International Journal of Evidence-Based Practice for the Dental Hygienist 2/2017 Every day you make clinical decisions that affect your patients' health and well-being. But are those decisions supported by current scientific evidence? This new quarterly journal will not only help you answer this question but also: • Provide the information you need, when you need it • Prepare you to answer your patients' questions with authority • Boost your confidence in your clinical decision-making ability • Teach you the skills you need to conduct your own scientific inquiry This rss-feed covers the latest table of contents including the abstracts. en Quintessence Publ. Comp. Inc. 2017-07-10 International Journal of Evidence-Based Practice for the Dental Hygienist 2/2017 Editorial: Communicating Science with Our Patients Frantsve-Hawley, Julie<br>Page 69 - 70 What Can Epigenetics Tell Us About Periodontitis? Leong, Pamela / Loke, Yuk Jing / Craig, Jeffrey M.<br>Page 71 - 77<br>Chronic periodontitis (CP) is a progressive inflammatory disease that can lead to mobility and pathologic migration of teeth in adults and is a major cause of tooth loss in both developed and developing countries. Susceptibility to CP varies from individual to individual and is not evenly distributed among populations. An individual's host response to pathogenic bacteria, along with numerous systemic health, lifestyle, and genetic risk factors, all impact the likelihood, severity, and extent of the disease. Epigenetic activity affects gene expression, influences the trajectory of health and disease, and is modified by exposure to environmental factors. This paper aims to provide a brief explanation of the connection between epigenetics and CP, highlighting why an understanding of epigenetic influences is important to the dental clinician if early diagnosis and management approaches of CP are to be more effective. Evolving Dental Media: Implications for Evidence-Based Dentistry Hicks, Diana / Isett, Kimberly / Melkers, Julia<br>Page 78 - 84<br>Evidence-based dental practice depends on access to relevant and credible information. Recent work addressing clinical information use has shown that both dentists and hygienists tend to rely most on traditional sources to seek out clinical information despite the advent of digital media. Over the past two decades, the rise of new digital media has challenged traditional, association-based media outlets. The causes and consequences of these shifts are much debated. The purpose of this article was to examine the relevant shifts in dental media and to reflect on those changes in light of wider debates. Dental media is reviewed and mapped by identifying important clinical information sources in dentistry. The contemporary dental knowledge media is a rich and ever evolving set of sources with a mix of traditional association-based outlets and newer digital components. The evolution of these outlets will change how science and evidence reach chairside dental professionals. Does Use of Alcohol-Containing Mouthrinse Increase Risk for Oral Cancer? Spolarich, Ann Eshenaur<br>Page 85 - 91<br>A possible association between the use of alcohol-containing mouthrinse and risk for oropharyngeal cancer has been a long-standing concern. Alcohol ingestion is a wellestablished cause of oropharyngeal and other cancers. Multiple mechanisms of carcinogenesis due to alcohol exposure have been documented, including oxidative stress and DNA damage resulting from formation of reactive metabolites. Reactive aldehydes, including acetaldehyde, are carcinogenic and alter lipid membrane permeability, exposing DNA to toxins and other carcinogens found in tobacco smoke. Other mechanisms include altered gene expression, induction of proinflammatory mediators, tumor promotion, and initiating stem cell repair mechanisms in response to cell death. Many species within the oral microbiome have been implicated in carcinogenesis of oral and gastric cancers by their ability to metabolize alcohol to acetaldehyde within the oral cavity. Individuals with genetic mutations that inhibit their ability to metabolize alcohol have higher salivary acetaldehyde levels and may be at greater risk. Rinsing with an alcohol-containing mouthrinse causes an immediate increase in salivary acetaldehyde level followed by a drop in level within minutes. This reduction may be explained by the broad spectrum of alcohol-containing antiseptic mouthrinses, suggesting a possible protective effect of these products against acetaldehyde-producing oral organisms. It is unknown whether alcohol-free variants produce the same effect. Clinical trials of 6 months duration demonstrate both efficacy and safety of alcohol-containing mouthrinses for reduction of supragingival plaque and gingivitis. Clinicians must weigh the benefits of use against the potential risks. Strategic Literature Searching: Part 3. Using Aliases and Alternate Terms Anderson, Patricia F.<br>Page 92 - 100<br>This article addresses the use of aliases and alternate terms for creating robust term generation to expand and enrich search queries, which will make them more likely to discover the most needed information. A robust term generation process based on the discovery and appropriate utilization of alternate terms and conceptual aliases is a critical part of designing effective search strategies. This article describes why this is so and offers a variety of techniques to maximize term discovery, which are illustrated with examples and worksheets to support the process of applying these techniques to your own work. Using the American Dental Association's Evidence Database for Evidence-Based Practice MacEachern, Mark P.<br>Page 100 - 102<br>The American Dental Association Center for Evidence-Based Dentistry (ADA EBD) website ( is an important gateway to scientific evidence for dental practitioners. It supplies an evidence database that consists of clinical guidelines, systematic reviews, critical summaries of systematic reviews, and plain language summaries that help practitioners communicate scientific evidence to patients. The evidence is categorized within specialty topics, such as pediatric dentistry and tobacco use and smoking cessation, with each topic area containing dozens to hundreds of pieces of evidence. As a resource that highlights high-level evidence, the ADA EBD site is a worthwhile addition to the repertoire of resources dental practitioners can use in their practice. Critical Thinking in Action: Consideration of Analogy Brunette, Donald M.<br>Page 103 - 105<br>This is one of a series of articles that will use excerpts from the dental literature to illustrate some of the concepts of critical thinking and apply them to aspects of dental hygiene and dentistry. In this article, consideration of analogy is discussed. Critical Thinking in Action: Percentages and Other Ratios Brunette, Donald M.<br>Page 106 - 109<br>This is one of a series of articles that will use excerpts from the dental literature to illustrate some of the concepts of critical thinking and apply them to aspects of dental hygiene and dentistry. In this article, consideration of percentages and ratios is discussed. Gingival Trauma: Tooth Brushing and Oral Piercings Hennequin-Hoenderdos, Nienke L. / van der Weijden, Fridus A. / Slot, Dagmar E.<br>Page 110 - 117<br>Maintaining healthy teeth and soft oral tissues for life is important. Gingival abrasions are reversible localized epithelial trauma of the gingiva. These soft tissue lesions are caused by oral hygiene procedures and are usually not detected during clinical examinations. One approach to assess gingival abrasions is to distinguish them from the normal gingiva by staining the undamaged gingiva with a commercially available plaque disclosing solution. Soft tissues in the oral cavity have the capacity to recover, but repeated trauma of the gingiva may result in gingival abrasions and/or recessions. Manual toothbrushes with end-rounded filaments cause significantly less gingival abrasions. Another factor that can potentially traumatize soft and hard oral tissues is oral jewelry. Oral piercings are not without risks, considering the serious complications for oral and general health reported in the literature. Both lip and tongue piercings are highly associated with the risk of gingival recession, and tongue piercings are associated with tooth injuries. To prevent the risk of complications, patients should be discouraged from wearing oral or perioral jewelry. Current Evidence on Prevention of Gingivitis: Oral Hygiene Devices and Dentifrices Sälzer, Sonja / van der Weijden, Fridus A. / Dörfer, Christof E. / Slot, Dagmar E.<br>Page 118 - 127<br>Numerous oral hygiene products are currently available on the market, and dental care providers have to select suitable products for the individual patient. Successful oral hygiene should rely on the current best available evidence; hence, oral care providers should be up to date with the advantages and disadvantages of the available oral hygiene products in order to provide their patients with proper information during oral hygiene instruction sessions. Prevention and Treatment of Peri-implant Diseases: Current Evidence on Cleaning of Titanium Dental Implant Surfaces Louropoulou, Anna / Slot, Dagmar E. / Barendregt, Dick S. / van der Weijden, Fridus A.<br>Page 128 - 141<br>Decontamination of an implant surface is an important component of the prevention and treatment of peri-implant diseases. The most suitable instrument for surface cleaning should be chosen depending on surface characteristics, localization of the surface, and treatment goals. The best results in the available data have been reported for air-abrasive devices, and the selection of powders seems to be of importance. However, proper maintenance of peri-implant soft tissue health is largely in control of the patient and dependent on daily self-care. Subsequently, oral hygiene around dental implants should be a priority of the research agenda in dentistry. Prevention and early diagnosis are key for long-term success with dental implants. Evidence for 8% Arginine Paste Regimen to Reduce Dentin Root Sensitivity After Nonsurgical and Surgical Periodontal Therapy Kearney, Rachel C. / Henderson, Rebecca<br>Page 142 - 144<br>Background: A high number of periodontitis patients report dentin root sensitivity (DRS) following treatment for periodontitis. Common treatments for DRS include various prescription and over-the-counter products to obtund the effect or interrupt nerve transmission of the painful stimuli. <br>Clinical question: Does a defined desensitizing treatment (8% arginine, calcium carbonate) applied after periodontal treatment prevent or reduce DRS symptoms? <br>Summary of methods: A randomized controlled clinical trial was conducted to compare the efficacy of an 8% arginine, calcium carbonate, in-office prophylaxis paste in combination with an 8% arginine, calcium carbonate, 1,450-ppm fluoride at-home toothpaste regimen (n = 38) with that of a control regimen of fluoride-free, in-office prophylaxis paste in combination with a 1,450-ppm fluoride at-home toothpaste (n = 36) in lessening the effect of DRS after periodontal therapy. The test and control in-office treatments were applied in week 1 (following nonsurgical treatment) and week 9 (following surgical treatment). The at-home treatments were ongoing throughout the study. DRS was evaluated using a visual analog scale and a Schiff score six times throughout the study. <br>Critical appraisal: The overall study design and sensitivity measures selected for the study were appropriate for the clinical question; however, the study was single blinded, not double blinded as claimed. The addition of a positive control and the elimination of the at-home regimen could have given clarity to the reason for a reported increase of DRS for the control group. This study indicates the potential for the application of arginine paste to reduce DRS after periodontal nonsurgical and surgical treatment. Use of Brushes, Rinses, and Cooling Solutions in Oral Care van der Sluijs, Eveline / van der Weijden, Fridus A. / Slot, Dagmar E.<br>Page 145 - 150<br>Oral hygiene is key to oral health, and mechanical methods of oral hygiene are considered the gold standard method for plaque control. An individual's motivation and manual skills contribute to optimal oral hygiene self-care. But certain oral hygiene recommendations, such as to prerinse with water and to start tooth brushing from the lingual aspect first, do not receive scientific support. Evidence suggests that in addition to tooth brushing, gingivitis can be further reduced with use of a mouthwash containing either chlorhexidine or essential oils, and mouthwashes with active ingredients can also be used as a cooling solution during nonsurgical therapy in conjunction with ultrasonic devices. However, plain tap water was shown to be a sufficiently effective cooling solution by itself. There is also evidence that drinking or rinsing with water could positively affect morning bad breath. A regimen of tooth brushing with tongue cleaning and rinsing can be beneficial for improving oral malodor. Oral Health Critically Appraised Topics (CATs) Page 151 - 160<br>The University of Texas Health Science Center at San Antonio (UTHSCSA) Oral Health CATs Library was established in 2011, with the aid of an NIH grant, as a component of the Dental School's Evidence-Based Practice Program. Each CAT provides a concise answer to a focused clinical question based on the most recent and highest level of evidence. This online searchable library contains over 950 CATs written by student/faculty teams, and about 150 new CATs are added annually. The CATs are indexed by the British Trip Database, which allows users to search over a large number of evidence-based sites. The journal is grateful to UTHSCSA for sharing these CATs with our readers. The Effects of Cheese on Caries Lesion Risk Factors: A Systematic Review Brodie, Arlynn / Hopper, Tammy / Pacheco-Pereira, Camila / Compton, Sharon / Clarke, Alix<br>Page 161 - 173<br>Background: Dental caries is a prevalent chronic disease that can be mitigated by forms of diet therapy. Cheese is one food item frequently recommended by dental professionals for its potential cariostatic effects. Substantial bench research indicates cheese may protect against demineralization through a variety of mechanisms such as buffering plaque pH levels and increasing concentrations of protective ions. However, the effect of cheese on human tooth decay in natural settings has been less well established in the literature. As such, the objective of this study was to conduct a systematic review of the literature to determine the effect of cheese on risk factors and development of caries lesions in humans. <br>Materials and Methods: A systematic search of the literature was conducted across six electronic databases, including Medline, Embase, Cochrane Controlled Trials, Scopus, CINAHL, and Cochrane Library. A Google Scholar search was also conducted. Inclusion criteria were experimental studies of cheese consumption in humans and outcomes related to caries risk factors or caries development. Studies were appraised for methodologic quality. The study results were summarized using descriptive analysis. <br>Results: The initial search yielded 323 articles, 9 of which met the inclusion criteria. A variety of cheese products were shown to have positive effects on multiple caries risk factors such as plaque calcium and pH levels; salivary calcium, phosphate, and pH levels; and Streptococcus mutans, lactobacilli, and yeast counts. The majority of included studies were of weak to moderate quality, subject to multiple avenues of potential bias, limited sample sizes, and inadequate study descriptions. Two studies were of good quality, indicating potential for cheese as a cariostatic agent. <br>Conclusion: Although there is some evidence that cheese may be used as a dietary intervention to reduce caries development, further high-quality studies are needed to support this conclusion. Assessment of Dental Hygienists' Intra- and Extraoral Cancer Screening Examinations, Techniques, and Referral Patterns Posorski, Ewa / Hill, Lindsey / Zigouras, Stephanie / Gwozdek, Anne<br>Page 174 - 182<br>Background: Head and neck cancer (HNC) is the sixth most common cancer in the world and causes significant morbidity and mortality. In the United States, approximately 9,750 HNC-related deaths were expected in 2016. Most cases of HNC are found in advanced stages, resulting in poor long-term prognosis and significant morbidity. There are multiple risk factors for HNC, many of which are associated with biologic factors, socioeconomic status (SES), access to care, behavioral factors, and age and gender. Intra- and extraoral screening examination is the standard of care for the practicing dental hygienist; however, there is concern with the frequency, consistency, and thoroughness of both in daily dental practice. The purpose of this study was to assess clinically practicing, registered dental hygienists' intra- and extraoral cancer screening examinations, techniques, and referral patterns. <br>Methods: This cross-sectional study surveyed a convenience sample of 170 dental hygienists from Michigan, Illinois, Arizona, and Washington, DC. The electronic survey consisted of 20 multiple choice, open-ended, and yes/no questions. <br>Results: A total of 78 responses were received for a response rate of 46%. Binomial proportion 95% confidence intervals (CI) were reported. Of the respondents, 81% (95% CI: 70% to 89%) indicated performing intraoral screening exams at a patient's first and recall visits, while 72% (95% CI: 60% to 81%) reported performing an extraoral screening exam at both the first and recall visits. A vast majority examined all of the high-risk OC areas. Forty-nine percent (95% CI: 37% to 60%) reported referring a patient with a suspicious lesion, and the tongue was cited as the most commonly confirmed cancerous site location (53%; 95% CI: 36% to 69%). While nearly all hygienists performed tissue observation/description (99%; 95% CI: 93% to 100%) and palpation (92%; CI 84% to 97%), only 28% (95% CI: 19% to 40%) utilized adjunctive screening devices. When it came to intraoral risk factors, tobacco (94%; 95% CI: 86% to 98%), alcohol use (82%; 95% CI: 72% to 90%), and human papillomavirus (77%; 95% CI: 66% to 86%) were assessed. Sun exposure (90%; 95% CI: 81% to 95%) was the most commonly assessed extraoral cancer risk factor. <br>Conclusion: Dental hygienists were performing intra- and extraoral screening examinations for HNC 81% and 72% of the time, respectively. There is still need for improvement when it comes to the frequency, consistency, and thoroughness of these exams. Further research is recommended to determine whether the results from this study are similar nationwide and how best to address the shortcomings.