CANADIAN JOURNAL OF DENTAL HYGIENE JOURNAL CANADIEN DE L HYGIÈNE DENTAIRE THE OFFICIAL JOURNAL OF THE CANADIAN DENTAL HYGIENISTS ASSOCIATION - PDF

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CANADIAN JOURNAL OF DENTAL HYGIENE JOURNAL CANADIEN DE L HYGIÈNE DENTAIRE THE OFFICIAL JOURNAL OF THE CANADIAN DENTAL HYGIENISTS ASSOCIATION QUARTERLY ISSUE FEBRUARY 2014 VOL. 48, NO. 1 Treatment modalities

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CANADIAN JOURNAL OF DENTAL HYGIENE JOURNAL CANADIEN DE L HYGIÈNE DENTAIRE THE OFFICIAL JOURNAL OF THE CANADIAN DENTAL HYGIENISTS ASSOCIATION QUARTERLY ISSUE FEBRUARY 2014 VOL. 48, NO. 1 Treatment modalities of oral cancer Dental hygiene care of the head and neck cancer patient and survivor Waterpipe smoking: A healthy alternative to cigarettes or a health hazard in disguise? Oral cancer and biopsy protocol: A primer for the dental hygienist Communicating effectively with the dental hygiene client about referral and biopsy Oral cancer screening: Dental hygienists responsibility, scope of practice, and referral pathway EDITORIALS Oral cancer and the dental hygienist: Making a difference and saving lives Dental hygienists: Agents of change for tomorrow s seniors A dental hygienist s journey through oral cancer treatment Implacare II: THE WAY TO GO FROM THE ONES WHO KNOW YOUR PATH TO IMPLANT MAINTENANCE Hu-Friedy s latest development in implant maintenance, Implacare II, provides thinner working ends and new designs so you have the choices you need for the best adaptation and efficiency. More importantly, since Implacare II is made from Plasteel, a high-grade, unfilled resin, it will cause the least amount of alteration to implant abutment surfaces. * PLASTEEL 20% THINNER TIP DESIGNS 5 TIP OPTIONS Visit us online at Hu-Friedy.com 2013 Hu-Friedy Mfg. Co., LLC. All rights reserved.*data on file. Scientific Editor Katherine Zmetana, DipDH, DipDT, EdD Regina, Saskatchewan CONTENTS FEBRUARY 2014 VOL. 48, NO. 1 Editorial Board Laura Dempster, PhD University of Toronto Indu Dhir, MS, RDH Canadian Academy of Dental Health Sciences Leeann Donnelly, DipDH, PhD University of British Columbia Zul Kanji, DipDH, MSc, RDH University of British Columbia Denise Laronde, PhD, RDH University of British Columbia Barbara Long, SDT, RDH, CACE BGS Kingston, Ontario Peggy J. Maillet, DipDH, MEd Dalhousie University Publisher Canadian Dental Hygienists Association 96 Centrepointe Drive Ottawa ON K2G 6B1 Tel: or Fax: ; Managing Editor Megan Sproule-Jones, MA Production Mike Roy, Daniel Bianchi Advertising Peter Greenhough, Keith Communications Inc or 2014 CDHA. All material subject to this copyright may be photocopied or downloaded from for non-commercial scientific or educational purposes. All uses of journal content must include a bibliographic citation, including author(s), article title, journal name, year, volume and page numbers, and URL. Front cover: istockphoto.com/ aleksandarvelasevic, modified to represent the seasonal quarterly publication of the journal. ISSN X (Print) ISSN (Online) EDITORIALS Oral cancer and the dental hygienist: Making a difference and saving lives...5 DM Laronde Dental hygienists: Agents of change for tomorrow s seniors / Les hygiénistes dentaires : des agents de changement pour les aînés de demain...7 M Bertone A dental hygienist s journey through oral cancer treatment...9 M Eaton LITERATURE REVIEWS Treatment modalities of oral cancer J Prelec, DM Laronde Dental hygiene care of the head and neck cancer patient and survivor S Rhodes-Nesset, DM Laronde Waterpipe smoking: A healthy alternative to cigarettes or a health hazard in disguise? A Khan, DM Laronde Oral cancer and biopsy protocol: A primer for the dental hygienist KY Wu, DM Laronde SHORT COMMUNICATIONS Communicating effectively with the dental hygiene client about referral and biopsy DM Laronde, KY Wu Oral cancer screening: Dental hygienists responsibility, scope of practice, and referral pathway LD Rock, EA Takach, DM Laronde INFORMATION Thank you to our reviewers Advertisers Index CJDH Research Award Canada Post Publications Mail agreement # Return undeliverables to CDHA, 96 Centrepointe Drive, Ottawa ON K2G 6B1 Printed by Dollco/LoweMartin Group. The Canadian Journal of Dental Hygiene is the official peer-reviewed publication of the Canadian Dental Hygienists Association (CDHA). Published in February, May, August, and November, the journal invites submissions of original research, literature reviews, case studies, and short communications of scientific and professional interest to dental hygienists and other oral health professionals. Bilingual Guidelines for Authors are available at All editorial matter in the journal represents the views of the authors and not necessarily those of CDHA or its board of directors. CDHA cannot guarantee the authenticity of the reported research. Advertisements in the journal do not imply endorsement or guarantee by CDHA of the product, service, manufacturer or provider. CJDH is indexed in the following databases: CINAHL; EBSCOhost; ProQuest; Thomson Gale KEYS TO YOUR SUCCESS? MINIMIZE CLEANING. MAXIMIZE CARE. Better client communication. Increased client compliance. Making a more powerful contribution to the practice. Find out how our programs are paying off for other dental hygienists at HealthyPracticeNow.ca Lisa Philp has not been compensated to appear in this ad. Lisa Philp RDH We mean business. Sensodyne Repair & Protect Powered by NovaMin Patented calcium and phosphate delivery technology Sensodyne Repair & Protect is the first daily toothpaste to contain NovaMin plus fluoride, a unique technology proven to help repair exposed dentin. 1 Delivers calcium and phosphate into the saliva 1 3 to form a reparative hydroxyapatite-like layer over exposed dentin and within dentin tubules Repairing exposed dentin NovaMin builds a reparative hydroxyapatite-like layer over exposed dentin and within the tubules 2 11 that: Starts building from first use 1 Is up to 50% harder than natural dentin 12 Provides continual protection from dentin hypersensitivity with twice-daily brushing Building a hydroxyapatite-like layer over exposed dentin and within dentin tubules 2,8 11 Protecting patients from the pain of future sensitivity The reparative hydroxyapatite-like layer firmly binds to collagen in dentin. 1,16 In vitro studies have shown it is: Built up over 5 days 1 5 µm Resistant to toothbrush abrasion 1 Resistant to chemical challenges, such as consuming acidic food and drinks 1,8,12,17 Fluoridated hydroxyapatite-like layer within the tubules at the surface Fluoridated hydroxyapatite-like layer over exposed dentin In vitro cross-section SEM image of hydroxyapatite-like layer formed by supersaturated NovaMin solution in artificial saliva after 5 days (no brushing). 10 Adapted from Earl J, et al. 10 TM / or licensee GlaxoSmithKline Consumer Healthcare Inc. Mississauga, Ontario L5N 6L GlaxoSmithKline Think beyond pain relief 1. Earl J, et al. J Clin Dent. 2011;22(Spec Iss): LaTorre G, et al. J Clin Dent. 2010;21(Spec Iss): Edgar WM. Br Dent J. 1992;172(8): Arcos D, et al. A J Biomed Mater Res. 2003;65: Greenspan DC. J Clin Dent. 2010;21(Spec Iss): Lacruz RS, et al. Calcif Tissue Int. 2010;86: De Aza PN, et al. Mat Sci: Mat in Med. 1996; Burwell A, et al. J Clin Dent. 2010;21(Spec Iss): West NX, et al. J Clin Dent. 2011;22(Spec Iss): Earl J, et al. J Clin Dent. 2011;22(Spec Iss): Efflandt SE, et al. J Mater Sci Mater Med. 2002;26(6): Parkinson C, et al. J Clin Dent. 2011;22(Spec Iss): Du MQ, et al. Am J Dent. 2008;21(4): Pradeep AR, et al. J Periodontol. 2010;81(8): Salian S, et al. J Clin Dent. 2010;21(3): Zhong JP, et al. The kinetics of bioactive ceramics part VII: Binding of collagen to hydroxyapatite and bioactive glass. In Bioceramics 7, (eds) OH Andersson, R-P Happonen, A Yli-Urpo, Butterworth-Heinemann, London, pp Wang Z, et al. J Dent. 2010;38: Prepared December 2011, Z GUEST EDITORIAL Oral cancer and the dental hygienist: Making a difference and saving lives Denise Laronde, PhD, RDH Is oral cancer a problem? Almost 400,000 people worldwide, including 4100 Canadians, were diagnosed with oral and oropharyngeal cancer in ,2 The total burden of the disease is increasing. In British Columbia (BC) alone, the number of oral cancer cases is predicted to increase by 45% from 2013 to The risk factors for oral cancer (including oropharyngeal) also appear to be changing. In the past, the typical oral cancer patient was assumed to be an elderly male smoker. While tobacco Denise Laronde and alcohol use are still significant risk factors, the incidence of tobacco-related lesions in the oral cavity is decreasing, as are the rates of other tobaccorelated cancers, such as lung cancer. In contrast, HPVrelated oropharyngeal cancer (OPC) is increasing in both men and women, with an earlier age of onset. 4 Why is early detection important? The treatment for oral cancer and OPC can have serious, long-lasting, and very visible effects. The BC Oral Cancer Prevention Program (BC OCPP), a multidisciplinary research team, focuses its research on enhancing early detection to minimize these late effects and to recognize clinical and molecular risk factors to help identify people at risk of oral cancer. The program also believes strongly in increasing professional awareness by developing assessment, triage, and referral pathways to guide the screening and referral process for the clinician. Ajzen s Theory of Planned Behaviour states that behaviour change is influenced by 3 things: beliefs, the opinions of people who are important, and perceived control over the problem. 5 The BC OCPP focuses on improving dental professionals perceived control by raising awareness of how to talk to clients about screening and referral and how to integrate screening into daily practice in a timely and efficient manner. The design and validation of new adjunctive screening devices to help in the decisionmaking process is also an important aspect of BC OCPP research. The BC OCPP is investigating new ways to reach vulnerable populations and those people who can t access screening within typical dental settings. As dental hygiene grows beyond the traditional dental office setting, it will play an invaluable role in reaching these populations. What is the dental hygienist s role? There are many things that we do in our daily dental hygiene practice that have a positive impact on our clients oral health, systemic health, their appearance, and perhaps even their self-confidence. But there is one specific thing we can do that can save a life oral cancer screening. (I should probably say oral mucosal screening because we are looking for more than just oral cancer and precancer). Perhaps the most common excuse I hear from dental professionals for why they don t provide oral cancer screening is that they don t have enough time. Let s face it, not having enough time is probably the number one excuse we give for why we don t do many of the things that we should be doing! When I hear limited time as an excuse for not screening, I mention both the American Dental Association and the British Mouth Cancer Foundation s advocating a 90-second oral cancer examination. 6,7 I have heard some other interesting excuses over the years, such as I wrote a report on oral cancer when I was in school. I don t want to think about it anymore or we leave that to the medical doctors. It s time to take ownership of a very important part of our scope of practice. Will we make a difference? I have had the opportunity to speak to many oral cancer and dysplasia patients over the years. There are common questions and comments that have come up, such as Why didn t my previous dental office see the lesion?, They told me they were watching it for a couple of years, so why didn t they tell me about it?, They said it couldn t be cancer because I don t smoke (or I m too young), They told me not to worry about it. It is impossible to answer these questions or respond to the comments adequately. Thankfully it is not always like that. My favourite comment, however, is my dental hygienist found it. Keep it up. With its focus on oral cancer, this issue of the journal is designed to educate the dental hygienist on clinically relevant aspects of oral cancer screening, from a new potential risk factor to triage and the referral pathway, biopsy, treatment, and the care of the cancer patient. I am very proud of the dental hygienists who contributed Correspondence to: Dr. Denise Laronde, Oral and Biomedical Sciences, Faculty of Dentistry, University of British Columbia; 2014 Canadian Dental Hygienists Association Can J Dent Hyg 2014;48(1):5-6 5 Guest Editorial articles for this theme issue. They are an impressive group of graduate students, degree completion students, and educators, working hard to improve oral cancer outcomes and care. Jelena Prelec reviews three treatment methods for oral and head and neck cancer (p. 13); Stacey Rhodes- Nesset provides an overview of the dental hygienist s role in caring for cancer patients and survivors (p. 20); Ambreen Khan examines the rise and potential risks of waterpipe smoking (p. 27); King Yin (Marco) Wu reviews how biopsies are performed, processed, and diagnosed (p. 34), and offers a complementary piece on discussing referrals and biopsies with dental hygiene clients (p. 40); Leigha Rock and Elaine Takach discuss oral cancer screening in the context of dental hygienists responsibilities and scope of practice (p. 42). In addition, I am honoured to include Marcia Eaton s personal reflection in this collection of articles (p. 9). Marci is a dental hygienist and an oral cancer survivor she is one of us! She is sharing her story, her cancer journey, to remind us that it could happen to anyone. Think about it. Rounding out the issue is an editorial from CDHA President Mary Bertone on the role of dental hygienists in improving oral health care for Canada s seniors (p. 7), another important sphere in which dental hygienists can make a difference. REFERENCES 1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, CA Cancer J Clin. 2005;55(2): Canadian Cancer Society s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics Toronto, ON: Canadian Cancer Society; BC Cancer Agency, Surveillance and Outcomes, Population Oncology. Projected Cancer Statistics. Vancouver, BC: BC Cancer Agency; Chaturvedi AK, Anderson WF, Lortet-Tieulent J, Curado MP, Ferlay J, Franceschi S, et al. Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. J Clin Oncol. 2013;31(36): National Cancer Institute. Theory at a glance: a guide for health promotion practice, 2nd edition. Bethesda, MD: National Cancer Institute; Perform a death-defying act. The 90-second oral cancer examination. J Am Dent Assoc. 2001;132 Suppl:36S 40S. 7. It takes just 90 seconds to save a life! [press release]. Surrey, UK: The Mouth Cancer Foundation; Can J Dent Hyg 2014;48(1):5-6 EDITORIAL Dental hygienists: Agents of change for tomorrow s seniors Mary Bertone, BSc(DH), RDH Les hygiénistes dentaires : des agents de changement pour les aînés de demain On December 11, 2013, I had the privilege of participating in a panel discussion entitled Oral Health Care: Essential to Healthy Aging and Quality of Life. The panel discussion, hosted by the University of Manitoba s Centre on Aging, was attended by oral, social, and health care providers, government officials, instructors and students from a variety of different disciplines, and a number of interested and concerned older adults from the community. Also observing the panel was Dr. Martin Chartier, Assistant Chief Dental Officer of Canada. Joining me on the panel were Dr. Margaret Pilley, BSc(Pharm), DMD, FAGD, representing private practice dentistry, and Dr. Khalida Hai-Santiago, DMD, Oral Health Consultant for Manitoba Health. I was delighted to participate, as the topic of applying oral overall health connection principles to improving the quality of life of seniors is particularly dear to my heart. With our society s aging population, never before has this focus been as critical to our dental hygiene profession as it is right now. 1 The panel discussion and the resulting interaction between the panelists and those in attendance affirmed very loudly and clearly that 1) the older adult cohort is here; 2) they are an ever-growing population; and 3) there is a growing deficit between their needs and currently available oral health services. Yes, the Canadian demographic reality is that our society is getting older. Over the last half of the last century, the proportion of senior citizens in Canada rose from 7.7% of the overall population to 13%, and is expected to increase to 20% by the year This cohort faces another unfortunate reality: as people retire, access to dental benefits that they may have enjoyed while employed is likely to diminish or disappear altogether. 3 More than half (53%) of the adults between the ages of 60 and 79 do not have any form of dental insurance, compared to 32% in the overall population. 4 If they are to maintain the same level of oral health, retirees must cover more and more of the costs of their oral care. At the same time, their ability to shoulder this increasing financial burden typically decreases as they age. 1,3 Something has to give, and far too often that something is adequate oral health care. Mary Bertone CDHA President/Présidente de l ACHD Le 11 décembre 2013, j ai eu le privilège de participer à une discussion entre spécialistes portant sur «Les soins buccodentaires : Essentiels pour le vieillissement sain et la qualité de vie». Invitées par le Centre de vieillissement de l Université du Manitoba, les personnes participantes comprenaient des fournisseurs de soins buccodentaires, sociaux et sanitaires, des fonctionnaires gouvernementaux, des enseignantes et des étudiantes de diverses disciplines ainsi que plusieurs autres adultes âgés, intéressés et concernés, de la communauté. L observateur de la table ronde était le D r Martin Chartier, dentiste en chef adjoint du Canada. S étaient jointe à moi à la table ronde, la D re Margaret Pilley, BSc(Pharm), DMD, FAGD, représentant la pratique dentaire privée, et la D re Khalida Hai- Santiago, DMD, consultante en santé buccale à Santé du Manitoba. J étais ravie de participer, car l application des principes de santé buccodentaire et généraux pour améliorer la qualité de vie des aînés est un sujet précieux à mon cœur. Avec le vieillissement de la population de notre société, ce sujet n avait jamais été aussi critique pour notre profession d hygiène dentaire qu actuellement. 1 La discussion du panel et l interaction entre les panelistes et l assistance ont affirmé vigoureusement et clairement la présence et le nombre toujours grandissant des personnes âgées ainsi que la croissance du déficit entre leurs besoins et les services de soins buccodentaires actuellement disponibles. Oui, la réalité démographique canadienne affirme que notre société vieillit. Au cours du dernier demi-siècle, la proportion de personnes âgées du Canada a augmenté, passant de 7,7 % à 13 % de la population, et l on prévoit qu elle atteindra 20 % en Cette cohorte fait face à une autre triste réalité : au moment de la retraite, il est fort probable que les prestations d assurance dentaire dont les gens auraient bénéficié durant leur emploi diminueront ou disparaîtront entièrement. 3 Plus de la moitié (53 %) des adultes âgés de 60 à 79 ans n ont aucune forme d assurance dentaire, comparativement à 32 % dans l ensemble de la population. 4 Pour maintenir le même niveau de santé buccodentaire, les personnes à la retraite doivent assumer de plus en plus le coût de leurs propres soins à cet effet. En outre, leur capacité de soutenir la croissance de ce fardeau financier diminue typiquement en vieillissant. 1,3 Certaines choses devront changer et, trop souvent, ce sont les soins buccodentaires adéquats. Les adultes âgés d aujourd hui sont beaucoup plus conscients de l importance de maintenir une bonne santé buccodentaire. Ils sont plus éduqués en ce sens, plus astucieux politiquement et plus Correspondence to/correspondance à: Mary Bertone, CDHA President/Présidente de l ACHD; 2014 Canadian Dental Hygienists Association Can J Dent Hyg 2014;48(1):7-8 7 Editorial Today s older adults are much more aw
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