Exposing one of dentistry's dirty little secrets

Warning: What you are about to read will not be candy coated to be politically correct or apologetic about exposing the truth about a dirty little secret that is so widely accepted in the dental profession that it has become an accepted and even comfortable inconvenient truth. The purpose of this article is to shed some light on a defective methodology so pervasive and unchallenged in dentistry it is the gold standard … and yet is not even common sense. It’s time to raise the bar by raising awareness about this dirty little secret.

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The biggest dirty little secret most widely accepted in daily clinical practice is working blindly in one of the most filthy, biofilm-infested areas of the human body … the periodontal pocket. In hygiene and dental schools, we are taught to perform blind root planing, which is an impossible task with no definitive end point (other than the clock on the wall). We are taught to grope around under the gums with various instruments to determine how well we removed calculus. Sometimes it even helps to close your eyes to enhance tactile sensitivity … or so we think. And yet the insanity of this time-honored tradition is that burnished subgingival calculus cannot be detected … even with the most sensitive of instruments.

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The problem

The first step to recovery and change is admitting there’s a problem. What we are often not taught or even discuss openly at meetings is that the research is replete with evidence demonstrating that blind root planing is only effective to 4mm. Beyond 4mm, 30-50% of the subgingival root surface is still covered with undetectable burnished calculus. Rather than discussing this problem openly and hitting it head on, we are taught to learn how to perform blind root planing better. This advice is like telling a blind person to drive better. Instead, we are expected to ignore this foundational issue and to enhance our inept blind technique by using equally blind adjunctive therapies such as air polishing, lasers, or local delivery antimicrobials to more effectively disrupt and alter biofilm, with no mention of the source of the problem … the very home of the biofilm, the calculus. The foundational problem with all of these BAND-AID methodologies is that mature biofilms will reform within a matter of days wherever subgingival calculus exists. Thorough removal of calculus is the cornerstone to excellent periodontal therapy due to the more permanent removal of, and prevention of, the formation of mature biofilms. Toxic biofilm, growing and changing into an even more toxic soup with every day it goes undisturbed. Toxic biofilm, with complete freedom to infect its hosts systems further through tiny capillaries in the walls of inflamed periodontal pockets with direct access to the entire vascular system, and hence all systems of the body. Our “dirty little secret” has ever more serious consequences than we may fully understand or even think about.

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The idea of thorough calculus removal is such an integral aspect in arresting disease progression that flap surgery often follows blind root planing in order to achieve a definitive end point more conducive to periodontal health. So what is wrong with this picture? Is it true that if we could see into the periodontal pocket that most periodontal surgeries would no longer be necessary (as many leaders in periodontal medicine have suggested through the years)? Is it a conspiracy by dentists and periodontists to keep the dental hygiene profession in its proper place of antiquity and unchanged darkness? Or is it possible that the dental hygiene profession is not taking on the important responsibility of working to change this dirty little secret? Why are we collectively allowing this lag in our progressive clinical ability to continue?

Click on the next page for the author's solution...

The solution

In the year 2000, dental endoscope technology emerged out of the darkness. For the first time in history, the subgingival environment could be viewed in real time and burnished subgingival calculus could effectively be removed without surgery. Considering that medicine has incorporated endoscope technology for more than 100 years, it was about time. This led to more than sufficient research demonstrating that visual root planing could result in periodontal health without subsequent surgery … even in advanced cases. Now 99% of burnished subgingival calculus could be removed and biofilms would have nowhere to flourish and multiply. Blind root planing could finally be abolished and replaced with visual root planing. The dental hygiene profession would be able to eliminate its “dirty little secret” and truly have profound clinical and systemic impact in patient care for the first time in history.

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Secrets are no good for anyone. Let’s be honest with ourselves. Who are we serving by continuing to ignore this inconvenient truth? Are we truly serving our patients and our profession in the process? Now is the time to demand more from ourselves and our profession. Make as much noise as possible about the absurdity of not having the proper tools to achieve health in your patients. Tell your professional associations you are fed up with being taught how to perform blind root planing better (a nonsensical idea at its core). Create a buzz and bring this secret into the light of meaningful discussion. There is power in numbers. The only way to create real change is to believe that change is possible … and it is.

Watch videos of residual calculus on roots after blind root planing

https://www.youtube.com/watch?v=ysqfYpBrQQQ

https://www.youtube.com/watch?v=Ow6VYa5cu2o

Learn more about the current research and clinical significance of endoscopic visual root planing over blind root planing

http://www.periopeak.com/resources.php

Editor's Note: Click here to listen to the author talk more about this article on the Cross Link Radio podcast.

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Author's Note: We’re anxious to hear your comments! Please post below to voice your opinion about blind dental hygiene practice and our dirty little secret.

About the author: Judy Carroll, RDH, is the founder and clinical director of PerioPeak Innovations, an independent non-surgical periodontal therapy practice exclusively focused on providing Regenerative Periodontal Endoscopy (RPE) and integrative treatment methodologies. Her clients fly in from around the globe seeking her pioneering treatment and comprehensive approach to periodontal care. Ms. Carroll’s 25 years in clinical dental hygiene has fueled her determined focus in providing and teaching definitive clinical treatment strategies and more personalized oral-systemic periodontal medicine.

Ms. Carroll currently lectures and teaches advanced endoscopic techniques and integrative care utilizing multi-disciplinary approach to Periodontists, Dentists, and Registered Dental Hygienists. She offers valuable hands-on and didactic training and is available by appointment for her interesting and informative lectures. She can be reached at www.periopeak.com.