Oral and perioral piercing: a unique form of self-expression.

A comprehensive review of oral and perioral piercing is presented. This contemporary phenomenon has many implications for the piercee and for the oral healthcare professional. Oral and perioral piercing, which have become prevalent recently, both have historical antecedents. The implications of piercing are described in detail including sites at the tongue, lips, cheeks, frenum, and uvula. Complications occurring immediately after, soon after, and long after the piercing are detailed with special emphasis on the possible deleterious effects on hard and soft oral tissues. Suggestions are provided for patient education including a pamphlet for downloading. Appropriate jewelry selection is described and accompanied with a video clip demonstrating removal of jewelry during the dental appointment and a suggested technique for keeping the piercing hole patent while the jewelry is out. Reviewing this information should educate the oral healthcare professional to be prepared for the patient presenting with an oral or perioral piercing.

Pilot study of six Colorado dental hygiene independent practices.

PURPOSE: The purpose of this pilot study was to gather demographic data about six Colorado dental hygienists who were practicing independently and their practices as well as assess productivity and service mix, evaluate structure and process, and compare the findings in these practices to those of a study of California Health Manpower Pilot Project #139. METHODS: A convenience sample of six dental hygiene independent practices was studied. A 21-item survey was distributed by mail to obtain demographic and practice information. Weekly surveys tracking patient visits and services provided were completed for three months. A general office audit to evaluate structure and a record audit of 22 patient records to evaluate process were conducted during visits at each practice site. The overall responses for each phase of this study were tabulated and frequencies were calculated using the SPSS/PC+ statistical package. RESULTS: The dental hygienists had practiced for an average of 13 years prior to establishing their practices. Four of the six practices were office-based, one was institution-based, and one was office- and institution-based. Health history, extraoral/intraoral examination, periodontal probing, adult prophylaxis, and oral hygiene instruction were provided during a majority of patient visits. The general office audit revealed compliance with infection control, office protocols for emergency situations, and practice management protocols. The patient record audit indicated a high standard for process of care for the practice sites. CONCLUSION: The six practices revealed a variety of backgrounds among the dental hygienists and diverse practice characteristics regarding both the populations served and practice settings. The services provided were consistent with allowable services for unsupervised practice. Compliance with specific guidelines was verified during the general office and patient record audits. Consistent with the findings of California Health Manpower Pilot Project #139, the care provided by the Colorado dental hygiene independent practitioners in this study and the environment in which the care was provided do not exhibit any undue risk to the health and safety of the public.

Effect of implant curets on titanium implant surfaces.

PURPOSE: To compare the surface roughness produced by various implant curets on titanium implant abutment surfaces. MATERIALS AND METHODS: Each of six titanium implants was divided into four quadrants, three experimental and an untreated control surface. The three experimental surfaces were instrumented with a gold platinum curet, an unreinforced resin curet, or a reinforced resin curet. Two implants were assigned to each of the following treatments: 128, 256 or 512 scaling strokes within a 4 mm wide area. Photographs were taken of the surfaces with a scanning electron microscope at approximately x500 magnification and classified by six investigators according to surface roughness. RESULTS: The surfaces were different at 8 and 16 years with P < 0.01 and P < 0.0005, respectively. At 8 years, the surface roughness was significant between the treatments in the following ascending order: untreated, unreinforced resin curet, reinforced resin curet and gold platinum curet. Significant roughness was observed for surfaces treated by only the gold platinum curet and the reinforced resin curet at 16 years. The gold platinum curet created the roughest surface P < 0.0006.

Effects of curet and ultrasonics on root surfaces.

PURPOSE: To compare the effect on root surfaces of three ultrasonic scalers to each other and to a periodontal curet. MATERIALS AND METHODS: Forty extracted teeth were washed and embedded in acrylic resin leaving one entire coronal-apical tooth aspect exposed. The teeth were divided between four treatments: piezoelectric A - Group A, piezoelectric B - Group B, magnetostrictive - Group C, hand instrumentation with a curet - Group D. A single experienced operator simulated clinical instrumentation over a 9 mm square area on each tooth until the surface was judged smooth by the operator. Three evaluations were used in the study: (1) root tracings with a surface roughness meter to determine the roughness average (Ra) and roughness maximum (Rmax) in microns, (2) use of a new EXD 11/12 explorer to assess planed roots and (3) visual evaluation of the root surfaces through a stereoscopic microscope (X 20). During examinations 2 and 3, root surfaces were assigned to one of four "smoothness categories" by the examiners. Data for evaluation 1 was analyzed by ANOVA. Data from evaluations 2 and 3 were analyzed using the Kruskal-Wallis non-parametric test. RESULTS: The mean Ra and Rmax were not significantly different between the four groups. The results from both clinicians' examinations showed a significant difference in the four groups (P=0.001). The curet produced the smoothest surfaces, the two piezoelectric instruments produced the next smoothest surface and the magnetostrictive instrument the least smooth root surfaces.

Effect of repeated sterilization and ultrasonic cleaning on curet blades.

PURPOSE: Instrument cleaning and sterilization are important steps in infection control. This study investigated the effect of repeated ultrasonic cleaning, cycles of autoclave or chemiclave, on the surface and cutting edge of stainless steel and carbon steel curets. METHODS: Eight carbon steel and six stainless steel Columbia #13/14 curets were cleaned or sterilized in a series of treatments by one of the following methods: ultrasonic cleaning, chemiclave sterilization, and autoclave sterilization. In addition, two carbon steel instruments were placed in an anticorrosive dip followed by autoclave. The blades of the curets were examined and photographed with the scanning electron microscope (SEM) at 200 X and 1000 X for baseline and after 2, 4, 8, 16, and 32 treatment cycles. Photographs were evaluated for visible change in surface appearance by four examiners independently. Photographs for each treatment time were compared to the baseline (pretreatment) photographs for the same instrument. They were scored as (1) no visible change; (2) slight change; or (3) moderate to major change. Changes observed were: surface pitting, corrosion products as additions to the surface, edge deterioration, or loss of structure. RESULTS: Stainless steel curets showed slight or no change after the three treatments. Carbon steel curets were affected by all treatments. The chemiclave produced slight change. The autoclave produced slight change after the fourth treatment cycle and moderate to major change after the eighth cycle. Those carbon steel instruments treated by anticorrosive dip followed by the autoclave showed pronounced change after 16 or 32 cycles. The most varied results were from the ultrasonic cleaner; one blade showed moderate to major change after only four cycles, the other showed slight change at that point and major change only after 32 cycles. CONCLUSION: With stainless steel curets, ultrasonic cleanings or sterilization with autoclave or chemiclave can be used without visibly affecting the cutting edge. With carbon steel instruments, chemiclave is the least damaging sterilization method followed by anticorrosive treatment before autoclaving. Use of the autoclave without the anticorrosive pretreatment or use of an ultrasonic cleaner negatively affects the integrity of the surface and cutting edge of these instruments.

Change in occlusal height resulting from placement of pit and fissure sealants.

This in-vitro study was done to identify the amount of change in occlusal height resulting from standard sealant application technique and to determine whether this change was uniform for both a filled and an unfilled sealant material. Twelve dental hygienists experienced in sealant technique each applied 10 filled sealants and 10 unfilled sealants in standardized artificial teeth mounted in a dentiform and mannikin setup in a dental unit. The teeth were measured with a digital caliper before and after sealant placement. Measurements were from a predetermined point at the apical area of the teeth to the depth of the central fossa. For the sample of 240 teeth, the mean sealant thickness was 0.43 +/- 0.20 mm. When the data for the filled and unfilled sealants were examined separately, the means were 0.47 +/- 0.23 mm and 0.38 +/- 0.16 mm, respectively. A t-test indicated a significant difference at p < 0.001. Analysis of variance revealed significant interoperator differences in sealant thickness (p < 0.01).

Occlusal discrepancies after sealant therapy.

To date there has been no evidence concerning the need for adjusting the occlusion after sealant placement. Thus, this study investigated the occlusal effects of filled and unfilled sealants. For each of 18 subjects a sealant was applied and the occlusion monitored for 1 week. Each participant received a filled and an unfilled sealant for the specified period. With the filled sealant, nearly all subjects experienced a perceptable occlusal change and most were unable to abrade the interferences to a comfort level. These results indicate that the occlusion should be routinely verified and, if necessary, adjusted immediately after placement of a filled sealant.

Use of toothpicks for chlorhexidine staining.

The purpose of this study was to determine if the extrinsic dental staining associated with the use of chlorhexidine gluconate (CHX) mouthrinse could be prevented or controlled by the patient with the use of toothpicks. 25 subjects received a prophylaxis to establish a stain-free baseline and were then randomly assigned a control and experimental side of the mouth. The rinsing regimen was 1/2 oz of 0.12% CHX mouthrinse 2x a day for 3 months. Subjects self-examined daily for the appearance of stain. Where stain was visible, a toothpick was used to 'rub it away' on the distolabial, labial and mesiolabial surfaces of the experimental side only. The rubbing action was similar to the use of an eraser to remove a pencil mark from paper. The amount and intensity of stain was photographed and graded by a blinded examiner after 2 weeks, 1, 2 and 3 months. Subjects kept calendars to encourage and document compliance. When analyzed across time, teeth and surfaces, there was a statistically significant difference in stain between the control and experimental sides for stain amount, intensity, and for a composite of amount/intensity. Clinical differences were slight. The study indicates that the use of a simple toothpicking technique can affect chlorhexidine stain.

A six-week study comparing the efficacy of a rotary electric toothbrush with a conventional toothbrush.

The rotary electric toothbrush, Rota-dent, is often recommended and used as an alternative to the conventional toothbrush. The purpose of this short-term study was to evaluate the effectiveness of the Rota-dent on plaque removal and gingival health in comparison to a conventional toothbrush. Twenty-four subjects were divided into two groups. For 6 weeks one group used the Rota-dent, while the other group used a conventional (Oral-B 40) toothbrush. Plaque and gingival indexes were evaluated each week. Results indicated that the Löe and Silness Gingival Index scores improved significantly for both groups. There was a significant improvement in plaque removal as measured by Turesky modification of the Quigley-Hein Plaque Index for the Rota-dent group, while there were no significant differences in the Silness and Löe Plaque Index for either group. Thus, both devices had a positive effect on gingival health, and the Rota-dent removed plaque better than a conventional toothbrush as measured by one but not another plaque index.

Effectiveness of a continuing education course in local anesthesia for dental hygienists.

The knowledge, skill level, and clinical practice habits of 97 dental hygienists were assessed after the hygienists completed a 24-hour continuing education course in local anesthesia. Three survey methods were used to assess changes: a written pretest/posttest, self-reports, and employer-reported behavior change. The self-report was completed prior to the course and again one month and six months after completion of the course. The dentists/employers completed the survey after six months. Data were analyzed by paired t-tests. There was a significant improvement in knowledge between the pretest and posttest, an increase in the number of dental hygienists administering local anesthesia, and an increased frequency of its use in the practice setting at both one and six months after the course. The majority of the dentists/employers stated that completion of the course by the dental hygienists had a positive impact on their practices as demonstrated by the practice running more smoothly, improved quality of dental hygiene services, more satisfied patients, and increased productivity of the dental hygienists.

Dental hygienists' performance of procedures emphasized in school. Frequency and barriers.

In the educational setting, dental hygiene students learn to perform a variety of clinical procedures. Some procedures regularly performed in the school clinical setting may not be practiced regularly in the employment setting. If students learn to value the necessity of performing these procedures, why does this disparity between school and practice exist? This study examined how frequently dental hygienists who have graduated from a baccalaureate program perform certain dental-related preventive/diagnostic procedures in practice that are regularly required with school clinical patients. Barriers to performing the procedures are identified, as well as the hygienists' feelings about not performing the procedures.