Oral health product research and influence on current and future patient care.

Over the past 50 years, the practice of dentistry and dental hygiene has changed markedly. According to an article published in the University of Alabama, Birmingham's UAB Magazine, in the late 1940s, going to the dentist was virtually synonymous with having a decayed tooth removed, since extractions were by far the most common procedure. There was no treatment at all for many kinds of periodontal disease, and the few treatments that were available were time-consuming and painful. (1) When the National Institute of Dental and Craniofacial Research (NIDCR), in an article, reflected back on 1940's life expectancy; patterns of morbidity and mortality; and prevalence and severity of tooth decay, periodontal diseases, and tooth loss, the findings were similar. Life expectancy was 55. Viral and bacterial infectious diseases were major determinants for morbidity and mortality. Tooth decay was rampant. Most people expected to be wearing dentures by the time they reached 45. (2)

These facts paint quite a different picture from the modern practice of dentistry and dental hygiene that we now experience. Research has brought about many scientific advances in oral health that have changed practice and improved patient outcomes. As we approach the year 2010, we find life expectancy is approaching 80. Remarkable progress has been made in the prevention and management of many infectious diseases. The etiology and pathogenesis of dental caries and periodontal diseases are now understood in the context of infectious microorganisms and host immunity; the selective use of antimicrobial drugs and routine professional prophylaxis strategies; and a number of health promotion measures including fluoridation, dental sealants and personal oral hygiene. Today, the prevalence of dental caries has been profoundly reduced, the management of periodontal diseases has progressed, and less than 10 percent of the adult population is edentulous. More people are dentate, free of pain and discomfort, and living longer than ever before in human history. (2)

These scientific advances are truly remarkable and have made a profound difference in the lives of our patients, yet many dentists' and dental hygienists' eyes begin to glaze over when they consider research. Nevertheless, research is something that not only affects clinicians on a daily basis, it is also a critical factor in the forward progression and vitality of the dental hygiene profession.

This article will show some instances of ways that research factors into many of the products that we use in the operatory or recommend for our patients to use in their home care every day. The intent is to clearly illustrate the many ways that research can touch the lives of practicing dental hygienists.

Dental Water Jets and Plaque Biofilm 

A key measure of an effective home care product is the ability to remove plaque biofilm. Dental water jets have been tested and proven to remove biofilm since the early 1970s. However, traditional measures of detecting plaque biofilm by staining and viewing with the naked eye provide only a cursory view, limited to the visible tooth surface and not interproximal or subgingival areas. To better understand plaque biofilm removal, a new level of science was necessary.

A study recently conducted at the University of Southern California, School of Dentistry by renowned biofilm expert Bill Costerton, PhD, evaluated the removal of plaque biofilm with a Waterpik[R] dental water jet using a scanning electron microscope. Periodontally involved teeth with existing plaque were extracted and then processed to accelerate biofilm growth. The teeth were then subjected to a three-second treatment with the Waterpik[R] dental water jet. Viewing the teeth under the highly sensitive microscope, the researchers were able to see far more than with traditional measures. The microscope revealed that 99 percent of the plaque biofilm had been removed by the Waterpik[R] dental water jet treatment. (3)

Biotech Breakthrough May One Day Produce Decay-Fighting Bacteria

According to information provided by Oragenics, a Florida-based company, scientists there have engineered a new bacterial strain, called SMART, that cannot produce lactic acid--plus, it releases an antibiotic that kills the natural decay-causing strain. "Dentists will only need to swab SMART, now in clinical trials, onto teeth once to keep them healthy for a lifetime," the company said.

Oragenics' patented replacement therapy technology is the result of 25 years of research conducted by Jeffrey Hillman, DMD, PhD, the company's chief scientific officer. Most human tooth decay is caused by Streptococcus mutans, which adheres to the tooth surface and converts dietary sugar to lactic acid. The lactic acid excreted by the bacteria causes tooth decay by dissolving hydroxyapatite in the enamel and dentin. Hillman and his research team have isolated a strain of S. mutans that produces a small amount of an antibiotic that is capable of killing all other strains of this species. Through recombinant DNA technology, Hillman's group succeeded in eliminating the gene in this strain that is responsible for producing lactic acid.

In 2005, Oragenics initiated a Phase I clinical safety trial, and has received permission from the U.S. Food and Drug Administration to begin a second safety trial, which will enlist healthy male subjects in an institutionalized, 12-day study with a two-month follow-up phase. As part of its global strategy, the company plans to begin the second human trial with the SMART technology in Mexico in 2009.

See the Research for Yourself on Plaque Biofilms and Antimicrobial Mouth Rinses

According to a special 2007 supplement to the Journal of Dental Hygiene, when considering the oral environment, about 20 percent is occupied by tooth surfaces, that is, those areas targeted for toothbrushing and flossing. Dental plaque biofilm is not limited to tooth surfaces. About 80 percent of the remaining surfaces include the oral mucosa and specialized mucosa of the tongue. Saliva, the tongue and oral mucosa serve as reservoirs of pathogenic bacteria able to relocate and colonize on the teeth and in sulci. Using an antiseptic mouthrinse produces an antimicrobial effect throughout the entire mouth, including areas easily missed during toothbrushing and interdental cleaning. Therefore, it is not surprising that in May 2007, the American Dental Association (ADA) Council on Scientific Affairs issued new advice highlighting the oral health benefits of ADA-accepted antimicrobial mouthrinses that help prevent and reduce plaque and gingivitis.

The supplement to the Journal of Dental Hygiene focused on our changing beliefs about antimicrobial mouthrinses and their value in maintaining oral health. The papers within contained extensive information about dental plaque biofilms, the effectiveness of antimicrobial mouthrinses, and how to incorporate these agents into patients' oral self-care. Within this supplement, dental hygienists found best practices regarding antimicrobial mouthrinses so they can confidently recommend their use to patients based on the evidence. Patients look to dental hygienists for trustworthy information that can make a difference in their oral and systemic health. The supplement is available at www.adha.org.

Reading journals to learn more about the evidence behind the products that we recommend can be an important first step in to the world of dental hygiene research. Clinicians need not consider research to be an esoteric area of the profession of hygiene that they don't understand. Every clinician plays an important role in research, each and every time that he or she recommends a product or treatment to a patient based upon the science and the available body of evidence.

Look for Product Focus columns in future issues of Access to occasionally highlight the research behind the products.

References

(1.) Short, Dale. Dentistry Now and Then a Revolution in Care, UAB Magazine, Spring 1998 Volume 18, Number 2

(2.) Slavkin H. NIDCR 50 Years of Scientific Progress. J Calif Dent Assoc. 1998 Jun;26(6):440-4.

(3.) Gorur A, Lyle DM, Schaudinn C, Costerton JW. Biofilm removal with a dental water jet. Compend Contin Educ Dent 2009:30 (Special Issue 1): 1-6.

Jeff Mitchell is ADHA's director of communications.