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The article discusses evidence-based practice for dental hygienists, with the continuous evolution of the profession and the profession's increasing role in care delivery. Topics discussed include emergence of new paradigm for medical practice that included combined systematic reviews (SRs) and meta-analysis (MA), combining research, experience and real-life observation in evidence-based practice to improve overall health of patient, and use of smart search strategy for evidence collection.

The article focuses on the rules and regulations decided by dental boards in the U.S. and their impact on the provision of dental hygiene services. Topics covered include the complaints about the provision of tooth-whitening services by non-dentists, the legal challenges faced by the California Health Manpower Pilot Projects Program and the complaint by the Federal Trade Commission (FTC) against the South Carolina Board of Dentistry for unlawfully restraining competition.

The article discusses the prevalence of dental health professional shortage areas in states where evidence based dental care exploiting the skills of American Dental Hygienists' Association (ADHA) members is not promoted. Alfred C. Fones is cited for envisioning the expanded role of dental hygienists which include general supervision levels, restorative functions and administration of analgesia in most states. Donald Berwick explains why states in the Deep South are lagging behind in services.

The article discusses how independent Canadian hygienist Nancy Johnston builds practice based on her beliefs and offers a review of The Smile Spa clinic she started in 2008. Tables showing the services offered by the clinic and the results of studies on subgingival air polishing are presented. Topics include Johnston's investment in high quality equipment, her EMS Air Flow Master Piezon which delivers various treatment applications and other modern technology items displayed in her operatory.

The article discusses the link of bidirectional diabetes to periodontal disease, and the oral and systemic links for promoting the mouth-body connection. Particular focus is given to the grading systems which are considered as a useful tool to help dental hygienists and dentists identify strength of the evidence surrounding the link between bidirectional diabetes and periodontal disease. An abstract about a randomized clinical trial for assessing the link is presented.

The article discusses the lack of access to dental care in Georgia. It mentions that Georgia has only 4.4 dentists per 10,000 people; this indicates that many people in Georgia do not have access to dental care. Several uninsured and low-income Georgians seek care at Emergency Departments for dental emergencies; dental caries, periodontal disease are on rise, however, the Georgia Dental Association (GDA) insists that there is no shortage of dentists; the dental forecast for Georgia is not good.

The article investigates the increasing use of salivary antioxidants to regulate oral chemistry and oral health. It cites the views of Dr. Sotirios Kotsovilis, a periodontist and researcher, on the association between high levels of reactive oxygen species (ROS) and the pathogenesis of periodontitis. Kotsovilis supports using antioxidants as part of the treatment of inflammatory conditions, but cautions that the efficacy of the therapy should be documented by appropriate research. INSET: Dr. Kotsovilis: The science behind free radicals.

An interview with Ted Bleckstein, a periodontist and author of the book "Diagnosis: Deception, The Darker Side of a Trusted Profession," is presented. When asked about the beginning of soft tissue management (STM) movement, he said that faulty STM protocols that were prevalent in 2003 led to its advent, and constructive steps taken by the American Academy of Periodontology (AAP) to resolve the problems. Bleckstein highlights the reasons as to why periodontal referrals are crucial.

The author discusses her experience of attending a one-week intensive course on evidence-based dentistry (EBD) in 2011. During the course, for analyzing published research reports for validity and applicability, she decided to interview Frieda Pickett, professor of dental hygiene. Few questions addressed during the interview include the status of link between preterm/ low birthweight and periodontal disease, its origin and evidence required to support or reject oral/systemic links.

The author commends the treatment approach used by Suzanne Newkirk, a perioscopy trainer and practitioner, and Dr. Bob Gottlieb, a periodontist, to treat a 39-year-old female patient with advanced chronic periodontitis. She includes a critical analysis of the treatment approach from an evidence based perspective, and mentions that the treatment included the "gold standard" of scaling and root planning with dental endoscope assisted ultrasonic instrumentation.

The author discusses the etiology of gingival recession and associated dentin hypersensitivity. She reviews the literature on risk factors that contribute to gingival recession that include aggressive toothbrushing and aberrant frenal attachment. Also cited is Van der Weijden and colleagues' systematic review on safety of oscillating-rotating powered toothbrushes compared to manual ones. Common treatments and home management suggestions for dentin hypersensitivity are also listed.

The author focuses on the concept of evidence-based periodontal protocols, and recollects an incident which involved her dog being treated for snakebite. She discusses that evidence-based dental hygiene (EBDH) can be applied in a hypothetical situation by sifting through available research findings, visualizing what constitutes higher quality evidence, looking at the current and highest quality evidence, and talking to clinical experts for clinical guidelines to make a decision.

The article looks at the science and professional guidelines surrounding air cleaning systems in the U.S. It lists contraindications for air polishing procedures, according to the American Dental Hygienists' Association (ADHA) 2010 Position on Polishing Procedures. It reveals that excessive use of air polisher can cause significant loss of tooth structure. The article shows how to protect dental patients by using the high volume evacuation (HVE) aerosol shield reduction device or other air cleaning system or combination of systems.

An interview with Chris Lavelle, a fellow in the Royal College of Pathology in Great Britain, is presented. He states that it is the obligation of the hygienist to serve as a general health care advocate and provide advice on both preventive oral and general health care strategies. He believes conventional periodontal standards of care are insufficient to reduce the risks for preterm births. He also explains the relationship between periodontal disease and cardiovascular disease.

The article presents information on phosphorus necrosis of the jaw, also known as phossy jaw, which is an occupational disease among workers exposed to phosphorus vapors. It describes the case of a matchmaker from London, England who has phossy jaw. It discusses the epidemiology of bisphosphonate-induced osteonecrosis of the jaw (BIONJ). It also explains the association of BIONJ with the oral administration of nitrogen-containing bisphosphonates to treat osteoporosis.

The author reflects on the value of professional irrigation. She states that she think about the qualifications for the practice of dental hygiene and dentistry when she tries to look at this issue and other questionable therapies. She urges all practicing hygienists to challenge each other in identifying the best standard of care when delivering non-surgical periodontal therapy.

The author focuses on evidence-based decision-making as applied to adjunctive oral irrigation. She notes that dental hygienists tend not to consider oral irrigation in their practice despite the existence of published research about it. She discusses various evidences on the benefits of oral irrigation on periodontal outcomes taken from several studies compiled by the Academy of Periodontology (AAP). She mentions that several dental hygienists reported positive results of oral irrigation among their patients.

The article focuses on the career of Diane M. Brucato-Thomas as a periodontist. The author cites the dedication and passion of Brucato-Thomas for periodontal therapy as they stand out among her accomplishments. Brucato-Thomas was certified in expanded functions periodontics and now focuses on the treatment of moderate top advanced periodontal diseases. She provides technology- and evidence-based care to her patients and always prepares herself for change.

The author explores the career and contributions of Doctor Paul H. Keyes to oral health in the U.S. She presented the text of a letter sent by Keyes to Mark Hartley, editor of the "RDH" magazine. She highlighted the views of Keyes on the dental profession and dental hygiene. The author also reflected on the significance of Keyes to the field of dental hygiene.

The article focuses on dental unit waterline and infection control in dental care settings. A synopsis of dental unit waterline treatment products and devices is presented. Individuals with HIV/AIDS and chemotherapy patients are more susceptible to microbial contaminants in drinking water. The ways to purify dental unit water are the continuous delivery system and an intermittent system in which a solution is delivered to the waterlines.

Features Edie Gibson, an independent dental hygiene practitioner in Crested Butte, Colorado. Description of the establishment being leased by Gibson for her practice; Background on laws governing dental hygiene practices in the state; Views of Gibson on forming personal relationships with her clients.

The article focuses on the occupational risk of immunocopromised dental personnel for exposure to certain infections. Immunocompromised hygienists are also obligated to avoid transmitting infectious agents to their patients. Vaccinations recommended for health care workers include influenza, hepatitis B, measles, mumps and rubella, and varicella.

Reports on changes in nonsurgical periodontal therapy since the 1980s. Dental hygienist Paul Keyes' pioneering work on conservative anti-infective therapy; Emergence of the concept of soft-tissue management; Changes in emphasis on root planing and increased use of ultrasonics.

The article focuses on the use of the Miller-McEntire Periodontal Prognostic Index to promote periodontal care. Topics mentioned include an overview of the index which is used to determine the prognosis of periodontally-involved molar teeth, recommendations on scoring all molars with moderate to severe periodontis, and criteria for success including having the recommended periodontal treatment, practicing daily plaque removal, and avoiding smoking.

The article addresses the question of whether to say goodbye to flossing instructions for patients diagnosed with periodontal disease by dividing the subject into several components that include scientific evidence for and against, clinical expertise and unique patient features. Topics discussed include findings that flossing plus brushing had a statistically significant benefit as compared to brushing alone and how the efficacy of any device like oral irrigation over flossing is inconclusive.

The article reviews the limitations the average dental hygienist faces today while instrumenting during a typical recare appointment, besides not being able to order preferred instruments. It explores the problem of the lack of agreement by oral healthcare professionals on instrumentation around dental implants. Several articles on implant maintenance/instrumentation and a systematic review (SR) on titanium surface alterations are also cited.

The article discusses issues regarding cement-associated peri-implantitis that are pertinent to registered dental hygienists (RDH) whose focus is on maintaining dental implant health. Topics addressed include the increase in dental implants in the U.S. between 1983 and 2002, the etiology of cement-associated peri-implantitis, and cement as a biofilm retentive-factor that exacerbates the disease process. Also mentioned are excess cement assessment considerations and cemented implant crowns. INSET: FIGURE 2: EXCESS CEMENT ASSESSMENT CONSIDERATIONS FOR THE RDH.

The article offers tips to dental hygienists on treating older people with dementia, according to Pat Poole, a research associate working for The Program on Aging, Disability and Long-term Care at The Cecil G. Sheps Center for Health Services Research. She emphasizes the importance of providing regular oral hygiene care to cognitively impaired people due to the link between poor oral health and systemic health. Poole recommends knowing the medical and personal history of the patient.

The author discusses whether human gum line is a moat polluted with disease causing microbes. She mentions that oral mircobiota of humans changed with their changing diet; she ponders whether the gradual change in the oral microbiotic ecosystem and loss in diversity of mircobiota is contributing to chronic oral disease in postindustrial lifestyles. She suggests that the focus should be on avoiding carbohydrate rich modern-day diet instead of oral-systemic links in dentistry as cause or effect.

The article discusses several examples of how many a times dental hygienists tends to be construed as spin doctors or those that ensure that others interpret data from a particular point of view. One such example is the claim of a perio-cardio link wherein better periodontal health is considered to promote good cardiovascular health. Evidence for a causal association between periodontal and cardiovascular disease is incomplete. The need to consider the source and motivations is highlighted. INSET: AMERICAN HEART ASSOCIATION.

The article discusses whether periodontal treatment modifies or lowers the risk of stroke. In that context, a team led by Frieda Pickett had critically appraised the literature concerning several oral/systemic links. In the aspect examined by Frieda, published in the Canadian Journal of Dental Hygiene, a consensus literature review by the European Society of Cardiology was found, according to which there is no compelling evidence that periodontal intervention will influence cardiac health.

The article pays a tribute to two deceased dental researchers Dr. Sigmund Socransky and Dr. J. William Costerton. Dr. Socransky is known for his microbial clusters that defined different states of periodontal disease and the application of checkerboard DNA-DNA hybridization method of analyzing oral microbes in health and disease. Dr. Costerton contributed to understanding of periodontal diseases by the direct observation of biofilm architecture in their natural ecosystem.

The author focuses on effective sorting large amounts of information in dentistry, since many dental hygienists are misinformed, and discusses hierarchy to be followed while searching the best evidence. She refers to her column and presents a different approach to it by providing the evidence she came across in American Dental Association's (ADA) review, that bisphosphonate- induced osteonecrosis of the jaw (ONJ) is replaced by antiresorptive agent-induced osteonecrosis of the jaw (ARONJ).

The article offers details on the Sonicare AirFloss, an effective rechargeable unit to traditional flossing with microbursts of water and air. It highlights a study by Berchier and colleagues to determine the efficacy of oral irrigation in addition to toothbrushing on plaque and periodontal inflammation. Also discussed is the concerns related to the airfloss and the comments from Dr. Joerg Strate, vice president, Philips Oral Healthcare, Clinical and Scientific Affairs. INSET: Untitled.

The article discusses the success of two dental hygienists in opening their own practices in Colorado based on independent business models. They are About Face owner Edie Gibson and Healthy Smiles Dental Hygiene Care Inc. owner Leslie LeFevre. Gibson and LeFevre operate a cash-only practice and they have an overhead cost of between 35 and 45 percent. The author believes that the success of Gibson and LeFevre may inspire other hygienists to start their own practices.

The article presents tips for dental hygienists on interpreting clinical studies easily. Dental hygienists are advised to access the PubMed Web page sponsored by the National Institute of Health, where they could find citations in dental, medical, and associated journals, as well as link to systematic reviews (SR). Finding a wide body of evidence on the clinical questions that needs to be answered is also suggested. INSET: Clinical Study Designs.

The article reviews the interactive video game "Attack of the S. Mutans!," developed by Firsthand Technology, which will be exhibited at the Pacific Science Center in Seattle, Washington in April 2010.