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with Perio Reports by Trisha E. O’Hehir, RDH, BS

May 2011 – Volume 7, Issue 5

Discussion from Hygienetown.com

Acute Lymphocytic Leukemia

Frozen Shoulder

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You are the gatekeeper ofyour patients’ total body health and well-being

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Visit us at:

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hygienetown.com « May 2011

from trisha’s desk hygienetown

1

by Trisha E. O’Hehir, RDH, MS, Hygienetown Editorial Director

Volunteering by RDHs

Many Townies participate in volunteer programsat home and around the world. HygienetownTownies have traveled to Honduras, Peru, Ecuador,the Galapagos Islands, Romania, India and Mexico asvolunteers providing everything from local anesthesiato oral hygiene instructions. They pay their own wayon these trips and bring their own instruments andsupplies. The overwhelming response from all whohave participated in volunteer trips overseas is thesense of receiving much more from those who theymet and treated than they gave in their time andexpertise as dental professionals. The sense of appre-ciation by those they treated was amazing.

Closer to home, many more Townies volunteer atlocal community free clinics, providing a half dayhere and there, or some find time to volunteer on aweekly or monthly basis. Clinics close to home needyour volunteer services as much as those far away. Thedental needs found in third-world countries are alsofound in our own neighborhoods. Dental hygieneand dental students often learn about local free clin-ics through rotations in these clinics. Several Townieshave participated in large community-based RAM orRemote Area Medical clinics. First designed to bringmedical and dental care to rural areas, RAM also pro-vides 10-day clinics in cities like Los Angeles, withhundreds of dental volunteers. Others are part of anentire dental team that opens the office one day eachyear to provide free dental care to those in need astheir own community service or through a state ornational program like Give Kids A Smile.

Townies are also generous with their time, takingthe prevention message to daycare centers, schoolsand senior centers. They teach preschoolers what toexpect when visiting the dental hygienist for the firsttime, complete with gloves for them to wear. Othersuse puppets to teach grade-school children oralhygiene and to bring in nutrition, they build a pizzausing healthy foods. Education is fundamental to pre-vention and Townies teach teenagers about the dan-gers of sour, tart, tangy, acid candies, gums, mints,

sports drinks and fruit-flavored waters. To senior cen-ters, Townies bring the news of xylitol, a sweet way toreduce bacterial biofilm in the mouth. The messagesare adapted to the age of the audience bringing infor-mation and fun to the experience.

Personally I donate time, money and services toAD World Health, a foundation begun by my step-son and daughter-in-law. I serve on the board ofdirectors as the secretary and have traveled to India toperform dental screenings and teach the children andadults basic oral hygiene at the Manjushree orphan-age in Tawang, India on the India/China border at10,000 feet. AD World Health, located in LosAngeles, California, is currently building a medical-dental clinic locally to provide care to underservedpeople in the Los Angeles area. AD World Healthprovides needed medical and dental care at the sametime as providing an educational experience for med-ical, dental and dental hygiene students.

We are blessed to be in the dental profession, ableto help others and provide for ourselves and our fam-ilies. You might give back with your time, clinicalservices, equipment and supply donations or mone-tarily. However you decide to give back, your dona-tions are sincerely appreciated and make a differencein the lives of others. Thank you for your generosityand caring. We have much to be thankful for in ourlives. Giving back is second nature to dental profes-sionals, and it turns out, you don’t have to go far fromyour own front door to find somewhere to help. n

In This Section

2 Perio Reports6 Townie Poll: Fresh Breath8 Profile in Oral Health:

Sitting Doesn’t Have to be a Pain in the Butt11 Townie Clinical: Acute Lymphocytic Leukemia12 Message Board: Frozen Shoulder

From Trisha_Layout 1 4/21/11 2:47 PM Page 1

May 2011 » hygienetown.com

hygienetown perio reports

2

Perio Reports Vol. 23 No. 5Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians.

Perio Reports research summaries will be included in each issue to keep you on the cutting edge of dental hygiene science.

Soft Bristle Toothbrushes Best

Oral bacterial biofilm isthe primary etiologic factorin both caries and periodon-tal disease. Mechanical dis-ruption using a toothbrushis the best way to removebiofilm from facial and lin-gual surfaces of the teeth.

Researchers at Witten/Herdecke University in Witten,Germany compared similar manual toothbrushes with different bristle stiffness to determine effects on plaqueremoval, gingival bleeding and tissue damage.

Dr. Best toothbrushes from GlaxoSmithKline wereused for the study creating three groups: soft, medium andhard. A total of 120 healthy volunteers participated in thiseight-week study. Subjects were instructed to brush twicedaily for two minutes each time.

At four weeks and eight weeks, plaque levels werereduced for all groups, with plaque levels reduced slightlymore for the hard-bristle toothbrush group. Bleeding wasreduced significantly more for those in the soft toothbrushgroup and increased from baseline levels in the hard tooth-brush group. The medium toothbrush fell between thesoft and hard bristle toothbrushes. The soft bristles mightreach subgingivally more comfortably to remove subgingi-val plaque, thus explaining lower bleeding scores for thesoft toothbrush users.

Evaluation of gingival abrasion revealed an average of 20 lesions in the hard toothbrush group, six in themedium toothbrush group and only two in the soft tooth-brush group.

Clinical Implications: Hard bristle toothbrushes willremove more plaque from smooth surfaces, but theywill also cause tissue trauma compared to soft bristletoothbrushes and lead to higher bleeding scores.

Zimmer, S., Öztürk, M., Barthel, C., Bizhang, M., Jordan,R.: Cleaning Efficacy and Soft Tissue Trauma After Use ofManual Toothbrushes with Different Bristle Stiffness. J Perio82: 267-271, 2011. n

Patients in intensive care units that have been intubated are at risk for ventilator-associated pneumonia (VAP), a life-threatening condition. The incidence varies between nine and45 percent of those intubated, with a mortality rate of 50 per-cent. Risk factors for VAP include underlying medical condi-tions, immunosuppression, brain injury, factors related toairway and ventilator management, presence of naso- or oro-gastric tubes and medication. Another risk factor is aspirationof oral bacterial biofilm in saliva. Although low levels of respi-ratory pathogens are found in oral plaque, oral pathogens aredetected in the lungs preceding the development of VAP.

Researchers at University College London comparedpower toothbrushing to the use of a sponge toothette forplaque control for intubated patients recently admitted to the National Hospital for Neurology and Neurosurgery inLondon, U.K. Colgate Actibrush was compared to a spongetoothette. Both treatments were provided by the nursing staffevery six hours for two minutes. Chlorindioxide was used onthe brush and the sponge each time.

Plaque levels and bacterial counts were gathered on dayone before the first oral hygiene intervention and again ondays three and five. More plaque was removed by theActibrush than by the sponge. A distinction was made by theauthors between decontamination with chlorhexidine andplaque removal with either the Actibrush or sponge.Mechanical disruption of the plaque with the power tooth-brush is considered more effective than antimicrobial chemi-cals to control oral biofilm and prevent VAP.

Clinical Implications: Toothbrushing is more effective inreducing oral biofilm than wiping with a sponge toothette.

Needleman, I., Hirsch, N., et. al.: Randomized Controlled Trialof Toothbrushing to Reduce Ventilator-Associated PneumoniaPathogens and Dental Plaque in a Critical Care Unit. J ClinPerio 38: 246-252, 2011. n

Toothbrush Better Than Spongefor Intubated Patients

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Aggressive periodontitis (AgP) also called “early onset peri-odontitis” or “localized juvenile periodontitis” is a rare diseasethat is characterized by rapid attachment loss and bone loss. Itaffects young people and can lead to eden-tulism early in life. AgP runs in families andaffects less than one percent of the popula-tion. Treatment is similar to that provided forchronic periodontitis, non-surgical, surgicaland oral hygiene.

Researchers at the University of Heidlebergin Germany wanted to know the risk for toothloss after treatment for AgP. They invitedpatients who had been treated at the University HospitalPeriodontology Clinic between 1992 and 2005 to participate inthe study. A total of 84 patients agreed to be re-examined. A fullperiodontal examination was done and past records were evaluatedto determine the supportive periodontal therapy (SPT) intervalsand if any teeth had been lost.

Less than half of the subjects lost teeth during the ensuingyears of SPT and only a few lost more than three teeth. A total

of 133 teeth were lost following therapy, or 0.6 percent. Thosewith only a high school education experienced more tooth lossthan those with a college education. Smoking also increased

risk of tooth loss. Those who routinely kepttheir SPT appointment were less likely toexperience tooth loss. Those with generalizeddisease compared to localized disease alsoexperienced more tooth loss. Recurrence ofthe disease was evident in 24 percent of those evaluated.

Clinical Implications: Following treatmentfor AgP, patients should abstain from smoking and followthe recommended perio maintenance interval to avoid therisk of tooth loss.

Bäumer, A., Sayed, N., Reitmeir, P., Eickholz, P., Pretzl, B.:Patient-Related Risk Factors for Tooth Loss in AggressivePeriodontitis After Active Periodontal Therapy. J Clin Perio 38:347-354, 2011. n

Intergenerational studies show associations between theparents and offspring for cardiovascular disease, diabetes,metabolic syndrome, cancer, asthma, obesity, smoking, alco-hol use and drug abuse. Many studies have evaluated thefamilial role played in aggressive periodontitis, but few stud-ies are available evaluating the intergenerational effect ofchronic periodontitis.

Researchers at Otago University in Dunedin, NewZealand wanted to know if family history of periodontal dis-ease was a risk factor for future disease in the offspring.

Study subjects were part of the Dunedin MultidisciplinaryHealth and Development Study (DMHDS). During the age-32 assessments, a total of 913 subjects received a completeperiodontal examination. Parents of these subjects participatedin interviews about their periodontal health, being asked ifthey were ever told they had periodontal disease, were evertreated for periodontal disease or if they lost teeth due to peri-odontal disease. One or both parents were interviewed for 849subjects and both parents were interviewed for 625 subjects.

Parents were divided into two groups – high risk andlow risk. Subjects whose parents were in the high risk groupwere more likely to show early signs of pocketing andattachment loss. Not surprising, those who smoked and hadhigher plaque scores also had deeper pockets and moreattachment loss.

Identifying high-risk individuals early might lead to ear-lier preventive intervention and thus prevent the disease andthe associated cost involved with treatment later.

Clinical Implications: Parents share not only their genesand their saliva; they also share environmental and oralhygiene habits, leading to similar periodontal healthbetween parents and offspring.

Shearer, D., Thomson, M., Caspi, A., Moffitt, T., Broadbent, J.,Poulton, R.: Inter-Generational Continuity in PeriodontalHealth: Finding from the Dunedin Family History Study. J ClinPerio 38: 301-309, 2011. n

Like Father, Like Son – Like Mother, Like Daughter

Risk for Tooth Loss After Therapy

continued on page 4

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Black stain, also known as brown stain, black line stain or pigmenteddental plaque, has been investigated for more than a century and theexact cause still remains unknown. Researchers agree it is most likelycaused by specific chromogenic bacteria and perhaps metabolism by thebacteria of iron molecules. The stain might be a thin line or unconnecteddots on the enamel along the gingival margin. Examination of the blackstain finds high levels of calcium, phos-phate and an insoluble ferric salt.

Black stain is found in children anddisappears before age 20. Prevalence isreported to be from one to 20 percent,depending on the subjects evaluatedand the criteria used for identifyingblack stain.

Over the years several chromogenicbacteria have been suggested as the cause of black stain, primarily Prevotellamelaninogenica and Actinomycetes species.Salivary levels don’t differ between thosewith and without the stain, but the pH iselevated and higher levels of calcium andphosphate minerals are found in the salivaof those with black stain.

Black stain is not easily removed withtoothbrushing, instead requiring profes-sional dental hygiene care to remove itwith instrumentation and polishing.Removal reveals intact, healthy enamelwith no demineralization. Not in all, butin many studies, caries rates are reportedlower for children with black stain com-pared to children without the stain.

The unusual nature of black stainand the likelihood that specific bacteriaare responsible for black stain and lowercaries rates presents a model for the oralprobiotic replacement of missing oralmicroorganisms.

Clinical Implications: Black stain occursmost often in children and is linked toslightly lower caries rates and higheroral pH levels.

Ronay, V., Attin, T.: Black Stain - A Review.Oral Health Prev Dent 9: 37-45, 2011. n

Review of Black Stain

Tobacco use is a significant risk factor for many diseases, including peri-odontitis. Many governments have set smoking cessation goals and guidelinesto encourage professionals to provide the services necessary for smokers to quit.Dental hygienists are in the perfect position to question and counsel smokerswho are ready to quit, but several studies show the number of dental hygieneclinicians offering smoking cessation counseling to patients is low.

Researchers at Kings College London Dental Institute at Guys Hospital inthe U.K. evaluated hygienists’ attitudes and participation in smoking cessationactivities using a questionnaire. There are approximately 4,000 dental hygien-ists in the U.K. Surveys were sent to 671 hygienists in the east of England, anarea called the Home Counties. The return rate was 61 percent, with 412 sur-veys returned.

When asked if hygienists should set a good example by not smoking,97.4 percent agreed. Also, 93.5 percent of respondents felt it was importantto ask patients about smoking habits. Although hygienists were optimisticabout offering smoking cessation, 62.8 percent think most people will notgive up tobacco due to the nicotine addition, even if their hygienist tellsthem they should.

Based on other studies, hygienists who don’t offer smoking cessation coun-seling and activities lack the knowledge, training, time, educational materialsand confidence to achieve success with smoking cessation.

Clinical Implications: Hygienists with positive attitudes about the effec-tiveness of smoking cessation are more likely to initiate smoking cessationcounseling and activities for their patients.

Pau, A., Olley, R., Murray, S., Chana, B., Gallagher, J.: Dental Hygienists’ Self-Reported Performance of Tobacco Cessation Activities. Oral Health Prev Dent 9:29-36, 2011. n

continued from page 3

Smoking Cessation in the Hands of Hygienists

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hygienetown poll

May 2011 » hygienetown.com6

Do patients ask you for freshbreath advice? 78% Yes 22% No

175 total votes

Do you tell patients when they have bad breath?

44% Yes

56% No 178 total votes

Do you recommend specific products for fresh breath? 58% Yes 42% No

177 total votes

Do you tell the dentist when he or she has bad breath?

27% Yes

73% No 176 total votes

Hygienists’ Opinions AboutFresh Breath

Check out what your peers do in their offices in relation to their patients’ breath in this poll

conducted from February 14, 2011 to March 11, 2011. Don’t forget to visit Hygienetown.com

and participate in the current online poll.

Do you offer a fresh breath programin your practice? 207 total votes

89%No

Do you recommend a specifictongue cleaner to patients?

26% Yes

74% No176 total votes

Do you recommend tongue cleaning to your patients? 96% Yes

4% No

172 total votes

Do you provide tongue cleaningfor your patients?

23% Yes

77% No 176 total votes

Have you seen tonsil stones or tonsoliths in any of your patients?177 total votes

11%Yes

60%Yes

28%No

12%Don’t know what

they are

HT_May Poll_Layout 1 4/21/11 9:54 AM Page 6

Probiotics. They aren’t just

for digestion anymore.

EvoraPro® supports dental and gingival health and extends the “fresh from the dentist” clean. Each mint contains an extra-strength blend of ProBiora3® probiotics. These beneficial bacteria bind to teeth and go deep under the gingival margin, crowding out harmful bacteria.

877-803-2624 ext. 248 I www.ForEvoraPro.com

Oragenics probiotic products were developed from basic research begun more than 30 years ago at the Harvard-affiliated Forsyth Institute in Boston. This body of research has shown that a few key naturally-occuring oral bacteria can act as antagonists to harmful oral bacteria. EvoraPro is 100% natural, and will not harm tooth enamel, dental work, bridges, or dentures.

Introducing EvoraPro® probiotic mints from Oragenics – the first professional-strength probiotics for oral care.

Let us help you maintain your patients’ oral health while enabling them to be more active in their own care. Make EvoraPro a part of your practice. To learn how, call us at 877-803-2624 ext. 248 or visit ForEvoraPro.com.

EvoraPro PROBIOTIC MINTS AT A GLANCE• Professional-strength probiotics for oral care

• Contains ProBiora3 blend of benefi cial bacteria

• Promotes healthy bacterial balance in mouth

• Extends effects of professional cleaning

• Does not harm tooth enamel, dental work, or dentures

• 100% natural

Oragenics_0511_Layout 1 4/21/11 9:55 AM Page 7

May 2011 » hygienetown.com

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by Juli Kagan, RDH, MEd

As a society and specifically as a dental community, we sita lot. Whether in our car, at a computer, on the sofa, or on adental stool, our spine is sadly at increased risk of injury dueto the excessive amount of sitting we endure most of our day.Numerous epidemiological studies have shown that clinicians,as well as professional office workers, who are in a seated posi-tion, have an increased chance of suffering from back trouble.The reference list is endless – but you know firsthand, yourown back pain is evidence enough. The bottom line is this: sit-ting can be helpful instead of hurtful.

Firstly, to better appreciate why sitting can be so damaging,it is helpful to understand the curvature of the spine and evensome history regarding the evolution of chairs. The spine hasthree natural curves: the cervical, thoracic and lumbar. Everybody has different spinal configurations and degrees of curva-ture. For example, female gymnasts commonly exemplify alarge degree of lumbar curvature, termed lordosis, and con-

versely, a retired senior dentist who hunchedover his patients for numerous years,

might show a severe thoracic curva-ture called a kyphosis.

The spine has a natural gentle lumbar slope at the base ofthe spine; however, when we sit, this natural curve is lost andthe amount of pressure on each intervertebral disc is doubledwhen compared to the normal lumbar curve when it is notviolated.1 Preventing this loss of curvature is incumbent whensitting on a chair or dental stool; however, most dental stoolmanufacturers have left out this vitally important aspect ofstool mechanics. It has only been very recently that a “lumbarsupport” has been added to dental stools, but this simple addi-tion is not enough.

Problems arise when the pelvis, which intricately attachesto the lower part of the spine at the sacrum, is asked to per-form a function it was not designed to do. It is analogous tothe patient who uses anterior teeth to gnash food when someof the posterior teeth are missing. Over time, inevitable dam-age occurs.

Chair Changes and Stool Alterations The earliest chairs were an article of state and dignity as

well as an emblem of authority (e.g., a king or queen’sthrone).2 These chairs were often made of hard wood, ebony

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or ivory. In Europe, thanks to the Renaissanceperiod, chairs ceased to be a privilege andbecame a standard item of furniture, but onlyfor those who could afford them. Ergonomicswas certainly not part of chair design.

Around the early part of the industrial rev-olution the divide between upper and lowerclass became more distinct. The poor workingclass stood all day. Up until this time, dentalclinicians also stood; however, some dentistswanted to sit in order to elevate their statusand earn greater respect in their profession.

In the mid-early-1800s Sir John Tomes ofBritain was the first dentist to have a stool inhis operatory and perhaps the first person tosit down and perform dentistry. The chair was“overstuffed,” and by 1870 dental stools werecommercially available to dentists. Despitethe growing market for stools, by the end ofthe century, dentists still did not feel justified in sitting down.3

In 1909, William Reynolds patented the first dental stool.4

It was not until 1958 that John Naughton, founder of theComfra Lounge Chair Company, had a meeting with two den-tists at a convention to create a dental chair. Even at this time, adental stool for the clinician was not part of the overall designalong with the patient chair. But after observing the clinicians atwork, Naughton was convinced that the dentist needed to workfrom a seated position to preserve energy.5

In the medical arena, stools were originally used in the mid-1960s when doctors wanted to sit down to evaluate theirpatients. These stools employed a round seat pan and a sort of“one-size-fits-all” phenomenon for quick examinations. Tryingto borrow from the medical profession, doctor stools were sim-ply ineffective for dentists who needed to sit for longer periodsof time.

Dental StoolsToday, practicing dentistry or dental hygiene requires the cli-

nician to often sit in a prolonged position. Even while seated thepractitioner works between two positions: active and passive. Upuntil recently, most stool manufacturers only crafted stools towork in the passive position. That is, there was no mechanismthat allowed the chair to tilt forward.

When there is no forward tilt mechanism the clinician isforced to work from the body instead of the support of the chair.Working in this compromised position, the upper- and mid-back rounds and becomes kyphotic to get closer to the patient.In addition, significant pressure is forced onto the hamstring legmuscles, which bear the brunt of the lean, causing restriction of

blood to the lower extremities. Lastly, the lower back, whichmust compensate for the head being held down and forward, isjeopardized. Imagine a bowling ball hanging from your neckwhile leaning over a patient and you can understand that yourtail must overcompensate and round under to counterbalancethe weight of the head, which can be more than 10 pounds.More significantly, the head weight is doubled for every inch itprogresses forward. It is simple physics: what happens at one endaffects the opposite end.

Up until about 2004, most stool manufacturers used maledimensions to create a stool, and it was often made to “match”the décor of the patient dental chair, with little attention tooperator ergonomics. Currently, with the number of femaledentists increasing every year, the advent of a more personal-ized and customized chair, designed for women in particular,seems paramount.

Unfortunately, most seat pans in the industry are too deep forthe average woman.5 When a woman sits on a stool with a seatpan that is too large, she often has to perch on the edge of thechair in order to work and view the mouth. While seated in thisvery precarious position, the back is unsupported and the bodymust compensate with sophisticated maneuvers to get closer tothe patient. The end result is that the back ultimately gives out.

Back to ErgonomicsThere has been tremendous progression of positioning

theories over a very short period of time. It was only in 1988that ANSI, the American National Standards Institute,emphasized the 90-degree sitting upright posture as the bestposture. This position is difficult to maintain, especially

hygienetown.com « May 2011

profile in oral health hygienetown

continued on page 10

Fig. 1: Due to an unsupported back, the operator perches forward and cranes her neck in order to get closerto the patient.Fig. 2: A combined back support and tilted seat pan allows for a healthy lumbar curve and anteversion ofthe pelvis. Note the hip opening to approximately 130 degrees.

Fig. 1 Fig. 2

9

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hygienetown profile in oral health

when a clinician needs to get close to apatient, and due to the forward lean,most people do not sit back far enoughto get back support in that posture.Currently it is believed that opening thehip angle (formed between the top ofthe thighs and the abdomen whileseated) should approximate 130 degrees.

Even in the forward tilt position,unless the back is supported by the back-rest, stress is put on the spine. Ideally, aslight backward tilt would be the mostcomfortable and perfect position, how-ever, this is impossible in dentistry unlesswe can get a patient dental chair to be sus-pended from the ceiling and work under itlike a car mechanic works on a lift.

For now only a handful of dedicatedchair manufacturers take judicious time toengineer stools that are ergonomicallysound. More often, stools that “come witha patient chair” are often not customized,nor ergonomically sound.

Personalized stools come in a variety of styles each asunique as the user. For example, Crown Seating sculpts out thearea in the back of the seat pan to relieve pressure on the tail-bone and rounds the front sides of the pan to relieve pressureunder the thighs which increases blood flow to the lower legs(it’s shaped like a bicycle seat) and especially beneficial forwomen users. RPG Dental allows for a forward tilt waterfalldesign, thereby allowing the clinician to maintain a healthyamount of natural lordosis in the lower back. And as anotherexample, Orascoptic was one of the first to utilize armrests toaid in neck and shoulder relief.

Many clinicians are starting to prefer a small, but extrathick lumbar backrest, which provides a proprioceptive qual-ity, allowing continuous feedback to the spine, both in theactive as well as the passive position. Conversely, many femaleclinicians are favoring the saddle-type stool with no backrestbecause it aids in moving the pelvis into a more anteriorverted

position. This allows the clinician to sitsoftly or almost stand while working.

Assembling all the beneficial featuresnoted above into an effective stool/chairwas the brainchild of Le Mans racecar winner and owner of Crown Seating, SteveKnight. The new innovative chair calledthe Virtù was unveiled at the recentChicago Midwinter Meeting. It has apatented ZenWave motion that providesmild support while in a forward tilt posi-tion (which opens the hips to approxi-mately 130 degrees), allows the pelvis torotate forward in a natural position (whichpermits the pelvis to be more anteverted)and aligns the spine (keeping it neutraland unstressed) thereby protecting thespine from further injury. The best com-ponent is that the backrest moves with theoperator in both the active and passivepositions, which massages the vulnerablelumbar region, promoting blood flow andnutrients to the lower back muscles and

intervertebral discs. This chair/stool collectively puts all theimportant and vital components of stool ergonomics together.

We have come a long way from wooden chairs and over-stuffed stools. Today, the operator demands more comfort andfunction while working. But, choosing a stool can be as com-plex as the spine itself; every body is different. What mightwork for one body might not work for another. When in themarket, try different types of stools for a period of time. Seewhat works for you. n

References1. Nachemson, A.The lumbar spine, an orthopaedic challenge. Spine 1976; 1(1):59-71.

2. Retrieved from en.wikipedia.org/wiki/History_of_the_chair. February 23, 2011.

3. Wynbrandt, J.The Excruciating History of Dentistry. St. Martin’s Press; New York, NY;

1998: pp 202-205.

4. Official Gazette of the United States Patent Office. Jan. 12, 1909: Volume 138; pp.

292-293.

5. Knight, Steven R. The Art of Humaneering: Designing a Better Stool for Women.

Sullivan Schein Sidekick, Summer, 2006.

continued from page 9

10

Juli Kagan, RDH, MEd: Devoted to wellness, and passionate about physical and mental fitness, as well as proper posture, Juli isa certified Pilates instructor, yoga teacher and professor of health education. With an energy and enthusiasm that transformsknowledge into practice, Juli wrote Mind Your Body: Pilates for the Seated Professional and has created numerous free videos onher Web site. For more information, visit www.julikagan.com.

Author’s Bio

The revolutionary Virtú stool/chair with aZenWave seat pan has a unique free-floatingbackrest that aligns the spine, massages the backmuscles and improves blood flow to the vulnera-ble lumbar region.

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message board hygienetown

hygienetown.com « May 2011 11

Find it online at

www.hygienetown.com

periosupport Posted: 1/28/2011

Post: 1 of 13

Acute Lymphocytic LeukemiaSometimes clinical signs suggest a serious systemic condition rather than the typical periodontal infection.

A female patient in her late 50s was referred by her general dentist to evaluateher gingival hyperplasia. The clinical picture suggested a systemic etiology and aprovisional diagnosis of leukemia was made. She was referred to her physician for aconsultation and work up.

Fig. 1: Note the atypical gingival hyperplasia on the right side. I did not probethe patient.

Fig. 2: Maxillary left gingival hyperplasiaA diagnosis of acute lymphocytic leukemia was made. She passed away about six

months later. ■

Thanks for sharing this with us. How sad! Are those large ulcers inthe buccal sulcus also? ■

Very often it is the dental professional that makes the tentative diag-nosis from the clinical presentation. Yes, absolutely sad and her husbandwas a patient of mine as well.

[Posted: 1/29/2011]Yes, there is some ulceration evident in the vestibules – a red flag! ■

Leukemia

lindadouglasPosted: 1/29/2011

Post: 3 of 13

periosupport Posted: 1/29/2011

Posts: 4 & 5 of 13

Fig. 1 Fig. 2

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May 2011 » hygienetown.com12

hygienetown message board

mmmrdh Posted: 3/15/2011

Post: 1 of 11

Frozen ShoulderOne of the risks of clinical work is a frozen shoulder or adhesive capsulitis, which causes pain and stiffness in the shoulder leading to limited

range of motion.

I have been having a lot of pain in my right shoulder, wrist, elbow and now fingers for the past month. Have been using NSAIDs and icing it, but it has beengetting worse. Went to see the MD yesterday and she said I have a frozen shoulder.No patients for two weeks and physical therapy for a month.

Has anyone else had this? Did it go away with physical therapy? Will it affect myclinical abilities in the future? The research I did said it doesn’t seem to be indicativeof any one profession or industry, but I wonder. ■

Had frozen shoulder months after mastectomy and it took a year to get it backto no pain. Pain did not usually bother me at work. Good luck. Not all physicaltherapists are equal. Hope you find a good one. ■

Does this involve your neck as well? I have had (for years) multiple episodes offrozen neck and shoulder with radiating numbness to my non-dominant hand. Ihave been a clinical RDH since 1989 and finally found relief with a combinationof chiropractic care and exercise. I found acupuncture to be helpful as well.NSAIDS, massage and icing were not enough. Physical therapy alone was mini-mally helpful and my primary care physician had suggested cortisone injections(this is when I decided to try chiropractic treatment).

I believe a “frozen shoulder” is also known as thoracic outlet syndrome and rota-tor cuff tendinitis.

I also found wearing magnification loupes very helpful to improve myergonomics. Poor patient operator positioning is a key cause of these disorders.Making certain to position your patient supine (patient heels even with the chin) iscritical to better clinician alignment and will work especially well with loupes. Also,keep your “wings” in to prevent the strain on the shoulders. It might take manymonths to undo years of wear, so be patient. I hope you find relief soon! ■

I have a sister who carries heavy trays for a living with her right armand shoulder; she ended up with this condition. I urged her to see a chi-ropractor with a good familiarity with this condition and of the “pro-adjuster” method (computer scan method) of chiropractic. She waited andwaited (very skeptical about chiropractors) and was in severe chronic pain

for months. She finally went to a chiropractor because she couldn’t handle the painanymore. Long story short, she is all better after this care and has had no recurrencefor over a year now. No surgery or other things required; a full recovery it seems. Youcan go online to find a “pro-adjuster” doctor near you. ■

jelrdh Posted: 3/25/2011

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jlj2595 Posted: 3/25/2011

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periopeak Posted: 3/25/2011

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KeriRDH Posted: 3/26/2011

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AnnieB25 Posted: 3/27/2011

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mmmrdh Posted: 3/28/2011

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I have very similar pain! I am currently in pain management and going throughlidocaine IV fusion therapy. I just started and it seems to be working. I know peoplethat have gone through this therapy and have been pain-free for more than two years.I got some relief from Voltaren cream. The treatment that helps the most is stretch-ing and watching my ergonomics. I would also consult an orthopedic surgeon. ■

I currently am being treated for frozen shoulder by an orthopedic surgeon. Mytreatment has consisted of three cortisone shots two months apart with some physi-cal therapy. He said it’s common in peri-menopausal women and that, if we do noth-ing, it will go away on its own in a couple of years. Fortunately for me, I do notpractice clinically. I was working three hours a week clinically, but gave that up whenthis started. My full-time job is teaching and there are some things I can’t do, like turnon my overhead projector to get a PowerPoint presentation going. My students help.Also writing on the white board is difficult if I go too high. Being on the computer isnot good. Did you have an X-ray or an MRI? It’s important to get a correct diagnosis. I

struggled for a few months with an incorrect diagnosis of rotator cuff tendonitisbecause my internist did not refer me to an orthopedist soon enough. I went throughpainful physical therapy for the wrong condition! I say that to spare you the suffering.Get an X-ray and see a specialist! ■

Though this might seem too simple to really work – I have a closefriend who has been in massage therapy for many years. She has spenthuge amounts of money to further her knowledge in neuromuscular ther-apy (NMT). This woman works miracles on muscle problems. If you can track down a therapist who is skilled at NMT you might save your-self months of pain and a lot of money or even surgery. The NMT is fast, too. Startcalling around to the local massage schools or tap into the massage network in yourarea to find that person with the hands of gold. ■

I have had some physical therapy and am definitely showing improvement inrange of motion and level of pain. Not 100 percent yet, but definitely better than Iwas two weeks ago (and able to back off a bit on the NSAIDS).The physical therapist has been using a combo of heat, ultrasound, massage, exer-

cises and cold. I am following up at home with heat, exercise and cold before I turnin at night. When I start seeing patients again she is going to come in and evaluatemy posture, etc. I will also probably contact our ergonomics department for an eval-uation. She also suggested I start getting regular massages. Tomorrow I have anappointment with someone in our integrative medicine department that was recom-mended by another hygienist. ■

Frozen Shoulder

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