the idea of losing his teeth. He didn’t like his dentist. It was time to do something about this. It was time to shop for a new dentist. After some research, he decided he wanted to give the “saving the teeth” option a try. Here is his story.

Call to the dental profession: Saving the art of scaling and root planing in periodontal treatment

Dr. Victor M. Sternberg sets forth the value of scaling and root planing for the maintenance of periodontal patients. As such, he references studies that speak of its value for periodontal treatment and explains how he believes the procedures of scaling and root planing have become abandoned in the institutions of graduate schools, dental schools, dental hygiene schools, dental practices, the dental industry, and patients themselves. As he says, “At one time, the giants of periodontology walked the halls of American dental schools.” He offers four frank suggestions to remedy these problems as he sees them.

A guideline for clinical practice: The search for a successful adjunctive periodontal therapy

In July 2015, the Journal of the American Dental Association published an “Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts.” Dr. R. Bruce Cochrane says, “The problem for all practitioners is that the guidelines offer only a limited evaluation of adjunctive care.” In this article, he explains the protocol he uses that helps him achieve his goal of solid teeth, little to no bleeding, minimal pocket depth, and happier and healthier patients.

10 steps to perform an oral cancer screening

Squamous cell carcinoma of the oral cavity and throat account for about 45,000 cases each year in the United States, resulting in approximately 8,000 deaths per year. Studies show that successful treatment is highly dependent upon diagnosis and treatment of this disease in its early stages. Although there have been advances in surgical, chemotherapy, and radiation treatment, five-year survival rates of patients with moderate to advanced cases of oral cancer are less than 60%. Patients who do survive typically have trouble chewing, speaking, eating, and smiling after treatment thus it is extremely important to diagnose OC before it becomes advanced, since treatment for early cancer is not as severe. Editorial Director Dr. Scott Froum offers steps to use as you screen patients in your office.

Increasing dental case acceptance through the use of salivary diagnostics

A tremendous amount of literature supports the correlations between gingivitis and/or periodontitis and systemic health. Reports and research continue to find correlations between inflammation of the oral cavity and other inflammatory disease processes, especially cardiovascular disease and diabetes. Educating patients about these links and encouraging oral health awareness has always been a challenge. Dr. Michael Scialabba talks about how salivary testing along with personalized custom periodontal therapy can be a tool to help patients improve not only their oral health but also their overall health.

Manage, repair, or regenerate periodontal disease?

The American Academy of Periodontology warns of a significant public health problem: One out of every two American adults 30 years and older has periodontal disease. (1) As dental professionals, we need to step up to this challenge and change the way we evaluate and treat mucosal oral infections. The research, tools, and biologic products are now available to regenerate bone and tissue—not simply “manage or repair”! Susan Wingrove, RDH, says our role as dental professionals is to identify the optimal time for regenerative periodontal therapy.

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Letter to the editor regarding study comparing chlorine dioxide oral rinse to chlorhexidine

The editors of Surgical-Restorative Resource recently received a letter from Bill Landers, president of OraTec, regarding the article, “An in vitro study comparing a two-part activated chlorine dioxide oral rinse to chlorhexidine” by Richard D. Downs, DDS, Jeffrey A. Banas, PhD, and Min Zhu, DDS, PhD. Landers objected to some of the wording in the article. The authors responded to his comments here.

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An in vitro study comparing a two-part activated chlorine dioxide oral rinse to chlorhexidine

Chlorhexidine is considered the “gold standard” for antiplaque agents. However, there are side effects associated with long-term use of chlorhexidine. Richard D. Downs, DDS, Jeffrey A. Banas, PhD, and Min Zhu, DDS, PhD, present the results of a study that compared a chlorine dioxide-based mouth rinse (Oracare) with chlorhexidine for antimicrobial activity and an ability to remove volatile sulfur compounds (VSCs) generated by the periodontal pathogen Porphyromonas gingivalis.

Colleen M. Olson, RDH

In case you missed it: Three lecture summaries from the 2014 AAP Dental Hygiene Symposium

Colleen M. Olson, RDH, attended the 100th Annual American Academy of Periodontology Meeting in San Francisco in late September, during which the California Society of Periodontists hosted a Dental Hygiene Symposium. In this article, Olson summarizes the lectures of the three presenters.

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