Gingivitis: A Wolf in Sheep’s Clothing

How New Approaches to Biofilm Management are Transforming Preventive Care

By Katrina M Sanders RDH, BSDH, M.Ed, RF

One of my favorite ways to decompress as a practicing dental hygienist, speaker, business owner and thought leader is to schedule a lunch or happy hour with my friend Debi Dencek, who is an RDH and entrepreneur. I adore Debi’s sharp mind and unique wit, and she and I both share countless provocative ideas about the dental industry. It is always fun to enjoy a glass of wine while sitting across from her and debating key topics.

We both laugh, because most of what we share is simply too contrarian to be appropriate for a podcast or blog post, yet somehow, we find common ground in evaluating the past, present, and future of dental hygiene on a global scale. 

I recently had the opportunity to sit down with Debi at a local coffee shop for one of our beloved “shop talk” sessions. In between sips of kombucha, Debi and I discussed the “identity crisis” we seem to experience in dental hygiene. I’ve been lovingly called everything from “the technician” to “the cleaning lady” and every other undesirable label you can think of in between.  For Christmas a few years ago, my mom gifted me a coffee mug. This mug, still sitting in a kitchen cabinet somewhere, reads “I’m proud to be a spit sucking, x-ray taking, crown-making dental assistant!” …thanks for the mug, mama.

Nevertheless, dental hygienists across the globe experience an identity crisis by patients (and one coffee-mug gifting mama) who perhaps do not understand the extensive education, licensure, certifications, advanced degrees and continuing education we attain in order to hold the proud title of “the cleaning lady.” As a thought leader, I travel the country empowering hygienists to think beyond “the cleaning lady” expectations and rise to positions of leadership as the periodontal therapist and preventive specialist in the office. In my opinion, it is only then that our profession, as an industry, can continue to grow.

Similarly, I believe that oral disease has had its own unique “identity crisis.” I do believe that most dental hygienists treat patients in a perceived state of health. The chronic nature of oral disease oftentimes means patients do not experience oral discomfort, are seemingly unconcerned with the redness of their gingiva, and blame “that pokey thing” for stimulating their bleeding tendency. In turn, we find ourselves supporting our patients in providing education about the low-grade, chronic, and oftentimes painless nature of oral disease in between answering questions about which whitening procedures we offer.

In response to oral disease, my hygiene schooling taught me to recognize that my patients were either categorized as patients who: one, needed a preventive service; two, needed active therapy; or three, needed a maintenance service. I graduated from dental hygiene school understanding my role as a preventive specialist was to prevent the progression of gingivitis, a reversible disease, into its irreversible successor, periodontitis, for which I would then implement my skills as a periodontal therapist. And for as long as I’ve practiced dental hygiene, this has been an ongoing belief.

Provocative idea: maybe we’ve been chasing the wrong disease
 

As research continues to link oral inflammation to systemic disease, bacterial species to specific chronic diseases, and oral dysbiosis to advanced inflammation, I can’t help but think that perhaps the ongoing belief about “prevention” being aimed at the progression to periodontitis is incorrect.

Gingivitis, as we know it, presents as an inflammatory process in response to the presence of pathogenic bacterial species. The host responds by initiating a cascade of protective inflammatory mediators and subsequently destructive cytokines such as interleukin-1, tumor necrosis factor, and prostaglandin E2, to name a few. These cytokines are responsible for increasingly concerning systemic factors, such as insulin resistance, and contribute to genetic susceptibility to systemic disease.  As inflammation increases in the oral environment, the liver releases c-reactive proteins capable of advanced destruction on a systemic scale.

In my humble opinion, gingivitis as I have known it, presents as a wolf in sheep’s clothing, and I believe dentistry has spent so much time focusing on how to diagnose and treat periodontitis that we have had our backs turned while we let this wolf mingle with our precious sheep. It’s time to protect our sheep and unmask the culprit, biofilm. There are several dental products available to us to do this.

Concepts on biofilm management have found support in Europe and are emerging in North America. The groundbreaking protocol, Guided Biofilm Therapy (GBT) provides us with the opportunity to target and address oral disease using cutting edge (pun intended) processes and technologies.

The introduction of Guided Biofilm Therapy into the United States provides a promising opportunity for dental professionals to build upon the foundational understanding we have of oral disease: that oral disease is best addressed through a combination of targeted biofilm therapy and enforced oral hygiene instruction with consideration for minimal damage to the dentition and surrounding periodontium.

Provocative idea: the sequelae of gingivitis requires a delicate balance between preventive therapy and active therapy, and it is time for dental hygienists to arm themselves with the knowledge, skills, understanding, and armamentarium to better equip themselves to address the earliest signs of oral disease.

With Guided Biofilm Therapy, dental professionals will find themselves utilizing disclosing solution to both educate and target care. The use of low abrasive erythritol powder for gentle supragingival and subgingival biofilm removal by AIRFLOW® Therapy will ensure effective removal of biofilm without subsequent scratching, etching, or damage to the tooth structure. For removal of calculus, integration of temperature-controlled water through specialized piezoelectric tips will ensure efficient removal of deposits. Precise finishing with hand instrumentation will effectively remove any remaining calculus and deposits in hard to reach areas.

This multi-step approach to the integrative management of oral inflammation provides the dental professional with a unique service that elevates the conversation, paradigm, and management of oral disease in a significant way. I implore you to keep your eyes peeled for course content on Guided Biofilm Therapy as it simplifies protocols, provides directives, and introduces products aimed at delivering significant, individualized care to manage the exacerbations of oral inflammation. 

By taking a more active approach to preventive treatment, clinicians can begin to address the “identity crisis” in oral health. Processes like Guided Biofilm Therapy provide the framework for a renewed approach to biofilm management and patient education that builds awareness and changes perception among patients.

Hygienists are already so much more than “the cleaning lady,” whether patients realize it or not. Although we probably can’t solve that particular identity crisis today, there’s nothing stopping us from continuing to build upon our extensive experience and abilities with new treatment methodologies. While I may never get a “technician” mug from my mother, it’s gratifying to know that the position of dental hygienist is more important to preventive care than ever. 

From Debi and me: thank you for joining us on our virtual “happy hour.” Cheers!
 

About Katrina Sanders
 

Katrina Sanders is a hygienist, author, and international speaker dedicated to empowering and instilling compassion within the industry through her board prep and continuing education programs. She is an expert in the oral-systemic link and the provision of preventive care, in addition to other topics. Whether working with students or veteran hygienists, Katrina emphasizes a message of empowerment and action within the profession. To learn more visit KatrinaSanders.com.

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