Sleeper, J. (2014). Protect implant outcomes.

The Dimensions of Dental Hygiene,

12(11): 24,26,28

The article, Protect Implant outcomes, discusses the importance of care and

maintenance of dental implants from both the dental hygienist and the patient.

Including good oral hygiene such as brushing and flossing the article expresses

therapeutic mouthrises to be another beneficial aspect for caring for an implant. The

article starts off explaining that implants have come a long way since they were first

invented dating back to the Egyptians using mulberry wood. Implants are now

titanium made and are surgically placed where they osseointegrate. To protect the

implant from failure and potentially irreversible/reversible conditions the dental

hygienist and the patient must work together from pretreatment to maintenance.

Before the patient undergoes surgery they should visit their dental hygienist to get a

CMS, periodontal screening and a prophylaxis within a month of the surgery.

Afterwards the dental hygienist should educate the patient on good oral hygiene and

the use of therapeutic mouthrinses. The article discusses that chlorhexidine is

frequently used for pre treatment and post treatment of implant surgery. It is know

for having a bacteriostatic effect and greatly reduces the amount of bacteria present

in the mouth. Adverse reactions of chlorhexidine result in staining and taste

alteration. Another type of antiseptic mouth rinses is hexetidine. Hexetidine

demonstrates similar effects of chlorhexidine but with fewer adverse reactions. In

addition to rinsing with chlorhexidine pre and post surgery patients should dip their

power toothbrush into the mouth rinse and brush. Other options could be replacing
water the oral irrigators with chlorhexidine. The article explains that a study was

done on replacing oral irrigators with chlorhexidine compared to rinsing with

chlorhexidine and with proper technique the oral irrigator was 3 times more

effective.

I chose this article because we had just learned about chemotherapeutics and

I wanted to relate what I had just learned to this article and the relation to implant

success. I enjoyed reading this article, it was easy to read and I thought that adding

the history of the implants was interesting and good touch. The only part of the

article that I didn’t agree on was the fact that they left out how long you should be

using the chlorhexidine. I also didn’t agree on how much you should be using the

mouth rinse. They discussed brushing your teeth with chlorhexidine in addition to

rinsing with it/ irrigating with it. I honestly feel like that might be a little too much

especially if they don’t add the time frame of how long you should use this

mouthrinse. Content that I learned from this article is that there are other types of

therapeutic mouth rinses similar to chlorhexidine. Hexetidine also has

antimicrobial actions with less side effects but less potent than chlorhexidine. I also

learned that if you swish with chlorhexidine for 30 seconds 90% of the bacteria is

inhibited for over a five-hour period. That just seems crazy to me especially since we

develop pellicle right after you brush your teeth. In dental materials and other

dental hygiene classes we learned what implants are how they osseointegrate in the

bone and how to clean them. This article has given me more options to teach my

patients to help them keep their implants clean and preventing them from failing.
Hodges, K. (2012). Reduce the bacterial load. The Dimensions of Dental Hygiene,

10(6): 52,54-55.

The article, Reduce the Bacterial Load, focuses on choosing the best

antimicrobial dentifrices for your patient. The article discusses two antiseptics that

are used in antimicrobial dentifrices: triclosan and stannous fluoride. Triclosan is an

antibacterial substance that helps reduce gram-positive and gram-negative bacteria.

Triclosan has been shown to help reduce plaque, bad breath and gingivitis as well as

improving the build up of supragingival plaque/calculus. In 2011 a study found that

triclosan also helps prevent gingivitis turning into periodontal disease and helping

prevent periodontal disease from progressing. Stannous fluoride is an antibacterial

substance that is both bacteriostatic and bactericidal. It has been shown to reduce

gingival bleeding and reduce tooth sensitivity as well as killing/inhibiting grown of

bacteria which causes caries and gingivitis. Stannous fluoride also contains tin,

which prevents bacteria from adhering to the tooth surface. The down side to

stannous fluoride is its ability to cause staining on the tooth surface. A study did find

that if stannous fluoride is mixed with sodium hexametaphosphate the staining is

reduced to almost none within a 6-month period of brushing twice a day. When

choosing an antimicrobial dentifrice it is best to consider what the patient needs, the

adverse reactions and how well the patient will comply with the brushing

instructions.

I chose this article because I wanted to get a further understanding on the

differences between the antimicrobial ingredients triclosan and stannous fluoride.

After reading this article I feel like I have a stronger understanding on the

differences between these two ingredients and I really liked that they added studies

to back up their statements. The article also added a table that helps show the

differences between the two and I really enjoyed being able to compare the

mechanism of action and indications. The only real indication that is different is

stannous fluoride helps with sensitivity and triclosan does not. I almost feel like

stannous fluoride may be the better antimicrobial since it is both bactericidal and

bacteriostatic. That is of course if the patient is requiring more antimicrobial

assistance and they will just have to deal with the staining until they can get the

disease under control in their mouth. There are two parts in the article I don’t

100% agree on. The first part I don’t agree on is the claim that with

hexametaphosphate stannous fluoride does not stain. I know that they included a

study that proves that it doesn’t, but why does almost every book for students say

otherwise? I haven’t been around dental hygiene long enough to form my own

opinion but if I had to I would have to go with what all the books say over one study.

The second part I am slightly confused on is in the included table under general

dosage they say with stannous fluoride to only brush for 1 minute two times a day.

We always teach to brush for 2 minutes to our patients and they also say to brush

for 2 minutes with triclosan so why not with stannous fluoride? Along with all of

the material I have learned throughout dental hygiene and this article I feel like I

have a good understanding to be able to recommend what type of dentifrice my

patients should use and why.

Wilder, R. & Ryan, M. (2010). Chemotherapeutics in the treatment of periodontal

diseases. The Dimensions of Dental Hygiene, 8(6): 44-46, 48.

The article, Chemotherapeutics in the Treatment of Periodontal Diseases,

discusses combining several different treatment options for managing periodontal

diseases. The article starts off explaining that although scaling and root planning is

the main way to remove biofilm clinicians are never truly successful at removing all

of the bacteria. Thus this is why combining adjunctive therapies as well as

mechanical therapies to help manage periodontal diseases. Some chemotherapeutic

agents the article includes are mouth rinses and dentifrices. Mouth rinses that are

beneficial to reducing plaque and gingivitis are chlorhexidide, essential oils,

cetylpyridinium chloride and stannous fluoride. Chlorhexidine is per prescription

only and works to reduce bacterial formation and the formation of pellicle. Essential

oils such as thymol, menthol and eucalyptol help to alter the bacteria thus reducing

the plaque formation and reduce gingivitis. Cetypridinium chloride helps to reduce

plaque and gingivitis by rupturing the bacteria and decreasing the ability for the

bacteria to adhere to the tooth surface. Stannous fluoride can be either a mouth

rinse or dentifrice. It is also known for reducing biofilm and gingivitis. Triclosan is

an ingredient used in dentifrices to help manage periodontal disease. Triclosan is an

antimicrobial agent that is used to reduce calculus formation, gingivitis, caries and

plaque. Although mechanical debridement, mouth rinses and dentifrices may work

for some patients other patients may require other assistance such as locally applied

antimicrobials. Three locally administered antimicrobials that are used today are:
Arestin, Atridox and Perio Chip. These agents, which are administered

professionally, are placed at the base of a periodontal pocket and antiseptic and

antibiotics are delivered locally. The article also discusses that Perio Chip is the only

adjunctive therapy that is not an antibiotic and does not have tetracycline.

Therefore pregnant woman and people allergic to tetracycline should be given this if

LAA is needed. The goal of LAA is to slowly release the antibiotic/antiseptic to

reduce bleeding, pocket depths, and gain clinical attachment. These three locally

applied antimicrobials all have different ranges of substantively. Arestin’s

substantively is the greatest and should last around 14 to 21 days. The Perio Chip

and Atridox’s substantively is around 7 days. Other locally applied products that are

less used are Periowave, Perio Pocket. Periowave uses a cold laser light to destroy

gram negative bacteria. It is non-antibiotic and the goal is to kill bacteria without

creating a resistance. Periowave is not yet approved in the United States and is

currently used in Canada. Perio Pocket is designed to chemically change the bacteria

in the infected pocket and stop the growth of biofilm. It is applied with a custom

made tray and the FDA has not approved the technique. The article concludes by

explaining that patients with chronic progressive disease should be monitored and

dental hygienists must understand when nonsurgical therapy is not enough and

surgical treatment should be considered.

I chose this article because I wanted to compare this article to what I have

learned about Chemotherepeutics in class. After reading this article I was slightly

overwhelmed. It’s not that I haven’t heard of the products they are describing it’s

just they threw it all at you and the article seemed a little messy to me. I also was a
little confused on them including products that are not approved in the U.S. I don’t

think I agree with them adding this part. I get that it’s an alternative product but for

now its not even allowed so it’s like saying hey if you want to try it you have to go to

another country to get it. Although it was interesting and I learned that there are

other ways they are killing the bacteria such as a laser that emits cold light. It makes

me think of burning off a wart! I also learned about Perio Pocket, its somewhat like a

bleaching tray that you put it your mouth and it helps alter the bacteria in the

pocket. In clinic over the summer I had a patient that had previously had Arestin put

in and at that time I was uneducated on the product and really couldn’t give any

sound advice and had to resort to asking my instructor. Thankfully, now after

reading this article and what I have learned in class I feel like I could answer my

patient’s questions comfortably.

Ramakrishna, J. (2012). Irrigate for oral health. The Dimensions of Dental Hygiene,

10(11): 54-56, 59.

The article, Irrigate of Oral health, discusses oral irrigation as an alternate for

interdental cleaning and the benefits it has on people with braces, diabetes,

periodontal diseases and dental implants. The article starts off explaining that

studies have proven oral irrigation to help reduce gingivitis and bleeding because of

its ability of reaching pockets up to 6mm. A study was conducted and found that the

pulsation and pressure from the water nearly removed all of the biofilm and within

two weeks can reduce gingivitis, bleeding and plaque. The article thus explains that

since the oral irrigator can reach up to 6mm pockets it can be beneficial for patients

with periodontal diseases and help reduce bleeding and biofilm build up in the

pockets. Antimicrobial agents such as chlorhexidine can also used with oral

irrigators to rinse out pockets eliminate bacteria. Patients with braces or

orthodontic appliances can also benefit with using oral irrigators. It is common for

food and debris to get caught causing there to be a rinse of bacteria in the mouth.

Patients may also avoid flossing due to difficulty or inconvenience. Oral irrigators

have orthodontic tip and studies have shown that after brushing and using oral

irrigation over half of lactobacilli was reduced and there was a significant amount of

bacteria decreased subgingivally. Oral irrigation may also be beneficial to people

with diabetes. People with diabetes are at higher risk for periodontal diseases

therefore they may benefit from using oral irrigation to decrease biofilm build up

and gingivitis and possibly preventing periodontal diseases. Lastly, people with
dental implants may also benefit from oral irrigation. Failure of implants is

increased from the build up of biofilm and unhealthy tissues. A study was

conducted and it found that patients used oral irrigators with antimicrobial agents

had reduced biofilm build up and gingivitis than those who just rinsed with

antimicrobial agents. Good oral hygiene is key to keeping a health mouth and body.

Teaching patients other methods of cleaning interproximal such as oral irrigation

may help them have a better view on oral hygiene and help prevent them from

gingivitis and periodontal diseases.

I chose this article because so many people despise flossing and as a dental

hygienist I need to understand other methods to teach my patients. I enjoyed

reading this article, it was informative and to the point. I liked that they gave

examples on which patients would benefit most from the use of oral irrigation. One

thing I didn’t agree on was the fact that they never emphasized on the importance of

correct form or how to use it. Irrigation is not beneficial if it is used incorrectly and

could potentially harm the patient more than it would help. Something that we

learned in class but it didn’t sink in until I read it in the article was that oral

irrigation can reach up to 6mm. Patients would be able to keep the deeper pockets

clean a little better than if they just flossed. We always say we need to take and

ultrasonic to clean out the pockets and the patients can go home and do almost the

same thing. Overall I enjoyed this article, I’ve never used an oral irrigator but now if

my patients are interested I will have some background to help them make a

decision if this would benefit them.

Rethman, J. (2008). Tips on technique. The Dimensions of Dental Hygiene, 7(3): 50.

The article, Tips on Technique, discusses periodontitis and pregnancy

outcomes. The article starts out with a question asking if there actually is a

connection between periodontal disease and if so what we should tell our patients.

The article then goes on to explain that premature birth rates have been on a rise

and are contributing factors to neurological disorders and expensive treatments.

Periodontal disease is an oral infection and since conditions with infections have

been shown to cause premature birth periodontitis may increase the chance or

preterm birth. There have been studies that show besides preterm birth periodontal

diseases can cause preeclampsia and the babies being delivered with low birth

weight. Although some studies show that periodontal diseases has an affect on

pregnancy we cannot tell patients that is exact reason to their pregnancy outcome.

Treating patients with periodontitis may help prevent a bad outcome by removing

the infectious bacteria and the unborn child will benefit from it. We should always

discuss the importance of good oral hygiene and advise periodontal therapy to a

pregnant woman.

I chose this article because I don’t know a lot about the correlation of

periodontitis and pregnancy. I had always heard that periodontitis can cause issues

during pregnancy but not exactly the main issues. I liked that this article was a

question and answer type format, the author made it short enough where you could

read it and not get bored, but it was packed full of statistics and studies. Something

that really threw me off was one of the studies she quoted said that periodontal
diseases and preterm low birth rate were not linked. That to me seems crazy

especially since a chronic infection in your body has to affect the baby in some way

shape or form. How could they grow up in a body that has gram-negative scary

bacteria floating around in the body and not get any of that bacteria? Babies are very

vulnerable in the womb therefore you would think that infection would get to them

in some way. Something that I learned and that will stick with me is how to answer

to a pregnant woman that has periodontitis and is informed that it is possible to

have adverse pregnancy outcomes. Telling them that it could affect your pregnancy,

but with periodontal therapy both the baby and the mother could benefit. I’ve only

had patients with gingivitis in clinic, but now if I do have a patient at any stage of

periodontal disease I will have more knowledge to help them understand the

importance of periodontal disease on both the baby and the mother.

 Dental Hygiene IV
Assignment Criteria

Log of Literature Review Assignment Guidelines

50 Points Possible (10 points/article)
5 ARTICLES related to DHIV subject matter
Due Date: Nov. 9, 2017

Point Breakdown:
Content 40
Format 10
Total 50

Content: 1. Summary/review of article content (20 points-4 points per article)

First paragraph…In own words! No quotes, stats…read more
than the
abstract and if a study, describe the results.

2. Critique of Article Contents (20 points-4 points per article)

A. How does the article affect you?
B. Do you agree or disagree with the information presented?
C. Include content on what you learned from the article
D. Include content on how information relates to something you
have already learned in a dental hygiene course

Format: 1. Reference for article (see provided example) (2 points)

Errors: 1. Spelling/grammar: -1 point per error…

2. Minimum 1 page (no more than 1” margins), typed, double
spaced
(12 font), -1 point per article
3. Attach rubric to assignment-5points!

Sample Reference: Placed at top of page/article

Martin, P. (2013). Ultrasonic instrumentation: An update. Journal of Periodontics,

18(11), 210-212.

**note the 2 double spaces**

The use of power driven scalers is increasing with the advancement of

specialized, site specific tips.