The Promise of Stem Cells in Dentistry Obesity Effects on Periodontal Disease Drug Abuse Aware and Prepared Office-Based Anesthesia ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
March/April 2018 • The Promise of Stem Cells in Dentistry • Obesity Effects on Periodontal Disease • Drug Abuse Aware and Prepared • Office-Based Anesthesia March/April 2018 The Dental Assistant PG 1
All Specials Effective Jan. 1st to Mar. 31st, 2018 CELEBRATING 2O YEARS OF ANNIVERSARY SALE! EXCELLENCE Is your practice EPA pH Compliant?* For eVac Maintenance or Between Patient Flush TRAP TRAP Guaranteed To Improve BEFORE AFTER Suction Performance! Cleans 24/7 1 Microbe Becomes 10,000,000 in 24 Hours • *Bio-Pure® meets NEW EPA pH guidelines. • Eliminates trap hand cleaning. • All natural & non-foaming. • Easy to use - mix with water and go. • Less than $10/mth/operatory. Bio-Pure • Cost 40% LESS than other brands. Made In USA • FREE! $25 Rebate Coupon “Saves you money!” (Included in Restore Kit - Item# 2801101) Rochelle Bache, of UCLA Faculty Group Dental Practice • FREE! Dispenser “No more slogging down during a productive day.” (with the purchase of a 48oz. Powder - 2801003) Dr. Ted C. Kawulok Boulder, CO. 1-800-368-8106 info@sableindustriesinc.com www.sableindustriesinc.com $25.00 rebate with proof of purchase on your second order (powder = 3 x 14 oz. or 1 x 48 oz., or liquid = 4 x 32 oz. or 1 x 1 gal.). Mail proof of purchase and original coupon to Bio-Pure Products Inc., P.O. Box 177 Wellington, NV 89444. PG 2 The Dental Assistant March/April 2018
March/April 2018 Volume 87. No. 2 ADAA President Natalie Kaweckyj, LDARF, CDA, CDPMA, COA, COMSA, CPFDA, CRFDA, MADAA, BA Executive Director John E. Kasper, PhD, CAE Managing Editor Angela Hickman 877-874-3785 X220 Advertising Sales Manager John E. Kasper, Jr. 877-874-3785 X214 Editorial Review Board Jan DeBell, CDA, MS, BS Ronda Lane, CDA, RDA Cathy Roberts, EFDA, MADAA, CDA-Emeritus, CDPMA-Emeritus, COA-Emeritus, CPFDA-Emeritus Robynn Rixse, AS, CDA, EFDA, FADAA The Dental Assistant Journal 140 N. Bloomingdale Road, Bloomingdale, IL 60108-1017 General inquiries 877-874-3785 • fax 630-351-8490 e-mail: publications@adaausa.org • www.adaausa.org To obtain a copy of our Writer’s Submission Guidelines or the Editorial Calendar, please go to the ADAA website, www.adaausa.org. Copyright 2018 by the American Dental Assistants Association. Reproduction in whole or in part without permission is prohibited. DISCLAIMER: “Authors and advertisers are solely responsible for the accuracy of any and all material provided to The Dental Assistant. Authors and advertisers are also solely responsible for checking that any and all material relevant to dental care in a clinical setting meets OSAP standards. The information and opinions expressed or implied in articles and advertisements that appear in The Dental Assistant are strictly those of the authors and advertisers. They do not necessarily represent the opinion, position or official policies of the American Dental Assistants Association.” March/April 2018 The Dental Assistant PG 3
FEATURES 9 Research: The Promise of Stem Cells in Dentistry By Anderson Benavides and Diana Macri, RDH, BSDH, MEd Although not all procedures done with stem cells have succeeded, the rapid advances have shown many positive and beneficial outcomes. Stem cells have the potential to revolutionize the field of dentistry. 12 Research: Obesity Effects on Periodontal Disease By Annie Chitlall, RDH, BS Obesity and periodontists continuously affect more people in the world, and a link between obesity and periodontal disease has been scientifically established. It’s important for dental professionals to understand how obesity can affect the practice of dentistry. 16 Drug Abuse Aware and Prepared By Cris Zimmerman, RDH, BS The opioid problem is affecting all areas of the workforce, including the dental profession. It’s a harsh reality for those in management positions who are trying to maintain a safe and a profes- sional work environment. There are many indicators that you can watch for to reveal if a person is abusing drugs. 18 Office-Based Anesthesia: How Dental Assistants Ensure Safe Patient Care By Martha Peters Training for excellence in office-based anesthesia requires leadership, preparation, and simulation. Learn how dental assistants can contribute to the effectiveness of the surgical team. 20 From the Archives: “Can Decay of the Teeth Be Prevented?” In 1938, Walter T. McFall, DDS discussed how preventing tooth decay is a cooperative effort between patient and dentist. DEPARTMENTS 6 Editor’s Desk 26 Trustee News 7 President’s Page 29 Member Spotlight 22 News Briefs The Dental Assistant (lSSN-1088-3886) is published bi-monthly (every other month). Non-member subscriptions are $30. Allow 6-8 weeks for subscription entry. Publisher is the American Dental Assistants Association, 140 N. Bloomingdale Road, Bloomingdale, IL 60108-1017 PG 4 The Dental Assistant March/April 2018
Appreciates Dental Assistants The ONLY Buyer’s Guide for you. . Bu yers . G uide Increase Productivity Reduce Practice Expenses . As sistan t D ental Source Quality Products T SIGH EEL R E AL IN THERS F GET O R HOW AREE INTO T THEIR C CON TROL B O U ION A CT INFE OUR R OLL IN ND Y OME U R XPA YO NE INC U CA AND H OW YO , SKILLS, VISIT BOOTH #1648 N Y LEAR NSIBILIT E SPO R RT DENTAL ASSISTANT APPRECIATION! SMA AY IN ROLE G CAN PL OMICS FREE GIFT BAG! * TH E N N HASI E ECO PURC L OFFIC DEN TA Includes: Fluorescent® Take-Home Whitening Kit ZING and a bag of premium chocolates! M A XIMI YOU (*While supplies last.) G ARE EARNIN U R YO NTIAL? RE? POTE U CO YO MPA DO HOW T GREA A K ES A N T ? TM TA WHA A L A S S I S DEN T TA ISTAN L ASS ATION T DOWNLOAD https://goo.gl/1y9nrc N DE -EVALU P? RE U SELF M EASU O U Y DO HOW Stat-Flo™ Spira-Flo™ Sol-u-Flo™ Compare to Ultradent®* Product: Compare to Ultradent®* Product: Compare to Ultradent®* Product: Metal Dento-Infusor®* Tips Inspiral®* Brush Tips Black-Mini®* Brush Tips Fluorescent™ Doctor’s Kit Compare to Ultradent®* Product: Opalescence®* PF Doctor Kit (877) 418-4782 | www.vista-dental.com | info@vista-dental.com March/April 2018 The Dental Assistant PG 5 * Free shipping on all orders excludes equipment sales and international shipping. *Ultradent®, Metal Dento-Infusor®, Inspiral®, and Black Mini® are all registered trademarks of ULTRADENT Products, Inc.
Editor’s Desk Angela Hickman Managing Editor The Dental Assistant New Research and Everyday Advice W elcome to the March/April issue of The Dental effects of obesity on the progression of PD is significant, Assistant. This research-heavy edition offers and oral health care professionals need to be able some important information on everything to understand that obesity can also affect the dental from stem cells to the relationship between obesity process of care,” she writes. and periodontal disease. In each issue, we seek to Shifting gears, this issue also takes a look at a strike a balance between offering new research topic that is the subject of daily news stories. The and sharing everyday advice from practicing dental opioid problem has become a nationwide epidemic, assistants and other professionals in the office, as well affecting people from all walks of life and in virtually as educators and outside experts. every profession. The dental field is not immune. “It’s This issue’s lead story discusses the promise of stem a harsh reality for those in management positions cells for dentistry. While stem cells for regenerative who are trying to maintain a safe and a professional therapy have largely been used in patients with work environment,” writes Cris Zimmerman, RDH, BS. leukemia and lymphoma, stem cells show enormous She notes a number of indicators of drug abuse and potential for regenerating alveolar bone, periodontal points out that blood tests are far from fail proof in ligament, pulp, dentin, and enamel. In fact, some determining whether a suspected employee has a drug suggest such treatments could become a reality in as problem. “An impaired dental assistant puts herself, the little as 5 years. “The encouraging data coming from practice, and the patient at risk,” Zimmerman writes. trials done on animals have made stem cells a popular “The onus is on managers to be aware of opioid and topic in dentistry since people care more about health other drug abuse and have systems in place to identify and aesthetics than they ever did,” write authors employees who may be at risk or already abusing Anderson Benavides and Diana Macri, of Eugenio drugs.” Maria de Hostos Community College. “Although not This issue also discusses the importance of dental all procedures done with stem cells have succeeded, assistants as part of the team delivering office-based the rapid advances have shown many positive and anesthesia. “Office-based anesthesia privileges are vital beneficial outcomes. Stem cells will revolutionize to the livelihood of all dental practices that administer medicine and are poised to have a massive impact in anesthesia and sedation,” writes Martha Peters, CDA. dentistry as well.” Because the dental team must deliver quality office- Another research manuscript in this issue discusses based ambulatory anesthesia, training for dental the relationship between obesity and periodontal anesthesia assistants—staff members who work disease. Today, about half of American adults over the under the care of dentists who administer anesthesia age of 30 have chronic periodontitis; in fact, 38 percent and sedation—is critical. “Raising the bar by creating have moderate to advanced stages of the disease. “Oral anesthesia training standards and protocols for your health disparities, such as periodontal disease and office will lead the way for successful management of dental caries related to obesity, affect 3.9 billion people office emergencies,” she says. worldwide,” writes Annie Chitlall, RDH, BS, of the New Don’t miss this issue’s introduction to ADAA York City College of Technology and Eugenio Maria de members in Member Spotlight. Learn what inspires and Hostos Community College. Chitlall suggests dentists motivates your peers every day. and oral health care professionals should consider implementing the measurement of BMI index as part of routine dental screening. “The dental professional Interested in writing an article for can use the BMI index to determine if treatment the journal? modification will be necessary and to predict any Email the Managing Editor at abrady@adaausa.org. possible complications related to the treatment. The PG 6 The Dental Assistant March/April 2018
President’s Page Natalie Kaweckyj, LDARF, CDA, CDPMA, COA, COMSA, CPFDA, CRFDA, MADAA, BA President 2017-2018 American Dental Assistants Association Pride, Passion and Professionalism: Are You Doing YOUR Part? and independent streak that makes us passionate about “If passion drives you, let reason hold the reins” doing things we have set our mind on, even if we are – Benjamin Franklin told not to. That’s what passion is about. Employers are continually looking for people with passion and T hree words—pride, passion and dedication to be added to their dental teams. professionalism—mean different things to So what can you do? Get involved! For some, this different people. In late February, the Chicago may sound scary because you may not know anyone. Dental Society held its annual Midwinter Meeting, For others, time commitment may play a factor in https://www.cds.org/meetings-events/midwinter- participation. At ADAA, we value the participation and meeting, with just this theme: Pride, Passion, and opinion of all dental assistants, whether you are a Professionalism. ADAA had an opportunity to present student, in mid-career, or a career veteran with so many education in the main catalog to two sold out sessions. tips of the trade to share that you could write a book. Our title, Dental Assisting: A Mixture of Pride, Passion How do you get involved enough to make a difference? and Professionalism, focused on a variety of areas By participating in progress and giving feedback to important in the daily life of a dental assistant. The questions asked. Pride comes with the realization intent of the three-part lecture was to inspire dental that you do indeed make a difference. Everyone does, assistants at all stages of their careers. So often through my travels, I encounter dental assistants who do not value their true worth to the profession, or who At ADAA, we value the feel that they contribute very little. Honestly, we all make a difference. Collectively, we could have a huge impact. It is time for some action. participation and opinion of all At some point in our careers, most of us have been hit with that pit-of-the-stomach, Monday-morning dental assistants, whether you moment of questioning: “OMG, do I really have to go to work?” For some of us, this feeling may begin are a student, in mid-career, or a mid-afternoon Sunday, ruining the remainder of the weekend and setting you up for anxiety-filled dreams in career veteran with so many tips the night to come. For others, it may happen regularly and with some frequency. So what is missing? Our drive for being a top dental professional is a positive of the trade to share that you emotional connection to our career and often our most energy-consuming quest. However, with soul searching, could write a book. planning, action, and support, you can redirect your career to incorporate what truly excites and invigorates whether you think so or not. We make a difference to you in dental assisting. our team, our patients, students, and our colleagues. We come into this world with so much passion for Participate in the progress of the professional so many different things. We love our food, our toys, association by first becoming a member, and secondly and those people close to us who play a role in our by getting involved and giving feedback, demonstrating lives. We are passionate about new experiences and your eye for detail and your desire to contribute to repeating old experiences that we particularly like. We improvement. Take pride in the fact that you have a like security, but at the same time, we have a stubborn voice in professional matters. March/April 2018 The Dental Assistant PG 7
President’s Page continued Be a positive force in the field. We all know someone who has the tendency to be the “Debbie downer” at everything that is proposed or suggested. Be aware and demonstrate a keen sense of being positive at work and within your profession. Embrace your organization’s history, culture, and vision of the future. We will celebrate our centennial in a few years. There are some ADAA staff Peter Kasper (front left) and Jay Kasper (back right) and President Natalie Kaweckyj and President-Elect Jan DeBell at the Chicago Dental Society Midwinter Meeting in February. state associations of ADAA that are already celebrating their centennials. What a milestone! What dedication the members had to keep things moving forward to reach 100 years! Your environment is what you make it; take pride in being a positive force at work and in Newly appointed ADAA 1st District Trustee Nancy Leary (back your association. Engage with positive-minded people left) and President Natalie Kaweckyj (back right) at the Yankee and invest in building positivity around you and in your Dental Congress with students enrolled in the dental assisting personal and professional environment. Remember program. what you achieved and what the future holds for the best to identify them early on, course correct, and create profession. Take pride in that joint achievement. On future plans by very clearly avoiding such individuals. the flip side, steer clear of negative influences, people, Every professional organization has seen failures and ex-employees’ sub-standard practices. If you skew or a time of low member morale. It happens in cycles. towards negativity, then you are clearly in the wrong ADAA has seen its share of changes through the years, place. as well as struggles of reestablishing itself within the Those who demonstrate lack of pride are easy dental community. Although change is difficult for enough to identify—being non-participative, keeping many, it is needed to keep moving a profession forward. their heads down and not giving feedback even when Are you doing your part? We are continually looking asked. When things do go south, as they do from time for members to become more involved. It is a great to time, these folks are the first to point fingers. From a learning experience and comes with mentoring and management perspective, the signs are all there. Why the opportunity to serve on the local, state or national would anyone want someone like this on their team? It’s levels. The time is now: Get involved! PG 8 The Dental Assistant March/April 2018
Research: The Promise of Stem Cells in Dentistry Although not all procedures done with stem cells have succeeded, the rapid advances have shown positive and beneficial outcomes By Anderson Benavides and Diana Macri, RDH, BSDH, MEd R ecently, scientists have made new discoveries regarding stem cells that can potentially revolutionize the field of dentistry. Regenerative medicine started in 1998 with the discovery of human embryonic stem cells, which are easier to manipulate and obtain.1 In regenerative therapy, stem cells are mostly being used in patients with leukemia and lymphoma. Since regenerative medicine has not been around for long, the topic of stem cells is not often discussed among dental assistants. Stem cells have self-renewing abilities and can differentiate into multiple cell lineages.1 This process shows enormous potential for regenerating alveolar bone, periodontal ligament, pulp, dentin, and enamel. Thus far, stem cell treatments have only been tested on animals such • Stem Cells from Apical Papilla (SCAPs)—mesenchymal as dogs, pigs, and mice. More research is needed in stem cells (MSCs) found in the apical papilla of order to receive approval from the Food and Drug incompletely developed permanent teeth. Administration to begin research on human subjects. • Dental Follicle Progenitor Cells (DFPCs)—extracted from dental follicle surrounding tooth germ in early Stem Cell Basics tooth formation, DFPCs have shown the greatest Stem cells can divide to repair damaged tissues and results in the regeneration of the bone. have the ability to develop into distinct types of cells Current Standard of Care in the human body. There are two types of stem cells: Most of the research done on stem cells has focused embryonic stem cells, from embryos (fertilized egg) on regeneration of damaged tooth related structures.3 and non-embryonic stem cells, also known as adult Diseases of the oral cavity include dental caries and stem cells.2 It is important to note that embryonic stem periodontal disease. The Centers for Disease Control cells are fertilized in vitro and not inside a woman’s (CDC) estimates that periodontal disease affects body. Researchers carefully cultivate a controlled 47 percent of the population, to varying degrees environment that allows embryonic stem cells to (mild, moderate, severe), sometimes causing severe differentiate into cell types such as muscle, nerve, and inflammation and irreversible loss of bone tissue.4 blood cells. Adult stem cells are found in mature tissue However, the irreversible nature of this condition may such as bone marrow. Stem cells can be instructed be a thing of the past. Researchers have been evaluating to become any type of cell in the body, including different methods to reverse or find an alternative osteoblasts, which are responsible for bone formation. solution to the effects of periodontitis. Unfortunately, There are five types of stem cells that can be obtained these methods have not yet achieved a successful full from the structures of the oral cavity:3 restoration of the periodontium. However, there are • Dental Pulp Stem Cells (DPSCs)—mesenchymal type current treatments available in the market that can of cells found inside dental pulp tissue. repair periodontium and replace missing teeth. • Stem Cells from Human Exfoliated Deciduous Teeth Bone and tissue grafts and flap surgery are some (SHEDs)—found in deciduous teeth, these cells show of the most popular treatments available to treat greater proliferation and differentiation than bone periodontitis. Both methods help treat inflammation, marrow stem cells (BMSCs). but bone and tissue grafting recover lost periodontal • Periodontal Ligament Stem Cells (PDLSCs)—exhibit tissue and bone. Gingival grafting is a procedure that properties similar to mesenchymal stem cells (MSCs), uses synthetic material or tissue from another area of the most widely studied adult stem cells. the mouth to cover exposed roots.5 Treating periodontal disease with flap surgery is recommended for people March/April 2018 The Dental Assistant PG 9
The Promise of Stem Cells in Dentistry continued with moderate to severe periodontitis. In this procedure, created from stem cells and successfully transplanted to the gingiva (free gingiva and attached gingiva) is a human. The patient appeared in various news reports separated from the underlying alveolar bone in order to saying how well he felt after the procedure. There were debride root surfaces that are too deep to be accessed many legal and ethical issues presented, especially when with traditional methods.6 Once the areas have been the patient died two years after the procedure. Other thoroughly debrided, the gingival is reattached. This reasons that might have influenced the death of the process effectively reduces pocket depth to allow both patient are still unclear. patient and dentist to have better access to the affected Realizing the incredible potential of stem cells to heal, area. It is also used to facilitate placement of dental there now exists the possibility of banking stem cells. implants. People can save their biomaterial to use in the future for While effective in allowing access to previously regenerative therapy, and that service can be provided unreachable areas, these methods have some in the dental office.10 Dental stem cells are found in disadvantages because they are not efficient in repairing teeth with “healthy pulp.” Often these teeth are seen bone and soft tissue loss. In gingival grafting, the “new” as waste because they are the wisdom teeth, which are gingiva does not adhere completely, which leaves deep usually extracted, or deciduous teeth. pockets that can accumulate bacteria if not properly Conclusion maintained. Another downside to these treatments is Dr. Rena D’Souza, from the University of Utah School of that the body can reject the transplant (i.e. graft), which Dentistry, believes that treatment using stem cells will will lead to more surgery to remove the implant.6 If become a reality within 5-10 years.11 The encouraging stem cell treatment is perfected, transplanting tissue data coming from trials done on animals have made from a different part of the mouth will not be necessary. stem cells a popular topic in dentistry since people Successful Regeneration on Animals care more about health and aesthetics than they For stem cell treatment to become a reality, it first ever did. Although not all procedures done with stem needs to be approved for testing on human subjects cells have succeeded, the rapid advances have shown by the Food and Drug Administration. While there many positive and beneficial outcomes. Stem cells is no data regarding human subjects, successful will revolutionize medicine and are poised to have a generation of biological tooth crowns and roots has massive impact in dentistry as well. been accomplished in animals.7 Japanese researchers Anderson Benavides is a senior student in the dental have been able to form a whole tooth from stem cell hygiene program at Eugenio Maria de Hostos Community in mice.8 A study on pigs using bone marrow fluid and College. Diana Macri is an assistant professor in the Dental mesenchymal stem cells was successful as researchers Hygiene Unit, Allied Health Department, at Eugenio Maria were able to grow a whole tooth after 40 weeks of de Hostos Community College. implantation.7 The downside of this experiment, however, and one that many scientists are finding, may also be the main reason why trials in humans have not been yet conducted. Issues involving the shape determination, size control, and eruption of the tooth need to be solved.8 Because stem cells obtained from the oral cavity have a specific role in the formation of the tooth, scientists are trying to pinpoint the stage of tooth development in which stem cells become active, and at which point they stop this activation. A few years ago, the pressing problem was how to stop stem cells from growing when trying to create certain organs or tissues. Recently, a trachea was PG 10 The Dental Assistant March/April 2018
The Promise of Stem Cells in Dentistry continued References 6. Zuhr O, Baumer D, Hurzeler M. The addition of soft tissue 1. Mudda J, Bajaj M. Stem cell therapy: A challenge to replacement grafts in plastic periodontal and implant periodontist. Indian Journal of Dental Research. 2011; surgery: critical elements in design andexecution. Journal 22:132-139. of Clinical Periodontology. 2014; 41 (Suppl. 15): S123–S142. 2. NIH Stem Cell Information Home Page. In Stem Cell 7. Nadig R. Stem cell therapy–Hype or hope? A review. Information [World Wide Web site]. Bethesda, MD: Journal of Conservative Dentistry. 2009; 12:131-138. National Institutes of Health, U.S. Department of Health 8. Chen Y, Yu Y, Liu L, et al. Human Umbilical Cord and Human Services, 2016. Cited January 30, 2018. Mesenchymal Stem Cells: A New Therapeutic Option for Available at https://stemcells.nih.gov/info/basics/1.htm Tooth Regeneration. Stem Cells International. 2015; 2015: 3. Park Y, Cha S, Park Y. Regenerative Applications Article ID 549432, 11 pages. Available at http://dx.doi. Using Tooth Derived Stem Cells in Other Than org/10.1155/2015/549432. Tooth Regeneration: A Literature Review. Stem Cells 9. Tzong-Fu K, Hsin-Chi L, Hao-Hueng C, et al. Bone Marrow International. 2015; 1-12. Combined with Dental Bud Cells Promotes Tooth 4. American Dental Association. Study Estimates Nearly Regeneration in Miniature Pig Model. Artificial Organs. Half of American Adults Have Periodontal Disease. 2011; 35:113-121. Published September 27, 2012. Accessed January 30, 10. Majeski J. Dental Stem Cells in Research and Practice. 2018. Access. 2009; 23:24-26. 5. National Institute of Dental and Craniofacial Research. 11. YouTube. http://www.youtube.com/watch?v=_ Periodontal (Gum) Disease: Causes, Symptoms, and Gyv-BVniAw. Published October 9, 2013. Accessed April Treatments. https://www.nidcr.nih.gov/OralHealth/ 3, 2017. Topics/GumDiseases/PeriodontalGumDisease.htm Published 2013. Updated December 8, 2014. Accessed January 30, 2018. WANTED! Dental Assistants... To speak at major meetings, To write for the Dental Assistant Journal, and to develop ce cources and webinars. Put your dental assisting knowledge and skills American Dental to work for you and your colleagues. Assistants Association 140 N Bloomingdale Rd. VOLUNTEER AND GET INVOLVED Bloomingdale, IL 60108-1017 THE ADAA WANTS YOU! Toll Free: 877-874-3785 Contact: Sidonia Peto at speto@adaausa.org or Phone: 630-994-4247 Fax: 630-351-8490 Call 877-874-3785, Ext. 229 www.adaausa.org March/April 2018 The Dental Assistant PG 11
Obesity Effects on Periodontal Disease Oral health care professionals need to understand how obesity affects the dental process of care By Annie Chitlall, RDH, BS T he public and health-care providers have Background shown increasing interest regarding the link In 1977, the first association between PD and obesity between oral and systemic health. Obesity and appeared after interesting changes were observed in periodontitis continuously affect more people in the the periodontium of obese rats. The rats accumulated world, and a link between obesity and periodontal biofilm, which produced severe periodontal disease has been scientifically established.1 inflammation and destruction of alveolar bone.1 The Periodontal disease (PD) is a bacterial-induced chronic inflammatory process in obesity is similar to the disease inflammatory disease that releases endotoxins.2 process in periodontal disease because inflammation The endotoxins in PD activate the pro-inflammatory releases cytokines in both disease processes.2 Obesity cytokines interleukin (IL)1– and tumor necrosis factor is a systemic condition capable of exacerbating the alpha (TNF-a), which destroys the periodontal ligament severity and advancement of periodontal disease.5 As and causes resorption of the alveolar bone.3 A a result of the systemic chronic inflammatory process general dentist or a periodontist is responsible for that occurs in obesity, there is an increased production making a clinical diagnosis of PD.4 Several variables, of reactive oxygen species resulting in an aerobic such as tooth loss, recession, clinical attachment environment; the oxidative environment alters the host loss, periodontal probing depths, tooth mobility, and immune system and increases vulnerability to various radiographic evidence of bone loss are used to make a infections.6 clinical diagnosis of periodontal disease.5 Obesity and Oral Health Approximately 50 percent of American adults over Globally, the most prevalent oral health condition is the age of 30 have chronic periodontitis, and 38 percent untreated dental caries in children.10 Approximately have moderate to advanced stages of the disease.3 621 million children have dental caries in deciduous Overweight individuals are predisposed to high bacterial teeth.9 The leading causes of increased dental diseases cells in subgingival plaque, and oral bacteria may are excessive sugar intake and improper oral hygiene.11 increase metabolic efficiency when transferred through A diet high in fermentable carbohydrates is associated the gastrointestinal tract.6 An obese individual is more with diseases of the oral cavity.8 A sugary diet fosters the susceptible to infections because obesity alters the host development of other non-communicable conditions, immune response.7 Globally, obesity is the most notable such as diabetes, chronic kidney disease, and obesity.7 public health problem, affecting 34 percent of adults in Obesity, weight gain, and increased waist circumference the United States alone.3 may contribute to the development of periodontal Oral health disparities, such as periodontal disease disease.1,4 and dental caries related to obesity, affect 3.9 billion Additionally, obesity impairs healing related to people worldwide.8 Oral health professionals are maxillofacial surgical procedures.4,11 Obesity makes third responsible for assessing the degree to which a molar extractions difficult with complicated post-surgical patient’s risk factors outweigh the protective factors healing.6 The total time for extraction increased in and provide recommendations to tip the balance overweight patients with 50% of the surgeries in obese toward health. Patients typically have more trust in the patients categorized as very difficult.11 Approximately recommendations of their oral health care provider and 3.9 billion people worldwide are affected by periodontal will be more accepting of treatment recommendations disease and dental caries related to obesity.12 given by a dentist or dental hygienist regarding the state of their periodontal health and body weight.9 Dental Etiology of Periodontal Disease and systemic diseases are both the byproducts of a high The exact cause of periodontal disease has not been carbohydrate diet.8 Some suggest that dental diseases definitely identified; however, augmented secretion are early indicators of diabetes, obesity, and coronary of pro-inflammatory cytokines is assumed to be a heart disease.9 This article explores the links between contributing factor.1 The mildest form of periodontal oral hygiene status, periodontal health and obesity. disease is gingivitis. Gingivitis is an inflammation of the gingival tissue induced by the pathogens residing in PG 12 The Dental Assistant March/April 2018
Obesity Effects on Periodontal Disease continued dental plaque around the gingival margin and sulcus.13 gluconeogenesis, which elevates the triglycerides The bacteria in the gingival sulcus foster the progression levels because of high numbers of free fatty acids.6 In of periodontal disease, which results in apical loss of men, obesity is parallel to an increase in abdominal epithelial attachment along with loss of hard and soft and visceral fat.7 In women, fat is distributed by an periodontal tissues.14 Gingivitis is reversible by removing enlargement of subcutaneous and visceral fat along with the etiological factors; however, if left untreated, a modest amount of fat in the gluteofemoral region.12 gingivitis progresses to irreversible periodontal disease.5 Prevalence of Obesity There are 400 species of bacteria found in Increased sedentary lifestyles and a high caloric diet subgingival plaque. However, the bacteria most created a worldwide epidemic of obesity.15 According frequently associated with the progression of PD is to the CDC, one in every three adults is obese, and Porphyromonas gingivalis, a particularly pathogenic 61 percent of overweight children aged 5 to 10 years organism, which initiates an inflammatory response have one or more risk factors for chronic diseases.16 that destroys alveolar bone, facilitates ulceration of The prevalence of obesity worldwide has doubled in the epithelium, and exposes the connective tissue.14 North America, the United Kingdom, Eastern Europe, In periodontitis, a vast number of cytokines mediate the Middle East, the Pacific Islands, Australia, and the inflammatory mechanisms that occur during tissue China.11 By 2015, approximately 2.3 billion adults will be destruction.6 Bacteria are the prime etiological factor in overweight, and more than 700 million will be obese.10 periodontitis; however, bacteria alone are insufficient In 2007 to 2008, in the United States, the overall obesity to advance the disease process. Various risk factors, rates reached 24.1 percent, making it the country with such as stress, genetics, and systemic health outweigh the highest obesity index amongst all high-income the effects of bacterial metabolism in the development countries.2,10 of periodontitis.5 Porphyromonas gingivalis activates host cells, which results in the release of cytokines and Risk Assessment for Obesity and Periodontal Disease tumor necrosis factor.14 The pro-inflammatory process Obesity is suggested as the second risk factor after in periodontal disease is similar to the release of smoking for the inflammatory process that destroys cytokines and hormones from adipose tissue in obesity.2 tissue in periodontal disease.11 Additionally, in an obese In PD, the cytokines are part of the circulation system.12 individual, there is increased clinical attachment loss Porphyromonas gingivalis is also a risk factor for various and deeper periodontal pockets.11 Obesity is a state systemic diseases, including obesity. There is substantial of low-grade inflammation due to the increase in the evidence linking periodontal disease to atherosclerosis, release of tumor necrosis factor- a and interleukin 6 Type 2 diabetes, and obesity.14 (IL-6).17 The state of low-grade inflammation is fueled by cytokines that adjudicate inflammation.15 Obesity Etiology of Obesity increases the chance of destructive periodontal disease Obesity is the abnormal or excessive accumulation of by 35 percent.12 fat.15 Obesity has a wide range of etiological factors, including genetic, biological, social, and behavioral Pathophysiology of Obesity and Periodontal Disease factors, which all combine and eventually lead to an The primary cause of obesity and periodontal disease imbalance between energy intake and expenditure.15 is inflammation. Human fat cells secrete 12 types of The measuring tool used to classify an individual as inflammatory cytokines, including interleukin-6 and obese or overweight is the body mass index (BMI).2 The TNF-a, which alters the metabolic mechanism of the BMI is calculated using a person’s weight in kilograms cytokines in the body and fosters low-grade systemic divided by the square of height in meters.16 According inflammation.9 For each unit increase in BMI, there to the World Health Organization, a person with a BMI was a 5% increase in the progression of alveolar bone equal to or more than 30 kg is considered to be obese.10 loss13, and for every one-centimeter increase in waist In obesity, adipose tissue is an inactive organ used for circumference, there was a 1% to 2% increase in the storage of triglycerides.2 The liver of an overweight progression of probing depth and clinical attachment person decreases the uptake of insulin and increases loss.18 An obese patient who presents with periodontal March/April 2018 The Dental Assistant PG 13
Obesity Effects on Periodontal Disease continued disease becomes high risk for cardiometabolic illnesses Conclusion compared with individuals with a healthy weight.17 Obesity is a contributing risk factor for periodontal Gingivitis scores decreased by one-third when there was disease separate from other risk factors, such as age, a moderate decrease in high carbohydrate diet.9 gender, race, and ethnicity.17 Inflammation related Treatment of Periodontal Disease to obesity is a contributor to periodontal disease The traditional approach to periodontal therapy progression.17 Adipose tissue secretes inflammatory is scaling and root planing (SRP) with manual and markers, which increase gingival inflammation and ultrasonic scalers.19 Scaling and root planing is a enhance the spread of bacteria.1 The disease process simple and affordable method of eliminating microbial in periodontitis also influences the production of pro- deposits which favors optimal periodontal health.6 inflammatory cytokines, which stimulate various chronic There are also various other methods of non-surgical metabolic diseases, including obesity.1 While men are adjunctive periodontal treatment, such as lasers and at a higher risk for developing PD than women, the locally delivered controlled-release antimicrobials, hormonal changes occurring in women can also increase which promote reductions in pocket depths.19 In gingival inflammation and create susceptibility to the United States, locally delivered, control-released periodontitis.1,25 The influence of sex on the association antimicrobial products are tetracycline, chlorhexidine between overweight/obesity and development of chip, doxycycline gel, and minocycline microspheres.20 periodontitis is inconclusive.24 In the presence of obesity, younger adults, Periodontal Therapy and Obesity women, and non-smokers experienced greater Periodontal therapy has been shown to have positive epithelial attachment loss and increased prevalence effects on the inflammatory markers in patients with of periodontal disease.24 Dentists and oral health obesity and other systemic diseases.6 Obese patients care professionals should consider implementing the with periodontal disease responded clinically to measurement of BMI index as part of the routine dental periodontal therapy similar to normal weight patients screening. The dental professional can use the BMI with PD.21 As inflammation decreases, there is decrease index to determine if treatment modification will be in the release of cytokines in the gingival crevicular necessary and to predict any possible complications fluid following periodontal therapy.22 Obese patients related to the treatment. The effects of obesity on the presented with good clinical scores and consistent progression of PD are significant, and oral health care levels of adipocytokines and high-density lipoprotein professionals need to be able to understand that obesity serum.21 Research shows there was an increased risk can also affect the dental process of care. for future cardiovascular disease in individuals who did not respond well to periodontal treatment.23 Successful Annie Chitlall, RDH, BS, is an adjunct periodontal therapy may influence the progression of lecturer in the dental hygiene department subclinical cardiovascular disease.23 The periodontal at New York City College of Technology parameters in both overweight and healthy weight and the dental hygiene unit at Eugenio patients had significant improvements in periodontal Maria de Hostos Community College, therapy.22 Periodontal treatment resulted in significant both in New York City. In addition to reduction of serum leptin and C-reactive protein levels, teaching, Chitlall also works as a clinical which demonstrated that periodontal therapy produced hygienist in two private practices. beneficial outcomes in patients with obesity and chronic periodontitis.4 Periodontal treatment is a simple and cost-effective method of eliminating microbial deposits favoring optimal periodontal health. It is safe to conclude that periodontal treatment is effective in altering the progression of inflammation in obese patients.4 PG 14 The Dental Assistant March/April 2018
Obesity Effects on Periodontal Disease continued References 12. Pasquali, R. The hypothalamic-pituitary-adrenal axis 1. Keller A, Rohde J, Raymond K, Heitmann B. Association and sex hormones in chronic stress and obesity: between periodontal disease and overweight and obesity: Pathophysiological and clinical aspects. Annals of The New a systematic review. Journal of Periodontal Research 2015; York Academy of Sciences 2012; 1264, 20–35. 86:766-776. 13. Bhatt S, Garrison C, Johnson Y, Patel S. Periodontal 2. Fearing Tornwall R, Chow A. The association between Screening: Patient Attitudes and Clinical Care Decision periodontal disease and the systemic inflammatory Making. Journal of California Dental Hygienists’ Association conditions of obesity, arthritis, Alzheimer’s and renal 2014; 30:6-13. diseases. The Canadian Journal of Dental Hygiene 2012; 14. Boyd L, Giblin L, Chadbourne D. Bidirectional relationship 46:115-123. between diabetes mellitus and periodontal disease: State 3. De Pergola G, Abbinante A, Cagiano R, et al. The bad of the evidence. The Canadian Journal of Dental Hygiene association: obesity, periodontal disease, inflammation 2012; 46:93-102. and insulin resistance. Review and personal findings. 15. Khosravi, R., et al. Tumor necrosis factor-a and Nutritional Therapy & Metabolism 2014; 32:53-60. interleukin-6: Potential inter organ inflammatory 4. Types of gum disease. American Academy of mediators contributing to destructive periodontal Periodontology. Available at: http://www.perio.org/ disease in obesity or metabolic syndrome. Mediators of consumer/types-gum-disease.html. Accessed January 28, Inflammation 2013, 1–6. 2018. 16. Centers for Disease Control and Prevention. 2015, May 5. Mosley M, Offenbacher S, Phillips C, Granger C, Wilder R. 15 body mass index (BMI). Available at: http://www.cdc. North Carolina Cardiologists’ Knowledge, Opinions and gov/healthyweight/assessing/bmi/index.html. Accessed Practice Behaviors Regarding the Relationship between January 28, 2018. Periodontal Disease and Cardiovascular Disease. Journal of 17. Hein, C., & Batista, L. E., Jr. Risk assessment for obesity and Dental Hygiene 2014; 88:275-284. periodontal disease. Decisions in Dentistry 2017, 1–12. 6. Gurav AN. The association of periodontitis and metabolic 18. Gorman A, Kaye E, Apovian C, Fung T, Nunn M, Garcia syndrome. Dental Research Journal 2014; 11:1-10. R. Overweight and obesity predict time to periodontal 7. Papageorgiou S, Reichert C, Jäger A, Deschner J. Effect of disease progression in men. Journal of Clinical overweight/obesity on response to periodontal treatment: Periodontology 2012; 39:107-114. systematic review and a meta-analysis. Journal of Clinical 19. Zammit E. Comparison of Er: YAG laser debridement Periodontology 2015; 42:247-261. versus conventional scaling and root planing. The 8. Meier T, Deumelandt P, Christen O, Stangl G, Riedel K, Canadian Journal of Dental Hygiene 2012; 46:183-186. Langer M. Global Burden of Sugar-Related Dental Diseases 20. Finkelman R, Polson A. Evidence-Based Considerations for in 168 Countries and Corresponding Health Care Costs. the Clinical Use of Locally Delivered, Controlled-Release Journal of Dental Research 2017; 96:845-854. Antimicrobials in Periodontal Therapy. The Journal of 9. Watterson, D. G. The role of diet in oral disease Dental Hygiene 2013; 87:249-264. prevention. RDH Magazine 2013; 79–81. Available at: http:// 21. Duzagac E, Cifcibasi E, Cintan S, et al. Is obesity associated www.rdhmag.com/articles/print/volume-33/issue-10/ with healing after non-surgical periodontal therapy? features/the-role-of-diet-in-oral-disease-prevention.html. A local vs. systemic evaluation. Journal of Periodontal Accessed January 28, 2018. Research 2016; 51:604-612. 10. World Health Organization. 2009 fact sheet on unhealthy 22. Nair V, Bandyopadhyay P, Kundii D, Das S. Elucidating diets and physical inactivity report 2009. Available at: the Role of Non-Surgical Therapy on GCF Interleukin-18 http://www.who.int/nmh/publications/fact_sheet_diet_ Levels in Indian Population with Periodontal Disease. en.pdf. Accessed January 28, 2018. International Medical Journal 2016; 23:21-25. 11. Yuan J, Lee D, Afshari F, Galang M, Sukotjo C. Dentistry and 23. Holmlund A, Lampa E, Lind L. Poor Response to obesity: a review and current status in U.S. Predoctoral Periodontal Treatment May Predict Future Cardiovascular dental education. Journal of Dental Education 2012; Disease. Journal of Dental Research 2017; 96:768-773. 76:1129-1136 24. AlJehani, Y. A. Risk factors of periodontal disease: Review of the literature. International Journal of Dentistry 2014, 1–10. March/April 2018 The Dental Assistant PG 15
Drug Abuse Aware and Prepared The opioid crisis brings a new risk to today’s dental practices, including patients and employees By Cris Zimmerman, RDH, BS T he opioid problem has become a nationwide epidemic, affecting every generation, gender, race, income level, and profession. The opioid It is disheartening to see what any problem is affecting all areas of the workforce, including the dental profession. It’s a harsh reality form of addiction can do to a for those in management positions who are trying to maintain a safe and a professional work environment. wonderful person and competent There are many indicators that you can watch for to reveal if a person is abusing drugs. And, it’s important to know that the recommended urine or blood tests are employee. Any number of devastating not fail-proof resources for determining if a suspected employee may have a drug abuse problem. issues can contribute to drug abuse. Consider some lessons I’ve learned in my own work as a dental hygienist and in discussions with However, it’s important for dental professional peers. One manager shared her experience with an practices to be aware of the risks. employee who started to show a decline in her work skills and personal appearance. This staff member was a great employee when she was first hired. However, the results would indicate whether an employee was the manager started to notice a rapid change in her abusing narcotics. After sending an employee for two appearance and work ethic. Furthermore, her behavior separate drug tests, and knowing from other employees became peculiar; she hid things where no one else that this person was in fact abusing narcotics, the would even think to look for them. She was fidgety employee passed both tests. The manager knew and appeared nervous. She tried very hard to come from my other sources that one of his employees was across as confident with a leadership desire but the snorting pain killers along with other drugs and bragging actions didn’t line up with her words. She began to about it to other co-workers. He needed proof in order develop sores on her face that she claimed was a form to fire the employee. He contacted the lab and asked of acne, but the manager knew it was nothing like if the employee’s tests were supervised because he the acne she had experienced or seen. A number of figured he must have taken someone else’s urine with people approached the manager with genuine concern him. She assured the manager that the second test and compassion for this individual, including patients was supervised. The manager then inquired further on who genuinely cared for the employee in question but how someone could pass a urine test when they are had also noticed alarming changes. The manager was likely abusing drugs. He was told that if someone has unaware these issues were indicators of a drug problem a prescription for Adderall or similar drug, which is a until it was brought to her attention. methamphetamine, the lab looks at the prescription Ultimately, the manager used her state’s online history and automatically gives a pass on anything in substance abuse reporting system to check the that category. This would have been the same result if employee’s history of narcotic prescriptions, a resource he had sent him for a blood test, which costs more, and typically used by medical practices to protect themselves was his next course of action. from drug-seeking patients. Unfortunately, the manager It is disheartening to see what any form of addiction found a need to check out an employee, especially after can do to a wonderful person and competent employee. she had requested pain medications from the practice. Any number of devastating issues can contribute to drug The manager was shocked at how many prescriptions abuse. However, it’s important for dental practices to be for controlled substances had been prescribed to the aware of the risks. Patients trust in our care and should employee and her husband from the practice. feel confident that the employer will hire the capable In another instance, a manager indicated that he team to deliver the standard of care they need and assumed if he sent an employee for drug testing, deserve. PG 16 The Dental Assistant March/April 2018
Drug Abuse Aware and Prepared continued An impaired dental assistant puts herself, the practice, and the patient at risk. The onus is on managers to be aware of opioid and other drug abuse and have systems in place to identify employees who Interested in writing an article may be at risk or already abusing drugs. The North for the journal? Carolina Controlled Substance Reporting website is an excellent resource: www.nccsrsph.hidinc.com. Bear in mind, there are strict rules for how the site can be Email the Managing Editor at utilized. Generally, drug problems begin with pain abrady@adaausa.org medications, but when that becomes too costly and difficult to continue, abusers seek out heroin and other dangerous drugs. Medical/dental professionals are catching on and monitoring the amount of prescription drugs they prescribe. Dentists are now required to take at least an hour of continuing education on controlled substance prescribing. North Carolina dentists will soon be required to be listed on the North Carolina site and required to look up any patient before they provide a controlled substance and also document that prescription in the patient’s chart. Be aware of what is going on in your community and workplace at all levels. Please be sure to look further into the rules of employment within your local employment security commission and remember that you can’t single out one employee for drug testing. PARTNERSHIP. At my own practice, it has become our policy that all employee candidates are drug screened prior to INTEGRITY. employment, although, as noted, these tests aren’t without flaws. I have adopted a policy that was given INNOVATION. to me from a mentor: Be slow to hire and quick to fire. Obviously, we aren’t going to fire unless there is Working hard to deliver the very best in reasonable, documented cause, but always act in the patient experience and practice lifestyle. best interest of the work environment for patients and At Patterson Dental, we are proud to connect you with the rest of the team. innovative tools and resources so that you can focus on providing expert dental care. Cris Zimmerman, RDH, BS, is a dental hygienist and Let us be your partner in providing everything you need office manager in Jacksonville, NC. Reach her at to excel at dentistry. christinecrannie@yahoo.com. CONTACT YOUR LOCAL BRANCH 800.873.7683 | PATTERSONDENTAL.COM 18P0687c (1/18) March/April 2018 The Dental Assistant PG 17
Office-Based Anesthesia How Dental Assistants Ensure Safe Patient Care By Martha Peters, CDA O ffice-based anesthesia privileges are vital to the skills used in anesthesia administration. Frequently livelihood of all dental practices that administer providing the dental team with opportunities to expand anesthesia and sedation. The ability to provide knowledge through hands-on training and evaluation effective pain and anxiety management to patients in a is an effective way to master skills. Recognition and safe environment is a need that has always existed. management of office emergencies are essential to Because the dental team must deliver quality office- successful outcomes. Recognizing and responding to based ambulatory anesthesia, a critical need exists emergency situations are fundamental skills that must to properly validate training for dental anesthesia be mastered. assistants—staff members who work under the care of A number of resources are available for training and dentists who administer anesthesia and sedation. The developing the dental anesthesia team for excellence: validation of this training and skillset continues to be • The DAANCE (Dental Anesthesia Assistant National under scrutiny because of the importance of patient Certification Examination), developed by AAOMS safety when administering anesthesia. Anesthesia (American Association of Oral and Maxillofacial and sedation administration is a right earned by many Surgeons), is a core educational curriculum geared dentists through intensive training and is a privilege that towards training the dental anesthesia assistant must be held to the highest standards and delivered for office-based anesthesia and sedation assisting. with safety, confidence, and effectiveness. DAANCE is also offered to all dental specialty Training for excellence in office-based anesthesia anesthesia assistants where sedation and anesthesia requires leadership, preparation, and simulation. A are administered in offices that hold valid anesthesia comprehensive training plan starts with the dentist’s permits. vision for the practice to build, lead, and engage • The Anesthesia Assistants Review Course (AARC), the team, encouraging them to weave purpose, sponsored by AAOMS, is a comprehensive live, commitment, and passion into every aspect of patient in-person review course that emphasizes essential care. Leadership from the surgeon is a key component anesthesia protocols/guidelines for the dental to attracting and retaining top quality staff that will anesthesia assistant. A condensed version is also engage in training and support the practice vision. available online. AARC also prepares the assistant for Dentists who expect excellence will get excellence. the DAANCE examination. Staff will respond to a dentist who clearly communicates the expectations and provides support, • The Anesthesia Assistants Skills Lab (AASL) for as well as sharing knowledge. While dental anesthesia AAOMS allied staff provides hands-on training with assistants don’t administer anesthesia and sedation, anesthesia administration, airway management, they play an important role in supporting the dentist dysrhythmia recognition, and medical emergency as he administers anesthesia. Teachable and trainable management. moments elevate the practice. Constant immersion • AAOMS also recently offered its members an in training is the single-most important element to upcoming live in-person course on Advanced emergency preparation and management. Skills are Protocols for Medical Emergencies that discusses mastered with confidence through in-depth knowledge, emergencies encountered in the OMS office setting understanding, and frequent performance. Training for and the participation of the assistant in these excellence prepares staff for the unexpected. Skills are situations. Upcoming AAOMS webinars on preparing improved through constant review of our proficiencies staff to handle an office emergency are also available. and deficits. Identifying the gap between what we have • ACLS (Advanced Cardiac Life Support) and PALS mastered and what we need to master is critical. Part of (Pediatric Advanced Life Support) certification provide the training plan needs to fill that gap. a systemic approach to advanced resuscitation Training Opportunities efforts through recognition and evaluation of Training for excellence in office-based anesthesia algorithms, airway management, and pharmacology includes teaching, practicing, and demonstrating administration. PG 18 The Dental Assistant March/April 2018
You can also read