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HT July Cover_Layout 1 6/25/13 3:01 PM Page 1 Dental Hygiene Diagnosis Perio Reports Vol. 25 No. page 1 page 3 July 2013 Probing Techniques Message Board, page 6 HT_InThisIssue_Layout 1 6/25/13 2:44 PM Page 1 hygienetown in this section Dental Hygiene Diagnosis by Trisha E. O’Hehir, RDH, MS Hygienetown Editorial Director To some, the word “diagnosis” is taboo for hygien- ists to even consider using, let alone doing! Diagnosis is simply recognizing the signs and symptoms of disease, something all hygienists are required to do to take their licensing exam. Hygienists also must practice this in the clinical setting to provide care for patients. If a hygienist can’t tell the difference between health and disease, keeping a clinical position will be difficult. Those who don’t want RDHs to “diagnose” must instead want a robot to simply “scale teeth.” Every dentist I’ve know wants the RDH employed in the practice to “actually have a brain,” to quote Dr. Michael Rethman. Providing dental hygiene care involves critical thinking to assess the health of each individual patient. A wide variety of information is gathered to determine health, disease and individual risk factors presented by each patient. With the identi- fication of the dental hygiene diagnosis, the dental hygiene treatment plan can be devised and followed by the RDH. The dental hygiene diagnosis and treatment plan are part of the comprehensive dental diagnosis and treatment plan created by the dentist. Working as colleagues, the dentist and dental hygienist gather information necessary to accurately assess the health of each patient and provide the necessary treatment, prevention and maintenance care. In this issue, Lori Frey presents the history of the periodontal probe and advice on effective technique. Information collected with the probe, plus the extra- and intra-oral examination and information gathered through interviewing the patient about eating habits, daily oral hygiene and medical history provides the basis for creating both the dental hygiene diagnosis and a dental hygiene treatment plan. These activities, including diagnosis, are all essential parts of the dental hygiene process of care. n Inside This Issue 3 Perio Reports 6 Message Board: Probing Techniques 7 Continuing Education: Periodontal Probes » 1 JULY 2013 » hygienetown.com Young_0713_Layout 1 6/24/13 1:08 PM Page 2 Historical images courtesy of Bibby Library, Eastman Institute for Oral Health, Univ. of Rochester Medical Center Join Young in celebrating At Young Dental, we have been producing clinically advanced preventive dental hygiene products since 1900. Today, we remain dedicated to continuing that spirit of innovation with high quality products that provide clinical benefits to the patient while providing effi cacy, reliability, and comfort to the dental professional years of dental hygiene using them. A er more than 100 years, we’re still Young. Disposable Prophy Angle Winner – Past 7 Years Visit prophywithapurpose.com for more information on Young’s line of prophy angles and cups. proudly made in the USA Perio Reports_Layout 1 6/25/13 2:46 PM Page 3 hygienetown perio reports Modified Manual Periodontal Probe Many attempts at automating periodontal probing have fiber optic sensor and transmitted by cable to a personal been made over the years, however the manual probe is still computer outside the mouth. the one used most often in practice today. This pilot study compared probing and bleeding scores Since the manual probe is still the number-one choice of on six individuals with moderate to severe periodontitis. Six clinicians, researchers at the Tokyo Medical and Dental measurements per tooth were recorded around the first University in Japan modified a manual probe by attaching a molar in each quadrant. Measurements were repeated one fiber optic sensor to record probing depths. They compared week later for comparison. the sensor probe to a standard manual probe for accuracy of Averaging all probing scores together, the manual probe measurements. score was 3.03mm and the fiber optic probe was 3.08mm. The fiber optic sensor mechanism is an external sheath In pockets 7mm or deeper, the fiber optic probe scores were that covers the manual probe, adding approximately 8mm not as deep as the manual probe. This may be due to pres- of length. As the probe is inserted into a sulcus, the sheath sure buildup on the gingival margin, pushing the margin is stopped by the gingival margin and slides back as the down, thus giving a shallower reading. probe moves forward. A spring-loaded mechanism is used as the sheath slides back. The sliding distance is detected by the Clinical Implications: New options might become available that modify manual probes rather than creating auto- Perio Reports Vol. 25, No. 7 mated probes. n Perio Reports provides easy-to-read research summaries on topics of specific Ishihata, k., Wakabayashi, N., Wadachi, J., Akizuki, T., Izumi, Y., interest to clinicians. Perio Reports research summaries will be included in each Takakuda, K., Igarashi Y.: Reproducibility of Probing Depth Measurement by an Experimental Periodontal Probe Incorporating Optical Fiber. J Perio issue to keep you on the cutting edge of dental hygiene science. 83:(2)222-227, 2011. www.hygienetown.com t Interdental Brush Provides Patient Self-test and Plaque Removal Gingival bleeding can be assessed between the teeth, pro- All four quadrants were tested, half with the probe fessionally using a periodontal probe, or by the patient using inserted 2mm into the gingival sulcus and the other half a triangular-shaped wooden stick moved in and out from with one pass through with an interdental brush. Rather facial to lingual four times. Self-assessment by patients of than using the probe on one side of the mouth and the their own gingival health provides them with feedback and a interdental brush on the other side of the mouth, con- means of cleaning between the teeth. tralateral quadrants were assigned. Randomly assigned Researchers at the University of Zürich in Switzerland quadrants were either the maxillary right and the compared periodontal probing to the use of an interdental mandibular left or the maxillary left and the mandibular brush to determine if the information about bleeding, plaque right. The presence or absence of both plaque and bleed- and gingivitis was similar. The test subjects were 64 consecu- ing were recorded. tive patients being seen for their semi-annual periodontal Average bleeding scores were similar for the sites meas- maintenance visit with the dental hygienist. All had gingival ured with the periodontal probe and the sites tested with the inflammation with at least 50 percent papillary height and interdental brush. Scores were 47 percent for the periodontal no pocket depths exceeding 4mm. probe and 46 percent for the interdental brush. Clinical Implications: Correctly sized interdental brushes can be used as a reliable self-test for interproximal bleeding. n Hofer, D, Sahrmann, P., Attin, T., Schmidlin, P.: Comparison of Marginal Bleeding Using a Periodontal Probe or an Interdental Brush as Indicators of Gingivitis. Int J Dent Hyg 9:(3)211-215, 2010. 3 JULY 2013 » hygienetown.com Perio Reports_Layout 1 6/25/13 2:46 PM Page 4 hygienetown perio reports Bacteria Cling to Periodontal Probes In 1985 researchers reported the translocation of Actinobacillus actinomycetemcomitans (Aa) from infected sites to healthy sites. Although the bacteria were moved, The Future is Ultarsonic Probing they were unable to survive the ecology of the healthy sul- cular environment. While inoculation is possible, suitable To diagnose periodontal disease, radiographs and growth conditions are required for successful colonization. periodontal probing are always used. Radiographs Dental hygiene researchers at provide a two-dimensional image of three-dimen- University of Missouri, Kansas City sional structures and require ionizing radiation. compared four probes in sites 3mm Periodontal probing is an invasive procedure influ- or less and sites 4mm or greater. A enced by clinician technique, force used, probe total of eight probes were tested, size and topography of the pocket. Researchers are four in shallow sites and four in looking for a non-invasive approach to diagnosis deep sites. The probes were inserted that overcomes current sources of error. subgingivally, held there for two sec- Ultrasonography may be the answer. onds and removed directly to a vial Researchers in London used a non-invasive of transport medium and sealed 20MHz ultrasonic imaging system to determine with wax. Each probe was then bone and tissue levels from the facial surfaces of processed for evaluation under a three teeth in each of three pig jaws. A fourth pig scanning electron microscope. jaw was used for histological evaluation. A notch Microbial samples from 80 pockets were collected and was made on each tooth as a landmark. An ultra- cultured to compare shallow and deep pockets. As sonic gel was used between the ultrasonic probe tip and expected, shallow pockets had fewer bacteria than deep the gingival tissues on the facial surface of the tooth. pockets. The researchers were surprised to see just how Measurements were taken through the gingival tissue rough the probe surfaces were. Striations around the metal and provided 15mm X 6.25mm images within one sec- probes indicated use of a lathe in the manufacturing ond. Images were captured in a computer and com- process. Roughness and barbed edges were typical of the pared to actual measurements of the pig jaws. cuts for millimeter markings. The plastic probes had Trans-gingival measurements or “soundings” were done smoother surfaces than the metal probes and were made of with a periodontal probe from the gingival margin two identical halves sealed together. Excess plastic flashing through the attachment to the bone crest. Direct meas- around the ball tip of these probes was evident.