Key learning from first pan-European dental hygienist webinar
STOCKHOLM, Sweden: The European Dental Hygienists Federation (EDHF) held a webinar on 9 June that focused on two topics: understanding and supporting oral cancer patients post diagnosis, and the role of dental hygienists in a modern approach to the non-surgical treatment of periodontal disease. The webinar was open only to EDHF members, and Dental Tribune International (DTI) spoke with EDHF Vice President Ellen Bol-van den Hil about what was discussed.
The webinar included presentations by Stefano Checchi, dental hygienist and EDHF delegate for Italy; EDHF President Yvonne Nyblom; Dr Catherine Waldron, dental hygienist, postdoctoral researcher at the Division of Population Health Sciences at the Royal College of Surgeons in Ireland and past EDHF delegate for Ireland; and Deepak Simkhada, dental hygienist, international speaker and writer.
Understanding and supporting oral cancer patients post diagnosis
Waldron spoke about the likely impact of oral cancer on dental patients and how hygienists can offer support to patients in order to minimise this impact and help them to maintain their oral health.
Bol-van den Hil told DTI that the early impact involves how patients cope with a cancer diagnosis and the associated treatment while continuing to live an active life. “The impact on their oral health includes dealing with trismus, mucositis, dry mouth, oral infections and radiation caries,” Bol-van den Hil explained. During her presentation, Waldron outlined stretching exercises that must be undertaken by patients in order to prevent trismus, ways to minimise and deal with mucositis, and the changes that patients need to make to their diet and oral hygiene habits in order to reduce caries and minimise other oral health complications.
Waldron explained that dental hygienists can play a role in supporting and guiding patients during this difficult time. They can provide support by listening and being empathetic, providing encouragement and timely advice, and by keeping updated on oral cancer prevalence rates in their home country and staying informed about new supportive strategies. Waldron reminded attendees that it was of the utmost importance that dental hygienists screen their patients for oral cancers during every treatment.
A modern dental hygienist’s approach to the non-surgical treatment of periodontal disease
This topic was covered by Simkhada, who explained how non-surgical treatment modalities have evolved during the last 60 years and outlined the latest evidence-based approach to how dental hygienists can manage periodontal disease. During the webinar, Simkhada led attendees through the four steps of the EFP S3 Level Clinical Practice Guideline 2020, in which dental hygienists play an important role.
Step 1 is aimed at guiding behavioural change in patients and motivating them to control risk factors and remove supragingival dental biofilm. Simkhada explained that this first step should be implemented in all periodontitis patients, irrespective of the stage of their disease. In this step, it is important to develop skills in dental biofilm removal, to modify them as required and to allow for the appropriate response of the ensuing steps of therapy. The step should be re-evaluated frequently in order to continue to build motivation and adherence, and to explore other alternatives in order to overcome barriers, Simkhada said.
Non-surgical treatment modalities have evolved during the last 60 years
Step 2, cause-related therapy, is aimed at controlling subgingival biofilm and calculus, and may include the use of adjunctive physical or chemical agents, adjunctive host modulation agents, adjunctive subgingival locally delivered antimicrobials and adjunctive systemic antimicrobials.
Simkhada noted that, if the treatment during Step 2 is successful in achieving the end point of therapy, patients can be placed in a supportive periodontal care programme (Step 4).
Step 3 is aimed at treating areas of the dentition that have not adequately responded to the second step of therapy—where the presence of pockets (≥4 mm with bleeding on probing) or deep periodontal pockets (≥6 mm) persist. It aims at gaining further access with subgingival instrumentation, or at regenerating or resecting lesions that add complexity to the management of periodontitis.
Step 4, Simkhada explained during the webinar, is known as supportive periodontal care and aims to maintain periodontal stability in all treated periodontitis patients. It combines preventive and therapeutic interventions that are defined in the first and second steps of therapy and should be provided at regular intervals. If recurrent disease is detected during recall visits, patients may require retreatment, and a proper diagnosis and retreatment plan should be instituted.
“In addition, compliance with the recommended oral hygiene regimens and healthy lifestyles are part of supportive periodontal care. Also in this step, the dental hygienist plays a role,” Bol-van den Hil summarised.