Volume 27, #2, Summer 2012 Journal

Transcription

Volume 27
Number 2
Summer 2012
Living Through and
Surviving Cancer
Dental hygiene’s role in supporting
patients with cancer
Staying Healthy
Fighting cancer with your fork
Spotlight on
Student Research
The future of the profession
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In this issue of the
Summer 2012
3
From the Editor’s Desk
Cancer in Our Lives
4
Remembering Liz Chaney
5
President’s Message
Our Garden, Our Community
6
LifeLong Learning
Cancer: An Epidemic of the 21st Century
Practice Pointers – Caring for Patients with Cancer
15 FeatureFocus
Tha Faces of Oral Cancer
Living Through and
Surviving Cancer
3
17StudentConnection
Original Student Research
Cora Ueland Scholarship Award Recipients
2012 Table Clinic Competition
23 CareerCorner
Sharon Golightly, RDH, EdD
23
26StayingHealthy
Fighting Cancer with Food and Activity
29
EducationExchange
Mentoring Student Research
The Role of the Dental Hygiene Educator
32NewsBytes
What’s new around CDHA
29
Journal Sponsored by Philips Oral Healthcare
This Journal is printed on 100% recycled paper
2011–2012 Executive Officers
Contributions of scientific and original articles.
The Journal of the California Dental Hygienists’
Association is formatted by and published under the
supervision of the Editor. The opinions expressed or
implied in this publication are strictly those of the
authors and do not necessarily reflect the opinion,
position or official policies of the CDHA nor are
claims or statements by authors verified.
The only permission granted for photocopying or
storage of items is for personal use, or the use by
libraries; all other uses require the written permission
of the Editor or President. CDHA reserves the right
to illustrate, reduce, revise or reject any manuscript
submitted. Articles are considered for publication on
condition they are contributed solely to the Journal.
Contributors are notified within 90 days if a
manuscript is accepted for publication.
Correspondence should be addressed directly
to the Editor:
Cathy Draper, RDH, MS
E-mail : [email protected]
FAX: 408-252-4350
Mail: 1310 Regency Drive • San Jose, CA 95129
Display and classified advertising. The California
Dental Hygienists’ Association does not assume
liability for contents of advertisements. Inquiries
regarding display advertising should be directed to:
Shanda Wallace, RDH
611 Bristol Ave. • Stockton, CA 95204
[email protected]
info available @ cdha.org
Copyright ©2012 by the California Dental
Hygienists’ Association. The Journal is published on a
regular schedule by the California Dental Hygienists’
Association. Subscription rate is as follows:
$15 for CDHA members
$25 for non-CDHA members and ADHA members within U.S.
$50 to ADHA members outside the U.S. and
non-members within the U.S.
All change of name or address should be sent to:
California Dental Hygienists’ Association
130 North Brand Boulevard, Suite 301
Glendale, CA 91203
Phone: 818-500-8217
FAX: 818-247-2348
E-mail: [email protected]
Internet: http://www.cdha.org
President
President Elect
VP Membership &
Professional Development
VP Administration
& Public Relations
Lisa Okamoto, RDH, AS
Susan Lopez, RDH, BS
Terri Vosper, RDHAP, BA
Karine Strickland, RDHAP, BS
Secretary-Treasurer
Lygia Jolley, RDH, BA
Immediate Past President
Ellen Standley, RDH, BS, MA
Executive Administrator
Rosie Tesselaar
Component Trustees
Central Coast Tracy Woods-Boyan, RDHAP
East Bay Tresa Irby, RDH
San FernandoValley
Kirsten Thye, RDH
San Francisco Michael Long, RDH
Kern County Harriet A. Luzinas-Smith, RDH
San Gabriel Valley Beverly Legg, RDH, MS
Long Beach Beth Wilson, RDH
San Joaquin Valley Fred Thomas, RDH
Los Angeles Tricia Osuna, RDH, BS, FAADH
Monterey Bay Mary Jo Cardinale, RDH, BS
Mt. Diablo Frannie Driscoll, RDH, BS
Napa-Solano Ivy Zellmer, RDH
Santa Barbara Alexandra Major, RDH
Santa Clara Valley
Jocelyn Weinhagen, RDH, BA
Kendra Edwards, RDH
Shasta
Six Rivers Eva Adams, RDH
Orange County Rhonda McMorran, RDH
South Bay Carole Broder, RDH, BS
Peninsula Angela Punaro, RDH
Tri County Darlene Cheek, RDH, BS, MPH
Redwood Tamara Wells, RDH
Valley Oaks Michelle Gray, RDH
Sacramento Valley Carol Lee, RDH, BS
Ventura County Erica Johnson, RDH
San Diego County
Jackie Buchanan, RDH
Journal Staff
Editor Cathy Draper, RDH, MS
Advisory Board
Toni S. Adams, RDH, MA
Carol Lee, RDH, BS
Elllen Standley, RDH, MA
Donna Smith, RDH, MSEd
Graphic Design Dorreen P. Davis
Printer
Moore Bergstrom Co.
Calendar of Events
August 11, 2012
Summer CE Extravaganza
San Mateo, CA
August 12, 2012
Summer BOT Meeting
San Mateo, CA
November 3, 2012
Fall BOT Meeting
Burbank/Glendale, CA
March 2-3, 2013
Student Regional Conferences
About the Cover: Eva Grayzel in flight, photographed by her son, Jeremy Cohen.
From the Editor’s Desk
Cancer in Our Lives
Cancer, a six letter word, has a profound effect on anyone who is touched by it. Ask
anyone who has been diagnosed with any type of malignancy and they will tell you, that
their lives are never quite the same. Add families, friends and colleagues and the impact
of cancer grows exponentially. This year in the United States alone, approximately
1,638,910 individuals will be given a cancer diagnosis. This does not include most cases
of carcinoma in situ (non-invasive cancer) or basal and squamous cell skin cancers.
Approximately 77% of new cases will be in individuals 55 years of age and older.1 While
the five year relative survival rate for all cancers continues to improve, from 49% in the mid 1970’s to 67% for cancers
diagnosed in 2001-2007, over 1,500 people will die each day this year as a result of this complex group of diseases.
Growing up in the 50’s and 60’s my memories of cancer were of whispered conversations amongst the adults in my
family. The “Big C” had so many unknowns. Was it caused by a virus? Was it contagious? Society in general was not
ready to discuss cancer openly. In the early 1950’s the New York Times informed a prospective support group organizer,
Fanny Rosenow, that they were unable to print the words breast or cancer in their newspaper. It wasn’t until 1969 that
the American Cancer Society challenged then President Nixon to direct his attention to wage the “war on cancer”.2
Unfortunately, a cancer victory would not be found in a universal cure or vaccine, the vision of the 1971 National Cancer
Act. Scientists know today that cancer cells are genetic mutations of normal cells. Treating and curing cancer appears to lie
in understanding the biology of the disease. Targeted therapies hold out great promise for the future.
Prevention plays a vital role in this insidious disease. As healthcare providers, we are in an ideal position to educate and
screen for early signs and symptoms of cancer, particularly in the area of the head and neck. As part of the healthcare
team we also need to be prepared to support the estimated 12
Experiencing cancer is life-changing. million Americans who are living with and surviving cancer.
Educate, screen and support your
Understanding the various treatments and their potential side
patients, families and friends.
effects, particularly as related to oral health, is essential.
Thirteen years ago, a young mother, Eva Grayzel, from Easton, Pennsylvania was diagnosed with stage IV squamous
cell carcinoma of the tongue. She was given a 15% chance of survival. Today, she lectures around the world sharing her
story, promoting oral cancer awareness, education and screening. Cancer has transformed her mission in life. In 1993,
entrepreneur Brian Hill was diagnosed with late stage oral cancer. After his recovery from his therapy, he established the
Oral Cancer Foundation, a national public service, non-profit entity designed to reduce suffering and save lives through
prevention, education, research, advocacy, and patient support activities.
In 1992, my sister was diagnosed with ovarian cancer. When she died two years later, I began to volunteer at the Stanford
Hospital Health Library. I wanted to be able to support others as they made their way through the maze of medical
choices within the hospital. Located in the Cancer Center, the Health Library provides scientifically-based, medical
information to help people make informed decisions about their health and health care. September marks my 18th year
as a library reference associate.
1. American Cancer Society. Cancer facts and figures 2012. Atlanta: American Cancer Society; 2012.
2. Mukherjee, S. The emperor of all maladies. A biography of cancer.
New York: Scribner; 2010. 571p.
CDHA Journal – Summer 2012
Editor
3
Tribute to Liz Chaney
Remembering Liz Chaney
Dental hygiene mourns the passing of Elizabeth “Liz” Chaney,
advocate for the profession and friend to all, who died due to
complications of pneumonia on April 5, 2012, at the age of 87.
Dental Hygiene Career
While Liz Chaney’s name is often synonymous with California and
CDHA, she completed her dental hygiene education at the Ohio
State University, graduating with a Bachelors degree in 1946. One
of her first positions after graduation was working as an instructor
at Ohio State, teaching gross anatomy to dental and medical
students. Marriage brought her to sunny California. Following the
premature death of her first husband, Liz re-married to a man in
the military. Liz and her family travelled the world and she was
able to work in a variety of places including Japan and Germany.
Eventually Liz landed back in California at the March Air Force Base
near Riverside and later at the Norton AFB in San Bernardino.
Liz spent the majority of her career as a civil servant, working
alongside military periodontists treating active duty - patients at
Norton AFB. She was the first civil service dental hygienist at Norton
and wasted no time in using her powers of persuasion to increase
the professional pay scale for civil
service dental hygienists. Through
her persistence, the General
Schedule pay scale system was
raised two levels, thus increasing
the compensation for all dental
hygienists who would follow in the
Air Force civil service. Reflecting
back on this achievement, Liz
Liz, Christine Charles, Katie Dawson
said, “I just believed that if you
Pfizer. ADHA Award 2006
went to school for more education
that you should be paid accordingly.” Liz received many awards
over her long career working with the military, most notable being
the “Exceptional Civilian Service Decoration” presented personally
by President Bill Clinton.
Passion for Politics
Liz first became interested in politics in the late 1960’s when
Ronald Reagan was governor of California. She began by
campaigning for SB 716, the first bill which would eventually
lead to the establishment of the Committee on Dental Auxiliaries,
the advisory body for dental hygiene and dental assisting to the
Dental Board of California. She then enhanced her political savvy
by canvassing the voters all over the Inland Empire for her son-in4
law, the former State Assemblyman
Steve Clute. Liz said it was while
campaigning for Steve that she got
to know California’s legislators on a
personal basis and realized education
in all things related to dental hygiene
would be key to moving our profession
forward. She was instrumental in the
formation of the California Dental
Hygiene Political Action Committee,
or CalHyPac, and served as its chair for 14 years. Created with the
goal of educating and supporting legislators on the needs of the
dental hygiene profession, CalHyPac continues to be a vital force in
the political process for dental hygiene.
Liz’s persuasive powers were put to good use working within the
political process to improve oral health for all Californians; from
the first COMDA bill to the funding of school oral hygiene and
fluoride rinse programs, to the establishment of the Registered
Dental Hygienist in Alternative Practice, Liz was always advocating
for oral health.
Fundraiser Extraordinaire
Liz was also a dedicated advocate for dental hygiene education
and research. She was instrumental in raising tens of thousands of
dollars for the American Dental Hygienists’ Association Institute of
Oral Health. If Liz asked you in her gently persuasive way to donate
to the Institute, you would be hard pressed to say no. In 2001
she was the first recipient of the ADHA Institute of Oral Health
Liaison of the Year Award, which has since been renamed the Liz
Chaney Liaison of the Year Award. This award honors those who
demonstrate exceptional service and accomplishment in the area of
fundraising on behalf of the Institute.
Achievements in “Retirement”
After retiring from clinical practice, Liz continued to lecture
to middle school children through the University of California
Riverside’s “Healthy Body Healthy Mind” program, stressing the
importance of oral health. Always active in CDHA, she attended
almost every House of Delegates meeting and served as an ADHA
delegate for many years. She was a member of the legislative
action committees of the American Association of Retired People
and the National Association for Active and Retired Federal
Continued on Page 33
CDHA Journal Vol. 27 No. 2
Message from the 2011-2012 President
Author(s)
Our Garden, Our Community
Dear Colleagues,
Spring and summer are wondrous seasons. Life, hope, joy and
renewal are evident all around us in a vibrant display of colorful
blossoms. This is my favorite time of year at Filoli, a historical
country estate just south of San Francisco built in 1915 with its
16 acres of beautiful gardens. You can roam among hundreds
flowering plants and trees, with classic varietals interspersed with
newer varieties. At Filoli, you witness life in collaborative harmony.
A garden is a community of many elements, that have evolved
to thrive in a symbiotic environment, encompassing everything
around it -- insects, birds and other creatures all contributing to
the success and health of the garden and each other.
We are approaching the 100th anniversary of our profession. Over
the past year I have been sharing the history, growth and evolution
of our profession. It occurs to me that the name FILOLI could
be applied to dental hygienists and our profession. It stands for
FIght for a just cause, LOve your fellow man, LIve a good life. Our
careers are defined by our passion for and pursuit of better health
for our patients. Ours is a profession focused on living well. Given
the opportunity, a wealth of possibilities exists for bettering the
health of our patients and the public, especially if a collaborative
approach is embraced.
Many health care practitioners now accept the concept that a
collaborative, patient centered, inter-professional approach is
necessary to effectively meet today’s complex health care needs
in our diverse and rapidly changing environment. Oral health is an
integral part of overall health, and it only stands to reason that all
facets of health care must be intertwined as well. Just as medicine
now recognizes the impact of oral disease on systemic health, we
must treat the whole patient not just disease in the oral cavity.
Collaboration between dentistry and medicine is a necessity.
However, of equal importance is the need for collaboration and
respect for one another as members on the same team within the
dental care delivery system.
As we look to address the unmet health needs of the public, the
isolated health care provider model is not a part of the solution,
in medicine or dentistry. As already being practiced in medicine,
overlapping scopes of practice in dentistry will need to enhance
care for a greater portion of our population. The groundwork for
widening the scope of practice is already being laid with expanded
function assistants, advanced dental hygiene practitioners and
dental therapists. In January 2011
the UCSF Center for the Health
Professions released its research report,
“Collaborative Practice in American
Dentistry: Practice and Potential”.1
The study evaluated the potential of
collaborative practice models in oral
health delivery systems. As California
policymakers consider expanding
or creating new oral health practice models, this report is an
invaluable reference tool, providing definitions of collaborative
practice arrangements and comparisons of five ideal collaborative
practice structures. Key findings are discussed as they relate to
the oral health care field. The report encourages comprehensive,
inter-disciplinary health education programs as well as educating
dentists and other health care providers together. Inter-professional
education facilitates communication, improves understanding and
fosters trust, all key elements necessary for effective and efficient
collaborative practice.
This is our garden, our community. We must all work together for it
to grow and thrive.
I would like to take this opportunity to thank you for allowing me
to represent the profession as CDHA President this past year. It
is with great pleasure and pride that I pass the gavel on to Susan
Lopez, RDH, BS, to lead the association as you “step up and reach
out” over the coming year. Adaptation and evolution promise bright
advances for our profession. To paraphrase the late senator Ted
Kennedy, “ For you and for me, for our profession and our
Association – the work begins anew, hope rises again, and the
dream lives on.”
Smiles,
Lisa
2011-2012 CDHA President
1. Dower, C, Lindler, V, Mertz, E. Collaborative practice in American dentistry:
practice and potential. Center for the Health Professions at the University of
California San Francisco. [Internet]. 2011 Jan 1[cited 2012 Jun 21]. Available
from:www.futurehealth.ucsf.edu/Content/29/201101_Collaborative_Practice_
in_American_Dentistry_Practice_and_Potential.pdf
5
LifeLongLearning
Debra Jo Johnson, RDH, Ph.D
Cancer: An Epidemic of the 21st Century
Introduction
As recently as 2005, reports of a worldwide cancer epidemic
have been appearing on professional editorial pages causing
researchers considerable pause. Worldwide statistics demonstrate
cancer incidence is elevated, and, not surprisingly, more evident
in developing nations.4 In 2008, the International Agency for
Research on Cancer (IARC) reported 12.7 million new cancer cases
occurring worldwide, with 5.6 million cases arising in developed
countries, compared to the 7.1 million found in the developing
world.2 Mortality rates from cancer are estimated at approximately
21,000 per day.2 The global burden is anticipated to expand into
21.4 million new cancer cases and 13.2 million deaths by the year
2030 resulting from such factors as population growth, increasing
longevity, reductions in infectious disease deaths, and declining
childhood mortality rates.2 Shifting disease patterns worldwide
also facilitate this epidemic global trend. However, national and
world leaders are not yet directing sufficient resources and energies
toward resolving the crisis.
It is widely known that there are stark discrepancies in the
economic resources of developing and developed nations. Economic
conditions can either facilitate or impose blocks to education.
Without adequate education, people tend to engage in more highrisk behaviors related to cancer acquisition. As developing nations
evolve, they also transition to western lifestyles that include high
risk behaviors such as tobacco use, poor nutrition and sedentary
habits, as well as indiscriminant sexual practices.2, 3 Lung, breast,
and colorectal cancers are associated with these lifestyle choices
and are also the most common cancers found among developed
countries worldwide.2 Meanwhile, the face of this epidemic is
further complicated by other existing health system disparities.
Healthcare systems worldwide are being challenged and the
struggle to manage the burden of cancer as well as the efforts to
effect global change is ongoing.
Learning Objectives
This continuing education article will examine the current status
of cancer in the United States, discuss cancer risk factors and their
implications, and consider guidelines for cancer screening during
routine care.
6
Upon completion of this course, the dental hygiene professional
should be able to:
1. Identify the influencing factors for the reclassification of
cancer as a non-communicable disease.
2. List the cancer risk categories and specific risks, and identify
which factors are modifiable.
3. Explain the challenges faced by cancer survivors for
successful long-term prevention of recurrence.
4. Identify clinical objectives for incorporating a cancer
screening into daily practice.
The Cancer Epidemic in the United States
In 2000, the U.S. Surgeon General attempted to direct healthcare
change by identifying key healthcare issues.15, 19 Over time, these
issues distilled into five objectives and include optimistic efforts to
change perceptions, overcome barriers, enhance research and its
application, strengthen infrastructure, and expand health promotion
efforts.15 These objectives gave rise to “Healthy People 2000”,
a focused initiative to change healthcare on a national scale.15
This first effort demonstrated some early success and promoted a
resurgence of activity ten years later with “Healthy People 2010”,
and currently “Healthy People 2020”. Despite this flurry of interest,
support, and effort from national healthcare and political leaders,
the surgeon general’s report has achieved only a modicum of
change. Eliminating health disparities by the end of the decade, an
identified goal from the first initiative, has not materialized.9, 15, 16
In fact, disparities in mortality and morbidity have risen rather than
declined, and correlate to education gaps within the population.
The gap between mortality and life expectancy across age, sex,
disease type, and risk behaviors widens considerably in less
educated populations.9 While many of the planned solutions for
healthcare reform indirectly address patient awareness and health
education for the masses, the specific level of education required
for improving mortality rates is not known.
One in four Americans will die from cancer related illnesses in
2012.6 Cancer is second only to cardiovascular disease as a
leading cause of death in the United States and the mortality rate
differential between the two has narrowed every year since the
1970’s.7, 16 During the first half of the twentieth century, infectious
LifeLongLearning
diseases were primarily responsible for high mortality rates in the
United States.3, 16 Today, deaths due to tuberculosis, influenza, and
pneumonia have declined, creating a nearly inverse correlation
between infectious disease mortality rates and cancer.3, 16
Population longevity has increased with the decline in deaths due
to infectious diseases.
The general cancer statistics as reported by the North American
Association of Central Cancer Registries (NAACCR) are broken
down by state with California reporting the highest number of
cases followed by Florida, New York, Texas, and Pennsylvania.6
These figures are taken from age-standardized incidence rates for
all combined cancers for 2002-2006, coupled with estimated new
cases by state.6 Across the board, California exhibits the highest
numbers of cases, spanning every type of cancer as well as leading
the nation in numbers of annual cancer deaths.6 Although mortality
trends command the larger preventive interest from the medical
community, the number of new cases demand equivalent, if not
greater, concern. Each reported case is an individual, a person,
who lives not only with the physical and emotional consequences
imposed by cancer therapy, but an individual who also bears the
added specter of increased risk for recurrence.
Recent U.S. statistics demonstrate a reduction in the numbers of
new cancer cases and suggest, at least in this country, some degree
of prevention efforts may be working to turn the tide.12 In a report
from the National Cancer Institute, statistics indicate that mortality
rates from all cancers across genders and age groups have been
declining since the early 1990s.12 While survival rates from certain
cancers are increasing, the report indicates the presence of cancer
disparities across populations, a finding suggesting that survival
rates are skewed favoring some demographic groups over others.4,
12
The increasing numbers of survivors also imposes added risks
of cancer recurrence. The risk of recurrence, when paired with the
numbers of new cases, supports a perspective that these changing
disease patterns contribute to an ongoing national epidemic.4, 6 The
increasing longevity of the population is another factor sustaining the
cancer epidemic, with more cases being diagnosed because people
are living longer. In the same sense that cancer is epidemic, it is also
considered to be chronic, requiring long-term medical management
and monitoring. An understanding of cancer and its risk factors is
essential for all healthcare providers.
Cancer and Risk
Cancer, in its most basic terms, is a rapid proliferation of cell
mutations growing in some area of the body. If the mutations
remain unchecked, cancer cells will then travel to other parts of the
body. Cancer statistics are frequently reported by body categories,
related to how cancer assaults a wide range of bodily systems and
organs. Broad cancer categories affecting both sexes include: the
oral cavity and pharynx, the digestive, respiratory, genital, urinary,
and endocrine systems, bones, joints, soft tissue, skin, breast,
eye and orbit, lymphoma, myeloma, leukemia, brain and other
nervous systems along with other and unspecified primary sites.6
Malignant cell growth, influenced by many factors, can either be
rapid or slow. Cancer tumor staging relates to cancer cell type,
tumor size, and growth rates at the initial diagnosis. Gender, age,
and other risk factors broadly affect all cancers.1 A 2009 report
from the American Cancer Society identifies two categories of risk:
hereditary and environmental.1 In general, hereditary factors are
Table 1: Cancer Risk Categories & Common Risk Factors
Risk Category
Behavioral
Biologic
Genetics
Environment
Risk Factor
Modifiable
Tobacco
√
Alcohol
√
Sun exposure
√
Poor diet
√
Sedentary lifestyle
√
Not
Modifiable
Aging
√
Obesity
√
Some viruses &
bacteria
√
Certain hormones
√
Family history
√
Obesity
√
Ionizing radiation
√
Certain chemicals &
other substances
√
Certain hormones
√
Ref. National Cancer Institute (NCI), Understanding the Puzzle. Accessed on 12/29/11,
available from http://understandingrisk.cancer.gov/learn/whatareriskfactors.cfm.
Continued on Page 8
7
LifeLongLearning
not modifiable since they stem from familial and
genetic sources.1 Environmental or acquired factors
are considered modifiable and include tobacco use,
poor nutrition, sedentary lifestyles, obesity, some
infectious agents and medical treatments, as well
as exposure to excessive sun and other carcinogens
existing in the air, food, water, and soil as pollutants.1
Modifiable risk factors, accounting for the greatest
cancer burden, are generally manageable and
preventable.
Prevention and Screening of
Non-communicable Diseases
Non-communicable diseases, including cancer, are
considered chronic diseases. Cancer prevention
shares similar risk factors with non-communicable
diseases.13 Non-communicable diseases led the 2003
global death toll of 56 million people.3 Of those
deaths, 16 million were from cardiovascular disease,
7 million from cancer, 3-4 million from chronic
respiratory disease, and 1 million from diabetes.3
National debate over cancer prevention grew out of
the World Health Organization (WHO) discussion from
the Framework Convention on Tobacco Control.13
The cancer prevention debate prompted the World
Health Assembly (WHA) to urge the integration of
oral disease prevention into national cancer-control
programs, and then promote appropriate training
across oral health professionals.13 Despite the WHA
resolution, long-standing practices between dentistry
and medicine continue to resist change.19 For the
most part, dentistry and medicine continue to operate
in the model of specialized and separate. Patients,
including those with a cancer diagnosis, generally seek
treatment and receive therapy from segregated health
communities. Unfortunately, comprehensive patient
therapy, regardless of the diagnosis, is still rare.
The greatest cancer burden is due to deaths related
to tobacco use at 30%, followed by a combination
of risk factors related to nutrition, physical inactivity,
and obesity at 35%.1, 2 Cancers caused by
occupational and other environmental carcinogens
produce a smaller risk, but still account for 6%, or
approximately 33,700 of the annual cancer deaths
8
in the U.S.1 What is most remarkable about this data is, the majority of these
risk factors stem from lifestyle choices which can be altered, by forming different
habits. “Choice” suggests that many cancers may be preventable. Risk assessment
coupled with focused patient-centered discussions for lifestyle change is a logical
chairside approach for oral healthcare professionals not only for cancer prevention,
but also for monitoring survivors.
Modifying behavior requires action and long-standing, unhealthful behaviors
are difficult to change. The challenge for oral health professionals is to engage
the tough conversations necessary for effecting change and to establish the
necessary interdisciplinary relationships with other health care providers.
Permanent behavior change requires broad support. Screening for oral cancer is
already embedded in dental and dental hygiene education. Expanding screening
practices, including general cancer risk assessments coupled with patient-centered
discussions for lifestyle change, has the potential to significantly diminish the
national cancer burden.
PATIENT SCREENING
Patient Name: ________________________ Date: ___________
Patient Status
Risk Factor
General Cancer Signs
& Symptoms
Asymptomatic
Modifiable
Unexplained weight loss
Symptomatic/undiagnosed
Alcohol
Fever
Diagnosed
Tobacco
Fatigue
Surgery
Diet
Pain
Chemotherapy
Sedentary Life Style
Skin Changes: warts, moles,
or any new skin change
Radiation
Sun Exposure
GI: changes in bowel habits
or bladder
Cancer Survivor
Not Modifiable
Sores that do not heal
Year 1
Age
Oral: white patches in the
mouth, white spots on the
tongue
Year 2
Family History
Unusual bleeding or discharge
Year 3
Viruses
Breast: thickening lump in
breast or other body parts
Year 4
Bacteria
Indigestion
Year 5
Hormones
Difficulty swallowing
> 5years
Chemicals
Nagging cough or hoarseness
Ref. National Cancer Institute (NCI), Cancer Care: Signs and Symptoms of Cancer. [Internet]
Last revision: 2010 Jan. 6. Accessed on 5/19/12, available from http://www.cancer.org/Cancer/
CancerBasics/signs-and-symptoms-of-cancer
This form is designed specifically for cancer screening purposes only and should not be used
in lieu of a comprehensive medical examination.
LifeLongLearning
Oral Cancer Risk Factors
Oral cancers comprise a group of cancers that fall into
a broader category known as head and neck cancers.
Worldwide, head and neck cancers are the sixth most
common cancer type with oral cancers comprising
approximately 85% of all cancers within this category.8,14
Unfortunately, oral cancer mortality rates remain
persistently high due to late stage diagnoses.14 Delayed
diagnoses are often attributed to the issue that oral cancer
symptoms often bear similarity to other oral problems and
can be ignored or misdiagnosed in their early stages. This
is particularly true when the individual does not present
with the traditional risk factors. An oral cancer diagnosis
often occurs after the primary lesion has metastasized to
another location, usually the lymph nodes of the neck.
Early detection of oral lesions permits isolation and
localized treatment, whereas lymph node involvement
promotes rapid spread within the total body system.
The traditional oral cancer risk model identifies men of
varying ethnicities, over the age of 40, coupled high risk
behaviors of tobacco and alcohol abuse.14 Obesity, a
significant risk factor for all cancers, is specifically linked
to esophageal cancers.14 As alcohol and tobacco use have
changed in the U.S., demographics for head and neck
cancer have begun to shift into a younger population
of male non-smokers between the ages of 40-50. The
human papillomavirus (HPV), particularly HPV 16, has
been implicated as the causative agent for this group.5,8,14
Although previously identified as a cause of anogenital
cancers, the oral HPV 16 cancers now generate a new
subset for squamous cell carcinomas of the head and neck
creating a subtle shift in the demographics and causation
for head and neck cancer in developed countries.5, 8, 14
Living Through and Surviving Cancer
A cancer diagnosis commonly produces fear and anxiety
in patients, their families and friends. While cancer can
still be the ultimate cause of death, current therapies
can prolong life, and in some cases, provide a cure. In
general, cancer staging predicts disease progression,
although staging is not an absolute predictor of survival.
While individuals may receive the same cancer diagnosis,
due to a wide array of variables, the outcomes may
differ. The presence or absence of a support group, for example, may
influence the patient’s overall response and treatment outcome. Age, sex,
spiritual practices, worldview, genetics, along with other factors may influence
tolerance and response to cancer therapy. No matter what the individual
circumstance, a cancer diagnosis and the corresponding treatment bring
about permanent and lasting life changes in a myriad of ways.
Breast Cancer Therapy Side Effects
Prior to chemotherapy
Chemotherapy day 10
2 months post radiation therapy
In the face of surgical, chemical and/or radiation interventions, cancer
patients require not only specific clinical care, but also, sensitivity to their
condition, their disposition, the stage of their treatment, and their ongoing
therapy. Physical, emotional, and mental challenges are common. Cancer
patients may face multiple challenges and difficult realities throughout their
treatment which can include multiple disfiguring surgical interventions,
chemotherapy and radiation. Despite evolving technology and therapeutics,
cancer treatment has, by no means, achieved its zenith. Chemotherapy and
radiation targeted to cause cell death are not without serious, life altering
side-effects and complications. Managing the consequences of cancer as a
chronic disease is in its infancy. Cancer patients are ambulatory; they survive,
and they walk among us. They enter our treatment rooms and require our
care, discretion, and best efforts to maintain their health both during and
following cancer therapy. Monitoring cancer survivors for disease recurrence is
the responsibility of all healthcare providers.
Conclusion
Cancer is a global epidemic requiring greater intervention and dedication
of healthcare resources. Ineffective health systems contribute to the
cancer mortality and morbidity burden. The consideration of cancer as
an epidemic has only recently come to light influenced by the declining
incidence of infectious disease and increasing population longevity. These
trends have promoted a shift in the perception and classification of cancer.
Historically, cancer, like HIV, was viewed as a death sentence. Fortunately,
this perspective is shifting. Cancer, reclassified as a non-communicable
References on Page 10
9
LifeLongLearning
disease, is like other non-communicable diseases, considered a
chronic disease. Worldwide, cancer education is essential, not only
for the population at large, but, also, for world leaders who are
responsible for effecting change. In the U.S., while overall cancer
mortality and morbidity rates are declining, the disease remains
epidemic. As healthcare providers, dental hygienists play a key
role in screening for the disease in addition to promoting cancer
prevention strategies and supporting patients throughout cancer
therapy. Cancer care and prevention is everyone’s responsibility.
7. Kochanek, K.D., Jiaquan, X., Murphy, S.L., Miniño, A.M., Kung, H-C.
National Vital Statistics Reports, Vol. 59, No. 4, 2011 Mar. 16, p. 1-53, U.S.
Department of Health and Human Services, Centers for Disease Control and
Prevention, National Center for Health Statistics, National Vital Statistics
System.
About the Author:
10. National Cancer Institute (NCI), Cancer Care: Signs and Symptoms of Cancer.
[Internet] Last revision: 2010 Jan. 6. Accessed on 5/19/12, available from
http://www.cancer.org/Cancer/CancerBasics/signs-and-symptoms-of-cancer.
Debra Jo Johnson, RDH, Ph.D. is an adjunct
professor of dental hygiene at Southwestern
College Dental Hygiene Program in
National City, California. She also practices
clinical dental hygiene in a periodontics
and implantology specialty practice in La
Jolla, California. For over thirty years, Dr.
Johnson has facilitated the education of
post-doctoral residents, and dental and dental hygiene students
from Los Angeles to San Diego. Her research and writing interests,
although varied, primarily involve curriculum and curriculum
change. Her doctoral dissertation evaluated curriculum change in
nursing. The lessons learned from her research as they apply to
dental hygiene are planned for future publication. Dr Johnson is a
breast cancer survivor.
References
1. American Cancer Society. Cancer Facts & Figures 2009, Atlanta: American
Cancer Society, 2009, 70 pages. Accessed on 5/11/12, available from
http://www.cancer.org/Research/CancerFactsFigures/cancer-factsfigures-2009.
8. Marur, S., D’Sousa, G., Westra W.H., Forastiere, A.A. HPV-associated head and
neck cancer: a virus-related cancer epidemic [Internet] www.thelancet.com/
oncology, 2010 Aug. Vol. 11: 781-789.
9. Meara, E.R., Richards, S., Cutler, D.M. The Gap Gets Bigger: Changes In
Mortality And Life Expectancy, By Education, 1981-2000, Health Affairs,
2008 Mar., 27, No. 2, 350-360 Accessed on 2/17/2012, available from
content.healthaffairs.org.
11. National Cancer Institute (NCI), Understanding the Puzzle. Accessed on
12/29/11, available from http://understandingrisk.cancer.gov/learn/
whatareriskfactors.cfm.
12. National Cancer Institute (NCI), Report to the nation finds continuing declines
in cancer death rates since the early 1990s. [Internet] Accessed on 5/11/12,
available from http://www.cancer.gov/newscenter/pressreleases/2012/
ReportNationRelease2012.
13. Petersen, P.E. Oral cancer prevention and control – The approach of the World
Health Organization, Oral Oncology, 2008, Vol. 45, Issues 4-5, Pages 454460.
14. The Oral Cancer Foundation, Oral Cancer Facts [Internet]. Last update: 2012
Mar. 16, 2001-2011©. Accessed on 5/11/12, available from http://www.
oralcancerfoundation.org/facts/index.htm.
15. U.S. Department of Health and Human Services. Oral Health in America: A
Report of the Surgeon General [Internet] Rockville, MD: U.S. Department of
Health and Human Services, National Institute of Dental and Craniofacial
Research, National Institutes of Health, 2000, Sept. Accessed on 12/28/11,
available from http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/
home.htm.
16. U.S. Department of Health and Human Services. (2000) Healthy People 2010
2nd Ed. [Internet] 2 vols. Washington, DC: U.S. Government Printing Office,
2000 Nov. Accessed on 12/28/11, available from http://www.healthypeople.
gov/2010/redirect.aspx?url=/2010/.
2. American Cancer Society. Global Cancer Facts & Figures 2nd Edition,
Atlanta: American Cancer Society, 2011, 59 pages. Accessed on 5/11/12,
available from http://www.cancer.org/Research/CancerFactsFigures/
CancerFactsFigures/cancer-facts-figures-2011.
17. U.S. Public Health Service, Vital Statistics of the United States - 19001970, annual, Vol. I and Vol. II; 1971-2001, U.S. National Center for Health
Statistics, Vital Statistics of the United States, annual; National Vital Statistics
Report (NVSR) (formerly Monthly Vital Statistics Report); and unpublished
data, 2005©. Accessed on 1/3/12, available from http://www.infoplease.
com/ipa/A0922292.html.
3. Beaglehole, R., Yach, D. Globalisation and the prevention and control of noncommunicable disease: the neglected chronic diseases of adults, The Lancet,
2003 Sept. 13, Vol. 362: 903-908.
18. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd
Edition, U.S. Department of Health and Human Resources, 1996, Williams
and Wilkins, Baltimore, MD, p. 953.
4. Center for Disease Control (CDC), Rates for New Cancer Cases and Deaths
based on Race/Ethnicity and Sex. Updated 2011 Aug. 11. Accessed on
12/30/11, available from http://www.cdc.gov/Features/dsCancerDisparities/.
19. World Health Organization. Strategies for oral disease prevention and health
promotion, 2012, pp. 1-2, accessed on 12/29/11, from http://www.who.int/
oral_health/strategies/en/.
5. DeNoon, D.J. Virus Behind Oral Cancer Epidemic, 2010, LLC. Accessed on
11/19/11, available from WebMD News Archive at http://www.webmd.com/
cancer/news/20101013/virus-behind-oral-cancer-epidemic.
6. Jemal, A., Siegel, R., Xu, J, Ward, E. Cancer Statistics, CA Cancer J. Clin. 2010,
60: 277-300.
10
LifeLongLearning
Practice Pointers – Caring for Patients with Cancer
Oral hygiene and oral care can often become a low priority for
patients with a life threatening cancer diagnosis. Dealing with the
physical and emotional impact of cancer, along with scheduling and
keeping multiple appointments with a variety of medical specialists
often leaves little room for the recommended pre-cancer treatment
dental examination and dental hygiene care appointment. Yet, the
oral manifestations resulting from chemotherapy and radiation
can be the most debilitating and often dose limiting side effects
of cancer treatment. Oral mucositis in its simplest terms is an
inflammatory process affecting the mucous membranes of the oral
cavity and the gastrointestinal tract. Varying degrees of mucositis
can be seen in patients receiving cytotoxic therapy with the signs
and symptoms ranging from mild sensory changes to multiple,
confluent ulcerative lesions extending from the oral cavity through
the gastrointestinal tract. Severe oral pain, bleeding and infection
affect the patient’s ability to speak and eat and impact their overall
quality of life. The oral pain of mucositis is often ranked by patients
as the most significant complication of their cancer therapy.1
The incidence of oral mucositis varies depending on the specific
type of cancer and the treatment modality used. It is estimated
that anywhere from 30% to 75% of all patients undergoing
chemotherapy and between 90% to 100% of all head and neck
radiation therapy and stem cell transplant patients will experience
oral mucositis.2 In the past, the majority of the research related
to the prevention and treatment of oral mucositis was focused on
adults receiving high dose chemotherapy and patients with head
and neck cancers. However, more recent reviews of the literature,
particularly from sources outside of the United States, show an
increased focus on oral side effects in the pediatric population.3
There is a growing awareness in the medical community that oral
care is an important aspect of cancer care from diagnosis, through
treatment and the rest of the life span. Identifying and providing
evidence based recommendations and interventions regarding
changes in the oral cavity can expand the role of the dental
hygienist as a provider of supportive care for patients throughout
their cancer experience.
Pre-treatment Oral Examination and Care
A pre-treatment oral examination is recommended for all
individuals ideally one month prior to beginning cancer therapy.
This is particularly important for patients receiving radiation therapy
to the head and neck region. Within the parameters of the pretreatment examination, the dental team can evaluate and treat
any existing dental infections, fractured teeth and restorations and
periodontal disease. This examination also serves as a baseline
for future comparisons of the patient’s oral health status. It is
also beneficial to exchange information with the oncology team
regarding the patient’s oral health status and proposed cancer
treatment. The pre-treatment oral examination appointment is an
ideal time to provide patient education regarding oral care during
cancer treatment and the need for monitoring oral health during
cancer therapy. Risks for oral complications such as mucositis
should also be discussed at this time. New research indicates that
good oral hygiene can reduce the incidence and severity of oral
mucositis. Unfortunately, patients with cancer do not always receive
oral care until complications develop.4,5
Oral Care During Cancer Therapy
Vigilant monitoring of oral care and oral hygiene is essential to
the prevention and treatment of oral complications during cancer
therapy. The soft tissues should be examined regularly by the
patient or caregiver in addition to members of the oncology team.
There are a number of oral assessment guides and rating scales
specifically designed for nursing interventions. The Oncology
Nursing Society (ONS) has performed extensive reviews of the
literature to create evidence based recommendations for oral
care protocols during cancer therapy particularly in the area of
managing oral mucositis. Recommendations from National Dental
and Craniofacial Research and the ONS 2009 Putting Evidence into
Practice Recommendations include the following:5,6
Brushing and Flossing
• Use an extra soft toothbrush to brush all tooth surfaces at least
twice a day for a minimum of 90 seconds
• Soak the brush in warm water if needed for tender tissues
• Allow the toothbrush to air dry before storing
• Replace the toothbrush frequently and whenever the bristles are
splayed or worn
• Gently floss at least once a day or as advised
• Waxed floss slides easily and is less likely to cause tissue trauma
• Avoid flossing tender, bleeding areas
Rinses, Toothpastes and Fluoride
• Rinse the mouth four times a day with a bland rinse
• Avoid mouth rinses that contain alcohol
• Maintain adequate hydration
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LifeLongLearning
• Use a saline and sodium bicarbonate rinse to remove food
debris and aid with oral hydration. Recommended proportions
are ¼ teaspoon salt, ¼ teaspoon baking soda mixed in 1 quart
warm water. Omit the salt if mucositis is present.
• Use a mild flavored fluoride toothpaste
• Mint or cinnamon flavoring may irritate the tissue
• Use a prescription fluoride toothpaste for caries control
• Use supplemental fluoride trays as prescribed
Additional Recommendations
• Avoid all tobacco products
• Avoid acidic, hot, rough, or spicy foods
• Avoid candy, gum and soda unless they are sugar free
• Avoid acidic beverages
Considerations for Patients Receiving Hematopoietic
Stem Cell Transplants
Patients undergoing stem cell transplantation for certain types
of cancers are at extremely high risk of developing mucositis,
ulceration and infection due to the immunosupressioncaused
by the intensive conditioning regimens prior to transplantation.
Stem cell transplant patients are under close supervision by
the oncology team to manage their oral complications. While
the complications begin to resolve once the hematologic status
improves, immunosupression and the risk of infection may last for
over a year following the transplant. These patients are also at risk
of developing graft-versus-host disease manifested in mucosal
inflammation, ulceration and xerostomia. Careful supervision of oral
care during and following stem cell transplantation is critical for the
patients’ general health.5
• Suck on ice chips
• Use water based moisturizers to protect the lips
• Petroleum based lip balms can potentially promote
bacterial growth
• Avoid the use of glycerin swabs and sponge tooth cleaners
• Prevent jaw stiffness from head and neck radiation by opening
and closing the mouth as far a s possible without causing pain.
• Collaborate with a multidisciplinary team in all phases
of treatment
• Provide written instructions and education outlining the key
points to patients and or their caregivers
Patients experiencing oral mucositis may require a variety of treatments for pain and symptom control. Some of the targeted therapies
include mixtures of lidocaine and diphenhydramine, keratinocyte
growth factors, a bioadherant gel and low level laser therapy.
Opiates may be necessary for pain relief in the more severe cases.7
Oral treatment including oral prophylaxis must be coordinated
with the oncology team. Patients undergoing chemotherapy should
have blood work performed 24 hours prior to dental treatment to
determine whether the platelet and absolute neutrophil counts are
sufficient to deliver dental care safely. Patients with central line
catheters or implanted ports may require antibiotic prophylaxis
prior to treatment.5 Again, collaboration with the oncology team is
essential for coordinating patient care.
Common Side Effects of Cancer Therapy5
AlopeciaAnemia
Diarrhea/constipationDysgeusia
FatigueInfection
Memory issues
Nausea/vomiting
Oral mucositis/stomatitis Peripheral neuropathy
Skin and nail changes
Urinary tract changes
Xerostomia
Oral Manifestations Common to
Chemotherapy and Radiation
Abnormal dental development (children 9 and under)
Anorexia
Dysphagia
Dysgeusia
Oral Infections
Oral Mucositis
Malnutrition
Xerostomia/Salivary Gland Dysfunction
Additional Oral Complications due to Chemotherapy
Dental Neurotoxicity
Oral Bleeding
Additional Oral Complications due to Radiation Therapy
Lifelong risk of radiation caries
Trismus or tissue fibrosis
Osteonecrosis of the Jaw
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LifeLongLearning
Oral Care for Life after Cancer
About the Author
Patients may resume their regular dental hygiene care schedule
once all of the complications of chemotherapy have resolved.
Individuals with ongoing immunosupression will need to have
their hemotologic status confirmed prior to receiving care. Patients
who have received intravenous bisphosphonate therapy for their
cancer will be at increased risk of developing osteonecrosis of
the jaw. Individuals who have undergone radiation therapy for
head and neck cancer will need regular evaluations, every 4 to
8 weeks, for the first 6 months. Once the first 6 months have
passed, a continuing care schedule can be made based on the
individual needs of the patient. It is important to remember that
oral complications such as radiation caries and osteonecrosis of the
jaw can occur long after the treatment has ended. Meticulous oral
hygiene, good nutrition and hydration coupled with lifelong fluoride
applications are critical for patients with salivary gland dysfunction
following head and neck radiation therapy.5
Cathy Draper, RDH, MS, graduated
in 1975 from Foothill College and
completed her MS in dental hygiene
at the University of Michigan in 1978.
She is an adjunct faculty member at
Foothill College and works in private
practice. Cathy has been a library
reference associate at the Stanford
Hospital Health Library for the past 18 years. She also lectures
to patients and professionals groups on oral care during cancer
therapy. Cathy is the editor of the Journal of the California Dental
Hygienists’ Association.
The ability to competently provide oral care throughout cancer
treatment can prevent or reduce the severity of oral complications.
Dental hygienists should be well prepared to provide supportive care
to patients with all types of cancer and collaborate with healthcare
providers as members of the comprehensive cancer care team.
2. Elting LS, et al. The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis. Cancer 2003; 98:1531-1539.
Resources for Patients and Professionals
The National Cancer Institute
www.cancer.gov
Comprehensive information and free education materials
from the United States Government.
References
1. Eilers J. Nursing interventions and supportive care for the prevention and
treatment of oral mucositis associated with cancer treatment. Oncol Nurs
Forum 2004;31(suppl):13-23.
3. Eilers J, Million R. Clinical update:prevention and management of oral mucositis in patients with cancer. Semin Oncol Nurs 2011; 4: e1-16.
4. Eilers J, Epstein JB. Assessment and measurement of oral mucositis. Semin
Oncol Nurs 2004; 21:22-29.
5. US Department of Health and Human Services. Oral complications of cancer
treatment: what the dental team can do. Bethesda, MD: National Institutes of
Health: 2009.
6. Harris DJ, Eilers J, Harriman A, et al. Putting evidence into practice-improving
oncology patient outcomes. Pittsburgh, PA: Oncology Nursing Society; 2009:
pp193-213.
7. Cawley MM, Benson LM. Current trends in managing oral mucositis. Clin J
Oncol Nurs 2005; 5:584-592.
The National Institute of Dental and Craniofacial Research
www.nicdr.nih.gov/OralHealth/Topics/CancerTreatment/
Features oral health “Cancer Care and You” series of
publications for patients and professionals
Multinational Association of Supportive Care in Cancer
www.MASCC.org
An association dedicated to the prevention and management
of the adverse effects of cancer and its treatment. Includes
guideline on the management of treatment side effects.
The Stanford Health Library
http://healthlibrary.stanford.edu
Features an online request form for customized research on
medical or health related questions.
13
LifeLongLearning 2 CE Units (Category I)
Home Study Correspondence Course
“Cancer: An Epidemic of the 21srt Century and Caring for Patients with Cancer”
2 CE Units – Member $25, Potential member $35
Circle the correct answer for questions 1-10
1. Which of the following statements is true about cancer as a disease?
a. cancer is infectious and communicable
b. cancer is chronic and non-communicable
c. cancer is chronic and infectious
d. cancer is chronic and communicable
2. Factors contributing to the worldwide increase in cancer incidence
and mortality include:
a. population growth
b. increased longevity
c. reductions in infectious disease deaths
d. reductions in childhood mortality rates
e. all of the above
3. Without education and awareness people tend to engage in more
high risk lifestyle behaviors. These correlate with increased cancer
incidence. Among these high risk behaviors are:
a. tobacco use
b. poor nutrition
c. sedentary lifestyle
d. indiscriminant sexual practices
e. all of the above
4.
Cancer tumor staging helps predict disease progression. Factors
contributing to cancer tumor staging are:
a. cell type, tobacco and alcohol use
b. age, weight and tobacco use
c. cell type, tumor size and growth rate
d. age, weight and sun exposure
5. Dental hygiene assessment and treatment plans should include
screening, risk assessment and counseling for lifestyle choices:
a. only for those patients who are perceived at risk
b. only for those patients who have no history of cancer
c. only for those patients over 40
d. for all patients
6. Dental examination and treatment are recommended prior to
starting cancer therapy. The benefits for the patient include:
a. treat existing restorative and periodontal needs to prevent
unnecessary complications during and after cancer therapy
b. establish a baseline for future comparisons
c. provide education and support for cancer therapy and
potential oral complications
d. all of the above
7. Oral mucositis is a common and debilitating side affect of chemo
and radiation therapy. The symptoms vary from mild to severe and
include the following quality of life issues:
a. pain and difficulty eating and speaking
b. difficulty with cognitive processing and memory
c. difficulty sleeping and breathing
d. all of the above
8. Recommendations for oral care during cancer therapy include
the following:
a. use OTC and Rx fluoride products
b. avoid use of ultrasonic brushes
c. rinse frequently with bland alcohol-free rinses
d. both a and c
9. Patients undergoing therapy for head and neck cancers should
avoid the following:
a. tobacco products and alcoholic beverages
b. spicy, hot, rough, and acidic foods
c. petroleum based lip balms
d. all of the above
10. Maintaining hydration is important for oral cancer patients. Besides
reminding patients to intake adequate fluids, advice can be given to:
a. suck on ice chips
b. avoid acidic beverages
c. use super charged energy drinks
d. both a and b
The following information is needed to process your CE certificate. Please allow 4 - 6 weeks to receive your certificate.
Please print clearly:
ADHA Membership ID#: ________________________ Expiration:___________
❑ I am not a member
Name: _____________________________________________________ License #: ___________________
Mailing Address: __________________________________________________________________________
Phone: ______________________ Email: __________________________ Fax: ______________________
Signature: ______________________________________________________________________________
Please mail photocopy of completed Post-test and completed information with your check payable to CDHA:
130 N. Brand Blvd, Suite 301, Glendale, CA 91203
14
FeatureFocus
The Faces of Oral Cancer
Eva Grayzel and Brian Hill were the featured speakers on June 1,
2012, at the California Dental Hygienists’ Association’s continuing
education program prior to the opening session of the annual
House of Delegates in Santa Clara. Both speakers, late stage
oral cancer survivors, brought their personal experiences and
perspectives to the disease as well as the ongoing need for oral
cancer awareness and early detection and follow-up care. Of
equal importance in the program was how both Eva and Brian
have taken their own cancer experience and transformed it into
an opportunity to change the outcome of the disease through
education, advocacy and activism.
Eva Grayzel
Turning Adversity into Opportunity
“I had the sore on my tongue for about
a month but everything else in my life
seemed more important as a wife and
mother of two young children. Eventually
I did see an oral surgeon who performed
a biopsy without mentioning the possibility of oral cancer. The diagnosis was hyperkeratosis and I became
asymptomatic for two years. When the lesion returned, I bounced
back and forth between my dentist and oral surgeon for gels, rinses,
occlusal adjustments and a nightguard. The day to day changes in
the sore were subtle and I was continually being told to monitor
it for changes and to come back if it didn’t improve. After eight
months, I developed unbearable ear pain and was treated for water
on my ear drum. Again, none of my doctors mentioned the possibility of oral cancer. Desperate for answers, a family friend suggested
that I visit a medical center and see Dr. Mark Urken, chief of Head
and Neck Surgery at Mt. Sinai Hospital in New York City. After
examining the enlarged lymph nodes in my neck and the sore on
the side of my tongue, Dr. Urken performed a biopsy and gave me
the definitive diagnosis of stage IV squamous cell carcinoma of the
tongue. As a professional storyteller and performance artist, this
was a particularly devastating diagnosis. Plus, I ate well, exercised
and did not use tobacco or abuse alcohol. Given a 15% chance
of survival, in the spring of 1998, I had a radical neck dissection,
partial glossectomy and tongue reconstruction surgery followed by
a grueling course of radiation therapy.
Fourteen years later, I have beaten the odds for survival and devote
my energies to sharing my personal story in the hopes that it will
inspire listeners to demand oral cancer screenings for themselves
as well as for those they love. Together, we can save lives. It is more
than my mission to educate. It’s my tribute to all those that came
before me and my obligation to those who will follow.”
As an author and motivational speaker,
Eva Grayzel has developed a variety
of educational materials and speaking
programs for a wide range of audiences
including healthcare professionals,
cancer patients, survivors and the public.
She received a honorary membership in
the American Academy of Oral Medicine
for her Six-step Screening, Best Practice
in Oral Care postcard. Eva has recently
published her second book in the Talk
4 Hope family book series, Mr. C Plays
Hide & Seek, written to help children
understand cancer.
A full listing of Eva Grayzel’s programs
and publications can be found at www.evagrayzel.com
For more information on the Six-step Screening, best practice in
oral care program visit www.sixstepscreening.org
Brian Hill
The Oral Cancer Foundation
Executive Director and Founder
Brian Hill can trace an interest in medicine
back to his early experiences as a 19 year
old medic serving in Vietnam with the First
Medical Battalion. After returning from
the war, Brian began working in sales for
several big medical firms. Eventually he started his own company,
Implant Support Systems Inc., designing, manufacturing and selling
dental implants. In 1993, Implant Support Systems was sold to
Lifecore Biomedical and Brian and his wife were able to enjoy
life to the fullest. One day everything changed; an asymptomatic,
painless lump appeared on the side of his neck, hidden under
15
FeatureFocus
his full beard. After visiting an ear, nose, and throat specialist the
conclusion was that the lymph node was swollen due to a dental
or unknown infection and he was prescribed a course of antibiotics.
Having received dental care from two different dentists and regular
continuing care from two different hygienists, Brian was certain
that he did not have any dental issues causing this infection. He
remembers, “My dentists were on top of my oral health and I
took great care of my mouth. I didn’t smoke; I ate well and was
physically active.” A second ENT was consulted after the antibiotics
had no effect and this time a red patch on the pillar of the right
tonsil was biopsied. The diagnosis came several days later, squamous
cell carcinoma with bilateral metastases, a stage IV cancer that had
gone unnoticed by a number of medical and dental professionals.
Brian’s experiences as an oral cancer patient at MD Anderson
Cancer Center in Houston and as a survivor, led him to look
for ways to change the high morbidity and mortality rate of
the disease, starting with a national effort in awareness and
early discovery screening programs. He also saw the need to
motivate professionals to provide more opportunistic oral cancer
examinations. While medical science may one day cure oral cancers
in the future, heightened awareness and early detection programs
can provide tangible opportunities to reduce mortality rates today.
Brian also found a critical need to support oral cancer patients and
their families with access to evidence-based, scientific information
to allow patients to make the best decisions possible in their
cancer journey. The Oral Cancer Foundation (OCF) began as an
idea in 1999 with Brian and his wife Ingrid serving as its original
founders and financial supporters. Today, through the support of key
oral cancer experts from all disciplines, professional medical and
dental societies and thousands of donors and volunteers, the OCF
has grown into a powerful national force for proactive change and
improved quality of life.
The OCF is Brian Hill’s passion; he is the face of the foundation,
frequently lecturing on oral cancer, advocating for the disease and
all those affected by it.
Support the mission of the Oral Cancer Foundation by
becoming a member or organizing an oral cancer
awareness activity.
Learn more about the Oral Cancer Foundation
and its education, research, advocacy, and patient
support programs at www.oralcancerfoundation.org
16
Oral Cancer Demographics 2012
The incidence of oral cancer is increasing in the United States
with the emergence of the Human Papilloma Virus #16
bringing a new demographic of individuals to the disease.
The human papilloma virus is one of the most common
virus groups worldwide, affecting the skin and mucous
membranes with over 120 identified variations. The majority
of human papilloma viruses, transmitted by skin to skin
contact, are non-cancerous and treatable. However, some
forms of HPV are sexually transmitted and are associated
with oncogenic potential in the genitalia and oral cavity. The
virus, particularly HPV 16, has established a new pathway
outside of the traditional high risk groups of individuals over
the age of 50 with a history of heavy alcohol and tobacco
use, into the population at large. This new demographic
emphasizes the importance of vigilant oral cancer awareness
and screening programs for all individuals. The sites of the
presenting malignancies have also changed. HPV positive
related cancers tend to appear more frequently in the tonsilar
area, the base of the tongue and on the oropharynx with HPV
negative malignancies appearing on the anterior tongue, floor
of the mouth and buccal and alveolar mucosa. In all cases,
a tissue biopsy and careful laboratory analysis is required
for determining the pathology of the neoplasm. At this time,
treatment modalities for HPV+ and HPV- tumors are the
same although it is possible that future clinical trials may
be conducted focusing on biologically targeted therapies for
HPV+ cancers.
Source: Oral Cancer Foundation
www.oralcancerfoundation.org/hpv/index.htm
StudentConnection
Original Student Research –
The Effects of Proximity on Aerosol Distribution
of Bacteria on Toothbrushes
By Elly A. Montero, BSDH*, Isabelle B. Isom, BSDH*, Jeanne Fults, BSDH*, Samantha Cvijanovich, BSDH*,
Aubree Chismark, RDH, MS and Benjamin B. Tran, MSc
* The following research was conducted prior to completing the requirements for the BSDH degree.
Interest in the microbial contamination of toothbrushes and the
role that this contamination can play in oral infections has grown
in recent years. Concerns on the transmissibility of disease via a
contaminated toothbrush has become more than a theoretical
discussion when considering the large number of individuals
with compromised immune systems due to disease, organ
transplantation or cancer therapy. Toothbrush storage guidelines
along with methods of sanitization in the manufacturing process
and during use require scientific evidence in order for clinicians
to make recommendations for patients.
In this original research study, students from West Coast
University, along with their faculty advisors, studied the effects
of the proximity of aerosols on toothbrush contamination, thus
contributing to the body of knowledge in dental hygiene practice.
This study supports the National Dental Hygiene Research
Agenda (NDHRA) priority area, Health Promotion and Disease
Prevention: Investigate the effectiveness of oral self-care
behaviors that prevent or reduce oral diseases among all age,
social and cultural groups.
ABSTRACT
Purpose: Bacteria found on toothbrushes may affect overall health.
While it is common to find certain bacteria in one part of the
body, they can be harmful if they inhabit elsewhere. Coliforms are
indicator bacterium of the intestines, colon, and fecal matter. These
particular bacteria can be found throughout the bathroom due to
the aerosols created when a toilet is flushed. The aim of this study
was to test toilet flushing aerosols and bacterial accumulation on
a toothbrush by relating distance of the toothbrush from the toilet
while flushing with the lid up.
Methods: A control swabbing was performed on 32 sterile
toothbrushes to test for coliforms. They were divided and placed into
four typical residential restrooms at four determined locations. For
14 consecutive days, four investigators exposed each toothbrush
to microflora and moisture. At the end of the experiment, each
toothbrush was swabbed and tested for additional coliforms.
Results: There were significantly more coliforms on the toothbrushes
stored in bathrooms when compared to those that were sterile.
However, comparisons between the tested conditions did not reveal
significant differences. Surprisingly, the covered condition showed
as much bacteria accumulation as the exposed conditions.
Conclusion: Our findings suggested there is a uniform distribution
in aerosol bacteria from toilet flushing, which was indicated in
additional coliform deposits on toothbrush bristles of those kept in
the tested bathrooms. Moreover, our results suggested that storing
of toothbrushes in drawers or cabinets does not diminish the levels
of toilet aerosol exposures. One possible factor in this finding is
the promotion of anaerobe growth in dark and possibly damp
conditions indicative of drawers and cabinets.
Keywords: Toilet aerosols, toothbrush bacteria, toothbrush
storage, bacterial accumulation
INTRODUCTION
It has long been established that oral health is an integral
component to overall patient health. Bacteria are found in different
areas of the body including: saliva, oral mucosa, conjunctiva, lower
gastrointestinal tract and superficial layers of the skin. Bacteria that
are not harmful to the body are deemed microbiota and those that
are harmful are deemed as pathogens.1
Bacteria in the Gastrointestinal Tract
The gastrointestinal (GI) tract, also known as the alimentary
canal, starts at the mouth and ends at the anus. Bacteria found
in different areas of the GI tract can be classified as opportunistic
pathogens capable of causing injury if there is an overabundant
amount of certain bacteria.2 Thus, it is essential to have an
understanding of the common bacteria found within the body.
Although many bacteria are normally found within the body, when
we are exposed to them from an outside source, the end result
proves they are not always good bacteria.
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StudentConnection
Toilet Aerosols
Flushing a toilet creates an aerosol, which contaminates most of the
surfaces inside bathrooms. Although droplets are not visible, they
can travel between 6 to 8 feet from the toilet leaving no surface
safe from possible contamination.3 The aerosol is produced by force
of the water dispensed along the walls of the toilet bowl along
with the momentum used to flush waste.4 A single act of flushing
a toilet disperses millions of bacteria into the air, which makes the
bathroom a prime area for bacterial contamination and growth.5
The droplet formation of sewage from toilets has a high potential
for disease spread because aerosols occur during each use of the
toilet.6 It is also important to note, the aerosol produced creates an
infection hazard and unfortunately, closing the toilet lid has little
effect in the reduction of microorganisms released into the air.4
Bacteria on Toothbrushes
After a toothbrush has been in use, one would expect to find
bacteria on the bristles due to their contact with the microbiota
found in the oral cavity. However, toothbrushes are manufactured
free of microorganisms and therefore, will not harbor bacteria until
first use.7 In addition to the oral microbes, other species can also
be found on in-use toothbrushes. Sources of these contaminates
include bacteria introduced by hands, aerosols from the toilet, and
storage areas. The quantity and species of bacteria may differ, which
is dependent on wet or dry storage conditions.8
Bacteria found on toothbrushes are predominantly Staphylococci.
Other microorganisms were identified as Candida albicans,
Cornybacteria, Pseudomonads, and coliforms. In addition to
residing and multiplying on toothbrushes, these bacteria have
the capability of transmitting and creating both local and
systemic diseases and can create a source of infection in the
immunocompromised. Oral manifestations that may arise include
dental caries, sore throats, thrush, and Herpes Simplex.5 Other
conditions that may result from these bacteria may include, but are
not limited to, diarrhea, fever, hypertension, renal impairment, and
cardiovascular disease.9
Bacteria Accumulation
Previous studies have shown that regardless of the experimental
design used to test toothbrushes, bacteria is always present with
Streptococcus mutans being the most common bacteria tested.
After a toothbrush is used for fifteen minutes, over ten million
S. mutans are found to be present.5 An experiment of thirty
toothbrushes demonstrated over 40% of at least 14 samples
to be positive for anaerobes, aerobes, streptococci, and aerobic
gram-negative bacteria. In detail, 83% of 25 samples tested
positive for anaerobes, over 73% of 22 samples tested positive for
aerobes, 80% of 24 samples tested positive for streptococci, and
18
over 46% of 14 samples contained aerobic gram-negative bacilli.
Surprisingly, these data were collected from toothbrushes that had
been disinfected.10 These findings indicated that numerous forms of
microorganisms are found on toothbrushes regardless of the area
they are stored or if they have been disinfected.
In summary, bacteria found on toothbrushes may affect overall
health. While it is common to find certain bacteria in one part of
the body, they can be harmful if they inhabit elsewhere. Coliforms
are indicator bacterium of the intestines, colon, and fecal matter.11
These particular bacteria can be found throughout the bathroom
due to the aerosols created when a toilet is flushed. One question
of interest is whether varying proximity to the toilet would affect
collection of bacteria on toothbrushes kept in bathrooms. Another
question of interest is whether an enclosed storage would affect
microbial load found on toothbrushes. Our study aims to address
these two questions.
METHODS AND MATERIALS
Four bathrooms were used in a 14 day study to collect bacterial
samples on a total of 32 toothbrushes. Each bathroom was
equipped with 8 toothbrushes in 4 different locations: 2 feet
from the toilet bowl, 5 feet away from the toilet bowl, top of
the toilet water tank and inside a cabinet or drawer. Prior to
toothbrush placement, a control sampling was performed on the 32
toothbrushes by swabbing for coliforms.
Control Study:
All 32 toothbrushes used in this study were uniquely labeled and
swabbed by submersion and agitation in 3 ml sterile distilled water
in a sterile centrifugation tube. An additional 3 ml of nutrient broth
was added to the sample for a total of 6 ml volume. The control
sample mixtures were incubated for 24 hours at 37 ºC. Following
incubation, the control samples were poured into sterile 100 mm x
10 mm Petri dishes with 10 ml of EMB molten media at 55 ºC by
sterile serological pipette. These Petri dishes were incubated inverted
for 48 hours and thereafter, manually counted for coliforms.
Experimental Study:
Following control swabbing, the same 32 toothbrushes were placed
in four bathrooms, with eight toothbrushes in each bathroom.
Within each bathroom, two toothbrushes were placed in each of the
following locations: 2 feet away from toilet bowl, 5 feet away from
toilet bowl, top of the water tank and inside a medicine cabinet
or drawer. For each bathroom, each of the 8 toothbrushes were
exposed to oral microbiota and moisture once a day. To ensure
consistent and uniform exposure, each toothbrush was assigned
to one quadrant of the oral cavity, with either AM brushing or
PM brushing. The investigators kept a daily tally of toothbrush
StudentConnection
exposure and bathroom usage. At the end of the experiment, the 32
toothbrushes were collected and re-swabbed for possible addition or
growth of bacteria using the same methodology as the control study.
Microbial Growth Quantification:
Colony Forming Units (CFU) in the Petri dishes were manually tallied
using a 6.5 mm square grid at 4x magnification. The resultant CFU
counts were multiplied by 140 dilution factor for CFUs/ml.
Control
61,800
137,000
59,000
42,000
SEM
8,860
39,100
6,400
10,000
Experimental
229,000
306,000
344,000
379,000
SEM
66,500
58,600
63,600
82,100
Table 2: Values of CFUs from Table 1 averaged per bathroom location.
SEM calculations were with a sample size of 6 per location.
Table 3: Aerosol Collection of Bacteria by Location
One-way ANOVA of Experimental CFUs by Condition 2 feet
5 feet
Tank
Cabinet
560,000
276,000
428,000
490,000
156,000
560,000
246,000
220,000
150,000
284,000
480,000
634,000
190,000
360,000
536,000
548,000
174,000
150,000
184,000
192,000
144,000
206,000
190,000
189,000
6
6
6
6
229.000
306.000
344.000
378.833
163.035
143.633
155.779
201.125
X ave
314.458
source
df
SS
MS
F
P-value
treatments
3
74349.125
24783.042
0.8857
0.4654
error
20
559646.833
27982.342
total
23
633995.958
Table 3: Statistical comparisons between pre-study control and post study experimental
CFUs by paired t-test. Inter-condition variance comparisons did not yield significant results.
Of the 32 toothbrushes in the study, CFU counts from 24
toothbrushes were used in the data analysis (Table 3). These 24
toothbrushes represented aerosol collection from 3 bathrooms. Eight
toothbrushes, all from the same bathroom, were excluded from the
analysis. CFU counts from these 8 brushes were statistical outliers
when compared to counts from the remaining 24 toothbrushes.
CFUs from the 24 toothbrushes were averaged per condition,
resulting in 6 samples measured per condition. Standard Error
Table 2: CFU Comparisons
Two Tailed Paired t-Test
Condition
Control vs. Experimental
2 Feet
0.04
5 Feet
0.002
Tank
0.005
Cabinet
0.007
1
2
3
4
5
6
n
X
s
CFU counts in the control and experimental samples were averaged
and the standard error of the mean (SEM) were calculated (Table
1). Statistical comparison between the control average and
the experimental average for each experimental condition was
performed by paired t-tests. Inter-condition comparisons for control
and experimental averages were performed using a one-way
ANOVA (Table 2).
RESULTS
Table 1: Mean and Standard Error CFUs per Condition
Condition
2 feet
5 feet
Tank
Cabinet
Statistical Comparisons of CFU Counts:
CFU/mL
Control
Experimental
86,000
560,000
63,000
156,000
50,000
150,000
86,000
190,000
56,000
174,000
30,000
144,000
Toothbrush ID
3
4
13
14
27
28
Condition
2 feet
2 feet
2 feet
2 feet
2 feet
2 feet
5
6
15
16
25
26
5 feet
5 feet
5 feet
5 feet
5 feet
5 feet
120,000
330,000
91,000
107,000
88,000
83,000
276,000
560,000
284,000
360,000
150,000
206,000
1
2
9
10
31
32
Tank
Tank
Tank
Tank
Tank
Tank
84,000
48,000
66,000
47,000
43,000
66,000
428,000
246,000
480,000
536,000
184,000
190,000
7
8
11
12
29
30
Cabinet
Cabinet
Cabinet
Cabinet
Cabinet
Cabinet
32,000
70,000
74,000
39,000
20,000
17,000
490,000
220,000
634,000
548,000
192,000
189,000
Table 1: Colony Forming Units (CFUs) of aerosol bacteria collected among
four different bathroom locations on 24 toothbrushes within a 14 day study.
19
StudentConnection
from the toilet does not have significant results on bacterial accumulation.
Perhaps the dispersion of bacterial aerosols from the toilet bowl is fairly well
distributed. More evidence is needed in demonstrating the amount of bacterial
contamination on toothbrushes located at different distances from the toilet.
Figure 1 Bacteria on Toothbrushes
CFUs/ml
500,000
450,000
400,000
350,000
300,000
Control
Experimental
250,000
200,000
150,000
100,000
50,000
0
2 feet
5 feet
Tank
Cabinet
Figure 1: Comparison of values from Table 1. Mean and SEM CFUs by
location. There are notable differences between pre-treatment controls
and post treatment experimental samples.
(SEM) values were also calculated for these conditions
(Table 1). When comparing the CFUs between control
and experimental samples, there were consistently
and significantly more CFUs/ml in the experimental
samples when matched with pre-treatment controls,
as shown by paired t-test. The sample means and
corresponding variance for the different bathroom
locations were not statically different from one another,
as shown by one-way ANOVA. This was true both for
the control and experimental treatments (Figure 1).
DISCUSSION
The levels of bacteria found on toothbrushes before
the study is in contrast to previous work demonstrating
that toothbrushes are sterile when manufactured.7
Our study indicated that the control group, comprising
of new and packaged toothbrushes, could be
contaminated. One explanation of this result is the
possible contamination of the control swabs. This
contamination may have been caused by investigator
error or incubation placement among other reasons.
However, consistent with our understanding, bacteria
were found to accumulate on the study toothbrushes
once they were opened and used in the oral cavity.5
Bacterial accumulation on toothbrushes may be
influenced by species antagonism on the bristles.12
Bacteria can come from contaminated hands, storage
areas and toilet aerosols;8 although, the overwhelming
source of exposure is the bacteria from the oral cavity.
Additional factors affecting species diversity include
frequency of exposure or use, toothbrush storage.8, 12
Previous studies showed that toilet aerosols can travel
up to 6 to 8 feet.3 We expected to find differences
in bacterial accumulation based on proximity to the
toilet bowl; however, our study showed that distance
20
Toothbrushes located in cabinets, counter to our initial expectations, did not
show a reduction in the amount of harbored bacteria. In support of our findings
a previous study, reported in the Journal of Dental Hygiene, showed that covered
toothbrushes had significantly higher amounts of bacteria in comparison to
uncovered toothbrushes.13 Consequently, it is surmised that bacteria harbor
better in areas with warmth and darkness, such as bathroom cabinets.
To minimize the possibility of bacterial contamination on toothbrushes, either
from manufacturing processes, aerosol accumulation, or bacterial growth during
storage, many in the dental profession have advocated the use of UV light on
toothbrushes.14 Further research is needed about UV sterilization products in
reducing microbial accumulation on toothbrushes.
CONCLUSION
In conclusion, we recommend that either toothbrushes are kept outside of
bathrooms, and thus they are out of aerosol range, or if they are kept within
bathrooms, they are allowed to fully dry between use, as previous work has
demonstrated that bacteria can harbor on moist toothbrushes.13 Practical
application of this second recommendation would mean using two sets of
toothbrushes, one for the morning and another for the evening, where each
toothbrush is allowed time to fully dry in between daily use. In this instance, the
brushes can remain in the bathroom uncovered.
ACKNOWLEDGEMENTS
The authors would like to thank West Coast University for contributing the
materials needed for this study.
About the Authors
Elly A. Montero, BSDH, Isabelle B. Isom, BSDH, Jeanne Fults, BSDH, Samantha
Cvijanovich, BSDH completed the requirements for a Bachelor of Science degree
in Dental Hygiene from West Coast University in 2011. They conducted this
original research as students in the dental hygiene program at WCU.
Faculty Research Advisors: Aubree Chismark, RDH, MS, and Benjamin Tran, MS.
From left to right: Elly A. Montero, BSDH, Isabelle B. Isom, BSDH, Jeanne Fults, BSDH,
Samantha Cvijanovich, BSDH
StudentConnection
References
1. Freeman J, Anderson D, Sexton D. Seasonal peaks in Escherichia coli
infections: possible explanations and implications. European Society of
Clinical Microbiology and Infectious Diseases. 2009;15:951-953.
2. Poxton R, Brown R, Sawyerr A, Ferguson A. Mucosa-associated bacterial ﬂora
of the human colon. Journal of Medical Microbiology. 1997;46:85–91.
3. Saini, R, Saini S. Microbial flora on toothbrush - at greater risk. Ann Nigerian
Me. 2010;31-32.
4. Barker J, Jones M. The potential spread of infection caused by aerosol
contamination of surfaces after flushing a domestic toilet. Journal of Applied
Microbiology. 2005;9:339-347.
5. Ankola A, Hebbal M, Eshwar S. How clean is your toothbrush? International
Journal of Dental Hygiene. 2009;7:237-240.
6. Morawska, L. Droplet fate in indoor environments or can we prevent the
spread of infection? Inter J Indoor Env Health. 2006;16(5):335-347.
7. Nelson-Filho F, Bezerra da Silva R, Rossi M, Ito I. Evaluation of the
contamination and disinfection methods of toothbrushes used by 24- to 48month old children. Journal of Dentistry for Children. 2006;3(3):152-158.
8. Taji S, Rogers A. The microbial contamination of toothbrushes: a pilot study.
Australian Dental Journal. 1998;3(2):128-130.
9. Clark F, Sontrop M, Macnab J, Salvadori M, Moist L. Long term risk
for hypertension, renal impairment, and cardiovascular disease after
gastroenteritis from drinking water contaminated with Escherichia coli
O157:H7: a prospective study. British Medical Journal. 2010;1-9.
10. Sato S, Ito I, Lara E, Panzeri H, Ferreira de Albuquerque R, Pedrazzi V.
Bacterial survival rate on toothbrushes and their decontamination with
antimicrobial solutions. Journal of Applied Oral Science. 2004;2(2):99-103.
11. Elliot E. Acute gastroenteritis in children. British Medical Journal. 2009;
334:35-40.
12. Kreth J, Zhang Y, Herzberg MC. Streptococcal antagonism in oral biofilms:
streptococcus sanguinis and streptococcus gordonii interference with
streptococcus mutans. Journal of Bacteriology. 2008;190(13): 4632-4640.
13. Borso H, Crump R, Schelling M. The effect of toothbrush covers on bacteria
retention. The Journal of Dental Hygiene. 2004;78(4):19.
14. Berger JR, Drukartz MJ, Tenenbaum MD. The efficacy of two UV toothbrush
sanitization devices. A pilot study. N Y State Dent J. 2008;74(1):50-52.
2012 Cora Ueland Scholarship Award Recipients
Dental Hygiene Associates Incorporated (DHAI), the not-for -profit
subsidiary organization of CDHA recently announced the 2012
recipients of the Cora Ueland Scholarship. First established as a
loan fund in the 1950s in the memory of Cora Ueland, founder
and director of the dental hygiene program at the University of
Southern California, the fund has been a student scholarship since
1998. This year’s recipients continue to carry on Cora Ueland’s
commitment to excellence in education and service to others.
Morgan Kozek is a 2012 dental
hygiene graduate from The Herman
Ostrow School of Dentistry of the
University of Southern California.
President of the Student Chapter of
the ADHA at USC, Morgan enjoys
meeting new people in the dental
hygiene profession. In 2011, Morgan
participated in the ADHA table clinic
research session, and continues to
be interested in learning about new
and innovative research in dental hygiene. Morgan is committed to
providing services to those in need, both locally and internationally.
She recently traveled to Cartagena, Colombia, where she provided
dental hygiene care to both children and adults. Morgan is very
passionate about the dental hygiene profession and is excited to
get involved in her local component and beyond.
Lauren Umetani is a first-year dental
hygiene student at Foothill College.
She holds a B.A. degree in web
design from Cogswell Polytechnical
College in Sunnyvale, CA, graduating
as class valedictorian in 2003. The
following year, she graduated from
the Baking and Pastry Arts Program
of the California Culinary Academy in
San Francisco and worked as a pastry
chef and baker for six years. Ready
for a career change, Lauren chose to follow in the footsteps of her
mother Aileen, a 1968 graduate of Foothill College, and become
a dental hygienist. Between studying and volunteering in the
community, Lauren also played a key role in organizing the Foothill
dental hygiene students’ inaugural Walk for Oral Cancer Awareness,
raising over $5000 for the Oral Cancer Foundation. Lauren is
honored to receive the Cora Ueland Scholarship and would like to
thank her family and friends for all their love and support as she
pursues her new profession.
21
StudentConnection
California Students Share their Knowledge
at the 2012 Table Clinic Competition
Over two hundred dental hygiene students from dental hygiene
programs throughout the state came together in Anaheim for the
annual CDHA Table Clinic competition. This year’s program marked
a new collaboration with the California Dental Association, the CDA
Foundation and Calfiornia Dental Hygienist Assoiciation bringing
additional judges and funding for the award winning clinics. CDHA
and CDA member judges had a challenging time selecting the
winning presentations in the table clinic and research categories.
Informational Table Clinics
By virtue of their hard work and valuable contributions to the
exchange of information amongst fellow professionals, all of
the student participants were truly “winners” in the competition.
Abstracts of the top three research and informational table clinics
are available online at www.cdha.org under student members.
CDHA and CDA look forward to furthering our collaborative efforts,
strengthening the relationship between our organizations and
benefitting our profession and the public.
2nd Place –
West Los Angeles City College
Shine the Light on Bleaching
3rd Place –
Cerritos Community College
Enamel Facts on Celiacs
Research Poster Presentations
Sandy Levy and Sophia Perez
Kaitlyn Tarbert & Amanda Roberts
1st Place – West Los Angeles City College
Go Green
Christopher Johnson, Jennifer Kuo, Samantha Nebel, Mizuho Sato
Thank you to our team of judges from CDHA and CDA
CDHA Judges
1st Place – Loma Linda University
A Comparison of Three Surface Disinfectants
Julianne Souza, Debra Gruzensky, Jeanne Gustafson
2nd Place –
Loma Linda University
The Effects of Magnolia Bark
on Oral Microbial Growth
3rd Place –
Fresno City College
pH for the RDH
Melissa Fife & Michelle Herrera
CDHA and CDA
leadership teams
and CDA judges
Special thanks to Crest Oral B
and the CDA and CDA Foundation
for sponsoring this year’s table clinic competition
Michelle Kaiser, Lindsay
Sharman, Amanda Armand
22
CareerCorner
Carol Lee, RDH, BS, FAADH
Beginning with the End in Mind
In the best-selling book, The 7 Habits
of Highly Effective People, the late
author and leadership consultant
Steven Covey stated that the successful
individual begins each task, project and
day with a clear vision of the desired
direction and then works to continue
to make it happen. If you ask Sharon
Golightly about this “habit” she would
say, to make sure that the direction is
proactive and the desire to reach it is undeterred, two qualities that
describe her vision for her career and the profession.
Sharon Golightly, RDH, EdD, has taken her career from California to
South America, Maryland, Washington and back again to California.
Sharon’s dental hygiene career began in 1964 when she received
her Bachelor of Science in Dental Hygiene from Loma Linda
University. After graduation, Sharon was inspired to give back to
others by joining the Peace Corps. While serving in Brazil, Sharon
had the opportunity to meet Robert Kennedy, whose words would
continue to be a recurring theme, defining Sharon’s passion and
vision for the profession.
“Some see things the way they are and ask ‘why?’ I
dream of things that never were, and ask, ‘why not?’”
~ Robert Kennedy
After completing her tour in the Peace Corps, Sharon settled
into private practice in northern California, followed by a move
to Maryland, later returning to southern California to earn her
credentials in Higher Education Instruction and Supervision from
UCLA. Sharon then taught at Sacramento City College where she
was offered the position of Interim Director of the dental hygiene
program. However, school policy at the time required that only a
dentist could serve as program director. Recognizing the limited
leadership opportunities, in 1975 Sharon accepted a faculty
position at Pierce College in Ft. Steilacoom, Washington. She would
spend the next 32 years in Washington, expressing her vision for
moving dental hygiene forward. Initially hired to teach didactic and
clinical courses, Sharon soon became the program director, adeptly
steering the program through a demanding accreditation process.
While serving as director, she found many opportunities to address
oral health disparities, access to care, and workforce issues. Sharon
also found time to run for a seat in the Washington State Senate.
Running as a Democrat in a Republican district, her bid fell short
of a win, receiving 43% of the vote. However, her actions have
continued to inspire other dental hygienists to run for public office.
Always striving to advance her education, in 1998, Sharon received
her Doctorate in Education Leadership from Seattle University.
I recently caught up with Sharon at the ADHA Annual Session in
Phoenix, Arizona and asked her a few questions about her career as
a hygienist, educator, a mentor and most of all as a “change agent”.
How has dental hygiene care changed since you were
first licensed?
Washington was the first state to allow dental hygienists to perform
Expanded Functions back in 1971. Dental hygienists can be a force
multiplier in a dental practice, freeing up the dentist to perform
more complex procedures. Expanded functions have been a boon
for the people of Washington and for the general dentists and
specialists working with dental hygienists. Approximately one-third
of practices employ hygienists in this fashion. Frequently, dentists
employ dental hygienists specifically to administer local anesthesia
in the office. Various studies have shown a 30-50% increase in
productivity as one of the benefits of employing dental hygienists.
What were some of your responsibilities as Director of the
Pierce College Dental Hygiene Program?
As director, I was responsible for the day to day operation of an
educational program with a budget of over $650,000; supervised
14 employees; oversaw clinical operations and incorporation of
technology for the program; taught didactic and clinical courses
and successfully met accreditation standards for seven different
American Dental Association Accreditation site visits. I was also
active in the college governance and served as President of the
Faculty Association.
In 1997, Washington was the first state to bring the issue
of dental hygiene independent practice, expanded scope of
practice and self-regulation to the voters. Would you please
provide some insight into the effort?
After 18 years of failed attempts in the legislature, we decided to
take the issue of independent practice to the people of Washington
23
CareerCorner
in the form of an initiative. I was on the steering committee and
part of the campaign. We pounded the pavement and were able
to collect an overwhelming number of signatures to get on the
ballot. The landmark Initiative 678, also known as SHOUT (Support
Hygienists and Oppose Unequal Treatment), received statewide
endorsement from a wide range of stakeholders. Unfortunately, in
the final weeks, voters were bombarded with negative TV and radio
ads and mailers urging, “NO on I-678.” Additionally, there were
several other initiatives on the ballot polarizing conservative voters.
Unfortunately, I-678 was at the bottom of the ballot and we lost by
1% of the vote.
Collaborative practice is often cited as a means to increase
access to care and reduce health disparities. How does dental
hygiene take a leadership role in promoting the collaborative
practice model?
Dental hygienists are in a unique position to spend more oneto-one time with a patient than other healthcare providers. The
hygienist takes a comprehensive medical and dental history and
performs full assessments, screening for disease both inside and
outside of the oral cavity. I always convey our special responsibility
to patients when I am working with my students. I encourage them
to make referrals to other health care providers as necessary. I feel
dental hygienists are under appreciated for what they contribute
to a dental practice and health care. By working with other health
professionals, we can reinforce the quality of our education and
services. Value needs to be placed on the care we deliver to improve
a patient’s oral and overall health. Third party payers need to assess
their policies for preventive care. I feel we need to continue with
our legislative goal nationally for professional autonomy; setting
the educational standards and professional parameters for dental
hygiene. Education is a key element for dental hygienists to lead
the way for our profession.
What is on your “Wish List” for California Dental Hygienists?
• Attain self-actualization and become a true profession in every
sense; complete “autonomy for dental hygienists.”
• Establish a true pathway from entry level dental hygiene to the
Dental Hygiene Practitioner level; using technology to bring
educational opportunities to “place-bound” students.
• The human and financial resources to move the dental hygiene
profession forward.
• Enlightened, forward thinking dental hygienists stepping
forward to fill leadership positions within and outside of
dental hygiene.
24
In 2007, Sharon retired from her position as Dental Hygiene
Program Director at Pierce College. However, Sharon is not finished
manifesting her vision for the profession. Since “retiring”, Sharon
has contributed to the development of the curriculum for ADHA’s
Advanced Dental Hygiene Practitioner. Back in California, Sharon
is a member of the CDHA Government Relations Council and is an
ADHA delegate. She urges every hygienist to be an active member
as this is such a crucial time in California. She says, “We are at an
intersection in our profession and we must to be poised to be in
the best position to contribute and meet the needs of the public.”
Recently, Sharon began what she refers to as her “encore career.”
She has been named Director of the Dental Hygiene Program at
Carrington College in Sacramento.
“Best wishes to you, Sharon,” as you inspire and mentor a new
generation of dental hygienists.
“It is because of Sharon and the Expanded Functions Program she
established that I am able to practice in the state of Washington.
Her program was creative and organized, making, it easier to
acquire the new skills I needed.”
Susan Savage, RDH, BS
ADHA President and Former Pacific NW Institute student
“She taught me everything I know! She mentored me with
patience and encouragement.”
Lynn Steadman, RDH, MEd, MA
Director of Columbia Basin College Dental Hygiene Program
“She brought Washington State into the future, inspiring us to
believe we could have it all, the whole enchilada. She was the
major force in moving us forward.”
Colleen Gaylord, RDH
Chair of the WA State Government Relations Council
“Having met Sharon during an accreditation site visit, I was
inspired to pursue my doctorate.”
Janet Woldt, RDH, PhD
Associate Dean for Academic Assessment, A.T. Still University
Arizona School of Dentistry & Oral Health
“She is as passionate and enthusiastic today as she was when she
moved to Washington. She definitely ‘takes the path less traveled.’
How fortunate for you that she is back in California.”
Kathy Bassett, RDH, BSDH, MEd
Professor of Dental Hygiene, Pierce College
Author and Speaker
CareerCorner
“Dental hygienists have advanced the practice of dentistry over
the past 20 years. We have been the first to implement new
technology, science and treatment into what is now considered
mainstream dental care. After all, it was dental hygienists
who embraced and incorporated comprehensive periodontal
assessment, infection control, sealants, fluoride varnish, cancer
screenings, loupes, salivary testing and even power toothbrushes
into private practice. And by incorporating these important
changes, dental hygienists have contributed to a higher overall
standard of care.”
Carol Lee, RDH, BS, FAADH has been
practicing dental hygiene since 1977. A
member of the adjunct faculty at
Sacramento City College, Carol is also a
frequently requested speaker for continuing
education courses especially in the area of
ergonomics and clinical practice. Passionate about community dental health, Carol
has organized numerous outreach programs
and activities particularly for seniors and the
homebound. She is a past president of CDHA, a member
of the Information Technologies Council, serves on the
CDHA Journal Editorial Advisory Board, and is a Fellow in the
American Academy of Dental Hygiene.
The Time is Now!
Earn Your BSDH Degree Online
With over 50 years of dental hygiene experience, the Department of Dental Hygiene
is dedicated to providing the highest quality education. Offering an environment for
learning that emphasizes Christian values, intellectual development and community
service, Loma Linda University encourages personal wholeness and professional growth.
◆ Online BSDH degree completion program
◆ Designed for licensed dental hygienists with a
Certificate or Associate degree
◆ Two tracks available:
Dental Hygiene Education
Public/Community Oral Health Services
◆ Courses designed for the working professional
◆ Now accepting applications for March 2013 and September 2013
Contact us Today!
[email protected]
25
StayingHealthy
Vicky A Newman, MS, RD
Fighting Cancer with Food and Activity
Key to reducing cancer risk and progression are lifestyle choices we
can control. These include the type and amount of food we eat, and
the frequency and intensity of the physical activity we enjoy. Both
diet and activity are lifestyle factors that affect the environment
(or “terrain”) in which our cells reside. Actions we can take to
encourage a “terrain” resistant to cancer growth include controlling
weight, maintaining good circulation, eating plenty of plant foods
(vegetables, fruits, whole grains, beans/legumes), and choosing
healthy fats.
Control Your Weight
Being overweight or obese increases the risk of cancer.
Common cancers associated with obesity include cancers of the
gastrointestinal tract (esophagus, gallbladder, colon, rectum)
and hormone-related cancers (breast, uterus). It’s not just the
number of pounds on the scale that is a concern, but perhaps more
importantly the amount of stored fat compared to lean body mass
(muscle) that makes up those pounds.
In addition to the amounts eaten, the type of foods and beverages
we consume play a role in weight control. Diets plentiful in highly
processed foods that are low in natural fiber and contain mainly
refined carbohydrates (like white flour, sugar), as well as purified
fats (like corn, cottonseed, safflower, soy oils) make it easy to
consume excessive energy which favors fat storage. Excessive
intake of simple sugars like fructose (as in high-fructose corn syrup)
in the absence of fiber (as found in fruit) contribute to obesity by
affecting the hormonal regulators of hunger and satiety.
Physical activity increases metabolic rate, allowing us to consume
more food and more disease-fighting nutrients without gaining
weight. Inactivity contributes to loss of lean body mass and
favors fat accumulation. Excess stored fat in turn leads to insulin
resistance, which is associated with chronically higher levels of
insulin and insulin-like growth factor, both associated with a
“terrain” more conducive to cancer growth. The link between
obesity, diabetes, and cancer is currently being studied.
Most health authorities recommend that we maintain a healthy
weight and avoid gaining weight during adulthood (preferably
less than 11 pounds gained after the age of 18 years, assuming a
healthy weight at 18). If weight loss is needed, it is best to avoid
rapid weight loss of greater than 2 pounds/week. Extreme caloric
restriction leading to rapid weight loss can deprive the body of
key nutrients needed for optimal body functioning, as well as
overwhelm the body’s detoxification systems by releasing too many
potentially damaging environmental chemicals into the circulation
for the body to neutralize and eliminate safely.
26
Maintain Good Circulation
Good circulation is critical for good health. You might think of
it like this: circulation = energy = life. Optimizing energy flow
or Qi (pronounced “chi” or“chee”) is a fundamental premise of
Chinese medicine. Taking a more Western view, we might focus on
supporting a healthy flow through our cardiovascular and digestive
systems.
Our blood delivers oxygen and nutrients to our tissues, and the
blood, bowels, kidney, liver, and lymphatic system remove the
toxins. Regular physical activity supports good blood circulation
and waste removal by stimulating the bowels and the lymph
system. A diet rich in plant foods also helps to maintain a healthy
circulatory system. Plant foods are generally lower in fat, especially
saturated fats (hard at room temperature) that increase the
tendency of the blood to thicken and clot. Plant foods are also
rich in antioxidant and anti-inflammatory “protectors” that help to
reduce cellular damage and inflammation that can lead to plaque
buildup which ultimately affects blood flow. The fiber provided by
plant foods supports regular waste removal via the bowels.
In addition to its role in supporting weight control and circulation,
regular moderate physical activity helps to reduce several key
biological indicators of cancer risk, including sex hormone levels,
insulin resistance, and inflammation. Physical activity can also help
strengthen the immune system, which plays an important role in
controlling the growth and spread of cancer cells.
The current guidelines for moderate physical activity are 30-60
minutes at least 5 days/week. If walking is your activity of choice,
aim for a minimum of 100 steps per minute (a 30-minute walk
would be 3,000 steps or more). Or if you choose to walk on a
treadmill, set the pace at 3-4 miles/hour (or a 15-20 minute mile).
According to recent research, simply moving rather than being
sedentary is critical to good health. Sedentary behavior (sitting for
prolonged periods of time) has emerged as a distinct risk factor
for cancer, as well as other chronic diseases. It’s helpful to wear a
pedometer and set a goal of 10,000 steps/day. When you check
your pedometer mid-morning and find you have only done 1,500
steps, it can be a powerful incentive to get up and move more
through the rest of the day.
Eat Plenty of Plant Foods
A diet that helps fight cancer is one that includes plenty of plant
foods (vegetables, fruits, whole grains, and beans/legumes), while
limiting processed (refined) foods, and red meats. Plant foods
provide fiber, along with protective nutrients and phytochemicals.
StayingHealthy
Fiber-rich foods help us to feel full with fewer calories, which
supports weight control. Fiber also lowers the glycemic load or
elevation of blood sugar after a meal. Frequent ingestion of meals
and snacks low in fiber contribute to chronically elevated blood
sugar, which is in turn associated with higher levels of insulin
and insulin-like growth factor, both of which are associated
with increased cancer risk. Fiber also speeds transit through the
gastrointestinal tract, reducing exposure of gut mucosa to cancercausing chemicals. Additionally, fiber enhances the excretion of
carcinogens and helps normalize hormone levels, which in turn
can reduce the risk of hormone-related cancers (like breast and
uterine). Fiber also promotes the growth of “friendly bacteria” in
the gastrointestinal tract. These “friendly bacteria” use fiber as
a fuel source to produce some of the nutrients needed to keep
the lining of the gut healthy, as well as some nutrients that are
reabsorbed and used to keep our body systems working properly.
Phytochemicals are what give plants their color, taste, and
fragrance. Plant foods with BIG color and STRONG flavor not only
please the senses, but also help to protect our health. Carotenoids,
found in deep orange, red, and green plants, are powerful
antioxidants that help to protect our DNA from damage that can
lead to cancer. Carotenoids are also the raw material from which
retinol or vitamin A is made. Vitamin A not only supports the health
of epithelial cells (skin, GI tract, genitor-urinary tract), but is also
critically important for the normal functioning of the immune system,
which works to search out and destroy cancer cells. Flavonoids,
supplied by plants, protect tissues from oxidative damage (acting
as antioxidants) and also have anti-inflammatory properties. The
sulfur compounds (indoles, isothiocyanates, allyl sulfur) found in
cruciferous vegetables (like arugula, broccoli, cabbage, kale) and
in onions and garlic, and the terpenoids found in herbs and spices
increase the activity of detoxification enzymes in the body.
It’s recommended that we consume about 25-35 grams of fiber
each day. (Table 1) You can estimate your fiber intake by figuring
that every serving of vegetable or fruit provides about 2 grams of
fiber, each serving of whole grains provides about 3 grams of fiber,
and each serving of beans/legumes provides about 6 grams of
fiber. To determine if a grain product promoted as “whole grain”
actually is whole grain, check to make sure the first ingredient is
whole, sprouted or malted wheat or grain. Wheat flour is actually
white flour so be sure and read the label. You can also check
the label to confirm that a serving of the grain product actually
provides at least 3 grams of fiber.
To obtain a good supply of the plant protectors, it’s a good idea to
eat at least 5 - 9 servings of vegetables and fruits every day. The
range is based on body size and caloric intake. Smaller women
need at least 5 servings every day, while larger people (most men)
need at least 8 - 9 servings every day. A serving is a ½ cup cut-up
vegetable or fruit, 1 cup raw leafy vegetable, or ¼ cup dried fruit.
To insure adequate fiber and plant protector intake, it is best not
to count iceberg lettuce, fruit juice, or white potatoes as you work
toward your vegetable and fruit goal.
Plant foods also provide a wide array of protective nutrients and
phytochemicals that play important roles in maintaining health and
preventing diseases like cancer. Phytochemicals are biologically
active compounds produced by plants to protect them from
damage from the environment. When we eat plants, these “plant
protectors” in turn help to protect our body from damage that can
lead to cancer and other chronic conditions.
Table 1 – Getting Enough Fiber
(25-35 g/day)
Food
Recommended
Serving/day
Fiber/Serving
(g)
Total Fiber
(g)
Vegetables
4 -5
2
8 -10
Fruit
2 -3
2
4- 6
Whole Grains
2- 3
3
6- 9
1/2 - 1
6
3- 6
Beans
TOTAL
21-31
Serving = 1/2 cup cut-up fruit, vegetable; 1/2 cup cooked grains
or beans; 1 slice bread
Choose Healthy Fats
To reduce cancer risk, limited fatty food and choose healthy fat.
Not only are fatty and fried foods energy-dense, making weight
control more challenging, but fat can be a source of fat-soluble
contaminants. The rancid fats found in aged meats, cheeses, and
deli meats can contribute to oxidative damage of body tissues
contributing to cancer risk. To reduce ingestion of fat-soluble
contaminants, it is helpful to eat smaller sized animals (like
chickens) and fish (like sardines) that are lower on the food chain.
27
StayingHealthy
The larger, longer-lived animals (beef, lamb, pork) and fish
store more contaminants in their fat. The EPA recommends that
consumption of farmed salmon be limited to one serving (3 oz)/
month. It is also helpful to limit or avoid full-fat dairy products and
red meats, as well as processed foods made with hydrogenated
(trans) fats. Not only are these fats unhealthy for the cardiovascular
(circulatory) system, but research continues to show an association
between red and deli meats and cancer (both cancer risk and
cancer mortality). The current guideline is to limit red meat (beef,
lamb, pork) consumption to 18 ounces per month.
Refined oils (corn, cottonseed, safflower, sunflower, soy) and
processed and fried foods made with these oils are best minimized
or avoided, because these oils tend to be pro-inflammatory.
Chronic low-grade inflammation contributes to a “terrain” more
permissive of cancer growth. The healthiest fats are those found in
plant foods, like avocadoes, nuts, and seeds, because along with
fat, these foods also provide nutrients and other plant protectors.
Including some anti-inflammatory omega-3 fats in your diet
several times each week is also helpful. While fish and seafood
provide the most biologically active forms of omega-3 fatty acids
(DHA and EPA), flaxseed, hemp, and chia seeds also provide these
anti-inflammatory fats.
Remember, you can use your fork to reduce cancer risk and
progression by:
• Avoiding excess weight gain
• Eating plenty of vegetables, fruits, whole grains, beans
• Reducing the consumption of fatty foods
• Eating fish or seafood (not fried) 2-3 times each week
• Avoiding sweetened beverages & food made with
high-fructose corn syrup
About the Author
Vicky A. Newman, MS, RD, is Director
of Nutrition Services for the Cancer
Prevention & Control Program at the
UCSD Moores Cancer Center, and an
Associate Clinical Professor (Voluntary) in
the Department of Family and Preventive
Medicine, UCSD School of Medicine.
Vicky has been involved in nutrition and
behavior change research at UCSD for over 35 years. The second
edition of her book “Food for Thought—Healing Foods to Savor”
was published this spring. Read more about her work and the
UCSD telephone nutrition coaching program at
www.healthyeatingucsd.org
References
Reducing Cancer Risk and Progression
• Maintain a healthy weight
• Enjoy a physically active lifestyle:
- 30-60 minutes/day moderate intensity activity
- At least 10,000 steps/day
• Eat plenty of plant foods:
- Vegetables (4-5 servings/day)
- Fruits (2-3 servings/day)
- Whole grains (2-3 servings/day)
- Beans/legumes (3-4 servings/week)
• Limit fatty foods and choose healthy fats:
- Minimize fried, savory snack foods, fast foods
- Go easy on salad dressings, mayonnaise
- Limit red meat (no more than 18 ounces/month)
- Eat fish or seafood (not fried) 2-3 times each week
(but farmed salmon no more than 1 serving/month)
1. Mayo Foundation for Medical Education and Health Research. Bone health:
Tips to keep your bones healthy. [Internet] Rochester (MN); 2010 Dec 7.
[cited 2012 Jan 3]. Available at: http://www.mayoclinic.com/health/bonehealth/MY01399.
2. World Health Organization. WHO scientific group on the assessment of
osteoporosis. [Internet]Geneva(CH); 2004; WHO Press [cited 2012 Jan 3].
Available at: http://www.who.int/chp/topics/Osteoporosis.pdf
3. Institute of Medicine. Dietary Reference intakes for calcium and vitamin D.
[Internet] Washington, DC; 2011. National Academy of Medicine [cited 2012
Jan 3]. Available at: http://www.iom.edu/Reports/2010/Dietary-ReferenceIntakes-for-Calcium-and-Vitamin-D.aspx
4. Office of Dietary Supplements. Dietary supplement fact sheet: Vitamin D
[Internet] Bethesda(MD); 2011 June 24 National Institutes of Health [cited
2012 Jan 3]. Available from:
http://ods.od.nih.gov/factsheets/vitamind
5. Office of Disease Prevention and Health Promotion. Dietary guidelines for
Americans. [Internet] Washington, DC: US Government Printing Office;
2011 Jan 31 [cited 2012 Jan 3]. Available from: http://health.gov/
DietaryGuidelines/
• Avoid sweetened beverages and foods made with
high-fructose corn syrup
28
EducationExchange
Aubreé Chismark, RDH, MS
Benjamin B.Tran, MSc
Promoting Student Research:
The Role of the Dental Hygiene Educator
Introduction
The primary goal of dental hygiene programs is educating practitioners, with a large portion of the curriculum devoted to technical
training. It is required that dental hygiene students evaluate the
literature and make decisions based on evidence.1 The Commission
on Dental Accreditation (CODA) requires that dental hygiene students utilize Evidence-Based Decision Making (EBDM) when treating patients.2 As faculty, incorporating critical thinking and EBDM
into all coursework will teach students the necessary skills needed
to incorporate these practices into the clinical setting.1 Having access to computers in the clinic allows greater access for students to
incorporate EBDM into their daily practice.1 Providing the best care
for patients requires the necessary skills of utilizing the Internet
to search for reliable resources. Faculty should work closely with
librarians on campus to ensure the school has access to a sufficient
number of peer-reviewed journals to support the students in EBDM
and research.1 EBDM in dental hygiene relies solely on research
that has been conducted by dental professionals therefore, we have
provided some guidelines to empower dental hygiene faculty when
guiding students with their research assignments.
existing skills.4 As dental hygiene faculty members, it is important
to mentor our students when it comes to the scientific method. It is
also important to have personal research experience and be able to
collaborate with other departments when guiding students in their
research efforts. Since dental hygiene research allows us to make
decisions based on evidence, it is important to encourage students
to pursue research topics they have a strong interest in.
The use of the research agenda will facilitate the discovery of new
knowledge in the field of dental hygiene.4 When students are brainstorming for a research topic, refer them to the NDHRA and be
sure they identify the category and sub-category their research falls
within. The content provided in the agenda reveals current health
issues within the profession, and the decisions that clinicians must
make in order to provide the best services for their patients based
upon clinical experience and research.4
American Dental Hygienists’ Association National Dental
Hygiene Research Agenda
The American Dental Hygienists’ Association (ADHA) National
Dental Hygiene Research Agenda (NDHRA) is a guide for dental
hygiene researchers to identifying the research priorities within
the profession. The NDHRA includes the following categories:
Health Promotion/Disease Prevention; Health Services Research;
Professional Education and Development; Clinical Dental Hygiene
Care; Occupational Health and Safety.3 The importance of having
a research agenda is to guide dental hygiene researchers to focus
their topics on priorities where there is limited evidence. It also
brings our profession to the same level as other health professional
associations and allows us to share goals with a larger population.3
Facilitating Student Research
Many schools require dental hygiene students to conduct original
research, such as table clinic projects, or writing literature reviews
on a specific topics. Undergraduate dental hygiene programs are
responsible for teaching their students the basic skills required to
conduct research, whereas graduate programs build upon their
Dental hygiene students conducting research projects
at West Coast University in Anaheim, CA.
Being a Suitable Mentor
There has been much debate on the attributes or functions that
constitute being a good mentor. Discussions on the role of the
mentor date back over 2 millennia and the definition of a good
mentor varies by industry, such as professional practice or education. Moreover, the definition of a good mentor can also vary within
fields such as nursing, medicine, dentistry and academia.5,6 On
the issue of research mentorship, there are certain criteria that are
critical to the successful mentoring of student research.
Qualifications of a Research Mentor
The field of dental hygiene traditionally has focused on the education of clinicians both at the associate and baccalaureate levels.
However, with the ever increasing scientific knowledge, dental
29
EducationExchange
hygienists interested in mentoring student research must be skillful
in a multitude of tasks typically taught at the graduate level. Such
skills include: searching and evaluating the scientific literature to
guide EBDM in clinical practice and teaching; being fluent in the
scientific process; being competent and self-confident in one’s
research technical skills, and having experience with scientific publishing.7 As such, the role of the research mentor typically requires
at a minimum, a Master’s degree.1
Ideally, a student research mentor is one who has conducted
research as part of their own clinical or academic profile, as
opposed to either clinical practice or teaching. Successful research
mentors should be able to teach students how to find information,
organize the information, and share the information with life-long
learners. Work experience alone is usually not enough to mentor
student research projects, as this process requires skill sets not
typically experienced in private practice or teaching.1
Attributes of a Research Mentor
The role of the mentor is one of a teacher and role model. In these
capacities the mentor also advises, counsels and coaches students
in their research projects. The mentor utilizes their own research
experience to guide the student projects through completion. In
order to be successful, the student research mentor has to be
approachable and interpersonal with the students and effectively
demonstrate their research skill sets to form a personal and professional collegial relationship.7
The mentor and mentee relationship is one that should be based
on shared interests, especially if that interest is within the expertise
of the mentor. In such a case, that mentor is able to offer unique
guidance on the student research project that other mentors, with
differing expertise, may not. Therefore, the mentoring relationship
should not be based on the convenience of available mentors.1
The mentoring role is often instigated by the mentee and as such,
the mentee may find it suitable to have several mentors, rather than
the single mentor, to fill the various support roles due to the functions that mentor serves for the mentee. The actual person acting
as the mentor may not play as critical a role as in the case of career
development within a department, where the specific mentor may
have significant influence on one’s advancement.6 Mentoring roles
that are biased, harassing or competing in interests or agendas
should be avoided. Mentors should not impose their personal viewpoints or issues in the student project or workplace.8 Mentors within
a student research project should have no tolerance for discrimination, preferential treatment, and have a clear understanding of
30
boundaries both personally and professionally. The mentoring role
should be a no fault relationship without risk of harm to either the
mentor or the mentee.6
Responsibilities of the Mentor
The duties of a mentor vary by industry and field. Certainly there
is a wide range of opinions in the literature even though there
have been studies attempting quantification of the mentoring
relationship.5,9 Common to many studies on the role of the mentor
are these responsibilities: commitment to mentoring; provision of
resources, expertise, or source materials; guidance and direction
on research issues; encouragement of mentee ideas and work;
constructive and actionable critiques for improving mentee work;
and challenging the mentee to expand their abilities.5, 7, 9
The role of the mentor heavily emphasizes the experience, influence and achievement in the mentor’s field of expertise in order to
leverage support for the student research project. In this regard,
the mentoring relationship can be informal and short-term to
formal and long-term. Thus, mentoring is a voluntary relationship
instigated by the mentee to receive advice, information, guidance,
support, and provide an opportunity for professional development.5
The efficacy of the mentor in fostering student research depends
on how well the mentor understands their role in the relationship.
Student learning is better supported when the mentor has a good
understanding of their role in the relationship. Ultimately, the overarching goal of the mentor is to familiarize the mentee into their
professional field.9
The Research Process and Publication Preparation
Critical to the success of the student research project is formulating
a testable hypothesis, wherein the research question can be easily
defined, measured and evaluated. Students new to the scientific process will need considerable guidance in developing their
research question, experimental design, data collection tools, and
results analysis. The student research project may be unsuccessful due to any of these components. Moreover, even after project
completion, peer rejection of the study during critical review may
stem from poor implementation of any one these components.
The research mentor responsible for offering the most guidance
to the student project, should have expertise related to the critical
project components in particular, the research laboratory techniques.1 Ideally, the mentor should be able to guide all aspects of
the project, including data analysis. However, many clinicians may
not have the expertise to apply statistical methods to their research
EducationExchange
data. Consequently, many academic departments may have a
dedicated statistician on staff.
Student research work often requires restructuring and revision
to improve the scientific argument and to conform to journal
guidelines. Since the students are involved in other coursework,
competing for their time during manuscript preparation can be
challenging. Key to completing revisions, is the setting of timelines
for each component of the project.
Faculty mentor Aubreé Chismark
(second from left) and dental
hygiene student researchers at
the CDA poster session.
Benjamin Tran, MSc is an Assistant
Professor in the Sciences Department at
West Coast University in Anaheim, CA. His
expertise in biomedical research includes
published studies in neuroscience, molecular
biology, and toxicology. Benjamin can be
contacted at: [email protected]
References
1. Spolarich AE, Gadbury-Amyot C, Forrest JL. Research issues related to
education. J Dent Hyg.[Internet]. 2009 [cited 2011 Dec 3];83(2):79-83.
Available from http://www.adha.org. Registration required for access.
2. Forrest JL, Miller SA, Overman PR, Newman MG. Introduction to evidencebased decision making. In: Evidence-based decision making. A translational
guide for dental professionals. 1st ed. Philadelphia, PA. Lippincott Williams &
Wilkins Publishing. 2009. p. 8.
3. Forrest JL. The American dental hygienists’ association national dental hygiene
research agenda. J Dent Hyg. [Internet]. 2009 [cited 2011 Dec 3];83(4):159160. Available from http://www.adha.org. Registration required for access.
Conclusion
In order to expand the knowledge in areas where there is a lack
of scientific evidence within the dental hygiene profession, it is
important to use the NDHRA as a guide to facilitating research.
Mentoring students in the research process takes time and commitment. Having the necessary skills and expertise to mentor and
guide students is key to successfully completing a student research
project. Our goal as dental hygiene educators is to share as much
knowledge with our students as possible, as well as encourage
students to look at other opportunities outside of clinical practice.
The dental hygiene profession is in need of more researchers, and
mentoring our students successfully through the scientific method
will help to expand the body of knowledge within our profession.
4. Spolarich AE, Forrest JL. Utilization of the ADHA national dental hygiene
research agenda. J Dent Hyg. [Internet]. 2009 [cited 2011 Dec 3];83(1):3335. Available from http://www.adha.org. Registration required for access.
5. Berk RA, Berg J, Mortimer R, Walton-Moss B, Yeo TP. Measuring the effectiveness
of faculty mentoring relationships. Academic Medicine. 2005;80(1):66-71.
6. Jackson VA, Palepu A, Szalacha L, Caswell C, Carr PL, Inui T. Having the right
chemistry: a quantitative study on mentoring in academic medicine. Academic
Medicine. 2003;78(3):328-334.
7. Carr E, Ennis R, Baus L. The dental hygiene faculty shortage: causes,
solutions and recruitment tactics. J Dent Hyg. [Internet]. 2010 [cited 2011
Dec 3];84(4):165-169. Available from http://www.adha.org. Registration
required for access.
8. Warren O, Carnall R. Medical Leadership: Why it’s important, what is required,
and how we dit. Postgrad Med J. 2011;87:27-32.
9. Stenfors-Hayes T, Hult H, Dahlgren LO. What does it mean to be a mentor in
medical education? Medical Teacher. 2011;33:e423-e428.
About the Authors
Aubreé Chismark, RDH, MS, is an
Assistant Professor in the Dental Hygiene
Department at West Coast University
Anaheim, CA. She recently contributed a
research article to the Journal of Dental
Hygiene entitled: Use of Complementary
and Alternative Medicine for WorkRelated Pain Correlates With Career
Satisfaction Among Dental Hygienists.
Aubreé can be contacted at: [email protected]
31
NewsBytes
May 18, 2012, marked the graduation of the first class of 12
students from the new Master of Science in Dental Hygiene degree
program at the University of
California, San Francisco, the
only MS degree program in
dental hygiene in California.
The one-year program
consists of three quarters
of interdisciplinary dental hygiene science course work and one
quarter of field work in preparation for graduates to assume roles
as educators and research collaborators in academic, public health
or oral healthcare-related industry settings. Graduates of the class
of 2012 are already taking positions as educators, researchers,
public health administrators and as entrepreneur developers of
health applications. For more information about the UCSF program,
go to http://dentistry.ucsf.edu.
Susan Jordan Lopez, RDH, BS was installed as president of
the CDHA on June 2, 2012 at the annual House of Delegates held
at the Santa Clara Hyatt Regency Hotel. A 1972 graduate of UCSF,
Susan has been a lifelong member of CDHA and the San Francisco
Component. Her installation speech echoed her theme, “Step up,
Reach out” encouraging hygienists to move outside of the walls
of traditional private practice and embrace the new opportunities
that are presenting themselves to oral healthcare providers.
Joining Susan on the CDHA Executive Committee are President
Elect Nadine Lavell, RDH MS, Secretary Treasurer Lygia Jolley,
RDH BA, Vice President of Administration and Public Relations
Karine Strickland, RDHAP, BS, Vice President of Membership and
Professional Development Teri Vosper, RDHAP, BA and Immediate
Past President Lisa Okamoto, RDH.
32
Katie Dawson, RDHAP, BS
was honored at the 89th Annual
Session of the ADHA as one of the
recipients of the 2012 Johnson
and Johnson/ ADHA Awards for
Excellence in Dental Hygiene. Katie
was recognized for her outstanding
accomplishments spanning over 35 years in the profession.
Starting out as Vice President of the Associated Dental Students
of the University of California San Francisco in 1975 to her work
as president of the ADHA in 2006, Katie’s leadership has been
instrumental in advancing dental hygiene. Sharing in her special
day were her granddaughters, Sierra and Amaya Dawson.
East Bay Component member Cathy
Critchfield was the happy winner
of the 2011-2012 “It’s a Small World”
drawing. As the grand prize winner,
Cathy received a $2000 gift card
to Costco.”You too, can a winner!”
Support CDHA’s mission and programs
by purchasing tickets for the 2013 CDHA “Step Up, Reach Out”
drawing through your local component or at CDHA events. Each
ticket is only $10 for the opportunity to win a $2000 gift card to a
retailer of your choice!
Stanford bioengineer Manu
Prakash is leading a team of
developers in testing a Smartphone
oral cancer screening device, Oscan.
Concerned by the high incidence of
in his home country of India, along
with the challenges of underserved
rural populations, Prakash wanted to
develop a device that could transmit
the image of a suspicious lesion to
a medical or dental provider for analysis. Oscan consists of an
oral positioner, a circuit board and two rows of fluorescent-lightemitting diodes. It attaches to any smartphone’s built-in camera,
and allows an operator to take a high-resolution, panoramic image
of a person’s oral cavity. While only in its early stages of testing, the
device shows promise as a future oral cancer screening device. For
more information visit the Stanford School of Medicine web site
http://med.stanford.edu/ism/2012/april.
NewsBytes
Dental hygienists are needed
for the upcoming CDA Cares
oral health outreach event
sponsored by the California
Dental Association Foundation.
The program will be providing oral
health care services including oral
prophyaxis, fillings, extractions, oral
health education and assistance in
finding a dentist for follow-up care at the Cal Expo in Sacramento
on August 24 and 25, 2012. Healthcare volunteers, including
dental hygienists, dentists, oral surgeons, assistants, lab technicians,
nurses and pharmacists, are needed to make this event successful
for the approximately 10 million Californians who do not have
access to an oral healthcare provider. Registration information is
available at www.cdafoundation.org/cdacares
Angela Punaro, RDH and
Michael Long RDH were among
the northern California dental
hygienists who came out to support the
Remote Access Medical (RAM) dental
clinics this past spring. RAM came to
the Oakland Coliseum March 22-25
and went on to Sacramento March 30April 2. Over 6,114 patients, received
care for a total cost of services provided
estimated at 2.3 million dollars during
the 6 days RAM was in California.
Foothill College dental hygiene students sponsored
Liz Chaney continued from Page 4
the first annual walk for oral cancer awareness on April 14, 2012
on the Foothill College Campus. The students solicited pledges from
the community as well as family and friends. Walkers included,
Foothill College President Judy Miner. The students were able to
present a check for $5,300 to the Oral Cancer Foundation, director
and founder, Brian Hill at the CDHA House of Delegates Continuing
Education program in June. Plans are already underway to hold the
next oral cancer awareness walk on April 13, 2013.
Employees. Ever the advocate, Liz used her background as a dental
hygienist to educate these organizations on oral health and the
dental hygiene profession.
Liz’s impact on the profession was recognized nationally at the
American Dental Hygienists’ Association when she was the recipient
of the Alfred C. Fones
Award in 1996 and the
2007 Pfizer/ADHA Award
for Excellence in Dental
Hygiene. Both awards
honor lifetime service and
professional excellence. At
the state level, in 2003,
Liz was honored with life
Liz surrounded by her Tri-County friends
membership in CDHA.
During a 2011 visit from members of the Tri-County Component,
Liz reminisced about her dental hygiene career.
“It’s been a long ride, but it’s been worth it! It’s been
an exciting career. I never wanted to do anything else.
I loved it from day one.”
Liz, your lifetime dedication and passion for dental hygiene will
never be forgotten.
33
Why I belong?
Liz Marks, RDH
CDHA member since 1994.
I live in a small town in California. CDHA keeps me connected with
legislative updates, continuing education, networking and much
more. My membership really allows me to feel part of my profession.
Living 35 minutes away from the major cities in my area and only
working with one other hygienist in my practice, I am happy to
be a part of an association that protects my profession. Having a
local component nearby has helped me feel connected though outreach opportunities, social
networking and professional guidance. I’m a proud member of the California Dental Hygienists’
Association and I thank all who continue to move our profession forward!
Dental Hygiene Associates Inc. (DHAI)
Established to support scholarships and
research grants for CDHA members
“I feel rewarded to be able to inspire my patients on a daily basis to appreciate not only periodontal treatment,
but a new way of life, valuing their own oral health.”
~ Jessica Sanchez, RDH 2011 Scholarship Recipient
“I am now applying for my Master’s degree in Gerontology with hopes of becoming a clinical professor
in dental hygiene.”
~ Susan Hong, 2011 Scholarship Recipient
Advance DHAI’s mission of improving oral health through education,
research and community service by making a donation today!
Make check payable to DHAI, and mail to:
CDHA • 130 N. Brand Blvd., Suite 301 • Glendale, CA 91203
Donations are 100% tax deductible.
DHAI is a 501 (c) (3) nonprofit organization. wTax ID # 95-3532416
Any questions, please call CDHA’s Central Office at 818-500-8217
34
The Ultimate
Sonicare
Power
Toothbrush
New Philips Sonicare DiamondClean — the ultimate clean for ultimate results.
Help your patients experience the difference of Sonicare technology. It will be love at first brush.
• Removes up to four times more plaque than a manual toothbrush after four weeks of use
1
• Powerful yet gentle dynamic cleaning action helps improve gum health in just two weeks
1
• Clinically proven to whiten teeth in just one week
2
Experience Philips Sonicare for yourself — call 1-800-676-SONIC (7664)
or go to sonicare.com/dp
Be part of your community — join one of our Facebook groups
just for dental professionals. www.sonicare.com/facebookDP
1. Milleman K, Milleman J, Putt M, et al. Comparison of gingivitis reduction and plaque removal by Sonicare DiamondClean and a
manual toothbrush. Data on file, 2011. 2. Colgan P, DeLaurenti M, Johnson M, Jenkins W, Strate J. Evaluation of stain removal by Philips
Sonicare DiamondClean power toothbrush and manual toothbrushes. Data on file, 2010.
Rosie Tesselaar, Executive Administrator
California Dental Hygienists’ Association
130 North Brand Boulevard, Suite 301
Glendale, CA 91203
Presorted STD
U.S. Postage
PAID
Permit No. 104
San Dimas, CA
CDHA2008
RETURN SERVICE REQUESTED
CDHA Presents:
A Sizzling Hot Summer
CE Extravaganza!
Saturday
August 11, 2012
San Mateo Marriott
1770 South Amphlett Blvd.
San Mateo, CA
Education. .
Exhibitors. . .
Networking
Earn up to 8 CEUS
Morning Program 9:00AM – 12:00PM
Betsy Reynolds, RDH, MS
“Pathos of Pathology: Puzzles,
Perplexities and Paradigms”
Afternoon Program 1:30PM - 4:30PM
Allen Budenz, MS, DDS, MBA
“Numb, Numb-er, Numb-est:
An Update on Anesthesia and Technology”
RDHAP Session (open to all)
5:00PM – 7:00PM
Spencer Schmerling, BS, CEO
“Business Strategies and Marketing
Medias: Start your Business”
Register today at www.cdha.org or call 818-500-8217 for more information

Volume 27, #2, Summer 2012 Journal

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